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PubMedDate not supplied

[Ways to decrease blood loss during total hip joint endoprosthesis].

Total replacement (endoprosthesis) of the hip joint was carried out in 93 patients aged 18-60 years. Sixteen operations were performed under prolonged epidural blockade, 66 under neuroleptanalgesia, and 16 under ataralgesia. A deficiency of circulating blood volume was detected in all patients before surgery. The lowest mean arterial pressure was recorded in the prolonged epidural block group, while in the neuroleptanalgesia and ataralgesia groups the mean arterial pressure was virtually the same. Isovolemic hemodilution in patients with preoperative deficit of circulating blood volume decreased blood loss during long traumatic operations. Prolonged epidural blockade in combination with isovolemic hemodilution and spontaneous respiration led to a notable (70%) decrease of the true blood loss in comparison with the traditional neuroleptanalgesia.

Adolescent↗
PubMed1993

Fatigue failure in the cement mantle of an artificial hip joint.

The cement mantle of an artificial hip joint was retrieved, largely intact, during a revision operation, and subjected to detailed failure analysis. The results reveal a number of features which are important to our understanding of the failure of bone cement in situ and its consequences for prosthesis loosening. Microscopic examination showed clear evidence of fatigue cracking in the mantle prior to removal. This took the form of worn areas in certain regions of the fracture surfaces, which elsewhere showed evidence of rapid, brittle fracture. The mantle contained two large defects which had been introduced during insertion; fatigue was shown to have originated both from these defects and from the proximal surface. Results from a finite element analysis were used, together with the techniques of fracture mechanics, in an attempt to explain the magnitude and direction of fatigue cracking. Fracture mechanics calculations, though subject to some uncertainty in this case, indicate that the local stress intensity in the region of the principal defect would have been sufficient to exceed the threshold for fatigue crack propagation in this material. This approach demonstrates the advantages of this 'defect-tolerance' analysis.

Bone Cements↗
PubMed1977

[Post-traumatic protrusion of the hip joint].

23 patients with post-traumatic protrusion of the hip joint--due to fracture of the base of the acetabulum--have been re-examined by the authors. On the basis of the radiomorphological alterations developed in consequence of the fracture and according to the severity of the articular deformation the cases have been classified into four categories. The relationship between the morphological alteration, the functional ability of the joint and the subsequent arthrosis--as well as the problems of the social rehabilitation are discussed.

Accidents, Traffic↗
PubMedDate not supplied

[Osteoradionecrosis of the hip joint].

The radiation induced osteonecrosis of the hip is a rare complication after radiation therapy. The time of radiological manifestation is dramatically longer (2 to 17 years) than reported from other bones. There is an inverse correlation between age at the time of radiotherapy and the latency time. Sclerosis, focal lyses, fractures and migration of the femoral head are seen in the radiographs. Differential diagnosis to neoplastic changes should be achieved by bone scan and MRI. We have seen five patients with this condition and had operated on four of them. Treated with THR the fractured acetabulae healed within 9 months and the sclerosis diminished. We did not see any progression of the damage induced by irradiation.

Aged↗
PubMed2006

Sonography of the hip-joint by the emergency physician: its role in the evaluation of children presenting with acute limp.

OBJECTIVE: To describe a new imaging bedside test called Sonography of the Hip-joint by the Emergency Physician (SHEP) and to examine if its use as a triage tool for the presence of fluid in the hip joint can guide the emergency physician to the right diagnosis. METHODS: Case series of 5 children presented to the ED with an acute onset of limp. In addition to a careful clinical history and physical examination, each child received SHEP. RESULTS: Follow-up confirmed that the presumptive diagnosis made in the ED was correct. The SHEP tests were found helpful in diagnosing transient synovitis (3 cases), septic arthritis (1 case), and osteomyelitis of the femur (1 case). CONCLUSIONS: The SHEP tests provided additional information that narrowed the differential diagnosis, and minimized unnecessary blood tests and diagnostic imaging studies.

