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PubMed2004

Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study.

UNLABELLED: In this prospective 12-year study in men and women 60 years of age and older, there was a 4-6% per year reduction in the incidence rate of overall osteoporotic fractures, but the study was unable to exclude any change in the hip fracture incidence rate. Approximately one-half of hip fractures occurred before 80 years in men and two-thirds before 85 years in women. The age distribution of hip fractures underlines the need for earlier intervention in osteoporosis. INTRODUCTION: Although hip fracture is the major osteoporotic fracture in terms of health outcomes, quality of life, and costs, there is a paucity of long-term data on secular changes in men and women within a defined community. This long-term prospective population-based study over 12 years from 1989 to 2000 specifically examined the age distribution and secular changes in the incidence rates of hip and other osteoporotic fractures in men and women 60 years of age and older in a predominantly white population in Dubbo, Australia. MATERIALS AND METHODS: Hip and all other clinical fractures were ascertained by reviewing all radiography reports from the two area radiology services, ensuring complete ascertainment of all clinical osteoporotic fractures. RESULTS AND CONCLUSION: Among the 1055 symptomatic atraumatic fractures (after excluding pathological fractures), there was a significant reduction in the overall fracture incidence rate in women (4% per year; p = 0.0003) and men (6% per year; p = 0.0004) over the 12 years. There were 229 hip fractures (175 in women and 54 in men) within 39,357 person-years of observation. The overall rate +/- SE of hip fracture was 759 +/- 57 per 100,000 person-years in women and 329 +/- 45 per 100,000 person-years in men, with an exponential increase with age. With advancing age, the incidence rate of hip fractures in men approached that in women; the female:male ratio fell from 4.5 (95% CI: 1.3-15.7) to 1.5 (0.9-2.5) and 1.9 (1.2-2.8) in the 60-69, 70-79, and 80+ year age groups, respectively. In women, the absolute number of fractures and incidence rate continuously increased with age; however, in men, the absolute number of hip fractures peaked at 80-84 years of age and then decreased. Most importantly, despite the continuing increase with age, almost one-half (48%) of the hip fractures occurred before the age of 80 years in men, and 66% of hip fractures occurred before the age of 85 years in women. The overall hip fracture incidence is comparable with other white (except Sweden) and Asian groups as well as two other Australian studies. This study could not exclude a change in hip fracture incidence rate, even in those 80 years of age and over among whom the incidence of hip fractures was the highest. The incidence data highlight the fact that a large proportion of hip fractures occurs in those under 80 years of age, particularly in men. This age distribution underlines the need for earlier intervention in osteoporosis in women and particularly in men to achieve the most cost-effective outcomes.

Age Distribution↗
PubMed2006

BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women.

UNLABELLED: In a prospective study of 5384 older men, hip BMD was a very strong predictor of hip fracture, much stronger than spine BMD. The relationship between hip BMD and hip fracture risk seemed to be stronger than observed in a large prospective study of women. Hip BMD is an excellent test for predicting fracture risk in men. INTRODUCTION: There have been few studies of the relationship between BMD and risk of fractures in men and none for the association between lumbar spine BMD and risk of hip and nonvertebral fractures. There is also controversy about whether the associations between BMD and risk of fracture are the same in men and women. MATERIALS AND METHODS: We measured proximal femur and lumbar spine BMD in 5384 men, 5384 men, >or= 65 years of age. We compared the results to the very similar cohort of 7871 women >or=65 of age. During 4.4 years of 99% complete follow-up, we validated 317 nonvertebral (59 hip) fractures in men and 1169 nonvertebral (208 hip) fractures in women. RESULTS: Total hip BMD was very strongly associated with risk hip fracture in men (3.2-fold increased risk per sex-specific SD decrease in BMD; 95% CI, 2.4-4.1). The association was stronger than observed in SOF (2.1; 95% CI, 1.8, 2.4; p < 0.001 for interaction). Among the men, lumbar spine BMD was weakly associated with risk of hip fracture (relative risk [RR] per sex-specific SD decrease in BMD: 1.5; 95% CI, 1.2, 2.0). The association between total hip BMD and risk of nonvertebral fractures was somewhat stronger for men (RR = 1.6; 95% CI, 1.5, 1.8) than found for women (p = 0.01 for interaction). The risk of nonvertebral fracture was substantially higher in women than in men for all T scores of hip BMD, regardless of whether sex-specific or female reference values were used. CONCLUSIONS: Hip BMD is strongly associated with risk of nonvertebral, and especially hip fracture, in older men. These associations are at least as strong as in women. As in women, lumbar spine BMD in men is only weakly associated with risk of hip fracture. Regardless of whether sex-specific or female reference values were used, T scores indicated different risks of fractures in men than in women.

