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Two cases of clostridial cellulitis are presented in patients who had Charnley total hip joint replacement for severe osteoarthritis. Early deep infection can be a major problem in this operation, and is usually due to Staphylococcus aureus.
To ensure the stability of ceramic ball heads of hip joint prostheses over the long term, both standards for the material and FDA-regulations for the components have been established. In this paper the philosophy underlying design and reliability is discussed. On the basis of fracture loads determined for Biolox ball heads the high level of stability and reliability that has been achieved and can now be guaranteed, is demonstrated.
We tested an appropriateness of indications tool for total hip joint replacement in patients with osteoarthritis. Criteria were developed using a modified Delphi panel judgment process. Ratings were analyzed regarding level of agreement among panelists. Another panel rated the same indications; results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. Appropriateness indication judgment was applied to 84 patients and compared to health-related quality-of-life improvement before and 3 months following intervention. Main panel ratings compared to those of a second panel resulted in a kappa statistic of 0.77. Test-retest kappa for the main panel was 0.81. Patients considered appropriate candidates for surgery, based on their composite indication scores, showed more improvement in health-related quality of life after 3 months than those considered inappropriately by composite indication scores. The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this indications algorithm as a screening tool for assessing the appropriateness of hip replacement surgery in osteoarthritis.
We determined contact stress on the articular surface of the hip joint in a group of patients who underwent operative treatment for severe slipped capital femoral epiphysis. Two different procedures were considered: the modified osteotomy of Dunn-Fish and the osteotomy of Imhäuser. In order to determine the stress distribution, a three-dimensional mathematical model was used taking into account the geometrical parameters of the pelvis and hip, which were measured from standard antero-posterior radiographs. We found that the Dunn-Fish procedure produced lower peak stress than the Imhäuser procedure.
The mechanisms of severe vascular injury during surgery of the hip joint are depicted with reference to the authors' own patient series and a review of the literature. Massive arterial hemorrhage is most commonly caused by the tip of a Hohmann retractor. Special care must be given to placement of the proximal retractor directly against the pelvis behind the anterior lip of the acetabulum, and this must be checked with the finger tip. Other mechanisms of injury are: massive venous bleeding can result if a coil of pelvic vein is rolled up with a Kirschner wire; arterial thrombosis can be caused by the polymerization heat of bone cement; or intimal dissection can be caused by pressure of a retractor or loosening of an intimal plaque, resulting in ischemia of the corresponding limb; arterio-arterial embolism can originate from appositional thrombus formation on a chronically weakened arterial wall; false aneurysms may be due to instrumental arterial injury; and arteriovenous fistulae can be caused by a piercing instrument. Laceration of the external iliac or common femoral artery is best treated by interposition of a saphenous vein graft. Angiological examination before and immediately after hip surgery is advocated.
Application of the proteases inhibitors constitutes one of possible pharmacologic methods of the blood loss compensation during performance of operative intervention in orthopedics, especially for endoprosthesis of the main joints. Application of contrykalum for endoprosthesis of the hip joint is expedient, if prognosticated intraoperative blood loss exceeds 1000 ml. Efficacy of preparation was not established for the lesser blood loss cases.
The forces acting during physiotherapy in both hip joints of one patient have been measured in vivo using a telemeterized joint prosthesis. During supported exercises the loads are up to 50% of the body weight (BW). Active movement of the leg against resistance in a lying position let the forces rise up to 250% BW. During symmetric two-legged-stance the load is typically 70% BW, while during walking peak values of about 300% BW were measured. By use of one crutch a 25% reduction of the joint force can be achieved.
Clinical and radiological results as well/as complications after 123 total hip arthroplasties performed as secondary procedure have been evaluated. These patients underwent primary operation because of femoral neck fracture or intertrochanteric osteotomy in the treatment of hip osteoarthritis. The scores of clinical results according to the Merle d'Aubigené and Postel scale were as follows: pain 4.48, walk 3.99, movements 4.02. Radiological features of loosening of the cup were observed in 14.4 per cent and of the stem in 17.3 per cent of those investigated. Early infections were 3 times higher and summed with late infections constituted 8.8 per cent of those operated on. Deep infections and aseptic loosening caused revision in 11.5 per cent of those investigated.
