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PubMed1988

Modular noncemented total hip arthroplasty for congenital dislocation of the hip. Case report and design rationale.

The highest rate of failure and the greatest technical difficulty in total hip arthroplasty occurs with congenital dislocation of the hip (CDH). Predisposing factors are failure to secure special femoral components to fit an extremely narrow and straight medullary cavity with space for only a very thin mantle of cement. The acetabulum is usually atrophic, and bone grafts are commonly required to support a small-diameter cup. The young age of the average patient and high levels of activity contribute to cement failure. A new modular cementless prosthesis provides excellent immediate skeletal fixation and pain relief in CDH patients. Five modular components are screwed or press-fit into bone. The modular approach facilitates implantation, reduces inventory, and is adaptable to unforeseen problems. These advantages are ordinarily absent with standard or custom cemented components. Modular components may also permit easier revision. The prosthesis is made of titanium alloy for its superalloy strength, elastic modulus, and bioinertness. By omitting the cement mantle, press-fit is obtained with the largest possible implant. The large size minimizes stem breakage in these young, small bones. Excellent short-term results suggest that modular cementless implants are indicated in some patients with CDH.

Adult↗
PubMed1984

Total hip replacement for Paget's disease of the hip.

We reviewed our experience with total hip replacement for coxarthrosis due to Paget's disease. The clinical and radiographic results in twenty-one patients who had a total hip replacement between October 1972 and February 1982 were analyzed. The ages of the patients averaged 68.6 years (range, fifty-seven to eighty years) and there were twelve women and nine men. The follow-up averaged five years and two months (range, two years to eleven years and four months). A good or excellent result was achieved in eighteen patients. Of the other three patients, two required a revision operation at two and one-half and five years postoperatively for symptomatic mechanical loosening of the femoral component. The remaining patient had a fair result because of activity of the Paget's disease. Special problems that we encountered included varus deformity of the proximal end of the femur predisposing to varus placement of the femoral component, protrusio acetabuli, increased blood loss, sclerotic bone that made reaming difficult, and heterotopic ossification.

Aged↗
PubMedDate not supplied

Total hip arthroplasty in congenital dislocated hips.

Experience with six typical cases demonstrates that total arthroplasty for congenital dislocated hips may be associated with malalignment of the ipsilateral knee, leg-length inequality, pelvic obliquity and structural changes in the lumbosacral spine. The preoperative planning may include computerized tomography scan to obtain accurate information about the optimal placement of the socket and the size and shape of the prosthetic components. Loosening of the stem or socket rather than polyethylene wear is the expected cause of late failure. The design of the femoral component should fit the canal and the shape of the proximal femur. Biological causes for failure, such as granulomatous reaction to wear, particles, and infection, are known but were not encountered in the present series of cases. The surgical technique is designed to obtain complete coverage of the socket in the available bone. A supplementary bone graft provides additional bone stock and is especially important for revision operations. Orientation of the components, stability of the joint, the need for tenotomy of contracted structures, and the improvement of abduction and flexion muscle power are also important considerations. Elderly patients with degenerated, painfully dislocated hips that are refractory to conservative treatment, may be candidates for arthroplasty.

Acetabulum↗
PubMed1995

Total hip replacement and other orthopedic hip procedures.

The history of total hip replacement including that of the Girdlestone procedure and resurfacing procedures is discussed. An overview of total hip replacement and its indications and complications forms the bulk of this section. Also, the use of porous-coated prostheses and endoprostheses as well as pins and plates is discussed and illustrated.

Bone Cements↗
PubMed1994

Resultant hip joint force after total hip replacement.

Bending moments acting on the LIMA-LTO femoral stem were calculated using a 3D mathematical model of the hip in the one-legged stance based on muscle anatomical data. The effects of 1 cm medialization and lateralization of the hip joint rotation centre (RC) on the bending moments were determined for different body weights. It was found that the bending moments and hence the stem loosening incidence are higher in lateralization compared to medialization of the RC. In order to diminish the bending moments, body weight should be reduced.

Biomechanical Phenomena↗
PubMed1993

Iatrogenic Z-deformity of the proximal femur in an osteoarthritic hip. Subtrochanteric osteotomy with intramedullary fixation for arthroplasty of the hip. A case report.

Hip osteoarthritis in its final stage may require arthroplasty. Sometimes an extreme Z-deformity of the proximal femur is present, if a previous valgus trochanteric osteotomy has been performed. To correct a Z-deformity of the proximal femur during total hip arthroplasty, a subtrochanteric corrective osteotomy was performed in a 52 year-old woman. Intramedullary fixation of the osteotomy was secured using a standard long-stem isoelastic femoral component alone.

