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PubMed2003

Incidence and risk factors for a second hip fracture in elderly women. The Study of Osteoporotic Fractures.

Women with hip fracture have an increased risk of second hip fracture but other risk factors for a second hip fracture have not been established. We sought to determine the incidence and risk factors for second hip fracture, in a prospective cohort study of community-dwelling postmenopausal women over 65 years: the Study of Osteoporotic Fractures. From a cohort of 9,704 women, 632 women with a documented first hip fracture during the study were followed up until a second hip fracture or the end of follow-up. Clinical risk factors and bone mineral density were assessed at the beginning of the study. Fifty-three second hip fractures were validated by radiographs. Women with hip fracture had a 2.3% per year risk of second hip fracture. Women who walked for exercise at baseline were less likely to sustain a second hip fracture with a relative risk (RR) of 0.5 [0.3-0.9], as were those who had normal depth perception (RR=0.5 [0.3-0.9]). Women who lost weight since age 25 years had an increased risk of second incident hip fracture (RR = 2.7 [1.6-4.6]), as did those who had a low calcaneal bone mineral density (RR=1.5 [1.1-2.0] per standard deviation decrease in bone mineral density). Current use of estrogen replacement therapy at baseline was protective (RR=0.5 [0.3-0.9]) up to 2 years of follow-up. We conclude that community-dwelling women with a first hip fracture have a high risk of second hip fracture, and risk factors for this second fracture are similar to those of first hip fracture.

Aged↗
PubMed2005

Methodological issues in the identification of hip fractures using routine hospital data: a database study.

The proportion of the population over the age of retirement has risen in many countries, and this means there is a corresponding rise in the incidence of hip fractures. However, in order to reliably investigate the ability of interventions to prevent fracture, there needs to be a reliable measure of the incidence of hip fracture. The purpose of this study was to examine the inclusion and exclusion criteria used to identify hip fracture from hospital admission data and to examine the impact that these criteria have on estimated incidence of hip fracture. We examine the influence of: individual compared to consultant episode data; primary data compared to any diagnosis of hip fracture; emergency compared to elective admissions; and the influence of type and rate of surgery on incidence estimates. The results showed that classifying hip fractures by use of consultant episodes overestimated the rate of hip fracture by 6-31%, and this overestimation has increased in recent years. The use of primary diagnosis as opposed to any diagnosis underestimates hip fracture by 5%. Two percent (2%) of the people studied had an operation for a hip fracture but did not have a hip fracture diagnosis (many had a multiple fracture diagnosis), and 5.5% of the people studied had an elective admission for the hip fracture (perhaps falling in hospital during an elective admission). We conclude that the selection criteria can have a great influence on the number of hip fractures identified using routine data. There should be a standardized selection procedure for the identification of hip fracture, as this would enable interventions and preventive measures to be evaluated over time and facilitate comparisons of rates in different regions and countries, in order to examine factors associated with hip fracture.

Accidental Falls↗
PubMed1994

Cementless porous-coated anatomic medullary locking total hip prostheses.

