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PubMed1991

[The transosseous approach to the hip joint in reconstructive operations].

The authors noted a number of peculiarities and positive moments in case of application of hip joint transosseous access after Kulish with 87 patients, aged 14-64 years, with deforming coxarthrosis, femoral head aseptic necrosis, coxa vara, congenital hip dislocation and femoral head epiphyseolysis. The access is simple, effective, comparatively low traumatic and can be successfully applied in hip joint reconstructive orthopedics.

Adolescent↗
PubMedDate not supplied

[Maturation curve of the ultrasonographic alpha angle according to Graf's untreated hip joint in the first year of life].

In addition to Graf's classification into different hip-types a maturation-curve of the sonographic alpha-angle was established in order to optimize the differentiation between mature hip joints and those ones which need follow-up and those ones which need treatment at any time within the first year of life. The results obtained are confirming our present knowledge about the spontaneous maturation of physiologically immature hip joints: The mean-value of the alpha-angle crosses the 60 degrees-borderline at about the age of two months, then reaches an about 64 degrees-level at about four months. This 64-degrees-level is more or less unchanged up to the end of the first year of life.

Age Factors↗
PubMed2004

Inequalities in accessing hip joint replacement for people in need.

OBJECTIVES: To quantify the effects of rurality and socio-economic disadvantage on prior evidence of need for total hip joint replacement and use of health services after adjusting for age and gender. DESIGN: Self-completion validated questionnaire mailed directly to subjects. SETTINGS: Geographical areas covered by Wiltshire and Sheffield Health Authorities in England. PARTICIPANTS: Random stratified sample of 15,000 aged 65 years and over taken from the central age-sex registers. MAIN OUTCOME MEASURE: Prior need for hip joint replacement surgery and whether general practice and hospital services were being used as assessed by the questionnaire. RESULTS: The response rate was 78% after three mailings. Prevalence of need for total hip replacement in the over 64s was 3.4% (95% confidence interval is 3.0% to 3.8%) and in those without co-morbidity 5.4% (95% confidence interval is 4.8% to 6.0%). There were inequalities demonstrated due to age, geography, and deprivation, but not rurality in accessing general practice and hospital services. People who were poor had more need. Older people in need were less likely to be accessing health services. CONCLUSIONS: There is an important unmet need for hip joint replacement in older people with marked inequalities in levels of need and use of services. The use of numbers of people waiting as a performance indicator is perverse for this procedure. We have urgently to expand orthopaedic services and the training of orthopaedic surgeons in England.

Aged↗
PubMed1989

[Entrapment of the synovium of the hip joint in children: a report of 15 cases].

15 cases, aged 4 to 14 years, experienced, a few days after a mild trauma, slight pain and limited motion of hip joint with the corresponding leg lengthened, a result of restrained adduction. Plane X-ray films of these hip joints showed nothing wrong, yet arthrography done on 4 cases and operative exploration in 1 patient found that a portion of synovium at the anteromedio-inferior part of the hip had been entrapped into the joint, on account of which the term entrapment of synovium of hip joint is coined. Under general anesthesia, gentle manipulation resulted in immediate relief in all hips but one, which failed to respond and then under went open operation, a very good chance of looking into the matter: a big portion of synovium incarcerated in the joint, the actual offender. There has been no recurrence found up to the time of writing. The pathogenesis and the related differential diagnosis have been discussed in detail.

Adolescent↗
PubMed2000

Reduction of polyethylene wear by concave dimples on the frictional surface in artificial hip joints.

For the purpose of reduction of polyethylene wear generated in artificial hip joints, concave dimples were formed on the surface of the metal femoral head by electrical discharge etching with the constant diameter of 0.5 mm, pitch of 1.2 mm, and depth of 0.1 mm. Using a hip joint simulator, the total amount of polyethylene wear was 7.2 mg in the concave-patterned condition and 23.1 mg in the nonpatterned condition. The reasons for the reduction of polyethylene wear by the concave pattern may be i) a reduction of abrasive wear by providing escape dimples for wear particles and ii) an improvement in the lubricity on the frictional surface by the supply of lubricant that is stored in dimples.

