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PubMed2005

[Infection of the hip joint following psoas abscess. Case report and literature review].

Infection of the hip joint following psoas abscess is uncommon. In fact, only two cases have been reported in the literature. The clinical aspect of psoas abscess is characterised only by unspecific back pain and hip pain, which are responsible for delayed diagnosis. MRT and culture of joint aspirate can permit early diagnosis. The preferred treatment is immediate surgical intervention with debridement, drainage and antibiotic therapy. Percutaneous drainage of psoas abscess alone only rarely is sufficient. In cases of infected hip joint, resection arthroplasty often cannot be avoided. Following complete decline of inflammatory parameters and certain absence of bacteria confirmed by repeated joint aspiration, prosthetic joint replacement is possible. This decision should be made on an individual basis, because Girdlestone hip also can lead to a satisfactory result concerning pain relief and functional outcome.

Actinomycetales Infections↗
PubMed1990

Hip joint arthrosis: an occupational disorder among farmers.

Observations among Swedish farmers indicate that coxarthrosis is a common disorder in farming populations. In this case-referent study, we describe relationships between farming and hip joint arthrosis. The case-group consisted of 105 persons who have had surgery because of coxarthrosis and the referents consisted of 222 randomly selected persons. Non-responders totaled 9%. Farming was significantly more common in the case group. The ratio varied between 2.1 and 3.2, varying with the length of time in farming. Longer exposure did not seem to result in greater risk. There was no risk elevation related to forestry or transportation work. Nor was there any over-representation of accidents with injuries to the lower extremities in the case group. Heavy work load did not seem to be related to the genesis of coxarthrosis. Farming is an amalgamation of different types of work. However, we develop the hypothesis from this study that tractor driving may be related to hip arthrosis. Unfavorable angles in the hip joints may occur during tractor driving. Other studies support this hypothesis, as it has been found that unsuitable conditions for the hip joints may be related to arthrosis.

Aged↗
PubMed1989

[Role of mechanical factors in the development of degenerative dystrophic lesions of the hip joint].

The authors present the results of their studies of distribution of pressure on the articular surfaces of the hip joint with regard to the value of the angle between the femoral neck and the diaphysis and the state of the cartilaginous coat. The regularity of distribution of pressure was studied on a real model of the hip joint by means of tensometry and ichnography. It was established that the region of maximum pressure was most frequently affected by degenerative dystrophic process, and the epicenter of pressure on the femoral head surface was shifted due to an increased or decreased angle between the femoral neck and the diaphysis directed laterally or medially as compared with the normal state. These peculiarities should be taken into consideration when performing corrective osteotomies.

Biomechanical Phenomena↗
PubMed1975

[Modern viewpoints of hip joint dysplasia, clinical and radiologic. III. Radiologic follow-up].

Dysplasia of the hip-joint can unequivocally be recognized at the age of 7 weeks as proved by further developments. Defects in the acetabular angle remain in spite of abductionsplints which may have to be continued until the acetabular roof including its angle have become normal. It must not be abandoned when the PDW has returned to normal. One ought to demand that treatment should be started before this stage has been reached i.e. before the 7th week of life. 1. Clinical and radiologic observations in the first 3 months prove that dysplasia of the hip-joint can be well recognized at this early stage. A diagnosis beyond the 3rd month is a late diagnosis. 2. Essential radiologic signs are: wedge-segments, delayed ossification of the acetabular angel, "Tailliation" at the angle, subchondral sclerosis of the acetabular roof, double contour of the angle in radiographs and, in severe cases, steep PDW. 3. The averages and standard deviations of the Tonnis statistics have proved too large for the radiographs of the first 2 months of life and useless as shown in follow-up. 4. The dysplastic acetabulum is not immature but pathologic. 5. The common mild dysplasias cannot be recognized with PDW but only when searching for structural and contour changes at the acetabular roof.

Acetabulum↗
PubMed2003

[Septic arthritis of the shoulder and hip joint in cattle: diagnosis and therapy].