Acute Disease↗
PubMed1990

[Weitbrecht's retinacula of the hip joint].

On the basis of his own cadaver studies and data presented in the literature (mainly those presented by Anseroff) the author describes synovial folds of the hip joint also called retinacula of Weitbrecht and deals with the significance of these folds for the blood supply of the proximal end of the femur. In total there are three retinacula of Weitbrecht in the hip joint. Retinaculum anterius passes along the anterior surface of the neck originating from linea intertrochanterica toward the femoral head. It has the shape of a flat fold which is quite often divided into more stripes. Sometimes it is missing. Retinaculum mediale sometimes called Amantini's fold passes from the lesser trochanter to fovea capitis femoris along the medial surface of the neck. In children it has the shape of a single strip, in adults it most often has the shape of an upside-down "T". Its occurrence is constant. This applies also to retinaculum lateral passing along the superior surface of the neck from the greater trochanter toward the head. This retinaculum has always the shape of a flat plate. Corresponding to the number and course of retinacula is also the classification of the so called neck arteries into three groups as presented by Tucker and Ogden. In the lateral retinaculum there pass also so called posterosuperior retinacular vessels, in the medial one the so called posteroinferior retinacular vessels. Both groups of vessels originating from a profundus a. circumflexae femoris medialis supply the femoral head. In the anterior retinaculum there pass vessels of the same name originating from r. transversus a. circumflexae femoris lateralis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Modified rotational acetabular osteotomy (RAO) for advanced osteoarthritis of the hip joint in the middle-aged person. First report.

Classical methods for pelvic osteotomy, such as those of Salter, Pemberton, Chiari, and Wagner, have been developed for reconstruction of the subluxed hip joint in children and young adults. Regarding pelvic osteotomy involving a middle-aged patient, however, there are not as many operation methods to consider, and it is difficult to choose the most suitable technique for alleviating advanced osteoarthritis. Based on current practice, total hip replacement (THR) seems the accepted method, though it presents problems such as loosening, sinking, and infections; because of these factors physicians hesitate to recommend THR surgery, particularly if the patient is otherwise healthy and appears to have many good years ahead of him. As an alternative, we have been developing and improving the acetabular osteotomy, based on Tagawa's rotational acetabular osteotomy (RAO) and Wagner's acetabular osteotomy (type II). In this paper we present the results of a modified RAO operation performed on 50 middle-aged patients with an average age of 42 years and 2 months (31-61). The average follow-up was 3 years and 3 months (1-9 years). In 82% of patients the result was satisfactory (41 of 50 cases). A similar osteotomy technique has been used by Eppright and Wagner. We feel that our method achieves a more favorable result for an older patient with severe osteoarthritis, since both the surgery and the follow-up rehabilitation are more comprehensive. A modified acetabular osteotomy should not be regarded as merely an alternative to total hip replacement, but as the preferred choice for hip-joint reconstruction.

Adult↗
PubMedDate not supplied

[Remodeling of the acetabulum after experimental hip joint dislocation--an animal experiment study of the rabbit].

