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PubMed1998

Influence of hip position and gender on active hip internal and external rotation.

A general lack of descriptive details exists for measurements of hip rotation range of motion. This study was designed to establish the influence of gender and hip flexion position on active range of motion of the hip in external and internal rotation. Sixty (39 females and 21 males) healthy college-age (21.8 +/- 1.7 years) subjects were studied. Hip rotation of the dominant leg of each subject was measured in the prone (hip near 0 degree of flexion) and seated (hip near 90 degrees of flexion) positions using a standard goniometer. Data were analyzed using an analysis of variance model. Pearson's r statistics were used to determine the degree of association between measurements of hip rotation made seated vs. prone. A statistically significant difference (p < 0.05) was found between mean hip external rotation (ER) measured seated (36 +/- 7 degrees) and mean hip ER measured prone (45 +/- 10 degrees). Conversely, mean hip internal rotation (IR) measured seated (33 +/- 7 degrees) was not statistically different than mean hip IR measured prone (36 +/- 9 degrees). Females had statistically more active hip internal and external rotation than males (p < 0.05). A moderate degree of association existed between measurements of hip ER taken in the prone vs. seated position (r = 0.57, p < 0.05). For IR, the degree of association between the two measurement positions was slightly higher (r = 0.72, p < 0.05). Unlike the amount of active hip internal rotation which showed little difference between measurements made prone vs. seated, our data indicate that measurement position had a significant effect on the amount of active range of motion of the hip in ER. These findings are clinically significant for they stress the importance of documenting measurement position. They also stress the need for representative norms to be established for each hip position and gender.

Adult↗
PubMed1993

[External hip protectors against hip fractures. A randomized study in a nursing home].

Most hip fractures seem to be related to trauma near the hip, so a controlled trial was conducted to investigate the effect of external hip protectors on the prevention of such fractures in residents of a nursing home. Ten of 28 wards of the nursing home were randomized to receive external hip protectors; thus 167 women and 80 men were given protectors and 277 women and 141 men no protectors. A fall register was set up for two treatment wards (45 residents) and two control wards (76 residents). There were eight hip and 15 non-hip fractures in the hip protector group and 31 hip and 27 non-hip fractures in the control group. The relative risk of hip fractures among women and men in the intervention group was 0.44 (95% CL 0.21-0.94). None of the 8 residents in the intervention group who had a hip fracture was wearing the device at the time of the fracture. 154 falls were registered and 20% of these falls produced a direct impact to the hip. In 25 falls direct impact to the hip was sustained at a time when hip protectors were not being worn, and six fractures were produced. The study indicates that external hip protectors can prevent hip fractures in nursing-home residents.

Accidental Falls↗
PubMed2000

Bipolar hip arthroplasty as a salvage treatment for instability of the hip.

BACKGROUND: Recurrent instability of the hip in the absence of an identifiable cause is a challenging problem. It has been proposed that bipolar hip arthroplasty may have a role in the treatment of these complex cases. The purpose of our study was to evaluate the results of bipolar hip arthroplasty for the treatment of recurrent instability of the hip in a series of patients at our institution. METHODS: We reviewed the records of twenty-seven patients who had undergone bipolar hip arthroplasty as a salvage procedure for the treatment of recurrent instability of the hip after total hip replacement. All patients had undergone at least two, and a mean of three, stabilizing operative procedures on the hip prior to the bipolar arthroplasty. The mean duration of follow-up was five years (range, two to twelve years), with no patient lost to follow-up. There were six deaths, of unrelated causes. RESULTS: Bipolar arthroplasty prevented redislocation in twenty-two hips (81 percent). At the time of final follow-up, twenty-five patients (93 percent) had a stable hip. Five patients (19 percent) had had episodes of subluxation or dislocation following the bipolar arthroplasty. Two of these patients had only a single episode of dislocation that was treated successfully by immobilization. Two of the remaining three patients required a reoperation because of the instability. The hip was stabilized with the use of a constrained cup prosthesis in one of these patients, and the other patient eventually required resection arthroplasty. The third patient had continuing instability but improved function and pain relief, and a reoperation was not performed. There were a total of seven reoperations; these included revision because of disassembly of the cup in one hip, revision bipolar arthroplasty because of continuing instability in two, resection arthroplasty because of deep infection in two, revision arthroplasty because of recalcitrant groin pain in one, and revision arthroplasty because of deep infection and superior migration of the implant in one. The Harris hip score improved significantly, from a mean of 24 points (range, 5 to 45 points) preoperatively to a mean of 55 points (range, 35 to 80 points) postoperatively (p < 0.05). CONCLUSIONS: We believe that, despite some potential problems, bipolar hip arthroplasty can have a role in the salvage management of recurrent instability of the hip in patients in whom other stabilization procedures have failed.

