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PubMed1984

On hip and lumbar biomechanics. A study of joint load and muscular activity.

Loading moment of force about the hip and lumbo-sacral joints during straight and flexed knee lifting was calculated at regular intervals during the lifts, using a computerized sagittal plane model. Lift with flexed knees and burden moved close to the body was found to induce lower load. Important parameters influencing the induced joint load are discussed. EMG levels from three trunk and seven hip muscles were recorded with surface electrodes and normalized, i.e. expressed as a percentage of the recorded level of each muscle during an isometric voluntary contraction. The erector spinae, gluteus maximus and adductor magnus muscles were more activated initially in the flexed knee lifts than in the straight knee lift, while the hamstrings were more and earlier activated in the flexed knee lifts. In order to estimate what proportion of the maximum hip extensor muscle moment was used to counteract the induced load moments about the hip, assessments of maximum hip extensor muscle moments were made: the highest extensor muscle moment was exerted at 90 degrees hip flexion, decreasing with decreasing hip angle. The knee angle did not significantly influence the muscle moments exerted by the hip extensor muscles. To calculate the magnitude and direction of the hip compressive load from known load moments, the length of the moment arms of three hip extensors was determined at every fifth degree of flexion at hip flexion angles between 0 degrees and 90 degrees by combining data from autopsy specimens and patients, the latter examined by computed tomography. There were significant differences in moment arm length between men and women but there was low correlation between subject's height and length of muscular moment arms. The calculated compressive force during the lifts was about three times body weight and the direction of the compressive force passed through the area described by others as having the most severe osteoarthrotic lesions on the femoral head. Hip joint load moments and normalized EMGs from five hip muscles were assessed during rising exercises for the lower limb in order to determine to what extent joint load and EMG is influenced by adaptive adjustments of the exercise. A multicomponent force-measuring platform and pictures on cine-film were used in the calculations of load moments. Posterior foot position lowered the load moment and slightly increased the level of muscular activity in the hip extensors. The design and use of a force prediction diagram for estimating induced hip extensor muscular forces is described.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1997

Uncemented total hip arthroplasty in osteonecrosis: a 2- to 10-year evaluation.

All patients undergoing uncemented total hip arthroplasty for end stage hip disease related to osteonecrosis of the femoral head were assessed prospectively between November 1983 and October 1992. The results of clinical evaluation using the Harris Hip score and radiographic assessment of fixation were analyzed to identify features of success or failure that may be unique to this population. Four different stem types and 4 different acetabular components were used. Sixty-four patients had 98 hips implanted during the time of the study. The 42 male and 22 female patients averaged 41 years of age (range, 21-69 years). Average followup was 87.3 months (7.3 years; range, 31-134 months). The cause of osteonecrosis was corticosteroids (42 hips), alcohol (27 hips), trauma (5 hips), and other (24 hips). Three patients (5 hips) have died and 4 patients (6 hips) are lost to followup. At last followup 65 of 87 hips (75%) remained radiographically stable and clinically functional, 18 of 87 (21%) have been revised, and 4 were failing (osteolysis). Of the 22 hips with revision or impending failure, 4 were for technical reasons on the femoral side and 18 were for acetabular wear. Patient factors such as weight or underlying disease state did not seem to influence the ability to achieve stable fixation or contribute to accelerated failure. Failures related primarily to problems of first generation devices including accelerated wear of acetabular components, technical issues of femoral component placement (undersizing of components or femoral fracture), and the use of noncircumferentially coated femoral components. Age may be a factor in early failure. This 10-year experience with total hip arthroplasty for the patient with end stage hip disease due to osteonecrosis suggests that uncemented total hip arthroplasty can be applied predictably to this younger, potentially more active patient population.

Adult↗
PubMed2006

The outcome of total hip replacement in obese and non-obese patients at 10- to 18-years.