During eight years, in 17 cattle a septic arthritis of the shoulder or hip joint was diagnosed at the Veterinary Surgery Department, University of Munich. The diagnosis was based on the results of the synoviocentesis and confirmed by ultrasound and radiographic examination. The average number of leucocytes in the synovia was 65,137/microliter (median 43.344/microliter), with 97% neutrophils (median 96%). Of the 17 animals, 13 were treated. In two patients arthrotomy, and in 11 repeated joint lavage was performed. As a lavage solution, 500 to 1000 ml of Ringer's solution, with 800 to 1600 mg Gentamicin added, was used. Four animals were not treated because of advanced radiographic changes (1), purulent arthritis and phlegmon (1) or economic reasons (2). Ten patients could be cured long-term (follow up time 10.5 months on average, median 6.5 months), three remained lame and were slaughtered. As a conclusion, septic arthritis of the shoulder or the hip joint in cattle has a good prognosis when diagnosed and treated early.

Animals↗
PubMed1999

[Quantitative determination of pressure distribution in the hip joint during the gait cycle].

The objective of this investigation was the experimental determination of the contact pressures in the hip joint for characteristic phases of the gait cycle. The joint forces determined in vivo with telemetric endoprosthesis by Bergmann et al. (1993) were converted into a pelvic reference system, based on kinematic gait analysis. In eight cadaveric hip joints (age 18-75 yrs.) the reaction forces were applied corresponding to four phases of the gait cycle (heel strike, mid-stance, heel off, toe off) and the pressure distribution determined with FUJI pressure sensitive film. We found maxima of 10 MPa during mid stance. The areas of highest pressure were located in the ventro-superior aspect of the acetabulum (anterior part of the acetabular roof) and in the dorso-inferior aspect of the lunate surface. The pressure distribution was relatively constant during the four phases and the maxima did not vary proportional to the applied load. The normal pressure distribution in the hip appears to be determined by the physiological incongruity of the articular surfaces and the inhomogeneous bony support of the acetabulum. During operative interventions this normal load transfer should be restored as accurately as possible.

Adolescent↗
PubMed2005

Microvascular density of rapidly destructive arthropathy of the hip joint.

PURPOSE: To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head. METHOD: Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted. RESULT: The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count. CONCLUSION: These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.

Adult↗
PubMed2003

The Artek cup for total hip replacement of dysplastic hip joints.

BACKGROUND: One specific difficulty in total hip replacement for developmental dysplasia of the hip is a shallow acetabulum with a short anteroposterior diameter. In a prospective cohort study we investigated the short-term results of the Artek cup, designed with a shallow outline and a height-reduced metal inlay for a large size 38 mm metal head, in a group of female patients with mild dysplasia of the hip. METHODS: Fourteen consecutive patients with 17 dysplastic hip joints were included in the study. Their average age was 42 years. Fourteen hips had dysplasia Crowe grade I; 3 hips had dysplasia Crowe grade II. The femoral head centre was localized according to Pagnano in zone 1 in 3 cases, in zone 3 in 6 cases, and in zone 4 in 8 cases. The Harris hip score was 49 points (range 30-68 points). RESULTS: Mean follow-up was 20 months (range 14-24 months). The Harris hip score improved to a mean of 91 points (range 78-98 points). The postoperative radiographic measurements showed an inclination angle of 52.1 degrees (range 43-66 degrees ). The femoral head centre was in Pagnano zone 1 in 13 cases, in zone 2 in 1 case, in zone 3 in 1 case, and in zone 4 in 2 cases. The mean postoperative deviation from the approximative rotational centre was 0.17 mm (range -15 to 13 cm) in the superior direction and 5.3 mm (range -5 to 17 mm) in the lateral direction. CONCLUSION: In a small series of 17 implantations, stable press-fit fixation without screws or bone grafting was achieved despite acetabular defects. The complication rates were high. Inclination angles up to 54 degrees were not correlated with complications. Inclination angles of 60 degrees and more led to subtotal or complete dislocation. Mid-term results are still to follow concerning wear, dislocation rate, loosening and revision.

Adult↗
PubMed2005

Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip joint replacement.

