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PubMed1997

Anatomical study of the synovial plicae of the hip joint.

Observations and measurements of the synovial plicae of the hip joints were made on 63 embalmed cadavers. The cadavers were divided equally among three age groups (fetuses, children, and adults). Our observations showed that the plicae appeared in two forms (flat and villous) and were mainly confined to the external surface of the lower medial part of the acetabular labrum (labral plicae), the base of the ligament of the head of the femur (ligamental plicae), and along the reflecting line of the synovial membrane on the base of the femoral neck (neck plicae). The ligamental plicae were well padded with a fibroelastic pad of fat filling the acetabular fossa, and the neck plicae were far away from the articular surfaces of the joint; as a result, neither was likely to be injured or entrapped during joint movements. The labral plicae were larger than the ligamental or neck plicae and had an incidence of 73.8% in the fetal group. The fetal plicae were found only after the fetal age of 5 months. In nine cases of the child and adult groups, the labral plicae extended between the articular surface of the femoral head and the lower part of the acetabulum during medial rotation of the thigh. When the thigh was rotated laterally, the plicae in six of the same cases could be returned to their original positions. In the remaining three cases, there was continual impingement.

Adolescent↗
PubMed1988

[Contraindications regarding total prosthesis of the hip joint].

The authors have made an analysis of unsatisfactory remote results in 83 (21.5%) out of 387 patients operated for endoprosthezing of the hip joint which resulted from shaking loose the endoprostheses in the bone tissue. A conclusion is made that the following factors may be considered as contraindications to endoprosthesis of the hip joints: coxarthrosis against the background of arthroso-arthritis, neglected stages of protrusive coxarthrites, deforming osteoarthrosis due to the use of corticosteroids, pronounced senile osteoporosis.

Adolescent↗
PubMed1980

[A contribution to the biostatic analysis of the hip joint III (author's transl)].

Following description of a model which can be applied in clinical practice for planning an operation with regard to the load and strain placed on the hip joint, as expounded in previous articles, the present article explains two more realistic possibilities of calculation of the pressure on the joint. We now have, therefore, three pressure models which can be compared with each other: 1. Assumption of equal distribution of the pressure over the hip joint with calculation of the maximal pressure. 2. Assumption of a linear drop in pressure from the acetabulum in the direction of the floor of the acetabulum. 3. Assumption that the articular cartilage displays an ideally elastic behaviour (calculation of pressure according to Hooke's Law). The last-named model No. 3 is probably the most realistic one, but in view of the fact that it requires complicated calculations, it will be employed in specific cases only, which will usually be mostly of a theoretical nature; Model No. 1 requires a reasonable amount of calculation and will suffice, as shown in the present article, for daily routine surgical planning.

Biomechanical Phenomena↗
PubMed2006

[Hip joint arthroplasty following surgical treatment of acetabular fracture].

PURPOSE OF THE STUDY: A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study. MATERIAL: In the period from 1997 to 2004, 49 patients, 35 men and 14 women, with posttraumatic arthritis following acetabular fracture were treated in our department. The average age was 42 years, with 67 % of the patients being younger than 40 years. The average follow-up was 42 montsh (range, 18 to 92). The acetabular fractures evaluated by the AO classification included type A1 in 17 patients, type A2 in seven, type B1 in nine, type B2 in six, type B3 in seven, type C1 in three and type C2 in two patients. METHODS: In 11 patients with aseptic necrosis of the femoral head without acetabular deformity, cementless Zweymüller Bicon or Spotorno CLS acetabular components were used. Twenty-nine patients with acetabular defects of type I and II, according to the American Academy of Orthopedic Surgeons (AAOS) classification, underwent acetabular reconstruction with the bone impaction grafting technique, using allogenic grafts and cementless Zweymüller Bicon acetabular components. Four patients with AAOS type III acetabular defects were treated with impacted morsellized bone allografts, using titanium mesh and cemented polyethylene acetabular cups. Three patients were treated with solid bone grafts fixed with osteosynthetic material. In two patients with type IV defects, osteosynthesis using a plate completed with allogenic bone graft, a mesh and a cemented cup were used. RESULTS: The patients were evaluated with the use of Harris hip scores. In 20 patients (43 %) the outcomes were excellent, and very good in 18 (37 %), satisfactory in six (12 %) and poor in four (8 %) patients. DISCUSSION: Hip joint arthroplasty following the surgical treatment of acetabular fracture is indicated in patients with post-traumatic hip arthritis. This frequently occurs due to complications associated with surgery for acetabular fractures, or the cause remains unknown. Some types of these fractures show a high proportion of poor results. The group can be divided into two different subgroups: the patients with a spherical, healed acetabulum and the patients with acetabular deformity or defect, of which the most serious condition is pseudoarthrosis of one or both columns. In the first subgroup, the surgical technique of acetabulum replacement is the same as in cases with arthritis due to degenerative disease. In the other subgroup, the procedure for cup implantation resembles revision arthroplasty for acetabular loosening. The options for treating defects or deformities and the implants used are identical in both situations. Therefore the results should be compared with those of revision arthroplasty and not primary implantation. Scars, fibrotic changes in muscles, para-articular ossification, bone defects, residual deformities of the acetabulum, devitalized bone fragments or hindering previous implants make the surgical procedure more difficult and interfere with good results. CONCLUSIONS: Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.

