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A 76-year-old woman developed an abdominal-to-right hip joint fistula following repair of an aneurysm of the right iliac artery. The aneurysm appeared as a complication of an intraarticular (protrusio acetabula) fracture six years after bilateral hip arthroplasty. Prompt recognition and effective treatment saved the patient's life.
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Arthroscopy of the hip joint has developed into a useful tool for the hip surgeon. Hip joint anatomy, however, makes special demands of the arthroscopist. He needs to be familiar with the arthroscopic anatomy of the hip and its variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order to avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a combined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without traction. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force should be broken by distension of air or fluid. This leads to maximum distraction of the joint and reduces the risks of damage to labrum and cartilage during first access to the joint. For a diagnostic round through the central compartment, at least two portals have to be placed. The use of a 3-portal technique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the anterolateral or lateral portal should be used as the first portals to the central compartment. In addition, the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should be used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondromatosis and pigmented villonodular synovitis, associated lesions in underlying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least, "idiopathic" hip pain. The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complications after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, synovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in the hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studies have demonstrated the advantages of the arthroscopic treatment of the hip.
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The aim of this paper was to evaluate the development of different elements of the hip joint after surgical treatment, depending on age, anatomic conditions and degree of dysplasia at the time treatment was implemented. 100 hip joints were evaluated in 76 children treated because of congenital hip dislocation with the Dega or Chiari method in the years 1988-1993, according indication proposed during the XXVI Conference of the Polish Orthopedic Society. Age of patients at the time of surgery ranged from 2.5 to 7.5 years. There were 62 girls and 14 boys. The Dega method was implemented in 85 joints and the Salter method in 12 joints. Follow-up period ranged from 5 to 10 years. The best results were obtained in children who underwent surgery before 4 years of age.
Movements at the hip joint are first discussed in terms of free movement of the lower limb on the trunk. The biomechanics of standing on one lower limb limited to the situation in the coronal plane are presented. The role of the hip muscles in the upright posture and in the movements at the hip joint during walking on the flat and upstairs and downstairs is described.
Computed tomography through the hip joint should be used only after conventional radiographs (at least a.p. views). It may provide information that is diagnostic or helpful, eg. in bacterial infections, trauma or praearthrotic states. Indications for surgery may be obtained in the presence of inflammatory-rheumatic and degenerative hip disease, arthritic deformities and trauma, and the type of suitable operation may be indicated. The obturator internus muscle, which can be seen medial to the acetabulum on the scan, is an important diagnostic indicator where there is trauma or bacterial infection of the hip joint. The capsule of the hip joint can be visualized directly. Slice thickness of 6 mm. or less is necessary.
We report a method of monitoring hip joint development for congenital dislocation of the hip in children. The c/b ratio was measured on serial radiographs of 41 hips in 38 patients. The measurement was compared to c/b ratio obtained from normal hips. It was used to detect concentric reduction or its loss by migration of the femoral head during growth. The age at diagnosis ranged from 8 months to 10 years 6 months. The normal c/b ratio was found to change little with age. Deviation of the c/b ratio from normal in congenital dislocation of the hip resulted in a poor outcome and identified cases requiring further surgical intervention. This measurement of c/b ratio is simple and accurate, using easily determined points. The graphic display promotes critical analysis of situation and allows selection of cases at risk for treatment.
The paper outlines mechanisms underlying the development and predetermining the forms of hip joint disorders consequent to setting of congenital hip dislocation, the results of a 3-8-year follow-up of relevant 75 cases in children. Individual treatment regimens combined appropriate exercise, biomechanical correction, physiotherapy, acupuncture, manual therapy.
On total hip arthroplasty,there are some kinds of surgical approach. In all cases the operators should perform THA with skillful surgical approach. They ought always consider normal anatomy of hip joints,and then do the surgical performance. Total hip arthroplasty which is performed with trained surgical protocol and reliable anatomical knowledge is successful certainly.
Based on the clinical and radiological examinations of 95 patients with unilateral restricted movement of the hip, the deformities of ileosacral joint and symphysis are described. The pathological changes of ileosacral joints and symphysis could be demonstrated in cases with severe contractures of the hip. Low grade contractures under 15 degrees have been tolerated over many years.