Age Factors↗
PubMed1997

The natural history of untreated asymptomatic hips in patients who have non-traumatic osteonecrosis.

The aim of this study was to evaluate retrospectively the rate of disease progression in the asymptomatic hip of patients who had non-traumatic osteonecrosis and pain in the other hip. Of seventy-five consecutive patients with non-traumatic osteonecrosis who were initially evaluated between 1978 and 1987, forty-six (61 per cent) initially had pain in only one hip. Radiographs were made for all patients, but routine magnetic resonance images and computed tomography images were not. Twenty-two of the asymptomatic hips had radiographic evidence of involvement, but three of them were excluded because they were treated with elective prophylactic core-drilling; this left nineteen hips with radiographic evidence of involvement in the final study group. The other twenty-four asymptomatic hips had normal findings on the initial radiographs; one of these was treated with elective core-drilling, leaving twenty-three hips with normal radiographs in the final study group. All but one patient, who died at fifty-one months, were followed for at least five years or until symptoms developed in the asymptomatic hip. Of the nineteen untreated asymptomatic hips with initial radiographic evidence of involvement, five were still asymptomatic at the most recent follow-up examination. The other fourteen hips had become painful: nine, within five years after presentation, and five, more than five years after presentation. Pain or radiographic changes developed only rarely in the twenty-three asymptomatic hips with normal findings on the initial radiographs, and only one hip had both pain and radiographic changes within five years after presentation. Nineteen (83 per cent) were still asymptomatic at the most recent follow-up examination. The prolonged pain-free interval for many of the asymptomatic hips with radiographic evidence of involvement contrasts with the over-all rapid progression of disease reported for most hips with non-traumatic osteonecrosis. The present study draws attention to the fact that an adequate period of follow-up is needed for asymptomatic hips that are treated operatively in order to determine whether such intervention alters the natural history of the disease. Our results also showed that few asymptomatic hips with normal findings on initial radiographs are at risk for pain or radiographic abnormalities; when disease does develop, deterioration is slow and operative intervention is rarely indicated.

Adult↗
PubMed2005

[Ultrasound screening for hip dysplasia in newborns and treatment with Frejka pillow].

BACKGROUND: The prevailing strategy concerning ultrasound screening for DDH in newborns in Norway does not intercept all who should be treated. In recent years typical rates for hospital treatment of late hip dislocations in newborn have been 15-20 cases. By universal ultrasound examination, 10-20 % of the newborns present with "physiological immature" hips. By this we mean hips with subnormal ultrasound values that will normalise in the course of the neonatal period. An agreed basis of defined and standardised criteria in order to diagnose and treat physiological immature hips is required. We hope tat this study will contribute to the final solution to these questions. MATERIAL AND METHODS: Over the period 1 February 1998 through 2002 we had 2466 alive newborns at our hospital. 26 were directly transferred to another hospital, 130 were left out because of limited skills or inadequate training in ultrasound among temporary staff. The hips have been graduated morphologically in accordance with Graf's alpha angle. All newborns have been investigated by ultrasound and clinical examination with Ortolani/Barlow test 1-3 day after birth. Those with diagnosed dysplasia (alpha < 50 masculine) and those with positive clinic and physiological immature hip were immediately treated with Frejka pillow. Those with negative clinic and physiological immature hip were revaluated after 4 weeks by ultrasound, and those still immature were given Frejka pillow. Duration of pillow treatment was 4 months, followed by further clinically and radiological surveillance. All infants given the pillow treatment were clinically examined 2-3 months after they were able to walk without support, and again 1-5 years later radiologically. RESULTS: Of the newborn, 31 (1.3%) had a positive Ortolani/Barlow test. Among them, 7 had dysplasia, 20 immature hip; 4 were normal. Among the 2275 infants with normal clinic, 9 had dysplasia and 232 (10.9%) had at least one physiological immature hip. After 4 weeks, 26 still had immature hip by ultrasound evaluation. A total of 62 infants (2.7%) were treated with Frejka pillow. At the "walk alone" control and the radiological control 1-5 years later, there were no pathological findings, specially no sign of aseptic necrosis. In the total material we had 2 girls with late subluxations, detected at the age of 8 and 10 months. Both had normal clinic with an ultrasound immature hip at birth. They should have been followed up, but were missed, for uncertain reasons. Both attained normal hips after treatment. CONCLUSION: Our study of universal ultrasound screening for DDH of the hips in newborns shows that 1 % of the infants born with normal hips clinically still have physiological immature hips at the age of 4 weeks. Taking those into account as potentially dysplastic, it gives an overall treatment rate of 2.7%. Today, the only possible way to intercept those physiological immature hips that will not normalise is by universal ultrasound examination. For these children, early treatment with Frejka pillow is effective, without any risk of iatrogenic injury.

