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PubMed1996

Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture.

The value of routine aspiration of the hip joint before revision of a hip arthroplasty remains controversial. We reviewed the results of such aspirations in an attempt to determine clinical or laboratory factors that could help the surgeon to identify hips that are infected and that should be aspirated preoperatively. One hundred and fifty consecutive revision total hip arthroplasties were performed by one of us. Preoperative aspiration was not performed or data were excluded for eight hips; no fluid was obtained from one of these hips (0.7 percent of the 150). Of the remaining 142 hips, 128 had preoperative aspiration once and fourteen, twice. Twenty-one (15 percent) of the 142 hips were infected, as demonstrated by the intraoperative culture. The intraoperative culture for two of these hips, however, was considered to be false-positive. The initial aspiration was considered to be positive only if an organism grew on the solid medium or if grossly purulent fluid was obtained. The initial aspiration was positive for nineteen hips; on culture of specimens from one hip, Bacteroides thetaiotaomicron grew in the liquid medium only; and purulent fluid was obtained from one hip but no organisms grew on culture. Fourteen aspirations were repeated for various reasons, most commonly to confirm the presence of an unusual organism. The repeat aspiration did not change the diagnosis for these hips. When the two hips with a false-positive intraoperative culture were excluded, preoperative aspiration had a sensitivity of 92 percent, a specificity of 97 percent, and an accuracy of 96 percent. Seventeen of the nineteen truly infected hips were associated with an abnormally elevated erythrocyte-sedimentation rate (mean, 80.8 millimeters per hour). However, fifty-eight (50 percent) of the 116 hips that were not infected, and for which the results were available, also had an abnormally elevated erythrocyte-sedimentation rate (mean, 32.0 millimeters per hour). This difference was significant (p = 0.001, Fischer exact test). The peripheral leukocyte count was not helpful in predicting infection. Hips in which the implants had been in situ for more than five years were less likely to be infected (p = 0.008, Fisher exact test) than those in which the implants had been in situ for five years or less. None of the infected hips in which the implants had been in situ for more than five years were associated with a normal erythrocyte-sedimentation rate. In this study, preoperative aspiration of the hip joint had an excellent sensitivity and specificity with regard to the prediction of infection, On the basis of our findings, we now favor a selective approach to aspiration, as determined by the erythrocyte sedimentation rate and the amount of time that the implant has been in situ.

Adult↗
PubMed2005

Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty.