The authors studied 50 consecutive and nonselected patients (52 hips) who were followed for a minimum of 7 years (range, 84-89 months) after they had a primary total hip arthroplasty with an uncemented Anatomic Medullary Locking (DePuy, Warsaw, IN) hip system. The average age of the patients at operation was 47.6 years (range, 19-88 years). The operative diagnoses were: avascular necrosis of the femoral head in 18 hips (34%), osteoarthritis in 16 (31%), fracture of the femoral neck in 14 (27%), and miscellaneous in 4 (8%). The average preoperative Harris hip score was 59 points (range, 6-67 points) that improved to 91 points (range, 69-100 points) at the 7-year follow-up examination. To assess the adequacy of intramedullary fit, the fit of the stem at the proximal canal and isthmus level was evaluated. Forty-one hips (79%) had a good press-fit at both the proximal canal and isthmus level, five hips (10%) had a good press-fit at the proximal canal only, and the remaining six hips (11%) had a poor fit at both the proximal canal and isthmus level. Of the 46 hips that had a good press-fit at the proximal canal and/or isthmus level or proximal canal only, 32 (70%) had bone ingrowth and 14 (30%) had stable fibrous tissue ingrowth. Of the remaining six hips with a poor press-fit at both the proximal canal and isthmus level, three (6%) had stable fibrous tissue ingrowth and another three (6%) were unstable. Of the three hips (6%) with femoral component loosening, one was revised and the other two were asymptomatic. There was an alarmingly high incidence of perioprosthetic osteolysis in our series: 16 hips (31%) had acetabular and femoral osteolysis and 13 hips (25%) had femoral osteolysis only. Also, there was a strikingly high incidence of polyethylene-liner wear (12 hips or 23%). Although the incidence of component loosening was low, a high incidence of periprosthetic osteolysis and excessive wear in the polyethylene linear remain challenging problems after insertion of the cementless Anatomic Medullary Locking prosthesis.

Adult↗
PubMed2006

Pre- and post-alpha motoneuronal control of the soleus H-reflex during sinusoidal hip movements in human spinal cord injury.

The aim of this study was to establish the contribution of hip-mediated sensory feedback to spinal interneuronal circuits during dynamic conditions in people with incomplete spinal cord injury (SCI). Specifically, we investigated the effects of synergistic and antagonistic group I afferents on the soleus H-reflex during imposed sinusoidal hip movements. The soleus H-reflex was conditioned by stimulating the common peroneal nerve (CPN) at short (2, 3, and 4 ms) and long (80, 100, and 120 ms) conditioning test (C-T) intervals to assess the reciprocal and pre-synaptic inhibition of the soleus H-reflex, respectively. The soleus H-reflex was also conditioned by medial gastrocnemius (MG) nerve stimulation at C-T intervals ranging from 4 to 7 ms to assess changes in autogenic Ib inhibition during hip movement. Sinusoidal hip movements were imposed to the right hip joint at 0.2 Hz by the Biodex system while subjects were supine. The effects of sinusoidal hip movement on five leg muscles along with hip, knee, and ankle joint torques were also established during sensorimotor conditioning of the reflex. Phase-dependent modulation of antagonistic and synergistic muscle afferents was present during hip movement, with the reciprocal, pre-synaptic, and Ib inhibition to be significantly reduced during hip extension and reinforced during hip flexion. Reflexive muscle and joint torque responses--induced by the hip movement--were entrained to specific phases of hip movement. This study provides evidence that hip-mediated input acts as a controlling signal of pre- and post-alpha motoneuronal control of the soleus H-reflex. The expression of these spinal interneuronal circuits during imposed sinusoidal hip movements is discussed with respect to motor recovery in humans after SCI.

Adult↗
PubMed1998

Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly.

PURPOSE: To determine the importance of fall characteristics, body habitus, function, and hip bone mineral density as independent risk factors for hip fracture in frail nursing home residents. SUBJECTS AND METHODS: In this prospective, case-control study of a single, long-term care facility, we enrolled 132 ambulatory residents (95 women and 37 men) aged 65 and older, including 32 cases (fallers with hip fracture) and 100 controls (fallers with no hip fracture). Principal risk factors included fall characteristics, body habitus, measures of functional assessment, and hip bone mineral density by dual-energy X-ray absorptiometry. RESULTS: In multivariate analysis, including only those with knowledge of the fall direction (n=100), those who fell and suffered a hip fracture were more likely to have fallen sideways (odds ratio 5.7, 95% confidence interval [CI] 1.7 to 18, P= 0.004) and have a low hip bone mineral density (odds ratio 1.9, 95% CI 0.97 to 3.7, P=0.06) than those who fell and did not fracture. When all participants were included (n=132) and subjects who did not know fall direction were coded as not having fallen to the side, a fall to the side (odds ratio 3.9, 95% CI 1.3 to 11, P=0.01), low hip bone density (odds ratio 1.8, 95% CI 1.03 to 3, P=0.04), and impaired mobility (odds ratios 6.4, 95% CI 1.9 to 21, P=0.002) were independently associated with hip fracture. Sixty-seven percent of subjects (87% with and 62% without hip fracture) had a total hip bone mineral density greater than 2.5 SD below adult peak bone mass and were therefore classified as having osteoporosis using World Health Organization criteria. CONCLUSIONS: Among frail elderly nursing home fallers, the preponderance of whom are osteoporotic, a fall to the side, a low hip bone density, and impairment in mobility are all important and independent risk factors for hip fracture. These data suggest that, among the frailest elderly, measures to reduce the severity of a sideways fall and improve mobility touch on new domains of risk, independent of bone mineral density, that need to be targeted for hip fracture prevention in this high-risk group.