Cohort Studies↗
PubMed2005

[Appearance of spastic hip pain in cerebral palsy children].

UNLABELLED: Pain is a serious complication in the development of spastic dislocation of the hip joint, sometimes determining future of the patient, limiting the degree of his independence and comfort of his life. OBJECTIVES: Determination of 1. the frequency of appearance of lower limbs' pain among patients with subluxation and dislocation of the hip joint in the course of spastic form of cerebral palsy; 2. the influence of the surgical treatment on pain development. MATERIALS: We analysed 82 patients (126 spastic hips) treated between 1970 to 1995 with spastic form of cerebral palsy. Patients were divided into 3 groups according to the degree of hip instability and the performed method of treatment. Group 1-41 patients (77 spastic hips) without neurogenic instability of hip (mean value of migration percentage (MP) - 25%), group II - 14 patients (19 hips) with untreated dislocation of hip (MP - 100%), group III- 25 patients (30 hips) with dislocation and subluxation of hips treated by open reduction combined with Dega's pelvic osteotomy and intertrochanteric varus osteotomy of femur. METHODS: Each patient underwent clinical and radiological evaluation of hips. We assessed the value of migration percentage according to Reimers. We adopted the scale of intensity of pain according to Barie: 1) no pain, 2) sporadic pains, 3) frequent pains retreating after administration of routine analgesic drugs, 4) frequent pains persisting after administration of typical analgesics. The evaluation of pains also comprised their localisation within the hip joint and the knee joint of the same limb (projected pains). RESULTS: Group I in 11.7% of hips occurred mild pain, in 20.8% light pain and in 67.5% pain didn't occur, there was no severe pain. In group II in 73.7% appeared severe and mild pain, in 10.5% light pain and in 15.8% pain didn't appear. In group III severe and mild pain occurred in 37%, light in 33% and no pain in 30%. In all groups appearance and severity of pain depends of the degree of hip dislocation (p < 0.01 to 0.001). Appearance and aggravation of hips' pain depends on the degree of decentration of the femur's head from the acetabulum, estimated by the migration percentage (MP). Treatment and prevention demands "aggressive" operative procedure to avoid expansion of the hip's pain. Surgery decreases the frequency and intensity of pain but doesn't make patient totally free from the risk of its appearance.

Adolescent↗
PubMed2006

[Metal-metal-backed polyethylene cemented hip arthroplasty: mid-term results].

PURPOSE OF THE STUDY: Metal-on-metal bearings in total hip arthroplasty may, in theory, provide an effective answer to osteolysis in active patients. The purpose of this retrospective study was to evaluate the results of a consecutive series of Metasul total hip arthroplasties with a cemented socket. MATERIAL AND METHODS: The series was composed of 28 total hip arthroplasties in 23 patients (13 women and 10 men). The mean age at operation was 44 +/- 8.3 years (range 22-59 years). The initial diagnosis was osteoarthritis (14 hips), osteonecrosis of the femoral head (11 hips) and rheumatoid arthritis (3 hips). Cemented cups with a metal articulation surface molded into the polyethylene were used. The cup was articulated with a 28-mm metallic head. Cemented stems were used in 27 hips, whereas a hydroxyapatite coated stem was implanted in one hip. RESULTS: One hip required revision for deep infection five months postoperatively. One patient (one hip) was lost to follow-up. Twenty-six hips were evaluated at an average 31-month follow-up (range 12-47 months). All hips were rated excellent or very good. Radiographically, seven hips (27%) had a progressive acetabular radiolucent line, including three complete radiolucent lines. The latter always were located at the bone-cement interface. No implant migration was noted. In these cases, the mean socket diameter was lower than for the rest of the cohort (p < 0.001). DISCUSSION AND CONCLUSION: Progression of acetabular radiolucent lines remains of concern in this series of Metasul artificial hips. It is hypothesized that the diminution of polyethylene thickness has led to an increased rigidity of the socket, resulting in a higher rate of constraints at the bone-cement interface. Special attention must be given to these hips.

Adult↗
PubMed2000

Joint proprioception in the elderly with and without hip fracture.

