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PubMed2005

Kinematic study of a reconstructed hip in paediatric oncology.

In 1997, a large portion of the femur of a four-year-old child affected by a Ewing's sarcoma was reconstructed with an innovative technique that used a massive bone allograft, in conjunction with a vascularised fibula autograft that was directly articulated within the acetabulum. The aim of the present study was to assess the kinematic behaviour of the reconstructed hip during flexion, once the acute remodelling process observed after the operation had ceased. A few additional CT slices of the hip joint region, in a flexed position, were taken at month 33 of the follow-up. The helical axes relative to the neutral-flexion motor action were estimated: their relative positions, with respect to the anatomical femoral heads, were compared, and the translation of the anatomical head centres was estimated. The angles spanned by the two femurs were almost equal, as were the translations along the respective helical axis. The main difference between the two femurs was the distance between the estimated femoral head centres and the relative helical axes. This resulted in a non-negligible translation of 2.9 mm of the fibula head inside the acetabulum during flexion, significantly higher than the 0.5 mm found for the intact contralateral femur. The results showed that, although the transplanted fibula grew and remodelled during the follow up, the action of the reconstructed hip joint still cannot be described as a ball-and-socket.

Biomechanical Phenomena↗
PubMed1999

[Quantitative determination of pressure distribution in the hip joint during the gait cycle].

The objective of this investigation was the experimental determination of the contact pressures in the hip joint for characteristic phases of the gait cycle. The joint forces determined in vivo with telemetric endoprosthesis by Bergmann et al. (1993) were converted into a pelvic reference system, based on kinematic gait analysis. In eight cadaveric hip joints (age 18-75 yrs.) the reaction forces were applied corresponding to four phases of the gait cycle (heel strike, mid-stance, heel off, toe off) and the pressure distribution determined with FUJI pressure sensitive film. We found maxima of 10 MPa during mid stance. The areas of highest pressure were located in the ventro-superior aspect of the acetabulum (anterior part of the acetabular roof) and in the dorso-inferior aspect of the lunate surface. The pressure distribution was relatively constant during the four phases and the maxima did not vary proportional to the applied load. The normal pressure distribution in the hip appears to be determined by the physiological incongruity of the articular surfaces and the inhomogeneous bony support of the acetabulum. During operative interventions this normal load transfer should be restored as accurately as possible.

Adolescent↗
PubMed2005

Estimation of pelvic tilt on anteroposterior X-rays--a comparison of six parameters.

OBJECTIVE: To compare six different parameters described in literature for estimation of pelvic tilt on an anteroposterior pelvic radiograph and to create a simple nomogram for tilt correction of prosthetic cup version in total hip arthroplasty. DESIGN: Simultaneous anteroposterior and lateral pelvic radiographs are taken routinely in our institution and were analyzed prospectively. The different parameters (including three distances and three ratios) were measured and compared to the actual pelvic tilt on the lateral radiograph using simple linear regression analysis. PATIENTS: One hundred and four consecutive patients (41 men, 63 women with a mean age of 31.7 years, SD 9.2 years, range 15.7-59.1 years) were studied. RESULTS: The strongest correlation between pelvic tilt and one of the six parameters for both men and women was the distance between the upper border of the symphysis and the sacrococcygeal joint. The correlation coefficient was 0.68 for men (P<0.001) and 0.61 for women (P<0.001). Based on this linear correlation, a nomogram was created that enables fast, tilt-corrected cup version measurements in clinical routine use. CONCLUSION: This simple method for correcting variations in pelvic tilt on plain radiographs can potentially improve the radiologist's ability to diagnose and interpret malformations of the acetabulum (particularly acetabular retroversion and excessive acetabular overcoverage) and post-operative orientation of the prosthetic acetabulum.

Adolescent↗
PubMed1997

Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship.

OBJECTIVE: Rapidly destructive hip disease (RDHD) is an uncommon disorder of the hip that has been considered a disease of unknown cause and distinct from ischemic necrosis of the femoral head. The objective of this study was to investigate ischemic necrosis of the femoral head as one potential cause of RDHD. DESIGN AND PATIENTS: In 600 patients who underwent MR imaging of the hip, 20 cases of ischemic necrosis involving the entire femoral head in 18 patients (3%) were retrospectively studied with routine radiography and MR imaging. All patients had surgically confirmed ischemic necrosis of the femoral head. RESULTS AND CONCLUSIONS: All patients showed rapid destruction of the femoral head on routine radiography and MR imaging as compared with the gradual onset of clinical symptoms. Plain radiographs showed several bone fragments at the inferomedial aspect of the femoral head (75%), acetabular erosions (55%), eccentric depression at the lateral articular surface of the femoral head conforming to the adjacent acetabulum (35%), and mild osteoarthritis (15%). Bone sclerosis was often present at sites of impaction between the femoral head and the acetabulum. MR imaging showed marked distention of the joint capsule in all cases. In 14 of 20 cases, the contents of the joint space showed predominantly low or intermediate signal intensity on T1- and T2-weighted images. Ischemic necrosis involving the entire femoral head may represent one of the causes of RDHD.

