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PubMed1991

[The pathogenesis of rapidly destructive coxarthrosis].

Using clinical, radiological and histologic examinations, 41 cases with the rapidly destructive coxarthrosis (RDC) were studied. (a) The radiological findings of RDC were classified into the following three types; type I suddenly started from the normal hip joint and terminated in the upper outer subluxation with destruction of the head and acetabulum resulting in narrowing of the joint space; type II was clinically very similar to type I. The joint was destructed but remained in the primary acetabulum; type III developed into sudden destruction of the joint during ordinary course of secondary RDC. (b) The histological findings of RDC were classified into those involving avascular necrosis and those involving osteoarthritis. (c) 65% of cases of radiological Type I showed avascular necrosis, 33% in Type II, and 12.5% in Type III. (d) The clinical examinations revealed that most cases have some immunological abnormality. The present study, therefore, indicates that the most common pathogenesis of RDC has a basic condition of avascular necrosis in the femoral head in the elderly, in addition, the accompanying rapid destruction appears to be related to an immunological abnormality.

Adult↗
PubMed1990

[The relationship between the gait of humans and the hip joint structure in the frontal plane].

The forces at the hip joint acting between the femur head and acetabulum are significant for the function properties a lifetime. These forces are determined by the geometry of skeleton and the dynamic of limbs motions. The interaction of hip joint anatomy, gait dynamics, and joint force is described biomechanically. The connections are verified by 35 adults. The results of this investigation allow to conclude that individual variants of macroscopic hip joint anatomy are founded by the relation between maximum loading during gait and hip joint structure. The correlation between the angle of weight-bearing-surface and the hip joint force direction is very significant. For a normal hip joint function, the anatomical structure of the acetabulum is essential more important as that of the coxal femur.

Adult↗
PubMed1990

[Traumatic indications for total hip joint prosthesis].

In the years 1978-1986 the authors implanted 207 total prostheses in patients with the fracture of the femoral neck or after the fractures in the area of the hip joint. 50 patients were operated on for an acute fracture of the neck. The surgical technique in these indications does not differ on principle from the surgical technique of coxarthrosis. They point out a higher number of some peroperative complications. They checked 141 patients with and average follow-up of 47 months. In 4.2 per cent of late complications they reported roentgenological symptoms of loosening. Reoperation because of the loosening of the acetabular component was inevitable in 2.9 per cent of patients. All these cases fall into the group of patients in which the total hip arthroplasty was performed after the fractures of the acetabulum. In no patient it was necessary to reoperate the femoral component. Within the check up the patients underwent roentgenological examination and the result was assessed by the method according to Harris. In total, excellent result was reported in 43.2 per cent of patients, good result in 29.8 per cent, fair result in 14.2 per cent and poor result in 12.8 per cent of patients. With regard to a low number of complications and very good results of the evaluation according to Harris the authors consider total hip arthroplasty in the treatment of post-traumatic conditions for fully indicated. Total hip arthroplasty is indicated also in acute fractures of the femoral neck in which it brings in a short time interval good functional results with minimum complications. A group at risk is represented by patients operated on after the fractures of acetabulum.

Aged↗
PubMed1990

Development of the hip joint in relation to congenital dislocation.

As an introduction to the pathology and treatment of C.D.H., a simplified outline of fundamental embryologic events and growth characteristics of the hip joint (selected from past and actual bibliography) is presented. Congenital dislocation of the hip appears to be the result of various genetic, developmental, environmental and mechanical factors that affect articular structures in the perinatal period. At this time, the hip joint is anatomically and functionally more vulnerable to alterations of its normal concentric disposition. If incongruency persists, subsequent morphological changes, characteristic of dysplasia will develop. The main conclusions derived from a review of the development of the hip joint in relation to C.D.H. are: 1) The hip joint is an anatomical and functional unit derived from a common primitive blastema. 2) Primitive condensed sclerotomic mesenchyme transforms into cartilage that shapes in a genetically determined pattern to form the femur and os innominatum in continuity. 3) The joint space develops by autolytic degeneration in the 7-8 week embryo. By the 11th week, the joint cavity, evolved in the capsule lined internally by synovium, has a well differentiated labrum and ligamentum teres with the basic morphology of a developed hip joint. Only after this stage is displacement possible. 4) Depth (and stability) of the acetabulum increase with development of the glenoid labrum and cartilaginous rim (incomplete only in its inferior portion). Here a fibrous band (transverse ligament) offers less resistance to displacement, but on occasions is an anatomic barrier to concentric reduction. 5) In the early fetal period, the acetabulum is a deep set cavity, becoming shallower at the time of birth. Femoral head coverage at birth is more deficient than at any other previous or subsequent stage of development. 6) The relationship between femoral and acetabular anteversion (instability index) is more important than absolute values which are variable during intrauterine life. The degree of femoral anteversion depends on teh rotational attitude and muscular action of the extremity.(ABSTRACT TRUNCATED AT 400 WORDS)

Hip Dislocation, Congenital↗
PubMed1989

Endoprosthetic surgery in 1988.

