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At least 793 records · Page 44Linked to original sources
PubMed1995

Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study.

OBJECTIVE: To compare the efficacy of the gamma nail (GN) to the dynamic hip screw (DHS) in the management of intertrochanteric hip fractures. DESIGN: Randomized, prospective clinical trial with a mean follow-up of 52 weeks (range from 11 to 82 weeks). SETTING: A university teaching hospital. PATIENTS: One hundred and one patients with 102 fractures: 49 fractures were treated with the DHS and 53 fractures were treated with the GN. INTERVENTIONS: Fracture fixation with the DHS or the GN. MAIN OUTCOME MEASURES: Comparison of duration of operation, blood loss, early and late complications, functional outcome and duration of hospital stay. RESULTS: There was no significant difference between the two groups with respect to intraoperative blood loss, days in hospital, time to union and eventual functional outcome. The length of the procedure and fluoroscopy time were longer for the GN group. CONCLUSIONS: Both the GN and the DHS can be used effectively for the treatment of intertrochanteric fractures. In this study the DHS was associated with a lower risk of local complications and should still be considered to be the implant of choice for patients with intertrochanteric fractures.

Adult↗
PubMed1994

[Cemented hip alloplasty. 11-13-year follow-up study of the Richards' series 2 hip prostheses].

The study comprises a follow-up (11-13 years) of an orthopaedic department's first 131 consecutive cemented total hip arthroplasties (THA). All operations were performed with Richards' Series 2. Posterior approach, plug, lavage, cementation with cement pistol, antibiotics and low-dose heparin. At the time of follow-up 44 patients (38%) were dead (= 49 THA), and 56 patients representing 65 THA (50%) were available for the follow-up, on average 11.95 years (11-13 years) after the operation. The patients hip/hips were examined as regards a) pain b) walking ability and c) hip-mobility (M. d'Aubigné) (HFI). A frontal x-ray of the pelvis and hip/hips was taken. The examining surgeon evaluated the hip/hips based on a clinical examination and the x-ray as 1 = stable, 2 = perhaps loose, 3 = most likely loose and 4 = definitely loose both with regard to the acetabular and femoral component. Pre-operatively 78% of the patients had an ideopathic coxarthrosis. Eight patients had considerable postoperative complications. Ten patients (7.8%) were reoperated during the examination period: two due to loosening of the total prosthesis, one due to loosening of the cup, three due to loosenings of the femoral component, two because of recurring luxations, one late (deep) infection and one fracture of the femur near the prosthesis. Preoperatively the patients' HFI was at 8.6, at follow-up 15.8. The clinical and the radiographic examination showed that 86% of the acetabular cups and 63% of the femoral components were fixed solidly.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

The development of a physiological hip prosthesis: evaluation of the strains after implantation of a prototype of hip implant: experiment in a dry femur.

Based upon previous research on the relation between hip prosthesis designs and strain distributions in a proximal femur model, a prototype of a "physiological" hip prosthesis was designed and manufactured. Strain gauge measurements on a dry femur before and after implantation of this prosthesis were made in different loading conditions simulating one-legged stance with and without torsional loading and two-legged stance. The strains in the outer cortex were within 10% of the physiological values along the whole medial side in all measurement conditions.

Biomechanical Phenomena↗
PubMed1996

[Placement of anti-rotation screw using a fixed parallel bore guide device in dynamic hip screw management of hip para-articular femoral fractures].

We implanted in case of hip-near fractures of the femur after DHS the anti-rotation screw with help of a special parallel drill guide. It was possible to position the anti-rotation screw in a parallel fashion in all patients so that the dynamic effect of the DHS was not impaired and a faulty penetration of the screw into the hip by a badly positioned anti-rotation screw could be avoided. The radiological follow up shows us no sign of impaired healing.

Bone Plates↗
PubMedDate not supplied

Perthes' disease after "irritable hip": delayed bone age shows the hip is a "marked man".

We report 13 children, aged 4 through 8 years, who were seen with a prolonged or recurrent irritable hip syndrome. Only those with > 2 years' delay in their bone age eventually declared themselves to have been in the early phase of Perthes' disease at initial examination when the original hip radiographs had been normal. A plain wrist radiograph was found to be a useful screening tool to differentiate those who should have early repeat investigation such as radiographs, or preferably a magnetic resonance image scan if available, to detect the disease in its initial phase. This facilitated early regular imaging to assess femoral head shape and so permitted early treatment before deformity had occurred in those with whole-head involvement.

Age Determination by Skeleton↗
PubMed1996

[Replacement of total hip prosthesis--what does the patient expect? Analysis of 248 aseptic hip revisions].