OBJECTIVES: Decreased proprioception may contribute to the risk of falls in elderly patients. The purpose of this study is to determine whether patients with hip fractures have decreased hip proprioception compared with aged-matched controls, and whether hip proprioception differs in patients with repaired fractures compared with patients who have undergone prosthetic hip replacement after hip fracture. DESIGN: Retrospective. PATIENTS/PARTICIPANTS: Both hips of twenty-four hip fracture patients and age-matched patients without hip fractures were studied. Hip fracture patients were divided into osteosynthesis (twelve hips) and hemiarthroplasty (twelve hips) groups. INTERVENTION: Reproducibility of index angles (thirty hip flexion and thirty hip abduction) were compared with a six-degree-of-freedom electrogoniometer (instrumented spatial linkage; angular accuracy +/-0.5 degrees). RESULTS: There was no significant difference (flexion, p > 0.20; abduction, p > 0.67) in joint proprioception between fracture and no fracture groups. Likewise, there was no difference (flexion, p > 0.99, abduction; p > 0.74) in joint proprioception between osteosynthesis and hemiarthroplasty groups. CONCLUSIONS: Joint proprioception of hip fracture patients was not found to be diminished compared with age-matched normal controls. Additionally, replacement of the femoral head did not reduce joint proprioception compared with osteosynthesis with an intact femoral head. Maintenance of the femoral head does not seem to be necessary for the maintenance of joint proprioception in elderly hip fracture patients.

Aged↗
PubMed2004

Dependency issues in survival analyses of 55,782 primary hip replacements from 47,355 patients.

Artificial hip joints are used in only one hip for about 85 per cent of the patients and in both hips (bilateral) for about 15 per cent of the patients. The occurrence of bilateral prostheses and the influence they have in survival analyses of joint arthroplasties are seldom considered. In this study we therefore focus on issues related to bilateral primary hip prostheses, time to revision surgery, and some commonly used statistical methods. We used information from 47,355 patients with 55,782 primary hip prostheses reported to the Norwegian Arthroplasty Register between 1987 and 2000. Due to the large number of diagnoses, fixation techniques for the prostheses, and combination of prostheses brands, we furthermore considered a 'homogeneous' subset of 8703 prostheses from 7930 patients with primary osteoarthritis, and Charnley prosthesis fixed with antibiotic-containing Palacos cement. Kaplan-Meier curves for all prostheses, ignoring that some patients have bilateral prostheses, were compared with Kaplan-Meier curves using only the first inserted prostheses, and with survival curves modified for patients with bilateral prostheses. Cox regression analyses were used to assess explanatory variables and to adjust for confounding factors. The results from the ordinary Cox regression analyses were compared with results from a marginal model, a shared gamma frailty model, and a model using a time dependent covariate to condition on failures in the opposite hip. We found no practical difference between the three calculated survival curves for the hip replacement data. The ordinary Cox-model and the marginal model gave equivalent results. In the shared gamma frailty model estimates for the risk factors were comparable with the former two approaches. The estimated frailty variance was higher when all data were used, even after adjustment for confounding factors. For the 'homogeneous' data the estimated frailty variance was negligible. Using a time dependent covariate to condition on previous revisions in the opposite hip, we found a higher risk of revision for the remaining primary hip prosthesis if the opposite hip had been revised (RR = 3.49, p < 0.0001). There was no difference in risk for revision between right and left hip prostheses. If the time interval between the two primary operations was more than two years, for the full data, the first hip prosthesis had an increased risk of revision compared to prostheses in patients with only one prosthesis (RR = 1.25, p = 0.01). For the 'homogeneous' data no statistically significant difference was found between unilateral and bilateral prostheses. A revision in one hip, for patients with bilateral prostheses, is a risk factor for revision of the other hip. Thus, in analyses of prostheses survival, dependencies between two hip prostheses from one patient should be considered. However, ignoring possible dependencies does not necessarily have an impact on the results on standard risk factors.

Aged↗
PubMed2003

Dual hip bone mineral density in postmenopausal women: geometry and effect of physical activity.

The objectives of this study were to (1) obtain both femoral neck strength (FNS) and hip axis length (HAL) values from left and right femurs (regardless of hip dominance) measured by DXA and evaluate their relationship with BMD of all hip regions including total hip, (2) determine if there is a difference between dominant and nondominant hip BMD in any of the hip regions, and (3) determine how physical activity influences hip BMD. Participants were 136, generally healthy Caucasian women (57.4-88.6 years). BMD was measured by DPX-MD. Past and present activity was assessed by the Allied Dunbar National Fitness Survey for older adults and normal/brisk walking pace was measured in a straight hallway. FNS analysis uses femoral geometry to calculate stresses at the femoral neck for two loading conditions: Safety Factor Index (SF) indicates risk of fracture for forces generated during a one-legged stance, and Fall Index (FI) indicates risk of fracture for forces generated during a fall on the greater trochanter. Simple and multiple regression analyses were used to determine predictive ability of HAL, SF, and FI for respective hip BMD values. There was no statistical difference in BMD between two hips in any of the measured regions, however, the nondominant hip correlated better with other skeletal sites. Subjects with a faster normal walking speed had higher neck BMD in the nondominant hip, 0.832 +/- 0.12 vs. 0.791 +/- 0.10 g/cm2 (P < 0.05). Longer HAL of the left hip was negatively related to neck, trochanter, shaft, and total hip BMD. FI was significantly associated with all sites of the hip BMD, while SF was associated only with neck and wards BMC (P < 0.05). In summary: (1) a longer HAL is associated with lower BMD and a higher FI with higher BMD, (2) it might be sufficient to measure BMD in only the nondominant hip, and (3) walking at a faster pace may positively benefit femoral neck BMD. Therefore, it appears that HAL, SF, and FI all play important roles in estimating fracture risk and should be assessed along with BMD when using DXA.