Adult↗
PubMed2002

[Cemented total hip arthroplasty for severe dysplasia or congenital dislocation of the hip].

OBJECTIVES: We evaluated total hip arthroplasty and short-term results in the treatment of coxarthrosis due to neglected congenital dislocation or severe dysplasia of the hip. METHODS: Cemented total hip arthroplasty was performed in 23 hips of 22 patients (2 men, 20 women; mean age 48.6 years; range 28 to 65 years) with osteoarthrosis due to congenital dislocation or severe dysplasia of the hip. The acetabular component was placed at the level of the true acetabulum; four patients required augmentation with autogenous bone grafts due to severe acetabular deficiency. Femoral shortening osteotomy using a subtrochanteric step-cut osteotomy was performed in seven patients with high-riding hips. Five patients underwent proximal femoral shortening after the trochanter major was osteotomized and distally advanced. All patients were evaluated with the use of the Merle d'Aubigne and Postel hip scores. Radiologic evaluations were made by preoperative and follow-up radiographs. The mean follow-up was 52.8 months (range 30 to 108 months). RESULTS: According to the Merle d'Aubigne and Postel hip scores, the results were excellent in 17 hips (74%), good in four hips (18%), fair in one hip (4%), and poor in one hip (4%). One hip required revision because of nonunion of the acetabular graft. The femoral stem was fractured in one patient. Complications included temporary sciatic nerve palsy in one patient, deep venous thrombosis in one patient, early dislocation in one patient, and nonunion of the femur in one patient who underwent subtrochanteric step-cut osteotomy. CONCLUSION: Total hip arthroplasty for congenitally dislocated or severely dysplastic hips is more effective than other treatment methods. Long-term results can be improved by the use of contemporary cementing techniques.

Acetabulum↗
PubMed2003

Effects of hip posture on the frontal impact tolerance of the human hip joint.

The pattern of left- and right-side hip injuries to front-seat occupants involved in offset and angled frontal crashes suggests that hip posture (i.e., the orientation of the femur relative to the pelvis) affects the fracture/dislocation tolerance of the hip joint to forces transmitted along the femur during knee-to-knee-bolster loading in frontal impacts. To investigate this hypothesis, dynamic hip tolerance tests were conducted on the left and right hips of 22 unembalmed cadavers. In these tests, the knee was dynamically loaded in the direction of the long axis of the femur and the pelvis was fixed to minimize inertial effects. Thirty-five successful hip tolerance tests were conducted. Twenty-five of these tests were performed with the hip oriented in a typical posture for a seated driver, or neutral posture, to provide a baseline measure of hip tolerance. The effects of hip posture on hip tolerance were quantified using a paired-comparison experimental design. In six pairs of tests, one side of each cadaver was tested with the hip joint oriented in the neutral posture and the contralateral hip from the same cadaver was tested with the hip joint adducted 10 degrees from the neutral posture. In four pairs of tests, the hip was tested in neutral and 30 degrees flexed postures. The average fracture tolerance of the hip in the neutral posture was 6.1-/+1.5 kN. Hip tolerance decreased by an average of 34-/+4% with 30 degrees of flexion from the neutral posture (p<0.0001) and by 18-/+8% with 10 degrees of adduction from the neutral posture (p=0.008).

Journal Article↗
PubMed2001

[Hip arthroscopy. Minimal invasive diagnosis and therapy of the diseased or injured hip joint].