Accidental Falls↗
PubMed2001

Functional roles of ankle and hip sagittal muscle moments in able-bodied gait.

OBJECTIVE: The main objectives of this study on able-bodied gait were (a) to identify the main functions of the ankle and hip muscle moments and their contribution to support and propulsion tasks, and (b) to illustrate the interaction between the ankle and hip moment activities. DESIGN: Twenty young, able-bodied male subjects walked along a 13 m path at a freely chosen speed. BACKGROUND: Functional contributions of the ankle and hip muscles and their interactions in achieving support and propulsion tasks during gait are still subject to controversy. METHODS: Principal component analysis was applied as a curve structure detection method to identify the main functional characteristics of the ankle and hip muscle moments. The first two principal components which contained over 70% and 85%, respectively, of the information in the ankle and hip moment curves revealed their functional tasks. Ankle versus hip moment plots was used to illustrate the interactions between muscles acting at the hip and ankle in the sagittal plane. Correlation coefficient and covariance calculations quantified the interaction between the ankle and hip moments. RESULTS: The first principal component revealed that the main role of the ankle and hip is to keep the body from collapsing. The second principal component is associated with the functional contribution of both ankle plantarflexors and hip flexors during the propulsion phase (50-60% of the gait cycle). High coordination (r=0.82) between the ankle and hip moments was observed. CONCLUSION: Maintaining body support against gravity was identified as the first functional task of the ankle plantarflexors and hip extensors, while contribution to propulsion was recognised as the second major role for the ankle plantarflexors and hip flexors. RELEVANCE: Identifying the main roles of the muscles acting at the hip and ankle during able-bodied walking provides better insight into how pathological gait should be evaluated.

Adult↗
PubMed2003

Effect of a hip flexor-stretching program on gait in the elderly.

