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PubMed2002

Experience in prosthetic supply of patients with lower limb amputations in Croatia.

This study analyses some demographic characteristics of the amputees in Croatia, reason and level of amputation, care the amputees receive, the first prosthetic supply and functional level after rehabilitation. Anonymised data on all amputees in the Clinical Institute for Rehabilitation and Orthopaedic Aids in Zagreb (a national centre) were collected during the year 2000. Follow-up was undertaken for one year. As a result, the authors analysed 221 patients, classified into 3 groups according to the level of amputations: trans-tibial, except foot (TT), trans-femoral (TF) and bilateral amputations (bilateral). Among the population there were: 76% men and 24% women with average age of about 62 years (the average age of women was 8 years more than men). The most common diseases that resulted in amputation were: diabetes mellitus (DM) 48.9%; obstructive vascular diseases (OD): occlusive peripheral arterial disease, Buerger's disease and atherosclerosis 27.1%; trauma 11.3%; both OD and DM 7.2%; osteomyelitis (OM) 3.2% and tumours (TM) 2.3%. Average period from the amputation to admission for prosthetic supply was over 190 days but the average period from admission to discharge from the Institute was about 40 days. Prosthetic supply was accompanied by certain complications: flexion contractures of neighbouring joints, knee 37.9% and hip 35.2%; local complications of soft tissues: necrosis, wound dehiscence, soft tissue surplus, ischaemic tissue damage (the most frequent in TT amputation 35.9%) and phantom pain (55.7% of patients). Hours of daily use of the prosthesis at discharge was about 5 hours. Greater independence in fitting and removing the prosthesis was observed in patients with TT amputation (86.4%). In conclusion, it can be said that the time between the amputation and the beginning of the prosthetic supply, mobility at the time of admission, frequency of general and local complications and number of days in prosthetic supply, are very important for the result of rehabilitation.

Adult↗
PubMed1980

[Diastrophic dwarfism (author's transl)].

On the basis of their own patient the authors discuss clinical and radiological features of diastrophic dwarfism. In this rare disorder the infant is dwarfed, the limbs are shortened. It is associated with marked talipes equinovarus, limited movements and contractures of other joints. Dislocation in the hip or knee and development of kyphoscoliosis leads to furhter deformity. As aetiopathogenesis the authors consider the role of infection in the mother during her early pregnancy or teratogenic aspects of some drugs (tetracyclines, septrim).

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Orthopedic problems in Lesch-Nyhan syndrome.

Lesch-Nyhan syndrome is an X-linked disorder of purine metabolism. The orthopedic problems and results of treatment of nine Lesch-Nyhan patients are reviewed. Associated orthopedic problems included hip subluxation or dislocation (nine of 18 hips), fractures (three), autoamputation, infections (three), minor scoliosis, and contractures. Lesch-Nyhan patients can safely undergo orthopedic procedures and the results of surgery are satisfactory and similar to those of patients with spastic cerebral palsy. All of the seven operated-on hips maintained good reduction at 6-year mean follow-up. With adequate cast technique, fractures and hip subluxation/dislocation may be treated successfully. The treating orthopedist should be aware of the increased incidence of heterotopic ossification in this population, as well as the potential for serious complications such as hardware failure or femur fracture, if appropriate immobilization is not used.

Adolescent↗
PubMed2003

Total hip arthroplasty in adult patients who had childhood infection of the hip.

BACKGROUND: Adult patients with a history of infection of the hip in childhood present a challenge as candidates for total hip arthroplasty because of abnormal bone development, soft-tissue contractures, the possibility of reinfection, and their relative youth. The purpose of this study was to analyze the mid-term results of primary total hip arthroplasty in adult patients who had had infection of the hip in childhood. METHODS: We retrospectively analyzed 170 total hip arthroplasties that had been performed between 1983 and 1996 in patients who had had infection of the hip during childhood. Forty-seven hips had cemented or hybrid total hip replacements, and 123 hips had cementless total hip replacements. The age of the patients at the time that the infection was contracted was an average of 7.3 years (range, one to eleven years). The average age of the patients at the time of the index total hip arthroplasty was 41.9 years in the cemented or hybrid group and 42.7 years in the cementless group. The interval between active infection and arthroplasty was 34.9 years in the cemented or hybrid group and 31.9 years in the cementless group. All but two hips (one patient) had a quiescent period of infection of more than ten years. The average duration of follow-up was 9.8 years (range, seven to seventeen years) in the cemented or hybrid group and 10.8 years (range, seven to seventeen years) in the cementless group. RESULTS: All hips with a quiescent period of more than ten years had no recurrence of infection. The remaining two hips in one patient with a quiescent period of seven years had recurrence of the infection. The mean Harris hip scores improved from 50 points preoperatively to 85 points at the latest follow-up examination in the cemented or hybrid group and from 50 points preoperatively to 89 points at the latest follow-up examination in the cementless group. Eight (17%) of forty-seven hips with cemented or hybrid fixation and eighteen (15%) of 123 hips with cementless fixation had revision of both components because of aseptic loosening and/or osteolysis. The mean rate of linear wear of the polyethylene was 0.25 mm per year in the cemented or hybrid group and 0.29 mm per year in the cementless group. The prevalence of osteolysis was 53% (twenty-five of forty-seven hips) in the cemented or hybrid group and 59% (seventy-two of 123 hips) in the cementless group. CONCLUSIONS: There was no recurrence of infection after total hip arthroplasty in the patients with a quiescent period of infection of more than ten years. These young, active patients with technically difficult arthroplasties were at considerable risk for aseptic loosening. The prevalence of polyethylene wear and osteolysis was attributable to the less than optimal prosthetic designs and materials used during the time-period of this study.

