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At least 523 records · Page 29Linked to original sources
PubMed1979

Arthrography of the hip in the diagnosis of postoperative painful conditions after total hip replacement.

Arthrography of the artificial hip joint was performed postoperatively in 29 patients with pain after total hip replacement. In 23 cases the arthrographic findings were checked by operation and corresponded in 91%. In two arthrographies which did not give reliable results sinuses outside the thigh or a large pseudocapsule prevented a satisfactory performance of the arthrography. The unoperated patients had only mild discomfort or were considered a high risk for reoperation; they were treated with physiotherapy and medication. As a result of this investigation arthrography can be regarded as a highly reliable method of diagnosing the various causes of pains in the hip after total hip replacement.

Hip Joint↗
PubMedDate not supplied

[Concentric centering of the normal hip and concentric reduction of the dislocated hip. Radiological study on their determination and clinical application].

A radiological method to determine the ideal, geometrical, center of the acetabulum and femoral head is described by the author; the proceedings for these localizations and the interrelationship between them, are also described. These factors were taken from a series of simple radiography and arthograms, which is called; "Concentrical Centring" in normal hips, as well as other seires of dislocated hips, which were radiographed in anteroopsterior view, and in frog position, as well as in histological sections. The necessity to look for the concentrical reduction of the dislocated hips is also emphasized, as a basic point for the good development of the acetabulum, which is achieved, at the time of treatment, if the location is made of the point of the femoral head with that of the acetabulum (Concentrical Reduction). This method will permit to evaluate this interrelationship easily in a numerical scale figure and with a minimum of error. This is a useful resource previous to the arthrography in those hips which have been just recently reduced; and latter, in their follow-up.

Anthropometry↗
PubMed1994

Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip?

We have undertaken routine ultrasound screening for neonatal hip instability in Coventry since June 1989. Of the 14,050 babies scanned during the first three years, 847 (6%) had ultrasound abnormalities. A grading system, based on the percentage of femoral head coverage, is presented. The proportion of abnormal hips decreased gradually so that by nine weeks, 90% had normal ultrasound appearances. Abnormality was more common in babies with a family history of CDH and in breech presentations. All babies with clinically abnormal hips had an abnormal first ultrasound examination. Five babies not diagnosed by clinical examination and with no risk factors had abnormal ultrasound appearances and were subsequently found to have clinically abnormal hips. Routine ultrasound screening has detected cases which would otherwise have presented late.

Female↗
PubMed1997

Total hip arthroplasty for avascular necrosis and degenerative osteoarthritis of the hip.

Although several studies of various treatment modalities have been reported during the past decade, osteonecrosis of the femoral head remains a difficult therapeutic problem. Total hip replacement which is reserved for patients showing collapse of the femoral head, usually shows poorer results in patients with osteonecrosis compared with those with osteoarthritis. Uncemented total hip arthroplasty was performed on 29 patients with avascular necrosis of the femoral head and 29 patients with degenerative osteoarthritis. After a mean followup of 7.6 years and 7.1 years for the two groups of patients, only one failure was observed in one patient with osteonecrosis. Clinical evaluation after cementless total hip arthroplasty in both groups of patients revealed improvement in all parameters. Postoperatively, pain improved from 1.4 to 5.1, walking ability from 3.4 to 5.3, and range of motion from 4.5 to 5.5 in patients with osteonecrosis, and pain improved from 1.2 to 5.3, walking ability from 3.2 to 5.4, and range of motion from 3.1 to 4.7 in patients with osteoarthritis. Thigh pain was observed postoperatively in only two and three patients treated for osteonecrosis and osteoarthritis, respectively. The present results using cementless arthroplasty seem to be somewhat better than those reported for cemented arthroplasty in patients suffering from osteonecrosis. The clinical and radiographic findings after noncemented arthroplasty in patients with osteonecrosis of the femoral head and in patients with degenerative arthritis of the hip were similar in the two groups.

