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PubMed1979

Total hip replacement in congenital dislocation and dysplasia of the hip.

The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in sixteen, fair in one, and poor in one. The operative technique included superolateral bone grafts to increase the acetabular coverage in six hips. Twenty-seven hips required smaller and straighter femoral components than normal. The incidence of major complications was 19 per cent.

Acetabulum↗

PubMed1979

[Spasm of the adductor muscles, pre-dislocations and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part II. The importance of the iliopsoas tendon, its tenotomy, of the coxa valga antetorta, and correction through osteotomy turning the hip into varus (author's transl)].

The following factors besides spasm and contraction of the adductor muscles contribute to the occurrence of dislocations of the hip in spastic paralysis: Spasm and contraction of the iliopsoas muscle and enhanced valgus position and antetorsion. The author holds the opinion that in case of malformation of the proximal end of the femur, it is not only the indirect action of the spastic musculature via the proximal femur-epiphyseal cartilage which is responsible for this phenomen in accordance with the law on functional adaption through longitudinal growth (Pauwels), but also the direct traction of the iliopsoas tendon. A clue in this direction is the often very pronounced elongation or enlargement of the trochanter minor. The author demonstrates the pathogenetic importance of iliopsoas contracture and malpositioning of the neck of the femur by means of analyses of the course in two patients. The following principles of treatment are postulated for spastic dislocation of the hip: Elimination of the pathogenetic factors through myotenotomy of the adductor muscles and complete resection of the obturator nerve, with observation of strict aftertreatment criteria, tenotomy of the iliopsoas, repositioning and osteotomy with turning into varus. Osteotomy without previous elimination of the pathogenetically acting muscular forces does not appear useful. Likewise, permanent re-positioning by means of muscle-relaxing operation cannot be sufficiently safe-guarded without additional osteotomy once the dislocation has taken place. In twelve patients with spastic dislocation of the hip, treated in accordance with these guidelines (two without osteotomy) aged 6 6/12 and 19 5/12 years, a roentgenologically good result was obtained in half of the cases, whereas the functional result was satisfactory not only with these patients but also with part of the other patients. If surgical treatment is instituted early enough, and if the experiences described here are taken into consideration, it is to be expected that the results will be even more satisfactory. The corset supporting the seated patient, developed by us, has been found very useful during the aftertreatment stage. A definite stand is taken against the therapeutic nihilism which leaves treatment of spastic dislocations to physiotherapy. It is also pointed out that indication for treatment is not represented only by the target of learning how to walk, but also by providing an overall improvement of the life situation of the patient, by either enabling him, or improving his ability, to sit or by "merely" improving the care of the perineum.

Adolescent↗

PubMed1979

Circulatory and vascular changes in the hip following traumatic hip dislocation.

An experimental study of the extraosseous and intraosseous vascular and circulatory changes following traumatic hip dislocation in dogs and rabbits is reported. The observations were made by dissection, angiography and histology following posterior dislocation and reduction at varying intervals. Traumatic dislocation of the hip causes extraosseous circulatory disturbance in the hip resulting in intraosseous circulatory deficiency in the femoral head. The sites of the vascular lesions are the extraosseous branches of the femoral circumflex arteries and their extraosseous branches of the epiphyseal and metaphyseal arteries and the retinacular artery of the circulus vasculosus articularis. The types of the vascular damage are irreversible tear of the minority of vessels along the ruptured capsule and teres ligament, and the compression, traction and spasm of the majority of intact vessels which are reversible by early reduction. In prolonged dislocation the circulatory disturbance persists or worsens due to additional pathological changes such as posttraumatic inflammatory changes, fixed deformity in the dislocated position, thrombosis, fibrosis and occlusion of vessels which may eventually cause an ischemic necrosis of the femoral head. Early reduction within several hours after dislocation restores nearly normal regional anatomy and relieves vessels from compression, traction or spasm and restores extra and intraosseous circulation. It also prevents or minimizes thrombosis, fibrosis and occlusion of vessels and avascular necrosis of the femoral head.

Animals↗

PubMed1984

Soft tissue collagen in congenital dislocation of the hip. Biochemical studies of the ligamentum teres of the femur and the hip joint capsule.

Collagens of the ligamentum teres of the femur and the hip joint capsule of 14 patients with congenital dislocation of the hip (CDH) were studied biochemically. Collagen was a major component of these tissues. Solubility of collagen was reversely related to age except in two cases. Collagen of both ligamentum teres of the femur and hip joint capsule was composed of type I, III and V collagens except in three cases. In these three cases with nevus or general joint laxity, two additional collagenous components were also found. The ratios of type III collagen to type I collagen were increased in CDH except in one case with short stature. These abnormalities of collagen metabolism could be the underlying cause of CDH and other clinical symptoms in these patients.

