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PubMedDate not supplied

[Late hip dislocation--treatment results of 1193 hips in attenuated abduction (Hanausek position)].

Results of 1193 dislocated and dysplastic hips in 695 children of a consistent treatment by skin traction and splinting in a mitigated abduction device (Hanausek position) are given with regard to the acetabular development and avascular head necroses. The acetabular development depends on the initial acetabular dysplasia and is overall satisfactory through final acetabular angles (Hilgenreiner) between 22 and 25 degrees even in highly dysplastic acetabula in late cases. The procedure is non-aggressive proven by low rate of femoral head necroses of 3.4%. Factors contributing to higher rates and degrees of iatrogenic damage to the femoral head are short time or no preceding longitudinal traction, low initial acetabular pathology and prolonged splinting.

Acetabulum↗
PubMedDate not supplied

[Development of femoral head ossification in hip joint dysplasia and hip joint dislocation].

The occurrence and development of the ossification nucleus of the femoral head on X-ray films were studied in 85 children with hip joint dysplasia/dislocation. Delayed development was found to be related to treatment modalities or the severity of the dysplasia. Delayed development of the ossification nucleus of the femoral head is probably of considerable prognostic importance.

Child, Preschool↗
PubMed2002

The Gotfried PerCutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain.

BACKGROUND: The PerCutaneous Compression Plate (PCCP) was developed by Gotfried (Israel, Haifa) for minimal-approach osteosynthesis of pertrochanteric fractures. METHODS: One hundred fifteen patients, aged 60 or more, with intertrochanteric fractures (AO type 31A1 or 31A2) were selected randomly for fixation with either the PCCP (53 patients) or the Dynamic Hip Screw (62 patients). All surviving patients were scheduled for a 1-year follow-up. RESULTS: Less invasive surgical stabilization of pertrochanteric fractures with the PCCP resulted in shorter theater and surgical time and reduced postoperative pain. The PCCP treatment showed a tendency toward a lower transfusion need and a reduction of fracture impaction; however, results were not statistically significant. There was a trend toward a higher mechanical complication rate with the PCCP: anatomic closed reduction without posterior sagging of the fracture and fluoroscopic control of the placement of the first neck screw in two directions are essential to avoid technical complications. CONCLUSION: Minimal invasive treatment of pertrochanteric fractures with the PCCP reduces operation time and postoperative pain.

Activities of Daily Living↗
PubMed1997

The burden of waiting for hip and knee replacements in Ontario. Ontario Hip and Knee Replacement Project Team.

The objectives of this study were to assess the impact of major joint replacements in reducing pain and disability and to describe the burden of pain and disability that could be avoided by ordering the queues with respect to severity of disease. A secondary goal was to compare the uses of a general health status measure, the Short Form Health Survey (SF-36), and a disease-specific measure, the Western Ontario McMaster Osteoarthritis Index (WOMAC), for accomplishing the objectives. The results are based on interviews with 209 patients before and after they had surgery. Only 15.9% of the patients had surgery within 3 months' waiting time, 19.2% waited 4-6 months, 30.7% waited 7-9 months, and the remaining 34.1% waited a year or more. The waiting times were unrelated to the severity of pain or disability reported in the initial interview. Following surgery, there were large reductions in the WOMAC scores for pain, stiffness and difficulty in functioning. The SF-36 showed substantial improvements in relief from pain and in physical functioning, and reductions in role limitation due to physical problems, but not for scores related to mental health. The WOMAC scores were more responsive to the benefits of surgery than the SF-36 scores. Queuing systems keyed on burden of symptoms could reduce the burden of pain and disability suffered by patients awaiting surgery. The improvements from hip and knee replacements suggest that equitable access for these procedures should be a priority in Ontario.

Aged↗
PubMed2006

Head replacement, head rotation, and surface damage effects on metal-on-metal total hip replacements: a hip simulator study.

The possibility of replacing the femoral head alone, in either solid or articular surface replacement form, during revision operations on metal-on-metal total hip replacements remains an attractive feature of such implants. In the present investigation, laboratory simulator studies of the influence upon volumetric wear of inserting a new femoral head, of introducing some head rotation, and of damaging the femoral head by scratches have all been explored. New and rotated heads both involve an additional running-in period, but the experimental studies show that the volumetric wear associated with this process is less than the initial running-in wear. The beneficial effects upon volumetric wear of small clearances have been confirmed, while the processing of high-carbon Co-Cr-Mo materials appears to be much less influential. Scratches did not affect wear as much as head replacement or head rotation, but the ongoing wear rates were somewhat higher.