We studied a consecutive series of 285 uncemented total hip replacements in 260 patients using the Taperloc femoral component and the T-Tap acetabular component. The outcome of every hip was determined in both living and deceased patients. A complete clinical and radiological follow-up was obtained for 209 hips in 188 living patients, followed for a mean of 14.5 years (10 to 18.9). They were divided into two groups, obese and non-obese, as determined by their body mass index. There were 100 total hip replacements in 89 patients in the obese cohort (body mass index > or = 30 kg/m(2)), and 109 in 99 non-obese (body mass index < 30 kg/m(2)) patients. A subgroup analysis of 31 patients of normal weight (body mass index 20 kg/m(2) to 25 kg/m(2)) (33 hips) and 26 morbidly obese patients (body mass index > or = 35 kg/m(2)) (30 hips) was also carried out. In the obese group five femoral components (5%) were revised and one (1%) was loose by radiological criteria. Femoral cortical osteolysis was seen in eight hips (8%). The acetabular component was revised in 57 hips (57%) and a further 17 (17%) were loose. The mean Harris hip score improved from 52 (30 to 66) pre-operatively to 89 (49 to 100) at final follow-up. Peri-operative complications occurred in seven patients (7%). In the non-obese group six (6%) femoral components were revised and one (1%) was loose. Femoral cortical osteolysis occurred in six hips (6%). The acetabular component was revised in 72 hips (66%) and a further 18 (17%) were loose. The mean Harris hip score increased from 53 (25 to 73) prior to surgery to 89 (53 to 100) at the time of each patient's final follow-up radiograph. No statistically significant difference was identified between the obese and non-obese patients with regards to clinical and radiological outcome or complications. The subgroup analysis of patients of normal weight and those who were morbidly obese showed no statistically significant difference in the rate of revision of either component. Our findings suggest there is no evidence to support withholding total hip replacement from obese patients with arthritic hips on the grounds that their outcome will be less satisfactory than those who are not obese.

Acetabulum↗
PubMed2003

The SH3 domain-containing adaptor HIP-55 mediates c-Jun N-terminal kinase activation in T cell receptor signaling.

HIP-55 (hematopoietic progenitor kinase 1 (HPK1)-interacting protein of 55 kDa, also called SH3P7 and mAbp1) is a novel SH3 domain-containing protein. HIP-55 binds to actin filaments both in vitro and in vivo. HIP-55 activates HPK1 and c-Jun N-terminal kinase (JNK), which are two important lymphocyte signaling molecules. Until now, the regulation and function of HIP-55 in T cell receptor (TCR) signaling were unknown. We found that HIP-55 was recruited to glycolipid-enriched microdomains upon TCR stimulation, which indicates that HIP-55 is regulated by TCR signaling. HIP-55 interacted with ZAP-70, a critical protein-tyrosine kinase in TCR signaling, and this interaction was induced by TCR signaling. ZAP-70 phosphorylated HIP-55 at Tyr-334 and Tyr-344 in vitro and in vivo, and the HIP-55 mutant (Y334F/Y344F) was not tyrosine-phosphorylated in stimulated T cells. To study its function in T cell activation, HIP-55-deficient Jurkat T cells were established using the RNA interference approach. In the HIP-55-deficient cells, TCR (but not UV)-stimulated JNK activation was decreased. Furthermore, the activation of HPK1, a known JNK upstream activator and HIP-55-interacting protein, was also decreased in the HIP-55-deficient cells. Our data reveal the regulation of HIP-55 during TCR signaling, and using a genetic approach, we demonstrate for the first time that HIP-55 plays a functional role in TCR signaling.

Blotting, Western↗
PubMed1996

Mutational analysis of the hsp70-interacting protein Hip.

The hsp70-interacting protein Hip participates in the assembly pathway for progesterone receptor complexes. During assembly, Hip appears at early assembly stages in a transient manner that parallels hsp70 interactions. In this study, a cDNA for human Hip was used to develop various mutant Hip forms in the initial mapping of functions to particular Hip structural elements. Hip regions targeted for deletion and/or truncation included the C-terminal region (which has some limited homology with Saccharomyces cerevisiae Sti1 and its vertebrate homolog p60), a glycine-glycine-methionine-proline (GGMP) tandem repeat, and a tetratricopeptide repeat (TPR). Binding of Hip to hsp70's ATPase domain was lost with deletions from the TPR and from an adjoining highly charged region; correspondingly, these Hip mutant forms were not recovered in receptor complexes. Truncation of Hip's Sti1-related C terminus resulted in Hip binding to hsp70 in a manner suggestive of a misfolded peptide substrate; this hsp70 binding was localized to the GGMP tandem repeat. Mutants lacking either the C terminus or the GGMP tandem repeat were still recovered in receptor complexes. Truncations from Hip's N terminus resulted in an apparent loss of Hip homo-oligomerization, but these mutants retained association with hsp70 and were recovered in receptor complexes. This mutational analysis indicates that Hip's TPR is required for binding of Hip with hsp70's ATPase domain. In addition, some data suggest that hsp70's peptide-binding domain may alternately or concomitantly bind to Hip's GGMP repeat in a manner regulated by Sti1-related sequences.