Adult↗
PubMed1998

[Radiologic changes following cement-free implantation of hip prostheses. 5-year follow-up and clinical experience with the cement-free hip prosthesis Autophor-900-S].

PURPOSE: To evaluate early reliable radiographic signs of loosening in cementless total hip arthroplasty compared to clinical follow-up. METHODS: Within a time interval of 5 years 89 patients with 101 hips underwent total hip arthroplasty using the Autophor 900 S-prosthesis. Clinical and radiographic follow-up were first performed retrospectively followed by a prospective investigation. RESULTS: Radiographic evaluation showed prosthesis fixation in 93%. Loosening of the prosthesis was identified in 4 cases of the acetabular component and in 4 cases of the femoral stem. Pain was associated with radiographically detectable loosening of the cementless arthroplastic components in only two cases. CONCLUSION: Within a follow-up period of up to five years, loosening of cementless total hip arthroplasty occurs in about 7%. The most reliable radiographic signs of loosening are complete radiolucent zones wider than 2 mm at the bone-component interface, progressive subsidence, migration, or tilt of the component. Pain and movement disorders are not specific symptoms and do not necessarily indicate a loosening of the prosthesis.

Adult↗
PubMed1998

Current practice in primary total hip replacement: results from the National Hip Replacement Outcome Project.

As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. Of respondents, 99% used routine thromboprophylaxis, with 79% using a combination of mechanical and chemical methods. Of surgeons, 84% routinely used stockings, whereas 95.5% used chemical prophylaxis, 63% employed low molecular weight heparins. Theatre facilities were shared with other surgical specialties by 6% of surgeons and 18% regularly used body exhaust suits for THR. Antibiotic loaded cement was used by 69% of surgeons, the majority (65%) used a single brand of normal viscosity cement with 9% using reduced viscosity formulations. Modern cementing techniques were commonly used at least in part, 87% used a cement gun and 94% a cement restrictor for femoral cementing. On the acetabulum, 47% pressurised the cement. In all, 36 different femoral stems and 35 acetabular cups were in routine use, but the majority of surgeons (55%) used Charnley type prostheses. Of the surgeons, 57% performed only cemented THR, while 3% exclusively used uncemented THR. Of consultants, 21% followed up their patients to 5 years, the majority discharge patients within the first year. Of concern is a large proportion of surgeons using low molecular weight heparins despite a lack of evidence with regard to reducing fatal pulmonary embolism, and also the small number of surgeons using prostheses of unproven value. Third generation cementing techniques have yet to be fully adopted. The introduction of a national hip register could help to resolve some of these issues.

Arthroplasty, Replacement, Hip↗
PubMed1998

Avulsion fracture of the ischium following complex total hip arthroplasty: an unusual cause of hip pain.

Total hip arthroplasty in the high riding dislocated hip is a technically difficult undertaking, with major reconstruction required on both the acetabular and femoral sides. With reconstruction at a near-anatomic hip center, reduction of the arthroplasty is difficult because of the long-standing limb shortening. The major block to reduction is tension of the soft tissues, particularly the hamstrings. We report a case of ischial tuberosity avulsion fracture following such a complex reconstruction despite femoral shortening subtrochanteric osteotomy. This illustrates the importance of the hamstring group in maintaining the dislocation and emphasizes the need to prevent overtension of the soft tissues in such complex reconstructive procedures.

Aged↗
PubMed2003

Untreated congenital and posttraumatic high dislocation of the hip treated by replacement in adult age: 22 hips in 16 patients followed for 1-8 years.

Between 1993 and 2001, we replaced 22 hips in 16 patients with high dislocation of the hip. All but 1 case was due to congenital dislocation. In all cases the femur was osteotomized below the lesser trochanter and a straight uncemented stem inserted in the medullary canal. The acetabular prostheses were inserted at the site of the original acetabulum, usually after augmenting the acetabular rim by using the medial half of the resected proximal femur. The lateral part of the proximal femur with the intact attachment of the gluteus medius muscle was transposed and fixed to the femoral diaphysis thereby restoring direction of muscle pull. The HHS score increased from a median value of 42 points preoperatively to a median of 86 points after median 25 months of follow-up. Limp, which before surgery was severe in all cases, was less marked or had disappeared at follow-up. The legs had been lengthened median 2.5 (1.0-4.5) cm. No postoperative infections occurred. Palsy or loss of sensory function was not observed in any patient. Dislocation was the commonest complication. It occurred in 3 hips, 2 of which had to be revised to ensure stability.