OBJECTIVES: To compare internal fixation, bipolar hemiarthroplasty and total hip arthroplasty for the management of displaced subcapital fracture of the hip in previously fit patients of 60 years or older. DESIGN: A prospective randomised clinical trial. SETTING: This multicentre trial was carried out in 11 Scottish hospitals with acute orthopaedic trauma units. PARTICIPANTS: The participants were 298 previously fit patients of 60 years or older with displaced subcapital hip fractures. INTERVENTIONS: The three surgical interventions for comparison were reduction and fixation, bipolar hemiarthroplasty and total arthroplasty (total hip replacement). Participating surgeons elected to randomise patients either among all three types of operation (three-way randomisation) or just between fixation and hemiarthroplasty (two-way randomisation). MAIN OUTCOME MEASURES: Clinical outcomes were mortality rates, reoperation rates and the complication rates associated with each procedure. Functional outcome was measured using a hip specific questionnaire [Johanson Hip Rating Questionnaire (HRQ)] and a general health status questionnaire [EuroQol 5 Dimensions (EQ-5D)]. Economic analysis compared the costs in the randomised groups of hospital treatment for the initial and subsequent admissions for up to 2 years. RESULTS: Altogether, 207 patients were randomised among all three trial operations, and 91 between just fixation and bipolar hemiarthroplasty. There were no statistically significant differences in clinical outcomes, but confidence intervals (CIs) were wide. At 2 years fixation failure reached 37% among those allocated fixation and 39% had undergone further surgery. Further surgery rates after hemiarthroplasty and total hip replacement were 5% and 9%, respectively. The group allocated fixation had significantly worse HRQ and EQ-5D scores than both arthroplasty groups at 4 and 12 months. At 24 months the results still favoured arthroplasty, but the overall HRQ and EQ-5D scores were no longer statistically significant. Total hip replacement had the best patient-assessed outcome scores. At 24 months the overall HRQ and EQ-5D scores for total hip replacement were significantly better than for hemiarthroplasty. The mean costs for the initial episode ranged from 6384 pounds Sterling for fixation to 7633 pounds Sterling for total hip replacement. The cost differences were largely due to differences in theatre costs and the cost of prostheses and hardware. The cumulative cost over 2 years of hemiarthroplasty was around 3000 pounds Sterling lower than for fixation (95% CI 1227 pounds Sterling to 7192 pounds Sterling). Compared with total hip replacement, both fixation and hemiarthroplasty were characterised by increased costs arising from hip-replacement admissions. When total (initial episode and subsequent hip-related admissions) hip-related costs are compared, total hip replacement conferred a cost advantage of around 3000 pounds Sterling per patient (versus hemiarthroplasty, 95% CI -pounds Sterling 1400 to 7420 pounds Sterling). CONCLUSIONS: In fit, older patients the results of the study show a clear advantage for arthroplasty over fixation; arthroplasty was more clinically effective and probably less costly over a 2-year period postsurgery. The results suggest that total hip replacement has long-term advantages over bipolar hemiarthroplasty, but these findings are less definite. This study provided support for the use of total hip replacement to treat displaced intracapsular hip fractures in fit, older patients. A larger trial comparing total versus hemiarthroplasty for these fractures could help to verify these findings. It would also be useful to know whether the findings of this study apply to patients aged 60 years or less who are usually treated with reduction and fixation. A clinical trial comparing arthroplasty versus fixation in patients older than 40 years would be a logical extension of the current study.

Aged↗
PubMed1993

The value of aspiration of the hip joint before revision total hip arthroplasty.

The role of aspiration of the hip joint before revision of a total hip arthroplasty remains controversial. To address this issue, we reviewed the results of 270 consecutive hips in which aspiration had been attempted before revision procedures that were performed between 1980 and 1988. All hips had intraoperative findings and clinical follow-up of at least two years to confirm the presence or absence of infection. Only six (2 per cent) of the 270 hips were determined to be infected. Aspiration had been attempted in all six hips, but fluid could be obtained from only four. All six hips also had clinical or radiographic signs, or both, of infection, including increasing pain within three years after the arthroplasty (four hips), inability of the patient to attain pain-free status after the original procedure (four hips), radiographic findings compatible with infection (six hips), and a positive finding on culture of a specimen obtained from a previous aspiration (two hips). Because of these factors, aspiration was attempted a second time in four of the six hips and a third time in three of the four. The four hips from which fluid could be obtained had a total of ten successful aspirations; the cultures of specimens obtained from six of these procedures were positive and those from four were negative. The appearance of the capsular tissue at the time of the operation suggested infection in five of the six infected hips. Histological sections were positive for inflammation in all six: there was acute inflammation only in one, chronic inflammation only in two, and acute and chronic inflammation in three. No organisms were seen on gram stains of specimens from any of the six infected hips. Of the 254 hips that did not have an infection and had been aspirated successfully, thirty-two (13 per cent) had a false-positive result on culture of a specimen of the aspiration fluid. Only two (6 per cent) of the thirty-four hips that had a positive result on culture of fluid from the initial aspiration had a true-positive result. No hip had a true-positive result on culture of fluid that had been aspirated preoperatively without also having clinical and radiographic evidence of infection. On the basis of these findings, we recommend that aspiration be performed in selected patients rather than routinely. It also should be performed only if a detailed clinical history suggests infection or if radiographs demonstrate focal lysis, aggressive non-focal lysis, or periostitis.

Aged↗
PubMed2006

Association between prior non-spine non-hip fractures or prevalent radiographic vertebral deformities known to be at least 10 years old and incident hip fracture.