Female↗
PubMedDate not supplied

The prone hip extension test: a method of measuring hip flexion deformity.

The "prone hip extension test" is described as a simple, convenient, and reliable method of measuring hip flexion contracture. The test may be performed on a padded examining table or bed, it is applicable to the spastic patient, and as the patient is examined prone, it provides a method of flattening the lumbar spine under visual control to avoid obtaining either a falsely high or low value. It, therefore, circumvents the problems commonly associated with the traditional "Thomas Test".

Child↗
PubMed1977

Roentgenographic measurements after Müller total hip replacement. Correlations among roentgenographic measurements and hip strength and mobility.

In fifty-two patients with Müller total hip replacement, roentgenographic measurements of prosthetic component positioning were correlated with hip-muscle strength and mobility measurements. Compared with the normal side, the average position of the center of the prosthetic head was more medial and superior in the pelvis, and the greater trochanter was more distal and lateral. Increasing neck length (distance from the center of the prosthetic head to the lesser trochanter) and a more distal position of the greater trochanter were among the measurements that related favorably to measurements of patient function. More superior placement of the center of the prosthetic head in the pelvis was associated with a more superior position of the lesser trochanter, which related adversely to function.

Aged↗
PubMed1976

Total hip reconstruction in chronically dislocated hips.

The pathological anatomy of chronically dislocated hips makes reconstruction for more difficult in them than in most cases. The acetabular component must be seated at the site of the original triradiate cartilage and the femur must be shortened four or more centimeters to prevent excessive limb lengthening. This means that the femoral component must be seated in the smallest, strightest portion of the intramedullary canal. A specially designed prosthesis is often needed. Twenty-two hips were operated on in this series, and all patients had relief of pain and improvement of gait. One major complication occured: a sciatic-nerve palsy due to overlengthening of the femur and improper postoperative positioning.

Acetabulum↗
PubMed1987

Ultrasonic investigation of the hip in newborns in the diagnosis of congenital hip dislocation: classification and results of a screening program.

The method of ultrasonic examination of the hip is described, the latest updated Graf classification is explained, and the results of a prospective screening program are described. One thousand four hundred and sixty newborn infants were examined by ultrasound and clinically by independent observers. The distribution of the ultrasound types was determined. Recommendations are given for the use of ultrasonic investigation of the hip for groups at risk in the neonatal period.

Female↗
PubMed1992

Prevention of deep vein thrombosis with low molecular-weight heparin in patients undergoing total hip replacement. A randomized trial. The German Hip Arthroplasty Trial (GHAT) Group.

In a double-blind, randomized multicentre trial, the efficacy and safety of two regimens for the prevention of postoperative venous thrombo-embolism, low-molecular-weight heparin (LMWH) CY 216 and unfractionated heparin (UH), were compared in 341 patients undergoing elective total hip replacement. A group of 169 patients received one subcutaneous injection of 48 mg (approximately 10,000 anti-Xa IC units) LMWH and two placebo injections per day and 172 patients received a fixed dose of 5000 IU UH t.i.d. Deep vein thrombosis was assessed by bilateral phlebography on day 14 +/- 1 after surgery. Phlebography was successfully performed in 136 patients in the LMWH group and 137 patients in the UH group. Deep vein thrombosis occurred in 45 of 137 patients (33.1%) treated with LMWH CY 216 and in 47 of 136 patients (34.3%) who received UH. Pulmonary embolism occurred in 2 of 167 evaluable patients (1.2%) in the LMWH group and in 6 of 168 patients (3.6%) in the UH group. In addition, the incidence of proximal deep vein thrombosis was evaluated and was found to be 10.3% (14/137 patients) in the LMWH group and 19% (26/136 patients) in the UH group (P = 0.044, two-sided). The safety of the treatments, as assessed by the incidence of major haemorrhage, intra- and postoperative blood loss, transfusion requirements, haemoglobin drop and frequency of wound haematomata, was similar in the two groups. It is concluded that prophylaxis of postoperative thrombo-embolism in hip surgery with one subcutaneous injection (48 mg) of LMWH CY 216 is as effective and as safe as prevention with fixed low-dose heparin (5000 IU t.i.d.). A tendency to reduced rates of pulmonary embolism (3.6% vs. 1.2%) and proximal deep vein thrombosis (19% vs. 10.3%) was observed in favour of LMWH CY 216.

Aged↗
PubMed2005

[Comparison of total hip replacements cup orientation and position. Navigation vs. conventional manual implantation of hip prostheses].