Arthroscopy of the hip joint has developed into a useful tool for the hip surgeon. Hip joint anatomy, however, makes special demands of the arthroscopist. He needs to be familiar with the arthroscopic anatomy of the hip and its variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order to avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a combined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without traction. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force should be broken by distension of air or fluid. This leads to maximum distraction of the joint and reduces the risks of damage to labrum and cartilage during first access to the joint. For a diagnostic round through the central compartment, at least two portals have to be placed. The use of a 3-portal technique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the anterolateral or lateral portal should be used as the first portals to the central compartment. In addition, the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should be used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondromatosis and pigmented villonodular synovitis, associated lesions in underlying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least, "idiopathic" hip pain. The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complications after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, synovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in the hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studies have demonstrated the advantages of the arthroscopic treatment of the hip.

Arthroscopy↗
PubMed2000

Acetabular revision after failed total hip arthroplasty in patients with congenital hip dislocation and dysplasia. Results after a mean of 8.6 years.

BACKGROUND: Revision of a total hip arthroplasty in a patient who has had congenital hip dysplasia or dislocation is often more difficult than a standard revision operation. The purpose of this study was to assess the efficacy and complications of use of a cementless hemispherical acetabular component for revision of an acetabular component of a failed total hip replacement in patients whose initial problem was arthritis secondary to congenital dislocation or dysplasia. The mean duration of follow-up was approximately eight years. METHODS: We reviewed a consecutive series of sixty-one hips in fifty-three patients who underwent a cementless acetabular revision with use of a hemispherical acetabular component, with or without concurrent femoral revision. Data were collected prospectively. The mean age of the patients at the time of the index operation was fifty-six years. A mean of 1.9 ipsilateral hip operations had been performed previously. Thirty-nine hips (64 percent) had a so-called high hip center prior to the index revision. With one exception, the uncemented acetabular component was fixed with screws. Fifty-one acetabular components were placed with so-called line-to-line fit, and ten were oversized by one to three millimeters. In thirty-eight hips, the femoral component was revised as well. Twenty-nine femora were reconstructed with use of a cemented device, and nine were revised with an uncemented patch-porous-coated femoral stem (a stem on which the porous coating appears in patches). RESULTS: Four patients (five hips) died prior to the five-year minimum follow-up interval. With the exception of one hip treated with resection arthroplasty because of deep infection, none of the hips in these deceased patients had been revised or had a loose component. One living patient (one hip) had a resection arthroplasty, and one additional patient (two hips) had both stable acetabular components rerevised at the time of femoral rerevision at another institution because of loosening and osteolysis. One patient refused to return for follow-up, but the components had not been revised. The remaining fifty-two hips in forty-six patients were followed for a mean of 8.6 years (range, 5.0 to 12.7 years). The mean Harris hip score was 80 points (range, 56 to 100 points) at the time of the latest follow-up. No acetabular component had been revised, although two had migrated. No other acetabular component was loose according to our radiographic criteria. Thus, the mechanical failure rate on the acetabular side was 3 percent (two of sixty-one) for the entire series and 4 percent (two of fifty-two) for the patients who had been followed for a mean of 8.6 years. On the femoral side, the mechanical failure rate was 3 percent (one of twenty-nine) for the cemented stems and six of nine for the uncemented patch-porous-coated stems. CONCLUSIONS: Of the approaches used in this difficult series of patients requiring revision, the hybrid arthroplasty (a cementless acetabular component and a cemented femoral component) yielded overall good results after an intermediate duration of follow-up.

Acetabulum↗
PubMedDate not supplied

[Changes of biomechanical parameters in dysplasia of the hip by total hip replacement].

AIM: Dysplastic hips or dislocated hips lead to loss of muscle strength claudication, and finally to coxarthrosis. This study analytically compares the hip joint forces in normal, dysplastic hips and hips after implantation of a hip prosthesis for several positions. METHOD: The results of 173 total hip replacements in 153 cases of either severe congenital dysplasia or dislocation were analyzed. A 2 dimensional mathematical model of the hip was developed to evaluate the effects of surgically achievable mechanical alterations such as acetabular placement, femoral shaft-prosthetic neck angle, and neck length of the femoral prosthesis. RESULTS: 63 % of the hip prosthesis were implanted on the right, 72 % on the left. Before implantation, the femoral shaft-prosthetic neck angle in mean was 146 degrees +/- 10 degrees, after implantation it was 135 degrees. The hip centre was displaced on in average 10 mm distally. Postoperatively hip joint force was increased 21 %. CONCLUSION: Minimum joint contact forces occurred when the femoral shaft prosthetic neck angles were small. The loads on the hip were lowered significantly by placing the centre of the acetabulum as far inferiorly and medially as possible. Another important finding is that displacement of the hip centre distally has a great effect on muscle performance and hip joint force.

