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PubMed1977

[Investigations of the final settling of implanted hip-joints by use of 85Sr (author's transl)].

Up to 8 years after replacement of hip-joints in 26 patients the strontium-85-uptake over both thighs was followed scintimetrically. In contrary to normal healing of fractures, this uptake became normal on the side of the operation not earlier than the end of the 2nd year after operation. One cause of this delay could be the continuing liberation of monomeres of polymethyl-methacrylates at the bed of the implant. It is important to consider the clinical signs on the opposite side, since there a raised strontium-85-uptake could produce a "pseudo"-diminished ratio between the two sides.

Aged↗
PubMed1989

[A gamma scintigraphic assessment of blood supply of the hip joint in Perthes disease].

In order to specify the peculiarities of the blood supply of the hip joint in Perthes' disease the authors carried out gamma scintigraphy by 99m Tc-pyrophosphate in 34 children. Patients with roentgenologically confirmed diagnosis of Perthes' disease at various stages as well as those in whom Perthes' disease was suspected, but convincing roentgenologic changes were absent, were examined. The data of scintigraphy and roentgenography were compared. The following phases of disturbances in blood supply were distinguished: ischemia, instable blood supply and stable revascularization. It is supposed that recurrences of ischemia may take place at the stage of resorption. Radionuclide investigation allows to make early diagnosis even before the appearance of roentgenologic changes with differentiation of doubtful cases.

Child↗
PubMed1975

[Peripheral nerve injury due to total replacement of the hip-joint (author's transl)].

Report on peripheral nerve lesions due to total replacement of the hip-joint based on the literature and the authors' own experience. In 15 patients our diagnosis was made on clinical and electromyographic evidence. 16 endoprostheses had been inserted. The femoral nerve was involved on 12 occasions, the sciatic in 5, the glutei in 5, the obturator in 2, the lateral cutaneous femoris in 2 and the posterior cutaneous in 1 instances. One has to count on about 1% of such lesions. This type of paresis has to be distingushed from pseudopareses for which electromyography was proved very effective. Damage due to overstretching is probably the main cause. Treatment with thorough physiotherapy and faradic stimulation is needed. When this is done the prognosis is generally favourable. In some cases, however, these complications may limit the success of the operation and postoperative disability may be worse than before.

Aged↗
PubMed1999

Validation of a functional method for the estimation of hip joint centre location.

The present study assesses the accuracy with which the subject specific coordinates of the hip joint centre (HJC) in a pelvic anatomical frame can be estimated using different methods. The functional method was applied by calculating the centre of the best sphere described by the trajectory of markers placed on the thigh during several trials of hip rotations. Different prediction methods, proposed in the literature and in the present investigation, which estimate the HJC of adult subjects using regression equations and anthropometric measurements, were also assessed. The accuracy of each of the above-mentioned methods was investigated by comparing their predictions with measurements obtained on a sample of 11 male adult able-bodied volunteers using roentgen stereophotogrammetric analysis (RSA), assumed to provide the true HJC locations. Prediction methods estimated the HJC location at an average rms distance of 25-30 mm. The functional method performed significantly better and estimated HJCs within a rms distance of 13 mm on average. This result may be confidently generalised if the photogrammetric experiment is carefully conducted and an optimal analytical approach used. The method is therefore suggested for use in motion analysis when the subject's hip range of motion is not limited. In addition, the facts that it is not an invasive technique and that it has relatively small and un-biased errors, make it suitable for regression equations identification with no limit to sample size and population typology.

Adult↗
PubMedDate not supplied

Fluorescence spectroscopic analysis of surface and subsurface residual stress fields in alumina hip joints.

We aim to establish a confocal spectroscopic technique able to study the features of fluorescence spectra arising from native Cr3+ impurity in polycrystalline alumina (Al2O3) as a biomaterial and to use their emission lines as microscopic probes for the characterization of residual stress fields stored in artificial hip prostheses during their implantation in vivo. As an application of the technique, we report for the first time concerning the evolution of microscopic (residual) stress fields stored on the surface and in the subsurface of N=7 retrieved Al2O3 hip joints after exposure in the human body from a few months to 19 yr. The micrometric diameter of the laser beam waist impinging on the joint surface (typically about 1 microm in lateral resolution) enables us to estimate the patterns and magnitude of residual stress with high spatial resolution, at least comparable with the grain size of the material. In addition, a selected confocal configuration for the optical probe enables minimization of the probe size along the in-depth direction. According to a statistical collection of data on the microscopic level for retrieved femoral heads in toto, a residual stress field arising from loading history in vivo during the lifetime of the Al2O3 femoral head can be revealed. Finally, an interpretation is given of microscopic wear mechanisms in Al2O3 artificial hip joints consistent with the observed evolution of surface residual stress fields on elapsed time in vivo.

Aluminum Oxide↗
PubMed1979

Indomethacin treatment in osteoarthritis of the hip joint. Does the treatment interfere with the natural course of the disease?

