[Development of the hip joint during the conservative treatment of congenital hip dislocation in children].
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Child, Preschool↗
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Late diagnosis dislocation of the hip joint in children.
Dating from 1953, the hips of newborn have been examined routinely all over Sweden. In 1963 more than 99 per cent of all newborns (about 110,000) were delivered at maternity departments, where such examination was recommended. 615 cases of preluxation or dislocation were diagnosed, which means a frequency of 5.6 per thousand. A high frequency reported in some hospitals suggests overdiagnosis. To assess to what extent the examination of newborns has reduced the frequency of late diagnosis dislocation and dysplasia, extracts of the records were obtained concerning all infants born in 1963 and treated for dislocation of the hip in 1963-1966 at orthopaedic departments in Sweden. Twenty-seven reported cases were analysed and the children were reviewed after 4-10 years. Fourteen (52 per cent) of the children were found to have normal or practically normal hips at the review. Eight still had dysplasia with subluxation and 3 had substantially deformed joints, one had moderate deformity and one, untreated, still had luxation. Possible causes of late diagnosis are discussed and it is stressed -- that all physicians who examine newborns should be well versed in examination of the hip joints.--that the hip joints should, when possible, be examined on two occasions during the first weeks of life, especially newborns predisposed to dislocation owing to heredity, breech presentation or different kinds of malformations.--that it should be borne in mind that complete luxation, though rare, may exist already in the neonatal period,--that one should not forget to examine the hips of newborns who, because of prematurity, asphyxia etc., are referred immediately for intense treatment before routine examination of the hips has been carried out,--that a child health centes one should not rely on the results of the examination during the neonatal period, but should always examine the hip joints.
Child↗
Experience with a modified posterior approach to the hip joint. A technical note.
A modified posterior approach to the hip joint is described with particular applicability to revision or complex primary hip arthroplasty. The procedure involves osteotomy of the posterior one-third of the greater trochanter with posterior reflection of a full-thickness flap, consisting of the posterior trochanteric fragment, short external rotators, joint capsule, and posterior portion of the gluteus medius. The approach allows for excellent exposure of the acetabulum and femoral canal, with minimal disruption of the gluteal muscle insertions. The majority of the greater trochanter is left intact, enhancing femoral component stability. Closure is accomplished by suture of soft tissues and reattachment of the posterior trochanteric fragment with bone screws. An intact soft tissue envelope is thereby restored around the prosthetic components. A limited clinic series has identified no problem referable to this exposure. No loss of reduction or nonunion has been encountered.
Acetabulum↗
[The results of radical-rehabilitative surgical treatment in tuberculous osteitis of the hip joint in children].
Radical restorative surgery is an operation of choice in treatment of tuberculous osteitis of the hip joint in children of all age groups irrespective of the destructive process localization and duration. The early surgical treatment provided recovery from tuberculous osteitis in 100 per cent of the patients and proper development of the operated hip joint in 90 per cent of the patients.
Adolescent↗
[Noncemented revision of femoral hip joint prostheses with severe bone defects (preliminary report)].
The authors present an account of their initial experience with Wagner's non-cemented femoral revision prosthesis of the hip joint. After a brief technical description of the implant the mention the indications and contraindications of they revision shaft. They emphasize the necessity of peroperative planning and describe the surgical technique. Since 1992 they used a revision shaft in five patients (three times in aseptic loosening of a TEP of the hip joint, once during septic loosening and once when treating a periprosthetic fracture with extensive bone destruction). Long-term experience will be the subject of a subsequent paper.
Cementation↗
[Value of radiologic evidence for the diagnosis of the loosening of cement-fixed total prostheses of the hip joint].
A diagnosis of loosening of cement-anchored alloarthroplasties of the hip joint is mainly based on morphological x-ray film findings. Definite signs of loosening, however, are represented by drastic positional changes or ruptures of the implant only. All other radiological signs, such as concentric or defined osseous absorptions (bordering), damage of the osseous implant bed with slight positional change, or reactive ossifications of the osseous prosthesis bed, as well as disruption of the bone cement alone, are useful only as pointers or as latent signs of loosening. It is only when several of these signs appear together in a typical constellation, that one can safely concluded that loosening has actually occurred.
Equipment Failure↗
Hip joint remodeling in an adult following excision of a giant cell tumor involving the acetabulum: a case report and literature review.
We describe a 47-year-old man with a giant cell tumor of bone involving the acetabulum treated with curettage and bone grafting which resulted in good remodeling of the hip joint. The patient had a 15 x 18-cm(2) mass lesion extending from the right ischium to the acetabulum. Treatment included curettage, phenol, and ethanol application as an adjuvant, and cancellous bone allografting was performed on the subchondral area of the acetabulum. The posterior column of the acetabulum was disappeared by tumor invasion. Despite central migration of the femoral head, adequate hip joint repair was achieved without surgery 5.5 years postoperatively and with no tumor recurrence. The patient could walk without pain or ambulation aids; hip range of motion was 100 degrees for flexion, 0 degrees for extension, 30 degrees for abduction, 45 degrees for external rotation, and 10 degrees for internal rotation, and the functional result was 93.3% in the Enneking scoring system. We performed intralesional curettage with phenol and ethanol adjuvant therapy for pelvic giant cell tumor without tumor recurrence, and good repair of a hip joint adaptation can be achieved even in an adult patient.