Amino Acids↗

PubMed1978

Total hip arthroplasty in chronically dislocated hips. Follow-up study on the protrusio socket technique.

The so-called protrusio socket technique of total hip arthroplasty was shown to be very effective in a series of twenty-two chronically dislocated or subluxated hips. In seventeen patients with follow-up of sixteen to fifty-nine months, excellent results were obtained in all but two hips. Obesity and rheumatoid arthritis or other systemic causes of osteopenia are considered contraindications to the procedure.

Adult↗

PubMedDate not supplied

Dislocation after total hip arthroplasty. Treatment with an above-knee hip spica cast.

A study was undertaken of 32 dislocations occurring during a nine-year period in 25 of 1280 postoperative total hip arthroplasty patients. Dislocations occurred in 0.6% of 1030 primary procedures, 1.6% of 165 conversions of hemiarthroplasties to total arthroplasties, and 20% of 85 revisions of previous total hip arthroplasties. Average time to dislocation was 31 days after primary procedures and 106 days after revisions. Acetabular cup malposition and poor patient cooperation appeared to be the causes of dislocation after primary procedures. Trochanteric absence or compromise was a factor in dislocation after revision. Treatment consisted of 13 closed reduction and 19 open reductions. An above-knee hip spica cast was employed for six weeks following closed or open reduction in 16 patients. These 16 patients have been followed up for an average of 32 months (28-45 months). Only one redislocation has occurred.

Acetabulum↗

PubMed1993

Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips. Technique for replacement with a straight femoral component.

A new straight cementless stem was used for replacement of 67 dislocated or severely dysplastic hips. There were 45 hips with complete dislocation, 27 of which were cases after Schanz osteotomy. Technical solutions for various deformities are presented here. The acetabular component was placed at the level of the original cotyloid cavity or some lower position. In hips after total dislocation a metaphyseal shortening osteotomy was combined with distal advancement of the greater trochanter with intact attachment of the abductor muscles. This method was appropriate also for the femora, where high-seated Schanz osteotomy was previously performed. If the diaphysis was too narrow for the stem, it was split about 10 cm both anteriorly and posteriorly. In cases with unilateral total dislocation where Schanz osteotomy had been seated low, metaphyseal segmental shortening with angular correction was performed and the stem was used as an intramedullary nail. Special attention was paid to achieve sufficient abduction strength to balance the pelvis and abolish Trendelenburg limp and to restore leg length. The clinical and radiographic results of the consecutive series were assessed three to five years after the arthroplasty. Pain relief and the functional results including improvement of gait were generally good, primary complications were few, but the loosening and revision rate of the smooth-threaded acetabular component was unacceptably high. There were no problems with the press-fit cups. In general the outcomes were good even when reoperation was required.

Adult↗

PubMed1996

The Balgrist hip socket for fixation without cement: analysis of 387 primary total hip replacements.

The results of 387 primary hip arthroplasties in which an uncemented Balgrist hip socket had been used in 346 patients were reviewed after a maximum of six years. The mean age of the patients at the time of operation was 54.3 years. Acetabular deficiency according to the AAOS classification was found in 21% of these primary arthroplasties. Three acetabular components (0.77%) had been revised. Using Kaplan-Meier survivorship analysis, with the use of prosthesis revision as the endpoint of failure, the survival rate at five years was found to be 99%. Four acetabular components (1%) had migrated and lysis of bone around the component in zone III occurred in one patient (0.26%). The data suggest that the unique socket design of the Balgrist hip socket (consisting of two tapered parts: an expansive outer titanium-alloy split ring and an insert of polyethylene) provides very satisfactory clinical results with various acetabular defects.

Adolescent↗

PubMed1998

Gothenburg osseointegrated hip arthroplasty. Experience with a novel type of hip design.

The culmination of more than 10 years of laboratory and clinical research has been the clinical trial of a novel hip arthroplasty for osseointegration. The femoral component of this Gothenburg hip is a neck retaining, threaded fixture with rotational symmetry, produced in commercially pure titanium with a specific surface texture. Proximally, a standard orthopaedic taper trunnion mates with a 28-mm diameter zirconia head that articulates against the acetabular component. The latter is also of textured commercially pure titanium, encapsulating a thick ultra high molecular weight polyethylene liner. Dedicated alignment guides and cutting instruments ensure accurate bone preparation and implant placement. Limited clinical trials commenced in 1992 and expanded to multicenter clinical trials in 1997. Every hip has been monitored with radiostereometry to measure migration to an accuracy of 0.1 mm. All calcar implanted femoral components show excellent function at 4 to 5 years followup, with no migration revealed by radiostereometry.