PURPOSE: Little is known about the remodeling potential of the acetabulum after dislocation and relocation of the hip joint. Most clinical data rely on radiographic measurements in a clinical setting, with only few singular reports on histologic changes at the time of surgery. This study was undertaken to examine the remodeling potential of the rabbit acetabulum after different length of hip dislocation and to gain insight into the histology of the remodeling process involved. METHOD: The right knee joint was immobilized in 28 matched New Zealand white rabbits, causing dislocation of the associated hip joint. Assessment of the joint status was made by serial X-rays in a reproducible standardized way, allowing measurement of the Acetabular Index (AI). The untreated left hip joints served as controls in the histologic sections and also allowed to develop an age matched scale of normal acetabular development for radiographic assessment. Dislocation was unsuccessful in 2 rabbits, 9 animals were sacrificed with the joint dislocated, and in 13 animals a closed reduction was performed and maintained in a Petrie type position for 10 days. Reduction was unsuccessful in 4 cases. The reduced group was sacrificed after 4 to 12 weeks, the point of harvesting being determined by no further change in the serial standardized radiographic measurements of the AI. All surgical procedures were done under the supervision of a veterinary surgeon and followed an approved protocol. RESULTS: In the time observed, the normal values of the Acetabular Index drop from 30 degrees to 20 degrees over a time of 3 months. In animals with a dislocated hip the AI increased to 40 degrees, which was completely reversible and reached normal values in 4 weeks, if reposition was done at this time (group A). Later reposition did improve the AI, but compared to normal age matched values, the AI remained elevated (> 30 degrees), demonstrating a residual dysplasia (group B). The histologic sections of the control left joints showed normal hyaline cartilage with physiologic vertical stacking of the cartilage zones. In the dislocated group the vertical stacking was lost, with chondrocytes demonstrating a fibro-cartilaginous metaplasia. There was hypocellularity with loss of nuclear staining. These changes were completely reversed in the group A, but remained in group B. CONCLUSIONS: This study demonstrates that an early reduction will not only allow for a normalisation of the radiographic values, but that the histologic changes as they develop during dislocation can completely be reversed. Long standing dislocation will lead to a permanent tissue metaplasia similar to the one seen in compression testing of joint cartilage, therefore loosing the potential for remodeling. Similar processes may occur in the human situation and the findings here underline the necessity for early reduction to allow for a complete remodeling of the hip joint.

Acetabulum↗
PubMed1990

Length and moment arm of human leg muscles as a function of knee and hip-joint angles.

Lengths of muscle tendon complexes of the quadriceps femoris muscle and some of its heads, biceps femoris and gastrocnemius muscles, were measured for six limbs of human cadavers as a function of knee and hip-joint angles. Length-angle curves were fitted using second degree polynomials. Using these polynomials the relationships between knee and hip-joint angles and moment arms were calculated. The effect of changing the hip angle on the biceps femoris muscle length is much larger than that of changing the knee angle. For the rectus femoris muscle the reverse was found. The moment arm of the biceps femoris muscle was found to remain constant throughout the whole range of knee flexion as was the case for the medial part of the vastus medialis muscle. Changes in the length of the lateral part of the vastus medialis muscle as well as the medial part of the vastus lateralis muscle are very similar to those of vastus intermedius muscle to which they are adjacent, while those changes in the length of the medial part of the vastus medialis muscle and the lateral part of the vastus lateralis muscle, which are similar to each other, differ substantially from those of the vastus intermedius muscle. Application of the results to jumping showed that bi-articular rectus femoris and biceps femoris muscles, which are antagonists, both contract eccentrically early in the push off phase and concentrically in last part of this phase.

Biomechanical Phenomena↗
PubMed1991

[Treatment of bilateral dysplastic instability of the hip joints].

In the article are described the peculiarities of the treatment tactics and presented an integral assessment of treatment efficiency of 563 patients with bilateral dysplastic instability of the hip joints (bilateral dislocation, bilateral primary subluxation, dislocation of one and subluxation of the other joint), carried out in the hospital of the institute named after M. I. Sitenko in 1955-1989. There is noted a necessity of achievement of anatomo-functional symmetry of the hip joints as a strategic aim of treatment and an expediency of application of "anticipation estimate" principle while planning the treatment measures for these patients.

Adolescent↗
PubMedDate not supplied

[Value of ultrasound in differential diagnosis of pediatric hip joint effusion (Perthes disease, C. fugax, epiphysiolysis coapitis femoris].

