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PubMed2005

Contribution of hip strength indices to hip fracture risk in elderly men and women.

UNLABELLED: In this prospective, case-control study, femoral neck diameter, cross-sectional moment of inertia, or section modulus was an independent predictor of hip fracture risk after adjustment for BMD. However, the contribution of each of these indices to hip fracture prediction was modest in the presence of BMD. INTRODUCTION: The relative contribution of measures of hip strength to hip fracture prediction is unclear. This study was designed to characterize the association between hip strength indices and hip fracture risk in relation to BMD in elderly men and women. MATERIALS AND METHODS: Seventy-one women and 25 men>or=60 years of age, who sustained a hip fracture during the study period of 1989-2003, were selected from the prospective, population-based Dubbo Osteoporosis Epidemiology Study. These fracture cases were randomly matched for age and sex in a 1:2 ratio with nonfracture individuals. BMD at the femoral neck was measured before the fracture event by DXA (Lunar DPX-L). Hip strength indices, including femoral neck diameter (FND), cross-sectional moment of inertia (CSMI), and section modulus (Z), were estimated by reanalysis of the image files using hip strength analysis software. RESULTS: In women, after adjustment for BMD, increased risk of hip fracture was associated with smaller FND (OR, 1.6; 95% CI, 1.0, 2.7), lower CSMI (OR, 1.8; 95% CI, 1.0, 3.2), or Z (OR, 1.6; 95% CI, 1.1, 5.1). In men, none of these hip strength indices were significant predictors of fracture risk. However, using the results in women as a prior distribution, it was estimated that the BMD-adjusted OR for FND (OR, 1.5; 95% CI, 1.0, 2.3), CSMI (OR, 1.6; 95% CI, 1.0, 2.5), or Z (OR, 2.3; 95% CI, 1.4, 3.9) was each significantly associated with hip fracture risk in men. In the logistic regression model, BMD alone accounted for 32% and 16% of the variance of fracture liability in women and men, respectively. The addition of FND, CSMI, or Z to the model increased the respective variance proportion to 34% and 19%. CONCLUSIONS: These data suggest that smaller FND and lower CSMI or Z is an independent risk factor for hip fracture in both women and men. However, the contribution of these measures to hip fracture prediction over and above BMD is likely modest.

Aged↗
PubMed2007

Genetic parameters for body weight, hip height, and the ratio of weight to hip height from random regression analyses of Brahman feedlot cattle.

The objective of this research was to assess the genetic control of BW, hip height, and the ratio of BW to hip height (n = 5,055) in Brahman cattle through 170 d on feed using covariance function-random regression models. A progeny test of Brahman sires (n = 27) generated records of Brahman steers and heifers (n = 724) over 7 yr. Each year after weaning, calves were assigned to feedlot pens, where they were fed a high-concentrate grain diet. Body weights and hip heights were recorded every 28 d until cattle reached a targeted fatness level. All calves had records through 170 d on feed; subsequent records were excluded. Models included contemporary group (sex-pen-year combinations, n = 63) and age at the beginning of the feeding period as a covariate. The residual error structure was modeled as a random effect, with 2 levels corresponding to two 85-d periods on feed. Information criterion values indicated that linear, random regression coefficients on Legendre polynomials of days on feed were most appropriate to model additive genetic effects for all 3 traits. Cubic (hip height and BW:hip height ratio) or quartic (BW) polynomials best modeled permanent environmental effects. Estimates of heritability across the 170-d feeding period ranged from 0.31 to 0.53 for BW, from 0.37 to 0.53 for hip height, and from 0.23 to 0.6 for BW:hip height ratio. Estimates of the permanent environmental proportion of phenotypic variance ranged from 0.44 to 0.58 for BW, 0.07 to 0.26 for hip height, and 0.30 to 0.48 for BW:hip height ratio. Within-trait estimates of genetic correlation on pairs of days on feed (at 28-d intervals) indicated lower associations of BW:hip height ratio EBV early and late in the feeding period but large positive associations for BW or hip height EBV throughout. Estimates of genetic correlations among the 3 traits indicated almost no association of BW:hip height ratio and hip height EBV. The ratio of BW to hip height in cattle has previously been used as an objective measure of BCS in cows or calves; it may offer a unique assessment of body dimension. Results indicated that there is substantial additive genetic variation for this trait, and it may be possible to use EBV to increase BW without increasing frame score in Brahman cattle.