Adult↗
PubMed1994

Automated evaluation of hip axis length for predicting hip fracture.

The hip axis length has been shown in previous studies to be predictive of hip fracture independent of age and femoral bone density. The first studies of hip axis length were performed by manual measurement of dual x-ray absorptiometry (DXA) scan printouts. In this study, an automated analysis procedure is defined using software tools provided by the DXA manufacturer. Manual and automatic hip axis length measurements in 198 women were highly correlated (r = 0.98). Because of scaling factors of the printout, the automatic measurement was 58% longer than the manual value. Precision of the automatic measurement, based upon triplicate DXA scans of 33 women, was 0.07 cm or 0.68%. To define normative data, the hip axis length was measured from femoral DXA scans of 471 female volunteers aged 40-92 scanned on 14 different Hologic QDR-1000 systems. Mean hip axis length was 10.5 cm, with a standard deviation of 0.62 cm. No significant relationship between hip axis length and age was found (r = 0.07, P = 0.15). Based on previously reported odds ratios corrected for femoral bone density, age, height, and weight, an automatic hip axis length measurement of 11.0 cm is associated with a twofold increase in hip fracture risk compared with a woman with an average hip axis length. A hip axis length value of 11.6 cm increases hip fracture risk by a factor of 4 compared with a woman with a normal hip dimension. We conclude that the hip axis length can be easily incorporated into existing DXA hip analysis software in combination with a bone density measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed2005

Do hip protectors decrease the risk of hip fracture in institutional and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials.

Hip fractures are an important cause of morbidity and mortality in the elderly. Hip protectors are padded undergarments designed to decrease the impact of a fall on the hip. We systematically reviewed randomized controlled trials of hip protectors to determine if they reduce hip fractures in the elderly. Analyses were pooled according to participant residence--community or institutional (the latter, included nursing homes, residential group homes or seniors' hostels). We included individually randomized and statistically adjusted cluster randomized trials. Seven trials of 12- to 28-month duration were included. The Safehip brand of hip protector was used in most studies. Compliance rates in the treatment groups varied from 31 to 68%. In four trials including a total of 5,696 community-dwelling seniors, the hip fracture rates in control groups ranged from 1.1 to 7.4%, and the pooled risk difference with hip protector allocation was 0% [95% confidence intervals (CI), -1%, +1%), with a relative risk of 1.07 (0.81, 1.42). In three trials including 1,188 institutionalized elderly participants, hip fracture rates in the control groups varied from 8 to 19.4%, and the pooled risk difference for sustaining one or more hip fractures with hip protector allocation was -3.7% (95% CI, -7.4%, 0.1%), with a relative risk of 0.56 (0.31, 1.01) (with statistically significant heterogeneity of treatment effect). In a post-hoc subgroup analysis of two trials comprised of exclusively nursing home residents, the risk difference with hip protector allocation was -4.4% (-8.09, -0.76) with a relative risk of 0.50 (0.28, 0.91) (n=1,014). Thus, there is little evidence to support the use of hip protectors outside the nursing home setting. The potential benefit of hip protectors in reducing hip fractures in nursing home residents requires further confirmation.

Activities of Daily Living↗
PubMed2001

Hip fracture prevention trial using hip protectors in Japanese nursing homes.

