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PubMed2006

Bilateral hip fractures.

BACKGROUND: In the past, patients admitted for hip fractures had often sustained a contralateral hip fracture. The incidence of bilateral hip fractures has been reported to be 5%-10%, and in the future the number of bilateral hip fractures is expected to increase with the increase of unilateral hip fractures. We believe that bilateral hip fractures can be efficiently prevented if a fracture on the other side could be predicted after unilateral hip fracture. Therefore, this retrospective study of 835 patients with hip fractures investigated the incidence, prognosis, and risk factors of bilateral hip fractures. METHODS: We examined 835 hip fractures retrospectively in Japan. Among them, we found 94 patients with bilateral noncontemporary hip fractures. We investigated age, sex, interval between the two fractures, type of fractures, cause, physical functioning, and complications. Differences between the unilateral fracture and bilateral fractures groups were analyzed statistically for age, sex, and complications using Student's t test and the chi-square test. RESULTS: In this study, the mean interval between two fractures was 4.28 years, and the second hip fracture occurred within 5 years in more than 70% of patients. The type of hip fracture was the same in 72.2% of bilateral hip fractures. No difference in age and sex was found between the unilateral and the bilateral groups. However, concerning complications, 22.1% of patients in the unilateral group and 34.8% in the bilateral group had dementia, the difference being significant. CONCLUSIONS: These results revealed that the second hip fracture occurred within 5 years of the first in more than 70% of bilateral hip fracture patients and that dementia is a risk factor of bilateral hip fractures.

Accidental Falls↗
PubMed1996

Loss of hip motion in slipped capital femoral epiphysis: a calculation from the slipping angle and the slope.

The range of hip motion in 128 hips of 108 patients was measured at an average of 32.7 years after slipping of the capital femoral epiphysis (SCFE). Only hips without signs of osteoarthrosis were selected for the study. The hips were divided into three groups depending on treatment (i.e., fixation in situ, no treatment, osteotomy) and compared with those of a group with no slipping (normal hip). The slipping angle (SA) between the basis of the epiphysis and the perpendicular to the anteversion plane on lateral radiographs and the slope (S) between the basis of the epiphysis and the perpendicular to the axis of the femur on anteroposterior (AP) radiographs were measured. The only significant loss of hip motion evident in comparison of normal hips and hips with previous SCFE, was loss of external rotation in hips treated with osteotomy. Hips with no treatment and hips treated with fixation in situ showed no significant loss of hip motion as compared with normal hips. The greatest loss of hip motion in hips treated with fixation in situ was loss of internal rotation (LIR), which can be calculated using the radiographs as sin LIR = sin SA * sin S. The average difference between clinically established and calculated LIR was 1.15 degrees. We conclude that the loss of hip motion after SCFE is slight and in most patients not clinically relevant. Therefore, early surgical intervention, e.g., femoral osteotomy, due to expected loss of hip motion cannot be justified.

Adolescent↗
PubMedDate not supplied

Risk factors for hip fracture in hemodialysis patients.

BACKGROUND: The incidence and mortality of hip fractures were several times greater in the patients with hemodialysis (HD) than in the general population. Although patients with end-stage renal disease develop renal osteodystrophy, few published data examined the risk factor of hip fractures in the dialysis population. METHODS: The present study was performed to compare various indices and bone mineral density (BMD) of HD patients with or without the history of hip fractures. Moreover, we analyzed the factors which predicted hip fractures in 183 patients with chronic HD enrolled in the cross-sectional study. RESULTS: Serum level of alkaline phosphatase was significantly higher in HD patients with hip fractures, compared to those without hip fractures. Oral calcium carbonate dose was significantly lower in HD patients with hip fractures. 1/3 radius (R)-BMD and ultradistal (UD)R-BMD were significantly lower in HD patients with hip fractures. However, lumbar spine (LS)-BMD was comparable in HD patients with or without hip fractures. Although there was no significant differences of BMD between with and without hip fractures in diabetes mellitus, UDR-BMD of patients with hip fractures was significantly lower than that of patients without hip fractures in chronic glomerulonephritis. Radial BMD was lower in female patients with hip fractures, compared to without hip fractures, although there were no significant differences in male patients. In multiple logistic regression analysis, oral calcitriol dose and 1/3R-BMD were selected as a risk factor of hip fractures in HD patients. CONCLUSION: Radial BMD was lower in HD patients with hip fractures. However, its contribution is different, depending on gender and the original disease leading to HD. Radial BMD and oral calcitriol dose seemed to be important to predict the risk of hip fractures.

