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[Concentric centering of the normal hip and concentric reduction of the dislocated hip. Radiological study on their determination and clinical application].

A radiological method to determine the ideal, geometrical, center of the acetabulum and femoral head is described by the author; the proceedings for these localizations and the interrelationship between them, are also described. These factors were taken from a series of simple radiography and arthograms, which is called; "Concentrical Centring" in normal hips, as well as other seires of dislocated hips, which were radiographed in anteroopsterior view, and in frog position, as well as in histological sections. The necessity to look for the concentrical reduction of the dislocated hips is also emphasized, as a basic point for the good development of the acetabulum, which is achieved, at the time of treatment, if the location is made of the point of the femoral head with that of the acetabulum (Concentrical Reduction). This method will permit to evaluate this interrelationship easily in a numerical scale figure and with a minimum of error. This is a useful resource previous to the arthrography in those hips which have been just recently reduced; and latter, in their follow-up.

Anthropometry↗
PubMed1984

Tegumental changes of Alaria marcianae (Trematoda) during migration in the domestic cat.

Mesocercariae of Alaria marcianae were removed from snake paratenic hosts and fed to domestic cats. The cats were necropsied at specified intervals, the parasites recovered, and studied by SEM. During the prepulmonary phase of migration in cats, mesocercariae recovered from the stomach wall, abdominal cavity, diaphragm, liver, and heart underwent no tegumental modification compared to those fixed immediately after removal from the paratenic host. The mesocercaria resembled the body of an enlarged cercaria. The oral sucker was encircled by 14 or 15 rows of simple, posteriorly directed spines. Similar spines were also located along the margins of the venter and equatorially at the level of the acetabulum. This spinal pattern left two regions, one anterior and one posterior to the acetabulum, devoid of spines. Uniciliate papillae were found in a distinct pattern associated with the spined areas. In the pulmonary phase, the mesocercariae transformed into diplostomula. Earlike lappets on either side of the oral sucker developed with subsequent differentiation of microvilliform processes on their ventral sides. Body spines divided to give rise to three-pronged serrations. A depression on the venter between the acetabulum and posterior end of the body gave rise to the tribocytic organ. Stout, densely-clustered spines arose de novo on this organ. A rudimentary cylindrical hindbody gave the diplostomulum a distinct scoop-shaped appearance. Worms coughed up from the lungs and swallowed were later found in the duodenum. This postpulmonary phase of migration was a quick event and young worms in the duodenum were indistinguishable from those in the lungs. Within 4 days, the diplostomula in the duodenum matured to adulthood.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Osteoarthrosis and late growth.

To examine the hypothesis that late growth of bone may occur, pelvic radiographs taken during 1990 to 1992 of patients born between 1901 and 1972 were studied. All radiographs were taken using the same equipment with constant exposure techniques. Films showing osteoarthrosis (obviously decreased joint space) or hip fracture were discarded. The remaining films of 116 women and 100 men divided into 3 age groups (18-39 years old, 40-59 years old, and > 60 years old) were measured. With a millimeter ruler and a circle template, the center and 5 radii of each femoral head, the width of the acetabulum, and the pelvic diameters, the femoral neck, and the height of the superior joint space were determined. Most of the measurements increased significantly with age, including those of the femoral head, the acetabulum, the femoral neck in women, and the pelvic diameters. The increase in superior joint space (the combined heights of the cartilage of the femoral head and acetabulum) with age was not significant, but in men between 50 and 70 years old there were cartilage measurements that were higher than in other age groups, and in women > 80 years of age there were significantly more single high values. The results are discussed against the background that growth of bone and of cartilage can hypothetically cause injuries of the cartilage.

Adult↗
PubMed1996

Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound.

We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femora head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum. Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness. We concluded that the Pavlik harness is indicated for type-A but not for type-B or type-C dislocations.

Contraindications↗
PubMed1996

[Long-term review of homogeneous and consecutive series of 100 "Charnley"-type total hip prostheses].