A method to protect the hips during falls could effectively reduce the incidence of hip fractures. We report the results of the first hip protector trial in Japan, performed between July 1996, and September 1999. One hundred and sixty-four elderly female residents of nursing homes, with Activities of Daily Living above the wheelchair level, agreed to participate in this study. Among them, 88 were randomly selected to wear a hip protector and 76 controls did not. All falls and resulting injuries were recorded daily. In anthropometric measurements and ultrasonic bone evaluation, no significant differences were found between the two groups, except in height. During an average of 377 days, the wearers and the non-wearers fell a total of 131 and 90 times, respectively. Among the wearers, there were two non-hip fractures and one hip fracture, so the annual hip fracture rate was calculated at 1.2%, against 8 hip fractures among the non-wearers, or 9.7% per year. The hip fracture rate was significantly lower among the wearers than non-wearers, while the annual number of falls per subject and the distribution of fallers remained the same. According to Cox's proportional hazard regression analysis, the effect of the hip protector on hip fracture prevention was independent of anthropometric data, ultrasonic bone assessment values or number of falls. Moreover, even after limiting the subjects to fallers only, the annual hip fracture rate in non-wearers was higher than in wearers (19.8% vs 2.0%) and the annual hip fracture rate per fall in wearers was lower than that in non-wearers (0.8% vs 8.2%). It was thus concluded that the hip protector is a beneficial device for the prevention of hip fractures.

Accidental Falls↗
PubMed1999

Do hip replacements improve outcomes for hip fracture patients?

BACKGROUND: Hip fracture is a common problem among older Americans. Two types of procedures are available for repairing hip fractures: hip replacement and open or closed reduction with or without internal fixation. The assumption has been that hip replacement produces better functional outcomes. Although that is the common wisdom, outcome studies evaluating hip replacement for treatment of hip fracture are few and have not clearly documented its superiority. OBJECTIVES: To compare outcomes of hip fracture patients who receive hip replacement versus another stabilizing procedure (open or closed reduction with or without internal fixation). DESIGN: Prospective cohort study. PARTICIPANTS: We studied 332 patients (age, > 65) who were hospitalized for a femoral neck fracture and discharged alive. MEASUREMENTS: We examined 2 treatment groups, hip replacement versus another procedure, on 6 outcomes [Activities of Daily Living (ADLs), walking, living situation (institutionalized or not), perceived health (excellent/good vs. fair/poor), rehospitalization, and mortality] at 3 postdischarge times (6 weeks, 6 months and 1 year). RESULTS: Mean age was 80, 80% were female, 96% White, 28% married, and 71% had a hip replacement. The treatment groups were similar at baseline (3 months before admission as reported at discharge) on ADLs, walking, living situation, and perceived health (all P > 0.24). After adjusting for demographics, clinical characteristics, fracture characteristics, and prior ADLs, walking ability, living situation, and perceived health, patients with a hip replacement did not do better at 6 weeks, 6 months, or 1 year post-discharge on any of the 6 outcome measures (all 18 P > 0.10). A global test of all 6 outcomes finds hip replacement patients doing less well at one year (P = 0.02). CONCLUSIONS: Despite the commonly held belief that hip replacement is a superior treatment for hip fracture, we found no suggestion of better outcomes for hip replacement on any of 6 key outcomes.

Activities of Daily Living↗
PubMed1998

Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients.

One hundred elderly patients who had an intertrochanteric femoral fracture were randomized to treatment with a compression hip-screw with a plate (fifty patients) or a new intramedullary device, the intramedullary hip-screw (fifty patients). All patients were followed prospectively for one year or until death. A detailed assessment of the functional status and the plain radiographs of the hip was performed one, three, six, and twelve months postoperatively. The two treatment groups were strictly comparable. The operative time needed to insert the intramedullary hip-screw was significantly greater than that needed to insert the compression hip-screw with the plate (p = 0.02), but use of the intramedullary hip-screw was associated with less estimated intraoperative blood loss (p = 0.011). The prevalence of perioperative complications, such as bronchopneumonia, cardiac failure, and urinary tract infection, was comparable in the two treatment groups. There were one intraoperative fracture of the femoral shaft and two intraoperative fractures of the greater trochanter in the group managed with the intramedullary hip-screw. One patient had pulling-out of the compression hip-screw on the seventh postoperative day. Four patients had a trochanteric wound hematoma, without infection, after insertion of an intramedullary hip-screw. All but one of the fractures healed. The one non-union, which was in a patient who had a compression hip-screw, was treated with a hemiarthroplasty. The mortality rate was similar in the two treatment groups. The patients who had an intramedullary hip-screw had, on the average, significantly better mobility at one (p < 0.0001) and three months (p = 0.0013) postoperatively. This difference was no longer seen at six and twelve months, although the patients who had an intramedullary hip-screw still had significantly better walking ability outside the home at those time-periods (p = 0.05). The compression hip-screw was removed from two patients because of pain in the mid-portion of the thigh, which had begun after consolidation of the fracture. Fourteen patients who had an intramedullary hip-screw had cortical hypertrophy at the level of the tip of the nail at twelve months postoperatively. Cortical hypertrophy was significantly related to the use of two interlocking screws (p = 0.02). Six of these patients also had pain in the mid-portion of the thigh, and the nail had been locked with two screws in five of them. Three of the six patients had the hardware removed because of the pain, and the symptoms resolved. A seventh patient had pain without cortical hypertrophy. The intramedullary hip-screw device was associated with significantly less sliding of the lag-screw and subsequent shortening of the limb in the region of the thigh (p = 0.012 and 0.019, respectively); these differences were more pronounced when the unstable fractures in the two treatment groups were compared (p < 0.001).