Administration, Oral↗
PubMed2005

Early complications of primary total hip replacement performed with a two-incision minimally invasive technique.

BACKGROUND: Total hip replacement performed through a small incision theoretically results in less trauma to the underlying structures, reduced blood loss, less pain, and a shorter hospital stay, but it may result in increased complications, particularly early in a surgeon's experience with a new technique. In the present study, we reviewed the early results of two techniques involving the use of smaller incisions; specifically, we evaluated one series of primary total hip replacements that had been performed through two small incisions and another series of total hip replacements that had been performed through a single small incision. METHODS: Eighty-nine consecutive primary total hip replacements were performed with use of the two-incision technique as described by Mears and Berger; all procedures were performed without cement and with use of fluoroscopic guidance. Outcomes data were reviewed at a minimum of six months following the procedure. The results of these procedures were retrospectively compared with those of a historical control series of ninety-six total hip replacements that had been performed by the same surgeon with use of a single mini-incision technique. No special attempt was made to discharge any patient early from the hospital. In preparation for the use of the two-incision technique, the surgeon attended a two-day seminar that included cadaveric training and mentoring by surgeons who had experience with this technique. RESULTS: In the two-incision group, nine patients (nine hips; 10%) required repeat surgery because of a femoral fracture that had been identified postoperatively (two hips), dislocation (one hip), a wound complication (two hips), or subsidence and loosening of the femoral implant (four hips). Twenty-two patients (twenty-two hips; 25%) sustained an injury of the lateral femoral cutaneous nerve, and one patient (one hip) had a neuropraxia of the femoral nerve. In the comparative series of ninety-six total hip arthroplasties that had been performed with use of a single mini-incision and a direct lateral exposure of the hip joint, the overall complication rate was 6% (six of ninety-six) and the reoperation rate was 3% (three of ninety-six). The rate of complications associated with the two-incision technique decreased significantly as the surgeon gained experience with the procedure (p = 0.0202). CONCLUSIONS: Although total hip arthroplasty with use of the two-incision technique was performed by a surgeon who was experienced in the performance of total hip replacement surgery with use of a single small incision, the rates of complications and repeat surgery associated with the two-incision technique initially were very high. While the rate diminished with increasing experience, total hip replacement with use of two incisions and fluoroscopic guidance is a technically demanding procedure that may be associated, especially initially, with higher rates of complications and repeat surgery.

Adult↗
PubMed2006

Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial.

BACKGROUND: Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. METHODS: In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total hip arthroplasty or a hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford hip score, and final radiographs were assessed. RESULTS: After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23 mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group. Patients in the total hip arthroplasty group walked farther (p=0.039) and had a lower (better) Oxford hip score (p=0.033) than those in the hemiarthroplasty group. Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the hips in the hemiarthroplasty group dislocated, whereas three hips in the total hip arthroplasty group dislocated. In the hemiarthroplasty group, two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision. In the total hip arthroplasty group, one hip was revised because of subsidence of the femoral component. CONCLUSIONS: Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.

Aged↗
PubMed2006

Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. Surgical technique.