Adolescent↗
PubMed1982

[The stiff hip (post-traumatic ankylosis)].

The partial or total ankylosis of the hip joint caused directly by an injury or indirectly as a consequence of a trauma is a severe and permanent handicap for the subject concerned. This is due to the fact that, because of its special position at the connection point between body and leg, a not functioning hip joint involves a permanent restriction in many fields of every-day life, above all at the working place, but also in private life. Not only the walking movement, but also the walking performance is restrained, and even the sitting capacity is disturbed, which also has unfavorable consequences. Contrary to ankylosed peripheral joints of extremities, the possibilities of compensation are limited. There are considerable secondary effects to other parts of the body, above all lumbar spine, contralateral hip and both knee joints, which partly will appear much later, when the possibilities of correction are already restrained by the altered function of the affected structures, the muscles especially. Some types of posttraumatic hip ankylosis can be prevented, others need specific therapeutic measures. The pathogenesis of the posttraumatic hip ankylosis does not differ fundamentally from other etiologies. This is why the results of contracture research are also valid for the functional conception and treatment of the posttraumatic hip ankylosis.

Adolescent↗
PubMedDate not supplied

Untreated hip dislocation in cerebral palsy.

The purpose of this study was to evaluate the problems associated with hip dislocation in adults with cerebral palsy. Twenty-nine subjects with dislocated hips and no prior hip surgery were identified. There were a total of 38 dislocated hips. Age range was 21 to 52 years (average 34). Seven dislocated hips (18%) were definitely painful and four hips (11%) produced only mild or intermittent pain. Twenty-seven hips (71%) were not painful. The seven painful hips underwent proximal femoral resection, resulting in excellent range of motion and no pain. In conclusion, for established nonpainful hip dislocation in the severely involved spastic quadriplegic patient, aggressive surgical treatment should be undertaken only after careful consideration of the natural history. If a dislocated hip becomes painful in adulthood or develops an adduction contracture interfering with perineal care, a proximal femoral resection can be performed with reliably good success.

Adult↗
PubMed1978

[A method for the measurement of the collodiaphyseal angle in case of external rotational contracture (author's transl)].

The authors discuss the objectivity of measurements for the collodiaphyseal angle of the hip fixed in external rotation on the a.p. projection. Since the antetorsion cannot be measured because of the external rotation contracture, an alternative projection is proposed. Several pictures are demonstrated for the determination of the rotation. To find the true value of the distorted collodiaphyseal angle the authors propose a formula for the calculation on theoretical grounds. They consider this formula valuable for clinical use.

Anthropometry↗
PubMed2004

Total hip arthroplasty in skeletal dysplasias: patient selection, preoperative planning, and operative techniques.

Patients with substantial skeletal dysplasia and hip arthritis are poor candidates for noncustom total hip arthroplasty (THA) because of hip size and deformity. To determine the efficacy of THA via modified prostheses and surgical techniques in this population, the authors analyzed 9 consecutive THAs in 7 small-stature adults (mean height, 118.6 cm; mean weight, 47.5 kg). The Student t-test was used to test for significant (P < 0.05) differences in outcome variables. Seven hips received custom femoral components based on imaging studies. Five hips required extensive soft-tissue releases secondary to severe contractures. Follow-up radiographs (range, 24-56 months) showed adequate position of all prostheses and no loosening. Follow-up mean pain and function scores (Harris Hip Score and WOMAC Arthritis Index) showed significant improvement from preoperative levels.

Adult↗
PubMedDate not supplied

Quantitative analysis of hip dysplasia in cerebral palsy: a study of radiographs and 3-D reformatted images.