Aging↗
PubMedDate not supplied

[Development assessment of a hip ultrasonographic screening program for the early diagnosis of congenital hip dysplasia at the orthopedic university department Homburg/Saar from 1986 to 1990].

The results of the hip ultrasound newborn screening at the orthopaedic department of the University Hospital Homburg/Saar underline the necessity of an early diagnosis of Hip dysplasia already during the first days of life. In the course of the following publication the benefit of using abduction-pants in case of physiological unripe and primary pathological hips is described closely. From October 1985 to December 1990 2317 newborns have been examined by ultrasound. The rate of Hip Dysplasia (type IID, IIg, IIIa) was at 104 hips (2.2%). Clinical striking facts were only found in 46.3% of all patients with primary pathological hips. After an precautionary broad swadling (Breitwickeln) or abduction-pants-treatment 331 (90.0%) hips of the 368 regular checked hips with type IIa developed with an average secondary anatomical healing of 2.5 months to Ia- or Ib-hips. After 3 months only just 12 hips corresponded to a diagnosis of type IIb according to Graf. A deterioration to a IIg or IIIa hip was only ascertained in two cases. With all 41 sufficiently controlled primary pathological hips an improvement to type Ia or Ib according to Graf achieved when treated with abduction pants (average duration of treatment: 4.3 months). None of the children had to undergo an operation because of instable hips.

Braces↗
PubMed2004

[Selection of the type in revision total hip replacement for failed hip arthroplasty].

OBJECTIVE: To evaluate the selection of the type of prosthesis in revision hip arthroplasty. METHODS: There were 33 hips in our study, male in 7 hips and female in 26 hips. The average age of the patients were 59 years. The reasons of the revision included aseptic loosing in 22 hips, infection in 8 hips (2 infection hips with discharging sinuses), and acetabular erosion in 3 hips. The operations for revision were 13 cemented and 12 cementless acetabular prosthesis with autograft in morselized form; the femoral revision were all selected in cemented prosthesis. The revision for infection hip were all cemented prosthesis of extensively porouse-coated. RESULTS: The average follow-up duartion was 3.9 years and 11 months. There was a radiolucency but no clinical instability accompanied in 2 hips and remaining moderate pain in 4 hips. No dislocation and fracture were seen in the series. Harris score were improved to 82.4 (68-88). CONCLUSION: The commonest reason of revision hip arthroplasty was aseptic loosing. The acetabular prosthesis in revision could select cemented or cementless components and femoral prosthesis could select extensively coated stem. The cemented components could yield good results in infection hips revision.

Acetabulum↗
PubMed1984

Prevention of congenital dislocation of the hip. The Swedish experience of neonatal treatment of hip joint instability.

The extensive work on early diagnosis and treatment of CDH (in the broad sense of this term) in Sweden has formed the basis of our present organization of prevention of hip dislocation. Practically all children are born in hospital, at present about 93,000 per year (1980). Routine examination of the hip joints has been included in the check-ups of newborns since the beginning of the 1950's. The centralization of obstetrics, especially during the last decade, has facilitated the organization of these examinations by paediatric consultants in all obstetric departments. All cases of hip joint instability are recorded, and during the last few years the frequency has been about 12 per thousand, probably with some over-diagnosis due to registration of uncertain cases. All definite cases of hip instability have been treated immediately at the orthopaedic departments. A study of a series of untreated newborns with transient instability has shown that the majority, but not all, will develop normal hip joints without treatment. This has been one reason for the recommendation to treat all unequivocal cases of hip instability. The present organization of examination and treatment is described. Detailed and practical instructions for the examination and treatment are given. Follow-ups of children treated for hip instability in the neonatal period are reported. It has been found that in practically all these patients anatomically normal hip joints are achieved by means of correct and carefully followed up treatment. The findings in 65 patients with neonatal hip instability in whom the treatment was unsuccessful or inadequate have underlined the importance of a strict treatment schedule, experienced doctors and detailed information to the parents. The effect of diagnosis and treatment of hip instability neonatally on the frequency of late-diagnosed cases of CDH was studied by recording all late-diagnosed cases at all orthopaedic departments. It was clear from the latter study that instability of the hip in newborns represents "preluxation" and that the treatment of this can prevent later dislocation. Dislocation of the hip joint in newborn infants is very unusual. Nowadays it is rare even after the neonatal period--in recent years only 12% of the late-diagnosed CDH cases between 1 and 6 months of age at diagnosis. However, the total number of late-diagnosed cases in the whole country has not decreased by more than 50% compared with the period prior to the introduction of hip examination of newborns.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1994

Muscular recovery around the hip joint after total hip arthroplasty.