OBJECTIVE: To examine whether a routine multidisciplinary inpatient rehabilitation program can increase patient self-efficacy, and to investigate the effects of high self-efficacy at admission, and increases in self-efficacy, on health changes in patients who undergo such rehabilitation after hip joint replacement. METHODS: Participants in this longitudinal study were 1,065 patients who underwent inpatient rehabilitation after hip joint replacement. Questionnaires were administered at admission, discharge, and 6-month followup. The main outcome variables were disability, pain, depressive symptomatology, and self-efficacy to cope with disability and pain. RESULTS: Significant improvements from admission to discharge from the inpatient rehabilitation program in disability, pain, depressive symptoms, and self-efficacy were found. In addition, higher levels of self-efficacy at admission and larger increases in self-efficacy over the course of the program predicted larger health changes (i.e., greater decreases in disability, pain, and depressive symptoms). Results were generally similar for health changes from discharge to 6-month followup. CONCLUSION: A routine multidisciplinary inpatient rehabilitation program after hip joint replacement can result in enhanced self-efficacy.

Adaptation, Psychological↗
PubMed1979

[Experimental study on an artificial hip joint made of Al2O3 ceramics (author's transl)].

For the purpose of developing the ceramic artificial hip joint, we carried out biological and mechanical experiments. Tiny blocks of polycrystalline ceramic were inserted into the femurs of rabbits. Also, ceramic powder was injected into the knee joints of rabbits. Biological reaction were examined after varying intervals. It was proved, as a result, that ceramics have good affinity with living tissue. As a next step, wedge-shaped test pieces were inserted into the distal end of the femurs of dogs and tensile tests were carried out to investigate the degree of fixation of ceramic with bone. The result was that ceramic test pieces showed firmer fixation than those of metal. In the hip joints of five dogs, ceramic total hip prostheses for dogs were implanted. The dogs were autopsied after varying intervals and investigated histopathologically and scanning electron microscopically. Fixation of the socket and the prosthesis with the bone was superior to those made of metal and, moreover, virtually no wearing had taken place. However, the socket or prosthetic stems in four dogs were observed damaged in some parts. From the above mentioned, it is evident that when making ceramic total hip prostheses, we have to select ceramics of good quality and thicken their weightconcentrated parts by a device of its own design or use partly metal components coated with ceramic.

Acetabulum↗
PubMed1997

[Contact surface and pressure load at implant-bone interface in press-fit cups compared to natural hip joints].

The implantation of an endoprosthetic socket into the acetabulum alters the mechanical stresses in the periacetabular region in a significant manner compared with the natural hip joint. In this way, a remodelling process is initiated. Primary stability to achieve osseointegration and a loading of the acetabulum owing to the biomechanical interaction between cup and bone that is similar to the natural joint, are important prerequisites for a long-term bony integration of the implant. Therefore, the intra-articular pressure distribution in eight hip joints of fresh-frozen human pelvic cadavers and in the bone/implant interface of two press-fit cups was investigated using pressure-sensitive Prescale films. A modular cup with a pure hemispherical shape (PCA cup) and a monoblock cup with a biradial surface and flattening of the pole (press-fit cup) were tested. Loads of up to twice body weight were introduced into the sacrum, simulating a single-leg stance with the hip in neutral flexion. The results were extracted from the pressure prints applying digital image processing methods. It was demonstrated that intra-articular contact occurs over the whole articular surface of the joint, with contact areas between 39.0% and 56.9% of the hemisphere, showing zones of higher pressures where the acetabulum is supported by the iliac, ischial and pubic bone. The biradial press-fit cup showed mean contact areas of 44.7% of its surface when inserted under press-fit only. This area was enlarged to 53.0% and to 64.2% with increasing load. The corresponding figures for the PCA cup are 45.1%, 48.9% and 57.1%. The low-profile PCA cup produces a small band of high pressure near the periphery, and with increasing load its pole area comes into contact with the acetabular fossa. Occasionally, irregular gaps do occur. The press-fit cup enlarges the contact area from the periphery to the pole within its optimised biradial contact zone until the lunar surface is loaded. The acetabular fossa remains unloaded owing to the flattening of the pole. This load distribution is close to that of the natural hip joint. The pressure distribution of both cups is also characterised by three zones at the iliac, ischial and pubic bones showing a higher load transmission.