Acetabulum↗
[Disseminated lung tuberculosis in a patient with undiagnosed chronic hip joint tuberculosis].
A case of a 69-year male patient is reported. His history is an illustration of difficulties in the diagnosis of hip joint tbc. Patient suffered from severe pain in the right hip and thigh while walking for 25 years. Despite abnormal bone structure confirmed by several X-rays, no other examinations were ever performed to establish possible diagnosis. The patient was told to have "an inflammation" or "degeneration" of the bone. Anti-inflammatory and analgesic agents were given him to enable walking for years. Untreated tuberculosis resulted in the complete destruction of the proximal end of thigh bone and unilateral hip joint. Etiology was confirmed when the patient developed disseminated lung tuberculosis. Antitubercular drugs proved effective and brought about fast improvement of patient's health. On completion of chemotherapy, surgical treatment of the affected bones was performed.
Aged↗
[Idiopathic chondrolysis of the hip-joint: report of two cases and review of the literature].
Two cases of idiopathic chondrolysis of the hip-joint in chinese boys were treated by the authors. By consulting medical literature, the etiology, diagnosis and treatment of this disease were discussed in this paper. The real cause of this disease is still unknown. When a preschool child, especially a girl, complains of pain and limitation of movement at one hip-joint without evident predisposing cause, plus narrowing of inter-articular space revealed by roentgenogram and normal values in hematology and ESR, this disease should be ruled out. Owing to lack of ideal therapy up to now, pain can be alleviated and ankylosis be prevented by performing active and passive functional exercises of the joint persistently under light load or no load conditions. Besides, immobilization of the joint by brace and plaster bandage are contraindications for this disease.
Cartilage Diseases↗
Evaluation of P-POSSUM scoring system in predicting mortality in patients with hip joint arthroplasty.
OBJECTIVE: To evaluate the applicability of Porthsmouth modified physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) in predicting the mortality of the patients undergoing hip joint arthroplasty. METHODS: A total of 141 patients (75 males and 66 females, aged 63.22 years+/-14.45 years on an average) undergoing hip joint arthroplasty during January 2002 and March 2005 were studied retrospectively with P-POSSUM. Their average physiological score and operative severity score were 17.48+/-5.16 and 12.43+/-3.05, respectively. The predicted postoperative mortality with P-POSSUM was compared with the observed value. Subgroup analysis was performed to investigate the predictive capability of P-POSSUM. POSSUM scoring system was used as the control. RESULTS: Three patients died after operation in this study actually. The average physiological scores were 32.33+/-9.87 in the death group and 17.16+/-4.56 in the survival group. The former was obviously higher than the latter, which showed statistical difference between the two groups (Wilcoxon rank sum test, P<0.05). Perfect agreement was found between the observed death number and the predicted death number calculated by P-POSSUM (Cochran-Mantel-Haenszel chi(2) test, P>0.05), though POSSUM overestimated the overall mortality. CONCLUSIONS: P-POSSUM can predict the mortality accurately in the patients undergoing hip joint arthroplasty, which is superior to POSSUM.
Aged↗
[Use of ultrasound in the study of the hip joints of fetuses during different periods of intrauterine development].
There has been investigated a hundred of women (aged 25-36 years) with aggravated obstetric-gynecologic anamnesis with wrong fetus position, familial predisposition for congenital hip dislocation and hip joint dysplasia. Fetuses were investigated at the "Toshiba" ultrasonography apparatus by a sensor with frequency of 5 mHz. Investigation of fetus hip joint in different terms of prenatal development has demonstrated that the joints were presented mainly by immature forms (11 a type) though at later terms of prenatal development there were present mature joints as well (1 a type). Ultrasonographic investigation permits to determine and measure the diameter of cartilaginous head of femur, evaluate its relation to cotyloid cavity, measure the center of the head ossification. The most intensive growth of the head occurs at 26-38 weeks of prenatal development. Hip joint stability can only be evaluated at later term of prenatal development.
Adult↗
Transacetabular arthrotomy of the hip joint.
Removal of a loose body or some other lesion in the acetabular fossa by an ordinary arthrotomy of the hip joint can be extremely difficult and may necessitate dislocation of the femoral head with the ensuing risk of vascular disturbances. A method has been developed to overcome these difficulties. Essentially it implies that a hole is made centrally in the acetabular fossa from the intrapelvic side via an inferior midline abdominal incision and extraperitoneal dissection. After the hole has been made in the bone, the fat pad in the acetabular fossa (pulvinar acetabuli) is incised and the pathological lesion, e.g. a loose body, can easily be removed. Large areas of the femoral head can be inspected by movements of the joint in different directions. If indicated, the whole acetabular fossa can be removed leaving only the cartilage-covered part of the acetabulum (facies lunata) intact. The method has been successfully used in four hip joints in three patients.