OBJECTIVES: To test whether a reduction in peak hip extension during the terminal stance phase of walking in elderly compared with young adult subjects represents a hip flexor contracture impairment rather than some dynamic consequence and to test the hypothesis that stretching the hip flexors improves both static and dynamic peak hip extension, as well as other age-related gait changes about the ankle. DESIGN: A double-blinded, randomized, controlled trial. SETTING: Stretching exercises were performed in the subjects' homes. Pre- and postassessments were performed in a gait laboratory. PARTICIPANTS: Ninety-six healthy elderly individuals in 2 groups: treatment (n=47) and control (n=49). INTERVENTION: The treatment group received a 1-time instruction in hip flexor stretching, whereas the control group received a 1-time instruction in shoulder abductor stretching. Participants in each group were asked to perform stretching exercises on their own twice daily for 10 weeks. MAIN OUTCOME MEASURES: Static and dynamic peak hip extension, peak anterior pelvic tilt, and other peak kinematic and kinetic variables during the gait cycle. RESULTS: There was a modest improvement in static peak hip extension as measured by a goniometer within the treatment group (mean +/- standard deviation, 6.1 degrees +/-2.5 degrees to 7.7 degrees +/-3.6 degrees, P=.032) compared with no change in the control group. At comfortable walking speed, dynamic hip extension tended to increase in the treatment group (5.1 degrees +/-9.7 degrees to 7.1 degrees +/-8.0 degrees, P=.103) compared with no real change in the control group (5.3 degrees +/-8.9 degrees to 5.4 degrees +/-7.5 degrees, P=.928). Similarly, at fast walking speed, dynamic hip extension tended to increase in the treatment group (6.4 degrees +/-9.8 degrees to 8.4 degrees +/-8.0 degrees, P=.093) compared with no change in the control group. Changes in ankle kinematics and kinetics included a significant improvement in peak ankle plantarflexion and a tendency to improved ankle power generation. CONCLUSION: The static and dynamic trends to improvement in peak hip extension were of similar magnitude, suggesting that age-related reduction in peak hip extension during gait is the result of a static hip flexion contracture rather than a dynamic consequence. Additionally, age-related changes in ankle kinematics and kinetics may be secondarily related to hip flexion contracture impairment rather than impairment at the ankle per se. This study was limited by the exercises being unsupervised and relying on 1-time instruction. A more rigorous and supervised hip flexor-stretching exercise program may yield more substantial improvements in gait parameters.

Aged↗
PubMedDate not supplied

The associated effects of untreated unilateral hip dislocation in cerebral palsy scoliosis.

INTRODUCTION: The presence of a unilateral hip dislocation in children with cerebral palsy (CP) may cause problems with sitting imbalance, pressure ulcers, and hip pain. There is a dynamic interplay between hip dislocation, pelvic obliquity (PO), and scoliosis. The effect of an untreated unilateral hip dislocation on the rate of curve progression of CP scoliosis has not been defined in the literature. The purpose of this study is to investigate the effect of unilateral hip dislocation on PO and the rate of curve progression in children with spastic quadriplegic CP. METHODS: Patients with spastic quadriplegic CP who had spine radiographs at the time of initial presentation with scoliosis and at the latest follow-up were evaluated. Twenty-three children with spastic CP who had an untreated unilateral hip dislocation and scoliosis constituted the study group. The control group consisted of 83 quadriplegic CP patients with scoliosis and well-located hips. The rate of curve progression, incidence of PO, and the rate of PO progression at follow-up were compared between the 2 groups. RESULTS: The mean ages of patients with a unilateral dislocation and with well-located hips at initial radiograph were 10.4 and 10.5 years, respectively. The mean follow-up was 3.5 years. The mean rate of scoliosis curve progression in patients with a unilateral hip dislocation was 12.9 degrees per year. In the control group, the mean progression rate was 12.2 degrees per year. The incidence of PO at follow-up was 74% in scoliotic patients with a dislocation and 63% in scoliotic patients with normal hips. Using repeated-measures analysis of variance, unilateral hip dislocation was found to have no significant effect on scoliosis progression; however, progression of PO was significantly increased in the hip dislocation group (P < 0.05). Pelvic obliquity was corrected after posterior spinal fusion to the sacrum with pelvic fixation, without reducing the hip(s) at the same surgery. CONCLUSION: Unilateral hip dislocation causes a significant increase of PO but does not affect the rate of scoliosis curve progression.

Adolescent↗
PubMed2006

Hip protectors: a pilot study of older people in Taiwan.

