[Multi-stage treatment following old irreversible destruction of the proximal femur].
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Adult↗
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Results for “HIP CONTRACTURE”
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Sequelae of abdominal radiation and their medical management.
As various chemotherapeutic agents are added to treatment routines, the possibility of adverse effects is appreciably increased, particularly in those organs for which the agents have specific toxicity. Symptoms most commonly associated with radiation sickness, such as malaise, anorexia, nausea, vomiting, diarrhea, dysphagia, dermatitis, and depleted hemopoietic elements, are usually seen late in the course of radiation therapy or shortly thereafter. Consequently, they are managed by the physician in charge of radiation or the patient's referring physician. The general physician may be concerned with symptoms arising from delayed organ pathology. These symptoms may arise in many tissues that are still considered somewhat radioresistant, but secondary to sequelae arising because of connective tissue changes from obliterative narrowing of the finer vasculature. Radiation may be only one of several possible causes, and the symptoms of sequelae may appear only after a long latent period, so that the previous radiation may not be considered in the differential diagnosis unless a detailed history is taken. The medical management of these sequelae is, in general, similar to that used for the pathology produced in these organs by other agents.
Abdominal Neoplasms↗
[Surgical treatment of para-articular ossifications after craniocerebral trauma].
This article reports on 45 cases in which extra-articular ossifications were removed following cranial-cerebral traumata. Radiologically detectable relapses occurred in 6% of the patients only; however, in none of these cases did the relapses lead to reankylosis of the joint. In the sagittal plane, the average gain in mobility was an increase of 84 degrees in the hip joint and of 100 degrees in the elbow joint. Considerable complications were caused by four fractures in extremely osteoporotic bones. To reduce the fracture rate, surgery should be performed as soon as possible after bone maturation. In addition, treatment of patients with craniocerebral traumata and serious concomitant conditions requires an experienced rehabilitation team.
Adolescent↗
Transient osteoporosis.
Six hips in four patients with hip pain, limited range of motion, no antecedent trauma, and normal laboratory studies demonstrated roentgenographic evidence of periarticular osteoporosis. The subchondral cortex was attenuated. There was little or no cartilage loss. The preliminary diagnosis was transient osteoporosis (migratory osteolysis, regional osteoporosis). This problem is most frequently seen in the hip joint in two population groups: men near 40 and women in the third trimester of pregnancy. Other joints may be involved and the process may regress in one joint but recur in another. Diagnosis is based on typical clinical and roentgenographic observations including an aspiration of sterile joint fluid. Radioisotope scanning may be helpful. Bone or synovial biopsy sampling is not necessary. Proper management requires accurate diagnosis and conservative treatment of a cooperative patient. Pain may persist for six months or longer. Treatment consists of analgesics, protection against stress fractures, and physical therapy for prevention of contractures.
Adult↗
[Involvement of the hip in systemic-onset forms of juvenile chronic arthritis. Retrospective study of 28 cases].
The objective of this work was to evaluate the course of hip disease in patients with systemic-onset juvenile chronic arthritis. 59 patients with systemic-onset juvenile chronic arthritis followed-up for a mean of 15 years (+/- 6 years) were studied retrospectively. 28 patients (47.5%) had involvement of the hip. Mean age at onset of symptoms of hip disease was 9.5 years (+/- 5 years). Hip arthritis was always preceded by other manifestations of the disease, including arthritis of other lower limb joints. Mean time interval between onset of the disease and onset of hip symptoms was 6.3 years (+/- 3 years). In 66% of cases, symptoms occurred simultaneously in both hips. Eight of nine patients with initially unilateral hip arthritis subsequently developed arthritis of the other hip; in four patients, less than one year elapsed between involvement of the two hips. Roentgenographic changes were variable and included acetabular protrusion (25%), complex cervico-cephalic and acetabular growth disorders (21%), subdislocation (18%), a short femoral neck with varus deformity (14%), and a long femoral neck with valgus deformity (14%). Avascular necrosis of the femoral head occurred in three patients. Roentgenographic evidence of repair was seen in one patient. Among the ten patients who required surgery, two had corrective osteotomy with adductor tenotomy and eight had total hip arthroplasty (of both hips in six patients) with good short- and medium-term outcomes. After arthroplasty, a single patient required reoperation in the short term, for persistent flexion contracture. Loosening of the acetabular arthroplasty required revision in two patients 5 and 10 years, respectively, after the initial procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Arthritis, Juvenile↗
Bipolar hip arthroplasty in ankylosing spondylitis.
Nineteen severely affected hips in 12 young patients with ankylosing spondylitis were treated with bipolar hip arthroplasty followed by a comprehensive postoperative rehabilitation programme. Additional operative procedures of adductor tenotomy, knee flexion release, supracondylar femoral osteotomy for genu valgum and tendo Achillis lengthening for equinus contracture were required in 13 limbs. After a mean follow-up of 45.8 months, results were good in all cases with respect to relief from pain, and there was significant improvement in posture and function. All the patients resumed employment. The average gain in sum total range of hip movements was 194 deg, and the mean preoperative Harris hip score of 27.8 improved to 82.6 after bipolar arthroplasty. Ectopic ossification did not develop in any case. Bipolar hip arthroplasty appears to be ideally suited for young patients with ankylosing spondylitis.