UNLABELLED: Hip pain during infancy is frequently harmless by nature and hardly demands any therapeutic intervention. A careful differential diagnosis is of great importance. AIM: In our study we attempted to evaluate the significance of sonography as a non-radiant and economical aid in the differential diagnosis of hip diseases during infancy. METHODS: The study population consisted of children aged from 2 to 14 years, who visited our clinic with hip complaints and evident capsular distension (more than 2 mm compared to the contralateral hip joint) and without preceeding diagnosis. The study period was from 1988 to 1995. From the 82 children enrolled in this study we diagnosed Coxitis fugax (n = 54), Morbus Perthes (n = 19), Epiphysiolysis capitis femoris (n = 5), rheumatic Arthritis (n = 2), septic Arthritis (n = 1) and femoral Osteoid-Osteoma (n = 1). All patients with Coxitis fugax were scheduled for clinical and sonographic re-examination. RESULTS: Coxitis fugax is the most frequent disease of the hip during infancy. Perthes disease is the most important differential diagnosis up to the age of 10 years. Epiphysiolysis capitis femoris and rheumatic diseases proved to be most common differential diagnosis among elderly children. As a result of our study we were able to establish a diagnostic algorithm of hip diseases during infancy. Sonographic examination proves to be of great value especially in the differential diagnosis of Coxitis fugax and M. Perthes. In many cases the X-ray examinations which were previously mandatory could even be dispensed with. RELEVANCE: Although this concept requires careful supervision of the patients, it spares 60% of the children from undergoing X-ray examinations or MRI.

Adolescent↗
PubMed2003

An in vitro investigation of the acetabular labral seal in hip joint mechanics.

Labrum pathology may contribute to early joint degeneration through the alteration of load transfer between, and the stresses within, the cartilage layers of the hip. We hypothesize that the labrum seals the hip joint, creating a hydrostatic fluid pressure in the intra-articular space, and limiting the rate of cartilage layer consolidation. The overall cartilage creep consolidation of six human hip joints was measured during the application of a constant load of 0.75 times bodyweight, or a cyclic sinusoidal load of 0.75+/-0.25 times bodyweight, before and after total labrum resection. The fluid pressure within the acetabular was measured. Following labrum resection, the initial consolidation rate was 22% greater (p=0.02) and the final consolidation displacement was 21% greater (p=0.02). There was no significant difference in the final consolidation rate. Loading type (constant vs. cyclic) had no significant effect on the measured consolidation behaviour. Fluid pressurisation was observed in three of the six hips. The average pressures measured were: for constant loading, 541+/-61kPa in the intact joint and 216+/-165kPa following labrum resection, for cyclic loading, 550+/-56kPa in the intact joint and 195+/-145kPa following labrum resection. The trends observed in this experiment support the predictions of previous finite element analyses. Hydrostatic fluid pressurisation within the intra-articular space is greater with the labrum than without, which may enhance joint lubrication. Cartilage consolidation is quicker without the labrum than with, as the labrum adds an extra resistance to the flow path for interstitial fluid expression. However, both sealing mechanisms are dependent on the fit of the labrum against the femoral head.

Acetabulum↗
PubMed1993

[Nuclear spin tomography, magnetic resonance tomography (MRT), nuclear magnetic resonance imaging (NMR). Technical and methodical hypotheses for the use of nuclear spin tomography on the hip joint of the dog].

The theoretical principles of nuclear magnetic resonance imaging and its application in human medicine are described. The most important parameters to produce informative images are explained. The tomographic examination of the canine hip joints demands a precise choice of section planes and measuring parameters. The resulting images of the hip joints of eight beagle puppies are evaluated and discussed.

Animals↗
PubMed1979

In vitro measurement of articular cartilage deformations in the intact human hip joint under load.