Friction↗
PubMed1976

Bone imaging after total replacement arthroplasty of the hip joint. A follow-up with different radiopharmaceuticals.

Bone imaging was done in patients after total replacement arthroplasty of the hip joint every 3rd month using 99mTc-HEDP and 18F. Uptake ratios were estimated over cup/normal hip and femur prosthesis/normal thigh. Ratios decline rapidly and reach a stable level 6-9 months, postoperatively. Eight cases of late infection were predicted correctly 1-3 months before any radiologic evidence was present. In four cases there had been false-positive results with 99mTc-HEDP while 18F gave always correct information except in cases of soft tissue inflammation. Here both 99mTc-HEDP and 18F ratios were elevated. The early diagnosis of late complications after replacement arthroplasty seems to be possible. The clinical significance, however, is low: only one out of eight patients with manifest infection is still on conservative treatment. Bone imaging should be done to exclude late infection as a cause of pain after total replacement arthroplasty of the hip joint only.

Arthroplasty↗
PubMed1993

[About the use of gonad shielding during the taking of hip joint x-rays].

X-rays of hip joints taken without gonadal shield can be found both in the literature and scientific presentations. The shield reduces irradiation of the ovaries 30 times. The shape and the size of the shield has been offered. Organisational measures to use gonadal shields have been suggested.

Adolescent↗
PubMed1977

[Clinical and diagnostic problems of the adolescence hip-joint (author's transl)].

The most important hip-joint diseases of the adolescence are discussed with their differential-diagnosis by means of clinical symptoms, characteristics in x-rays and other additional findings. Beside inflammatory and infectious diseases symptoms and treatment of the juvenile slipped epiphysis of the upper femoral end are discussed particularly.

Adolescent↗
PubMed1987

The widened teardrop distance: a plain film indicator of hip joint effusion in adults.

The teardrop distance is defined as the distance from the lateral margin of the pelvic teardrop to the most medial aspect of the femoral head as seen on anteroposterior pelvic radiographs. The structure responsible for the teardrop is the anteroinferior portion of the acetabular fossa with contributions from the ischium and from the superior pubic ramus. Anteroposterior pelvic radiographs of 10 patients with documented cases of unilateral hip effusion were retrospectively evaluated for teardrop distance widening on the affected side. Proof of the presence of hip effusion was based on the results of percutaneous hip joint aspirations as described in the patient's medical records. A teardrop distance widening of 1 mm or more was always consistent with hip joint fluid. In addition, radiographs from 20 patients with no known hip abnormalities were reviewed as a control population. These showed side-to-side symmetry in 16 cases (80%) and widening of less than 1 mm in the remaining four cases (20%). Thus, hip joint effusion in adults can be accurately diagnosed from plain radiographs in the presence of a teardrop asymmetry of 1 mm or more and in the absence of degenerative joint disease.

Adolescent↗
PubMed2002

[Cementless socket fixation based on the "press-fit" concept in total hip joint arthroplasty].