A prospective study was conducted to quantitatively measure the relative muscle torque strengths in 20 consecutive women with unilateral osteoarthritic hips and 20 consecutive men with unilateral osteonecrotic hips before and after primary cementless total hip arthroplasty. Maximal isometric torque strengths in the muscles of flexion, extension, and abduction around the hip joint were measured preoperatively and postoperatively at six months and one year, using a Cybex 340 dynamometer. The results showed improved muscle function after total hip arthroplasty in both diseased and healthy hips. In the diseased hips, all muscle groups improved significantly, from 150 to 250% of the preoperative levels, at six months and one year postoperatively, except in the osteoarthritic women, in whom the improvement at six months was minimal. Preoperatively, all muscle groups in the diseased hips were weaker than those in the uninvolved hips, especially in the osteonecrotic men (51-79% of healthy side). In both groups, however, the torques strengths of the diseased hips had not caught up to the healthy hips in the one-year follow-up period (84-89% in the osteonecrotic male group, and 79-81% in the osteoarthritic female group). The authors recommended that muscle strengthening exercises for the hip should be continued for at least one year, and perhaps longer, after total hip arthroplasty.

Adult↗
PubMed1997

Total hip arthroplasty for congenital dysplasia or dislocation of the hip. Survivorship analysis and long-term results.

Two hundred and thirty-two total hip replacements with cement were performed between 1965 and 1987 in 190 patients who had osteoarthrosis secondary to acetabular dysplasia resulting from congenital dysplasia or dislocation of the hip. Forty-nine patients (fifty hips) who died or who did not have at least three years of clinical and radiographic follow-up were excluded; therefore, the study comprised 141 patients (182 hips), 125 of whom were women and sixteen of whom were men. The mean age at the time of the operation was 42.5 years (range, 19.5 to 76.5 years), and the mean duration of follow-up was 9.9 years (range, 3.1 to 22.8 years). A Charnley low-friction prosthesis with a 22.25-millimeter femoral head was used in all hips. A trochanteric osteotomy was performed in 164 hips. A direct lateral approach was used only when there was a limb-length discrepancy of less than two centimeters. Bulk autogenous graft was not used to augment the fixation of the acetabular component. The hips were divided into two groups on the basis of the degree of subluxation or dislocation according to the classification of Crowe et al. One hundred and thirty-six hips were grade I, II, or III (indicating subluxation) (Group S), and forty-six hips were grade IV (indicating dislocation) (Group D). At the most recent follow-up evaluation, 128 (94 per cent) of the 136 hips in Group S and forty-four (96 per cent) of the forty-six hips in Group D caused no or only slight pain (a score of 6 or 5 points, respectively, according to the system of Merle d'Aubigné and Postel). Nineteen cups (10 per cent) and five stems (3 per cent) failed and were revised. The rate of revision for loosening of the femoral component in Group D (2 per cent [one stem]) was similar to that in Group S (3 per cent [four stems]). In comparison, the rate of revision of the acetabular component in Group D (15 per cent [seven cups]) was almost twice that in Group S (9 per cent [twelve cups]). This study demonstrated satisfactory clinical results at a mean of nearly ten years. The fixation of the femoral components appeared to be satisfactory; however, the failure of the fixation of the acetabular components in Group D (the dislocated hips) is a cause for concern.

Adult↗
PubMed2005

Total hip replacement with the CLS expansion shell and a structural femoral head autograft for patients with congenital hip disease.