BACKGROUND: Total hip replacement performed through a small incision theoretically results in less trauma to the underlying structures, reduced blood loss, less pain, and a shorter hospital stay, but it may result in increased complications, particularly early in a surgeon's experience with a new technique. In the present study, we reviewed the early results of two techniques involving the use of smaller incisions; specifically, we evaluated one series of primary total hip replacements that had been performed through two small incisions and another series of total hip replacements that had been performed through a single small incision. METHODS: Eighty-nine consecutive primary total hip replacements were performed with use of the two-incision technique as described by Mears and Berger; all procedures were performed without cement and with use of fluoroscopic guidance. Outcomes data were reviewed at a minimum of six months following the procedure. The results of these procedures were retrospectively compared with those of a historical control series of ninety-six total hip replacements that had been performed by the same surgeon with use of a single miniincision technique. No special attempt was made to discharge any patient early from the hospital. In preparation for the use of the two-incision technique, the surgeon attended a two-day seminar that included cadaveric training and mentoring by surgeons who had experience with this technique. RESULTS: In the two-incision group, nine patients (nine hips; 10%) required repeat surgery because of a femoral fracture that had been identified postoperatively (two hips), dislocation (one hip), a wound complication (two hips), or subsidence and loosening of the femoral implant (four hips). Twenty-two patients (twenty-two hips; 25%) sustained an injury of the lateral femoral cutaneous nerve, and one patient (one hip) had a neuropraxia of the femoral nerve. In the comparative series of ninety-six total hip arthroplasties that had been performed with use of a single mini-incision and a direct lateral exposure of the hip joint, the overall complication rate was 6% (six of ninety-six) and the reoperation rate was 3% (three of ninety-six). The rate of complications associated with the two-incision technique decreased significantly as the surgeon gained experience with the procedure (p = 0.0202). CONCLUSIONS: Although total hip arthroplasty with use of the two-incision technique was performed by a surgeon who was experienced in the performance of total hip replacement surgery with use of a single small incision, the rates of complications and repeat surgery associated with the two-incision technique initially were very high. While the rate diminished with increasing experience, total hip replacement with use of two incisions and fluoroscopic guidance is a technically demanding procedure that may be associated, especially initially, with higher rates of complications and repeat surgery.

Adult↗
PubMed1990

Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis.

Heterotopic bone formation was investigated in 392 Charnley low-friction total hip arthroplasties. A multivariate linear regression analysis was used to account for the influence of co-variables: sex, age at surgery, postoperative treatment with antiinflammatory drugs during at least the first 2 weeks, and previous ipsilateral hip surgery. A total of 232 hips had been treated for primary coxarthrosis, and 114 and 46 hips for secondary coxarthrosis due to congenital dislocation and fracture-dislocation of the hip, respectively. None of the hips with primary coxarthrosis previously had ipsilateral hip surgery, whereas 41 hips (36%) in patients with congenital dislocation of the hip and 28 hips (61%) in patients with fracture-dislocation of the hip had one or more ipsilateral surgical procedures prior to the arthroplasty. The sex ratio varied between the groups, with a male:female hip ratio of 1:1, 1:10, and 3:1 for the three groups, respectively. The risk of developing grades 2 or 3 heterotopic ossification after total hip arthroplasty were significantly higher in men, patients without postoperative treatment with antiinflammatory drugs, and patients above age 60. In contrast, the analysis documented that previous ipsilateral hip surgery and type of coxarthrosis did not influence lesion development, supporting the theory that a systemic, rather than local factor, is responsible for the development of heterotopic bone formation after total hip arthroplasty.

Adolescent↗
PubMed1997

Heparin/heparan sulfate (HP/HS) interacting protein (HIP) supports cell attachment and selective, high affinity binding of HP/HS.