Adult↗
PubMed2005

[Ways of surgical technique optimization and prevention of hip endoprosthesis dislocation following total hip arthroplasty].

The article presents experience concerning intraoperative prevention of hip endoprosthesis dislocation, gained in the orthopedic surgical clinic of Moscow Regional Research Clinical Institute. The results of 1208 total articular replacements allowed the development of intraoperative dislocation-preventive measures, taking into account the approach to the hip joint, necessary mobilization of articular ends, the relative position of total endoprosthesis components. The cases of hip endoprosthesis dislocation were analyzed. The offered preventive measure system allowes reduction in total endoprosthesis dislocation rate down to 1.5%.

Arthroplasty, Replacement, Hip↗
PubMed1999

Differences in risk factor patterns between cervical and trochanteric hip fractures. Swedish Hip Fracture Study Group.

The two types of hip fracture--cervical and trochanteric femoral fractures--are generally considered together in etiologic studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture we used data from a large population-based case-control study in Swedish women, 50-81 years of age. Data were collected by questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483 a trochanteric fracture during the study period; these cases were compared with 3312 randomly selected controls. Height and hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height, women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15-1.32) compared with an OR of 1.06 (95% CI 0.97-1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95, 95% CI 0. 91-0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current smokers had an OR of 1.48 (95% CI 1.12-1.95) for trochanteric fractures and 1.22 (95% CI 0.98-1.52) for cervical fractures. Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced risk only for trochanteric fractures: OR 0. 55 (95% CI 0.33-0.92) compared with 1.00 (95% CI 0.71-1.39) for cervical fractures. These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning preventive interventions.

Age Factors↗
PubMed2003

Acute effects of hip and knee positions on motor-evoked potentials of the sciatic nerve in total hip arthroplasty.

In 23 patients, motor-evoked potentials (MEP) of the sciatic nerve were elicited during total hip arthroplasty by using a stimulating electrode at the level of the acetabulum and recording from the middle portion of the tibialis anterior. The distal motor latencies were determined before dislocation (control), during dislocation, and after reduction with the trial prosthesis. While the hip was dislocated, recording was performed at varying angles of the hip and knee joints. During dislocation, the distal motor latencies were significantly increased in all positions except at hip flexion of 60 degrees and internal rotation of 60 degrees with the knee joint in maximum flexion. No significant correlations were found between the latency increase and limb lengthening. No patient had sciatic nerve palsy or causalgia after operation.

Adult↗
PubMed2005

The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips.

We randomised 143 patients--age 75 years or older--with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost.

Aged↗
PubMed2006

Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty.

Dislocation after total hip replacement is more common in the early, postoperative period. Postoperative intraarticular haematoma and remaining seroma fluid and/or weakened posterior soft tissue wall may be contributing factors. Our purpose was to compare and follow with sonography the resorption of the postoperative volume of intraarticular fluid/synovial oedema after total hip arthroplasty (THA) with or without posterior soft tissue repair. Thirty-three consecutive patients with hip osteoarthritis were admitted for THA. All of them received the same type of cemented implant. Patients were randomised for posterior soft tissue repair or not. Sonography, measuring the anterior capsular distension, indicating the volume of intraarticular fluid/synovial oedema in the prosthetic hip joints, was performed after six and 12 months in all patients. At six months postoperatively greater capsular distension, i.e., remaining volume of intraarticular fluid/synovial oedema, was observed in the group with posterior soft tissue repair than in the group without. After one year the capsular distension had decreased in both groups and there was no significant difference between the groups. Our results show that posterior soft tissue repair after THA is associated with increased capsular distension during the first six months. After 12 months the volume of intraarticular fluid/synovial oedema is the same with or without posterior soft tissue repair.