Biocompatible Materials↗
PubMed1997

Mortality and fatal pulmonary embolism after primary total hip replacement. Results from a regional hip register.

We calculated the rates for perioperative mortality and fatal pulmonary embolism (PE) after primary total hip replacement in a single UK health region, using a regional arthroplasty register and the tracing service of the Office of National Statistics. During 1990, there were 2111 consecutive primary replacements in 2090 separate procedures. Within 42 days of operation a total of 19 patients had died (0.91%, 95% CI 0.55 to 1.42). Postmortem examination showed that four deaths (0.19%, 95% CI 0.05 to 0.49) were definitely due to PE. The overall perioperative mortality and fatal PE rates are low and in our study did not appear to be altered by the use of chemical thromboprophylaxis (perioperative mortality rate: one-tailed Fisher's exact test, p = 0.39; fatal PE rate: one-tailed Fisher's exact test, p = 0.56). The routine use of chemical thromboprophylaxis for primary THR is still controversial. The issue should be addressed by an appropriate randomised, prospective study using overall mortality and fatal PE rate as the main outcome measures, but the feasibility of such a study is questioned.

Adult↗
PubMed2003

Mountain sports and total hip arthroplasty: a case report and review of mountaineering with total hip arthroplasty.

Participation in certain sports after total hip arthroplasty (THA) is common. Some high-risk sports such as extreme endurance sports with risks of falls and fractures are often cautioned against, except when the sport was participated in preoperatively and an excellent physical condition is present postoperatively. In this article, current concepts pertaining to this issue in general and in relation to mountain sports are discussed after a description of the activities of a 69-year-old patient who received cementless bilateral THAs in 1987 and 1995 and who resumed, after each rehabilitation, his preoperative sports practice (eg, walking and high-altitude mountaineering [6000+ m]). The patient, who was experienced in alpine and high-altitude mountaineering, was able, after his first operation, to climb classic alpine peaks (4000+ m) as well as participate in difficult and strenuous climbs outside Europe (Kilimanjaro, Elbrus, and Rolwaling trekking). After the second operation and an intensive rehabilitation program, he was able to climb 2 mountains in the range of 6000+ m. With excellent physical training, a long preoperative practice of the sport, and an intensive and careful rehabilitation, patients with a THA are, under specific circumstances, able to perform mountaineering at a very high, even professional level without signs of prosthesis loosening or higher than normal wear of the bearing materials.

Aged↗
PubMed1979

Total hip replacement in juvenile rheumatoid arthritis. Analysis of 59 hips.

The results of 59 Charnley low friction arthroplasties in 41 patients with juvenile rheumatoid arthritis are presented. Mean follow-up was 30 months and mean age at operation 30.5 years. At review 90 per cent had an excellent result and 10 per cent a good result as regards pain relief. Mobility was significantly improved in all but two patients. These two patients developed severe ectopic bone formation. With few exceptions, the results remained constant after 6 months. Intraoperative complications were the most common. Careful selection of patients, advance planning of surgery and appreciation of the developmental abnormalities in these hips are essential features in avoiding complications and achieving a good result.

Adolescent↗
PubMed1995

A large collar increases neck resorption in total hip replacement. 204 hips evaluated during 5 years.

We evaluated the effect of a prosthetic collar on the proximal femoral bone in 204 hips without any signs of loosening after 5 years. The patients were operated on at 5 centers, using different prosthetic designs, but the same cementing technique. Resorption was more often found in cases with a true and large collar (Lubinus, HD2, Scanhip) than in cases with a flanged or tapered stem (Charnley, Exeter). The resorption was also more pronounced with the former designs. It was concluded that, in spite of theoretical advantages, a large collar is not only unnecessary but may also have negative long-term effects.

Analysis of Variance↗
PubMed1997

Nerve injury after hip arthroplasty. 5/600 cases after uncemented hip replacement, anterolateral approach versus direct lateral approach.

In 600 consecutive uncemented total hip replacements, 2 surgical approaches were used: the direct lateral Hardinge approach in supine position (group I: 241 cases) or in a lateral position (group II: 280 cases) and the anterolateral Watson-Jones approach in supine position (group III: 79 cases). 5 patients had clinically evident peripheral nerve injuries confirmed with EMG: none in group I, 1 lesion of the nervus ischiadicus and nervus femoralis in group II and 4 nervus femoralis lesions in group III, of which 1 was combined with an obturator nerve injury. The nerve injuries were evaluated with EMG. All 4 nervus femoralis lesions recovered spontaneously, but the one patients in group II had a persistent palsy of the peroneal nerve. The anatomical basis for the higher prevalence of nervus femoralis lesions in the anterolateral Watson-Jones approach is described.