59 patients with implanted one- or two-sided hip prostheses (n = 74) have been investigated by two different scanning techniques to detect both possible loosening of the prostheses and a possible infection as the cause of the loosening. Of the investigated prostheses 47 were loose; in 45 cases this was evidenced by the bone scan using Tc-99m-DPD, thus showing a sensitivity of 95%. Specificity was 89%. In 21 cases (45%) of loose prostheses an infection could be clinically proven. With the aid of In-111 labeled leukocyte scans, 17 of 21 cases were correctly diagnosed as infected, showing a sensitivity of 91%, while the specificity was 94%. In view of the 93% accuracy, bone scanning can be regarded as the method of choice in detecting loosening of prostheses. The 91% accuracy in proving or ruling out infection by means of the leukocyte scan is high enough to assert correct findings in most cases. The main disadvantage of this method is the very demanding technique for marking of white blood cells.
Using a simplified model, tests were made to investigate the shear stress distribution at a hip joint prosthesis. A marked increase of stress at the tip of the prosthesis was found through photoelasticity. This peak stress resulted in a safety factor of 3 against exceeding the shear strength of bone cement. Since the calculation of the stress is based on unfavourable assumptions, the actual factor of safety should show a higher value still.
The aim of the study was the clinical and radiological evaluation of the hip joints treated operatively due to Perthes disease with incongruence of articular surfaces. 35 patients (37 hips) treated between 1988-1990 by means of proximal femoral and transpelvic osteotomy were evaluated. Average age of the child at the time of the operation was 7 years 3 months (5-10 years), and at the final examination 15 years (12-19 years). The average follow-up period was 7 years 7 months (5-9 years). At the clinical examination there were 46 percent excellent results (17 hips), 32 percent good (12 hips), and 22 percent fair results (8 hips). Radiological examination showed 19 percent excellent results (7 hips), 35 percent good (13 hips), 5 percent of fair (2 hips), and 41 percent of poor results (15 hips). This study proved that the described operative treatment appeared a useful method in Perthes disease with incongruence of articular surfaces.
When treating degeneration diseases, endoprosthesis operations are performed widely. The results of the treatment depend not only on the operating technique and up-to-date prostheses but also on the correct postoperative rehabilitation, applied in particular the kinesitherapeutic means. The aim of the research was to establish the effect of postoperative rehabilitation with wide use of kinesitherapeutic means in sanatorium conditions on the functional capacity of the joint operated on as well as on the general condition of the patient. The research has been done at the traumatology department of the Sanatorium "Versme" in Birstonas. The patients were prescribed a complex of kinesitherapeutic means, i.e. curative gymnastic exercises performed for 45 min twice a day, water kinesitherapy, self-dependent isometric exercises, walking and manual massage. Clinical examination of 30 patients has been undertaken on the first and last day of their rehabilitation in the sanatorium. The mobility of the hip joint, muscle strength and circumference of the thigh have been measured. The patient's tolerance to physical load, his/her sensitiveness to pain, the patient's rate of walking and self-care have been estimated. It has been established that kinesitherapeutic means applied during the 30 day course of rehabilitation undergone in the Sanatorium increased the amplitude (flexion and drawing back) of the joint operated on, the strength of quadriceps muscle femoris and the strength of drawing back and back femoral muscles, as well as decreased sensitiveness to pain and improved the rate of walking and functional class (p < 0.001). The circumference of the femoral muscle and functional independence of the patients remained unchanged. The functional capacity of the endoprothesized hip joint of the patients improved to some extent irrespective of the section performed during the operation as well as irrespective of the sex and age of the patients.
It is often possible to establish the origin of an arthosis of the hip joint radiologically. Only in 17 out of 445 patients were we unable to arrive at a classification because the arthrosis was already too advanced. Data relating to the history are of limited value -- only 21% of our patients knew of earlier disorders of the joint --, so definition of causes an radiographs is important. The high percentage of arthroses the origin of which is known, makes it likely that the concept of "primary arthrosis" is unnecessary, since behind it there hide those cases of apparently ill-defined arhtroses which -- as shown in our results -- can be further differentiated. This radiologically based classification will serve to increase the possibilities of progressing from symptomatic to prophylactic treatment.