Absorptiometry, Photon↗
PubMed2005

Optimizing patient selection and outcomes with total hip resurfacing.

UNLABELLED: Short-term failures of total hip resurfacing have been related to specific characteristics of the proximal femur. A radiographic arthritic hip grading scale was used to assess four characteristics of the proximal femur: bone density, shape, biomechanics, and focal bone defects. Hips with no unfavorable characteristics were Grade A, hips with one unfavorable characteristic were Grade B, hips with two unfavorable characteristics were Grade C, hips with three unfavorable characteristics were Grade D, and hips with four unfavorable characteristics were Grade F. One hundred forty-seven consecutive hips were treated with metal-on-metal resurfacing by a single surgeon. There were no femoral neck fractures. Of the 91 hips eligible for a minimum 2 year followup, 90% were Grades A or B, 10% were Grade C, and none were Grades D or F. With a minimum 2-year followup, arthritic hip grading was associated with preoperative Harris hip score, occurrence of mild to moderate postoperative pain, preoperative and postoperative range of motion, preoperative and postoperative hip center of rotation, preoperative and postoperative horizontal femoral offset, preoperative and postoperative limb length discrepancy, and acetabular radiolucencies. Hips with a lesser degree of secondary arthritic changes have a higher arthritic hip grade and better outcomes with total hip resurfacing. Relatively strict selection criteria for resurfacing were associated with a low occurrence of short-term failures. LEVEL OF EVIDENCE: Prognostic study, Level II (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2003

Strategies for avoiding hip impact during sideways falls.

UNLABELLED: During a fall, hip fracture risk increases 30-fold if there is direct impact to the hip. We conducted sideways falling experiments and found that subjects were able to avoid hip impact by rotating forward or by rotating backward during descent. These simple safe-landing strategies should be considered in designing hip fracture prevention programs. INTRODUCTION: Ninety percent of hip fractures in the elderly are caused by falls. During a fall, hip fracture risk is increased 6-fold by falling sideways (instead of backward or forward) and 30-fold if direct impact occurs to the hip. Previous studies suggest that impact to the hip during a sideways fall can be avoided by rotating forward during descent to land on the outstretched hands. Presumably, an alternative strategy for avoiding hip impact is to rotate backward to land on the buttocks. We conducted sideways falling experiments to test the hypothesis that each of these falling strategies is equally effective in allowing one to avoid hip impact. MATERIALS AND METHODS: Twenty-two young adult women participated in trials where they were released from an inclined standing position into a sideways fall onto a foam mattress. Subjects were instructed to "land as softly as possible" and to "avoid impacting the hip" by either rotating forward or rotating backward during descent. RESULTS: We found that absolute values of the hip proximity angle, which described how close the impact site was to the lateral aspect of the pelvis, were not different in forward rotation and backward rotation trials (mean = 55.9 +/- 22.4 degrees versus 61.5 +/- 15.8 degrees, respectively). However, compared with forward rotation trials, backward rotation trials involved greater pelvis impact velocity (2.95 +/- 0.25 versus 2.45 +/- 0.77 m/s; p = 0.001) and greater whole-body kinetic energy at impact (238 +/- 70 versus 156 +/- 90 J; p = 0.001). CONCLUSIONS: These results suggest that, during a sideways fall, individuals can avoid impact to the hip and thereby lower the risk for hip fracture by rotating forward or by rotating backward during descent. These simple yet effective safe-landing strategies should be considered in designing exercise-based hip fracture prevention programs.

Accidental Falls↗
PubMed1996

The teardrop in congenital dislocation of the hip diagnosed late. A quantitative study.