Acetabulum↗
PubMed1991

Design considerations for cushion form bearings in artificial hip joints.

Lubrication mechanisms and contact mechanics have been analysed in a new generation of 'cushion form' bearings for artificial hip joints, which comprise low elastic modulus layers on the articulating surfaces. Comparisons have been made with 'hard' bearings used in existing prostheses and also with the natural hip joint. Lubricating film thicknesses are enhanced by larger contact areas and lower contact pressures. For a fixed contact area, simultaneous changes in layer thickness and radial clearance have been shown to have a small effect on elastohydrodynamic film thickness. Hard bearings designed with the same contact area as the cushion bearings produced a similar film thickness, but lubricant film thickness is not optimized in current designs. The main advantage of using a cushion bearing with low elastic modulus layers was found to be associated with microelastohydrodynamic lubrication. Careful selection of the elastic modulus is important in order to ensure that this lubrication regime was effective. Low elastic modulus layers may also produce local deformations, which enhance squeeze film action. The elastic modulus of the material should not be lower than necessary to produce effective microelastohydrodynamic lubrication, as a further reduction in modulus only increases the strain distribution in the material. A lubricant film thickness of 0.3 microns has been predicted for a cushion hip prosthesis with a femoral head diameter of 32 mm and radius of contact zone of 16 mm, using a 2 mm thick layer with an elastic modulus of 20 MPa.

Biomechanical Phenomena↗
PubMed1998

Midshaft femoral fracture, concomitant ipsilateral hip joint injury, and disruption of the knee extensor mechanism: a unique triad of dashboard injury.

Our experience with 10 patients who suffered midshaft fractures of the femur and injuries to their ipsilateral hips has resulted in a treatment protocol that we believe can avoid unnecessary complications. The surgical protocol is a three-stage procedure based on (1) intramedullary nailing of the femur with interlocking for preserving the anatomic length and rotation of the femur; (2) treatment of the hip joint injury by means of open reduction and internal fixation of the acetabular fracture and/or reduction and fixation of the fractured femoral neck; and (3) repair of the extensor mechanism. Eight patients received this treatment and had fast recoveries. Union of the femoral fracture and full range of motion of the knee joint were observed within 3 months. In contrast, two patients who had received different surgical treatment had incomplete functional recoveries. This study offers a treatment protocol for ipsilateral disruption of the extensor mechanism, hip joint injury, and midshaft fracture of the femur in the multiply injured patient that can achieve full recovery with no complications. This relatively rare combination of injuries is definitely worthy of special attention.

Accidents, Traffic↗
PubMed1989

[Prosthesis loosening caused by infection of the hip joint. Current status and personal procedures in indications for primary and secondary exchange surgery].

More than 50,000 hip-joint endoprostheses are annually inserted in the FRG. Surgery for replacement of prostheses has, consequently, grown in frequency. Reported in this paper are 27 operations for replacement of hip-joint prostheses that had become necessary for infectious problems. Follow-up checks confirmed for 14 of 27 patients sufficient control of infection, ability to walk, and tight position of prosthesis. Replacement should be performed in two surgical sessions, since a short-time Girdlestone situation without extension treatment or immobilisation is properly tolerated by patients with walking capacity, and the benefit of infection control should be the primary consideration.