AIMS AND OBJECTIVES: This research explores the compliance by older people in Taiwan with wearing hip protectors and whether protectors can prevent fractures or decrease injuries after falls. BACKGROUND: The ageing process causes degeneration of nerves, joints, muscles and then the incidence of falls in the older people is higher than in the young. Therefore, fractures caused by falls, particularly hip fractures of older people, need to be studied. Hip protectors are designed to reduce hip fractures and hip injuries when falls occur, by distributing the impact load and absorbing the impact force generated during a fall. DESIGN: This research was designed as a longitudinal study using purposive sampling and intervention for six months. METHODS: The target population were older people at high risk for falls and the study was carried out during a six-month period. Self-reported data were collected by interview and questionnaires. The expert validity of the questionnaires, including demographics, high-risk group, compliance and correct wearing of hip protectors and fall injuries, as assessed by three experts, was 0.94 and the test-retest correlation coefficient was 0.95. Individuals were excluded from the research sample if they were 24-hour bedridden, non-mobile or had an existing hip injury. RESULTS: Ten female subjects participated in this study. Their mean age was 76.1 years. During a six-month follow-up, there were 12 falls while wearing hip protectors, however, no fractures occurred because of the falls. CONCLUSIONS: This is the first research into hip protectors in Taiwan. The reasons for low compliance by older people were (1) unaccustomed to use, (2) discomfort, (3) wearing only during the daytime, (4) lack of assistance from family caregivers. RELEVANCE TO CLINICAL PRACTICE: Fall prevention, exercise and the use of hip protectors can significantly decrease the incidence of hip fractures. Although hip protectors are effective in reducing fall fracture risk, the compliance rate remains low. In the future, the researchers will develop a hip protector program related to teaching the correct method for wearing protectors. Helping older people learn how to overcome the discomfort of wearing hip protectors and encouraging a willingness to wear them is imperative.

Accidental Falls↗
PubMed2005

A cost-benefit analysis of external hip protectors in the nursing home setting.

OBJECTIVES: To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective. DESIGN: A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and functional status. Costs, transition probabilities between health states, and estimates of hip protectors' effectiveness were derived from published secondary data. SETTING: Nursing home facilities in the United States. PARTICIPANTS: Hypothetical cohort of permanent nursing home residents aged 65 and older without a previous hip fracture. INTERVENTION: Program of hip protectors reimbursed by Medicare. MEASUREMENTS: Number of fractures, life years, and dollars saved. RESULTS: Three pairs of hip protectors replaced annually would result in a weighted average lifetime absolute risk reduction for hip fracture of 8.5%, with net lifetime savings to Medicare of 223 dollars per resident. When the annual cost of hip protectors is less than 151 dollars per person, relative risk of fracture is less than or equal to 0.65 with hip protectors, or adherence is greater than 42%, hip protectors are cost saving to Medicare over a wide range of assumptions. Extrapolating these results to the estimated population of U.S. nursing home residents without a previous hip fracture, Medicare could save 136 million dollars in the first year of a hip-protector reimbursement program. CONCLUSION: From a Medicare perspective, hip protectors are a cost-saving intervention in the nursing home setting when hip protector effectiveness is less than or equal to 0.65 over the remaining lifetime of subjects.

Aged↗
PubMed2000

Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension.

BACKGROUND: Limited hip extension flexibility due to tight hip flexor musculature or anterior hip capsular and ligamentous structures is a possible cause of increased anterior tilt of the pelvis during running. However, to date, research exploring this relation, as well as the kinematic relation between anterior tilt of the pelvis and peak hip extension range of motion during running, is not available. OBJECTIVE: To assess the relation of anterior pelvic tilt during running to peak hip extension range of motion measured during running and hip extension flexibility measured clinically. METHODS: Hip extension flexibility was assessed using the Thomas test, and the three dimensional kinematic motion of the pelvis and hips were recorded using a VICON motion analysis system with 14 elite athletes running on a treadmill at 20 km/h. RESULTS: Anterior pelvic tilt displayed a significant (p<0.01) correlation with peak hip extension range of motion during running. Anterior pelvic tilt tended to be increased in runners who displayed reduced absolute peak hip extension range of motion during terminal stance. No significant correlation was shown for hip extension flexibility with either anterior pelvic tilt or peak hip extension range of motion during running. CONCLUSIONS: The outcomes of this study indicate that anterior pelvic tilt and hip extension are coordinated movements during running. Static hip extension flexibility measured using the modified Thomas test does not appear to be reflective of these dynamic movements.