Aged↗
PubMed2002

Hip joint contact forces in normal subjects and subjects with total hip prostheses: walking and stair and ramp negotiation.

OBJECTIVE: To calculate the hip joint contact force in normal subjects and subjects with total hip replacements. DESIGN: An observational study of age matched normal subjects and subjects with hip joint replacements. BACKGROUND: Hip joint contact forces have been calculated using musculo-skeletal models and measured in vivo using instrumented hip prostheses. There are few examples of studies performed on subjects in the 40-60 year age range. This study characterises the forces in both normal subjects and subjects with hip joint replacements for these 'young' subjects. METHODS: Motion analysis and force plate data were used as input to a three-dimensional model of the leg. Five male and six female normal subjects and five male subjects with hip prostheses were studied. Each subject was observed walking and negotiating stairs and a ramp. RESULTS: Hip joint contact forces in both thigh and pelvic-based co-ordinate systems are presented. Subjects cadence, speed and stride length are given. CONCLUSIONS: In general subjects with hip replacements exhibited lower hip joint contact forces than age matched normal subjects. It is suggested that this was the results of the lower speeds, stride lengths and cadences adopted by the subjects with hip replacements. RELEVANCE: The characterisation of hip joint contact forces provides essential information for prosthetic joint design and testing. The comparison of hip joint contact forces in normal subjects with those in subjects with prosthetic joints provides evidence of, not only actual use of joints, but also of possible levels of force that might be applied to hip prostheses if subjects returned to normal use.

Adult↗
PubMed1999

Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series.

We performed a prospective study in 108 consecutive patients (116 hips) who were followed for a minimum of 10 years (10-12 years) after primary total hip arthroplasty using an uncemented porous-coated anatomic (PCA) hip prosthesis. The average age of the patients at operation was 48.4 years (range, 19-85 years), and the diagnosis was avascular necrosis of the femoral head in 46 hips, neglected femoral neck fracture in 27, osteoarthrosis secondary to childhood pyogenic arthritis in 24, childhood tuberculous arthritis in 5, and miscellaneous in 14. The average preoperative Harris Hip Score was 55 points, which improved to 87 points at 11 years. Seventy-five hips (65%) were excellent, 11 (9%) were good, and 30 (39%) were poor. The overall rate of revision was 15% (17 of 116 hips). The rate of revision of the femoral component was 11% (13 of 116 hips), and the rate of revision of the acetabular component was 15% (17 of 116 hips). The prevalence of thigh pain was 28% at 11 years. The increase in the incidence of aseptic loosening of the femoral component was found to explain the high incidence of severe thigh pain at 11 years' follow-up. At 11 years, there was femoral osteolysis in 69 hips (59%) and acetabular osteolysis in 65 hips (56%). At 6 years, 20 hips (17%) showed definite wear of the polyethylene liner. At 11 years, 81 hips (70%) showed definite wear of the polyethylene liner. Because the complication rate of the PCA hip prosthesis with respect to loosening, osteolysis, and excessive wear in the polyethylene liner is high, we abandoned the use of this implant.

Adult↗
PubMed2005

Hip protectors for preventing hip fractures in older people.

