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PubMed1984

Hip disease in Hutchinson-Gilford progeria syndrome.

Two cases of Hutchinson-Gilford progeria syndrome are presented with a focus on hip disease. A severe coxa valga is the first abnormality. The femoral head becomes increasingly uncovered as the acetabulum becomes more dysplastic. The center edge angle decreases, the acetabular index increases, and the medial wall of the acetabulum widens. Hip pain, subluxation, and eventually dislocation are the sequelae of these changes. Late osteotomy is unpredictable; thus the best therapeutic regimen is early osteotomy (age 4-6 years) and a regular exercise program to maintain muscle strength and range of motion.

Acetabulum↗
PubMed1983

[Value of computed tomography in congenital hip dysplasia and hip luxation].

A lot of methods of measurement have been developed to record precisely the degrees of luxation and the deviations from the normal form in the hip joints of the child and adult. The orthopaedic surgeon needs those data for a preoperative "coxometric program" before performing acetabuloplastic operations with osteotomy, osteotomy of the pelvis and combined operations. Computed tomography yields a series of informations and of possibilities of measurements which can determine the operative procedure in particular. These informations concern among other things the dimensions of the dysplasia of the acetabulum in the horizontal plane with the extension of the posterior lip and the angle of the acetabular opening, furthermore the physiological or pathological congruence between the head of the femur and the acetabulum, the angle of antetorsion of the neck of the femur and, in the small infant, the direct noninvasive imaging of the tube of the capsule with imaging of possible obstacles to reposition.

Acetabulum↗
PubMed1984

Advances in total hip arthroplasty. The metal-backed acetabular component.

Detailed, long-term studies of cemented total hip arthroplasties clearly show that failure of fixation of the acetabular component is a major problem, with a rising incidence and an unusual complexity. By finite element analysis the stress distribution in the human acetabulum before and after total hip arthroplasty was analyzed by three different groups of investigators. Data from all three studies are in agreement that the introduction of cemented acetabular components of high-density polyethylene results in major disturbances of stress distribution, with peak stresses after total hip arthroplasty occurring in the cement, trabecular bone, and medial wall of the acetabulum. The most effective way to reduce these peak stresses in these three critical areas is to use an acetabular component with a metal backing. Long-term follow-up studies of 51 patients who underwent total hip arthroplasty performed by the author during the period from 1971 to 1975 using metal-backed acetabular components confirm the improved fixation that results from use of this design. Both the analytic data of stress distribution and clinical follow-up studies strongly support the use of metal-backed acetabular components in cemented total hip arthroplasty.

Acetabulum↗
PubMed1981

Circulatory and vascular changes in the hip following innominate osteotomy: an experimental study.

The circulatory and vascular changes in the hip following Salter-type innominate osteotomy were studied in 35 dogs to determine the effects of innominate osteotomy on the blood supply of the hip joint. Microangiography, bone scanning, and isotope clearance were employed four months after the innominate osteotomy. Microangiography showed increased vascularity at the osteotomy site, in the ipsilateral side acetabulum, and in the femoral head in 65% of the dogs. Bone scanning with 99mTc diphosphonate showed increased activity at the osteotomy site, in the acetabulum, and in the femoral head and neck in 75% of the dogs. The 99mTc diphosphonate clearance studies showed that the blood supply to the femoral head was increased by almost 30% after innominate osteotomy in 50% of the dogs studied. These observations indicate that innominate osteotomy could increase the vascularity and blood supply of the hip by increasing the collateral circulation in the process of healing of the osteotomy. The physiologic basis of the joint to innominate osteotomy constitutes a rational basis for recommending the operation for the treatment of selected cases of congenital hip dislocation, Legg-Perthes disease of the femoral head, and degenerative osteoarthritis of the hip with or without acetabular dysplasia.

Acetabulum↗
PubMedDate not supplied

Design concepts, indications, and surgical technique for use of the protrusio shell.

Major deficiencies of the medial wall of the acetabulum arising from severe protrusio acetabula, migrated endoprostheses, old central fracture dislocations, and intrapelvic socket protrusions are a serious threat to the success and longevity of total hip arthroplasty. However, excessive strain on the weakened medial wall can be substantially reduced by the use of the protrusio shell. Treatment of existing complications includes augmenting and bone grafting the defect. The surgical technique is demanding but not complex. The protrusio shell is designed to conform to the anatomy of the acetabulum and permits independent positioning of the acetabular component in its optimum attitude. Major bony defects in the medial wall should be occluded by the autografts or allografts in conjunction with the use of the protrusio shell.

