EXPERIMENTAL PAIN FROM THE HIP-JOINT.
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Hip↗
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CONTRIBUTION TO THE ARTHROPLASTY OF THE HIP-JOINT.
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Arthroplasty↗
Development of optimized epoxy graphite implant for the total hip joint.
Various metal implants are available for total hip joint replacements. There are problems associated with the micromovement of the implants with bone and/or with bone cement and about ten percent failure cases are reported. The mechanical properties of the metal implants do not match with that of human bone in the femur resulting in a stress distribution in the femur different from one without implant. Many researchers are working with different materials like alloy materials with lower modulus of elasticity, ceramic, etc. The study conducted at S.D.S.M. & T. biomechanics laboratory investigates the feasibility of using epoxy graphite as an implant material. The mechanical properties of the implant material are being optimized using experimental and analytical methods. The reflection polariscope method (photo stress method) was used to determine the micromovement of the implant and the bone, and stress distribution in the femur subjected to cyclic loading. A finite element method was used to optimize the mechanical properties of the implant to obtain a stress distribution closer to the one without implant. An epoxy graphite implant with optimized mechanical properties is being manufactured and tests are in progress.
Carbon↗
Synovial cyst of the hip joint: an unusual cause of a pulsating groin mass.
Synovial cysts of the hip joint occur most frequently in patients with rheumatoid arthritis (1). Despite the increasing frequency of arthroplasty of rheumatoid hips, case reports documenting synovial cysts remain extremely rare. This case report emphasizes the need for the surgeon to include a synovial cyst in the differential diagnosis of a painless groin mass, particularly in patients with rheumatoid arthritis.
Aged↗
Factors associated with hip joint rotation in former elite athletes.
OBJECTIVES: To study factors associated with passive hip rotation range of motion (ROM) in former elite male athletes. METHODS: Athletes were interviewed about hip pain, disability, lifetime occupational loading, and athletic training. The passive hip rotation was measured with a Myrin inclinometer in 117 former elite male long distance runners, soccer players, weight lifters, and shooters aged 45-68 years. Magnetic resonance imaging was used to detect hip osteoarthritis. RESULTS: There were no differences in passive hip rotation ROM between the four athlete groups nor between diverging lifetime loading patterns associated with occupational or athletic activities. Among the subjects without hip osteoarthritis, hip pain, and hip disability according to a stepwise linear regression analysis, the only factor that was associated with the passive hip rotation ROM was body mass index (BMI), explaining about 21% of its variation. Subjects with high BMI had lower passive hip rotation ROM than those with low BMI. There was no right-left difference in the mean passive hip rotation ROM in subjects either with or without hip osteoarthritis as determined by magnetic resonance imaging. Nevertheless, hip rotation ROM was clearly reduced in a few hips with severe caput deformity. CONCLUSIONS: Long term loading appears to have no association with passive hip rotation ROM. On the other hand, the hip rotation value was lower in subjects with high BMI than in those with low BMI. A clear right-left difference in hip rotation was found only in those subjects who, according to our magnetic resonance imaging criteria, had severe hip osteoarthritis. These findings should be taken into account when hip rotation ROM is used in the clinical assessment of hip joints.
Aged↗
[Vascular and microscopic changes in hip joint tissues in Perthes' disease].
Electron-microscopic and angiographic studies of hip joints (healthy and sick) were performed. Bone-cartilaginous tissue and tissue of a joint capsula from 14 patients (7 to 14 years old) obtained during the operation were studied; angiography was performed in 6 patients during their life. Degenerative processes with a predominance of a hydropic dystrophy develop in the joint cartilage of the femur head. Collagen structures undergo mucoid swelling and dysproteinosis. Edema of the joint capsula, mainly its deep layers, is characteristic for this disease. Pathomorphological changes develop against the background of a vascular deficiency.
Adolescent↗
Effect of implant material properties on the performance of a hip joint replacement.