Amino Acid Sequence↗
PubMed1988

The use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement.

Formation of heterotopic bone (HTB) following total hip replacement may partially or completely ankylose the joint space, causing pain and/or limiting the range of motion. Patients at high risk for formation of HTB postoperatively include those with previous HTB formation, heterotopic osteoarthritis, and active rheumatoid spondylitis. Patients in these high risk groups have a 63-69% incidence of post-operative HTB formation, usually seen radiographically by 2 months post-operation. From 1980-1986 twenty-nine hips in 28 consecutively treated patients were irradiated post-operatively at the UCLA Center for the Health Sciences. The indication for irradiation was documented HTB formation previously in 26 of the 27 hips presented below. From 1980-1982 patients received 20 Gray (Gy) in 2 Gy fractions; from 1982-1986 the dose was reduced to 10 Gy in 2 Gy fractions. Twenty-seven hips in 26 patients completed therapy and were available for evaluation, with a minimum of 2 month follow-up, and a median follow-up of 12 months. Three of 27 hips developed significant HTB (Brooker grade III or IV) post-operatively, whereas 5 of 27 hips developed minor, nonsymptomatic HTB (Brooker grade I). When irradiation was begun by postoperative day 4, 0 of 17 hips formed significant HTB. If irradiation began after post-operative day 4, 3 of 10 hips formed significant HTB (Brooker grade III or IV). These 3 hips received doses of 10 Gy in one hip and 20 Gy in the other 2 hips. There were no differences in the incidence or severity of side effects in the 10 Gy vs. the 20 Gy treatment groups. Eighteen hips received 10 Gy, 8 hips 20 Gy and, 1 hip 12 Gy. In conclusion, 10 Gy in 5 fractions appears as effective as 20 Gy in 10 fractions at preventing post-operative formation of HTB. For optimal results, treatment should begin as early as possible prior to post-operative day 4.

Adult↗
PubMed2006

Hip-phase-dependent flexion reflex modulation and expression of spasms in patients with spinal cord injury.

The flexion reflex in human spinal cord injury (SCI) is believed to incorporate interneuronal circuits that consist elements of the stepping generator while ample evidence suggest that hip proprioceptive input is a controlling signal of locomotor output. In this study, we examined the expression of the non-nociceptive flexion reflex in response to imposed sinusoidal passive movements of the ipsilateral hip in human SCI. The flexion reflex was elicited by low-intensity stimulation (300 Hz, 30 ms pulse train) of the right sural nerve at the lateral malleolus, and recorded from the tibialis anterior (TA) muscle. Sinusoidal hip movements were imposed to the right hip joint at 0.2 Hz by a Biodex system while subjects were supine. The effects of leg movement on five leg muscles along with hip, knee, and ankle joint torques were established simultaneously with the modulation pattern of the flexion reflex during hip oscillations. Phase-dependent modulation of the flexion reflex was present during hip movement, with the reflex to be significantly facilitated during hip extension and suppressed during hip flexion. The phase-dependent flexion reflex modulation coincided with no changes in TA pre- and post-stimulus background ongoing activity during hip extension and flexion. Reflexive muscle and joint torque responses, induced by the hip movement and substantiated by excitation of flexion reflex afferents, were entrained to specific phases of hip movement. Joint torque responses were consistent with multi-joint spasmodic muscle activity, which was present mostly during the transition phase of the hip from flexion to extension and from mid- to peak extension. Our findings provide further evidence on the interaction of hip proprioceptors with spinal interneuronal circuits engaged in locomotor pathways, and such interaction should be considered in rehabilitation protocols employed to restore sensorimotor function in people with SCI.