BACKGROUND: Reconstruction of a dysplastic acetabulum in a patient with osteoarthritis of the hip may be accomplished with a variety of surgical techniques. The aim of our study was to assess the outcomes of total hip replacement with the uncemented CLS expansion shell and a structural femoral head autograft to augment the deficient acetabulum in patients with osteoarthritis secondary to congenital hip disease. METHODS: Between 1990 and 1994, we used a CLS expansion shell with a structural femoral head autograft in forty-three consecutive patients (forty-three hips) with osteoarthritis secondary to congenital hip disease. The ratio of male to female patients was 5:38, and the mean age of the patients was forty-eight years. According to the preoperative radiographic assessment, the dysplasia was categorized as Crowe type I in six patients, Crowe type II in thirty-one patients, and Crowe type III and type IV in three patients each. No patient was lost to follow-up. The mean duration of follow-up was 120 months. Plain radiographs were made immediately after surgery and at the latest follow-up evaluation. Clinical outcomes were determined with use of the Harris hip score and the Merle d'Aubigné and Postel score, and a radiographic analysis was performed. RESULTS: Postoperatively, the mean Harris hip score had improved 58 points for patients with Crowe type-I and II dysplasia, 47 points for patients with Crowe type-III dysplasia, and 46 points for patients with Crowe type-IV dysplasia (p < 0.05 for all). At the latest follow-up examination, the mean Harris hip score for all patients was 92.6 points. The mean Merle d'Aubigne and Postel score was 8.3 points preoperatively and 15.8 points at the time of the latest follow-up. The mean coverage of the shell by the graft immediately after surgery was 32.2%. Osteointegration of the CLS expansion shell was evident radiographically in all forty-three hips at the latest follow-up evaluation. There were no failures of the bone grafts. Clinical survival of the CLS expansion shell with a structural femoral head autograft was 100% at a mean of ten years after surgery. The rate of survival of the shell, with radiographic signs of loosening as the end point, was 88.2% at ten years. CONCLUSIONS: The CLS uncemented expansion shell, when used with a structural femoral head autograft, provides a reliable reconstruction, augments deficient acetabular bone stock, and allows placement of the socket at or close to the anatomic center of hip rotation in patients undergoing total hip arthroplasty to treat the sequelae of congenital hip disease.

Acetabulum↗
PubMed2003

Prevention of hip fractures by external hip protectors: a randomized controlled trial.

CONTEXT: Several randomized controlled trials have been performed to examine the effectiveness of external hip protectors in reducing the incidence of hip fractures, but the results are controversial. OBJECTIVE: To examine the effectiveness of hip protectors in reducing the incidence of hip fractures in an elderly high-risk population. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of elderly persons aged 70 years or older, who have low bone density, and are at high risk for falls. Participants lived in apartment houses for the elderly, homes for the elderly, and nursing homes in Amsterdam and surrounding areas in the Netherlands. They were enrolled in the study between March 1999 and March 2001; the mean follow-up was 69.6 weeks. Of the 830 persons who were screened, 561 persons were enrolled. INTERVENTION: External hip protector. Both groups received written information on bone health and risk factors for falls. MAIN OUTCOME MEASURE: Time to first hip fracture. Survival analysis was used to include all participants for the time they participated. RESULTS: In the intervention group, 18 hip fractures occurred vs 20 in the control group. Four hip fractures in the intervention group occurred while an individual was wearing a hip protector. At least 4 hip fractures in the intervention group occurred late at night or early in the morning. Both in univariate analysis (log-rank P =.86) and in multivariate analysis (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.55-2.03), no statistically significant difference between the intervention group and control group was found with regard to time to first hip fracture. In addition, the per protocol analysis in compliant participants did not show a statistically significant difference between the groups (HR, 0.77; 95% CI, 0.25-2.38). CONCLUSION: The hip protector studied was not effective in preventing hip fractures.

Accidental Falls↗
PubMed2006

Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study.