Animals↗

PubMed2004

Alumina hip joints characterized by run-in wear and steady-state wear to 14 million cycles in hip-simulator model.

The biphasic wear performance (run-in; steady-state phase) of 28-mm alumina-alumina hip implants was studied by hip simulator methods using bovine serum as the lubricant. The Biolox implants were run to 5.7 million cycles and Bioceram implants to 14.4 million cycles (Mc). Wear with all-alumina total hip replacements (THR) first showed a high wear rate of the order 1.2 mm3/Mc, lasting approximately 0.17 Mc. Overall to 0.7 Mc, the run-in phase appeared curvilinear but could be described by a linear phase averaging 0.3 mm3/Mc. From 0.7 to 1 Mc duration, the wear trend transitioned into a steady-state phase. Wear rates from 1 to 14 Mc were of the order 0.02 mm3/Mc. Surface contamination from the serum lubricant resulted in cyclic weight fluctuations of the order 0.2 mg. The transition from average run-in to steady-state phase represented a wear reduction of 13-fold. Comparing the steady-state wear value to that in standard 28-mm UHMWPE CUPS approaching 75 mm3/year, there was clearly a three-orders-of-magnitude wear superiority in favor of ceramic cups.

Aluminum Oxide↗

PubMed1994

Do variations in hip geometry explain differences in hip fracture risk between Japanese and white Americans?

Despite lower femoral neck bone mass, Japanese women have a substantially lower incidence of hip fracture than North American whites. Reasons for this discrepancy were sought in a study of 57 Japanese and 119 white American women aged 50-79. All women were in good health. Bone mineral content (BMC) in the femoral neck, femoral neck length (NL), femoral neck angle (theta), cross-sectional moment of inertia (CSMI), safety factor (SF), and fall index (FI) were calculated using dual x-ray absorptiometry. Height and weight were greater in Americans than in Japanese (1.62 versus 1.52 m; p < 0.0001 and 66.0 versus 49.4 kg; p < 0.0001, respectively). Mean BMC in the femoral neck and CSMI were greater in Americans than in Japanese (3.91 versus 3.02 g; p < 0.0001 and 0.99 versus 0.57 cm4; p < 0.0001, respectively). NL was longer in Americans (5.6 versus 4.4 cm; p < 0.0001) and theta was larger in Americans (130 versus 128 degrees; p < 0.01), whereas SF and FI were less in Americans than in Japanese (3.41 versus 5.12; p < 0.0001 and 1.00 versus 1.40; p < 0.0001, respectively). These results indicate that despite lower bone mass, Japanese women have lower risks of structural failure in the femoral neck, attributable primarily to shorter femoral necks and, to a lesser degree, a smaller femoral neck angle. Geometric characteristics of the femoral neck in Japanese women are associated with their lower hip fracture risk, and the measurement of proximal femoral geometry, combined with bone mass, may provide further clinical information about the risk of hip fracture.

Absorptiometry, Photon↗

PubMed1991

Function of the hip after femoral neck fractures treated by fixation or secondary total hip replacement.

Two matched groups of 28 patients each, with femoral neck fractures treated by primary internal fixation or by secondary total hip replacement after a complication of primary treatment, were evaluated and compared five years or more after primary pin fixation or secondary total hip replacement. The Nottingham Health Profile questionnaire was sent and returned by mail and the patient groups were matched with regard to age, sex, health, and social situation. Patients with healed fractures had less problems with sleep, housework and hobbies, and thus functioned better than patients who had required a secondary total hip replacement.

Activities of Daily Living↗

PubMed2005

[On the prognosis of hip fractures. Assessment of mortality after hip fractures by analyzing overlapping segments of longitudinal data].

BACKGROUND: Data on the treatment of hip fractures in acute care settings have been collected in a report card system for quality assurance in Germany since the beginning of the 1990s. However, there are no data on the long-term outcome and long-term quality of care. MATERIAL AND METHOD: In a retrospective study, data on 1393 patients from 1999 were collected from different sources: from the department of quality assurance at the medical association of Westfalia-Lippe, the Statutory Health Insurance Funds (AOK), and the Medical Review Board of the Statutory Health Insurance Funds (Medizinischer Dienst der Krankenkasse, MDK). Statistical analyses were performed by the Center for Clinical Studies of the University of Düsseldorf. RESULTS: Uni- and multivariate analyses reveal the following prognostic parameters for survival after hip fracture: sex, age, nursing care dependency, living in a nursing home, risk stratification according to ASA, and postoperative complications. Timing of the operation had no affect on survival. CONCLUSIONS: Prognostic factors for the outcome after hip fracture can only be obtained by analyzing data from the hospital stay and the post-hospital setting as well. Chances of survival can be significantly improved by rehabilitative care.