Heparin/heparan sulfate (HP/HS), HS proteoglycans, and their binding proteins play important roles in a variety of biological processes. Previously, we identified a novel cell surface HP/HS interacting protein (HIP) from human uterine epithelia and a variety of other human epithelial and endothelial cells and cell lines (Liu, S., Smith, S. E., Julian, J., Rohde, L. H., Karin, N. J., and Carson, D. D. (1996) J. Biol. Chem. 271, 11817-11823; Rohde, L. H., Julian, J., Babaknia, A., and Carson, D. D. (1996) J. Biol. Chem. 271, 11824-11830). In the current studies, we have purified and characterized HIP from HEC cells, a human uterine epithelial cell line, as well as recombinant HIP from a bacterial expression system. HIP supports attachment of the human trophoblastic cell line, JAR, in a HS-dependent fashion. Predigestion of JAR cells with a mixture of heparitinases, but not chondroitinase AC, abolished cell attachment to HIP. In addition, JAR cell attachment to HIP is highly sensitive to HP inhibition and much more selective for HP/HS than other glycosaminoglycans. Dermatan sulfate displays partial inhibitory activity as well, consistent with the observation that chondroitinase ABC digestion partially reduces JAR cell attachment to HIP. Solid-phase binding assays indicate HIP binds [3H]HP with high affinity (apparent KD = 8 nM). Furthermore, HIP bound cell surface/extracellular matrix-associated HS, expressed by RL95 cells, a human uterine epithelial cell line. Anti-HIP antibody generated against a synthetic peptide derived from a putative HP/HS-binding motif resident within HIP inhibited about half of [3H]HP binding to HIP, indicating that this domain is a functional HP-binding domain of HIP. Similarly, this same synthetic peptide motif of HIP could block about 50% of [3H]HP binding to HIP; however, this peptide almost completely inhibited cell attachment to HIP, suggesting a critical role, in this regard. Collectively, these results suggest that HIP can function as a HP/HS-binding cell-cell/cell-matrix adhesion molecule.

Animals↗
PubMed1995

Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To examine the cross-sectional association between radiographic features of hip osteoarthritis (OA) and bone mineral density (BMD) of the hip, spine, and appendicular skeleton among Caucasian women ages 65 and older who were participating in the Study of Osteoporotic Fractures. METHODS: Pelvis radiographs of 4,855 subjects were assessed for individual radiographic features of hip OA: osteophytes, joint space narrowing, subchondral sclerosis, cysts, and femoral head deformity. Hips were graded on a summary scale of 0 (no OA) to 4 (severe OA) based on the number of radiographic features present. Appendicular BMD was measured in all subjects, and hip and spine BMD in 84% of the group. We used linear regression to examine the association of BMD with hip OA, and to adjust for age, weight, and other determinants of bone mass. RESULTS: Three hundred fifty-one women (7.2%) had mild (grade 2) and 228 (4.7%) had moderate to severe (grade 3-4) radiographic evidence of hip OA. Women with grade 3-4 hip OA had a higher age-adjusted BMD at the femoral neck and Ward's triangle (9-10%; P < 0.0001), trochanter (4%; P < 0.01), lumbar spine (8%; P < 0.0001), and distal radius and calcaneus (5%; P < 0.0001 [for each comparison]) compared with those with grade 0-1 OA in the worse hip. Elevations in BMD were greatest in the femoral neck of hips with OA, in women with bilateral hip OA, and in women with hip osteophytes. These findings were essentially unchanged by adjustment for determinants of bone mass. CONCLUSION: Elderly Caucasian women with moderate to severe radiographic hip OA had higher BMD in the hip, spine, and appendicular skeleton than did women without hip OA. Our findings are consistent with a role of elevated BMD in the pathogenesis of hip OA.

Aged↗
PubMed1996

Preoperative irradiation for prevention of heterotopic ossification following total hip arthroplasty.