We retrospectively reviewed the radiographs of the pelvis and hips of forty-five patients who had unilateral congenital dislocation of the hip treated with closed reduction and application of a cast without subsequent operations. The radiographs were made at the time of the initial diagnosis, two years after the reduction, when the child was ten years old, and at skeletal maturity. The width, shape, and type of the teardrop; the thickness of the acetabular floor; the acetabular index; the center-edge angle; the articulotrochanteric distance; and the Severin class at maturity were measured in the dislocated and contralateral, normal hips. At the time of the initial diagnosis, a well defined teardrop was seen in thirty-six (80 per cent) of the normal hips and in seven (16 per cent) of the dislocated hips. There was no difference in the width of the teardrop in the seven dislocated hips compared with that in the normal hips, although the v-shaped and crossed types of teardrops were more frequent in the dislocated hips. The v shape was not observed in the normal hips but was seen in sixteen dislocated hips two years after the reduction and in twelve dislocated hips when the children were ten years old. The superior and inferior widths of the teardrop of the dislocated hips were significantly greater than those of the normal hips (p < 0.001 and p < 0.05, respectively) when the children were ten years old. The hips with residual acetabular dysplasia had a v-shaped teardrop, widening of the superior width of the teardrop, and thickening of the acetabular floor. These hips, which were usually Severin class IV at the time of skeletal maturity, had a poor prognosis in adult life.

Acetabulum↗
PubMed1997

Long-term clinical consequences of stress-shielding after total hip arthroplasty without cement.

Remodeling of the femur, or so-called stress-shielding, was observed on the two-year postoperative radiographs of forty-eight (23 per cent) of 207 hips that were part of a consecutive, non-selected series of 223 hips that had had a primary arthroplasty with use of the anatomic medullary locking hip system. Three patients (three hips) died within ten years after the arthroplasty, leaving forty-four patients (forty-five hips) who had a minimum of ten years of clinical follow-up. At the time of the latest follow-up, thirty-eight patients (86 per cent) reported that they had either no or mild pain related to the hip, forty-two (95 per cent) had less pain than they had had preoperatively, and forty-one (93 per cent) were satisfied with the results of the arthroplasty. Two patients had a reoperation, but neither procedure involved the femoral component; specifically, one patient had a revision of a loose acetabular component and one had an exchange of a polyethylene liner. No femoral component was associated with clinical or radiographic evidence of loosening. Femoral osteolysis, confined to zones 1 and 7 of Gruen et al., was observed on the ten-year radiographs of four of the thirty-three hips for which such radiographs were available. Stress-shielding (defined as evidence of pronounced femoral bone-remodeling on the two-year radiographs) had not adversely affected the outcome for these four hips by the time of the latest follow-up. The findings regarding postoperative pain, function, and over-all satisfaction for the forty-four patients (forty-five hips) who were included in the present study were similar to those reported for our larger (parent) series of patients who had been managed with the anatomic medullary locking hip system and to those reported for a similar series of patients who were followed for 9.5 years after the insertion of a porous-coated anatomic prosthesis. In addition, the prevalence of acetabular and femoral osteolysis (four [12 per cent] of thirty-three hips) and that of revision of the femoral component (zero [0 per cent] of forty-five hips) were lower than those for our larger (parent) series (fifty-four [39 per cent] of 137 hips and three [1 per cent] of 201 hips, respectively) as well as those for the series of patients who had been managed with the porous-coated anatomic prosthesis (thirty-five [45 per cent] and four [5 per cent] of seventy-eight hips, respectively).

Adolescent↗
PubMed2001

Primary cementless total hip arthroplasty in octogenarians. Two to eleven-year follow-up.

BACKGROUND: Cementless total hip arthroplasty is an accepted alternative to total hip arthroplasty with cement in younger patients, but it remains controversial for elderly patients. The purpose of this study was to evaluate the clinical and radiographic outcomes of cementless total hip arthroplasty with use of a proximally coated stem in patients who were at least eighty years of age at the time of the operation. METHODS: One hundred and twenty-three cementless total hip replacements were performed for the treatment of osteoarthritis in 114 patients between the ages of eighty and eighty-nine years. Seven patients (eight hips) died within two years after the surgery, seventeen patients (eighteen hips) died more than two years postoperatively but were not followed for at least two years, and five hips were lost to follow-up; this left ninety-two hips in eighty-six patients for review. The mean duration of follow-up was five years (range, two to eleven years). For the clinical evaluation, the Charnley modification of the Merle d'Aubigné and Postel scale was used. In addition, preoperative and postoperative Harris hip scores were available for sixty-nine hips. Seventy-eight hips were followed radiographically for two years or more. The focus of the radiographic evaluation was the status of the fixation of the femoral and acetabular components as well as cup wear. RESULTS: Perioperative medical complications occurred in association with 24% (thirty) of the 123 operations, but there were no deaths. The mean Charnley scores for pain and function for the ninety-two hips that were followed clinically for at least two years improved by 3.0 and 1.4 points, respectively. The sixty-nine hips for which preoperative and postoperative Harris hip scores were available had a mean improvement of 42 points, with a mean score of 82 points at the last follow-up evaluation. Mild thigh pain was present in four patients, but it did not limit their activity. There were no femoral component revisions. All of the femoral components were radiographically stable and had bone ingrowth. No acetabular component failed by loosening, but 41% (thirty) of the seventy-three hips with radiographs available for measurement of wear showed polyethylene wear. Of the seventy-eight cups that were followed radiographically for two years or more, 4% (three) were associated with lysis, but none had been revised. CONCLUSIONS: Cementless fixation in the elderly is safe, effective, and durable at the time of two to eleven-year follow-up.