Using a new roentgenographic technique for measuring cartilage deformation in intact joint specimens, twenty-eight normal human hip joints from subjects twenty-five to eighty-five years old were loaded with a force of five times body weight in a testing machine. The initial unloaded thickness of the articular cartilage of the femoral head and the changes in thickness of this cartilage under load were measured roentgenographically at seven to twelve sites on each femoral head. These measurements showed that the deformations of femiral-head articular cartilage under load in the intact joint are non-uniform and increase greatly with age. In twelve specimens measurements were also made of the increase in cartilage deformation with time when the load of five times body weight was maintained on the joint. A single osteoarthrotic joint was also studied. The experimental findings imply changes in the fundamental mechanical properties of the cartilage with age, which probably result from age-related alterations in cartilage microstructure and chemical composition.

Adult↗
PubMedDate not supplied

[Experiences with Wagner's hip joint cup endoprosthesis. Indication, results complications].

In the last 5 years the authors have installed Wagner hip joint cup prostheses in 260 patients. Of these, 211 were implanted with an iliofemoral approach after Smith-Petersen, severing the pelvitrochanterian musculature, and 49 with a lateral approach after Watson-Jones, modified after Harris, with temporary ablation of the trochanter major. Altogether, 160 of the patients thus treated were followed up 3, 6, 18, 24, 30 and 36 months after surgery. The most common postoperative complication, found in 36% of those examined, was periarticular calcification, which was rated as severe in 5%, moderate in 15% and slight in 16%. Even though the periarticular ossifications did not necessarily lead to severe restrictions of movement, the patients with severe and moderate calcifications who were examined after 3 years were found to have a reduction of function of approx. 24% in flexion and extension, approx. 50% in abduction and adduction and approx. 57% in internal and external rotation compared with preoperative findings. In contrast, patients with no significant periarticular ossifications were found to have a definite improvement in motility 3 years after surgery as compared to their preoperative conditions. Further important complications were 2 infections, 3 fractures of the neck of the femur, 3 slipped prostheses and 23 cases of loosening of the prosthesis. The number of loosened prostheses (9% of those examined) represents a marked increase as compared to the loosening rate with conventional total hip replacements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Evaluation of the functional state of the hip joint after alloplasty].

The use of the Charnley test and the Lazansky test in evaluation of function of the hip after alloplasty has been presented. The authors believe that the Lazansky test gives a more complete evaluation of hip joint condition but on the other hand the less complicated Charnley test enables quick evaluation of the hip, even at the out-patient clinic. The use of numerical methods of functional evaluation makes treatment results objective and fully comparable.

Adult↗
PubMed1984

Hip joint distension in osteoarthrosis. A triple-blind controlled study comparing the effect of intra-articular indoprofen with placebo.

In a triple-blind controlled study, significant pain alleviation (p less than 0.01) was registered in patients with osteoarthrosis (OA) of the hip in the first 24 h after hip joint distension. There was no significant difference between treatment with indoprofen (a new non-steroidal anti-inflammatory drug for intra-articular use) and placebo. Pain relief lasted for at least 12 weeks in approximately half of the patients, in whom a significant increase in joint mobility was registered. Intra-articular indoprofen was not superior to placebo as regards pain relief or increased joint mobility. These findings indicate that the effect of a single hip joint distension in OA is due to a mechanical distension of the joint capsule, perhaps involving disruption of local agglutinations, and not due to suppression of inflammation.

Adult↗
PubMed1992

[A radiological measurements of growing hip joint in 4,000 normal children].

Roentgenograms of 4,000 hip joints of normal children were analyzed. The indices we used were as follows, the YO-value as the standard of growth (half of the distance between the both Y-cartilages), the CO-value as an index of lateralization (the distance between the center line of the pelvis and the center point of the head of the femur), the EO-value as the index of formation of the acetabulum (the distance between the center line of the pelvis and the tip of the acetabular tegmen), epiphyseal height (A), epiphyseal width (B), the alpha-angle, the CE-angle, the Sharp angle etc. The evaluation method we used consisted basically of comparisons made among values indicating length and by which the pelvis showed nearly proportional growth. The correlation coefficient among the YO-, CO-, and EO-values was extremely good. Accordingly, those indices are considered useful for the prognosis of congenital hip dislocation.

Adolescent↗