A composite material implant prosthesis for hip replacement has been developed. The design of the prosthesis substructure was based on investigation of the stress and strain fields that were developed in the human femur at the proximal end when a prosthesis stem had been inserted into it. The prosthesis stem structure was of unidirectional fibrous composite material core (graphite fibres in polysulfone matrix), wrapped with four layers of the same material but orientated at different angles. The orthotropic moduli of the outer layer are very close to the moduli of a human cortical bone in the vertical and circumferential directions. The moduli increased gradually from the outer layer to the inner core. A three-dimensional finite element model of the prosthesis and the bone has been constructed and loaded with the range of forces that might appear upon operation. The behaviour of the composite prosthesis and the femur was then compared with the intact femur and three other types of prosthesis materials, namely stainless steel, titanium, an isoelastic material and a hypothetical one with moduli identical to the cortical bone. The titanium has modulus of elasticity that is only half of the stainless steel. It was found that the composite prosthesis gave the best performance for most of the categories that were examined.
Algorithms↗
Total prosthetic replacement in tabetic arthropathy of the hip joint.
The treatment of tabetic arthropathy of the hip by prosthetic replacement has been recorded in the literature in 5 cases, of which only 4 were followed up. The authors present 4 more cases in which follow-up showed that the operation was definitely contraindicated in this condition. All the cases developed recurrent subluxation and/or loosening of the prosthesis.
Aged↗
Classification of posterior fracture dislocation of the hip joint: a modification of the Thompsen Epstein classification.
The purpose of this paper was to describe a classification of posterior fracture dislocations of the hip joint, which would highlight the important aspects of managing this injury and more closely correlate with the prognosis. During the period from July 1994 to September 1997, the senior author operated on 60 posterior fracture dislocations of the hip joint. The results of the surgery were scored according to our ability to accurately anatomically reconstruct the acetabulum. We found that the degree of comminution was a greater determent of whether we could achieve an anatomical reconstruction than the presence of an associated acetabular floor fracture. Epstein showed conclusively that type II and III injuries have significantly different outcomes, but then grouped them together as type IV injuries if there was an associated floor fracture. We felt it more appropriate to continue with Epstein's fundamental feature of ascribing a grade according to the comminution and subdivided his type IV injuries.
Fractures, Comminuted↗
[Osteotomy of the greater trochanter in total prosthesis of the hip joint. Conventional versus dihedral osteotomy].
The dihedral trochanter osteotomy, compared to other types of osteotomy, is a safe technique that allows better exposure of the hip joint and avoids the risk of local complications, especially non-union.
Bone Wires↗
[Enlargement of the supporting joint surface as a therapeutic measure in arthrosis of the hip joint].
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Hip↗
The hip joint: structure, stability, and stress; a review.
A review of the structure of the hip joint as related to its stability is presented. The forces exerted at the hip and along the proximal end of the femur are discussed in relation to the anatomical position of bone and to normal stresses incurred during standing and gait. Clinical considerations of selected hip abnormalities include a review of changes in normal mechanical forces found in coxa valga, coxa vava, arthritis, and fracture.
Acetabulum↗
[Roentgenological and histopathological studies of the hip joint in rheumatoid arthritis].
In order to study the disease process of the hip joint in rheumatoid arthritis, roentgenological analysis was carried out along with histological studies on the resected femoral heads. For the roentgenological study, hip roentgenograms of seven patients with known natural course and sixty preoperative patients were used. For the histological study, sixteen resected femoral heads affected by various disease types were used. The histological findings were compared with the roentgenological findings. As specific roentgenological findings, there were osteoporosis, burrowing and inward protrusion of the acetabulum, and collapse and flattening of the femoral head. A sequential process of the femoral head destruction was demonstrated, starting from collapse, through flattening, and finally ending in disappearance. The collapse was divided into sclerotic collapse and porotic collapse, and their roentgenological and histological differences were discussed. In addition to the common destruction process, the presence of the following three uncommon types was suggested for a better understanding of clinical manifestations: stiff type (4.5%), synovial proliferation type (6.0%) and aseptic necrosis type (3.0%).
Adult↗
Matrix metalloproteinases and tissue inhibitors of metalloproteinases in loose artificial hip joints.