Adult↗
PubMed1991

Use of the uncemented bipolar endoprosthesis for the treatment of steroid-induced osteonecrosis of the hip in renal transplantation patients.

Osteonecrosis of the hip is a well known complication in renal transplantation patients who are treated with corticosteroids for immunosuppression. In a consecutive series of 10 patients with osteonecrosis of the hip, 16 primary uncemented bipolar endoprostheses were inserted between April 1984, and February 1986. The average follow-up period after surgery was 40 months, (range, 24-48 months). All patients developed osteonecrosis of their hips and were operated on within 2 years of their renal transplant. At the time of surgery, all patients were still taking corticosteroids as well as other immunosuppressants. The average age at surgery was 34.6 years (range, 21-48 years). All hips were classified as stage 3 or 4 before operation. The average Harris score at follow-up examination was 94.2 (range, 74-101), with 13 hips rated excellent, 1 hip rated good, and 1 hip rated fair. One patient's hip prosthesis was removed after 17 months secondary to a septic arthritis. This was the only major complication in this series. Pain was improved in all patients. However, postoperative limp and abductor weakness still presented a significant problem. An extensive radiographic evaluation was made on all hips. Eleven observations and measurements were made using radiographs of the pelvis and hip. Vertical subsidence was present in 33% of the hips and averaged 2.2 mm (range, 1-4 mm). No significant radiographic loosening was evident in any hip. Acetabular protrusio was evaluated in all patients, and was found to be less than 4 mm in either the superior or axial direction. Heterotopic ossification was present in 80% of hips, but resulted in loss of motion in only one hip.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMedDate not supplied

Computer modeling of the pathomechanics of spastic hip dislocation in children.

Spastic muscles about the hip cause subluxation, dislocation, and lead to acetabular dysplasia. Spastic hip disease occurs when the muscles about the hip exert forces that are too high or in the wrong direction or both. To determine the role of the hip forces in the progression of spastic hip disease and the effect of both muscle-lengthening and bony reconstructive surgeries, a computerized mathematical model of a spastic hip joint was created. The magnitude and direction of the forces of spastic hips undergoing surgery were analyzed preoperatively and postoperatively to determine which procedure is best suited for the treatment of spastic hip disease. The muscle-lengthening procedures included (a) the adductor longus, (b) the psoas, iliacus, gracilis, adductor brevis, and adductor longus, and (3) the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus. The bony reconstructive and muscle-lengthening procedures included (a) lengthening the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing femoral neck anteversion from 45 to 10 degrees , (b) lengthening of the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing neck-shaft angle from 165 to 135 degrees , and (c) lengthening of the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing femoral neck anteversion from 45 to 10 degrees and neck-shaft angle from 165 to 135 degrees . Results show that a child with spastic hip disease has a hip-force magnitude 3 times that of the a child with a normal hip in the normal physiologic position. Based on this mathematical model the best to normalize the magnitude of the hip-joint reaction force, the muscles to be lengthened should include the psoas, iliacus, gracilis, adductor brevis, and the adductor longus. To normalize the direction of the hip force, the extremity should be positioned in the normal physiologic position. The impact of decreasing the femoral anteversion or femoral neck-shaft angle or both had little additional effect on the direction or magnitude of hip forces.

Biomechanical Phenomena↗
PubMed2000

Total hip arthroplasty with use of the Metasul metal-on-metal articulation. Four to seven-year results.