Adolescent↗
PubMed2004

Hip osteoarthritis: where is the pain?

BACKGROUND: Pain radiating below the knee is typically thought to originate from the lumbosacral spine rather than degenerative hip pathology. We investigated the lower limb distribution of pain using body image maps in 60 patients awaiting primary hip arthroplasty and in 60 patients awaiting spinal decompression for confirmed spinal stenosis. The perception of 33 orthopaedic registrars regarding distribution of hip pain was also assessed. RESULTS: Groin and buttock pain are significantly more common in hip osteoarthritis. The presence of groin pain is 84.3% of those sensitive for hip dysfunction with a specificity of 70.3%. Patients with hip osteoarthritis had pain below the knee in 47% of cases whereas 88.5% of orthopaedic trainees believed hip pain did not radiate below the knee. Radiographic features of osteoarthritis within the hip joint, visual analogue pain score or Oxford Hip Score have no significant association with a patient's distribution of hip pain. CONCLUSIONS: Hip pain referred below the knee is common with a degenerate hip joint and follows the distribution of the saphenous nerve, which branches from the femoral nerve. Radiographic deterioration of a hip joint does not correlate with pain distribution or patient dysfunction as measured by the Oxford Hip Score.

Adult↗
PubMed1994

Total hip arthroplasty with cement in patients who are less than fifty years old. A sixteen to twenty-two-year follow-up study.

Eighty-nine Charnley total hip arthroplasties were performed with cement, by a single surgeon, in sixty-seven patients who were less than fifty years old at the time of the procedure. The follow-up period ranged from sixteen to twenty-two years (average, eighteen years). The most recent evaluation consisted of a clinical and a radiographic examination for forty-six patients (fifty-eight hips), a telephone interview and a review of the most recent radiographs for eleven patients (sixteen hips), and a telephone interview only for six patients (ten hips). Four patients (five hips) were lost to follow-up. Eleven (13 per cent) of the eighty-four hips that were followed were revised because of aseptic loosening of the acetabular implant, and two hips (2 per cent) were revised because of aseptic failure (loosening or fracture) of the femoral component. When the number of hips that were revised was combined with the number of hips in which there was radiographic evidence of failure, the rate of loosening of the acetabular component was 50 per cent (forty-two hips) and the rate of failure of the femoral component was 8 per cent (seven hips). Three hips had recurrent dislocations after the operation; none of the three was revised. One patient (two hips) had Grade-III heterotopic ossification according to the system of Brooker et al.; no other patient had more than Grade-II heterotopic ossification. Nine hips had a trochanteric non-union without migration of the trochanter.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed2003

Total hip arthroplasty in diastrophic dysplasia.

BACKGROUND: Diastrophic dysplasia results in severe disproportionate growth failure, multiple joint deformities, and early osteoarthritis of the hips. Mortality is increased in early childhood, but thereafter life expectancy is normal. Because of severe flexion deformities, resting pain, and diminished movements of the hip joints, total hip arthroplasty is indicated at an early age. The purpose of our study was to evaluate prospectively the midterm results of total hip arthroplasty in a consecutive series of patients with diastrophic dysplasia. METHODS: Between 1982 and 1996, forty-one total hip replacements were performed in twenty-four consecutive patients with diastrophic dysplasia (mean age, forty-one years) at our hospital. The patients were followed prospectively for a minimum of five years with clinical examination, determination of Harris hip scores, and radiographs. Twenty-two patients (thirty-eight hips) were examined clinically and radiographically at the time of follow-up, and the remaining two patients (three hips) were contacted only by telephone. The mean duration of follow-up was 7.8 years. RESULTS: The mean Harris hip score increased from 44 points (range, 25 to 66 points) before the operation to 70 points (range, 37 to 89 points) at the final follow-up examination (p < 0.001). Ten complications (24%) were recorded. Five (12%) of the forty-one hips required revision because of aseptic loosening of the acetabular component at a mean of 9.4 years after the primary operation. No revisions were due to aseptic failure of the femoral component. CONCLUSIONS: Implant survival was good and the Harris hip scores increased significantly after total hip arthroplasty in patients with diastrophic dysplasia. However, shortening femoral osteotomy and transposition of the greater trochanter, adductor and flexor tenotomies, and modification of the femoral stem were frequently needed. Total hip arthroplasty is recommended for patients with diastrophic dysplasia and severe degeneration of the hip joints, even for those who are relatively young. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed2003

