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[The surgical treatment of degenerative-dystrophic diseases of the hip joint].

An analysis of long-term results of surgical treatment of 609 patients with degenerative-dystrophic diseases of the hip-joint was made. Choice of the optimum methods of surgical treatment of such patients must be based on the prognosis of effectiveness of the operative intervention taking into account general regularities associated with the degree of the arthrosis alterations, dyscongruence of the articulation surfaces and duration of the disease, the degree of disturbances of the femur head blood supply, the disturbed supporting ability and severity of the trauma. When choosing the method of surgical treatment of young patients with coxarthrosis the operative interventions aimed at saving the hip joint should be considered.

Adult↗

Radiation prophylaxis for heterotopic ossification about the hip joint--a multicenter study.

PURPOSE: Prophylactic radiotherapy (RT) can prevent ectopic bone formation about the hip after total hip arthroplasty. The German Cooperative Group on Radiotherapy for Benign Diseases conducted a patterns of care study about this indication addressing the involved institutions, RT dose concepts, clinical handling, and treatment outcome of prophylactic RT about the hip joint. METHODS AND MATERIALS: In 1999, a patterns of care study was conducted in all German institutions to analyze the accrual pattern, number of patients, and different indications for the use and performance of prophylactic RT about the hip. The applied RT concepts of prophylactic RT were evaluated with regard to the RT technique, timing of RT (pre- or postoperative), RT dose prescription (median, range of single and total doses), and treatment outcome. All institutions were asked about the radiologic and functional failure rates at least 1 year after the completion of RT using the established radiologic (Brooker) and functional (Harris) scores with objective and subjective evaluation components. RESULTS: One hundred fourteen institutions reported their clinical experience with prophylactic RT for the prevention of heterotopic ossification about the hip joint: 70 community hospitals, 23 university hospitals, and 21 private RT practices. In 1999, 5677 patients (5989 hips) had received prophylactic RT. The median number per institution was 36 patients (range 8-240). The interdisciplinary referral included orthopedic surgery (89 institutions; 3763 patients), trauma surgery (82 institutions; 1611 patients), or other disciplines (8 institutions; 298 patients). Preoperative RT was applied in 53 institutions 0.5-24 h before surgery, and postoperative RT was applied in 54 institutions 1-120 h after surgery. Most patients received 1 x 7 Gy either pre- or postoperatively. The total dose range was 5-10 Gy (preoperative RT) or 5-16 Gy (postoperative RT); the median total RT dose of both RT concepts was 7 Gy. Cobalt-60 (n = 15), linear accelerators (n = 95), and a few lower energy units (n = 4) were used. Bony structures or prostheses were shielded with standard blocks in 31 and with individual blocks in 27 institutions. Long-term clinical evaluation was available in 30 institutions from 4377 hips. Of those, 475 (11%) developed radiologic failures according to Brooker's criteria. Functional hip evaluation was available in 5 institutions from 685 hips. Of those, 34 (5%) had functional failures according to the criteria of Harris. No difference in outcome was found between pre- and postoperative RT, but was with regard to the patient's referral and the timing of RT. The patients who were treated >8 h before surgery or >72 h after surgery experienced a higher radiologic failure rate; radiologic failures were an important precondition for functional failures (p <0.05). CONCLUSION: This patterns of care study comprises the largest number of cases reported for prophylactic hip RT to date. The results reveal that both preoperative (within 24 h) and postoperative RT (within 72 h) are effective in preventing heterotopic ossification after hip surgery. Both RT concepts achieved a similar low radiologic and functional failure rate. Single-dose RT concepts, especially, can be recommended as an excellent treatment alternative for patients with contraindications to long-term steroid or nonsteroidal anti-inflammatory agents, and this approach has become standard in most German RT institutions.

Hip Prosthesis↗

The development and clinical application of acoustical technique in hip joint.