Aged↗
PubMed1999

The effect of hospital-type and operating volume on the survival of hip replacements. A review of 39,505 primary total hip replacements reported to the Norwegian Arthroplasty Register, 1988-1996.

We investigated associations between the survival of total hip replacements (THRs), type of hospital and annual number of THRs per hospital. The study was based on 39,505 primary THRs reported to the Norwegian Arthroplasty Register from 45 local (n 20,756), 15 central (n 12,455) and 10 university hospitals (n 6,294) during 1988-1996. The annual number of THRs was highest at central and university hospitals, both of which are training hospitals. University hospitals were further characterized by the lowest mean annual number of THRs performed per surgeon. For cemented THRs, with adjustment for gender, age, diagnosis, surgical procedure, and annual hospital volume, the revision rates at central and university hospitals were 0.8 (95% confidence interval: 0.67-0.95) and 1.2 (CI: 1.02-1.47) times that of local hospitals, respectively. A high annual number of cemented THRs per hospital was not associated with lower revision rates. In uncemented THRs, survival results were similar in central and local hospitals, whereas the adjusted revision rate at university hospitals was 1.6 (CI: 1.13-2.19) times that of local hospitals. The adjusted 6.5 year revision probability was 12% in hospitals performing < or = 10 uncemented THRs per year (n 606), 8% in hospitals performing from 18-28 operations (n 1,378) and 5% in hospitals performing > 84 operations (n 526).

Adult↗
PubMed1991

Comparison of the early healing course of porous titanium with hydroxyapatite-coated porous titanium hip implants: clinical considerations for the use of hydroxyapatite coating in total hip replacement.

The role of hydroxyapatite (HA) coating in the fixation of human total joint prostheses remains to be established. Results of animal studies have been favorable, showing very rapid bone formation with a corresponding increase in bone-implant bond strength. In addition, the quantity of bone may be increased. This study compared identical porous titanium primary total hip implants with and without HA in similar patient populations. All of these patients were healthy and reliable, and had optimal bone geometry and bone quality for cementless fixation. The purpose of the study was to contrast the sequence of events, in the first year after surgery, between the two implant groups to identify the contribution of HA to early patient function and early radiographic appearance of the prosthesis. No significant clinical difference could be demonstrated between the two groups at 1 year from surgery. However, the HA group progressed more rapidly when comparing clinical scores at 6 months (P = .0058), and appeared to demonstrate more rapid bone remodeling at 6 months on the femoral side, although this observation did not quite make statistical significance (P = .0618). There was no difference between the acetabular components during the course of this study.

Female↗
PubMedDate not supplied

Biomechanical considerations of multiple-component hip prostheses. Analysis of three failures of the Lippman transfixation hip prosthesis.

Three cases are presented and analyzed in which a Lippman Transfixion Hip Prosthesis had to be replaced because of the discomfort of the patient. In each case, there was evidence of wear between the head of the prosthesis and the flange. The different wear patterns indicated problems which exist in the alignment of component parts of the prosthesis. In each case there was low grade sepsis to which the debris may have contributed. Because of phagocytosis, amount of debris accumulation was difficult to evaluate. The factors which appear to have contributed to the amount of debris accumulation were: the length of time the prosthesis had been used; the degree of alignment and amount of debris which may be formed and is phagocytized; the degree of manufacturing control. The design of this prosthesis incorporated mechanical problems which are generally undesirable because of: the eventual deformation of the end of the pivot rod or hole in the head of the prosthesis: progressive loosening of the movement due to this and inherent malalignment; the difficulty in fabrication, assembly and installation of the prosthesis because of the multiplicity of parts; the difficulty in maintaining adequate control of surface finishes.

Arthroplasty↗
PubMed1992

[The value of Ender nailing in hip para-articular femoral fractures in gerontologic traumatology. Ender nailing--hip para-articular femoral fractures--gerontologic traumatology].