BACKGROUND: Total hip replacements with a metal-on-metal articulation were commonly used until the mid-1970s; most were then abandoned in favor of hip replacement with a metal-on-polyethylene articulation. The reason for this change was primarily early cup loosening, which was more prevalent with these metal-on-metal designs than it was with metal-on-polyethylene designs. In the late 1980s, a metal-on-metal design with improved clearance (adequate space between the femoral head and the acetabular articulation surface to allow fluid film lubrication and clearance of any debris from within this joint), metal hardness, and reproducible surfaces was introduced by Sulzer Orthopedics in Switzerland. Orthopaedic surgeons were interested in this Metasul articulation because the contribution of polyethylene wear particles to the failure of total hip replacements had become evident. This study was undertaken to review the clinical performance of this implant and to determine if early acetabular loosening or revision and wear and osteolysis were prevalent. METHODS: Between 1991 and 1994, seventy patients (seventy hips) had a total hip replacement with the Metasul metal-on-metal articulation and a cemented Weber cup. Nine patients died less than four years after the replacement; none of these deaths were related to the operation. Five patients were not available for radiographic evaluation, but they were contacted and it was known that the hip was not painful and had not been revised. Fifty-six patients (fifty-six hips) had complete clinical and radiographic data four to 6.8 years after the operation, and they made up the study group. The patients were evaluated with use of the Harris hip score, a patient-self-assessment form, and radiographs. RESULTS: At an average of 5.2 years (range, four to 6.8 years) after the operation, the average total Harris hip score for the fifty-three patients who did not have a revision was 89.6 points (range, 62 to 100 points). The average Harris pain score was 41.0 points (range, 30 to 44 points), and the average Harris limp score was 9.4 points (range, 5 to 11 points). One patient had revision of a loose cup, but there were no other loose acetabular components in the series. Two patients had revision of the acetabular component because of dislocation. No patient had a loose or revised femoral component. Therefore, the mechanical failure rate was one (2 percent) of fifty-six patients. Thirty-six of forty-seven patients who completed the patient-self-assessment form rated their result as excellent; seven, as very good; two, as good; one, as fair; and one, as poor. Wear could not be measured on radiographs because of the metal-on-metal articulation. No hip had radiographic evidence of acetabular osteolysis and two hips had calcar resorption, but there was no other radiographic evidence of focal osteolysis. CONCLUSIONS: Our four to seven-year experience with this articulation surface indicates that the clinical results are similar to those of total hip replacements with a metal-on-polyethylene articulation. We believe that the Metasul articulation may have a role in reducing the wear that occurs with total hip replacement. The Metasul articulation appears to be particularly indicated for more active patients. A historical comparison with the reports in the literature of which we are aware indicated that the hips in our study had a lower rate of acetabular revision and loosening than did those with previous metal-on-metal designs and that they had no more acetabular loosening or osteolysis than did those with metal-on-polyethylene articulations followed for an average of five years.

Adult↗
PubMed2001

Second-generation cementless total hip arthroplasty. Eight to eleven-year results.

BACKGROUND: Second-generation cementless femoral components were designed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces. We examined the eight to eleven-year results of total hip arthroplasty with a cementless, anatomically designed femoral component and a cementless hemispheric acetabular component. METHODS: Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating (Anatomic Hip) and a cementless hemispheric porous-coated acetabular component (Harris-Galante II) were performed in eighty-five patients. These patients were prospectively followed clinically and radiographically. Six patients (seven hips) died and five patients (seven hips) were lost to follow-up, leaving seventy-four patients (seventy-eight hips) who had been followed for a mean of ten years (range, eight to eleven years). The mean age at the time of the arthroplasty was fifty-two years. RESULTS: The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up; 86% of the hips had a good or excellent result. Thigh pain was reported as mild to severe after seven hip arthroplasties. No femoral component was revised for any reason, and none were loose radiographically at the time of the last follow-up. Two hips underwent acetabular revision (one because of dislocation and one because of loosening). Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point. The ten-year survival rate was 96.4% +/- 2.1% for the total hip prosthesis, 100% for the femoral component, and 96.4% +/- 2.1% for the acetabular component. Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight (93%) of the -seventy-three hips with complete radiographic follow-up. Femoral osteolysis proximal to the lesser trochanter was noted in four hips (5%). No osteolysis was identified distal to the lesser trochanter. Periacetabular osteolysis was identified in twelve hips (16%). Five patients underwent exchange of the acetabular liner because of polyethylene wear. CONCLUSIONS: This second-generation cementless, anatomically designed femoral component provided excellent clinical and radiographic results with a 100% survival rate at ten years. The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty.