Adult↗
The thixotropic effect of the synovial fluid in squeeze-film lubrication of the human hip joint.
The thixotropic (shear-thinning) effect of the synovial fluid in squeeze-film lubrication of the human hip joint is evaluated, taking into account filtration of the squeezed synovial film by biphasic articular cartilage. A porous, homogeneous, elastic cartilage matrix filled with the interstitial ideal fluid, with the intact superficial zone (of lower permeability and stiffness in compression) already disrupted or worn away, models an early stage of arthritis. Due to a high viscosity of the normal synovial fluid at very low shear rates, the squeezed synovial film at a fixed time after the application of a steady load is found to be much thicker in a small central part of the lubricated contact area. In the remaining part, the film is thin as it corresponds to the Newtonian fluid with the same high-shear-rate viscosity. Filtration is lower for the normal cartilage with the intact superficial zone due to its lower permeability and compression stiffness. But even in the fictitious case of zero filtration, calculations show that the effect of thixotropy on the increase of the minimum synovial film thickness would manifest itself as late as after several tens of seconds since the physiologic load application. At that time, this thickness would be as low as about 0.3 microm. It follows that thixotropy of the normal synovial fluid (and so much more of the inflammatory fluid) is irrelevant in squeeze-film lubrication of both the normal and arthritic human hip joints.
Arthritis, Rheumatoid↗
High field (4.7 T) magnetic resonance imaging of feline hip joints.
Magnetic resonance imaging (MRI) is a non-invasive technique widely used to investigate degenerative joint disease (DJD). In this study, we obtained magnetic resonance images of feline hip joints, using a high magnetic field MRI unit (4.7 tesla) with proton density (PD)-weighted and T2-weighted fast spin-echo (FSE). PD-weighted FSE provided detailed anatomical images of feline hip joints with superb depiction of subchondral bones of the femoral head and acetabulum. Articular cartilage (AC) was also visualized with PD-weighted and T2-weighted FSE; however, mild AC lesions noted on gross examination were not detectable with these sequences.
Animals↗
[Epiphyseolysis of the hip joint and prearthrosis (author's transl)].
The question whether disturbances of hormonal regulation influence the development of the hip joint, is examined on the basis of roentgenographs in 25 patients with epiphyseolysis. We can conclude from the numerous collected data that gross anatomy (especially the harmonic development between head and acetabulum) is largely normal. A change of the abductor angle of Debrunner in the sense of a reduction may exercise an unfavorable influence on the load which the entire hip joint has to bear (due to reduction of the lever arm of the musculature with an abductor effect). Besides, hormonal dysregulation produces a very minimal enlargement of the head radius and of the load area as well as of the length of the neck of the femur c, which may possibly become biomechanically manifest. The slight change in shape of the entire pelvic girdle is reminiscent of the late form of osteoarthrosis of the hip (coxarthrosis) on the basis of a so-called enchondral dysostosis. The working hypothesis according to which this normal dysostosis would in fact be a late form of epiphyseolysis, remains unconfirmed.
Adolescent↗
[Wearing-away of the head of total endoprosthesis of the hip joint].
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Hip Joint↗
[Osteonecrosis of the hip joint in adulthood].
Osteonecrosis (ON) of the hip joint remains an unsolved therapeutical problem. Diagnosis of ON of the hip has been improved by the technical progress of imaging modalities and better understanding pathomorphology. Over a long period only plain radiographs have been available. Scintigraphy and computed tomography contributed to differential diagnosis and early detection of bone necrosis. Diagnosis in an early reversible stage is of importance. Understanding of pathophysiology, early diagnosis and therapeutical approach has been significantly improved by MR imaging. Using the ARCO system all imaging modalities and their diagnostic viability are described in the five ARCO stages. At the end a diagnostic algorithm will be proposed.
Diagnostic Imaging↗
[The growth of the juvenile hip joint. A planimetric study of x-ray films (author's transl)].
A total of 1.779 X-ray films of the pelvis done with the same technic in children and adolescents was divided into 8 different age groups between 5 and 20 years. Several planimetric parameters for the evaluation of pelvic growth were measured and statistically analysed. A growth quotient was found showing periods of limited intensive growth efforts of the human hip joint. Such growth periods were found in both sexes between 5 and 8 years, and again for girls between 9 and 12 years, for boys between 11 and 14 years. In pathologic hip joints the triradiate cartilage closes sooner. The development of the pelvic roof and the closure of the triradiate cartilage show a close relationship. By evaluating 802 normal hip joints, an acetabular form index useful for all age groups was found.
Adolescent↗