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At least 667 records · Page 37Linked to original sources
PubMed2005

Early MRI findings of the acetabulum and femoral head in a dysplastic hip resulting in a rapid destruction of the hip joint.

We documented a case of rapidly destructive arthrosis of the hip joint (RDA), in whom abnormal findings were observed not only in the femoral head but also in the acetabulum on magnetic resonance images (MRI) in the early stage. Radiographs made 1 month after the onset of pain showed a slight narrowing of the joint space. MRI obtained 2 months after the onset detected small foci of low signal intensity in the subchondral area of the femoral head on the T1-weighted images, and a linear pattern of high signal intensity in the lateral side of the acetabulum on the T2-weighted images. During the 17-month follow-up period, this case eventually underwent massive destruction of the femoral head as well as the acetabulum.

Acetabulum↗
PubMed1993

On the morphology and frequency of Weitbrecht's retinacula in the hip joint.

The flattened band reflecting from the fibrous capsule of the hip joint to the head and neck of the femur has been firstly described as "the retinacula" by Weitbrecht in the middle of eighteenth century. In the light of present clinical aspect, the retinacula has been noticed with renewed interests because the nutrient arteries running through this retinacula are one important criterion for orthopedic reduction in the cases of femoral neck fractures. The purpose of the present study is to investigate the morphology and occurrence of this retinacula from anatomical points of view using cadavers. The results show that there are two types of retinacula: a complete band shape and posterior membranous shape. The frequency of retinacula, totaled 94.8 percent in males and 92.5 percent in females. Therefore, the presence and condition of the retinacula should be carefully examined for pre-operative status in cases of femoral neck fractures.

Aged↗
PubMed2004

[Unusual "lipid cysts" in the acetabular labrum of patients with hip joint osteoarthrosis].

Diagnostic pathological examination of surgical specimens from patients with hip joint osteoarthrosis occasionally exhibits as yet undescribed pseudocysts consisting of folded granular membranes in necrotic or chondroid tissues. When stained with Sudan red, the content of these cysts indicates the presence of lipid substances. The presence of S100 protein-positive cells with intracytoplasmic fat vacuoles as well as such cells in the walls indicate that they develop from fat inclusions occurring in the chondroid cells of the labrum. Two different wall structures were detected by electron microscopy. The first type exhibited small walls of a granular material similar to the endoplasmic reticulum that surrounds intracytoplasmic fat globules. The second type consisted of broad layers of very tiny granules indicating a more advanced stage of the development of these cysts. The reason for the occurrence of these "chondrocytogenic lipid cysts" remains unknown-it may be assumed that they are due to mechanical labrum destruction that occurs in osteoarthrosis.

Aged↗
PubMed1999

Immunohistochemical analysis of type-X-collagen expression in osteoarthritis of the hip joint.

Conflicting data have been reported on the spatial distribution of type X-collagen expression in osteoarthritis, and no concise data exist on a possible correlation between type X-collagen expression and clinical and radiological alterations. Well defined clinical and radiological data were compared with histopathological and immunohistochemical findings to investigate the expression of type-X collagen in osteoarthritis of the hip joint. Femoral heads were obtained in toto from 11 patients undergoing routine hip arthroplasty for femoral neck fractures (n = 3) or osteoarthritis (n = 8) and from 13 patients (age: 12 days to 69 years) without any evidence of hip-joint pathology. Whole coronal sections from the femoral head were decalcified for routine histology and immunohistochemical analysis with use of type-specific monoclonal antibodies to type-X collagen. Our results demonstrate that type-X collagen is consistently found in osteoarthritic cartilage and is absent from normal adult cartilage (including the region of calcified cartilage). Except for the occurrence of type-X collagen in the middle zone of articular cartilage in advanced stages of osteoarthritis, there is no specific change in the staining pattern or intensity for the collagen during osteoarthritis, particularly when the staining is related to clinical and radiological parameters. Hardly more than 20% of the extracellular matrix stained for type-X collagen; therefore, we suggest that, in most cases, this type of collagen may not play a direct biomechanical role in the weakening of osteoarthritic cartilage but rather may contribute indirectly to a disturbance of the disc biomechanics by altering matrix-molecule interaction. However, expression of type-X collagen may indicate a change in chondrocyte phenotype that consistently coincides with the formation of chondrocyte clusters, one of the first alterations in osteoarthritis visible on histologic examination.