Acetabulum↗
PubMed2002

Morphometric assessment of the canine hip joint using the dorsal acetabular rim view and the centre-edge angle.

The dorsal acetabular rim (DAR) view of the hip joint can be used to assess the weightbearing portion of the acetabulum and the acetabular coverage, providing an adjunct to the conventional ventrodorsal (VD) view in the radiographic evaluation of hip dysplasia in the dog. A quantitative index of acetabular coverage in the DAR view, the acetabular slope (AS) angle, was originally proposed in 1990. The aim of the present study was to make a prospective, comparative assessment of a new parameter, the centre-edge (CE) angle, with the AS angle, for the evaluation of the acetabular coverage of the femoral head in the DAR view. The reliability and repeatability of the two parameters was assessed using the r(I) value of intraclass correlation coefficient (ICC) in a prospective study of 208 hip joints in large and giant breed dogs. An estimation of the added value of using the DAR view, compared with that of the VD standard view alone, was also assessed. The CE angle showed a higher r(I) value compared with the AS angle; in 26 per cent of hips of FCI classes A, B and C, the DAR view provided additional diagnostic information compared with the VD view, with respect to lateralisation and/or initial changes to the dorsal rim. It is concluded that the CE angle is more reliable than the AS angle in the evaluation of acetabular coverage, and that the DAR view provides valuable data compared with the VD view alone in the early stages of canine hip dysplasia.

Acetabulum↗
PubMed1994

A survey of degenerative arterial change in the capsule of the hip joint in different disease states.

Degenerative arterial disease does affect the ligamentum teres and the capsule of the hip joint. In this investigation, the frequency of these changes was investigated in four groups of patients with hip disease. It is concluded that the highest incidence of all of degenerative arterial disease is found in elderly patients with subcapital fractures and in young patients with avascular necrosis of the femoral head after renal transplantation. The significance of this finding needs to be investigated further.

Adult↗
PubMedDate not supplied

[Prediction of the location of the centre of rotation of the hip joint external landmarks].

AIM: The object of this study was to develop a new method to predict the location of the centre of rotation of the hip joint reasonably accurately. METHOD: We collected the coordinates of palpable bony landmarks in 50 patients, 25 males and 25 females, using CT scans to predict the physiological location of the centre of the hip joint centre. RESULTS: The centre of the hip was located, on average, at 12% (+/- 2.9) of the inter-ASIS (anterior superior iliac spine) distance medial, 33% (+/- 3.9) distal and 19% (+/- 2.7) posterior to the anterior superior iliac spine (ASIS). CONCLUSION: Knowledge of the physiological centre of rotation of the hip may be useful in navigation of the cup in total hip arthroplasty.

Adult↗
PubMedDate not supplied

[The hip joint in the frontal projection. A contribution to the roentgenologic comprehension of the femur head-acetabulum relation].

The development of hip deformities is strictly dependent on the congruence between the head of the femur and the acetabulum. The routine radiological examination shows this relationship in one plane only. The combination of the anterior-posterior and the frontal projection opens the view into the third dimension of the hip joint. The frontal projection is especially suitable for measuring the anteversion of the acetabulum which in combination with a marked antetorsion of the femoral neck leads to a reduction of the weight-bearing articular surface. As every decentration of the femoral head should be considered for operative procedures the frontal projection is of special interest in the radiological examination of the hip joint.

Acetabulum↗
PubMed1996

Open reduction and stabilisation of coxofemoral joint luxation in dogs and cats, using a stainless steel rope inserted via a ventral approach to the hip joint.

Open reduction and stabilisation of coxofemoral joint luxation was made via a ventral approach to the hip joint in dogs and cats, using a transarticular stainless steel rope. A feature of the procedure is transarticular penetration of the rope from the pelvic cavity to the femoral neck by guidance with a guide wire which was previously inserted from the femoral neck into the pelvic cavity and by detection of the guide wire in the pelvic cavity by use of forceps connected to an alarm-ohmmeter. Forty-seven animals (37 dogs and 10 cats) with acute and simple coxofemoral luxation were treated and postoperatively maintained in cage rest without external fixation. Most of the animals regained an almost normal gait within several days.

Animals↗