Aged↗
PubMed2002

Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement.

BACKGROUND: The purpose of this study was to assess the results of the use of a jumbo femoral head to restore stability in hips that had sustained recurrent dislocations after total hip replacement. METHODS: Twelve hips in twelve patients who had had multiple hip operations and recurrent instability of the hip underwent a total hip replacement with use of a femoral head with an average diameter of 44 mm (range, 40 to 50 mm). The average age of the patients was fifty-nine years (range, twenty-nine to eighty-four years). The twelve patients had had an average of four previous operations (range, one to eight operations) and seven dislocations (range, two to twenty dislocations). A bipolar head was used in ten hips that had a femoral stem with a fixed (non-modular) head, and a modular head (unipolar) was used in two hips. (One hip was first treated with a bipolar head and then with a unipolar head.) RESULTS: One patient died of unrelated causes fourteen months postoperatively. The hip had remained stable until the time of death. After an average duration of follow-up of 6.5 years (range, 3.2 to 11.8 years), ten of the remaining eleven hips had had no additional episodes of instability. One hip dislocated within one week after the revision, necessitating revision surgery to reposition the acetabular component. This hip was found to be stable at the time of follow-up 7.6 years after the revision. There were four other reoperations: one was done because of a fracture of the polyethylene; one, because of entrapment of cement within the articulation; one, because of pain related to loosening of the femoral stem; and one, because of late hematogenous infection. The preoperative and postoperative University of California at Los Angeles hip scores for the series were, respectively, 7 and 9 points for pain, 5 and 7 points for walking, 4 and 6 points for function, and 3 and 5 points for activity. CONCLUSIONS: A jumbo-diameter femoral head provided stability and improved function without compromising range of motion in patients with recurrent dislocations following total hip arthroplasty.

Adult↗
PubMed2003

Surgical treatment of limb-length discrepancy following total hip arthroplasty.

BACKGROUND: Although most patients with limb-length discrepancy following total hip arthroplasty have manageable symptoms, others may be disabled as a result of pain or functional impairment. In these patients, reoperation may be indicated to equalize the limb lengths. There is a paucity of published data regarding the outcome of surgical intervention to treat this problem. The purpose of the present study was to evaluate the results of revision hip surgery for the treatment of symptomatic limb-length discrepancy. METHODS: We retrospectively reviewed the clinical and radiographic records of patients who had undergone revision hip surgery at our institution for the treatment of a symptomatic limb-length discrepancy following a previous total hip arthroplasty. We identified twenty-one patients (twenty-one hips) who had an average age of sixty-six years at the time of revision hip arthroplasty. The average duration of follow-up was 2.8 years, and no patient was lost to follow-up. The indications for revision hip arthroplasty were severe hip and/or back pain for eleven patients, instability of the hip for eight, hip pain and ipsilateral limb paresthesia for one, and hip pain and ipsilateral foot drop for one. RESULTS: Revision arthroplasty was performed at a mean of eight months (range, six days to six years) after primary total hip replacement. The mean limb-length discrepancy at the time of the revision was 4 cm (range, 2 to 7 cm). Following revision arthroplasty, which involved revision of a malpositioned acetabular and/or femoral component, equalization of the limb lengths was achieved in fifteen patients. In the remaining six patients, the mean discrepancy had decreased to 1 cm. The mean Harris hip score improved significantly, from 56.5 points before the revision to 83.2 points at the time of the latest follow-up (p < 0.005). All but two patients were satisfied with the outcome of the revision surgery. CONCLUSIONS: Limb-length discrepancy following hip arthroplasty can be associated with pain, paresthesia, and hip instability. In these patients, careful evaluation of the position and orientation of the components may reveal the cause of the discrepancy. Revision arthroplasty may be indicated when a surgically correctable cause of limb-length discrepancy can be identified.

Acetabulum↗
PubMed2006

Influence of acetabular coverage on hip survival after free vascularized fibular grafting for femoral head osteonecrosis.