Adolescent↗
PubMed2001

The influence of phospholipid concentration in protein-containing lubricants on the wear of ultra-high molecular weight polyethylene in artificial hip joints.

There is considerable interest in the wear of polyethylene and the resulting wear-debris-induced osteolysis in artificial hip joints. Proteins play an important role as boundary lubricants in vivo in the pseudosynovial fluid, and these are reproduced in in vitro tests through the use of bovine serum. Little is known, however, about the effect of phospholipid concentrations within proteinaceous solutions on the wear of ultra-high molecular weight polyethylene (UHMWPE). The effects of protein-containing lubricants with 0.05, 0.5 and 5 per cent (w/v) phosphatidyl choline concentrations on the wear of ultra-high molecular weight polyethylene (UHMWPE) were compared with 25 per cent (v/v) bovine serum which had 0.01 per cent (w/v) lipid; the effects were compared in a hip joint simulator with smooth (n = 4) and scratched (n = 3) femoral heads. The control bovine serum lubricant produced UHWMPE wear of 55 and 115 mm3/10(6) cycles on the smooth and rough heads respectively. The increased phospholipid concentration significantly reduced the wear rate. At the higher concentration (5% w/v phosphatidyl choline) the average wear was reduced to less than 2 mm3/10(6) cycles. Even with the relatively low concentrations of 0.05% w/v phosphatidyl choline the wear was reduced by at least threefold compared with the bovine serum tests for both the smooth and rough femoral heads. There may be considerable differences in the phospholipid concentrations in patients' synovial fluid and this is highly likely to produce considerable variation in wear rates. In vitro, differences in the phospholipid concentration of lubricants may also cause variation in wear rates between different simulator tests.

Hip Prosthesis↗
PubMed2000

Osteomyelitis of the hip joint associated with systemic cat-scratch disease in an adult.

Reported here is the case of a 29-year-old male with cervical lymphadenopathy, fever and weight loss, followed by acute painful osteomyelitis of the left hip joint due to cat-scratch disease. The diagnosis was established by detection of IgG antibodies to Bartonella henselae in serum and histologic examination of a lymph node including a positive polymerase chain reaction test. Treatment consisted of clarithromycin and cefotiam for 2 weeks. Four weeks after discharge, all of the patient's symptoms had completely resolved. Magnetic resonance imaging of the left hip joint showed marked regression of bone inflammation 4 months later and normalization after 8 months. Cat-scratch disease should be considered in the differential diagnosis of osteomyelitis in an adult, especially when lymphadenitis is present.

Adult↗
PubMedDate not supplied

Eight-year prospective targeted ultrasound screening program for instability and at-risk hip joints in developmental dysplasia of the hip.

The use of targeted ultrasound screening for at-risk hips to reduce the rate of surgery in developmental dysplasia of the hip is unproven. A prospective trial was undertaken in an attempt to clarify this matter. This study was undertaken between May 1992 and April 2000. There were 28,676 live births. Unstable and at-risk hips were routinely targeted for ultrasound examination. One thousand eight hundred six infants underwent ultrasound examination (6.3% of the birth population). Twenty-five children (18 with dislocations, 7 with dysplasia) required surgical intervention in the form of open reduction of the hip or pelvic or femoral osteotomy (0.87 per 1,000 births for dysplasia, 0.63 per 1,000 births for dislocation). Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programs. The development of a national targeted ultrasound screening program for at-risk hips cannot be justified on a cost or result basis.

Breech Presentation↗
PubMed1997

Quantitative analysis of incongruity, contact areas and cartilage thickness in the human hip joint.