Adult↗
[Methods of functional management of patients after arthroplasty of the hip].
The authors present their methods of working out the movements in the first days after the arthroplasty of the hip joint performed according to A. C. No. 1058493 (1982). The peculiarities of the management of the patients with bilateral pathology with a steady flexion and adduction contracture or ankylosis with a faulty posture of the extremity in the opposite unoperated joint have been pointed out.
Adolescent↗
[Treadmill therapy in patients after ischaemic stroke].
Treadmill training with body weight support was applied in 30 patients who had suffered an ischaemic stroke, with the goal of improving their independence in the activities of daily living (ADL). The following inclusion criteria were used: inability to walk (FAC-score 0 - 2); motor abilities (the ability to sit without support, a palpable muscle function of the hip extensors, abductors and the knee extensors in the affected leg); adequate cooperation, motivation and vigility; absence of muscle contractures which would affect gait; onset of therapy no later than one year after the incident. The average duration of treadmill training was 6,6 weeks. The patients' age was an average 68 years (48 - 82). 87 % of the patients were able to improve their gait within the Functional Ambulation Categories (FAC) scale. 60 % of the patients achieved the ability to walk independently without technical aid. Apart from improving their gait, the patients also attained significantly increased scores in the motor scale of the Rivermead Motor Assessment (gross function) and the motor part of the ADL scale of the Barthel Index (items 2 - 4) and the Functional Independence Measure (items 3 and 4). Treadmill training is establishing itself as an important therapeutic approach in gait rehabilitation with patients with acquired brain damage.
Activities of Daily Living↗
Congenital dislocation of the knee: overview of management options.
Congenital dislocation of the knee (CDK) is rare and includes a spectrum of hyperextension disorders of the knee. Early recognition of CDK is important, and careful evaluation is required to rule out associated hip deformity. Early manipulation, combined with splinting and casting, is the mainstay of initial treatment. Patients with seemingly fixed contractures may respond rapidly to serial casting and then can be placed in a Pavlik harness. Severe recalcitrant deformities or late presentation of the deformity may require surgical release. We highlight the importance of diagnostic categorization, show management options, and provide an overview of this rare but clinically significant problem. We present two case reports that illustrate the full range of management options.
Humans↗
Patellofemoral dysplasia in infantile cerebral palsy.
The authors have studied the biomechanical basis of functional alterations in the extensor apparatus of the knee in cases of infantile cerebral palsy. Several interesting aspects of the problem, some of which are controversial, have emerged from this study and from a review of patients with flexion contracture of the knee treated surgically: 1. The neurological pathology of the motor system leads to problems of posture and dysplastic conditions of the hip (coxa valgus, etc.) which favour the development of patellofemoral pathology. 2. By contrast, the early clinical manifestations of this pathology are relatively insignificant and completely overshadowed by the major problems of adaptation and compensation imposed by the more serious overall disabilities which face the patient in order to stand and walk. The knee plays a prevalently static role at this stage and is not particularly stressed during joint movement. 3. The clinical manifestations of patellofemoral pathology are thus paradoxically brought into focus by surgery on the flexor apparatus to deal with contracture. Although on the one hand this improves function, on the other it brings to light the more complex functional mechanisms of the knee, thus emphasizing any deficit in the extensor apparatus.
Biomechanical Phenomena↗
The management of a person with haemophilia who has a fixed flexed hip and intractable pain.
The clinical picture of a fixed flexed hip associated with pain in a person with haemophilia is suggestive of a haemorrhage in that area. Sonography facilitates differentiation between a haemarthrosis, intraperitoneal haemorrhage, subperiosteal bleed, a bleed into the soft tissue around the hip joint or a psoas haematoma. All these aforementioned causes may result in the same clinical presentation. Two cases are described in which coxhaemarthrosis resulted in a flexion contracture of the joint associated with severe intractable pain. Narcotic drugs failed to alleviate the severe pain. Joint aspiration produced dramatic pain relief and early joint rehabilitation.
Adult↗
[A roentogenographical study on the alignment of the lower extremities in secondary coxarthrosis].
Alignment of the lower extremities in secondary coxarthrosis (273 lower extremities) and controls (240 normal lower extremities) were studied using roentogenograms of whole lower extremities including the pelvis taken in the standing position with both legs. Secondary coxarthrosis, which is caused by congenital dislocation of the hip joint, was classified into four groups: unreduced dislocation, high dislocation, incomplete dislocation, and dysplasia of the acetabulum. Comparative studies were conducted using statistical data on measured items, obtained from secondary coxarthrosis cases and controls. In controls, the femoro-tibial angle (FTA) was 175.5 +/- 2.08 degrees and the mechanical axis passed through the medial side to the middle of the knee. It has been noted that a tendency for bow-legs was seen after the age of 50. In coxarthrosis with high dislocation, the most marked knock-knees were observed (FTA of 172.5 +/- 3.88 degrees), while in coxarthrosis with incomplete dislocation and dysplasia of the acetabulum, there was a tendency to coxa valga but no tendency toward knock-knees was evident. Cases of total hip replacement revealed that it is possible to improve knock-knees by installing a socket in the primary acetabulum as much as possible, correcting the difference between the length of the legs and elimating adduction contracture. It was also possible to study factors contributing to bow-legs and knock-knees by means of multivariate analysis.
