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PubMed2001

Secondary malignant giant-cell tumour of bone: molecular abnormalities of p53 and H-ras gene correlated with malignant transformation.

AIMS: We report two cases of secondary malignant giant-cell tumour occurring without irradiation therapy. To elucidate the mechanism of malignant transformation in this tumour, we searched for the molecular abnormalities of p53, MDM2 and the H-ras genes. METHODS AND RESULTS: These cases were retrieved after a review of 103 cases of primary giant-cell tumour of bone, registered in our institute. One case occurred in the distal femur of a 42-year-old female after surgical curettage, while the other arose in the acetabulum of a 25-year-old male after en bloc resection. Microscopically, the malignant tumour in the distal femur was composed of a proliferation of ovoid or fusiform cells arranged in fascicles with high mitotic activities. The malignant transformed tumour in the acetabulum was made up of pleomorphic tumour cells with atypical mitoses. In the tumour of the distal femur, both p53 and H-ras mutations were detected. Abnormal nuclear accumulation of p53 protein and c-myc expression were also revealed by immunohistochemistry. In both cases, the recurrent malignant tumour over-expressed MMP-9 and revealed a higher MIB-1-labelling index compared with the primary conventional giant-cell tumour. CONCLUSIONS: Our results suggest that multiple oncogene or tumour suppressor gene mutations may play an important role during malignant transformation in conventional giant-cell tumours.

Adult↗
PubMed2003

The attachment of Clinostomum sp. (Digenea, Clinostomidae) to the oesophagus of the bird Ardea cocoi (Aves, Ardeidae).

The attachment of Clinostomum sp. to the oesophagus of the bird definitive host Ardea cocoi is reported. The parasite attaches to the mucous layer of the oesophagus by the acetabulum, oral sucker, and oral collar. The mucous layer of the oesophagus engulfed by the oral sucker presents an intense liquefactive necrosis, and the engulfment is not likely to contribute significantly to the attachment of the parasite. The oral collar of the parasite, surrounding the oral sucker, is juxtaposed to the oesophagus mucous layer, showing a perfect fitting of both surfaces. It is concluded that the main attachment mechanism of the parasites to the oesophagus of the host is provided by the acetabulum and by the juxtaposition of the oral collar of the parasites to the oesophagus host surface.

Animals↗
PubMed2002

Effects of traction, distension, and joint position on distraction of the hip joint: an experimental study in cadavers.

PURPOSE: To quantify the effects of traction alone and in combination with distension of air in different joint positions in order to find out the conditions for adequate distraction of the hip joint with minimal traction force. TYPE OF STUDY: Experimental cadaver study. METHODS: Eight cadaver hip joints were studied. The cadavers were placed supine on a fracture table and traction was applied in different joint positions for flexion and abduction with and without distension using air. For the measurement, the joint space between the acetabulum and femoral head was separated by 4 different lines characterizing the lateral margin of the acetabulum, the superior portions of the lunate cartilage, and the acetabular fossa. RESULTS: At all measurement lines, distraction of the hip was significantly better when traction and distension were combined. At traction forces from 250 to 300 N, traction plus distension resulted in a 1.59- to 2.25-fold increase of joint distraction compared to traction alone. The maximum effect of distension was achieved between 200 and 250 N. Up to traction forces of 250 N, the joint vacuum force counted for more than half of the total resistance. The effects of flexion and abduction on distraction of the hip were smaller. A trend for better distraction was found for 20 degrees of flexion and a significantly better distraction by avoiding abduction. CONCLUSIONS: High traction forces by breakage of the joint seal can be avoided by distension using air. The passive resistance of the soft tissues increases at higher traction forces. Slight flexion without abduction showed further increase of joint distraction. Reducing the amount of traction may possibly reduce the risk of soft tissue perineal and neurologic injuries.

Adult↗
PubMed2001

Impaction bone grafting using freeze-dried allograft in revision hip arthroplasty.

We report on 32 patients undergoing revision hip arthroplasty using cemented components and impaction allografting with processed freeze-dried bone. The survivorship with this type of graft at a mean follow-up of 4 years was 91%. There were no femoral component failures, although revision was required in 3 patients because of failure of the acetabulum. Freeze-dried graft can require prolonged rehydration for satisfactory impaction. The results of impaction bone grafting with freeze-dried bone alone have been satisfactory, although we recommend caution in its use alone in the hostile acetabulum.