PURPOSE OF THE STUDY: The key problem of implant fixation in THR is stress distribution, i.e. load transmission between bone and implant. The closer the load transfer is to the original physiological situation, the easier the adaptation of the periprosthetic bone to the new biomechanical conditions after implantation of the cup and the safer is its longlasting fixation. The aims of the studies were 1) to get information about the physiological load transfer in the normal hip joint, 2) to get information about the load transfer between acetabulum and acetabular sockets and vice versa, 3) to measure the periacetabular pelvic bone deformation as the stimulator of the remodelling process (third stage of osseointegration) in the normal hip joint and in hip joints fitted with different acetabular cups, 4) to study the morphological stages of osseointegration of a non-cemented press-fit cup and to compare the morphological structure of the periacetabular bone with the biomechanical data obtained by the in vitro studies and finally, 5) to compare the clinical and radiological outcome of follow-up studies of the senior author's "Press-Fit cup" with the theoretical hypotheses according to the experimental observations. MATERIAL AND METHODS: Load transfer between the acetabular bone and the femoral head on one side and press-fit cups has been determined by strain gauge measurements, finite element studies, pressure sensitive Fuji prescale films, CT-osteoabsorptiometry and telemetric measurements. Periacetabular deformation has been measured by Imetric Markers. Osseointegration of the senior author's press-fit cup and, thus, the remodelling process of the bony structures adjacent to the cup have been studied in autopsy specimens of THRs which have been in situ for several years. RESULTS: Load transfer measurements have shown that the main load in the original acetabulum as well as in the acetabulum fitted with a press-fit cup is transmitted to the periphery, especially to the acetabular cortical rim whereas the subchondral bone is exposed to lower, predominantly meridional (tension) stresses. Direct measurements of the periacetabular deformation under load revealed an increase of the peripheral press-fit with increasing stability of a (oversized) press-fit cup. Both the normal as well as the acetabulum fitted with a non-cemented cup deforms in a postero-medial direction. The histo-morphology of the periacetabular bone of autopsy specimens showed excellent bony in- and ongrowth of a porous titanium coating (SULMESH) and bone formation, especially at the periphery in zone 1 and 3 according to DeLee and Charnley. CONCLUSION: The studies have shown that the subchondral bone plate of the acetabulum has very little supportive function for non-cemented press-fit cups. For the preparation of the acetabulum it is, therefore, more important to ream the sclerotic subchondral bone until there is a well vascularized, well bleeding bone bed to facilitate osseointegration of a non-cemented acetabular socket than to preserve the subchondral bone plate as is the case in cement fixation. A non-cemented press-fit socket must transmit load predominantly to the cortical bone of the acetabular rim. Therefore, a too far medial positioning of the cup, and therefore loosing contact to the cortical rim, must be avoided under all circumstances. The clinical experience with acetabular revisions and with conversions of hip arthrodeses into a THR (where there is no subchondral bone at all) have shown the superiority of a well vascularized over a sclerotic (even mechanically stronger) bone bed. Furthermore, it has been shown that the additional use of screws for fixation of an acetabular cup is not only unnecessary but can be deleterious and causes complications including osteolysis and aseptic loosening.

Acetabulum↗
PubMedDate not supplied

[Experiences with cement-free implantation of the Zweymüller/Endler and Zweymüller total hip joint endoprosthesis. Indications, results, complications and modification of periarticular ossification by diphosphonate (ethylidene-1-hydroxy-1,1-diphosphonate)].

In the last six years the authors have implanted 340 hip joint prostheses of the Zweymüller/Endler or Zweymüller type in 285 patients from the lateral transgluteal approach. Approximately one-third of these patients (111) had previously undergone surgery on the hip joint in question. Intraoperative complications included four cases of elongation of the leg due to implantation of an over-long prosthesis shaft. Four of the shafts implanted were too small and in two cases subsequently loosened. In two patients a divulsion of the trochanter major occurred and there were two cases of cracking of the calcar femoris with involvement of the trochanter minor. There were also two cases of shaft divulsion at the level of the prosthesis tip. Postoperative complications included periarticular ossifications in 41 cases. There were 11 cases of phlebothrombosis and six of pneumonia. Superficial hematomas developed in the wound region in four cases. In addition, there were two cases of shaft and one of acetabular loosening, as well as three prosthesis dislocations. Between October and December 1987, a total of 232 of these patients were examined and the results rated according to Merl d'Aubigne's classification: 166 (71%) were classified as very good or good, 49 (21%) as satisfactory, and 17 (7%) as unsatisfactory. The most common postoperative complication was periarticular ossification, seen in 41 cases. Even though this is not a serious complication and the periarticular ossifications did not necessarily result in severe limitation of movement, a major functional loss as compared to the preoperative findings was seen in the patients with severe ossification (IIIrd degree) at the examination 12 months postoperatively. By giving EHDP, since November 1984, it has proved possible to reduce the incidence of periarticular ossifications from 28 to 12%. In the last 24 months even better results have been achieved by administration of EHDP unter function-scintigraphic control. According to the author's results the Zweymüller/Endler and Zweymüller systems satisfy the requirements for a cement-free total hip replacement since, on the one hand, intraoperative and postoperative complications are slight and, on the other, a good functional result is achieved. The Zweymüller prosthesis has proved particularly suitable for hip joints operated on previously.

Adult↗
PubMed1995

Hip joint position and architecture of rat semimembranosus muscle: implications for length-force characteristics.