Cerebral palsy patients (31 hips) were evaluated using radiographic and three-dimensional (3-D) images to quantify hip anatomy. The 3-D images overcome distortions caused by joint contractures. Changes were more pronounced in the non-ambulators and characterized by shallow sockets with increased neck-shaft angles. These hips tended to subluxate in a posterior-superior direction and most had defects in the femoral heads. Ambulators had increased femoral anterversion but other hip parameters tended to improve with age. The 3-D measures of roof steepness and socket depth were found to correlate strongly with radiographic parameters of subluxation.

Acetabulum↗
PubMed1976

Primary recognition and treatment of congenital dislocation of the hip.

The pathology associated with congenital dislocation of the hip has been reviewed. The pathophysiology as it affects the development of the hip under treatment makes a strong case for the avoidance of the "frog leg" position with fixed flexion and abduction of the hips in the plaster cast. It is apparent that tightness of the iliopsoas muscle and the underlying capsule makes that flexed abduction position necessary to hold the hip in position. The "frog leg" position is seriously implicated in the development of aseptic necrosis, not only of the dislocated hip but of the normal hip as well. The results seen in patients with surgical division of the iliopsoas tendon and capsular contracture, followed by leg immobilization in a functional position of extension at the hip accompanied by slight abduction and internal rotation, indicate the virtual elimination of the necessity for secondary reconstruction procedures on the hip at a later date. This appears to be the more conservative approach to treatment in children under age two. A period of one to three months in a splint that flexes and abducts the leg but permits changing positons may be tried before the obstruction is relieved. For children with lax capsule and iliopsoas, reduction may be possible by this route. For most the hip will be pressed in slightly improving the x-ray picture--but with the obstruction still before the femoral head. The seating of the femoral head must be exact. If it is not, imperfection in the development of the hip arises and may lead to later malfunction. Obstructions to perfect seating of the femoral head in the acetabulum must be overcome.

Age Factors↗
PubMed2000

[Functional gait adaptations in patients with painful hip].

PURPOSE OF THE STUDY: This prospective study was conducted to analyze the mechanisms of gait compensation in patients with painful hip and to search for correlations with preoperative clinical and radiographic findings. MATERIAL AND METHODS: Optoelectronic and multicomponent force-plate datas were used to calculate joint motion, moments and intersegmental forces for 26 patients with unilateral hip pain and 20 normal age and sex-matched patients. Height was similar in the two groups but mean weight in the study group (83 kg) was greater than in the controls (68 kg). The preoperative Harris score was 53 in the study group and 16 patients had a permanent flexion contracture of the knee (mean 15 degrees, range 5-30 degrees). Radiographically, there were 22 cases of osteo-arthritis hip disease and 4 cases of necrosis. RESULTS: Gait analysis showed a significant 0.66 +/- 0.06 m (12 p. 100) reduction in step length. Patients who had severe hip pain walked with a decreased dynamic range of motion (18 +/- 5 degrees, p<0.0001) with a curve reversal as they extended the hip. They also reduced dynamic range of motion of the knee and ankle. Patients who presented a reversal in their dynamic hip range of motion had a greater passive flexion contracture and a greater loss in range of motion during gait than those with a smooth regular pattern (p<0.0001). Patients with hip pain walked with significantly decreased external extension, adduction, and internal and external rotation moments (p<0.0001). They also unloaded the ipsilateral knee and ankle. The decreased hip extension moment was significantly correlated with an increased level of pain (p<0.0001). There was no correlation with radiological findings. DISCUSSION: Reversal of dynamic hip range of motion was interpreted as a mechanism to increase effective hip extension during stance phase through increased anterior pelvic tilt and lumbar lordosis. CONCLUSION: Patients with painful hip walked with a manner that was asymmetric. These gait modifications were related to hip limitation in passive motion and pain. Patients with flexion contracture adopted a compensatory gait mechanism. This study confirms relation between hip pain and forces across the hip joint.

Adaptation, Physiological↗
PubMedDate not supplied

Management of hip disorders in patients with cerebral palsy.

Hip disorders are common in patients with cerebral palsy and cover a wide clinical spectrum, from the hip at risk to subluxation, dislocation, and dislocation with degeneration and pain. Although the hip is normal at birth, a combination of muscle imbalance and bony deformity leads to progressive dysplasia. The spasticity or contracture usually involves the adductor and iliopsoas muscles; thus, the majority of hips subluxate in a posterosuperior direction. Many patients with untreated dislocations develop pain by early adulthood. Because physical examination alone is unreliable, an anteroposterior radiograph of the pelvis is required for diagnosis. Soft-tissue lengthening is recommended for children as soon as discernable hip subluxation (hip abduction <30 degrees, migration index >25%) is recognized. One-stage comprehensive hip reconstruction is effective treatment for children 4 years of age or older who have a migration index >60% but who have not yet developed advanced degenerative changes of the femoral head. Salvage options for the skeletally mature patient with a neglected hip are limited.