Adolescent↗
Heterotopic ossification as a complication of toxic epidermal necrolysis.
The development of heterotopic ossification (HO) as a complication of toxic epidermal necrolysis (TEN) has not been previously reported. TEN, also known as Lyell's syndrome, is a rare but serious skin disorder that typically occurs after the administration of drugs, especially sulfonamides, barbiturates, phenytoin, and nonsteroidal anti-inflammatory agents. TEN is characterized by the development of large fluid-filled bullae with separation of large sheets of skin. Complications of TEN can include extensive denudation of skin with dehydration and electrolyte abnormalities, gastrointestinal hemorrhage, acute tubular necrosis, secondary infection of denuded skin, pneumonia, bacterial conjunctivitis, keratitis, and septic infarcts of internal organs. We report a case of HO in a patient with TEN after treatment with trimethoprim-sulfamethoxazole. A 49-year-old man developed an erythematous rash, bullae, fever, and extensive skin loss consistent with a diagnosis of TEN. He was intubated for complications of TEN (pneumonia) and maintained on bed rest for several weeks. In addition, he developed HO that resulted in multiple joint contractures. He was treated with aggressive range of motion by physical therapy, surgical resection of the HO followed by radiation to both elbows, right hip, and right knee. Postoperative outpatient rehabilitation enabled improved function in his mobility and activities of daily living. HO is known to occur after spinal cord and brain injuries and burns. It has not been reported to occur after TEN. Our experience with this case suggests that HO may merit inclusion into the list of complications of TEN.
Anti-Infective Agents↗
Arthrographic findings in septic arthritis of the hip in infants.
Both standard radiography and arthrography are essential in the diagnosis of septic arthritis in infancy. Plain films demonstrate lateral subluxation, marked delay in appearance of the femoral ossification center, deformity of the femoral neck, and acetabular dysplasia. Arthrography shows cartilaginous deformity, subluxation, and contracture of capsular structures. These observations may distinguish the late sequelae of bacterial infection from other entities such as noninfectious avascular necrosis.
Arthritis, Infectious↗
[Radiation injuries of the locomotor system (author's transl)].
Radiation injuries of the locomotive apparatus manifest themselves in three ways, each one of which may appear alone or in combination with the other two: 1. Radiation osteonecrosis 2. Growth disturbance due to epiphyseal injury. 3. Scar formation in the skin, fascia, and muscles The results of corrective operative procedures depend almost totally on the condition of the soft tissue. In those patients with a reasonable life expectancy, extensive operation procedures are indicated if they will restore or preserve function in the extremity.
Adult↗
Gait analysis on the treadmill - monitoring exercise in the treatment of paraplegia.
STUDY DESIGN: A prospective study was performed to evaluate the gait training of seven consecutive spinal cord injured patients and 10 controls on a treadmill using instrumented gait analysis and video documentation. OBJECTIVES: To determine whether it is possible to maintain gait motion within physiological limits during treadmill training. SETTING: Primary and secondary care unit for spinal cord injury, Heidelberg, Germany. METHODS: Treadmill training was instituted as early as possible. Gait analysis was performed when the patients were stable enough to walk without manual aid from therapists and enough endurance to allow measurements. A control group of healthy volunteers were examined as well. Video documentation and a camera system using passive markers were employed. RESULTS: Treadmill training started with weight reduction of 25% of bodyweight (18 (0-35) kg), maximum walking speed 0.28 (0.15-0.7) m/s and maximum walking duration 4.7 (3-7) min. At the end of the training, weight reduction decreased to 9.3 (0-20) kg, maximum walking speed increased to 0.67 (0.23-1.1) ms with a maximum walking duration of 11 (8-15) min. 3-D motion analysis of hip, knee and ankle demonstrated joint excursions almost entirely within the limits of normal gait. Exceptions were due to fixed contractures. CONCLUSIONS: Our data suggests that it is possible to perform early gait training on a treadmill with no supportive orthoses within the physiologic range of joint motion. The risk for repetitive stress injuries or other negative effects is low.
Adolescent↗
Elbow Arthritis: Treatment Options.
The treatment of elbow arthritis is conceptually similar to that for arthritis of other major joints. The treatment of elbow arthritis has been evolving rapidly due to advances in arthroscopic techniques and surgical treatment for contractures and improved prosthetic designs. The reliability of total elbow replacement is approaching that of total replacement of the knee, hip, and shoulder. There remain a number of controversies and unanswered questions that require further experience and longer follow-up for resolution.
Journal Article↗
Orthopaedic problems associated with tuberous sclerosis.
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Achilles Tendon↗