Acetabulum↗
PubMed1982

Injury to the acetabular triradiate physeal cartilage.

Traumatic disruption of the acetabular triradiate physeal cartilage is an infrequent injury. When it occurs during adolescence, subsequent growth changes in acetabular morphology and congruency of the hip joint are unlikely. However, in younger children, especially those who are less than ten years old, acetabular growth abnormality is a frequent complication of this injury and may result in a shallow acetabulum similar to that seen in patients with congenital disease of the hip. By the time of skeletal maturity, disparate growth increases the incongruency of the hip joint and may lead to progressively more severe subluxation of the hip. Acetabular reconstruction may be necessary to correct the gradual subluxation of the femoral head. Variable irregularities of growth at the proximal end of the femur also may occur. In this series, nine patients with triradiate physeal-cartilage injury were classified according to the degree of displacement and the probable type of growth-plate disruption. Two main patterns of injury occurred. The first was a shearing type-1 or 2 growth-mechanism injury, with central displacement of the distal portion of the acetabulum. This injury pattern seems to have a favorable prognosis for continued normal acetabular growth, although premature closure of the triradiate physes may occur. The other pattern appeared to be a crushing type-5 growth-mechanism injury. This type has a poor prognosis, with premature closure of the triradiate physes occurring secondary to the formation of a medial osseous bridge. In either pattern, the prognosis is dependent on the age of the patient at the time of injury and on the extent of chondro-osseous disruption.

Acetabulum↗
PubMed1982

Symposium on Surface Replacement Arthroplasty of the Hip. Biomechanics: mutifactorial design choices--an essential compromise?

The main flaws to be overcome in realizing the potential success of the double-cup arthroplasty procedure are failures due to femoral cup loosening, acetabular cup loosening, and femoral-neck fractures. The clinical uncertainties include the selection of a suitable patient with adequate bone stock and the technical difficulties associated with (I) reaming the acetabulum adequately, (2) reaming down onto the neck without violating it, and (3) anchoring the components securely by interdigitation of acrylic cement. The higher frictional torques of the double-cup arthroplasty designs are not a clinical loosening issue--the resulting acetabular cement-bone shear stresses are very low. Computer models of both the femoral and acetabular components predict significant stress shielding of the cancellous bone under metal femoral shells. At the rim of the femoral cup, the stresses are increased by a factor of 3 owing to the stress concentration effect and can rise to a factor of 10 if cystic or osteoporotic changes are present. This finding if confirmed in the three-dimensional models may explain some of the femoral neck fractures. The thin polyethylene acetabular cups may also cause a stress concentration effect on the underlying cement and bone. This may explain the higher incidence of radiographic loosening around the acetabulum in double-cup arthroplasty designs compared with total hip replacements. Metal-backed sockets may reduce cancellous bone stresses and appear advantageous. There is no clinical evidence of unusual wear or wear-related problems. However, new material formulations are now either in use or being planned for the double-cup arthroplasty designs. As yet, there have been no published data on hip simulator wear for the efficacy of any of the current or proposed changes. Biologic fixation appears to be the theme for the 1980s. However, the combination of technology, design instrumentation, and patient selection will be critical in achieving success with this technically difficult procedure.

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PubMed1978

[Examination of the extension of the osseous facies lunata. A functional study (author's transl)].

In 30 human acetabula the osseous facies lunata was examined and measured. It was found that the acetabular notch is inclined ventrally against the vertical line for an amount of 18,3 degrees (mean value). It was further found that the widest region of the facies lunata is not situated in the acetabular roof (which is usually visible in X-ray photographs), but about 15 degrees in front of it. The outer margin of the osseous acetabulum corresponds to a parallel of latitude of 11,5 degrees, that means that it is situated distinctly above the equator. The cornu anterius is always narrower than the cornu posterius; the similarity between the sockets examined was so great, that a division into different types did not seem to be necessary and an "average acetabulum" was calculated. The width of the facies lunata is interpreted as an equivalent for the amount of stress brought upon; now and then existing indentations of subdivisions of the joint surface are correspondingly understood as places of reduced stress.

Acetabulum↗
PubMed1981

Patterns of deformity of the developing hip.