Age Distribution↗

PubMed2002

Revision hip arthroplasty in a patient with a hip rotationplasty (type B III b).

We report for the first time a patient who underwent a revision hip arthroplasty after a hip rotationplasty (Winkelmann type B III b) because of a chondrosarcoma in 1988. The clinical symptoms and radiographic findings (X-ray, bone scintigraphy, arthrography) of the aseptic loosening of the acetabular component are presented in detail. Furthermore, we present the functional results after hip revision.

Adult↗

PubMed2005

Percutaneous compression plating versus compression hip screw fixation for the treatment of intertrochanteric hip fractures.

Percutaneous compression plate (PCCP) devices are used for the fixation of intertrochanteric hip fractures by a minimally invasive technique. One hundred and eight patients who underwent this procedure were retrospectively compared with 155 patients who underwent compression hip screw (CHS) fixation. The general characteristics of the two groups, including age, sex, side of injury and co-morbidities assessed by the ASA score were similar. The operative time was significantly shorter in the PCCP group (67 versus 87 min, p=0.00). Postoperative blood transfusions were not required in 40% of the patients in the PCCP group compared to 24% of the patients in the CHS group (p<0.01). The rate of systemic postoperative complications was lower in the PCCP group (p=0.02) both in univariate and multivariate analyses. A considerable reduction was observed in cardiovascular complications (OR=3.1, p<0.05). Length of hospitalisation, implant failure and mortality rates were not significantly different between the two study groups. We conclude that the PCCP device offers several advantages over CHS device and may improve the current treatment of intertrochanteric hip fractures while maintaining a similar success rate in fracture fixation.

Aged↗

PubMed2005

Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures.

The results for a consecutive series of 1024 trochanteric hip fractures surgically treated by internal fixation with a sliding hip screw in a single centre are presented. The mean age of patients was 81.7 years and 78% were female. Seventy-five percent of fractures were classified as unstable. At 1 year from injury, 69% of patients were surviving. Of these, 95% had minimal or no pain, 85% had at least returned to their pre-fracture level of accommodation and 50% to their pre-fracture level of mobility. Complications related to surgical fixation were encountered in 3.6% of cases. Overall, 2.6% of patients required further surgery as a result of these. While significant mortality remains an issue, the overall fixation failure rate and re-operation rate for trochanteric fractures fixed with a sliding hip screw is low. The final outcome of surgery for the survivors is good, with most patients returning to their pre-fracture level of accommodation and mobility, with minimal pain 1-year post-fracture.

Accidental Falls↗

PubMed2004

Effectiveness of total hip arthroplasty in the management of hip osteonecrosis.

Total hip replacement initially showed universally bad results when performed in hips with advanced stages of osteonecrosis. Newer techniques and implants remarkably improved these results. Today cementless or hybrid total hip arthroplasty for osteonecrosis is proven to be safe and effective and to have survivorship similar to cases with osteoarthritis. Newer,more durable bearing surfaces will further improve the longevity of this procedure.

Adult↗

PubMedDate not supplied

[Results of the follow-up of Ludloff open hip repositions and closed repositions in congenital hip dislocations].

Three combinations of therapy of CDH (closed and open reduction, with and without foregoing so called "functional" conservative treatment, and with and without retention in the frog position) have been evaluated among 82 children with 100 dislocated hips. They had been operated on 71 times by Ludloffs open reduction and 29 times by gentle closed reduction in anaesthesia. If following a test-x-ray in 130 degrees flexion of the hips and 50 degrees of abduction no spontaneous reduction occurs, an attempt at careful closed reduction under anaesthesia seems to be justified. If it is not successful with lack of a deep position of the head, an immediate open reduction after Ludloff with retention in hip flexion of about 130 degrees and slight abduction was in our hands less frequently followed by an avascular necrosis of the femoral head than following conservative treatment. The latter and the inhuman frog position are according to our statistics probably more responsible for the avascular necroses than the open reduction as such. Every treatment of CDH has to be evaluated in regard to the frequency of irreversible avascular necrosis of the femoral head.

Casts, Surgical↗