Benzodiazepines and risk of hip fractures in older people: a review of the evidence.

A hip fracture epidemic is occurring in developed countries in association with population aging. The increasing number of people with a hip fracture has major implications for clinicians and health service managers. More importantly, a hip fracture is a devastating event in the life of an older person, as it often leads to loss of independence and death. Identification of risk factors for hip fracture is an essential first step towards prevention. The use of psychotropic medications is an established risk factor for hip fracture. The purpose of this article is to systematically review epidemiological studies of the relationship between use of benzodiazepines and risk of hip fracture and, then, to see how the findings of these studies fit with what is known about the pharmacology of benzodiazepines. Eleven primary epidemiological studies were identified. The results of these studies were not consistent; however, the inconsistency appeared to be almost entirely explained by research design. The studies that did not show an association between increased hip fracture risk and benzodiazepine use were nearly all hospital-based case-control studies, a type of study that often lacks validity because of the difficulty of finding an appropriate control group. After excluding the hospital-based case-control studies, all but one of the remaining seven studies found that use of benzodiazepines was associated with an increased risk of hip fracture that varied between 50% and 110%. The only higher quality study that did not find an association between benzodiazepine use and hip fracture was also the only study conducted entirely in nursing homes. There was no evidence that the risk of hip fracture differed between short- and long-acting benzodiazepines. People using higher doses of benzodiazepines and those who had recently started using benzodiazepines were at the highest risk of hip fracture. In very old people, there was some preliminary evidence that benzodiazepines that undergo oxidation in the liver may be associated with a higher risk of hip fracture than other benzodiazepines. The epidemiological evidence strongly suggests that the use of benzodiazepines by older people increases their risk of hip fracture by at least 50%. The benefits of benzodiazepines for older people are unclear. Given the high morbidity and mortality of hip fracture, it can be concluded that older people should rarely be prescribed benzodiazepines and that many older people already taking these drugs should have them withdrawn under appropriate supervision.

Aged↗
PubMed2000

Epidemiology, demographics, and natural history of congenital hip disease in adults.

This study examined the epidemiology and demographics of congenital hip disease in 468 (660 hips) patients who were examined between 1970 and 1996. In 356 (54%) hips, the diagnosis was secondary osteoarthritis due to congenital hip disease, and in 272 (41%) hips, the diagnosis was idiopathic osteoarthritis. In the remaining 32 (5%) hips, the diagnosis was uncertain. Of the hips with congenital hip disease, 170 (47.7%) hips were dysplastic, 85 (23.9%) had low dislocation, and 101 (28.4%) high dislocation. The majority of patients with congenital hip disease were women (338 [95%] hips). The natural history of the three types of congenital hip disease was studied in 157 patients (202 hips: 102 dysplastic, 42 low dislocation, and 58 high dislocation) who had received no treatment before the initial examination. Average length of follow-up was 17 years. In dysplastic hips, the disease remained undiagnosed until the onset of symptoms at an average age of 34.5 years. In patients with low dislocation, pain had started at an average of 32.5 years due to progressive degenerative arthritis within the false acetabulum. In patients with high dislocation, in the presence of a false acetabulum, pain started at an average age of 31.2 years, while in its absence, pain started at an average age of 46.4 years due to muscle fatigue. These findings suggest dysplasia, low dislocation, and high dislocation in adults are the results of untreated dysplasia, subluxation, and complete dislocation in infancy, respectively.