UNLABELLED: In this large cohort of elderly women, prior non-spine non-hip fractures and radiographic vertebral deformities >10 years old were modestly associated with incident hip fracture, but the excess risks of hip fracture attributable to those prior fractures and deformities seem to wane over time. INTRODUCTION: Whereas prior clinical fractures and prevalent radiographic vertebral deformities are well-documented predictors of incident hip fracture, the excess risks of incident fractures attributable to those prior fractures and deformities may decrease over time. Current guidelines regarding the assessment of fracture risk do not consider elapsed time since prior fracture or ascertainment of radiographic vertebral deformity. MATERIALS AND METHODS: We ascertained self-reported history of prior clinical fractures and calcaneal and total hip bone BMD and performed lateral spine radiographs in a cohort of 9516 community-dwelling elderly women who had not had a prior hip fracture. We prospectively followed them to assess incident hip fracture. Prevalent radiographic vertebral deformities were identified at baseline using morphometry, and incident hip fractures were confirmed by review of radiographic reports during three follow-up periods (0-5, >5-10, and >10 years after baseline exam). RESULTS: Among women who survived for 10 or more years after the baseline exam without having had a hip fracture, a history of non-spine non-hip fracture since age 50 reported at the baseline study examination was associated with a 21% age- and calcaneal BMD-adjusted excess risk (hazard ratio [HR], 1.21; 95% CI, 1.01-1.45) for subsequent incident hip fracture. Baseline radiographic vertebral deformity was associated with a 41% age- and BMD-adjusted excess risk (HR, 1.41; 95% CI, 1.15-1.73) of hip fracture after 10 years of follow-up. In comparison, the age- and BMD-adjusted HRs of incident hip fracture during the first 5 years of follow-up associated with prior non-spine non-hip fractures reported at the baseline study exam and prevalent radiographic vertebral deformities were 1.70 (95% CI, 1.30-2.22) and 2.10 (95% CI, 1.58-2.78), respectively. CONCLUSIONS: Self-reported prior non-spine non-hip fractures and prevalent radiographic vertebral deformities known to be at least 10 years old are modestly associated with incident hip fracture. The association between these predictor fractures and subsequent hip fractures seems to wane with increased time after ascertainment of the predictor fracture. Hip fracture risk assessment strategies incorporating prior fracture history should also consider elapsed time since those prior fractures.

Age Factors↗
PubMed1999

Relationships between results of the Ortolani method of hip joint palpation and distraction index, Norberg angle, and hip score in dogs.

OBJECTIVE: To determine whether results of the Ortolani method of hip joint palpation in dogs were related to distraction index (DI), Norberg angle, or radiographic hip score. DESIGN: Cross-sectional study. ANIMALS: 459 clinically normal dogs. PROCEDURE: Dogs were sedated for radiography and palpation of the hip joints. Results of hip joint palpation were classified as negative, mild positive, moderate positive, or severe positive. Distraction indices were measured for all dogs. Norberg angles were measured for 380 dogs for which ventrodorsal hip-extended radiographic projections were available. Hip scores assigned by the Orthopedic Foundation for Animals (OFA) were available for 95 dogs. RESULTS: Age, weight, and sex were not significantly associated with results of hip joint palpation. There was moderate correlation between results of hip joint palpation and DI (r = 0.636), low-moderate correlation between results of hip joint palpation and OFA hip scores (rs = 0.437), and weak negative correlation (r = -0.236) between results of hip joint palpation and Norberg angle. For joints without degenerative joint disease (DJD), there was a significant linear relationship between results of hip palpation and DI; however, for joint with DJD, there was not. Results of hip joint palpation were 5.3-fold as likely to be negative for dogs with DJD as for dogs without. CLINICAL IMPLICATIONS: Results of hip joint palpation were at best moderately correlated with radiographic measures of hip joint laxity. Therefore, hip joint palpation should be combined with hip-extended and stress radiography when assessing hip joint quality.

Animals↗
PubMed2005

The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists.