Aseptic loosening of prosthesis with consequential revision operations continues to be a major problem for both the patients concerned and the medical team. In the center of interest stands the magnitude of bone destruction caused by loosening effects. A concept designed to avoid uncontrolled progressive loss of bone stock is presented. Based on the experience of 248 cases of hip revision operations, advice to patients can be given. 2 septic (0.8%) and 6 aseptic (2.4%) cases with loosening and re-revision were documented. Statistical analysis of 5-year survivorship rate according to Kaplan-Meier shows 94.5%, and according to Armitage 92.5%. Clinical and radiologic 5-10-year findings in the first 72 consecutive cases are presented. Routine controls in patients with hip prostheses for early detection of bone destruction may help to perform simple and prognostically favourable revision operations.

Adult↗
PubMed1996

[Extra-articular proximal femur fracture in the elderly--dynamic hip screw or intramedullary hip screw for fracture management?].

Over a 6-year period we treated 119 pertrochanteric fractures using dynamic hip screws (DHS). During the following 3 years we stabilized 112 per-, sub- and intertrochanteric, as well as "trochanter-associated" fractures by means of intramedullary hip screws (IMHS) or gamma nails (GN). Within comparable patient groups we encountered the following complications: DHS vs IMHS/GN: secondary varus malalignment of the collum femoris with "cut out": 1.7% vs. 1.8%; secondary varus malalignment without "cut out": 0.8% vs. 1.8%; infections: 5.0% vs. 2.7%; hematomas needing revision operations: 2.5% vs. 0%; torn out plate: 1.7% vs. 0%; intraoperative fissures of the shaft: 0% vs. 1.8%; intraoperative perforations of the shaft: 0% vs. 0.9%. Thus, the rate of reoperation for complications within the DHS series was 11.8%, while the rate within the IMHS/GN series was 6.3%. For stable pertrochanteric fractures we therefore acknowledge DHS as the ideal implant in our opinion, while for all other extraarticular proximal fractures of the femur we recommend IMHS or GN.

Adolescent↗
PubMed2006

Femoral head diameter affects the revision rate in total hip arthroplasty: an analysis of 1,720 hip replacements with 9-21 years of follow-up.

BACKGROUND: In a previous study concerning 1,660 ScanHip THAs that were followed for up to 12 years, the cumulative revision rate was not found to be dependent on whether a 22-mm or a 32-mm head size had been used. We have re-examined these patients to see whether a longer follow-up time (9-21 years) would disclose an effect of head size on the revision rate. PATIENTS AND METHODS: We analyzed the cumulative revision rate for 1,720 Scan Hip arthroplasties with either 22-mm or 32-mm femoral heads. The patients were followed for 9-21 years. RESULTS: Arthroplasties with 32-mm head had 2.8-times higher cumulative revision rate than those with a 22-mm head. Older age reduced the risk of revision while male sex increased the risk. INTERPRETATION: We found that head size affects revision risk, but that even in a reasonably large material a long follow-up time is required to disclose the effects of head size--and thus wear--on survival.

Age Factors↗
PubMed1975

Total hip replacement as a salvage in traumatic lesions about the hip.

One hundred and eight total hip replacements have been accomplished in an attempt to salvage a problem caused by trauma. Many times, patients with traumatic arthritic problems have a quick transition from a normal existence to a severe disability. They may not have had the ability physically or mentally to handle this disability seen in patients with rheumatoid disease or idiopathic osteoarthritis. It has been shown that these patients with total joint replacement can be rehabilitated to almost a normal degree of function. Complications occur, but with careful planning and execution, they can be held to a minimum. In the long run, a high incidence of degenerative disease is seen in these problems. The primary procedure should not be done so as to jeopardize a secondary reconstruction.

Acetabulum↗
PubMed1994

Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip.

We compared the 3-month dislocation rate for hip hemiarthroplasties inserted via the posterior and direct lateral routes. In all, 2906 primary hemiarthroplasties, performed between 1986 and 1992 in four hospitals on a training hospital rotation, were analysed. The posterior approach was used in 1656 (57%) and the lateral in 1250 (43%). The groups were otherwise comparable. The overall dislocation rate for the posterior approach was 9.0% (149/1656), whereas that for the direct lateral approach was 3.3% (41/2150). The difference is statistically highly significant. In addition, we analysed the dislocation rate for each approach in the three broad groups of surgical trainee. For senior registrars, there was no statistical difference in the dislocation rate. However, for registrars and senior house officers, there were statistically highly significant differences in the dislocation rate for posterior and direct lateral approaches (8.4% vs 3.3% and 14.2% vs 3.6%, respectively). We conclude that, because of the high mortality associated with dislocation of a hemiarthroplasty, the posterior approach for this operation should now be abandoned, especially by surgical trainees early in their careers.