A non-invasive acoustical system was developed for the measurement of transmission properties of acoustic waves in the hip joints. The instrumentation consisted of three sub-systems. An excitation system employed a vibratory force at the sacrum of the test subjects. A transduction system included a pair of identical microphones installed in the tubes of two stethoscopes, which were placed at the greater trochanters on both sides for picking up the acoustical signals transmitted across the hip joints. The data acquisition and analysis system was a portable signal analyzer with a program of dual channel digital filter for measuring the power of acoustical signal in 1/3-octave frequency bands. 27 normal adults, 20 normal pre-school children and 40 normal neonates were randomly selected for testing. Coherence function (CF) and discrepancy (D) was measured during the testing. Results from the three groups showed that there was a high coherence of the signals (CF > 0.9) and a small discrepancy (D < 3 dB) between bilateral hips in the frequency range of 200-315 Hz. For normal neonates, there was a wider frequency range of 160-315 Hz in which the acoustical signals maintained a high coherence (CF > 0.93) and a smaller discrepancy (D < 2 dB) was observed. This study showed that the development of the acoustical technique provided a practical method with objective parameters. The results obtained in this study can offer a baseline for further investigation of hip disorders particularly those related to structural abnormalities of the hip.

Acoustic Stimulation↗

Subluxation of the hip joint after internal fixation of a trochanteric fracture.

The authors report an unusual case of hip subluxation after internal fixation without associated sepsis. We report one recently treated case in which a 75-year-old female experienced subluxation of her hip joint after open reduction and internal fixation for a trochanteric fracture. In this paper, we describe a case of progressive, spontaneous subluxation of the hip joint over several weeks. Most previously reported cases are associated with cerebral palsy. This entity has not been reported previously. Our patient was treated by hemi-arthroplasty and repair of the disrupted capsule, and achieved a good long-term functional result. The cause of this particular condition is discussed.

Aged↗

Hip joint loading during walking and running, measured in two patients.

The resultant hip joint force, its orientation and the moments were measured in two patients during walking and running using telemetering total hip prostheses. One patient underwent bilateral joint replacement and a second patient, additionally suffering from a neuropathic disease and atactic gait patterns, received one instrumented hip implant. The joint loading was observed over the first 30 and 18 months, respectively, following implantation. In the first patient the median peak forces increased with the walking speed from about 280% of the patient's body weight (BW) at 1 km h-1 to approximately 480% BW at 5 km h-1. Jogging and very fast walking both raised the forces to about 550% BW; stumbling on one occasion caused magnitudes of 720% BW. In the second patient median forces at 3 km h-1 were about 410% BW and a force of 870% BW was observed during stumbling. During all types of activities, the direction of the peak force in the frontal plane changed only slightly when the force magnitude was high. Perpendicular to the long femoral axis, the peak force acted predominantly from medial to lateral. The component from ventral to dorsal increased at higher force magnitudes. In one hip in the first patient and in the second patient the direction of large forces approximated the average anteversion of the natural femur. The torsional moments around the stem of the implant were 40.3 N m in the first patient and 24 N m in the second.

Aged↗

[Restoration of an infected hip joint with sartorius-plasty].

For treatment of infected hip joints we use the proximally based sartorius muscle. After ligation of the vessels in the distal part of the muscle, the sartorius muscle is elevated and transposed to the floor of the deep joint cavity. By completely filling the space defect, reinfection of the osteomyelitic cavity is prevented. In addition, the transposed muscle flap directs optimal blood perfusion to the hypoxemic capsule tissue via its own vascular pedicle.

Aged↗

[The painful hip joint in the child: differential diagnosis and therapy of coxitis fugax, Perthes disease and septic coxitis].

The differential diagnosis of a painful hip joint in children is important. Transient synovitis is frequently seen in children from 3 to 7 years of age with a short history of limping. The joint effusion is visualized by ultrasound. Radiograms and laboratory data are negative. Therapy consists of short term bed rest supported by an oral antiphlogistic drug. Children with Legg-Calve-Perthes disease complain about knee or hip pain in an early stage. X-ray documentation in the a.p and axial view are mandatory as well as ultrasound visualization of the accompanying effusion. Healing of the capital femural epiphysis is aided by weight relief and improved head containment. This may need from one to three years according to the age of the child and the amount of head involvement. More than half of the children's hips with Perthes disease surgical help to achieve a satisfactory result. Hip pain is overwhelming in cases of septic arthritis of the hip joint. This is the most important help to differentiate septic coxitis from transient synovitis or Perthes disease. Rapidly rising values of red cell sedimentation and c-reactive protein are important for early diagnosis. Septic effusions are visualized by ultrasound. X-ray changes are absent in the beginning and are seen only in delayed cases. Early arthrotomy with scrupulous rinsing of the joint, followed by parenteral antibiotic treatment, is the treatment of choice.