Acetabulum↗
PubMed2000

[Functional gait adaptations in patients with painful hip].

PURPOSE OF THE STUDY: This prospective study was conducted to analyze the mechanisms of gait compensation in patients with painful hip and to search for correlations with preoperative clinical and radiographic findings. MATERIAL AND METHODS: Optoelectronic and multicomponent force-plate datas were used to calculate joint motion, moments and intersegmental forces for 26 patients with unilateral hip pain and 20 normal age and sex-matched patients. Height was similar in the two groups but mean weight in the study group (83 kg) was greater than in the controls (68 kg). The preoperative Harris score was 53 in the study group and 16 patients had a permanent flexion contracture of the knee (mean 15 degrees, range 5-30 degrees). Radiographically, there were 22 cases of osteo-arthritis hip disease and 4 cases of necrosis. RESULTS: Gait analysis showed a significant 0.66 +/- 0.06 m (12 p. 100) reduction in step length. Patients who had severe hip pain walked with a decreased dynamic range of motion (18 +/- 5 degrees, p<0.0001) with a curve reversal as they extended the hip. They also reduced dynamic range of motion of the knee and ankle. Patients who presented a reversal in their dynamic hip range of motion had a greater passive flexion contracture and a greater loss in range of motion during gait than those with a smooth regular pattern (p<0.0001). Patients with hip pain walked with significantly decreased external extension, adduction, and internal and external rotation moments (p<0.0001). They also unloaded the ipsilateral knee and ankle. The decreased hip extension moment was significantly correlated with an increased level of pain (p<0.0001). There was no correlation with radiological findings. DISCUSSION: Reversal of dynamic hip range of motion was interpreted as a mechanism to increase effective hip extension during stance phase through increased anterior pelvic tilt and lumbar lordosis. CONCLUSION: Patients with painful hip walked with a manner that was asymmetric. These gait modifications were related to hip limitation in passive motion and pain. Patients with flexion contracture adopted a compensatory gait mechanism. This study confirms relation between hip pain and forces across the hip joint.

Adaptation, Physiological↗
PubMed2001

One-stage correction of neglected developmental dysplasia of the hip by open reduction and pemberton osteotomy.

BACKGROUND AND PURPOSE: Pemberton osteotomy is commonly used for correction of hip-dysplasia. Its application in treating hip dislocation is rarely reported. The purpose of this study was to determine the efficacy of one-stage open reduction and Pemberton osteotomy of neglected developmental dysplasia of the hip (DDH). METHODS: We retrospectively reviewed the clinical and radiographic results of one-stage total correction in 75 patients with neglected DDH (86 hips) from 1984 through 1996. Sixty-nine patients (77 hips) aged 13 to 76 months (mean, 21.5 mo) underwent open reduction, Pemberton osteotomy, and hip spica for 8 weeks. Seven patients (9 hips) aged 29 to 73 months (mean, 46.6 mo) underwent additional femoral shortening (another hip in one bilaterally involved patient underwent only open reduction and Pemberton osteotomy). RESULTS: Acetabular index improved markedly from 40.4 degrees (range, 25-60 degrees) preoperatively to 16.2 degrees (range, 0-30 degrees) postoperatively. Complications included redislocation in four patients (4 hips) and avascular necrosis in three patients (3 hips). Reoperation was performed in four patients (4 hips). All patients were followed up for at least 3 years. By Severin's classification, all operated hips had excellent (18) or good (68) final radiographic results. The functional results, evaluated by McKay's criteria, were also excellent (52 patients/60 hips) and good (23 patients/26 hips). CONCLUSIONS: Neglected DDH was safely and effectively treated by open reduction, Pemberton osteotomy, and optional femoral shortening with limited complications.

Age Factors↗
PubMed2004

[Total endoprosthesis replacement after hip joint arthrodesis].