PURPOSE OF THE STUDY: Long-term studies of total hip replacements often give diverse results because the series studied are not homogeneous. We report the long-term result in a homogeneous, consecutive series of 100 Charnley total hip replacements for idiopathic hip osteoarthritis in patient without previous surgery, by the same operator. MATERIALS: Of 200 patients with 223 Charnley or Charnley-Kerboull total hip prostheses, implanted more than 13 years earlier, 94 patients with 104 implants were alive at the time of the study. Ninety of them (95.7 per cent) with 100 implants were clinically and radiographically examined. Mean follow-up was 14 yr 8 mo and minimum follow-up was over 13 yr 6 mo. METHODS: Hip function was clinically assessed according to Merle d'Aubigné's criteria. Immediate postoperative x-rays and x-rays at 1, 5 and 10 years and at maximum follow-up were examined. For the acetabulum, alignment, radiolucent line, loosening and wear of the socket were analysed. For the femur, the position of the implant, radiolucent line and loosening, changes in the calcar and cortical bone were analysed. RESULTS: Two femoral implants had to be replaced because of implant fracture. The acetabulum became loose in 3 cases and the femur in 2, but did not require revision at the time of examination. Mean acetabular wear was 0.93 mm (0-5 mm). Wear was greater if the subjects were active (p < 0.05) overweight (p < 0.05) and if the acetabulum was vertical (p < 0.05). Changes in calcar, generally lysis, were more frequent when wear was marked (p < 0.001). Thinning of cortical bone was more frequent in women (p < 0.05), sedentary subjects (p < 0.001) and those in poor general condition (p < 0.05) and was less frequently associated with acetabular wear (p < 0.01). DISCUSSION: This study is characterised by its homogeneity: same etiology, same operator, same implants. Functional outcome at a mean of 14 yr 8 mo after surgery was good, as in most series of Charnley's total hip prostheses. Acetabular wear gave most cause for concern. It was linked with the weight and activity of the patients and with socket alignment. This wear led to deterioration of the calcar, due to granulomas and not to stress shielding. In spite of the homogeneity of the series, no factor was found to account for cortical thickening, whereas cortical thinning occurred in light-weight, osteoporotic patients whose prosthesis did not entirely fill the medullary canal. CONCLUSION: Charnley's total hip prostheses are a good method for treatment of idiopathic hip osteoarthritis. Cement does not appear to be a major deterioration factor over time, unlike polyethylene sockets in which wear and its consequences are a matter for concern.

Adult↗
PubMed1997

[Temporary antibiotic-loaded cemented prosthesis for two-stage septic hip arthroplasty].

PURPOSE OF THE STUDY: During the excision period of a two-stage revision arthroplasty, the hip has a low function and an unacceptable leg length discrepancy. The goal of this study was to expose technical details in order to perform a simple articulated cement spacer which could be implanted during this period to improve hip function, to authorize partial weight bearing and to avoid leg length discrepancy. MATERIAL: This method was applied in three two-stage procedures justified because of particular immunodeficiency conditions: a 43 years old man who had bone marrow allograft and immunosuppressive therapy because of leukemia suffering of subacute septic hip arthritis; a 58 years old man suffering of diabetes and active C-hepatitis who had a septic loosening of a total hip arthroplasty (THA); a 76 years old woman suffering of diabetes who had a third septic loosening of THA. METHOD: The prosthesis was made of antibiotic-impregnated cement according to organisms antibiotic resistance. The prosthetic junction between head and diaphysis was reinforced with a tibial plate. Prosthetic shape was identical to the one of femoral broaches inserted in the femur after prosthetic and cement removal. The broach size was chosen when mechanical stability in the femur was obtained, and avoided leg length discrepancy after trials with cups. The tibial plate was bent in order to reinforce the junction with regard to the shape of the determined broach. Two doses of antibiotic-impregnated cement were mixed and molded with hands, then the plate was incorporated at the appropriate location, finally the broach was applied on this composite and cement in excess was removed before polymerisation. For prosthetic head, two options were available: to mold the cephalic zone of the cement at the patient acetabulum diameter with a soft aluminium cup previously molded in the acetabulum; to mold the cement cephalic zone with a trial cup in order to obtain a 22 or 28 ball. For this last option, a third dose of antibiotic-impregnated cement was prepared and placed in the acetabulum, a trial femoral head was applied in it to mold the location for the 22 or 28 prosthetic head. Before insertion, a collar was applied on the stem to prevent migration. Active mobilization was encouraged, and partial weight-bearing authorized. RESULTS: The mean range of hip flexion during period was 60 degrees. The patients were discharged approximatively 12 days after the first stage. Two patients had effective painless partial weight-bearing. The second stage was performed six weeks later on the average. The second procedure was easier than the second stage of a conventional two-stage procedure because of: easy and low hemorrhagic dissection authorized by the prosthesis; low difficulties with soft tissue tension as the prosthesis prevents leg length discrepancy; preservation of the articular space which prevents soft tissue sacrifice during the second stage. CONCLUSION: This simple technique is effective to prevent complications related to the excision period of a two-stage hip revision arthroplasty. Likewise, the economical aspect (short delay of hospitalisation, quick functional recovery) should be considered when compared with the excision period of a conventional two-stage procedure.