Adolescent↗
PubMed1984

Arthrogryposis multiplex congenita occurring with maternal multiple sclerosis.

All children of a mother with multiple sclerosis (MS) had increasing grades of congenital joint contractures without demonstrable neuromuscular disease. Two had talipes equinovarus, one had congenital hip subluxation, and the youngest had arthrogryposis multiplex congenita. Maternal MS may be causally related to the development of congenital joint contractures.

Adolescent↗
PubMed1999

Length changes of the hamstrings and adductors resulting from derotational osteotomies of the femur.

Derotational osteotomies of the femur are frequently performed to treat persons with cerebral palsy who walk with excessive internal rotation of the hip. However, whether these procedures stretch or slacken the surrounding muscles appreciably is unknown. Determination of how muscle lengths are altered by derotational osteotomies is difficult because the length changes depend not only on the osteotomy site and the degree of derotation, but also on the anteversion angle of the femur and the rotational position of the hip. We have developed a three-dimensional computer simulation of derotational osteotomies, tested by anatomical experiments, to examine how femoral anteversion, hip internal rotation, and derotation affect the lengths of the semitendinosus, semimembranosus, biceps femoris long head, adductor longus, adductor brevis, and gracilis muscles. Simulation of derotational osteotomies at the intertrochanteric, subtrochanteric, or supracondylar levels decreased the origin-to-insertion lengths of the hamstrings and gracilis in our model by less than 8 mm (1.8%). Hence, the lengths of the hamstrings and gracilis are not likely to be altered substantially by these procedures. The origin-to-insertion lengths of the adductor longus and adductor brevis decreased less than 4 mm (1.9%) with subtrochanteric correction in our model, but the length of adductor brevis increased 8 mm (6.3%) with 60 degrees of intertrochanteric derotation. These muscles are also unlikely to be affected by derotational osteotomies, unless a large degree of intertrochanteric derotation is performed.

Computer Simulation↗
PubMed1994

Adaptations during the stance phase of gait for simulated flexion contractures at the knee.

Adaptations in the stance phase of gait to knee flexion contractures simulated by a knee-ankle-foot orthosis were studied in 20 healthy women (mean age: 25 +/- 3.6 years). Stride characteristics, joint postures, floor reactions, and indwelling electromyographic activity of the lower gluteus maximus, vastus lateralis, long head of the biceps femoris, and soleus muscles were measured during walking with the orthosis, with and without contracture simulation. Simulated knee flexion contracture resulted in decreased stride length and velocity and increased forefoot weight bearing and flexion posture in stance. Increases were also seen in magnitude and/or duration of flexion floor reaction torques and gluteus maximus, vastus lateralis, and soleus muscle activity. The addition of a restriction of plantar flexion resulted in a further decrease in velocity and stride length and a small increase in hip extension posture. These results show that knee flexion contractures, simulated in healthy subjects, cause a decrease in gait function with a simultaneous increase in muscular demand.

Adaptation, Physiological↗
PubMed1978

Pathologic features of a familial arthropathy associated with congenital flexion contractures of fingers.

Three siblings with a recently recognized form of familial arthropathy were studied clinically and by light and electron microscopy of the synovium. On light microscopy, the synovium from all 3 children showed synovial hyperplasia, necrotic villi, deposition of eosinophilic and PAS-positive material, and large numbers of multinucleated giant cells. Electron microscopy of the synovium in one patient revealed giant cells with profuse rough and smooth endoplasmic reticulum. Some phagocytic cells contained degenerated collagen in vacuoles or invaginations. There was granular and fibrinlike material on the synovial surface, but no amyloid. This symmetrical arthropathy now reported in three families appears to have characteristic histological appearance of synovium that allows its identification as distinct from other known joint diseases.

Adolescent↗
PubMed2005

Prognostic factors influencing the functional outcome of total hip arthroplasty for hip infection sequelae.

To investigate factors influencing functional prognosis for patients who have undergone total hip arthroplasty for late sequelae of infective arthritis of the hip, we conducted a retrospective analysis of 75 hips. All patients had had pyogenic or tuberculous infection and later underwent total hip arthroplasty. The average follow-up period was 5.8 years (range, 3-9 years). Various clinical and radiographic measures were analyzed with respect to Harris hip scores. Younger age at the time of infection onset, preoperative leg length discrepancy greater than 1 in, fusion, severe femoral hypoplasia, and severe acetabular dysplasia were associated with poorer prognosis. The complication rate, including 1 recurrent infection, was relatively low. Previous infections seemed to predict poorer results mostly because of the consequences of infection for the development of the hip joint, rather than because of infection recurrence.

Acetabulum↗