Aged↗
PubMed1997

Analysis of fluid film lubrication in artificial hip joint replacements with surfaces of high elastic modulus.

Lubrication mechanisms and contact mechanics have been analysed for total hip joint replacements made from hard bearing surfaces such as metal-on-metal and ceramic-on-ceramic. A similar analysis for ultra-high molecular weight polyethylene (UHMWPE) against a hard bearing surface has also been carried out and used as a reference. The most important factor influencing the predicted lubrication film thickness has been found to be the radial clearance between the ball and the socket. Full fluid film lubrication may be achieved in these hard/hard bearings provided that the surface finish of the bearing surface and the radial clearance are chosen correctly and maintained. Furthermore, there is a close relation between the predicted contact half width and the predicted lubrication film thickness. Therefore, it is important to analyse the contact mechanics in artificial hip joint replacements. Practical considerations of manufacturing these bearing surfaces have also been discussed.

Biocompatible Materials↗
PubMed1980

Congophilic substance with green dichroism in hip joints in autopsy material.

Cartilage and fibrous capsular tissue from the hip joints of 30 unselected autopsies have been examined for the presence of congophilic substance with green dichroism (CS-GD). Ninety-three per cent of the cases had CS-GD in the joint cartilage and 43 per cent contained amyloid deposits in the capsule. The relation of these substances to age and the relation of CS-GD to the upper and lower parts of the femoral head cartilage have been studied, as well as the inter-relationship between the presence of CS-GD in the cartilage and amyloid deposits in the capsule within each joint.

Adult↗
PubMed2001

Arthroscopic surgery for septic arthritis of the hip joint in 4 adults.

PURPOSE: Arthroscopic surgery for septic coxarthritis has not become a well-established technique despite its minimally invasive nature. The authors performed arthroscopic surgery and intraoperative high-volume irrigation on 4 adult patients with septic coxarthritis. This minimally invasive procedure was successful in treating these patients, and there was no recurrence of arthritis or other complications. The purpose of this article is to introduce this 3-directional-approach method of arthroscopic surgery for septic coxarthritis. Type of Study: Case study of arthroscopic surgery for septic arthritis of the hip joint in 4 adults. METHODS: There were 3 women and 1 man with an average age of 58 years. The length of time from onset of symptoms to surgery averaged 36 days. One patient had diabetes; another had subarachnoid hemorrhage and was being treated with steroidal drugs. The etiologic agent was found to be Staphylococcus aureus infection in 2 patients, Serratia sp. in 1 patient, and group-B Streptococcus in 1 patient. Three-directional-approach arthroscopic surgery and intraoperative high-volume irrigation were performed using 20 to 25 L of physiologic saline on the 4 patients. Continuous postoperative intra-articular irrigation was not performed. RESULTS: Inflammatory reactions subsided within 4 weeks of surgery in 3 of the 4 patients and within 6 weeks in the other patient. At the time of the final examination, the postoperative follow-up period ranged from 1 to 6 years and none of the patients had ankylosis of the hip joint. CONCLUSIONS: Three-directional-approach arthroscopic surgery in combination with intraoperative large-volume irrigation is an effective technique for treating septic arthritis of the hip joint because the joint can be preserved and it is less invasive than other open arthrotomy techniques.

Journal Article↗
PubMed1998

Amyloid arthropathy of the hip joint: MR demonstration of presumed amyloid lesions in 152 patients with long-term hemodialysis.

The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39%). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54%), decreased signal intensity in 11 patients (18%), and both increased and decreased signal intensity in 17 patients (28%). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis.

Adult↗
PubMed1989

[Radiologic dislocation value of the dysplastic hip joint in the child].

The discussed index is determined by the comparison of the proportion of localisation of the proximal and of the femur and transverse dimension of the pelvis by x-ray examination. It has been found by radiological measurements of 400 hip joints children in the age of 3-24 months, in whom dysplasia of the hip joint with dislocation was diagnosed. The displacements were divided into 5 grades on the basis of extent of lateral and superior dislocation. The index makes displacement objective, replacing the visual assessment; it allows to compare the displacements on x-ray pictures performed at different ages and in different conditions of x-ray exposition. It has proved to be very useful in diagnosis and analysis of treatment result of large material of congenital dysplasia of the hip with dislocation.