INTRODUCTION: Hip fracture patients represent a frail group of elderly with increased morbidity and mortality. The aim of this study was to evaluate the occurrence and distribution of a second hip fracture in the time interval between the first and the second hip fracture. METHODS: All incident hip fractures in residents of Funen County, Denmark, from 1994 through 2004 were recorded. Verified fractures were sequenced within each patient using the unique Danish identification numbers. RESULTS: In total, 9990 incident hip fractures occurred: 9122 first hip fractures and 868 (8.7%) second fractures. Within the first year after the first hip fracture, the incidence rate of the second fracture in men decreased from 73 per 1000 person-years (py) during the first 3 months to 8 per 1000 py at 12 months; in women, it decreased from 116 per 1000 py during the first 3 months to 15 per 1000 py at 12 months. Of all the second fractures, 50% occurred within 12 months in men and within 19 months in women. CONCLUSIONS: Few hip fracture patients experience a second hip fracture and when they do, it is within a short time-frame from the first. The risk of sustaining a second hip fracture is high during the first 12 months following the first hip fracture, decreasing to a level equal to or below the incidence of the first hip fracture after this 12-month period. Preventive strategies at the time of the first hip fracture should therefore aim at immediate effects, as interventions with effects after 12 months (men) and 19 months (women) bypass at least 50% of the fractures.

Age Distribution↗
PubMed2005

The effects of minor hip flexion, abduction or adduction and x-ray beam angle on the radiographic joint space width of the hip.

OBJECTIVE: Joint pain may cause patients to hold their limbs in mild flexion, abduction or adduction to minimize pain, regardless of the extent of articular pathology, and these positional changes may have substantial effects on the interpretation of radiographic joint space. We aimed to study the impacts of minor degrees of flexion, abduction or adduction of the hip, as well as the angle of the x-ray beam on the radiographic joint space width (JSW) of the hip joint. METHODS: In the first part of the study, 65 patients (44 males, 21 females, mean+/-SD age 49+/-17) without clinical evidence of hip osteoarthritis (OA) who underwent intravenous pyelography (IVP) were studied. The hips were differentially positioned during the sequential radiographs required for the IVP procedure. Baseline radiographs were taken at 15 degrees internal rotation of the hips [the standard position for anteroposterior (AP) pelvis radiography]; additional positions included the hips at 15 degrees and/or 30 degrees flexion, and 15 degrees adduction and/or 30 degrees abduction. Radiographic JSWs were measured at three sites using a dial caliper: superomedial, superolateral, and the point of narrowest JSW. In the second part, 15 patients without clinical evidence of hip OA who underwent supine abdominal radiography for non-rheumatological indications were evaluated by standard (AP) pelvis x-ray in the same setting and JSW measurements were made as described above. RESULTS: When the average of the three measurements of the JSW was taken for each hip, baseline JSW was 4.38+/-0.55 mm (mean+/-SD). Positioning of the hip significantly (P<0.01) affected the radiographic JSW, with apparent widening during adduction and 30 degrees flexion, (JSW 4.56+/-0.51 mm and 4.53+/-0.58 mm, mean+/-SD), respectively, but narrowing during abduction (4.17+/-0.59 mm, mean+/-SD). Fifteen degree flexion of the hip did not result in statistically significant change in JSW measurements. Upon comparison of the AP pelvis view with the supine abdominal view, neither the average JSW nor the point of narrowest JSW differed significantly, although the superolateral JSW was significantly greater on the AP pelvis view (P=0.02). CONCLUSIONS: Subtle positional changes in the hip, such as may occur during pain or in OA, may artifactually alter the measured radiographic JSW. Thus, longitudinal studies which employ hip JSW to assess disease progression may yield biased results due to changes in pain rather than structure unless care is taken to ensure constant positioning of the hip.

Adult↗
PubMed2003

Factors related to occurrence of hip fracture during a fall on the hip.

Recently, it has been shown that hip fractures can be effectively prevented by use of hip protectors. To determine who would gain most benefit from use of hip protectors, we conducted a study with the aim to clarify factors that contribute to the occurrence of fracture in individuals who fall on their hip. Hip fracture patients were compared with individuals who had fallen on their hip without sustaining a fracture. The study group consisted of 123 consecutive hip fracture patients aged 70 years or over (mean age 82 years, female 82 years and male 80 years). The control group comprised 132 individuals (mean age 81 years, female 81 years and male 80 years) obtained from a prospective study on falls, who had experienced a fall that caused a visible soft tissue injury (bruise or wound) at the hip or gluteal region without sustaining a fracture. Patients were questioned about associated diseases, medications, place of residence, walking ability, need for locomotor aids and some activities in daily living (ADL). Patients who sustained a hip fracture were more likely to be women, living in long-term institutional care, using neuroleptics, dependent in ADL and had more history of previous stroke with hemiparesis, more Parkinsonism and lower body mass indexes (BMI) than those who did not sustain a fracture on fall on the hip. According to a logistical regression model, institutional residence, low BMI and history of stroke with hemiplegic status differed between fracture cases and controls. Institutional residence, low BMI and history of hemiplegic stroke discriminate hip fracture patients from fallers who sustain a soft tissue injury on the hip region. In clinical practice, patients who have these characteristics would be potential candidates to use hip protectors and other preventive measures.