Aged↗
PubMed2003

Articulated distraction of the hip joint in the treatment of benign aggressive tumors located around the hip joint.

INTRODUCTION: The proximal femur and acetabulum are frequent sites for benign active and aggressive lesions. The risk of pathologic fracture is great when a bone-destroying pathology involves an anatomic location such as the hip joint that undergoes profound mechanical loading. If the destruction involves a large area around the joint, secure fixation cannot be achieved with internal fixation implants. The study investigates use of articulated hip distraction to protect reconstructions performed for the treatment of benign active or aggressive tumors presenting with pathologic fracture. PATIENTS AND METHODS: Five patients with a pathologic fracture of the proximal, intracapsular femur or the acetabulum were operated on at the authors' institution between 1997 and 1999. Following histopathologic approval of a benign tumor, all lesions were curetted, chemocauterized, and grafted and osteosynthesis was performed. The reconstruction was protected with an articulated hip distraction external fixator. All patients were mobilized in the immediate postoperative period. RESULTS: The patients were kept in external fixators for an average of 19.8 weeks (range: 16-24). The fixator was removed when bony consolidation was observed in anteroposterior and lateral x-rays of the lesion. The patients were followed for an average of 47 months (range: 38-56) after frame removal. None of the lesions recurred. At the last follow-up examination, all patients displayed an excellent function according to the Musculoskeletal Tumor Society Rating Scale. CONCLUSION: According to the authors' knowledge, this investigation is the first in the literature describing the use of articulated joint distraction in the treatment of benign active and aggressive lesions around the hip joint. The procedure adopts principles of joint distraction into bone tumor surgery.

Acetabulum↗
PubMed1998

Bilateral traumatic dislocation of the hip: simultaneously one hip anterior and the other posterior.

The case of a 28-year-old man with bilateral dislocation of the hip, simultaneously one hip anteriorly and the other posteriorly is reported. In this case a very drunk driver without a seatbelt crashed his car. Uncontrolled trauma resulted in two different types of hip dislocation. At the 2-year follow-up he had a serious mobilisation problem with avascular necrosis of one hip.

Accidents, Traffic↗
PubMed2005

Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip.

Infection is a devastating complication after total-hip arthroplasty. Between June 1991 and December 2001, 42 patients were treated at our center for chronically infected total-hip arthroplasty using a 2-stage articulating antibiotic hip spacer technique. Of the 27 patients available for review, 26 (94%) remain clinically free of infection at an average 76 months (range, 28-148 months) postoperatively. Twenty-two (81%) patients had a positive identification of the infecting organism. All patients received a minimum of 6 weeks of intravenous antibiotics and the Harris Hip Scores improved from 53 (range, 36-68) to 92 (range, 81-99) postoperatively. Advantages of this technique include improved patient function, maintenance of bone stock and soft tissue tension, thus simplifying reimplantation.

Adult↗
PubMed2006

Outcome of the contralateral hip in rapidly destructive arthrosis after total hip arthroplasty: a preliminary report.

We investigated the outcome of the contralateral hip in patients with rapidly destructive arthrosis of the hip after total hip arthroplasty. Twenty-four patients were included, and the mean duration of radiographic follow-up was 7.0 years (range, 3.8-17.8 years). To assess the capable parameters for predicting the development of osteoarthritis, we evaluated the receiver operating characteristic curves. Three (12.5%) of 24 patients developed osteoarthritis and underwent total hip arthroplasty within 3.8 to 6.5 years. In these 3 patients, both the acetabular-head index and the center-edge angle were significantly lower than those in patients without osteoarthritis (P < .005). Based on the receiver operating characteristic curves, both an acetabular-head index of less than 72% and a center-edge angle of less than 16 degrees were considered to be associated with the development of osteoarthritis.

Acetabulum↗