Joint incongruity and cartilage thickness have been shown to determine the contact stresses and the load partitioning between the solid and fluid phases of articular cartilage. Matrix stresses, which are relevant in the development of osteoarthrosis, can, however, not be determined experimentally but must be calculated using numerical methods. The aim of the present study was to quantify the incongruity and cartilage thickness of the human hip, in order to allow for the construction of morphologically accurate finite element models. Twelve cadaveric specimens (34-86 years), two fresh and ten fixed, were investigated. The loading configuration was based on in vivo measurements of hip joint forces during midstance. The incongruity and contact areas were determined using a polyether casting technique, in the minimally and the fully loaded state. The cartilage thickness was measured at identical coordinate points with an A-mode ultrasonic system. Generally, the contact started at lower loads at the edge of the lunate surface, and the joint space increased towards its central aspects. In some specimens the contact started in the acetabular roof, leaving a joint space of up to 2 mm in the horns of the lunate surface. In others, the initial contact was observed in the anterior and posterior horns of the lunate surface with a joint space width of up to 0.75 mm in the acetabular roof. The size of the contact areas increased from about 20% of the lunate surface to 98% at higher loads. The articular cartilage thickness ranged from 0.7 to 3.6 mm, the maxima being located in the ventral aspects of the femoral head and acetabulum. These quantitative data on joint space width, contact, and cartilage thickness in the human hip joint may be used to construct and validate finite element models which are required to elucidate the mechanical factors involved in osteoarthrosis.

Adult↗
PubMed1984

The incongruous hip joint: a loading study.

Hip incongruency was studied by load-displacement and casting methods. Twenty-five joints were loaded in 5 different positions of the walking cycle. Seventeen of them had a space at the apex in all positions, while 3 were congruent at low loads, and the remaining 5 had femoral heads smaller than their acetabula. No trends with age were apparent.

Adult↗
PubMed2000

The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary report.

OBJECTIVE: The pathophysiology of rapidly destructive arthrosis of the hip joint (RDA) is unknown. The purpose of this study was to document cases of subchondral insufficiency fracture of the femoral head, which has similar clinicoradiologic features to those of early-stage RDA. METHODS: This study was based on a retrospective review of 11 cases of subchondral insufficiency fracture of the femoral head that were confirmed histopathologically and for which radiographs both at the onset of hip pain and at the time of surgery were available. RESULTS: All patients were > 60 years of age (range 61-78 years, mean age 69), and 9 were women. On plain radiographs, the normal joint space had undergone rapid narrowing and/or disappeared within 9 months (mean 5.8 months). Magnetic resonance imaging, available in 2 cases, showed a pattern of bone marrow edema from the upper portion of the femoral head to the intertrochanteric region, with an associated focal low-intensity band on T1 paralleling the articular surface. In all cases, evidence of subchondral insufficiency fracture was confirmed histopathologically. In addition, in the marrow space, there were several round-to-oval granulomatous foci, which consisted of amorphous debris, fragmented bone, and articular cartilage surrounded by reactive histiocytes and giant cells. All 11 patients were osteopenic, as shown both radiologically and histopathologically. CONCLUSION: Subchondral insufficiency fracture resulting from osteopenia may lead to a rapid breakdown of the hip joint.

Aged↗
PubMed1997

An anterolateral approach to the hip joint.

I describe an anterolateral approach to the hip joint. The intermuscular plane is between the gluteus medius and tensor fascia lata. The anterior one third of gluteus medius and the insertion of gluteus minimus are stripped from the anterior aspect of the greater trochanter to raise a flap in a way that facilitates reattachment. The vastus lateralis muscle is left undisturbed. This simple and relatively quick approach provides sufficient anatomic orientation and exposure to allow the surgeon to perform total hip arthroplasty, with minimal dissection and without excessive retraction. There is no danger of injury to the superior gluteal nerve or its branches. This has been used in 178 patients for primary total hip replacement. The strength of the hip abductor muscles was unimpaired and there were no complications attributable to the approach in 128 patients reviewed after at least 6 months.

Arthroplasty, Replacement, Hip↗
PubMed1979

The mechanisms of severe arterial injury in surgery of the hip joint.