Adult↗
PubMed1978

Proximal focal femoral deficiency.

The term proximal focal femoral deficiency (PFFD) is applied to a spectrum of conditions characterized by partial absence and shortening of the proximal femora and thought to result from an early disturbance of growing mesenchyme. The mildest cases, Classes A and B, exhibit a relatively normal acetabulum and capital femoral epiphysis, despite the dysplastic shaft. There may be a subtrochanteric varus deformity or a pseudoarthrosis accompanying the shortening of the femoral shaft. At the opposite end of the spectrum, the most severely deformed cases, Classes C and D, have involvement of the acetabulum, and the entire proximal femur. In cases of advanced dysgenesis, the findings include: a stunted severely shortened femur with a club-shaped or pointed proximal end, an iliac projection just above the anatomic site of the acetabulum, a spherical obturator foramen, and squaring of the iliac crest. Twenty-one patients (2 bilateral) with proximal focal femoral deficiency are presented (23 femurs). Differentiation of proximal focal femoral deficiency from other congenital and acquired deformities of the hip joint is essential for selecting the proper treatment.

Adult↗
PubMed1975

A new pelvic fragment from Swartkrans and the relationship between the robust and gracile australopithecines.

A recently discovered hominid pelvic fragment from Swartkrans (SK 3155) is described in detail with particular reference to the relationship of the two presently recognized forms of australopithecines in South Africa. Results of this examination and metrical analysis indicate that the acetabulum and iliac blade of the early hominids are similar to Homo sapiens except for a unique pattern of traits: a relatively small sacral articular surface, a relatively small acetabulum, a relatively large iliac fossa, and wide lateral splaying of the iliac blades. The new Swartkrans fossil expresses these traits more strongly than does the gracile australopithecine (Sts 14) and is therefore somewhat less similar to Homo sapiens but it is very unlike any pongid.

Acetabulum↗
PubMed1989

Rotational acetabular osteotomy in congenital dysplasia of the hip.

Rotational acetabular osteotomy was carried out in 127 patients (147 hips) with acetabular dysplasia, some of whom showed early or progressive degenerative changes. Complications occurring during and after operation were transient lesions of the lateral femoral cutaneous nerve in 20 patients, of the femoral nerve in 2, fracture of the acetabulum in 1, inadequate rotation of the acetabulum in 11, and infection in 3 patients. Later complications were breakage of Kirschner wires in 3, ectopic bone formation in 2 and acute chondrolysis in 3 patients. Sixty-six patients (69 hips) were followed for an average of 5 years and 4 months, and in most of them satisfactory results were achieved in spite of these complications.

Acetabulum↗
PubMed1995

A computer simulation study of normal and abnormal hip joint contact pressure.

The contact pressure on 112 normal hip joints and 66 acetabular dysplastic hip joints was analysed using a three-dimensional rigid body spring model. Geometric models were made from conventional anteroposterior radiographs, with the assumption that the acetabular surface was spherical. In normal hips, the distribution of contact pressure was almost even over the joint surface, and the maximum contact pressure was relatively low. However, in a dysplastic hip joint, the pressure was concentrated on the anterolateral edge of the acetabulum and increased enormously not only with the reduction in lateral coverage but also with the reduction in the anterior coverage of the acetabulum. This result indicates that a three-dimensional analysis is indispensable for estimating the mechanical effect on acetabular cartilage.