Adult↗
PubMed1998

Porous coated anatomic total hip arthroplasty: 5- to 10-year follow up.

BACKGROUND: We report the medium term results of a study of patients with noncemented total hip arthroplasty (THA) using a first generation porous coated anatomic (PCA) prosthesis. MATERIALS AND METHODS: We reviewed 161 primary uncemented PCA THAs performed in 141 patients from November 1985 through March 1989 in our hospital. Subjects were followed up for a minimum of 5 years or until revision. Most common indicators for THA were osteoarthritis in 81 hips (50.3%) and avascular necrosis in 64 hips (39.8%). The average age at operation was 48.2 years. The average follow-up period was 6.9 years in patients without revision. RESULTS: The average modified d'Aubigne and Postel hip scores improved from 10.9 points preoperatively to 17.4 points at the final postoperative evaluation. Results were rated as good to excellent in 146 hips (90.7%). Twelve (7.4%) hips received revision arthroplasty, 8 because of cup loosening, one because of polyethylene wear, and 3 hips because of stem loosening. Prostheses were removed in 2 hips, one due to tuberculosis and the other due to infection. Other complications included focal osteolysis in 54 hips (33.5%), posterior dislocation in 3 hips (1.9%), and lesser trochanter fracture in one hip. Thigh pain occurred in 30 hips (18.6%). In 114 hips, the roentgenograms were used to assess polyethylene wear. The average wear rate was 0.11 +/- 0.15 mm/year. Excessive wear rate (> 0.2 mm/year) occurred in 28 hips (24.6%). Factors contributing to higher wear rate included young age, cup inclination angle beyond the range of 35-55 degrees, and thin polyethylene liner. CONCLUSION: The high rate of osteolysis and thigh pain in these patients should alert surgeons to be cautious in using this type of prosthesis.

Adult↗
PubMed2001

Surgical treatment of subluxation and dislocation of the hips in cerebral palsy patients.

BACKGROUND AND PURPOSE: Progressive subluxation and dislocation of the hip are major complications in patients with cerebral palsy (CP), causing functional deterioration and difficulties in personal hygiene. Treatment of these problems is difficult and complicated. The purpose of this study was to describe the surgical results and long-term follow-up in a group of CP patients. METHODS: Twenty-three CP patients with subluxated (15 hips) or dislocated hips (12 hips) underwent corrective surgery between 1985 and 1993. This included 11 quadriplegic, eight diplegic, and four hemiplegic patients. Before surgery, four patients were bed-ridden, eight were sitters, six were house-ambulators, and five were community-ambulators. The average age at surgery was 8 years and 5 months. The surgical procedures consisted of femoral varus derotational osteotomy in 21 patients (25 hips), selected soft tissue release in 18 patients (22 hips), and pelvic osteotomy in 18 patients (20 hips). The center-edge angle, acetabular index, and neck-shaft angle were used as parameters to evaluate preoperative and postoperative radiographic changes. RESULTS: After an average follow-up of 4.8 years, 19 patients (22 hips) had gained hip stability, and also had improved functional status. The four bed-ridden patients all became sitters; six of the eight sitters became house-ambulators and one became a community-ambulator; all six house-ambulators became community-ambulators, and the five community-ambulators had functional improvement. Complications included nonunion at the femoral osteotomy site in one hip, redislocation in two hips, and resubluxation in one hip. CONCLUSIONS: We conclude that subluxated or dislocated hips in patients with CP can be effectively treated with aggressive correction, which may include soft tissue release, femoral derotational osteotomy, and pelvic osteotomy for improvement of hip range of motion and functional status.

Adolescent↗