The course of osteoarthritis in 294 hips of 186 patients was evaluated by examining their radiographs. The development of the disease in patients treated with indomethacin was compared with that in a control material. In the indomethacin group the disease progressed more frequently and in one parameter the progress was more severe. The results support previous reports indicating that indomethacin might have a deleterious effect on osteoarthritic hip joints. Some possible explanations for this adverse effect of indomethacin treatment are discussed.

Adolescent↗
PubMed2001

Prediction of lubricating film thickness in UHMWPE hip joint replacements.

An elastohydrodynamic lubrication model developed for a ball-in-socket configuration in a previous studies by the present authors (Jalali-Vahid et al., Thinning films and tribological interfaces, 26th Leeds-Lyon Symposium on Tribology, 2000, pp. 329-339) was applied to analyse the lubrication problem of a typical artificial hip joint replacement, consisting of an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup against a metallic or ceramic femoral head. The cup was assumed to be stationary whilst the ball was assumed to rotate at a steady angular velocity and under a constant load. A wide range of main design parameters were considered. It has been found that the predicted lubricating film thickness increases with a decrease in the radial clearance, an increase in the femoral head radius, an increase in UHMWPE thickness and a decrease in UHMWPE modulus. However, the predicted lubricating film thicknesses are not found to be sufficiently large in relation to the surface roughness of the cup and head to indicate separation of the two articulating surfaces. It should also be noted that if the design features are unable to secure full fluid film lubrication, it may be preferable to select them for minimum wear rather than maximum film thickness. For example, an increase in head radius will enhance the film thickness, but it will also increase the sliding distance and hence wear in mixed or boundary lubrication conditions. Furthermore, it is pointed out that an increase in the predicted lubricant film thickness is usually associated with an increase in the contact area, and this may cause lubricant starvation and stress concentration at the edge of the cup, and adversely affect the tribological performance of the implant. The effect of running-in process on the lubrication in UHMWPE hip joint replacements is also discussed.

Biocompatible Materials↗
PubMed2001

Biomechanical evaluation of hip joint after Salter innominate osteotomy: a long-term follow-up study.

The biomechanical state of the hip after a Salter innominate osteotomy was investigated by using the radiographic data of 38 operated and 21 contralateral nonoperated hips from our archives. The centre-edge angle of Wiberg was determined from the radiographs taken shortly after the operation. From the radiographs of the latest follow-up (7-13 years after the operation), we also determined the peak value of contact hip joint stress normalized by the body weight, and the functional angle of the weight-bearing area. A mathematical model was used. We show that the geometrical parameters aside from the centre-edge angle may considerably influence the contact hip stress distribution. We also show that the functional angle of the weight-bearing area is a more relevant parameter than the normalized peak stress if the exact magnification of the images is not known and if there is considerable variation of the image size within the sample. The development of the centre-edge angle of the operated hips and of the contralateral hips was also studied. We found that the centre-edge angle increases on average during the follow-up time in the operated hips as well as in the contralateral nonoperated hips, but the average increase is smaller in the former. It is shown that an unfavorable stress distribution is connected to the decrease of the centre-edge angle over time. Finally, we found a weak positive correlation between the centre-edge angle shortly after the operation and the functional angle of the weight-bearing area at the of the latest follow-up.

Biomechanical Phenomena↗
PubMed1995

Effect of foot-progression angle on hip joint moments during gait.

Loosening has emerged as the most serious long-term complication of total hip replacement and torsional loading of the femoral implant has been implicated as a possible cause. In an effort to explore a strategy for minimizing this risk, the following hypothesis was tested: the foot-progression angle has a significant effect on the resultant hip moments, and particularly the internal-external rotation moment, during level walking. Twelve normal subjects performed a total of nine trials: three in which they walked normally with the right foot pointing approximately straight ahead; three in which they were told to walk with the foot internally rotated approximately 30 degrees; and three in which the foot was externally rotated about 30 degrees. The inverse dynamics approach was used to integrate the body segment parameter, kinematic and force plate data, and to solve for the resultant moment at the right hip joint. In all three conditions--foot straight, foot in, and foot out-the subjects walked at the same average speed of 1.5 (+/- 0.3) ms-1. For the flexion-extension moment (where the maximum flexion moment of 95 Nm was in good agreement with other published data), there was no significant difference between the three foot orientation conditions. For the abduction-adduction moment, the foot straight condition exhibited the classic double peak pattern with a maximum abductor moment of 57 Nm, and there was no statistically significant difference between the three curves.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[The immunological aspects of a hip joint lesion in childhood].

The paper presents an in-depth analysis of immunological mechanisms of the hip joint synovitis development in children. Studied in the pediatric patients with transient coxitis, Perthes disease, and tuberculous coxitis (n = 54, 15, and 15 respectively) with the aid of flow cytofluorometer FACStar PLUS was the subpopulation of immunocompetent cells with a wide spectrum of MCAB. Controls (n = 35) were sex and age-matched. Comparative analysis of immunological parameters in the above children disclosed a toxic-and-allergic origination of transient synovitis with predominant affection of the T-cell link of immunity (T-helpers failure and activation of T-suppressors). Joint mucose injury was noted to be developing against the background of reduction of serum IgA. Activation of non-specific mechanisms (natural killers, increase in SDH activity) is of compensatory character. Mechanisms of activation of cell processes (expression of panmitogenic receptor CD4+ antigen) in Perthes disease warrant further studies. In patients with tuberculous coxitis, immunological incompetence develops in the presence of cytotoxic reactions and activation of the B-link, with the production of IgM being on the increase but with no essential changes in the IgG fraction. It is necessary that selective stimulators of T-helpers be included into the treatment scheme together with drugs capable of exerting a selective effect on the T-link of immunity.