3.6 g acetylsalicylic lysin was injected into 30 patients daily after operative replacement of the hip-joint. Pulmonary embolism and (or) deep-vein thrombosis were diagnosed in 19 patients. Low-dose heparin (3 X 5000 IU/24 h) significantly reduced the incidence of deep-vein thrombosis (ten of thirty patients: P less than 0.05) compared with the acetylsalicylic acid group. The results demonstrate not only the inadequate thrombosis prophylaxis provided by acetylsalicylic acid, but also that low-dose heparin prophylaxis in these specially at risk patients is of limited efficacy.
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The aim of the present study was to assess the efficiency of ultrasonography in the screening of hip joints in newborn babies. In 1987, 2,531 newborns (92.4% of all liveborn babies) were examined clinically and with ultrasound. The coverage of the femoral head by the bony acetabular roof was measured on a longitudinal, coronal scan. The mean head coverage was 57% in boys and 55% in girls (p = 0.0001). Unstable hips, shown by both ultrasound and clinical examination, were found in 27 newborns (1.1%). The mean head coverage of unstable hips was 41%, significantly lower than for stable hips. No late hip dislocations were diagnosed in children with normal findings who were not included in the follow-up routines. In conclusion, the study indicated that ultrasonography measuring the femoral head coverage is an appropriate method of screening in newborns. It is useful for differentiating between a true and a false positive Ortolani sign. Moreover, ultrasound can show hip dysplasia that is not clinically demonstrable at birth.
OBJECTIVE: To evaluate the appropriateness of the use of hip joint replacements (HJRs) using explicit criteria developed by an expert panel. METHODS: Observational study. Nine hundred ninety-seven patients from five hospitals with a diagnosis of osteoarthritis, avascular necrosis, hip fracture, or revision who were undergoing HJR were consecutively included in the study during a 1-year period. The appropriateness of the indication was judged by explicit criteria. Complications were recorded at the time of the intervention and 3 months postoperatively. RESULTS: Of the 1,030 interventions, 604 were for osteoarthritis, 31 avascular necrosis, 191 fractures, and 204 revisions. No differences were found among the hospitals for the main clinical and patient variables. Indications for surgery were considered appropriate in 59% of cases, uncertain in 32%, and inappropriate in 8%, mainly in the osteoarthritis group. Differences were found in the rates of appropriateness among some centers. The complication rate did not differ among the groups based on the level of appropriateness of the procedure. CONCLUSIONS: The appropriate use of HJR, as measured by the criteria established by the panel, identified a moderate percentage of inappropriate indications. Those equivocal and inappropriate cases demand further studies to identify patients with an adequate risk-to-benefit ratio from this procedure.
Labral lesions are a sign of biomechanical decompensation of the hip joint and often represent the first clinical symptom of residual hip dysplasia (RHD) in the adult. Provocation tests (impingement, apprehension) are typical but not specific. Labral lesions and concomitant findings (intra- and extraosseous ganglia, stress bone marrow oedema) can be detected by magnetic resonance arthrography (MRA) with an accuracy of 91%. Primary therapeutic goal is the normalization of the underlying pathomorphology and instability by a redirectional acetabular osteotomy. There are several concepts concerning simultaneous arthrotomy at the time of osteotomy: no arthrotomy at all, selective arthrotomy, routine arthrotomy in every case. There are more clinical studies necessary before one of these concepts can be widely accepted and recommended. Based on preliminary results, palliative arthrotomy with partial labral resection but without corrective osteotomy in osteoarthritis secondary to residual hip dysplasia gives poor results; we therefore urgently dissuade from palliative labral surgery via arthrotomy. Whether labral surgery via arthroscopy might be a useful concept in symptomatic residual hip dysplasia, is still an open question. In this review article, the "state of the art" presented at the "Vienna Labral Symposium 1997" is reflected and summarized. At the end of this article, a "common statement" of the experts is published in English and German language.