Aged↗
PubMed1994

Failure of the sliding hip screw in the treatment of femoral neck fractures: 'left-handed surgeons for left-sided hips'.

The pre-operative radiographs of 265 patients consecutively treated with sliding hip screws were reviewed. In 244 cases the fixation was for a basicervical or intertrochanteric fracture. The post-operative radiographs of these 244 patients were examined for technical failure of the device. Of the 15 failures analysed, one had occurred where insufficient sliding length had been available to the screw within the barrel, and one was due to jamming of the screw within the barrel. Of the remaining 13 fixations, 12 had occurred where the screw had been poorly positioned within the femoral head, and one device had failed for no obvious reason. Malpositioning of the failures occurred significantly more frequently on the left than on the right, in a Unit where all the surgeons were right-handed. We conclude that the majority of technical failures of the sliding hip screw occur because of poor positioning of the screw. This occurs more commonly on the left side when the surgeon is right-handed.

Bone Screws↗
PubMed2002

Rose hip (Rosa canina L.) oil obtained from waste hip seeds by different extraction methods.

From the rose hip seed, which is generally a waste material, valuable oil can be obtained for medicinal use. Various extraction methods have been compared: traditional solvent extraction with ultrasound-, microwave-, sub- and supercritical fluid extraction (SFE). Unsaturated fatty acid (UFA: oleic-, linoleic- and linolenic acid; 16.25-22.11%, 35.94-54.75%, 20.29-26.48%) and polyunsaturated fatty acid (PUFA:linoleic- and linolenic acid) content were over 90% and 60% in the recovered oils. The oils contained different amounts of metals. The concentration of some metals, particularly iron in microwave oil (27.11 microg g(-1)) is undesirable from the aspect of stability. By traditional solvent extraction, oil was obtained in 4.85 wt/wt%. Subcritical FE appeared to be the best method for the recovery of rose hip oil with highest oil yield (6.68 wt/wt%), carotene- (145.3 microg g(-1)) and linoleic acid content (54.75%). Supercritical FE without organic solvent is suitable for mild recovery of oil. The oil was rich in UFA and PUFA (92.7% and 76.25%) and contained the lowest amount of carotene and pheophytin (36.3 and 45.8 microg g(-1)). Oil yield in most new extraction methods (microwave extraction, super- and subcritical FE) was higher than in the case of traditional Soxhlet extraction. The main benefit of supercritical FE with CO2 is the solvent free oil while in the case of other extractions evaporation of the solvent is needed. Although the content of bioactive compounds in oils was different, all oils may be appropriate for medicinal use.

Carbon Dioxide↗
PubMed2002

Segregation analysis of waist circumference, hip circumference and waist-to-hip ratio in the Korean Nationwide Family Study.

AIM: A central distribution of adipose tissue is frequently associated with cardiovascular disease and its risk factors. In this study, we investigated environmental, familial and genetic influences on waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR) in 2507 members of 435 families who had participated in the Korean Nationwide Health Examination Survey. METHOD: Maximum likelihood methods were used to fit several genetic and nongenetic models of inheritance to these data to determine whether an unobserved Mendelian major gene could explain the familial distribution of WC, HC and WHR. Adjustments for age, age(2), body mass index, smoking, alcohol consumption and exercise were carried out separately for males and females by multiple regression procedures for WC, HC and WHR phenotypes prior to segregation analysis. Regression models were used to test genetic and non-genetic models in these 435 families. RESULTS: Segregation analysis did not provide statistical evidence of a major gene controlling either HC or WHR. Mendelian single-locus models with two underlying genotypic distributions were best supported by these data on WC, and this putative major gene explained the 22.4% of variance in adjusted WC. CONCLUSION: Future linkage studies may be worthwhile to further clarify the mechanisms controlling WC.

Adipose Tissue↗
PubMed1993

[DHS (Dynamic Hip Screw)-osteosynthesis in the management of femoral fractures in the hip region and the place of this method in the treatment of such injuries].