Adult↗
PubMed1998

Neonatal hip: from anatomy to cost-effective sonography.

Therapeutic success in treating congenital dysplasia of the hip is associated with early diagnosis, but the specific neonatal anatomy makes screening difficult. The purpose of this study was to determine whether this specific neonatal anatomy is taken into account by current ultrasound (US) techniques. Anatomic studies were performed on 22 hips, US examinations on 7750 neonatal hips; 2370 untreated hips were reexamined at 1 month by US and at 3 months by X-ray. The transformation of the neonatal cartilaginous acetabulum into an osseous cavity is dependent on harmonious metaphyseal growth and a properly seated femoral head. Defects in the acetabular roof, together with displacement of the femoral head, cause an abnormal anatomical relationship which leads to further deformities. The described sonographic techniques give only partial information on these specific abnormalities. The sonographic monoplanar methods as used in Graf's technique, which relies largely on acetabular development, lead to difficulties in assessing posterior coverage of the femoral head and difficulties in assessing alignment of the metaphyseal weight-bearing surface with the femoral head. Combining Graf's morphological analysis with Novick's dynamic technique enables one to more accurately define the relationship of the femoral head and the acetabulum and increases the reliability and predictive value of the examination, while reducing the number of doubtful cases. This makes screening cost effective.

Cost-Benefit Analysis↗
PubMed2001

Description of the adult worms of a new Brazilian isolate of Echinostoma paraensei (Platyhelminthes:Digenea) from its natural vertebrate host Nectomys squamipes by light and scanning electron microscopy and molecular analysis.

Echinostoma paraensei Lie and Basch, 1967 (Echinostomatidae:Platyhelminthes), a 37 collar spine echinostome of the "revolutum group", has been used extensively as a model organism to study the interactions of digenetic trematodes with both their snail and vertebrate hosts. This worm was first isolated from the snail Biomphalaria glabrata from Belo Horizonte (BH isolate), Minas Gerais State, Brazil, by Lie and Basch [J Parasitol (1967) 53:1192-1199]. The natural definitive host for the BH isolate was never determined, and it has been maintained in the laboratory since 1967 in B. glabrata and hamsters. In this study, using light and scanning electron microscopy and molecular analysis, we describe an echinostome recently obtained from its natural vertebrate host, the wild rodent Nectomys squamipes (Rodentia: Sigmodontinae) from Sumidouro, Rio de Janeiro State, Brazil (RJ isolate). This echinostome was also compared to the laboratory-maintained BH isolate of E. paraensei. We observed that adult worms of both BH and RJ isolates could be differentiated from other echinostome species by the relatively small size of the dorsal collar spines relative to lateral and corner collar spines. SEM confirmed the similarity of this morphological character between the two isolates. As additional diagnostic features, the tegumentary spines are scale-like and the region between the genital pore and the acetabulum lacks scales. There is a folded protuberance with a pore just posterior to the genital pore. The tegument of the acetabulum is unspined and radially wrinkled, and there are numerous randomly distributed small, domed, ciliated papillae. The sequences of the internal transcribed spacers of the nuclear rDNA complex of the RJ and BH isolates are identical. Together these shared features provide strong evidence that both isolates are the same and can be referred to as E. paraensei. In conclusion, we have identified, for the first time, one of the natural definitive hosts for E. paraensei, the rodent N. squamipes, and have extended the known geographical distribution of this species to include Sumidouro in Rio de Janeiro State, Brazil.

Animals↗
PubMed2001

How do anterior/posterior translations of the thoracic cage affect the sagittal lumbar spine, pelvic tilt, and thoracic kyphosis?