Acetabulum↗
PubMed1998

Variations of relative anteversion of the femoral neck during walking.

Based on the geometric model developed by Netter [11], we determined the different positions of the femoral neck during monopodal support in walking in relation to a fixed frontal plane of reference (relative anteversion). This "relative anteversion" ranges on average from 24 degrees of retroversion at the beginning of support to 15 degrees of anterversion at the end if loading. We then studied the relations possibly existing between relative anteversion and acetabular orientation on the one hand, and the orientation of the resultant of the articular stresses on the other (both being variables during monopodal support in walking). The results showed that relative anteversion is well correlated with variations of position of the acetabulum since, at most, the deviation between the respective axes did not exceed the anatomic deviation due to absolute anteversion of the femoral neck and acetabulum. Lastly, analysis of the relations obtained with the orientation of the resultant of the articular stresses allowed a better comprehension of the functional distribution of forces.

Acetabulum↗
PubMed1985

Anatomical basis for study of acetabular migration of the prosthetic cup used in arthroplasty of the hip: a new technique for measurement of migration.

A retrospective study was carried out on 96 partial hip prostheses. Results of this study led us to define new radiological criteria for evaluation of the anatomical position of the prosthetic cup in the acetabulum. A method of measurement of the migration of the prosthetic cup in the acetabulum is proposed based on the results of roentgenological and anatomical study. The anatomical landmarks, geometric constructions and methods of computation of such measurement are described. The application of this technique to radiological/anatomical study was found to be reliable and allowed the determination of prognostic factors indicative of poor acetabular tolerance of the prosthetic cup.

Acetabulum↗
PubMed1991

MR-anatomy of infants hip: comparison to anatomical preparations.

The correlation between anatomical preparations and MRI images of the most important structures of newborn hips in coronal and axial orientation was performed in 18 post mortem babies. T1-weighted images present a good differentiation between cartilage, bone, ligaments and surrounding soft tissues. Coronal images give the best opportunity to study the clinically important structures of the roof of acetabulum including the labrum and the ground of the acetabulum. The latter is shown in a more detailed way by MRI than by sonography. Axial images allow additional examinations of the ventral and dorsal parts of the joint. By using both coronal and axial images the exact determination of the centering of the femur head in the hip joint is possible.

Acetabulum↗
PubMed1992

Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology.

Recent studies have suggested that ultrasound examinations may improve diagnostic accuracy in congenital dislocation of the hip, but there is differing opinion whether ultrasound diagnosis should be based on morphology or stability. Ultrasound was added to the routine clinical screening in 1503 newborns (1291 girls and 212 boys). Hip morphology was classified according to Graf (type 1-4), while sonographic stability was based on a modified Barlow maneuver, and classified as stable, elastic deflection (normal finding), unstable (provocating a gap between the femoral head and the acetabulum) and dislocated. Among 80 morphologically dysplastic hips, 73 (91%) were sonographically unstable or dislocated, while seven dysplastic hips were stable. On the other hand, in 49% of the sonographic unstable hips (69 out of 142) the acetabulum was either normal or just physiologically immature. 38 of these hips were left untreated and normalized spontaneously. There was a close correlation between sonographically and clinically determined hip stability (gamma = 0.95). Our study shows that the majority of morphologically dysplastic hips is sonographically unstable or dislocated, but also that morphologically dysplastic hips may be stable. Morphologically normal hips showing minor sonographic instability do probably not require treatment, and thus morphology seems to be an important diagnostic criterion.

Acetabulum↗
PubMed1998

[Labrum lesions in residual dysplasia of the hip joint. Biomechanical considerations on pathogenesis and treatment].