In the last four years we performed 182 osteosynthesizes with Dynamic Hip Screw, besides other methods on the fractures of the hip region. Here we are presenting the evaluation of our results, which, regarding the international scene, fall into the medium category. The operations were performed within three days after the injuries in 61 per cent of our patients. Our results are good in 80 per cent of our patients. The incidence of method-specific complications is 15 per cent in our statistics/such as wound haematomas, local infections, cut out of the device of the femoral head, metal failures, the fracture of the femur at the site of the introduction of the device). The rate of complications is 30 per cent in case of Ender nailing. More than a 1 cm shortening in the fracture after weight bearing was observed in the 47 per cent of our DHS cases. Patients who are complaining of pain during weight bearing belong to this group. In accordance with other authors, we consider the DHS osteosynthesis, due to its high stability, the best technique in case of unstable pertochanteric fractures of elderly patients. We recommend the angular plate fixation to the pertrochanteric fractures in young patients, in whose case it requires a more accurate reposition and who are able to walk without weight bearing. We can achieve good results with Ender nails in case of stable pertrochanteric fractures of elderly patients.

Adult↗
PubMed2007

Biofilm formation by bacteria isolated from retrieved failed prosthetic hip implants in an in vitro model of hip arthroplasty antibiotic prophylaxis.

Bacterial infection primarily with Staphylococcus spp. and Propionibacterium acnes remains a significant complication following total hip replacement. In this in vitro study, we investigated the efficacy of gentamicin loading of bone cement and pre- and postoperative administration of cefuroxime in the prevention of biofilm formation by clinical isolates. High and low initial inocula, representative of the number of bacteria that may be present at the operative site as a result of overt infection and skin contamination, respectively, were used. When a high initial inoculum was used, gentamicin loading of the cement did not prevent biofilm formation by the 10 Staphylococcus spp. and the 10 P. acnes isolates tested. Similarly, the use of cefuroxime in the fluid phase with gentamicin-loaded cement did not prevent biofilm formation by four Staphylococcus spp. and four P. acnes isolates tested. However, when a low bacterial inoculum was used, a combination of both gentamicin-loaded cement and cefuroxime prevented biofilm formation by these eight isolates. Our results indicate that this antibiotic combination may protect against infection after intra-operative challenge with bacteria present in low numbers as a result of contamination from the skin but would not protect against bacteria present in high numbers as a result of overt infection of an existing implant.

Arthroplasty, Replacement, Hip↗
PubMed1992

Inflammatory reactions in primary osteoarthritis of the hip and total hip prosthesis loosening.

In 14 patients [9 with loosened total hip arthroplasty (THA), 5 with primary osteoarthritis], the inflammatory cell infiltrate was characterized in cryostat tissue sections using antibodies against subsets of macrophages and lymphocytes. In all patients the abundance of a mature type macrophage (25F9+) was observed, whereas 27E10+ macrophages, characteristic of acute inflammatory reactions, were not seen in primary osteoarthritis but were found in 4 out of 9 patients with THA loosening. The RM3/1 + macrophage phenotype was seen in some of both sets of patients (osteoarthritis 4/5; THA loosening 4/9). The markers MRP8 and MRP14 typical of immature macrophages, were found in all patients with osteoarthritis and in some (4/9 and 8/9 respectively) of those with THA loosening. IOT4+ T-helper cells were only present in 1/5 5 patients with osteoarthritis and in 2/9 patients with THA loosening. IOT8+ T-suppressor lymphocytes were more frequently present (in 4/5 and 5/9 respectively). The data reveal remarkable differences between the two groups of patients. While the inflammatory infiltrate in patients with osteoarthritis lacks the characteristics of acute inflammation, in patients THA loosening the inflammatory process seems to be determined by periods of acute reactions. The occasional presence particularly of T-helper cells suggests that the inflammatory process is less T-cell but rather macrophage-driven.

CD4-CD8 Ratio↗
PubMed1986

Recurrent traumatic dislocation of the hip in a child: significance of early hip arthrography.

The authors describe a case of a recurrent posterior traumatic dislocation of the hip in a child in whom early arthrography demonstrated a large defect of the posterior capsule. The authors emphasize the necessity of prolonged immobilization and long-term follow-up. The operation of the patient was performed on the 7th day after the third recurrence of the dislocation. Revision and suture of the capsular defect from Gibson's approach were done.

Adolescent↗
PubMed2000

Arthrographic examination of the pseudocapsule of the hip after posterior dislocation of total hip arthroplasty.

We examined the pseudocapsule in ten patients with posterior dislocation after total hip arthroplasty (THA) using arthrography to investigate the relationship between dislocation and the state of the pseudocapsule. The pattern of contrast medium pooling demonstrated on tangential views was evaluated. In five patients with early dislocation arthrography showed leakage indicating lack of pseudocapsule whereas there was no leakage in five patients with late dislocation. Repeat arthrography revealed healing of the pseudocapsule could progress by 6-8 weeks after dislocation. These findings suggest that the difference in the pseudocapsule between those who dislocate early and late may explain different clinical outcomes in the two groups.

Arthrography↗