Alteration of hip joint angle, while keeping the knee position constant, changes the orientation of the biarticular rat semimembranosus lateralis muscle with respect to the bony origin at the pelvis. Geometrical and length-force characteristics of the muscle were determined in two experimental groups, each with a different orientation: angles between the muscle and line of origin were set at 68.1 +/- 5.3 degrees (condition 68) and 121.9 +/- 9.1 degrees (condition 122). For muscles of condition 68 and condition 122, the number of sarcomeres in series was similar in both proximal fibers (11,436 +/- 356 and 11,555 +/- 175, respectively) and distal fibers (12,585 +/- 844 and 12,787 +/- 288, respectively). At similar distal fiber lengths, the sarcomere length in proximal fibers was higher in condition 122 than in condition 68, indicating a change in heterogeneity of fiber sarcomere lengths in the muscle. Hence, length-force relationships of proximal and distal sarcomeres were more scattered with respect to muscle length in condition 122 than in condition 68. Range of distal fiber length between optimum and zero muscle force was increased by 2.7 mm (13%) in condition 122. These data indicate that biarticular muscles with bony origins can exhibit different length-force characteristics at similar distal fiber lengths. During hip joint movements and fiber shortening, muscle fibers of such biarticular muscles use shifting fiber length-force relationships with respect to muscle length.

Analysis of Variance↗
PubMed1997

Wear of ultra-high molecular weight polyethylene acetabular cups in a physiological hip joint simulator in the anatomical position using bovine serum as a lubricant.

The Leeds physiological anatomical (PA) hip joint simulator was developed to apply three axes of loading and a complex three-dimensional motion so that the forces and motions can reproduce exactly the walking cycles defined by Paul. This paper presents the results of a study using the Leeds PA hip joint simulator to determine the wear of 32 mm ultra-high molecular weight polyethylene (UHMWPE) acetabular cups against stainless steel and zirconia ceramic heads, using bovine serum as lubricant. These results have been compared with the results of a previous study that used water as the lubricant, which led to UHMWPE transfer film being formed on the stainless steel head. Comparisons are also made with clinical results and results from other simulators. The study indicates that it is preferable to use bovine serum in simulator studies. In addition, the results indicate that if the surface roughness of the metallic and femoral heads are similar, and they remain undamaged during the tests, the wear rates of the UHMWPE cups are likely to be similar.

Acetabulum↗
PubMed1978

[Model investigations on the static abnormal strain on the homolateral knee joint following arthrodesis or ankylosis of the hip joint in the frontal plane (author's transl)].

The static abnormal load on the homolateral knee joint after stiffening of the hip in the frontal plane (abnormal load associated with abduction or adduction) is examined via a simplified pelvis and leg model. Besides the direct impairment of the homolateral knee joint, it has also been possible to demonstrate the indirect impairment of the ankle joint and of the foot.

Ankle Joint↗
PubMed2000

Effects of hip joint centre mislocation on gait analysis results.

Methods to determine the hip joint centre (HJC) location are necessary in gait analysis. It has been demonstrated that the methods proposed in the literature involve large mislocation errors. The choice should be made according to the extent by which HJC location errors distort the estimates of angles and resultant moments at the hip and knee joints. This study aimed at quantifying how mislocation errors propagate to these gait analysis results. Angles and moments at the hip and knee joint were calculated for five able-bodied subjects during level walking. The nominal position of the HJC was determined as the position of the pivot point of a 3D movement of the thigh relative to the pelvis. Angles and moments were then re-calculated after having added to HJC co-ordinates errors in the range of +/-30 mm. Angles and moments at both hip and knee joints were affected by HJC mislocation. The hip moments showed the largest propagation error: a 30 mm HJC anterior mislocation resulted in a propagated error into flexion/extension component of about -22%. The hip abduction/adduction moment was found the second largest affected quantity: a 30 mm lateral HJC mislocation produced a propagated error of about -15%. Finally, a 30 mm posterior HJC mislocation produced a delay of the flexion-to-extension timing in the order of 25% of the stride duration. HJC estimation methods with minimum antero-posterior error should therefore be preferred.

Adult↗