BACKGROUND: Hip fracture in older people usually results from a fall on the hip. Hip protectors have been advocated as a means to reduce the risk of sustaining a hip fracture. OBJECTIVES: To determine if external hip protectors reduce the incidence of hip fractures in older people following a fall. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register (January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to January Week 2, 2005), EMBASE (1988 to 2005 Week 02), CINAHL (1982 to December Week 2 2004), other databases and reference lists of relevant articles. We also contacted trialists. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We sought additional information from trialists. Pooling of uncorrected data from cluster-randomised trials was only done on an exploratory basis. MAIN RESULTS: Fifteen included trials contributed data to this updated review. One trial, which was a study of compliance (adherence) lasting 12 weeks, contributed no fracture outcome data. Pooling of data from eleven trials conducted in nursing or residential care settings, including six cluster-randomised studies, showed evidence of a marginally statistically significant reduction in hip fracture incidence (relative risk (RR) 0.77, 95% confidence interval (CI) 0.62 to 0.97). This analysis showed significant statistical heterogeneity. Pooling of data from three individually randomised trials involving 5135 community dwelling participants, showed no reduction in hip fracture incidence from the provision of hip protectors (RR 1.16, 95% CI 0.85 to 1.59). There was no evidence of any significant effect of hip protectors on incidence of pelvic or other fractures. No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. AUTHORS' CONCLUSIONS: Accumulating evidence casts some doubt on the effectiveness of the provision of hip protectors in reducing the incidence of hip in older people. Acceptance and adherence by users of the protectors remain poor due to discomfort and practicality.

Aged↗
PubMed2003

Influence of contact hip stress on the outcome of surgical treatment of hips affected by avascular necrosis.

INTRODUCTION: Biomechanical analysis is an important tool that could improve the treatment of a diseased hip. However, it is still unclear how the biomechanical status affects the clinical outcome of a certain disease. In this work we studied the long-term effect of contact hip stress on the clinical outcome of hips that were operated on by various intertrochanteric osteotomies due to avascular necrosis of the femoral head. The hypothesis being tested is that the hips with a more favourable postoperative distribution of contact hip stress have a better clinical outcome. MATERIALS AND METHODS: The study was performed on a population of 30 hips. For each hip, we determined the peak contact hip stress before the operation and immediately after the operation by using a recently developed method based on a three-dimensional mathematical model and the data from standard anteroposterior roentgenographs of both hips and pelvis. The hips were evaluated clinically 9-26 years after the operation and divided into a successful and an unsuccessful group. The average change of the peak stress due to the operation was calculated for each group, and the values were compared by t-test. RESULTS: In the successful group the operation caused an average decrease of the peak hip stress of about 10%, while in the unsuccessful group the operation caused an average increase of the peak hip stress of about 4%, the difference between the respective changes of the peak stress due to the operation being statistically significant ( p=0.001). CONCLUSION: Our results support the hypothesis that the hips with a more favourable postoperative distribution of contact hip stress have a better clinical outcome.

Adult↗
PubMed2005

Auditing hip ultrasound screening of infants at increased risk of developmental dysplasia of the hip.

BACKGROUND: Clinical examination, while useful, has been shown to be insufficient as the sole screening method in infants. Ultrasound examination at 8 weeks in high risk infants is an integral part of the screening process in some units. AIMS: To show the efficiency of hip sonography in detection of developmental dysplasia of the hips in those without clinically dislocated hips. METHODS: All infants born at the National Maternity Hospital between January 1994 and December 2001 were included. All those with clinically dislocated hips were treated by a Pavlik harness and referred for follow up to a paediatric orthopaedic surgeon. An 8 week hip ultrasound scan was performed for those infants with stable hips on examination but who met the following criteria: (1) a first degree relative with congenital dislocation of hips; (2) breech presentation at birth; and (3) a persistent "click" at birth in an otherwise stable hip. RESULTS: During the period of study a total of 52 893 infants were born in the National Maternity Hospital. Based on the criteria above, 5485 hip ultrasound scans were performed. Of those scanned, 18 (0.33%) were found to have dislocated hips and 153 (2.78%) to have dysplasic hips. The 18 infants with dislocation were treated with Pavlik harness; the remaining 153 were followed up by serial ultrasound examinations but did not require active intervention. CONCLUSIONS: Among the population of infants at increased risk of developmental dysplasia of the hip, the hip screening programme identified 18 cases among 5485 infants; a rate of 3.2 per 1000. Hip sonography is therefore worthwhile.

Breech Presentation↗