Eighty-six hips in eighty-five patients who were considered to be at risk for heterotopic ossification following a total hip arthroplasty were prospectively randomized or assigned to one of two treatment groups that received a single 800-centigray dose of limited-field radiation either preoperatively (Group I) or postoperatively (Group II). The risk factors for postoperative heterotopic ossification included previous heterotopic ossification following an operation about the hip, hypertrophic osteoarthrosis or post-traumatic osteoarthrosis characterized by the presence of extensive osteophytes, radiographic evidence of diffuse idiopathic skeletal hyperostosis, and ankylosing spondylitis. The hips in Group I were irradiated within 6.1 hours before the operation and those in Group II, within 51.3 hours after the operation. Either extra-field ossification or heterotopic ossification was observed in forty-one (48 per cent) of the eighty-six hips, thereby confirming the high risk for the population in this study. After a minimum duration of follow-up of six months, thirty-seven (76 per cent) of the forty-nine hips that had been treated with preoperative irradiation exhibited no new heterotopic ossification and eleven, progression to grade-I or II ossification. The remaining hip in that group was in a woman who had Paget disease as well as previous grade-IV (ankylosing) heterotopic ossification about the ipsilateral hip; heterotopic ossification progressed from grade II on the radiographs made immediately after the index revision procedure to grade III at the most recent follow-up assessment. Of the thirty-seven hips that had been treated with postoperative irradiation, twenty-seven (73 per cent) exhibited no new heterotopic ossification and nine had progression from grade-0 to grade-I ossification. The remaining hip in that group was in a man who had Parkinson disease and previous grade-III ossification about the ipsilateral hip; heterotopic ossification progressed from grade III immediately post-operatively to grade IV at the time of the most recent evaluation. Extra-field ossification was identified in twelve (24 per cent) of the forty-nine hips that had been irradiated preoperatively compared with three (8 per cent) of the thirty-seven hips that had been irradiated postoperatively (p = 0.05). Extra-field ossification was not associated with clinical symptoms of bursitis of the greater trochanter in any hip. Three of the ten hips that had a revision operation subsequently had a non-union of the greater trochanter; all three had been treated with preoperative irradiation. The findings of the present study suggest that pre-operative irradiation is effective for the prevention of heterotopic ossification following total hip arthroplasty and that it eliminates the discomfort and morbidity that are associated with conventional postoperative treatment. Furthermore, the efficacy of preoperative irradiation suggests that osteogenic precursor cells that are active in this process are derived from the local tissues within the operative field rather than from distant blood-borne cell lines.

Adult↗
PubMed1991

Uncemented total hip arthroplasty. Prospective analysis of the tri-lock femoral component.

Fifty consecutive hip disease patients (56 hips) with total hip arthroplasties (THA) utilized the uncemented Tri-Lock femoral component. Forty-five patients (51 hips) were followed for an average of 46 months (range, 24-66). Forty-two patients (47 hips) were followed with clinical examination and roentgenographs, three (four hips) by telephone interview, four (four hips) were deceased, and one (one hip) was lost to follow-up evaluation. The diagnoses included osteoarthritis (30 hips), avascular necrosis (11 hips), juvenile rheumatoid arthritis (two hips), and degenerative joint disease secondary to childhood hip disorder (four hips). Of 47 hips, 34 were graded excellent, seven good, three fair, and three poor using the Harris hip score. The incidence of thigh pain was 19% at one year, but only 6% at final follow-up evaluation. Limp persisted in 19% of the patients. Of the three patients with four hips contacted by telephone, two had slight pain and two had no pain. The roentgenographic results found an alarming 38% incidence of varus shift of the components, relative to their preoperative position. The presence of a varus shift did not adversely affect the clinical results. Early experience with the Tri-Lock femoral component shows results comparable to those reported in the literature. The high incidence of femoral component shift, presumably because of geometry of the stem is of concern. Longer follow-up evaluation will be necessary to determine the fate of these uncemented THA operations.

Adolescent↗
PubMed1982

Revision total hip arthroplasty.

In this review, 110 hips in 107 patients underwent revision total hip arthroplasty at The Hospital for Special Surgery and the Robert B. Brigham Hospital. The minimum follow-up period was two years (average, 3.4 years). Failures of the original total hip arthroplasties were due to loosening of the femoral component (44 hips), loosening of both components (23 hips), loosening of the acetabular component (17 hips), fracture of the femoral component (14 hips), recurrent dislocation due to prosthetic malposition (7 hips), acetabular protrusion (3 hips), and fracture of the femoral shaft (2 hips). Sixty-six hips were categorized as good or excellent, and 25 hips were rated as fair. Nineteen poor results were due to: (a) deep infection (2 hips); (b) mechanical failure (15 hips); and (c) recurrent dislocation (2 hips). Complications included infection (3.6%), trochanteric problems (13%), mechanical failure (14%), and progressive radiolucent zones (26%). The quality of the result of a revision total hip arthroplasty is potentially as good as that of the original arthroplasty. However, the higher incidence of infection and mechanical failure reduces the frequency of such good results in the long-term. The extremely high incidence of progressive radiolucent zones at the bone-cement interface makes predictions for even longer term results guarded.