Vascular accidents occurring in the course of hip surgery may reach potentially catastrophic dimensions by posing an immediate and sudden threat to life and limb. This is a report of 15 cases with severe arterial injury representing 0.2--0.3% of all reconstructive hip operations performed during an 8 year period. In 6 cases perforation of either the external iliac artery, the common femoral artery of main branches of the lateral and medial circumflex femoral artery were caused by the tip of a narrow-pointed Hohmann retractor used to expose the hip joint. Other mechanisms were: intimal tear with appositional thrombosis, probably caused by mechanical strain imposed on atherosclerotic arteries, giving rise to complete limb ischemia (2 cases); the dangers associated with the entry of bone cement through a defective acetabulum into the pelvis causing thrombotic occlusion due to polymerization heat (one case) or intimate adhesion of artificial bone to the external iliac artery subsequently being ripped open during replacement of the cup (one case); the increased hazards of replacing firmly embedded hip prosthesis (3 cases of direct arterial injury with chisel, knife and cutting edge of protruding bone); and the complications associated with the development of a false aneurysm (2 cases). Fourteen of the 15 extremities were salvaged. Above-knee amputation was unavoidable in one case owing to delay of vascular repair. There was no immediate operative mortality. Knowledge of the causative mechanisms prevents arterial injury during hip surgery. The relatively low rate of vascular complications in spite of vicinity of main vessels gives credit to the well standardized technique of hip surgery, especially hip replacement. However, it is suggested that the surgeon should be sufficiently acquainted with the exposure of the main vessels above and below the groin to be able to control life threatening hemorrhage at all times. A McBurney incision with retroperitoneal exposure and clamping of the external iliac artery will suffice to diminish bleeding considerably. Thereupon careful dissection and placement of snares around the common femoral artery, the arteria profunda femoris, and whenever necessary, the lateral or medial circumflex femoral artery will enable closure of the lacerated artery. For hemorrhage resulting during replacement of firmly embedded hip prosthesis it might become necessary to ligate the internal iliac artery. Reconstruction of obliterated arteries should call for the cooperation of the vascular surgeon for eventual angioplasty. Angiologic examination of the lower extremities is mandatory whenever severe arterial trauma has occurred in the course of hip surgery and is best performed by measuring the ankle blood pressure with a Doppler ultrasound probe.

Adult↗
PubMed2006

Compensatory strategies during normal walking in response to muscle weakness and increased hip joint stiffness.

Compared to young adults, older adults exhibit a slower walking speed, smaller step length, shorter swing phase time and decreased range of motion in their lower extremity joints. The underlying mechanisms causing these gait adaptations is not well understood, with various musculoskeletal parameters being put forth as contributing factors, including increased joint stiffness and decreased isometric muscle strength. The objective of this study was to identify the necessary compensatory mechanisms to overcome such musculoskeletal deficits and regain a normal walking pattern. Understanding these mechanisms has important implications for designing effective rehabilitation interventions for older adults that target specific muscle groups and properties (e.g., isometric strength versus joint stiffness) to improve gait performance. Muscle-actuated forward dynamics simulations of normal walking were analyzed to quantify compensatory mechanisms in the presence of muscle weakness in specific muscle groups and increased hip joint stiffness. Of particular importance were the compensatory mechanisms provided by the plantar flexors, which were shown to be able to compensate for many musculoskeletal deficits, including diminished muscle strength in the hip and knee flexors and extensors and increased hip joint stiffness. This importance was further highlighted when a normal walking pattern could not be achieved through compensatory action of other muscle groups when the uniarticular and biarticular plantar flexor strength was decreased as a group. Thus, rehabilitation or preventative exercise programs may consider focusing on increasing or maintaining plantar flexor strength, which appears critical to maintaining normal walking mechanics.

Adaptation, Physiological↗
PubMed1985

Effects of intense "stretching"-flexibility training on the mechanical profile of the knee extensors and on the range of motion of the hip joint.

The sample for the study involved 12 volunteer male, active but not specially trained secondary school students. They averaged 15.33 years with a mean height of 168.20 cm, and a mean mass of 55.08 kg. Changes, if any, in the mechanical properties (MVC, half-relaxation time, fast isometric contraction, concentric contraction of the knee extensors) and flexibility of the hip joints were studied. The subjects executed passive, purely slow stretching as well as range-of-motion flexibility exercises for the knee extensors and the hip joints for 7 weeks three times a week. Pre- and post-measurements for flexibility and stride frequency on the spot showed significant improvement as did half-relaxation time, fast isometric force development, and speed of concentric contractions when low loads were to be overcome. In addition to studies in which improvements reported were attributed to and related to myoelectrical, reflex, and connective tissue changes, in the present study it was concluded that stretching exercises influence intrinsic muscle mechanical character along with a simultaneous improvement in range of motion of the joints exercised.