OBJECTIVE: Hip rating systems have been widely used in assessing severity of hip dysfunction but no uniform method has emerged. The current study was performed to determine the interobserver reliability of five different hip scores on patients with coxarthrosis. DESIGN: Test reliability among physical therapists for five commonly used hip scores. SUBJECTS: Thirty-five patients (48 hips) who had coxarthrosis and who were candidates for total hip arthroplasty were included in the study. METHODS: Patients were evaluated preoperatively by three physical therapists using five different hip rating systems; the Harris Hip Score, the Iowa Hip Score, the Charnley Hip Score, the Merle d'Aubigne Hip Score and the American Academy of Orthopaedic Surgeons' Hip Score. RESULTS: The average age of the patients was 58.8 +/- 2.2 years (range 28-76 years). For all scores, an excellent interobserver reliability between the physical therapists were found (kappa = 0.77-0.95). The best correlation between first and second observer was on Harris Hip Score (kappa = 0.91), between second and third was on Merle d'Aubigne Hip Score (kappa = 0.95) and between first and third was on Iowa Hip Score (kappa = 0.87). CONCLUSION: There was an excellent interobserver reliability for all hip scores between the physical therapists, suggesting that all these hip scores are suitable for use by physical therapists.

Adult↗
PubMed2004

[Acetabular reconstruction of total hip replacement in the treatment of dysplastic hip].

OBJECTIVE: To summarize the surgical experience of acetabular reconstruction of total hip replacement in the treatment of dysplastic hip. METHODS: From April 1998 to April 2002, 96 adult cases with osteoarthritis secondary to dysplastic hip were adopted in the study. Among them, there were 89 females and 7 males, age from 27 approximately 68 years. According to Hartofilakidis classification system, there were dysplasia in 73 hips, low dislocation in 18 hips and high dislocation in 21 hips. All patients received total hip replacement, 16 cases with bilateral replacement and 80 cases with unilateral replacement. Kocher-LangenBeck approach was used during operation and all the acetabular cups were reconstructed at the original anatomic location. The fixation methods were as follows: cement cup for 16 hips, cementless cup for 96 hips and bone graft in 11 hips. The reconstructive methods were as follows: regular replacement for 83 hips; installing a smaller cup after deeper reaming the acetabulum for 27 hips; installing a smaller cup after autofemoral grafting on the superior lip for 2 hips. RESULTS: The incision healed primarily and no infection or nerve injury occurred. Follow-up for 1 approximately 5 years (average for 3.5 years) in 85 patients, the Harris score increased from 33.9 preoperatively to 89.3 postoperatively, and 95 hips had good or excellent clinical results. Radiographically, the positions of the prostheses were normal, the average abduction angle of the cup was 44 degrees, the average superolateral bone coverage of the hips was 96.6%, no radiolucent line was observed at the acetabular side. All the bone grafts fused with the host bone successfully. CONCLUSIONS: Total hip replacement is an effective operation in the treatment of osteoarthritis secondary to dysplastic hip. The four specific factors that should be considered in acetabular reconstruction are: (1) the surgical approach, (2) the reconstructive position of the acetabulum, (3) the reconstructive method of the acetabulum, (4) the leg-length discrepancies. It's a challenging to the orthopaedic surgeon. Careful preoperative preparation is recommended.

Adult↗
PubMed2004

Hip protectors for preventing hip fractures in the elderly.