Adult↗
PubMed1996

Avascular necrosis of the proximal femur in developmental dislocation of the hip. Incidence, risk factors, sequelae and MR imaging for diagnosis and prognosis.

Avascular necrosis of the proximal femur still remains the major complication of the treatment for developmental dislocation of the hip. In a three part study I reviewed this problem. Part I analyzed incidence, causes, and risk factors of avascular necrosis. In 105 children with 113 hips who developed avascular necrosis out of 636 consecutive patients with 823 hips treated nonoperatively for developmental dislocation of the hip in the years 1972-1976 the risk factors of avascular necrosis were determined. A method of treatment in most cases was Frejka pillow. Conventional radiographs obtained in AP views during the course of treatment and follow-up were analyzed. Avascular necrosis was found in 14 percent of the hips, classified as mild (49%), moderate (14%), and severe (37%). The differences between mild and severe cases were significant as regards age at the onset of treatment (p 0.006); with higher average age in mild forms, and degree of dislocation (p 0.01) with higher values in severe forms. The older the child was at the onset of treatment, the greater the risk of necrosis, notably if treatment was begun after 6 months of age. However, the incidence of the more severe cases was higher in the group up to 6 month of age. In general, avascular necrosis was more likely to occur in cases with high degree of initial dislocation and the differences between groups with low and high degree of dislocation were significant. In the group with highest initial dislocation the number of both mild and severe forms was high. Part II evaluated the growth and remodeling of the hip joint with avascular necrosis after nonoperative treatment of developmental dislocation on the basis of conventional radiography. An attempt was also made to determine the correlation between the severity of necrosis as seen in conventional radiography and the clinical and radiographic appearance of the hip after completion of growth. Finally the prognostic value of conventional radiography in prediction of deformities of the proximal femur due to necrosis was estimated. 68 patients with 98 involved hips treated exclusively nonoperatively for developmental dislocation of the hip in whom avascular necrosis developed were selected for the study. The average age at the time when the final radiograph was made was 25 (18-36) years and the average follow-up period was 23 (18-35) years. 16 patients (27 hips) were examined twice after completion of growth with the time interval of 10 years, the second examination being at an average age of 30 (26-36) years. In this group also progress of signs and symptoms of degenerative changes in clinical and radiographic examination was noted. To achieve sufficient data necessary to establish indications for further operative treatment in 2 patients also CT examinations with three-dimensional surface reconstruction were performed after physeal closure. Physical examinations were performed in all patients after completion of growth. Radiographs made before the onset of treatment for developmental dislocation of the hip, during treatment, at the child's age of 4-6 years, all obtained until the cessation of growth, and at final assessment, were studied. By physical evaluation 77 hips were rated as excellent or good, being pain free or with only occasional mild pain after walking long distances, with a good range of hip motion and negative Trendelenburg sign. The reasons for 21 fair or poor clinical end-results were pain, mostly with activity, and limp due to pain and abductor weakness. By radiographic evaluation in this group there were 50 hips rated as excellent or good, and 48 hips rated as fair or poor. In 29 hips excellent or good clinical findings at final review contrasted with fair or poor radiographic scores. In no case fair or poor clinical end-result coexisted with excellent radiographic ones. In the group examined twice after completion of growth with the time interval of 10 years no difference in clinical score was found in

Adolescent↗
PubMed2004

Cost-effectiveness of hip protectors in frail institutionalized elderly.