Adolescent↗
PubMed1977

[Biostatic analysis of the hip-joint (author's transl)].

The literature of biostatic analysis of the hip-joint is discussed. An improved method of calculation is described an explained on examples of the material of the authors. Pre- and postoperative results are shown in diagrams of weightbearing, muscular power and demands made on the various joints which often enable us to say something about the biomechanical effects of the operations.

Adolescent↗
PubMed1996

The effect of variable size posterior wall acetabular fractures on contact characteristics of the hip joint.

The indications for open reduction and internal fixation of posterior wall acetabular fractures associated with a clinically stable hip joint are unclear. In previous work a large posterior wall defect (27% articular surface area) resulted in significant alteration of load transmission across the hip; specifically, there was a transition from evenly distributed loading along the acetabular articular surface to loading concentrated mainly in the superior portion of the articular surface during simulated single leg stance. However, the majority of posterior wall fractures involve a smaller amount of the articular surface. Posterior wall acetabular fractures not associated with instability of the hip are commonly treated nonoperatively. This practice does not account for the size of the posterior wall fracture. To study the biomechanical consequences of variably sized articular defects, a laboratory experiment was conducted evaluating three progressively larger posterior wall defects of the acetabulum during simulated single leg stance using superlow Fuji prescale film (Itochu International, New York): (a) 1/3 articular surface width through a 50 degrees arc along the posterior wall of the acetabulum, (b) 2/3, and (c) 3/3 articular width defects through the same 50 degrees arc along the posterior wall of the acetabulum. In the intact acetabulum, 48% of the total articular contact was located in the superior acetabulum. Twenty-eight percent of articular contact was in the anterior wall region of the acetabulum and 24% in the posterior wall region. After the 1/3 width posterior wall defect, 64% of the articular contact was located in the superior acetabulum (p = 0.0011). The 2/3 width posterior wall defect resulted in 71% of articular contact area being located in the superior acetabulum (p = 0.0006). After the 3/3 width posterior wall defect, 77% of articular contact was located in the superior acetabulum, significantly greater than the intact condition (p < 0.0001) and 1/3 width defect (p = 0.0222). The total absolute contact areas for all defect conditions were significantly less than the intact conditions. The results of this study reconfirm the observation that posterior wall fractures of the acetabulum significantly alter the articular contact characteristics in the hip during single leg stance. The relationship between defect size and changes in joint contact showed that the smallest defect resulted in the greatest alteration in joint contact areas, whereas larger defects resulted in minor increments of change in contact area. This finding is of concern because the clinical practice of managing acetabular fractures nonoperatively if the hip joint is stable is based on the supposition that the joint retains enough integrity to function without undue risk of late posttraumatic osteoarthritis. A better understanding of the natural history of stable posterior wall acetabular fractures is needed to ascertain whether some of these fractures merit operative repair.

Acetabulum↗
PubMedDate not supplied

[Fluctuations in synovial fluid pressure in the hip joint].

Close interrelation of the indications of pressure in the acetabular part of the joint and the position of the lower extremity was revealed in experimental preparations of the hip joint. The fluctuation of the pressure was shown to depend on anatomical features, in particular on the femur head shape and the state of the glenoid lip. The data obtained should be taken into account in endoprosthesis of the femur head and elaboration of new implants.

Adult↗
PubMedDate not supplied

[The behavior of 3-phase scintigraphy of hip joint prostheses].

With the results of about 600 hip joint prostheses examined by scintigraphy, it is evident that nuclear medicine is more than a supplementary examination, especially in the case of a non-cemented isoelastic prosthesis. The combination of 3-phase scintigraphy with leukocyte scintigraphy could solve the problems of infected and aseptic displaced prostheses in 90% of the cases. The conventional X-ray diagnostic being the only method to demonstrate bone morphology is still the primary examination.

Femur↗