Aged↗
PubMed1975

[The betA-angle. a diagnostic sign for the early diagnosis of congenital hip dysplasia (author's transl)].

A new radiographic sign for the diagnosis of congenital hip dysplasia is described. The beta-angle lies between the proximal end of the femur, the medial trochanter and the edge of the acetabulum. Measurements were carried out on 1174 hips and the size of this angle was established. The theoretical transition point between normal and dysplastics is 52 degrees. In reality the transition is smooth, and angles of 50 to 56 degrees are to be regarded as physiological transition values. A vertical position of the acetabulum or lateral position of the end of the femur necessarily results in an increase of beta angle. Values above 56 degrees indicate a definitely abnormal state in a child's hip joint.

Child↗
PubMedDate not supplied

[Results of cement-free St. Nabor hip prosthesis implantation and clinical and radiological results after 8 to 10 years].

PURPOSE OF THE STUDY: The aim of the retrospective study was to analyse the medium-term results of the cementless hip prosthesis St. Nabor. METHOD: 46 patients with complete postoperative and radiographic documentation were available for clinical review. The average follow-up was eight years and five months (range from eight years, one month to ten years). The average age at the last follow-up was 60 years. Ten patients showed severe coxarthritis and 32 patients a dysplasia of the acetabulum before surgery. Two patients suffered from a severe osteonecrosis of the femoral head and two patients had fractures of the acetabulum or femoral neck, respectively. RESULTS: The medium-term follow-up for the acetabular component showed a survival rate of 97.8%. The radiographic data visualized one loosening as a result of a low grade infection, 18 months after surgery. There was no migration of the acetabular component according to Sutherland et al. and no protrusion was found. None of the acetabular components showed radiolucent lines or was loose according to radiographic criteria. In comparison to the first post-operative radiograph, 26 of the hips were found with a significant reduction of lacunae, twelve of them showed a complete absence at last follow-up. The overall Harris hip score averaged 92 points (range 58 to 100 points) for the entire group. 41 (92%) of all hips were rated as excellent or good. Two hips (4%) of all hips were rated as fair and two hips (4%) were rated as poor. CONCLUSION: The high rate of good and satisfying results in medium-term follow-up proves this St. Nabor acetabular component system to be an excellent implant in total hip arthroplasty for younger patients with or without dysplasia.

Adult↗
PubMed2005

Acetabular fractures revisited: a new CT-based classification.

The objective of this investigation is to provide a new CT-based classification of acetabular fractures. The axial CT scans of 112 randomly selected acetabular fracture patients admitted to a Level 1 trauma center between January 1998 and December 2000 were analyzed by an experienced orthopedic trauma surgeon and two experienced emergency radiologists. When available, 3D reformatted images were analyzed as well. The fracture pattern for each acetabular fracture with respect to column(s) wall(s) and extension superiorly and/or inferiorly from the acetabulum, when present, was recorded. Fracture comminution was not a defining characteristic. Analysis of the acetabular fracture patterns showed that each fracture fell into one of four broad categories: Category 0--wall only; Category 1--single column; Category 2--both columns, with extension subcategories of (A) no extension, (B) superior extension only, (C) inferior extension only, and (D) both superior and inferior extension; and Category 3--the "floating" acetabulum. The axial CT display of acetabular fracture patterns provides a basis for a classification of acetabular fractures that is simple, unambiguous, readily understood by both radiologists and orthopedic surgeons, and provides clear direction for both diagnosis and surgical treatment planning. Category and subcategory fracture specificity creates a mechanism for intra- and interdepartmental postoperative assessment of any of the individual acetabular fracture types.

Journal Article↗
PubMedDate not supplied

[Status of cementation technique in total hip endoprostheses in Germany].