Aseptic loosening remains the main problem of arthroplasty. On one hand, this has led to the development of new cements and improvement in cementing techniques. On the other hand, especially intensive efforts have been made in recent years to anchor the implants directly to bone. The major alternatives available today for endoprosthetic fixation are cement "pressurization" and "bony ingrowth". The differences in implant fixation, with or without cement, must take into consideration the design, surface characteristics, and the material properties of the implants as well as the operative technique. In principle, there are major differences both with regard to the biology and to the mechanics between the acetabulum and the femur. On the acetabular side, the objective of reliable fixation has been achieved at least in the medium term. Gratifying advances are also being increasingly shown in the femur. However, until today hardly any prosthetic femoral model is able to provide reliable primary results with regard to freedom from pain, as is the case with the modern cement techniques. For many orthopaedic surgeons, a "hybrid" is the solution to the problem for patients over 60 years old: i.e. cementless anchoring of the acetabulum socket and cementing of the prosthetic shaft. For young, active patients and for revision arthroplasties, with major loss of bone substance, we require a cementless technique. With this technique and use of bone transplantation, it is today possible to reconstruct even severely damaged joints and to create situations corresponding to those of a primary arthroplasty. In the knee joint aseptic loosening of cemented endoprostheses is less of a problem and the decision in favour of cementless fixation depends even more on the quality of the bone than on the hip joint. For the future it is becoming increasingly apparent that a single method on its own will not exist, but that the surgeon must choose the most suitable method (with or without cement) dependent on the case. Accurate preoperative planning becomes indispensable.

Arthroplasty↗
PubMed1989

Congenital dislocation of the hip treated by total hip arthroplasty.

Thirty-two total hip arthroplasties (THAs) were performed on 26 severely incapacitated patients with congenital dislocation of the hip. The arthroplasty technique varied with the problems encountered, but the cup was always placed in the true acetabulum. In 19 cases, femoral head autografts were transplanted. The overall results were satisfactory. Roentgenologic evaluation of the bone grafts showed no nonunion or secondary displacement. Nineteen previously invalid patients now lead normal lives. Five patients are minimally incapacitated and only two were unimproved by the operation. THA with autogeneic grafts to deepen the acetabulum is recommended whenever a congenital dislocation of the hip in an adult is associated with severe pain.

Adolescent↗
PubMed1989

[Replacement of prostheses of the hip].

In view of the widespread insertion of total hip prostheses, in recent years loosening of such prostheses requiring operative revision has become increasingly frequent. Simultaneous bone resorption defects in the acetabulum and the femur pose a particular problem. Attrition of the polyethylene obviously plays an important part in this process, its effects becoming apparent after 15-20 years. When a total prosthesis is replaced every effort should be made to reproduce the normal anatomical situation as nearly as possible. In particular, the bone defects should not be filled up with massive implants or with bone cement, but should be reconstructed with bone transplants. Mechanical protection in the form of internal fixation is necessary for the larger bone transplants; if this is not provided they may not take properly. When there are defects in the acetabulum corticospongious bone chips taken from femoral heads are used in the vast majority of cases. For larger defects in the femur, large allogeneic transplants of cortical bone taken from cadavers and applied to the defects in the form of a cuff following sterilization with gamma irradiation have given very positive results in recent years.

Bone Transplantation↗
PubMedDate not supplied

The results of surgical treatment for Perthes' disease.

We report the clinical and radiological results following intertrochanteric varus osteotomy and Chiari pelvic osteotomy for Perthes' disease in 70 hips with a minimum follow-up of 3 years. The indication depended on lateralization of the epiphysis of the femoral head with or without full containment in the abduction radiograph, thickening of the acetabular floor, coxa magna, and osteoarthritis. Epiphyseal quotient and sphericity showed that head deformity is mostly permanent; the acetabulum-head quotient provided good coverage. Operation in the condensation stage achieved far better results than later operations. From these and other results, the late and mild occurrence of osteoarthritis can be assumed despite deformed femoral head or acetabulum, with full coverage provided.

Adolescent↗
PubMed1986

Legg-Calvé-Perthes disease.