Arthritis, Infectious↗

[Epiphyseal dysplasia of the hip joint, its diagnosis and differential diagnosis with MRT].

Sixteen hip joints of eight patients with multiple epiphyseal dysplasia were examined by clinical investigation, plain films and by magnetic resonance imaging (MRI), using T1- and T2-weighted images and gradient echoes. MRI is useful in demonstrating the congruity of the joint, in the changes of the epiphyseal signal intensities and the epiphyseal line. Individual changes of the signal intensity patterns on T1- and T2-weighted scans are described. Although MRI exhibits a variety of patterns in different patients, a clearcut differentiation from Legg-Calvé-Perthes' disease is possible.

Adolescent↗

[Applied anatomy of the hip joint in dogs].

Some introductory anatomical characteristics of both articular ends (coxal end of the femoral bone and the acetabulum) in the canine hip joint are described. In standard radiographs (ventro-dorsal view) the area of the coxal end of the femur overlapped by the dorsal part of the acetabulum is measured. The post operative increase of this area in 6 hip joints treated by unilateral "Triple-Osteotomy" is reported and discussed.

Animals↗

Post-mortem study of the hip joint. III. Correlations between observations.

Correlations between alterations in hip joints, described in a post-mortem study, have established the independence of limited and progressive alterations, and in addition have shown that there is a weak association between limited alterations and osteophytes and a strong one between progressive alterations and osteophytes. Nevertheless limited alterations may rarely undergo progressive damage. Cysts relate strongly to osteophytes but only moderately with progressive alterations. Limited alterations of both head and acetabulum can be subdivided. Some implications of these findings are discussed.

Acetabulum↗

Primary osteoarthritis of the hip joint in Japan.

Diagnostic criteria for primary osteoarthritis of the hip joint in the Japanese population were determined by the roentgenographic measurements of the center-edge (CE) angle, the Sharp angle, and the acetabular roof obliquity in 254 normal hips. Primary osteoarthritis must meet the following conditions: (1) absence of femoral head deformities; (2) a CE angle of Wiberg greater than 19 degrees; (3) a Sharp angle less than 45 degrees; and (4) acetabular roof obliquity less than 15 degrees. These measurements are taken from roentgenograms during the early stage of the disease. Under these criteria, primary osteoarthritis accounted for only 0.65% of 2000 consecutive cases of osteoarthritis. Observation of the natural course of primary osteoarthritis revealed two subtypes. The superolateral type developed from the subset of normal hips with a relatively greater degree of acetabular roof obliquity.

Acetabulum↗

[Regional arterial infusion in patients after reconstructive-restorative operations of the hip joint].

The effectiveness of the regional arterial infusion in prophylaxis of complications was studied in 14 patients after reconstructive-restorative operations upon the hip joint. The method and program of the complex infusion therapy are proposed which facilitate the correction of disturbed microcirculation and oxygen regimen in the tissues after operation (trauma) on the hip joint.

Acetabulum↗

[Sonographic neonatal screening of the hip joint--luxury or necessity?].

Based on the ultrasound investigation of 19,666 babies (1981-1988), 6341 of them directly at the maternity ward, we picked out the group of sonographically unstable or decentered hip joints, which must be treated instantly. Almost 50% of these hips did not show any clinical signs of instability! At follow-up the subgroup of sonographically screened hip joints showed optimal results after consequent earliest treatment: 100% physiological results of CE-angle (Wiberg and Engelhardt), no femoral head necrosis. Ultrasound screening is the only tool to detect definitely all newborn hips requiring therapy. Earliest treatment is the pre-condition of anatomical healing up. Thus--a general sonographic newborn screening is indispensable.

Follow-Up Studies↗

Hip joint instability in an infant with paraplegia following aortic surgery.

A report on an infant with paraplegia following aortic surgery who suffered from coarctation of the aorta and a ventricular septum defect (VSD). The spinal paralysis was complete and flaccid. He was found to have paralytic bilateral dislocatable hip joints. Magnetic resonance image (MRI) of spinal cord showed no pathological findings. The hip joints were treated by a hip abduction brace.

Aortic Coarctation↗