AIM: The correlation between improved cementing techniques and improved long-term results after total hip arthroplasty (THA) is well documented. The purpose of this study was to assess the use of modern cementing techniques in Germany. METHODS: A detailed questionaire regarding cement and bone preparation, cementing techniques on actabulum and femur, and implants used was sent to 584 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. In total, 333 questionaires were available for evaluation and statistical analysis. RESULTS: In this survey, Palacos bone cement is used in 84%, low viscosity cement in 9%. Cement chilling is performed in 58%. Mixing is done by hand without vacuum mixing systems in 53%, the mixing time is standardised in 66%. For the femur 83% and for the acetabulum 74% preserve cancellous bone, 13% use pulsed lavage. Cement application is done via cement gun in 97%, in 41% in a retrograde manner and in 18% without drainage of the intramedullary canal. A cement pressurising technique is used in 63% for the femur and in 57% for the acetabulum. A cement mantle of less than 2 mm is attempted in 41%. More than 50 different stem design are implanted with the Müller straight stem being used most often, followed by anatomic designs. Almost 50% of hips are used with a 28 mm head, and almost 50% are implanted with a 32 mm head. Half the heads are ceramic, half are metal. CONCLUSIONS: The results from this survey document, that overall only slightly more than 10% of hips are implanted using second/third generation (modern) cementing techniques with application of pulsed lavage. This has implications on the number of arthroplasties that may require revision. From the data available the current status of cementing technique in Germany cannot be judged satisfactory.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

[Indications and results of intertrochanteric reconstructive osteotomy in coxa profunda and protrusio coxae].

Coxa profunda often connected with coxa vara lead to an increasing stress on the medial part of the acetabulum. Secondary degenerative alterations with painful limited motion are the result. In 20 hip joints with coxa profunda a valgus intertrochanteric osteotomy was carried out in order to modify the direction of the resulting force from the depth to the roof of the acetabulum. A relief of pain was achieved in 18 of 20 cases. Therefore the valgus intertrochanteric osteotomy has to be considered an effective method in the treatment of coxarthrosis in coxa profunda.

Adult↗
PubMedDate not supplied

[Analyses of survival time of joints with dysplastic arthrosis after intertrochanteric femoral osteotomy].

METHODS: Survivorship analysis was performed up to 13 years after intertrochanteric femoral osteotomies in 136 dysplastic hip joints with osteoarthritis. Varus-valgus and rotational osteotomies were evaluated. The criterium limiting survival was the recurrence of pain postoperatively. RESULTS: Joints with severely pathological Sharp Angles (> 48 degrees) showed a diminution within 10 years to 50%. Moderately pathological joints (< 49 degrees) needed 13 years to diminish to 50%. 3 groups of the CE angle showed a similar picture with somewhat more difference between the groups, but not statistically significant during this time. This was different when evaluating the 3 grades of arthrosis. Joints with grade 1 were free of pain after 13 years in only 51.2%, joints of grade 2 already after 10 years in only 37% (p < 0.05). The final values of grade 3 joints were found after only 5 years. This demonstrates that varus osteotomy is only of limited value in dysplastic joints with osteoarthritis. Operations correcting the acetabulum have to be compared. CONCLUSION: In 21 patients rotational osteotomies to correct external rotation contracture had a marked effect on pain in 90.4%, valgus osteotomies with rotation in 75%, varusosteotomies with rotation in 65%. Without rotation a marked reduction of pain was found in varus osteotomy in 61.6% and in valgus osteotomy in only 55%. So far, patients with diminished anteversion of the femur were not separated and treated specially. But diminished anteversion of the femur and/or acetabulum leads to osteoarthritis too.

Adult↗
PubMedDate not supplied

[The treatment of hip dysplasia or dislocation with Fettweis' immobilization cast].

To verify the success of the cast immobilisation in a squatting position in the treatment of dysplasia and dislocation of the hip 41 children were reviewed whereby lapses up to 13 years had to be considered. In 9 hips the cast immobilisation leaded to an unsatisfactory result so that the joints had to be revised operatively. In the remaining 48 hips 31 (65%) were cured, 15 (31%) showed a light, 2 (4%) a grave remaining dysplasia. One hip joint showed an ischemic necrosis of the femoral head which corresponds to a rate of necrosis of 2.1%. As the concerned patient was treated with spreader pants in spite of the high grade of luxation of her hip it more likely that this avascular necrosis is caused by the preceding treatment and not by the cast immobilisation itself. Factors with negative effects on the result or bad prognostic signs respectively, were poor initial findings and reluxation during cast immobilization. The start of therapy had no noticeable influence on the result. On the other hand this factor was very important for the permanence of treatment. In hips with remaining dysplasia very often a clinical hypermobility was found. A positive Trendelenburg-sign was seen in the hip with defect-healed avascular necrosis of the femoral head and furthermore in 2 other hips with evident remaining dysplasia of the acetabulum. In comparison to other methods, the cast immobilisation according to Fettweis shows a low rate of avascular necrosis of the femoral head and a forced supplementary development of the dysplastic acetabulum. Because of its wide range of indication and its small rate of complications the Fettweis plaster cast is a very reliable method for the treatment of dysplasia and dislocation of the hip in infancy and early childhood.