BACKGROUND: Aim of this in-vitro study was to compare the hip cup placement for total hip replacement when using different navigation systems compared with the traditional, non-navigated technique. METHODS: Five different navigation systems were used: the CT-less systems Navitrack, Orthopilot and Surgetics Station, as well as the CT-based Navitrack and VectorVision. Three different surgeons carried out five cup implantations using all navigation systems and the manual approach on a surgery dummy. Cup orientation (inclination and anteversion) and the cup position (achieved cup center) were determined with a coordinate measuring machine. RESULTS: In the manual group the variability of the cup orientation was higher in comparison and hardly influenced by the surgeon. Navigation was identified as a significant factor for smaller deviations from planned inclination and anteversion angles (p<0,001 for both). Cup position was not affected by surgeon in the manual group (p=0,966). Compared with manual technique, the cup misplacement vector was significantly smaller in the CT-Navitrack group (p<0,001) but higher in the Navitrack (CT-less) and VectorVision group (p<0,001). CONCLUSIONS: The use of computer navigation will help the surgeon to orientate the acetabular component more accurately but not necessarily with regard to cup positioning.

Acetabulum↗
PubMed2001

Acceptance of hip protectors for hip fracture prevention in nursing homes.

In order to prevent hip fractures 548 fall-prone senior citizens living in 20 nursing homes participated in a randomized controlled trial of hip protectors. One hundred and sixty-four were randomly selected into the control group and 384 into the intervention group. Of the patients in the intervention group 138 (35.9%) wore the protector throughout the whole 10 months of the study's duration, 124 (32.3%) quit wearing the protectors after an initial wearing period and 122 (31.8%) refused to wear them at all. The regular wearers had the protector on during an average of roughly 12 hours a day, so they were protected for 50% of their exposure time (including at night). Fifty-nine percent of the drop-outs stopped wearing the protectors in the first two study months, mostly for non-medical reasons. Calculation by a forecasting model showed that those senior citizens who were initially prepared to wear the protector tended to be those who were physically restricted.

Accidental Falls↗
PubMed2002

Decreased interposition after closed reduction in the hip joint: a case of developmental dislocation of the hip observed by MRI.

A 4-month-old Japanese girl with a developmental dislocation of the right hip was treated with manual reduction under general anesthesia followed by cast immobilization. Serial magnetic resonance imaging (MRI) revealed that a large interposition of fat tissue in the acetabulum, observed immediately after cast immobilization, became remarkably small in size as the congruity improved after 3 weeks. These MRI findings demonstrate the mechanism of a "squeezing phenomenon" after reduction of the hip.

Casts, Surgical↗
PubMed2003

Long-term follow-up care recommendations after total hip and knee arthroplasty: results of the American Association of Hip and Knee Surgeons' member survey.

Long-term follow-up care is needed to evaluate and manage hip and knee arthroplasty outcomes, because impending failure may be asymptomatic. All active American Association of Hip and Knee Surgeons' members (N = 682) were surveyed for recommendations for follow-up care type and frequency, radiograph interpretation, and clinical indicators related to follow-up frequency intervals; and to describe reimbursement experiences and practice demographics. The response rate (65.5%, n = 447) established a 95% (+/-3%) confidence interval for the survey results. We found that 80% of respondents recommended annual or biennial orthopaedic clinical and radiographic examinations, with more frequent follow-up times for clinical or radiologic signs of failure, previous revision arthroplasty, previous joint sepsis, and subnormal periprosthetic bone quality. Further research is needed to correlate follow-up care type and frequency with outcomes, complications, and costs.

Arthroplasty, Replacement, Hip↗
PubMed2006

Patients' outcome after total hip arthroplasty: a comparison between the Western Ontario and McMaster Universities index and the Oxford 12-item hip score.

This prospective cohort study included 402 patients who had primary total hip arthroplasty. The Western Ontario and McMaster Universities Index (WOMAC) and the Oxford 12-item Hip Score (OHS) were used to assess patients preoperatively and at 1 year postoperation. The OHS has a higher responsiveness than the WOMAC in the global scale and in the pain subscale. However, the WOMAC has better responsiveness in its function scale. The point estimate of relative precision of measuring postoperative quality of life shows that the OHS has a tendency toward a better performance than the WOMAC; however, this finding is not statistically significant. The OHS also demonstrates similar floor and ceiling effect patterns as does the WOMAC. We recommend that the choice should depend on which scale researchers are using to power a study.

Arthroplasty, Replacement, Hip↗