Nailing according to Ender is one of several competing methods of osteosynthesis for treating per- and subtrochanteric fractures of the femur in geronto-traumatology. Within 5 years we have treated 62 geriatric patients by this procedure. The average-age of our patients was about 76 years. Only 20 of them were able to be examined after a time of ca. 37 months post operationem. Intraoperative complications were backing out of the femur corticalis at the entry hole, followed by perforations of the head or neck of the femur. In one case we saw a supracondylar fracture. In the postoperative period we mostly found dislocations of the nails to cranial or caudal. Moreover there were one wound infect and one pseudarthrosis. The mortality rate came to 6.5% and was never caused by the method. When leaving the hospital the majority of the elderly patients was mobilized and able to walk. In spite of reduction of function of hip and knee and external rotation deformity and shortened legs the patients declared to be content with the result of the operation. Important geronto-traumatological aspects of the Endernailing-method could be seen in the simple procedure, the short operating time, a minimal surgical trauma and a diminishing of the risk of the mostly multi-morbid patients. Regarding the great number of specific complications competing methods are going on to be preferred. Meanwhile the application of Endernails is an exception in geronto-traumatology.

Aged↗
PubMed1992

[A comparative study of the characteristics of femoral hip prosthesis heads--study and results ceramic-coated hip joint heads of titanium].

Today, only hard/soft cup and femoral head combinations are employed for hip joint prostheses. Highly polished ceramic is a material with very good tribological properties for femoral heads, being highly resistant to mechanical wear and tear, and highly resistant to chemical reactions in the biological environment. The advantage of metal heads, in contrast, undoubtedly lies in their resistance to breakage and the ease with which their geometry can be modified with respect, for example, to antirotation angle and neck length. The ideal material for femoral heads is a combination of the two materials. The new multi-layer combination of titanium-niobium oxide/nitride ceramic coating applied to a prehardened titanium head combines the positive material properties in an ideal manner. Femoral heads made of CoCrMo, oxide-hardened titanium, aluminium oxide or multilayer titanium-niobium ceramic were compared by means of friction an wear and tear tests. The TiNb-ceramic-metal heads showed similar abrasion at the surface as the ceramic heads. At the high loads of more than 400 kp, which may also be reached under physiological conditions, the specially coated titanium-ceramic heads proved to be superior in terms of resistance to fracture and tribological properties.

Biomechanical Phenomena↗
PubMed1990

[Hydroxyapatite-coated total hip prosthesis. 3d-generation hip prostheses].

Since 1987, 80 hydroxyapatite-coated (HA) cementless total hip prostheses have been implanted. Thirty patients were examined 21 months post-operatively and the results compared with data for uncoated prosthesis. Earlier mobilisation and freedom from pain, together with evidence of bone ingrowth without connective tissue membrane formation, confirmed the benefits of HA-coated prostheses.

Aged↗
PubMed1987

[Long-term development of primary osteochondritis of the hip (Legg-Perthes-Calvé). Apropos of 60 hips with a follow-up of more than 30 years].

This study concerns 60 hips in 57 patients aged between 33 and 56 years with a follow-up of 30 to 44 years since the onset of the disease. The progress of the condition was assessed by objective and subjective clinical criteria and radiographic criteria including roundness of the head, head height, head cover, abnormal head shape and the presence of arthrosis. The main prognostic feature was found to be the eventual shape of the femoral head. Normal heads (7 cases) and round heads with some flattening (20 cases) had few problems at the time of follow-up. Irregular heads (7 cases) and, most of all, very irregular heads (20 cases) progressed badly. Pain was common, often severe and the patients were disabled. Fourteen of them had consulted a doctor and seven had already been treated surgically. Arthrosis as a consequence of osteochondritis seemed to be due to joint incongruence. We consider that the prognosis can be made at the end of the progressive phase of the disease, since remodelling plays no part in the roundness of the head. These findings indicate the need for care in recommending treatment in the residual phase of the disease and suggest that it is difficult to determine what surgical treatment should be considered in adult life.

Adult↗
PubMed1977

[Periarticular ossification following replacement of the hip-joint. Clinical and radiologic examination of 697 hip-joints (author's transl)].

Systematic examination of 733 cases of replacement of the hip-joint, operated on with an identical technique and method of post-operative treatment. Frequency and severity of periarticular ossification, their relationship to pre-operative arthrosis and their effect on joint function are described. Development and localization of periarticular ossification, their higher incidence after tearing off of the trochanter, removal of osteophytes and occurrence of hematomata hint at surgical trauma as one of the causes. Preliminary operations on the proximal end of femur did not influence ectopic ossification. Ossification of grade I did not interfere with function, grades II and III limited movement in varying degrees.

Follow-Up Studies↗