The hip joint presents a coaptive relationship between the head of the femur and the acetabulum. Developmental changes in either component affect the responsive growth of its companion. Normal pressure of the head of the femur in the acetabulum maintains a balance in the proliferation of triradiate and acetabular growth cartilage. Secondary deformities occur as a result of failure of head-acetabular relationships as in congenital dislocation of the hip and primary epiphyseodesis of the triradiate cartilage (TRC). Anatomically the proximal femur adapts to the growth of the primary epiphyses and associated biomechanical forces. The femoral head and greater trochanter enlarge by appositional growth, and their subjacent growth plates, nourished by epiphyseal vascularity that penetrates the bony end plate, contribute to length and width of the neck, respectively. During infancy and early childhood the longitudinal growth plate (LGP) of the neck is horizontal. The shape of the proximal femur depends primarily upon lateral contributions of the trochanteric growth plate (TGP) and the femoral neck isthmus (FNI) balanced against the longitudinal and slightly medial contributions of the LGP. The resultant longitudinal vector of axial and medial (LGP) and lateral (TGP and FNI) directions of growth maintains biomechanical forces about the hip while at the same time insuring the trajectory of growth in line with the axis of the femur. An understanding of the interrelationships of the growth zones of the proximal femur and their alterations as a result of genetic, environmental, and developmental influences permits early diagnosis of growth deformities and the opportunity to plan early corrective procedures.

Acetabulum↗
PubMedDate not supplied

Morphometric study of the fetal development of the human hip joint: significance for congenital hip disease.

Hip joints (280) from 140 human fetuses, obtained from abortions and deaths in the perinatal period, were studied. The fetuses ranged from 8.7 to 40 cm in crown-rump length and are believed to be between 12 and 42 weeks in age. The joints were dissected, morphology inspected, and measurements taken of the depth and diameter of the acetabulum, the diameter of the femoral head, length and width of the ligament of the head, the neck-shaft, and torsion angles of the proximal femur. Regression models were fitted to determine which would best predict the growth pattern. Multivariate analysis of variance showed no significant differences between males and females or between the right and left sides. Acetabular depth was shown to be the slowest-growing hip variable, increasing less than fourfold in the period studied. Acetabular indices less than 50 percent indicate a shallow socket at term. Femoral head and acetabular diameter demonstrated a strong relationship (r = 0.860) and in many joints the femoral head diameter exceeded that of the acetabulum. Considerable variability was demonstrated in both femoral angles. The femoral angles showed only low correlation with the other hip variables. These observations indicate that soft tissue structures about the joint must play an important role in neonatal joint stability. The explanation of greater female and left side involvement in congenital hip disease must lie in factors other than growth changes of hip dimensions. Neither angle appears to be a useful indicator of normal joint development.

Acetabulum↗
PubMed1980

The biomechanics of the pediatric hip.

Containment refers to the relationship of the most lateral part of the femoral epiphysis to the lip of the acetabulum. Congruence refers to the relation between articular surfaces, but is not as useful a concept as sphericity. Coverage refers to the relationship of the lateral lip of the acetabulum to the resultant force across the hip joint and in most cases is best estimated by the center-edge angle. Femoral heads can be well contained but poorly covered and vice versa. Appreciation of these three concepts is important, not only in considering treatment of the pediatric hip but also in communicating with one's colleagues. Varus osteotomy redirects muscle forces about the hip and improves containment. The innominate osteotomy has these effects also but in addition improves coverage.

Acetabulum↗
PubMed1980

Complex acetabular fractures: a transtrochanteric lateral surgical approach.

Open surgery is recommended for complex fractures whenever primary conservative treatment fails to satisfactorily reduce the femoral head and the weight-bearing dome of the acetabulum. Surgical exposure has been a major problem in attempting open reduction of these fractures. The classification of acetabular fractures noted above is a useful guide to the indications for open operation. A transtrochanteric lateral approach provides a good extra and intraarticular access to the acetabulum. The excellent clinical results achieved in 28 cases of complex acetabular fractures with a mean of 5.7 year follow-up testify to the value of this approach.

Acetabulum↗
PubMed1980

Results of treatment of acetabular fractures.

If it is not possible to achieve a satisfactory position by conservative methods, surgical treatment is indicated in displaced fractures of the acetabulum in order to restore and stabilize both the hip joint structure and the integrity of the pelvic ring. Restoration of the joint surfaces to as near normal as possible offers the best chance for a symptom-free hip. The postoperative recovery time is not hastened, but the conditions for early activity and restoration of function are improved. As demonstrated in 270 cases reported here, and as is well recognized in the past, a significant proportion of patients will require secondary or salvage surgery, i.e., total hip arthroplasty. Such treatment may not be possible if there is extensive residual disorganization of the hip joint. Preparation for future reconstructive surgery is important as an indication for operative reduction of the acetabulum.