Adolescent↗
PubMedDate not supplied

[Triple osteotomy of the pelvis in dysplastic hip joints in children and adults].

We report on a post operative radiological and clinical follow-up (3-6.4 years) of 80 triple-osteotomies (29 operations according to the technique of Carlioz and 51 according to Tönnis). This study includes 32 osteotomies in children and 48 in adults. In 82% of the cases of low dysplastic hip joints and in 88% of the cases in severe dysplastic hip joints, the results came up to the expectations of the patients. The acetabular inclination angle and the acetabular angle improved about 10 degrees and the center edge angle about 25 degrees. In cases of neurological diseases, the radiological results of the hips were less satisfactory. The results is negatively influenced by pseudarthrosis and stress fractures in the ischium. These complications occur to a lower degree after Tönnis-osteotomy. From the age of 7, the triple-osteotomy represents an useful alternative to the operative correction of the hip joint dysplasia. The operation can be carried out in cases of congruity of head and acetabulum. Under certain circumstances, a transposition operation is additionally necessary, it is only indicated with a coxa valga. The triple-osteotomy can positively influence the biomechanical situation of the hip joint by means of an improved head roofing, by an ameliorated adjoining of the area of force reception to the pressure resultant and by medialisation of the acetabulum.

Adolescent↗
PubMedDate not supplied

[Corrective intra-articular surgery in juvenile femur head epiphysiolysis].

Treatment of severely slipped capital femoral epiphysis depends on the individual pathoanatomic and pathophysiologic conditions. Since the femoral neck vessels remain intact in chronic slip, they should be preserved whenever possible. Bilateral chondrolysis developed in 1 of our 9 cervical osteotomy patients. Long-term radiologic and clinical findings after a cervical osteotomy do not differ appreciably from those after an Imhäuser osteotomy, in some cases, with incomplete realignment of the femoral head-acetabulum relation. Apparently, not only the "quantitative" factor but also the "qualitative" factor plays an important role in epiphyseal separation. By contrast, severe acute slip is a severe irritation of the joint accompanied by intra-articular bleeding and rupture of the femoral neck vessels. Good results are achieved after immediate operative decompression, controlled reduction, and stable fixation of the epiphysis, providing anatomic realignment of the femoral head-acetabulum relation is not forced, but rather carried out only to the limit of tolerance without leverage maneuver and under moderate traction and vision. Epiphyseal necrosis developed after conventional open reduction in 2 of our 16 patients with acute slip. No cases of epiphyseal necrosis have been observed to date in any of our patients (N = 5) treated with this new technique of controlled reduction (i.e., partial reduction in "acute chronic slip").

Adolescent↗
PubMedDate not supplied

[Late prognosis of Perthes' disease: which factors determine arthritis risk?].

In 55 patients with Perthes' Disease the radiographic and clinical results were reviewed at the Orthopedic Clinic Balgrist of the University of Zurich (Switzerland) an average of 42 years (range: 28-56) after onset of the disease. Radiographs were available from the onset of disease to maturity. They were systematically evaluated utilizing the following criteria: Catterall grouping, "head at risk" signs, Mose's criteria and various indices and quotients for the measurement of femoral head deformity. The late results of the affected hips in adult life based upon clinical and radiological examination, and especially the development of arthrosis, were correlated with the earlier evaluations using statistical methods. Our results support the therapeutic concept of "femoral head containment" which means a better prognosis for those hips in which the femoral head is well contained without lateral subluxation or extrusion. In contrast to the negative prognostic significance of lateral calcification, which was found more frequently in the older children with poor end results, the amount of femoral head involvement according to the Catterall grouping was not found to have any influence upon the late outcome. A very important predictor of the prognosis was found to be the sphericity of the femoral head evaluated according to Mose's criteria, followed by the head-acetabulum quotient, the acetabulum quotient and the radius quotient. When severe residual deformity persisted after the healing phase arthritis developed in many cases. Age was also a significant factor. Fewer good results were found in children who were more than 8 years old at the onset of symptoms. The last assessment, based on clinical and radiological criteria, showed that 46% of patients had an excellent and 33% a good late result. Disabling arthritis requiring surgery developed in only 9 cases. We found, as have other authors of long term follow-up studies, that many patients, especially those with no or only mild femoral head deformity, do not develop significant coxarthrosis in early or middle adult life. More than 50% of the patients showed only mild or even no arthrosis an average of four decades after the onset of Perthes' Disease.