BACKGROUND: Hip fracture in the elderly usually results from a fall on the hip. Hip protectors have been advocated as a means to reduce the risk of sustaining a hip fracture. OBJECTIVES: To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register (February 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February Week 2 2004), EMBASE (1988 to 2004 Week 08), CINAHL (1982 to February Week 2 2004), other databases and reference lists of relevant articles. We also contacted trialists. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. We sought additional information from all trialists. MAIN RESULTS: An additional trial with 4169 participants was included in this update, giving a total of 14 included trials. One, which was a study of compliance (adherence) lasting 12 weeks, contributed no fracture outcome data. Five studies involving 4316 participants were cluster randomised by care unit, nursing home or nursing home ward rather than by the individual. Each of these studies reported a reduced incidence of hip fractures within those units allocated to receive the protectors. Because the majority of these trials had not been analysed to allow for clustering, pooling of their results was not undertaken. Pooling of data from five individually randomised trials conducted in nursing/residential care settings (1426 participants) showed no significant reduction in hip fracture incidence (hip protectors 37/822, controls 40/604, relative risk (RR) 0.83, 95% confidence interval (CI) 0.54 to 1.29). Three individually randomised trials of 5135 community dwelling participants, reported no reduction in hip fracture incidence with the hip protectors (RR 1.16, 95% CI 0.85 to 1.59). No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. REVIEWERS' CONCLUSIONS: There is no evidence of effectiveness of hip protectors from studies in which randomisation was by individual patient within an institution, or for those living in their own homes. Data from cluster randomised studies indicate that, for those living in institutional care with a high background incidence of hip fracture, a programme of providing hip protectors appears to reduce the incidence of hip fractures. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.

Aged↗
PubMed2004

High contact hip stress is related to the development of hip pathology with increasing age.

BACKGROUND: High contact hip stress is believed to be one of the key biomechanical factors involved in the hip cartilage degeneration and osteoarthritis. Accordingly, with increasing age high contact hip stress is expected to cause elimination of subjects from the population of healthy hips, but its predictive value has not been evaluated so far. The objective of the paper is to investigate whether the exposure of healthy hips to estimated high contact hip stress is related to the development of hip pathology with increasing age. METHODS: A cross-sectional age- and gender-matched analysis of the peak contact hip stress calculated from pelvic geometry was made in 103 adult subjects with healthy hips. The peak contact hip stress was calculated from anterior-posterior pelvic radiographs of healthy hips by using a mathematical model of the human hip in the static one-legged stance. FINDINGS: In both female and male population, the average values of the peak contact hip stress normalized to the body weight are significantly higher and the values are also more dispersed in younger subjects when compared to older subjects. INTERPRETATION: The hip joints which remain healthy in the old age have lower average estimated peak contact hip stress. These results are consistent with the explanation that subjects with high estimated peak contact hip stress are more likely to develop hip disease in the course of life.

Adult↗
PubMed1998

Total hip arthroplasty with use of an acetabular reinforcement ring in patients who have congenital dysplasia of the hip. Results at five to fifteen years.

The purpose of our study was to examine the clinical and technical problems associated with reconstruction of the hip in patients who had congenital dysplasia and to offer recommendations for their solution. We reviewed the records on 123 consecutive total hip arthroplasties that had been performed by one of us (M. E. M.), between 1981 and 1986, for the treatment of coxarthrosis due to congenital dysplasia of the hip. A minimum of five years of follow-up was required for inclusion in the study. The study group consisted of seventy patients who had had a total of eighty-seven reconstructions. According to the classification of Crowe et al., eleven hips had type-IV acetabular dysplasia; sixty-five, type-II; and eleven, type-II. Acetabular reconstruction was performed with use of the Müller acetabular roof-reinforcement ring and a polyethylene cup, which was inserted with cement. Autologous graft from the femoral head was used in forty-two hips. Femoral reconstruction was performed with use of the Müller straight-stem component for congenital dysplasia of the hip in eighty hips and with use of a standard Müller straight-stem component in seven hips. At an average of 9.4 years (range, five to fifteen years) postoperatively, the result was described as excellent for sixty hips (69 per cent), as good for twenty-three (26 per cent), as fair for two (2 per cent), and as poor for two. Nine (10 per cent) of the hips had been revised. One revision had been performed because of aseptic loosening of the acetabular component; one, because of aseptic loosening of the femoral component; one, because of aseptic loosening of both components; and six, because of infection. Of the unrevised hips, three had had superior migration of the acetabular component of less than five millimeters, and mild protrusion had developed in one. Two hips had a continuous radiolucent line around the acetabular construct. Two hips had had subsidence of the femoral stem of less than three millimeters; one had a complete, non-progressive radiolucent line at the bone-cement interface; and four had a radiolucent line at the proximal part of the bone-cement interface. Six hips had evidence of endosteal osteolysis. Six hips had grade-III or IV heterotopic ossification according to the system of Brooker et al. These results compare favorably with others in the literature. We recommend restoration of the anatomical hip center with the use of an acetabular roof-reinforcement ring and a polyethylene cup inserted with cement for the reconstruction of a deficient acetabulum. The acetabular reinforcement ring prevents resorption of bone graft and migration of the cup, which are major causes of failure of the cup in patients who have had a reconstruction of a deficient acetabulum. Bone graft should be used medially and superiorly as needed to augment bone stock notably. Cement should not be used to fill acetabular defects as we believe that it contributes to aseptic loosening.