The role of extracellular matrix metalloproteinase enzymes and the tissue inhibitors of metalloproteinase in the periprostetic connective tissue matrix of loose artificial hip joints is reviewed. In the periprosthetic granulomatous interface connective tissues between bone and implants and inner cellular regenerating pseudocapsular tissues, matrix metalloproteinase 1, matrix metalloproteinase 2, matrix metalloproteinase 3, matrix metalloproteinase-9, and membrane type 1 matrix metalloproteinase enzymes can be shown in the light of immunohistochemistry, enzyme activity analysis, and messenger ribonucleic acid levels. Tissue inhibitors of metalloproteinase 1 and tissue inhibitors of metalloproteinase 2 also are found in the corresponding tissues. Analysis of matrix metalloproteinase and tissue inhibitors of metalloproteinase interaction shows imbalance between the enzymes and the endogenous inhibitors in favor of matrix metalloproteinase. This induces pathologic connective tissue remodeling in the interface and pseudocapsule. The data suggest that matrix metalloproteinase and tissue inhibitors of metalloproteinase system participate in the extracellular matrix degradation and tissue remodeling in artificial hip joints, and may contribute to the periprosthetic weakening, implant loosening, and osteolysis around implants. More evidence for their active involvement is sought by intervention studies with type specific matrix metalloproteinase inhibitors.
Animals↗
Capital femoral epiphysis and growth plate of the asymptomatic hip joint in unilateral Perthes disease.
Radiograms of 173 children with unilateral Perthes disease were reviewed with particular reference to the presence of flattening and irregularity of the 'unaffected' epiphyses. The slope and shape of the growth plate were also evaluated. About 35% of children with Perthes disease showed changes of the unaffected proximal femur in the first radiograms of the hip joints. These consisted of small epiphysis, flattening of the epiphysis, contour irregularities (20%), and changes in the growth plate (15%). The radiographic abnormalities were not accompanied by any clinical symptoms of the asymptomatic hip joint and they receded with age during treatment.
Age Factors↗
A study of radiographic variations of the hip joint.
Anteroposterior radiographs of the pelvis were studied in 920 patients free of hip joint diseases. The average joint space was between 3 and 4 mm in width. Narrowing of the superior joint space was seen in 13 percent of the hips and may represent the earliest finding in osteoarthritis. It was noted as early as the second and third decade in some patients. Other changes noted were narrowing of the lateral joint space, uniform narrowing of the space, an irregular joint space and tilting of the femoral head on the neck.
Adolescent↗
An optimized protocol for hip joint centre determination using the functional method.
The functional method identifies the hip joint centre (HJC) as the centre of rotation of the femur relative to the pelvis during an ad hoc movement normally recorded using stereophotogrammetry. This method may be used for the direct determination of subject-specific HJC coordinates or for creating a database from which regression equations may be derived that allow for the prediction of those coordinates. In order to contribute to the optimization of the functional method, the effects of the following factors were investigated: the algorithm used to estimate the HJC coordinates from marker coordinates, the type and amplitude of the movement of the femur relative to the pelvis, marker cluster location and dimensions, and the number of data samples. This was done using a simulation approach which, in turn, was validated using experiments made on a physical analogue of the pelvis and femur system. The algorithms used in the present context were classified and, in some instances, modified in order to optimize both accuracy and computation time, and submitted to a comparative evaluation. The type of movement that allowed for the most accurate results consisted of several flexion-extension/abduction-adduction movements performed on vertical planes of different orientations, followed by a circumduction movement. The accuracy of the HJC estimate improved, with an increasing rate, as a function of the amplitude of these movements. A sharp improvement was found as the number of the photogrammetric data samples used to describe the movement increased up to 500. For optimal performance with the recommended algorithms, markers were best located as far as possible from each other and with their centroid as close as possible to the HJC. By optimizing the analytical and experimental protocol, HJC location error not caused by soft tissue artefacts may be reduced by a factor of ten with a maximal expected value for such error of approximately 1mm.
Biomechanical Phenomena↗