Adolescent↗
PubMed1981

[Our experience with the Monk-"soft-top"-endoprosthesis (author's transl)].

31 Monk-"soft-top"-femoral head prostheses were followed up for 12 to 48 months. They were implanted after a fracture of the femoral neck, provided there was no major osteoarthritic changes of the acetabulum. Our results are satisfying, no severe complications due to the high density polyethylene debris were encountered and no protrusions of the acetabulum either.

Aged↗
PubMed1980

[A contribution to the biostatic analysis of the hip joint III (author's transl)].

Following description of a model which can be applied in clinical practice for planning an operation with regard to the load and strain placed on the hip joint, as expounded in previous articles, the present article explains two more realistic possibilities of calculation of the pressure on the joint. We now have, therefore, three pressure models which can be compared with each other: 1. Assumption of equal distribution of the pressure over the hip joint with calculation of the maximal pressure. 2. Assumption of a linear drop in pressure from the acetabulum in the direction of the floor of the acetabulum. 3. Assumption that the articular cartilage displays an ideally elastic behaviour (calculation of pressure according to Hooke's Law). The last-named model No. 3 is probably the most realistic one, but in view of the fact that it requires complicated calculations, it will be employed in specific cases only, which will usually be mostly of a theoretical nature; Model No. 1 requires a reasonable amount of calculation and will suffice, as shown in the present article, for daily routine surgical planning.

Biomechanical Phenomena↗
PubMed2002

Fixation with poly-L-lactic acid screws in hip osteotomy: 68 hips followed for 18-46 months.

This study evaluated 68 consecutive hip osteotomies in 61 patients using absorbable poly-L-lactic acid screws for fixation. 47 hips underwent a rotational acetabular osteotomy, 17 hips Chiari's pelvic osteotomy, and 4 hips transtrochanteric rotational osteotomy. Cortical screws were used to transfix the osteotomized acetabulum, and cancellous screws to reattach the intraoperatively osteotomized greater trochanter. The average age at surgery was 35 (12-49) years. The mean duration of follow-up was 32 (18-46) months. All the osteotomized acetabulums united well, but 4 of 54 trochanteric osteotomies failed to unite.

Adult↗
PubMed2002

Infiltration of sarcomas into the hip joint: comparison of CT, MRI and histologic findings in 67 cases.

We analyzed the incidence, route, and characteristics of hip joint infiltration in pelvic or proximal femoral sarcomas. 67 patients with a sarcoma that originated around the hip joint (50 pelvic and 17 femoral) were included in this study. Preoperative CT and MRI were matched with the histological findings in tumor specimens. Tumor infiltration into the hip joint was suspected on the basis of preoperative imaging in 29 patients due to articular cartilage disruption, diffuse signal changes in the acetabulum or femoral neck, signs of a tumor in the joint, or markedjoint effusion. Of these 29 patients, 15 showed tumor invasion on histological examination. 12 of 31 chondrosarcomas, none of 12 Ewing's sarcomas, and 3 of 24 osteosarcomas infiltrated into the hip joint (p = 0.008). 10 of 26 low-grade sarcomas and 5 of 41 high-grade sarcomas infiltrated into the hip joint (p = 0.02). The joint infiltration rate of the chondrosarcomas was related to their size. Of 10 tumors originating in the acetabulum, 9 penetrated through or around the osseous-ligamentous junction and one through the acetabular cartilage. In 5 proximal femur lesions, all infiltrated the joint through the femoral neck, 3 of them also through the ligamentum teres.

Adolescent↗