Arthroplasty, Replacement, Hip↗
PubMed2002

Conversion of a fused hip to total hip arthroplasty.

BACKGROUND: Arthrodesis of the hip remains a viable treatment for severe unilateral arthritis after traumatic injury or infection in a young but otherwise healthy individual. The goal of the present study was to review the long-term clinical and radiographic results after conversion of a fused hip to a total hip arthroplasty and to identify the risk factors that would lead to a higher rate of failure. METHODS: We performed a retrospective review of the charts and radiographs of 187 patients (208 hips) who had conversion of a fused hip to a total hip arthroplasty. The mean duration of follow-up after the conversion to total hip arthroplasty was 9.2 years (range, two to twenty-six years). RESULTS: The mean age at time of the arthroplasty was fifty-one years. The mean time-interval between the arthrodesis and the conversion to a total hip arthroplasty was twenty-seven years. According to the information in the charts, at a mean duration of follow-up of 9.2 years after the total hip arthroplasty, 79% of hips were either pain-free or had minimal pain, 83% had good-to-excellent function, and 79% had good-to-excellent range of motion. Complications, which included fifteen nerve palsies, occurred in twenty-four hips. Twenty-eight hips had heterotopic ossification, but it was not associated with a recurrence of ankylosis or a marked reduction of motion. Revision arthroplasty was performed in twelve hips. The probability of survival of the implant was 96.1% (95% confidence interval, 91.5% to 98.2%) at ten years, 89.9% (95% confidence interval, 85.3% to 96.1%) at fifteen years, and 72.8% (95% confidence interval, 36% to 90.6%) at twenty-six years. CONCLUSIONS: Conversion of a fused hip to a total hip arthroplasty has a favorable outcome. However, the technically demanding nature of the procedure should not be underestimated. Patients should be cautioned with regard to the possibility of a higher rate of complications than that seen with primary total hip arthroplasty.

Adolescent↗
PubMed2006

Use of an alumina-on-alumina bearing system in total hip arthroplasty for osteonecrosis of the hip.

BACKGROUND: The results of total hip arthroplasty in patients with osteonecrosis of the femoral head are not always optimal. The use of alumina-on-alumina interfaces in young and active patients may decrease wear and lower the rate of aseptic loosening of the implant and appears to be an attractive alternative to the use of conventional cobalt-chromium-on-polyethylene bearings. The purpose of this study was to evaluate the safety and efficacy of the alumina-on-alumina bearing in patients with osteonecrosis and to compare this group of patients to a group of similarly treated patients with osteoarthritis and a group of patients who received conventional cobalt-chromium-on-polyethylene bearings. METHODS: Patients were selected from a United States Investigational Device Exemption multicenter prospective randomized clinical study that was initiated in 1996. Seventy patients with osteonecrosis of the femoral head (seventy-nine hips) received a cementless alumina-on-alumina bearing system and were directly matched to seventy-six patients with osteoarthritis of the hip (seventy-nine hips) who were managed with the same implant. Both groups were compared with twenty-five patients (twenty-six hips) with osteonecrosis and twenty-five patients (twenty-six hips) with osteoarthritis who were managed with a cementless cobalt-chromium-on-polyethylene bearing system. All patients received a cementless hydroxyapatite-coated femoral stem and were followed both clinically and radiographically. RESULTS: The clinical outcomes for alumina-on-alumina bearings were similar for both osteonecrotic and osteoarthritic hips. The seven-year survival probability was 95.5% for the osteonecrotic hips and 89.4% for the osteoarthritic hips in the alumina-on-alumina bearing group and 92.3% for the osteonecrotic hips and 92.9% for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group. At the time of the most recent follow-up, the mean Harris hip score was 96 points for both the osteonecrotic and the osteoarthritic hips in the alumina-on-alumina group and 96 points for the osteonecrotic hips and 97 points for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group. CONCLUSIONS: The results of the use of alumina-on-alumina and cobalt-chromium-on-polyethylene bearings in cementless standard total hip implants in patients with osteonecrosis and osteoarthritis were comparable. The low revision rate for the alumina-on-alumina bearing is encouraging and offers a promising option for younger, more active patients who have this challenging disease. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Adult↗
PubMed2004