Anterior and posterior thoracic cage translations in the sagittal plane have not been reported for their range of motion and effects on the lumbar spine and pelvis. Twenty subjects volunteered for full-spine radiography in neutral, anterior, and posterior thoracic cage translation postures in a standing position. While grasping an anterior vertical pole, with hands at elbow level, subjects were instructed on how to translate their thoracic cage without any flexion/extension, utilizing a full-length mirror. On the radiographs, all four vertebral body corners of T1 through S1 and the superior margin of the acetabulum were digitized. Segmental and global angles of thoracic kyphosis, sagittal lumbar curvature, and pelvic flexion/extension in translation postures were compared to alignment in the neutral posture. Using the femur heads as an origin, the mean range of thoracic cage translation, measured as horizontal movement of T12 from neutral posture, was found to be 85.1 mm anterior and 73 mm posterior. In anterior translation, the thoracic kyphosis is hypokyphotic (Cobb T1-T12 reduced by 16 degrees). In posterior translation, the segmental angles at T12-L1 and L1-L2 flexed, creating an "S" shape in the sagittal lumbar spine, while the thoracic kyphosis increased by 10 degrees. Using posterior tangents from L1 to L5 and T12 to S1, and Cobb angles at T12-S1, the lumbar curve reduced slightly (by less than 3.3 degrees for all global angle measurements) in anterior translation and reduced by 7.4 degrees, 5.7 degrees, and 8.1 degrees respectively in posterior thoracic translation. The angle of pelvic tilt (measured as the angle of intersection of a line through posterior-inferior S1 to the superior acetabulum and the horizontal) reduced by a mean of 15.9 degrees, and Ferguson's sacral base angle to horizontal reduced by a mean of 13.1 degrees in posterior translation. In anterior translation, pelvic tilt and Ferguson's sacral base angle increased by 15.1 degrees and 12.8 degrees, respectively. The findings of this study show that thoracic cage anterior/posterior translations cause significant changes in thoracic kyphosis (26 degrees ), lumbar curve, and pelvic tilt. An understanding of this main motion and consequent coupled movements might aid the understanding of spinal injury kinematics and spinal displacement analysis on full spine lateral radiographs of low back pain and spinal disorder populations.

Adult↗
PubMed1986

Mapping of surface area 'containment' of the femoral head during walking.

This note describes a mathematical method for the calculation of surface area of the femoral head covered ('contained') by the acetabulum as a time-dependent function. It uses displacement vectors from the center of rotation of the hip joint to the femoral joint surface, and rotates these vectors in small increments to simulate the desired motion. At each interval, the vectors are tested to determine whether they lie within the coverage area of the acetabulum. The result is a containment density plot which displays coverage area as a function of time. The general method is used in a variety of clinically important situations, and an example of its use in the study of abduction bracing is described.

Femur Head↗
PubMed1992

Bone scans in patients with osteoarthritis of the hip for the evaluation of bipolar hip arthroplasty: quantitative analysis using SPECT.

To establish the time-course of bone scans after bipolar hip arthroplasty (BHA) bone scanning was performed before and after surgery in 22 hips. The influence of migration of the outer head into the acetabulum on the time-course of bone scans was examined by analyzing the relationship between the uptake of radioisotope and the magnitude of migration. The bone scans were quantitatively analyzed by single photon emission computed tomography (SPECT) on the basis of the ratio of radioactivity at the acetabulum to that in the anterior superior iliac spine (ASIS). The increased radionuclide activity decreased exponentially to a baseline with time after surgery. The postoperative uptake ratio could be expressed as a function of the preoperative uptake ratio and the postoperative length of time. The regression slope representing the decreasing rate of uptake showed no significant differences between two groups divided by the magnitude of migration of the outer head. Migration of the outer head was considered not to influence the time-course of the bone scans.

Adult↗
PubMed2005

Total hip arthroplasty in developmental high dislocation of the hip.

In total hip arthroplasty for developmental high dislocations, placement of the implant cup in the true acetabulum and femoral-shortening osteotomy can produce satisfactory results. We performed total hip arthroplasties in 25 high dislocated hips (22 patients) between 1992 and 2000, placing all cups in the true acetabula and using noncemented components and performing a femoral-shortening osteotomy in 22 hips. The overall complication rate was 36%. At follow-up evaluation at an average of 5 years later, patients' mean scores had improved as follows: pain, from 2.3 to 5.7; function scores, from 2.3 to 4.5; mobility scores, from 2.3 to 4.4; Harris hip scores, from 37.8 to 95. We recommend both placing the cup in the true acetabulum to maximize host-bone contact with the implant and preserve as much host bone as possible and femoral-shortening osteotomy for a lower incidence of nerve injury than with aggressive soft-tissue release.

Adult↗
PubMed2005

Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living.