A randomized controlled trial was performed to examine the cost-effectiveness of external hip protectors in the prevention of hip fractures. Since the hip protectors were not effective in preventing hip fractures in our study, the main objective became to examine whether the use of hip protectors results in lower average costs per participant in the hip protector group as compared with the control group. In addition, the average costs of a hip fracture and subsequent rehabilitation in frail, institutionalized elderly were calculated. Residents from apartment houses for the elderly, homes for the elderly and nursing homes with a high risk for hip fractures were randomized to the hip protector group (n=276) or control group (n=285). Costs were calculated for the hip fracture and subsequent rehabilitation until 1 year after the fracture. Six months after each hip fracture, a nurse was interviewed and after 12 months, a questionnaire was sent to the general practitioner or nursing home physician to determine the utilization of health care resources. Differences in costs between the groups were analyzed using non-parametric bootstrapping. Eighteen hip fractures occurred in the intervention group and 20 hip fractures (in 19 persons) in the control group (log rank P-value=0.86). The average costs per participant, including the costs of the intervention, were Euro 913 in the intervention group and Euro 502 in the control group (cost difference of Euro -411; 95% confidence interval: -723; 57). The average costs of a hip fracture and subsequent rehabilitation were Euro 8100 (95% CI: 6716-10,010). The use of hip protectors was not associated with lower costs. In addition, the average costs of a hip fracture and subsequent rehabilitation in the first year after the fracture were estimated at Euro 8100 in institutionalized elderly.

Aged↗
PubMed2005

Assessment of risk factors for second hip fractures in Japanese elderly.

In an attempt to identify a cohort with a high risk of suffering a fracture of the contralateral hip (second hip fracture), we assessed patients who had suffered hip fracture. A total of 714 patients (130 men and 584 women) were prospectively followed to determine those who suffered a second hip fracture. Pathologic hip fractures and fractures that emerged from high-energy trauma were excluded from the analysis. Age, gender, Singh Index (SI), fracture type, cognitive impairment, and comorbid medical conditions were investigated as medical predictors. The 714 patients were observed for 1,579.5 person-years (mean: 2.4+/-1.4 years per patient). During the observation period, 45 second hip fractures were identified (bilateral group), giving an overall incidence of 0.029 per person-year. The annual incidence rate declined linearly from the occasion of the initial fracture. Furthermore, the second hip fracture tended to occur increasingly within 8 months after the initial hip fracture. The second hip fracture was of the same type (trochanteric or cervical) in 79% of the trochanteric and 71% of the cervical fractures. There was no significant difference in the incidence of second hip fracture by gender or age. In addition, there was no significant difference in the distribution of SI grades of the unfractured hip at the initial hip fracture between the 669 patients who had not suffered a second hip fracture (unilateral group) and the bilateral group. Cox proportional hazard regression analysis revealed that increased risk of a second hip fracture was associated with senile dementia and Parkinson's disease. We concluded that careful follow-up of hip fracture patients associated with senile dementia and Parkinson's disease might effectively prevent the incidence of a second hip fracture.

Aged↗
PubMed2001

The role of arthroscopic thermal capsulorrhaphy in the hip.

Arthroscopic thermal modification of collagen in the hip capsular tissue appears to be a treatment option for patients with hip instability. Traumatic hip instability is associated with frank dislocation or a subluxation, and labral tears. Atraumatic hip instability is associated with evidence of generalized ligament laxity. It can be associated with bone-collagen type disorders, including Ehlers-Danlos syndrome, Down syndrome, arthrochalasis multiplex congenita, developmental dysplastic hip, and idiopathic type. As previously discussed by Bellabarba et al, capsular laxity may be the underlying cause of dynamic hip instability. The capsule is a fibrous, thick, and strong structure that encircles the proximal femur and the acetabulum. The capsule is thicker anteriorly than posteriorly, and consists of two sets of fibers, circular and longitudinal. The capsule ligaments play a very important role in hip stability. The hip joint capsule is reinforced by the iliofemoral, pubofemoral, and ischiofemoral ligaments. It remains sensitive to stretch and serves as a mechanism for muscular feedback and pain. The iliofemoral ligament limits hyperextension and lateral rotation of the hip joint and is taut in full extension. Full extension of the hip exposes the capsule and ligaments to a twisting and shortening effect that forces the head onto the acetabulum. We are currently studying the effect of iliofemoral ligament deficiency and its relationship to instability. Many of the properties of synovial lubrication depend on contact with articular surfaces, and incongruency due to instability may have some functional role in distribution of synovial fluid, leading to stresses from weightbearing and eventually to rapid deterioration of the articular surfaces. The high-level athletes in this series include two professional baseball players, three professional golfers (PGA), one professional football player (NFL), one figure skater (Olympic gold medalist), one gymnast (Olympic level, bilateral hips), and one ballet dancer; they returned to their pre-injury level of activity. The other patients returned to their pre-injury functional lifestyle. Hip instability appears to present consistently with stable gait abnormalities and painful sensation of instability. Recognizing the various patterns of hip instability is complicated, and therefore management and outcome of these disorders are quite variable. Bellabarba et al concluded that physical therapy alone had been unsuccessful and that temporary success of a posterior capsular "plication" in one patient showed promise. Arthroscopic thermal modification of collagen in the hip capsular tissue appears to be a treatment option for patients with hip instability. The hip joint capsule is predominantly type 1 collagen, and the mechanism of tissue shrinkage through type 1 collagen alteration is well documented in the literature. Short-term results appear promising, however, more studies are required to determine the long-term efficacy of this procedure in the treatment of this challenging disorder.