Total hip arthroplasty for congenital hip disease.

BACKGROUND: It is generally agreed that the clinical and radiographic results of total hip replacement performed for degenerative arthritis secondary to congenital hip disease vary depending on the severity of the anatomical abnormality. In this study, we report the mid-term and long-term clinical and radiographic results of total hip arthroplasty performed for each of the three different types of congenital hip disease. METHODS: Between 1976 and 1994, the senior author performed 229 consecutive primary total hip arthroplasties in 168 patients with osteoarthritis secondary to congenital hip disease. Seventy-six hips were dysplastic, sixty-nine had a low dislocation, and eighty-four had a high dislocation. The Charnley low-friction technique was performed in 178 hips, and the so-called hybrid technique was performed in forty-six hips. Cementless arthroplasty was used in only five hips. RESULTS: After a minimum of seven years of follow-up, the rates of revision of the acetabular components were 15% in the dysplastic hips, 21% in the hips with a low dislocation, and 14% in those with a high dislocation. The rates of revision of the femoral components were 14%, 14%, and 16%, respectively. Survivorship analysis predicted an overall rate of prosthetic survival at fifteen years of 88.8% +/- 4.8% in the dysplastic hips, 73.9% +/- 7.2% in the hips with a low dislocation, and 76.4% +/- 8.1% in those with a high dislocation. CONCLUSIONS: An understanding of the anatomical abnormalities and the use of appropriate techniques and implants make total hip arthroplasty feasible for treatment of the three types of congenital hip disease. In patients with a low dislocation, the major technical problem is reconstruction of the natural acetabulum. In those with a high dislocation, the challenge is to place the acetabular component inside the reconstructed true acetabulum and to use an appropriate femoral implant in the hypoplastic narrow femoral diaphysis.

Adult↗
PubMed2002

Hip muscle strength and muscle cross sectional area in men with and without hip osteoarthritis.

OBJECTIVE: To study the hip muscle strength and cross sectional area (CSA) in men with hip osteoarthritis (OA) compared to age and sex matched healthy controls. METHODS: Based on the American College of Rheumatology criteria regarding classification of hip OA, 27 men (aged 47-64 yrs) with unilateral or bilateral hip OA and 30 age matched randomly selected healthy male controls were studied. The maximal isometric hip abductor, adductor, flexor, and extensor strength (Nm) at 0 degree of hip flexion in the supine position was determined with a dynamometer. The isokinetic hip flexion and extension strength (peak torque, Nm) was determined using angular velocities of 60 degrees /s and 120 degrees /s. The subjective severity of hip pain was rated by visual analog scale prior to the muscle strength test. CSA of the pelvic and thigh muscles was measured from magnetic resonance images. RESULTS: The reliability of intraclass correlation coefficients for repeated measures of muscle strength varied from 0.70 to 0.94 in controls and from 0.84 to 0.98 in subjects with OA. Hip isometric adductor and abductor strength was 25% and 31% lower (p < 0.001) in OA subjects than in controls, respectively. The hip isometric and isokinetic flexion strength was 18-22% lower (p < 0.01) in OA subjects than in controls, but extension strength did not differ between groups. In OA subjects, the hip flexion and extension isometric and isokinetic strength values were 13-22% lower (p < 0.05) on the more deteriorated side compared to the better side. CSA of the pelvic and thigh muscles did not differ between the groups. However, in OA subjects, the CSA of the pelvic and thigh muscles was 6-13% less (p < 0.05 to < 0.001) on the more severely affected hip compared to the better hip. CONCLUSION: Men with hip OA have significantly lower abduction, adduction, and flexion muscle strength than controls. The decrease of muscle size and hip pain may contribute to the decrease of muscle strength in hip OA. Other possible underlying causes of the muscle weakness need to be studied.