The capsular-labrum-complex consists of the triangular fibrocartilaginous labrum, which is fixed at the bony acetabular ring and supported by the ligamentum transversum actetabuli in the caudal part. In a normally developed and correctly orientated acetabulum, the femoral head is symmetrically covered by the contact area of the lunate surface. The vertical component of the resultant hip joint force concentrically meets the horizontal weight bearing surface: Evenly distributed compressive forces are transmitted; the capsular-labrum-complex does not have to compensate excessive shear or tension. In contrast, in a "dysplastic" acetabulum the femoral head is poorly covered by the pathologically orientated lunate surface: The lunate surface is sloping in an anterolateral direction, leading to tension and shear on the superolateral capsular-labrum-complex, which becomes a secondary stabilizer ("guide rail") against the decentering femoral head. The vertical component of the resultant hip force eccentrically meets the oblique weight bearing surface, causing extra stress in the labrum: The capsular-labrum-complex is trying to compensate this biomechanical stress with hypertrophy (Type IB). Progressive mechanical decompensation of the capsular-labral-complex might lead to tears (Type IIB) or complete avulsions (Type IIIB) of the labrum. In conclusion labral lesions result from pathobiomechanics caused by residual hip dysplasia (RHD). Logically, the basic therapeutic principle can only be corrective osteotomy.

Acetabulum↗
PubMed2000

[Operative treatment of complex acetabular fractures through the modified extensile iliofemoral approach].

Fourty-nine patients with 50 complex acetabular fractures were treated with open reduction and internal fixation from August 1993 to February 1996 in a prospectively documented study. The fractures were fixed with small fragment implants through a modified extensile iliofemoral approach (Maryland approach). Thirty-seven patients were polytraumatized with an ISS of 20 pts. on average. In 10 patients the ISS was > 25 pts. Good or anatomic initial fracture reduction with a fragment stepoff K 2 mm could be achieved in 48 fracturers (96 %). Thirty-six patients with 37 fractures could be evaluated after 25 months on average. In 28 fractures (76 %) the functional outcome was good or excellent according to the d'Aubigne and Harris scores. Radiological results were excellent in 21 fractures (57 %) and satisfactory in 12 fractures (Heeg score). In 7 cases (14 %) a postoperative subcutaneous seroma had to be treated surgically. No wound infections, however, were observed. Further complications were secondary a loss of reduction in 4 cases (11 %), relevant heterotopic ossifications (Brooker III/IV) in 5 cases (14 %), and aseptic femoral head necrosis in 2 cases (5 %). In two cases a total hip replacement (THR) for posttraumatic arthritis had to be performed. Two more cases are scheduled for THR due to symptomatic femoral head necrosis. A good joint reconstruction can be achieved through the modified extensile iliofemoral approach (Maryland) in complex fractures of the acetabulum. However, the approach related morbidity seems to be worrisome. In complex fractures with comminution in the roof of the acetabulum the prognosis remains uncertain even in cases where initial anatomic joint reconstruction can be achieved.

Acetabulum↗
PubMed2003

[Computerized tomography in evaluation of decreased acetabular and femoral anteversion].

Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum.

Acetabulum↗
PubMed1997

[Hip ultrasonography. Basic principles and current aspects].

Hip sonography is the subject of controversial discussion in several countries. This is because of the different demands made on the diagnosis. In principle the techniques described by Harke, Terjesen and Suzuki are satisfied by a differentiation of luxation from non-luxated joints. An evaluation of the hyalin cartilaginous preformed acetabular roof does not exist. Physiological variations dependent on age cannot be differentiated from real dysplasias by the techniques mentioned above. The sonographic examination technique in German-speaking countries evaluates the maturation of the joint and quantifies the cartilage and the bony acetabular roof. Additionally, this coverage is seen in relation to the age, and the deformation of the acetabulum in luxated joints is analysed. Physiological elastic deflection of the hyalin cartilaginous part of the acetabulum can be separated from real instability signs. Oblique positions of the probe during examination of the baby can lead to diagnostic errors, so special examination techniques have to be used. 3D-sonograms may improve the diagnostic possibilities. A general screening of newborns in use in Austria since 1992 has demonstrated that the rate of treatment can be decreased by about 50% and sonography, used correctly, can avoid overtreatment.

Acetabulum↗