Arthroscopy↗
PubMed2002

Lumbofemoral rhythm during hip flexion in young adults and children.

STUDY DESIGN: A two-group experimental design with repeated measures on one factor was used. OBJECTIVE: To describe the relation between movement of the hip and lumbar spine during active hip flexion in healthy young adults and children. SUMMARY OF BACKGROUND DATA: Many descriptions of hip movement and procedures for clinically assessing the range of hip joint flexion do not take into account the substantive range of lumbar spine motion that normally accompanies hip flexion. Posterior pelvic rotation, representative of lumbar flexion during hip flexion, has been incorrectly regarded as a compensatory movement. METHODS: Unilateral full range active hip (knee) flexion was examined using computer-aided video analysis in 22 healthy young adults and 22 healthy children. RESULTS: Except for the first 3 degrees to 5 degrees of the upward movement of hip flexion, hip and lumbar spine motion was concurrent in both phases of the test movement in children and adults. On the average, every 3 degrees of hip motion was accompanied by 1 degrees of lumbar motion. Throughout the upward movement, the relative contribution of hip movement decreased while that of the lumbar spine increased. During the downward movement, the hip returned nearly to its original starting position while the lumbar spine remained noticeably flexed. CONCLUSIONS: There is a concurrent motion of the lumbar spine-pelvis and hip during normal hip flexion that is analogous with the well-known scapulohumeral rhythm accompanying elevation of the shoulder. Failure to measure or account for the contribution of the lumbar spine to hip flexion could overestimate the range of hip flexion by as much as 33.3%.

Adolescent↗
PubMed2003

A randomised trial of hip protector use by frail older women living in their own homes.

OBJECTIVES: To investigate the efficacy and effectiveness of hip protectors in frail community living older women. DESIGN: Randomised controlled trial. SETTING: Aged care health services in New South Wales, Australia. PATIENTS: 600 women 74 years of age or more (mean age 83 years), who had two or more falls or one fall requiring hospital admission in the previous year, and who lived in their own homes. INTERVENTION: Use of hip protectors. MAIN OUTCOME MEASURES: Adherence with use of hip protectors, falls, incidence of hip fracture, and adverse effects of use of hip protectors. RESULTS: Adherence was approximately 53% over the duration of the study and hip protectors were worn at the time of 51% of falls in the intervention group. The risk of hip fracture when falling while wearing hip protectors, compared with a fall with no hip protectors in place, was significantly reduced (relative risk (RR) 0.23, 95% confidence interval (CI) 0.08 to 0.67). On an intention to treat analysis, 21 and 22 hip fractures occurred in the intervention and control groups respectively (adjusted RR 0.92, 95% CI 0.51 to 1.68). Three users of hip protectors sustained a hip fracture while wearing properly applied protectors, while 16 hip protector users (5%) developed minor local complications. CONCLUSIONS: Hip protectors prevent hip fractures in community dwelling older women if worn at the time of a fall. The overall effectiveness of hip protectors was not established in this study, because of incomplete adherence with use of the protectors, and limited statistical power.

Accidental Falls↗