BACKGROUND: Osteonecrosis of the femoral head frequently results in collapse of the head and subsequent arthrosis of the joint. Surgical treatment has been based entirely on the evaluation of the femoral side of the hip joint, with little consideration given to the possible influence on outcome of the orientation of the acetabulum. METHODS: We retrospectively reviewed a consecutive series of 200 hips in 160 patients with osteonecrosis of the femoral head who had undergone free vascularized fibular grafting between 1997 and 1998. The mean duration of clinical follow-up was 7.5 years. Ninety-one hips in seventy-one patients were evaluated radiographically for evidence of progression of femoral head collapse at a minimum of two years, and a mean of three years, postoperatively. We defined conversion to a total hip arthroplasty and progression of femoral head collapse as the failure end points, and we analyzed the association of the acetabular center-edge angle of Wiberg, the area and laterality of the lesion, the amount of preoperative collapse of the femoral head, and the etiology of the osteonecrosis with the likelihood of failure. RESULTS: Forty-eight (24%) of the 200 hips had undergone conversion to a total hip arthroplasty at the time of the final clinical follow-up. In addition, 15% (fourteen) of the ninety-one hips with sufficient radiographic follow-up demonstrated progression of femoral head collapse at the time of the final radiographic examination. Of the hips with a center-edge angle of </=30 degrees , 55% (of those with sufficient radiographic follow-up) demonstrated progressive collapse and 45% were converted to a total hip arthroplasty. In contrast, of the hips with a center-edge angle of >30 degrees , 10% had progressive collapse (p = 0.002) and 6% were converted to a total hip arthroplasty (p < 0.001). Neither the etiology nor the size of the lesion was significantly correlated with progression of collapse or conversion to a total hip arthroplasty. CONCLUSIONS: Patients with osteonecrosis of the femoral head and a suboptimal center-edge angle of the hip are at substantial risk for progression of femoral head collapse and conversion to a total hip arthroplasty following free vascularized fibular grafting. An estimation of the degree of hip dysplasia should be included in the preoperative assessment of patients with osteonecrosis of the femoral head for prognostic and possibly surgical planning purposes.

Acetabulum↗
PubMed2000

Prevalence and inheritance of hip osteoarthritis in Iceland.

The purpose of this study was to: (I) assess the prevalence of hip osteoarthritis (OA) in Iceland and compare it with that in Southern Scandinavia, (II) determine the incidence of total hip replacement (THR) for primary OA in Iceland, (III) compare two different methods for defining radiographic hip OA, (IV) assess in a population-wide study in Iceland the genetic contribution t hip OA leading to THR, and (V) perform a genome-wide scan of a large Icelandic family to identify a chromosomal susceptibility locus for hip OA leading to THR. many Icelandic patients with hip OA have been well aware that this disease "goes in the family". by examining a large proportion of all Icelandic colon radiographs taken 1990-1996 the prevalence of radiographic hip OA in Iceland was found to be at least five-fold higher compared to Swedish and Danish studies that have used the same methods. A comparison of two methods for estimating hip OA from colon radiographs showed that a simple quantitative method of measuring joint space was more reliable than a qualitative method. The age-standardized incidence of THR for primary hip OA in Iceland between 1982 and 1996 was estimated and found to be about 50 percent higher than for Sweden. The higher Icelandic prevalence of hip OA may explain most of this difference. To investigate the contribution of heritability to hip OA leading to THR, information from two population-wide database in Iceland was combined: A national registry of THR between 1972 and 1996, and a genealogy database of all Icelandic genealogy records for the last 11 centuries made available by deCode Genetics. The genetic contribution to THR for OA was assessed by (a) identifying familial clusters of THR for OA, (b) applying the minimum founder test (MFT) to estimate the minimum number of ancestors to account for all patients with THR for OA, compared to the average number of founders for control lists, (c) calculating an average pairwise kinship coefficient (KC) for the patient and control lists, (d) estimating the relative risk (RR) for relatives of patients with THR for OA. A large number of familial clusters of patients with THR for OA were identified. MFT showed that OA patients descended from fewer founders than the control groups. The average pairwise KC among patients with OA was greater than in the population. RR for siblings of THR for OA patients was 3.05 (2.52, 3.10). Icelandic patients with THR for OA are thus significantly more related to each other than are matched controls. These findings support a significant genetic contribution to a common form of OA and encourages the search for genes conferring an increased susceptibility to OA. New techniques now make it possible to search the whole human genome for chromosomal susceptibility loci associating with OA. A genome wide scan was done to identify susceptibility loci for hip OA leading to THR, using DNA from a large Icelandic family with a very high prevalence of primary hip OA. A genome locus with a lod score of 2.58 was identified on chromosome 16p. A similar locus has been reported on from England. This is the first instance where what may be the same susceptibility locus for OA is independently described in two different populations with hip OA. We have identified other families with hip OA which link to the studied family and are continuing an expanded genome-wide scan. Continued studies of the kind outlined here will clarify the complex genetic background of OA and identify genetic variation associated with the disease. In addition to improving our understanding of the pathogenesis of OA and identifying new molecular targets for treatment, this will allow a better insight into the interactions between genetic background and environmental factors that initiate and drive OA.

Adult↗