Femur↗
PubMed2005

Contact pressures in the flexed hip joint during lateral trochanteric loading.

Acetabular fractures are an especially problematic outcome of motor vehicle side impacts. While fracture type has been correlated with impact direction and femoral orientation, actual contact pressures in the hip joint have not been quantified for lateral loading conditions. In the present study, we used pressure sensitive film to measure contact areas and pressures in seven hip joints from four cadavers under quasi-static lateral loading through the greater trochanter. The aim was to quantify the interactions of the femoral head with the acetabulum associated with variations in femoral orientation. Three angles of hip flexion (80 degrees , 90 degrees , 100 degrees ) and hip abduction (-10 degrees , 0 degrees , 10 degrees ) were tested, producing nine test orientations for each joint. We observed that contact areas, pressures, and forces varied significantly with femoral orientation for the adducted hip. The principal locations of load transmission were in the anterior and posterior regions of the acetabulum. For the abducted femur, contact pressures were concentrated anteriorly, and with increased adduction, anterior contact pressures diminished while posterior and superior pressures increased. The movement of pressure sites was consistent with mechanisms of acetabular fractures described by Letournel and Judet and provides new data for validation of finite element models of the pelvis in side impact.

Acetabulum↗
PubMed1979

Correlation between muscle shortening and derangement of the hip joint in children with spastic cerebral palsy.

From clinical studies on hip derangement and measurement of muscle shortening around the hip joint in 244 patients with spastic cerebral palsy, we found that the incidence of subluxation was 17.0% and that of dislocation was 8.2%; there was no dislocation in ambulatory spastics and the incidence of hip derangement was high in non-ambulatory patients; significant shortening of the adductors was closely correlated with hip derangement; the combination of damaged flexors, hamstrings and adductors led to hip derangement; surgical intervention in the adductors, the flexors (particularly the iliopsoas muscle) and the hamstrings should be considered in the treatment of advanced hip derangement in patients with cerebral palsy.

Adolescent↗
PubMed1991

[Association of the ABO blood group system and hip joint dysplasia].

On the basis of distribution of ABO blood groups among 963 sick children with dysplastic pathology of hip joint and 1402 Georgians from among the total population of the city of Tbilisi there have been obtained significant associations of 0 group with this pathology. The hypothesis about genetic community of these symptoms has been rejected. Phenotypic correlations have demonstrated that 0 group of blood promotes an expression of hereditary predisposition to the hip joint dysplastic pathology. Predisposition to this pathology is increased in case of coincidence of 0 group in the patient's mother and in the patient himself.

ABO Blood-Group System↗
PubMed2002

Protective effect of moderate overweight on bone density of the hip joint in elderly and old Austrians.

The effect of weight, classified by body mass index (BMI), on bone mass (BMC) of the whole body and on bone mineral density BMD of the hip joint was analysed in a sample of 120 Austrians of Vienna and surroundings. The 68 females and 52 males of this cross sectional study ranged in age between 60 and 92 years (x = 71.7 +/- 7.7). Age distribution was not significantly different between sexes. The WHO (1997) classification of body mass index (BMI) was used for weight classification, i.e. normal weight (BMI 18.5-24.99) and moderate overweight (BMI 25.0-29.99). Obese subjects (BMI 30+) were not included in this study. Bone mass of the whole body as well as bone density of the hip joint were determined by Dual-energy-X-ray absorptiometry (DEXA) using a hologic 2000 scanner. As expected BMC and BMD values were significantly higher in males than in females. While in both females and males moderately overweight BMD of the hip was significantly higher than in those with normal BMI, statistically significant differences of BMC were restricted to females only. Such positive association between body weight and BMC and BMD is in agreement with previous studies on mature subjects, and menopausal and postmenopausal women in particular. In addition, this study demonstrates corresponding positive associations between moderate overweight and bone mass and -density in the elderly and old aged.

Absorptiometry, Photon↗