Accidental Falls↗
PubMed1999

Hip and ankle range of motion and hip muscle strength in young female ballet dancers and controls.

OBJECTIVES: To compare the hip and ankle range of motion and hip muscle strength in 8-11 year old novice female ballet dancers and controls. METHODS: Subjects were 77 dancers and 49 controls (mean (SD) age 9.6 (0.8) and 9.6 (0.7) years respectively). Supine right active hip external rotation (ER) and internal rotation (IR) were measured using an inclinometer. A turnout protractor was used to assess standing active turnout range. The measure of ER achieved from below the hip during turnout (non-hip ER) was calculated by subtracting hip ER range from turnout range, and hip ER:IR was derived by dividing ER range by IR range. Range of right weight bearing ankle dorsiflexion was measured in a standing lunge using two methods: the distance from the foot to the wall (in centimetres) and the angle of the shank to the vertical via an inclinometer (in degrees). Right calf muscle range was measured in weight bearing using an inclinometer. A manual muscle tester was used to assess right isometric hip flexor, internal rotator, external rotator, abductor, and adductor strength. RESULTS: Dancers had less ER (p<0.05) and IR (p<0.01) range than controls but greater ER:IR (p<0.01). Although there was no difference in turnout between groups, the dancers had greater non-hip ER. Dancers had greater range of ankle dorsiflexion than controls, measured in both centimetres (p<0.01) and degrees (p<0.05), but similar calf muscle range. After controlling for body weight, controls had stronger hip muscles than dancers except for hip abductor strength which was similar. Regression analyses disclosed a moderate relation between turnout and hip ER (r = 0.40). There were no significant correlations between range of motion and training years and weekly training hours. CONCLUSIONS: Longitudinal follow up will assist in determining whether or not hip and ankle range in young dancers is genetically fixed and unable to be improved with further balletic training.

Ankle Joint↗
PubMed2000

Effect of dam and sire qualitative hip conformation scores on progeny hip conformation.

OBJECTIVE: To determine in dogs what effect using hip conformation scores assigned by the Orthopedic Foundation for Animals (OFA) as a criterion for breeding selections would have on hip conformation scores of the progeny. DESIGN: Longitudinal study. ANIMALS: English Setters, Portuguese Water Dogs, Chinese Shar-peis, and Bernese Mountain Dogs for which OFA hip conformation scores were known. PROCEDURE: Pedigree data were obtained from the national breed clubs and the American Kennel Club and merged with data from the OFA hip conformation score database. An ANOVA was used to evaluate the effects of sex, age at the time of radiographic evaluation, and year of birth on the variation in hip conformation scores among the progeny. Heritability was estimated by use of within-year midparent offspring regression analyses. RESULTS: Significant differences in progeny hip conformation scores between sexes were not detected, but age at the time of radiographic evaluation and year of birth had a significant effect on hip joint conformation of the progeny. Estimated heritability (mean +/- SE) was 0.26 +/- 0.03, and dam and sire hip conformation scores had a significant effect on progeny hip conformation scores. Annual decreases in percentage of dysplastic progeny and increases in percentages of progeny and breeding dogs with phenotypically normal hip joint conformation were detected. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that hip conformation scores have moderate heritability in dogs and selection of breeding stock with better hip conformation scores will increase the percentage of progeny with phenotypically normal hip joint conformation.

Age Factors↗
PubMed1994

Spongy metal Lübeck hip prostheses for osteoarthritis secondary to hip dysplasia. A 2-6-year follow-up study.