PURPOSE OF THE STUDY: To evaluate mid-term results of conversion of arthrodesis to total hip replacement in terms of X-ray findings and benefits for the patient. MATERIAL: Ten patients who had undergone hip joint arthrodesis were clinically examined and X-rayed and the findings evaluated. The most common indications for arthrodesis were posttraumatic lesions or the sequelae of a dysplastic hip joint, Perthes disease and inflammatory hip arthritis. The average age was 24.6 years (range, 15-37) at the first operation (arthrodesis) and 42.5 years (range, 30-61) at the second operation (hip arthroplasty). The average follow-up was 9.3 years (range, 1-16). Patients with true ankylosis of the hip joint were not included. METHODS: The patients were clinically examined for the range of motion, which was evaluated by Harris hip scores and X-ray findings. RESULTS: All eight patients who underwent total hip replacement due to persistent pain in the lumbosacral region experienced pain relief or its absence. This also applied to the patients whose X-ray films showed signs of spondylarthritis. The Harris hip scores showed that six patients were able to walk to longer distances without any support. No radiographic evidence of acetabular component loosening was found. One patient had to undergo reimplantation of the femoral component because of aseptic loosening. In the early postoperative period, one dislocation of the prosthesis and one sciatic nerve injury resulting in transient paresis of the peroneal nerve were recorded. None of the complications required repeat surgery. All patients reported that they would undergo the procedure again despite an increased risk associated with this procedure. DISCUSSION: Our results are in agreement with similar findings in this field. We did not find an increase in failed hip arthroplasty in older patients. The X-ray findings were very satisfactory, particularly those concerning the acetabular component. Patients who had true ankylosis of the hip joint were not included in the study. The average range of motion achieved in our patients corresponds to that reported in the literature. CONCLUSIONS: Conversion of hip arthrodesis to total hip replacement is not a frequent surgical procedure. It is associated with a higher degree of risk because of changed anatomy due to previous surgical interventions in that region. Motion restoration in the hip joint results in reducing low back pain and, consequently, improving the quality of life. All evaluated patients would be willing to undergo the operation again.

Adolescent↗
PubMed1979

Canine hip dysplasia: study of heritability in 401 litters of German Shepherd dogs.

Heritability of hip dysplasia was estimated to be about 0.4 to 0.5 when based on the radiographic evaluations of the hip joints of 2,404 German Shepherd Dogs born at The Armed Forces Dog Training Center in Sweden. The material included all dogs in 401 litters born at the Center from 1965 through 1973 that reached the age of 15 months. To be expected with such high heritability, frequency of hip dysplasia in the offspring was shown to be affected by the hip joint status of sire and dam as well as by the hip joint status of their parents and littermates. Even matings between sires with normal hip joints and dams with only slight dysplasia resulted in significantly higher frequency of hip dysplasia in the offspring, when compared with the frequency if both sires and dams had normal hip joints. Frequency of hip dysplasia in the progeny of sires with normal hip joints varied greatly. Since 1973, selection of the breeding stock has been based on hip joint status (phenotype) of the breeding animals and of their relatives as well as on what had become known about frequency of hip dysplasia in the litters already born (progeny testing). In this way, frequency of hip dysplasia in 347 dogs born at the Center during 1975 was lowered to 28%. This figure should be compared with the figure of 50%, which represents the frequency of hip dysplasia in the kennel up to 1970, when selection was not as strict as could be expected in a well-controlled kennel.

Animals↗
PubMed1998

Computed-tomography-based computer preoperative planning for total hip arthroplasty.

For precise preoperative planning in total hip arthroplasty (THA), we developed a technique of computed tomography (CT)-based computer preoperative planning and compared this technique with the single X-ray and template method generally used. The subjects of this study were 42 hips in 38 patients who underwent THA using a cementless total hip system. Preoperatively, a standard anteroposterior X-ray of the hip was taken, and conventional preoperative planning was done with a template of the total hip system. Transverse images were obtained using a helical CT scanner, and a CT-based computer preoperative plan was performed on true coronal slice images of the proximal femur reconstructed from CT data. Postoperatively, 29 hips (69%) showed good proximal fit of the femoral component to the medial endosteal line. Of the 20 hips with good proximal fit on preoperative X-ray planning, 12 hips had good proximal fit on postoperative X rays. Sensitivity and specificity of the proximal fit on X-ray templating were 41 and 23%, respectively. In 27 of 28 hips with good proximal fit on reconstructed CT images preoperatively, the postoperative X ray revealed good proximal fit. Sensitivity and specificity of the proximal fit on computer planning were 93 and 86%, respectively. Twelve hips with good proximal fit on preoperative templating, the reconstructed images, and the postoperative X ray had 20 degrees or less of combined femoral neck anteversion and external rotational contracture of the hip on the X-ray table. Eight hips with good proximal fit on preoperative templating and proximal poor fit on the reconstructed images had 17-65 degrees of combined version and rotational contracture. In 16 hips with poor proximal fit on preoperative templating and good proximal fit on the reconstructed images, the combined version and rotational contracture ranged from 17 to 69 degrees. When combined femoral neck anteversion and external rotational contracture of the hip is less than 15 degrees, the simple X-ray and template method might be sufficient for THA planning. Otherwise, the CT-based method of preoperative planning is recommended.