Estimation of the hip joint contact area and pressure distribution during activities of daily living is important in predicting joint degeneration mechanism, prosthetic implant wear, providing biomechanical rationales for preoperative planning and postoperative rehabilitation. These biomechanical data were estimated utilizing a generic hip model, the Discrete Element Analysis technique, and the in vivo hip joint contact force data. The three-dimensional joint potential contact area was obtained from the anteroposterior radiograph of a subject and the actual joint contact area and pressure distribution in eight activities of daily living were calculated. During fast, normal, and slow walking, the peak pressure of moderate magnitude was located at the lateral roof of the acetabulum during mid-stance. In standing up and sitting down, and during knee bending, the peak pressures were located at the edge of the posterior horn and the magnitude of the peak pressure during sitting down was 2.8 times that of normal walking. The peak pressure was found at the lateral roof in climbing up stairs which was higher than that in going down stairs. These results can be used to rationalize rehabilitation protocols, functional restrictions after complex acetabular reconstructions, and prosthetic component wear and fatigue test set up. The same model and analysis can provide further insight to soft tissue loading and pathology such as labral injury. When the pressure distribution on the acetabulum is inverted onto the femoral head, prediction of subchondral bone collapse associated with avascular necrosis can be achieved with improved accuracy.

Computer Simulation↗
PubMed1997

A more stable posterior approach for hemiarthroplasty of the hip.

The dislocation rate following the insertion of a hemiarthroplasty of the hip via the posterior approach is variously quoted as between 8 per cent and 15 per cent. We set out to determine if this could be reduced by preserving the labrum and capsular structures at the time of surgery. We used a modification of the posterior approach, in which the labrum and capsule are preserved which appears not to have been widely reported. This increases the stability of the joint by adding to the depth of the acetabulum. We look prospectively at a series of 150 patients who were treated with an Austin Moore hemiarthroplasty using this technique. There were only two dislocations within 1 year of surgery in the series (one of these being in a patient with a dysplastic acetabulum) making our dislocation rate 1.3 per cent. We conclude that preserving the labrum significantly increases the stability of a hemiarthroplasty when it is inserted via a posterior approach.

Aged↗
PubMed2004

Posterolateral minimal incision for total hip replacement: technique and early results.

There presently exists in the arthroplasty community a new and heightened level of interest in minimally invasive techniques for total joint replacement. Several investigators have published their personal experience with differing techniques, all concluding that there are multiple advantages to this concept for total hip arthroplasty. The author's perception is that the advantages of minimally invasive posterolateral approach total hip arthroplasty are multiple. They include more rapid rehabilitation and more prompt return to activities of daily living. There has been a clear impression that patients experience less postoperative pain and improved satisfaction. A concomitant decrease in hospital stay has been noted. Patients undergoing the procedure today have an average length of hospital stay of 48 hours, which represents a 30% decrease in hospital stay over the last year. Other advantages include improved cosmesis and potentially reduced blood loss without increasing complication rates. Surgeons performing this procedure require familiarity with the local anatomy, because the technique is certainly more demanding than is traditional arthroplasty. It is perhaps a technique best applied by surgeons performing more than 50 total hip arthroplasties a year. The two keys to successful application of the technique are adequate surgical training and use of specialized instrumentation. It is a difficult procedure to teach, because only one person is able to access a good view of the anatomy at any one time. With respect to component positioning, there may be a tendency to vertical cup placement early in one's experience. This is avoided by proper location of the skin incision and by use of a dog legged acetabular component inserter that facilitates proper positioning of the component despite the prominence of the distal angle of the skin incision. A tendency to eccentric reaming of the acetabulum may be noted if the proximal femur is not adequately retracted anteriorly. One must beware of the potential for inadvertent levering of the acetabular reamers on the posterior aspect of there tracted femur if the operative surgeon is not performing the reaming of the acetabulum. Particularly in patients who are larger there may be a tendency toward an excessively posterior starting point in the femoral canal when broaching the femoral component. This is best avoided by careful attention at this portion of the procedure to any pressure being applied to the broach handle by the proximal corner of the skin incision. The skin incision must be lengthened at this point if the problem presents. Finally, there remains a risk for proximal skin abrasion, particularly when one is beginning to decrease, the incision length in posterolateral approach to total hip arthroplasty. The evolution of proximal femoral elevators and skin protectors has decreased this risk to an extremely low level.

Activities of Daily Living↗
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

Metric assessment of race from the pelvis in South Africans.