Hip joint dysplasia in dogs occurs mainly in large and heavy breeds. It brings about changes on the acetabulum (socket) and the head of thigh bone, thus causing pain, tiredness, refusal to jump and refusal of increased activity. Even though presently the genetic basis of development of this disease, numerous literary sources indicate existence of pre-disposing factors that facilitate development in later stages of life. Diet and unbalanced development of skeleton and support tissues-ligaments, joint capsule and musculature also have the effect on development of dysplasia. We have analyzed acquired results of X-ray examination of dogs-German shepherds. The size of the group was 4 206 and the examination was aimed at incidence of hip-joint dysplasia during the period of 1977-1995 in the Slovak Republic. We have found out that in 1977 there were 70.7% positive cases out of the total number of examined individuals. Gradual exclusion of dogs with heavier grades of dysplasia (D, E) decreased occurrence of dysplasia to current rate of 40.8%. We considered it to be a high incidence rate. Internal structure of the positive group has changed. The number of dogs with the lightest grade of dysplasia (B) has increased, while the number of heavier grade dysplasia (C, D, E) decreased. In other breeds of dogs, of which more than 20 have been examined at the clinic, the following results have been acquired: Slovak chuvash-32%, Bavarian and Hannover bloodhound-30.6%, Rotweiler-28.6%, Newfoundland dog-26.3%, Bern sheep-dog-13.6%. At the same time we analyze the incidence of dysplasia in dogs whose parents were negative. Group of descendants of 11 negative males and 28 females consisted of 73 dogs. Through x-ray examination, 42.5% of dogs were found to have dysplasia B, C and D at the age of 1 year.
Applying traction to the hip joint normally creates a 'vacuum phenomenon' between the femoral head and the acetabulum. With the presence of fluid in the hip joint, this effect does not occur. Traction radiography thus gives the clinician and radiologist an easy and noninvasive method for detecting fluid in the hip joint. The subsequent article illustrates the potentialities of traction radiography in several hip diseases.
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Forth hips in 35 patients were converted from pseudarthrosis to low friction total hip arthroplasty (LFA). Pain, function and range of motion were improved in most cases. Gait was improved and number of walking aids required were reduced in most cases. Abduction against gravity and straight leg raising were also improved. Limb length was restored in all but 9 cases. Two cases dislocated postoperatively. One was reduced and did well; the other had a trochanter avulsion with recurrent subluxation. Improvement of function is a prime indication for converting a pseudarthrosis to LFA whereas pain is not so significant a factor. This is a formidable procedure requiring a complete range of prostheses and instruments and complete familiarity with the technique of total hip replacement but the end results are gratifying.
To evaluate the quality of the joint surface of a prosthetic hip joint, such parameters were measured as roundness, sphericity and roughness of joint surfaces for conventional prosthetic hip joints. Roundness was measured at two cross-sections for spherical and semi-spherical parts; sphericity was deduced from measurements at 25 points using a coordinate measuring machine, and surface roughness was estimated from measurements at two points on the joint surface. The measured values were ranked in three levels, A (five marks), B (three marks) and C (one mark). The marks were totaled for a given prosthetic hip joint, and classified into the following 4 stages as a criterion for evaluation. The stages comprised A (more than 21 marks), B (20 to 18), C (17 to 15) and D (less than 14). The prosthetic hip joint evaluated as A has, on average, roundness, sphericity and roughness of the femoral head and acetabular cup, respectively of less than 0.1 and 20 microns, 5 and 50 microns, and 0.1 and 0.5 microns. (The maximum roughness of the acetabular cup was less than 5 microns.) Only a few products ranked A not only in individual measurements, but also in the total evaluation. This fact strongly supports the view that to be an effective product a prosthetic hip joint should meet at least the A criteria set up for evaluating the surface quality of its femoral head and acetabular cup.
Joint traction and other mobilization techniques are commonly used in physical therapy for patients with osteoarthrosis. The aim of this study has been to: (a) measure the separation of the joint surfaces in the normal hip joint during application of different forces; (b) investigate whether or not the degree of separation was influenced by the position of the joint; (c) compare hip joint laxity in men and women; (d) find the traction force needed to cause the appearance of vacuum phenomena. To achieve a separation in the hip joint, a traction force of at least 400 N must be applied. The distraction was greater in the loose packed position than in the close packed position at equal force and in both males and females. Vacuum phenomena appeared at between 400 and 600 N of traction, varying with joint position.