Anatomy, Cross-Sectional↗
PubMed2004

Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis.

OBJECTIVE: To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis. METHODS: Between 1995 and 2002, we implanted 23 cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18 females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with a cementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabulum and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31% (ranging from 10% to 45%). Eight hips had less than 25% cup coverage and thirteen between 25% and 50%. The average follow-up period was 4.7 years (range, 1-8 years). The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made. RESULTS: All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia. After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1 Brooker heterotopic ossification and one developed Grade 2. CONCLUSIONS: THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with developmental hip dysplasia when the cementless cup covered by the graft does not exceed 50%.

Adult↗
PubMed1993

Effect of external hip protectors on hip fractures.

Most hip fractures seem to be related to trauma near the hip, so a controlled trial was conducted to investigate the effect of external hip protectors on the prevention of such fractures in residents of a nursing home. 10 of the 28 wards in the nursing home were randomised to receive external hip protectors; thus 167 women and 80 men were given protectors and 277 and 141 men no protectors. A fall register was set up for 2 treatment wards (45 residents) and 2 control wards (76 residents). There were 8 hip and 15 non-hip fractures in the hip-protector group and 31 hip and 27 non-hip fractures in the control group. The relative risk of hip fractures among women and men in the intervention group was 0.44 (95% CI 0.21-0.94). None of the 8 residents in the intervention group who had a hip fracture was wearing the device at the time of the fracture. 154 falls were registered and 20% of these falls produced a direct impact to the hip. In 25 falls direct impact to the hip was sustained at a time when hip protectors were not being worn, and 6 fractures were produced. The study indicates that external hip protectors can prevent hip fractures in nursing-home residents.

Accidental Falls↗
PubMed2000

Prevention of hip fracture in elderly people with use of a hip protector.

BACKGROUND: Hip fractures are common in frail elderly adults worldwide. We investigated the effect of an anatomically designed external hip protector on the risk of these age-related fractures. METHODS: We randomly assigned 1801 ambulatory but frail elderly adults (1409 women and 392 men; mean age, 82 years), in a 1:2 ratio, either to a group that wore a hip protector or to a control group. Fractures of the hip and all other fractures were recorded until the end of the first full month after 62 hip fractures had occurred in the control group. The risk of fracture in the two groups was compared, and in the hip-protector group the risk of fracture was also analyzed according to whether the protector had been in use at the time of a fall. RESULTS: During follow-up, 13 subjects in the hip-protector group had a hip fracture, as compared with 67 subjects in the control group. The respective rates of hip fracture were 21.3 and 46.0 per 1000 person-years (relative hazard in the hip-protector group, 0.4; 95 percent confidence interval, 0.2 to 0.8; P=0.008). The risk of pelvic fracture was slightly but not significantly lower in the hip-protector group than in the control group (2 subjects and 12 subjects, respectively, had pelvic fracture) (relative hazard, 0.4; 95 percent confidence interval, 0.1 to 1.8; P > or = 0.05). The risk of other fractures was similar in the two groups. In the hip-protector group, four subjects had a hip fracture (among 1034 falls) while wearing the protector, and nine subjects had a hip fracture (among 370 falls) while not wearing the protector (relative hazard, 0.2; 95 percent confidence interval, 0.05 to 0.5; P=0.002). CONCLUSIONS: The risk of hip fracture can be reduced in frail elderly adults by the use of an anatomically designed external hip protector.

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