It is well known that there are measurable differences between whites and blacks in the size and proportions of skeletal components. There are also metric differences among populations within these racial phenotypes. The population specific quantification of this variation can be used to aid in the identification of racial affinity in the absence of a more racially definitive skeletal element like the skull. Therefore, the purpose of this research is to quantify these differences in the pelvis of South African whites and blacks. A sample of 400, ostensibly healthy known sex/race os coxae was examined. Skeletal material was obtained from the Pretoria and Dart collections. A series of 13 measurements were taken Data were subjected to SPSS stepwise and direct discriminant function analysis. Pubic length was chosen as best for discriminating between races for males and iliac breadth as best in females. Highest average accuracies (Function 1) were 88% for males (pubic length, greater sciatic notch posterior width, acetabulum diameter, total height) and 85% for females (pubic length, greater sciatic notch posterior width, acetabulum diameter, iliac breath). In conclusion, this research resulted in the development of standards of identification tailored to this population and unquestionably demonstrates that race differences in the skeleton are highly significant and must be considered in all skeletal analyses.

Anthropology, Physical↗
PubMed2003

Cemented first-time revision using Charnley cups: clinical outcome after 7 to 15 years follow-up.

Forty-six consecutive polyethylene cups used in cemented first-time revision of the acetabulum were evaluated at repeated occasions up to mean 10.7 years (range, 0.5-16.3 years). At the last follow-up, 3 cups had been revised (6.5%), 2 because of loosening and 1 because of fracture of the acetabulum. Furthermore, 4 were radiographically loose, corresponding to a radiographic loosening rate of 13% and a mechanical failure rate (revision or radiographic loosening) of 15.2%. Presence of rheumatoid arthritis was the only predictor of mechanical failure (relative risk [RR] = 7.7, 95% confidence limits, 1.7-36.2; P =.002). In patients without rheumtoid arthritis, there was only 1 (2.6%) revision and 3 of 39 cases (7.7%) with mechanical failure. Recementation of a Charnley cup in first-time revisions results in a low failure rate in an elderly, nonrheumatoid arthritis population with small or moderate bone deficiencies.

Adult↗
PubMed1999

[Preferential direction of collagen fibrils in the sub-chondral bone bone and the hip and shoulder joint].

We hypothesised that--due to bending and tension--there should exist a preferential direction of the collagen fibrils in the subchondral bone of the concave components of the hip and shoulder joint that results from bicentric or eccentric loading, but there should be no preferential direction in the convex joint partners. We therefore examined 25 human hip and 27 shoulder joints, these being decalcified after maceration. To analyse the preferential direction of the collagen fibrils, we used the split line method. The subchondral plate was pierced at regular intervals with needles that had been previously dipped in diluted ink. In the acetabulum, we found a predominantly transverse direction of the split lines in the ventral and dorsal horn of the lunatic surface, and these usually continued through the acetabular fossa. In the ventral part of the acetabular roof, arch-like orientations of the split lines were observed. In the glenoid cavity, a clearly preferential orientation was found in anterior-posterior direction, usually in the middle third of the articular surface. In the femoral and humeral heads, no preferential direction of the split lines was observed in any of the specimens. We interpret the split-line patterns in the acetabulum as an expression of the tensile stress that is encountered during a "spreading open" of the socket upon bicentric (ventral-dorsal) loading in the physiologically incongruous joint. In the glenoid, the relatively weak bony support in the ventral and dorsal part of the articular surface may be responsible for bending and tensile stress, particularly in view of eccentric loading during dynamic activity, and this could explain the observed anterio-posterior split line pattern. The results support the idea that the subchondral bone of concave joint partners encounters tension, leading to a preferential direction of the collagen fibrils. This can be considered as a functional adaptation of the subchondral bone on a microstructural level.

Aged↗
PubMed1992

Recurrent dislocation of the hip in adult paraplegics.

Recurrent dislocation of the hip is rare and has not previously been reported in adult paraplegics. This paper describes 3 cases. In one patient it was spontaneous, occurring 16 years after the original injury and was associated with a flexion-adduction contracture of the hip and a shallow acetabulum. One case occurred after minor trauma in a patient who experienced flexion-adduction spasms of the hip. In the third patient the condition was secondary to posterior acetabular deficiency following a conservatively treated fracture dislocation. All 3 patients experienced symptoms of disabling autonomic dysreflexia during the episodes of dislocation. The importance of recognising and adequately treating hip injuries in patients presenting with paraplegia secondary to spinal cord injury is stressed. In patients with spastic paraplegia presenting with recurrent dislocation of the hip, operative treatment combining a soft tissue repair and a bone block to augment the acetabulum is recommended.

Adult↗