Acetabulum↗
PubMedDate not supplied

Containment of the hip: a theoretical comparison of osteotomies.

Using a computerized model derived from anatomic specimens, coverage of the femoral head by the acetabulum during the gain cycle was studied and compared for normal hips, varus-derotation osteotomy, and innominate osteotomy (Salter). Theoretical estimates of joint reaction force were also studied during the gain cycle for the three conditions. The entire proximal femoral epiphysis was never covered by the acetabulum with any of these procedures. Innominate osteotomy gave better anterior coverage (with resultant poorer posterior coverage) than the femoral procedure. Varus-derotation osteotomy increased medial shear force at the epiphyseal plate to twice body weight, but in all cases the major component of force was normal to the epiphyseal plate (compression) rather than parallel to it (shear).

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PubMed1995

Revision total hip arthroplasty using a cementless acetabular component. Technique and results.

Are the midterm results (range, 7-11 years) for revision of the acetabulum with a cementless hemispherical component comparable with other published revision techniques at similar followup? One hundred thirty-eight acetabular revisions for aseptic loosening were done in 132 patients using a cementless hemispherical component coated with titanium mesh and inserted with supplemental screw fixation. Twelve patients died, 9 were lost to followup, and 6 could not return for followup, leaving 111 patients (115 hips) with a mean of 100 months of followup. Thirteen hips required revision (11%): 4 were done for recurrent dislocations, and 6 for sepsis; 3 stable cups were revised (at the time of stem revision). No cup was revised for aseptic loosening. Radiographic review was available for 105 patients (109 hips) at mean 98-month followup (78-135 months). A complete radiolucency was seen in 4% of the cups, a partial progressive radiolucency in 3%, and a partial nonprogressive radiolucency in 54%; no radiolucency was present in 39%. A screw radiolucency was seen in 2%, and osteolysis at the cup margin in 4%. Revision of the acetabulum with a cementless porous-coated hemispherical fiber-metal component is superior to the results reported for acetabular revisions with cement at similar followup.

Acetabulum↗
PubMed1979

Mechanical failures in total hip replacement requiring reoperation.

During the years 1971 through mid-1977, approximately 3,000 total hip replacements were performed at The Hospital for Special Surgery using metal-to-plastic prostheses. During that period of time, thirty-five operations were done for mechanical failure in the absence of infection. The mechanical failures were distributed as follows: Fourteen patients had dislocations of the prostheses and seven patients had loosening of the femoral component, mostly with varus positioning of the femoral stem. Six patients, most of them heavy, active men, had fractures of the femoral stem. Three patients had loosening of the acetabular component. (In two of three there was insufficient bone stock over the acetabulum.) Four patients had proximal migration of the greater trochanter and one had a fracture-dislocation of the acetabulum. In all cases a technical or anatomical problem could be identified as the reason for mechanical failure necessitating reoperation. By careful preoperative planning, proper selection of procedures and positioning of prostheses, bone-grafting when necessary, and stricter attention to the technique of using cement, we could conceivably have avoided two-thirds of these failures.

Acetabulum↗
PubMed1979

Posterior iliopsoas muscle transfer in myelodysplasia.

A Sharrard posterior iliopsoas muscle-transfer procedure was done in forty-two hips of twenty-four children with myelodysplasia. Folow-up ranged from twenty-nine months to approximately ten years. An over-all success rate of 50 per cent was achieved which included all hips operated on for potential and existing instability. The success rate for surgery in hips with an existing instability was 29.6 per cent. Factors predisposing to a poor result were: age more than five years old, dysplastic acetabulum (index more than 30 degrees), prior hip surgery, and inequality of limb length. This operation is recommended primarily for hips not previously operated on in children less than five years old who have a normal acetabular index. If the child is more than five years old or if acetabular dysplasia exists, reconstruction of the acetabulum should precede or accompany the tendon transfer for best results. Iliopsoas muscle transfer is unlikely to be successful if used as a salvage procedure.

Acetabulum↗
PubMed1979

Irreducible traumatic dislocations of the hip.

Little attention has been paid to the various causes preventing or blocking a concentric reduction following traumatic dislocation of the hip without apparent fracture. In a review of fifty-four dislocations, nine required open reduction after either a failed attempt at closed reduction or a non-concentric reduction. The factors preventing closed reduction included the femoral head buttonholed through the capsule and the piriformis muscle displaced across the acetabulum. A concentric anatomical reduction was prevented because of an inverted lumbus or an osteocartilaginous loose body in the acetabulum. Guidelines for diagnosis and treatment are discussed.

Acetabulum↗