Between May 1987 and December 1990, 66 hips in 59 patients with osteoarthritis secondary to hip dysplasia underwent cementless total hip arthroplasty with a spongy metal Lübeck hip prosthesis (S+G Implants, Lübeck, Germany) that had a fully porous-surfaced short stem made of cased cobalt-chrome-molybdenum alloy. Sixty-five hips in 58 patients were prospectively followed for 2-6 years (mean, 43 months). Patient age at operation ranged from 29 to 63 years (mean, 51 years). The Merle d'Aubigné hip score improved from 7.8 before surgery to 16.9 at the final follow-up evaluation. All hips were rated as either excellent (63%) or good (37%). Mild thigh pain was recognized in only three hips (5%) at 6 months after surgery, but it disappeared within 2 years. Serial roentgenograms showed stable fixation with bone ingrowth in all hips, that is, bone densification in contact with the implant and trabecular connection to the endosteal surface. The authors found no migration of the implant or circumferential radiolucency. Moderate osteopenia, presumably due to stress shielding, was seen in only four hips (6%). Acetabular bone-grafting performed in 31 hips gave successful support to the socket. Cancellous bone chips grafted to small defects showed excellent remodeling. The authors conclude that the spongy metal Lübeck hip prosthesis contributed to lower rates of thigh pain and migration than cementless prostheses.

Adult↗
PubMed1980

Morphological variants in the human fetal hip joint. Their significance in congenital hip disease.

In a study of 280 hips in 140 normal fetuses, sixty-five of the ninety-two hips of forty-six fetuses between the ages of twelve weeks and term showed morphological variants, yet they were neither subluxated nor dislocated and showed no statistically significant morphological differences from normal joints. The vazriants observed included flattening (fourteen hips) or rounding-off of the rim of the labrum (nine hips), localized dips in the labrum (twenty hips), folding of the labrum (six hips), capsular folds (four hips), extension of the pulvinar pad between the joint surfaces (six hips), and kinking of the ligament of the head of the femur (seven hips). The localization of these variants in the anterosuperior quadrant of the acetabulum was highly significant (p < 0.001), but there was no significant relationship to sex or side of involvement. A significant relationship to age, on the other hand, was evident since the frequency of these minor morphological variations in the fetal hip joint appeared to increase with age. Considering all 140 fetuses, the ones with variant hips formed 55 per cent of all of those older than twenty-eight weeks and only 23 per cent of those younger than twenty-eight weeks (p = 0.007). I suggest that some of these variants are subclinical manifestations of congenital hip disease.

Acetabulum↗
PubMed2005

Anatomical hip model for the mechanical testing of hip protectors.

An anatomical hip model has been developed to simulate the impact load on the hip of a falling person wearing a hip protector. The hip consists of an artificial pelvis made of aluminium, linked by a ball-and-socket joint to an anatomically shaped steel femur (thigh bone). The femur is embedded in silicone material with a hip-shaped surface to allow realistic positioning of the protectors with accessory underwear. Additionally, the silicone simulates the damping and load-dispersal effect of soft tissue. A triaxial load sensor is integrated in the neck of the femur to measure the axial and cross-sectional force components in response to external impact forces on the hip. The performance of the hip model was investigated in drop tests and validated against biomechanical data. In a first series of measurements, the shock absorption of 10 different hip protectors, including both energy-absorbing and energy-shunting systems, was analysed. To determine the importance of hip protector placement, each protector was tested in the correct anatomical alignment over the hip and anteriorly displaced by 3 cm. Considerable differences were found between individual hip protectors in their effectiveness to reduce impact forces on the femur. Position of the hip protector also influenced the forces applied to the femur.

Accidental Falls↗
PubMedDate not supplied

[Correlation of pathological clinical hip symptoms in the sonographic study of infant hips].

The relevance of clinical signs of infant hip dysplasia and the importance of a sonographic newborn-hip screening are often discussed. Between 1984 and 1990 at our department 6532 infant hips were examined both clinically and sonographically. Sonographic hip findings were pathological in 71.7% of the hips with positive clinical Roser-Ortolani sign and in 100% of the hips with positive Hilgenreiner sign. In contrast, pathological hip types according to Graf were seen only in 18% of the hips with limitations of the abductions of the hip joint. Examining other clinical signs for infant hip dysplasia within this study, as well we can conclude, that only the Roser-Ortolani sign and that of Hilgenreiner showed a high specificity for infant hip dysplasia, while most of the clinical signs e.g. limitation of abduction in the hip joint are rather unspecific.

Diagnostic Errors↗