Arthroplasty, Replacement, Hip↗
PubMed1999

Determinants of hip and knee flexion range: results from the San Antonio Longitudinal Study of Aging.

OBJECTIVE: We analyzed data from the San Antonio Longitudinal Study of Aging, a neighborhood-based study of community-dwelling elderly people, to identify factors that determine the flexion range (FR) of hips and knees. METHODS: The FR of hips and knees was measured in a cohort of 687 subjects aged 65 to 79 years. We used multivariate models to examine the associations among the FR of hips and knees, and between these and age, gender, ethnicity, body mass index (BMI), pain and its location, self-reported arthritis, and diabetes mellitus. The functional relevance of hip and knee FR was tested by measuring its association with 50-foot walking velocity. RESULTS: More than 90 degrees of flexion in both hips and both knees was observed in 619 subjects (90.1%). Correlations among the FR of hips and knees ranged from 0.54 to 0.80 (P < 0.001 for Spearman r values). Multivariate analysis revealed a pattern of significant associations between each of the joints and its contralateral mate and ipsilateral partner joints that was consistent for both hips and both knees. Using each individual joint as the unit of analysis, the following variables were independently associated with hip or knee FR in multivariate models: rising BMI and female sex with reduced FR of both hips and knees, a Mexican American ethnic background with decreased hip FR, and knee pain with decreased knee FR. The functional importance of the FR of these two important joints was supported by its significant association with walking velocity in a model that adjusted for age, gender, ethnic background, BMI, and hip or knee pain. CONCLUSIONS: Most community-dwelling elderly people have a FR of hips and knees that can be considered functional. The ipsilateral and contralateral hip or knee are significant independent determinants of the FR of each of these joints. Obesity, a health problem potentially amenable to preventive and therapeutic interventions, is a factor significantly associated with decreased FR of hips and knees.

Aged↗
PubMed1996

MRI in late sequelae of Perthes' disease: imaging findings and symptomatology in ten hips.

Five painful (group A) and five symptomless (group B) hips in nine patients with late sequelae of Perthes' disease were studied with plain radiography and magnetic resonance imaging (MRI) in order to correlate MRI findings with symptomatology. The unaffected hips were also studied. In group A hips, poor congruence of the articular cartilage surfaces was present in three of five cases, whereas good congruence was found in all group B hips. In one spherical but painful hip (group A), MRI revealed a protuberance in the anterolateral cartilage of the femoral head. The joint cartilage in group A and B hips was, on average, 0.5 and 1.5 mm thicker, respectively, than the cartilage in the unaffected hips. The lateral joint capsule was, on average, 3.0 mm thicker in group A hips than in the unaffected hips (P < 0.05), which possibly reflects reactive changes due to chronic irritation in the painful hips. The mean joint capsule thickness differed by only 0.5 mm between the unaffected and group B hips. Mean anterior acetabular coverage by MRI was 97 % in group A and 98 % in group B, while in the unaffected hips mean anterior coverage was 102 %. In an aspherical painful hip, MRI revealed a juxta-articular cyst not visible by radiography. A symptomless intra-articular fragment, due to osteochondritis dissecans, was well visualized with MRI. MRI is recommended for evaluation of pain in hips with late sequelae of Perthes' disease. It may show abnormalities in bony structures, as well as in joint capsule and cartilage.

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