B-Lymphocytes↗
PubMed1992

Histological examination of surface repair tissue after successful osteotomy for osteoarthritis of the hip joint.

In this study biopsy specimens of the surface repair tissue from the weightbearing area of the hip joint were collected from 15 patients who had undergone successful valgus osteotomy, and these were examined histologically. In 6 of the 15 patients the specimens stained strongly with safranin-O in all three layers of the matrix. However, the repair tissue from another 6 patients showed strong staining only in the intermediate and deep layers, while that from 2 patients stained only in the deep layer. Specimens from 5 patients were stained for S-100 protein and positive cells were detected in all cases, demonstrating that the cells in the repair tissue were chondrocytes. However, there was no tide mark in the repair tissue and the arrangement of the cells differed from that in normal cartilage. Discontinuity of the subchondral bone was also noted. These findings make it likely that the repair tissue was of bone marrow origin.

Adult↗
PubMed1988

Response of hip joint afferent fibers to pressure and vibration in the cat.

Mechanical properties of 33 slowly adapting and 8 quickly adapting capsule receptors of the hip joint were investigated. All the slowly adapting receptors identified were of a limited range, discharging only when the femur was rotated to its limit of movement. They behaved as single-spot high-threshold pressure receptors as shown by the von Frey's hairs. In addition they showed a low sensitivity to vibratory stimuli applied perpendicularly to their receptive field. Only 14 out of 33 units were found to discharge following vibration; 11 could be driven 1:1 at different frequencies. There was a general trend to be entrained at lower amplitudes for higher frequencies of vibration. A positive correlation between the pressure threshold and both activation angle and vibration threshold was found. The mechanical properties of all the quickly adapting capsule receptors were found to be similar to those described in other tissues. Finally, unlike joint receptors, slowly adapting muscle afferents travelling in the same hip articular nerve were highly sensitive to pressure and vibratory stimuli.

Action Potentials↗
PubMedDate not supplied

Dislocation and instability complicating low friction arthroplasty of the hip joint.

Among the complications in a series of 1,400 consecutive Charnley low friction arthroplasty procedures, there were 8 dislocations, and 3 highly unstable hips. Three dislocations followed severe trauma, in 2 of the 3 there was only fibrous union of the greater trochanter. In all but 2 of the hips, more than one previous operation had been performed. More than one technical fault was evident in most dislocations. Six of the 8 dislocations required reoperation. Meticulous attention to the Charnley procedure, including soft tissue elements of the hip joint is necessary to avoid instability and dislocation following total hip arthroplasty.

Adult↗
PubMed2005

Appropriateness of total hip joint replacement.

OBJECTIVE: To evaluate the appropriateness of the use of total hip joint replacements. DESIGN: Observational study of consecutive patients with a diagnosis of hip osteoarthritis and who had undergone total hip arthroplasty over a 1-year period from seven hospitals. MAIN MEASURES: The appropriateness of the use of hip replacement was judged by explicit criteria developed by a panel of experts using RAND methodology. The length of hospital stay during the admission and complications were recorded 6 months post-operatively. Patients were also surveyed 6 months after discharge to determine whether they believed they had recovered or their satisfaction with the intervention. Appropriateness results of this study were compared with a previous study performed with the same criteria 4 years previously. RESULTS: In total, 784 patients participated in the study. Indications for surgery were considered necessary in 52.2% of cases, appropriate in 21.3%, uncertain in 21.4%, and inappropriate in 5.1%. Differences were found in the rates of appropriateness exclusively from one hospital. At 6 months after discharge, differences between centres were found for the proportion of patients that reported they had recovered from surgery (range 57.7-24.8%) and in the length of hospital stay during admission (range 10-16 days). Improvement in the appropriateness rates were found for all participant hospitals during both periods. CONCLUSIONS: We identified a low percentage of inappropriate indications and differences in some outcomes between centres. Compared with previously, there has been improvement in the use of this technique, although both periods are not methodologically comparable.

Aged↗
PubMed1991

[3-dimensional model of the hip joint].

The main aim of this work was to build a three-dimensional theoretical pattern of the hip joint. It occurs as a generalization of the pattern of Pauwels, which was two dimensional. The equipment used is general mechanics plus an axiom we have added, which enables the calculation of the distribution of the surface pressures. Through theory, we find the experimental results of photo-elasticity. This pattern enables an analysis of the forces which act on the hip and their biomechanical role during gait. It leads to a better comprehension of the biomechanic failure, originating a pathology, and to a better choice in surgical correction. The calculation of the distribution of the surface pressures enables to understand the position of the acetabular rim. Our results contradict R. Bombelli's.

Biomechanical Phenomena↗