Legg-Calvé-Perthes disease, or osteochondrosis of the femoral head, occurs predominantly in boys 4 to 7 years of age. The disease progresses through synovitis, necrosis, fragmentation, and a residual stage. Outcome can be affected by age at disease onset, the extent of femoral head involvement as determined by x-ray, and the degree to which normal range of motion is maintained. The goal of treatment is to minimize residual deformity of the femoral head and acetabulum. This is accomplished by containing the femoral head well within the acetabulum and maintaining range of motion while the disease process runs its course. In extremely young patients, containment is often achieved during normal daily living activities. Containment treatment methods include abduction casting or orthosis; surgical containment can be accomplished by femoral or innominate osteotomy.

Casts, Surgical↗
PubMed1988

Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip.

A follow-up study was made on 129 consecutive Charnley arthroplasties in osteoarthritis secondary to congenital dislocation of the hip. The acetabular component was placed as far distal as possible using a standard technique. Bone grafting was not performed. The survival of the prostheses was assessed by the survivorship method. The cumulative survival rate of the prostheses was 93% after five years, 89% after ten years, and 80% after 15 years. In 77% of the cases the acetabular component had been placed in the true acetabulum or levels the rate of mechanical loosening of the acetabular levels the rate of mechanical loosening of the acetabular component (revisions and acetabular components showing a radiolucent line of increasing width) was 13% compared with 42% in the group where the acetabular component was placed proximal to the roof of the true acetabulum (p less than 0.005).

Adult↗
PubMed1988

[Applied anatomy of the hip joint in dogs].

Some introductory anatomical characteristics of both articular ends (coxal end of the femoral bone and the acetabulum) in the canine hip joint are described. In standard radiographs (ventro-dorsal view) the area of the coxal end of the femur overlapped by the dorsal part of the acetabulum is measured. The post operative increase of this area in 6 hip joints treated by unilateral "Triple-Osteotomy" is reported and discussed.

Animals↗
PubMed1988

[Reconstruction of the pelvic ring based on classification following resection of bone tumors].

Bone tumors in the pelvis (28 cases), which had been treated surgically were classified into types I to V and their subtypes A and B, according to the location and range of tumor resection, and were assessed with regard to both the method of reconstruction used and restoration of function. Type I-A, -B (6 cases) did not require any reconstruction of the pelvic ring. However, with type I -B, some difficulty was experienced in maintaining balance upon sitting for a long period. Type II (3 cases) included cases of resection of the anterior part of the pelvis, resulting in loss of ring continuity, but reconstruction was not necessary. In type III -A, the acetabulum excluding the hip joint (1 case) was resected and arthrodesis of the ilium and the femoral head performed. In type III -B the acetabulum with the hip joint was resected (2 cases) followed by replacement of the pelvis and hip joint with an artificial prosthesis. Type N included cases (5) of partial (-A) or total (-B) sacroiliac resection, both of which needed massive bone grafting to reconstruct the pelvic ring. Type V (7 cases) required partial (A) or total (B), resection of the sacrum dynamic reconstruction by spinal instrumentation and massive bone grafting. Among 13 cases of primary malignant bone tumors for which tumor resection was performed, 3 cases recurred. This classification was useful for comparing the surgical modalities of tumor resection, reconstruction and their functional results. Our method of total sacral resection was also introduced.

Adolescent↗
PubMed1988

Plagioporus gonii nov. spec. (Trematoda: Opecoelidae) from the fish Labeo gonius of Kalri Lake, Sind, Pakistan.

A new trematode, Plagioporus gonii sp. n., is described from the fish Labeo gonius of Kalri Lake, Sind, Pakistan. This species is characterized by possessing round, subterminal oral sucker; small prepharynx; pharynx subglobular; oesophagus short; acetabulum larger than oral sucker; caeca simple; testes subspherical to irregular in shape; ovary irregular in shape; vitellaria rounded, follicular, extending little behind intestinal bifurcation to the end of the body, interrupted on one or both sides at the level of the acetabulum; cirrus sac preacetabular; genital pore posterior to intestinal bifurcation; and eggs 0.071-0.078 by 0.033-0.042 mm in size.

Animals↗
PubMed1987

Cementless R.M. isoelastic total hip prosthesis in revision surgery for loose prostheses.

Forty-three patients with aseptic mobilization of hip prostheses were submitted to revision surgery using cementless R.M. isoelastic total hip prostheses. The femoral component was substituted in all cases, the acetabular component in 37. Autoplastic bone grafts were required in 27 cases to replace severe bone defects in the acetabulum or femoral diaphysis. All the patients were followed up for an average of 46 months (range 36 to 59 months). The results were good in 38 cases, evaluated both on the Harris scale (average 87 points) and the Charnley method (5.4 points for pain, 5.0 for walking, and 5.2 for movement). There were 2 cases of ankylosis, one case of infection, one paralysis of the peroneal nerve and one proximal migration of the acetabular component. Therefore we believe that the use of cement is contraindicated in revision surgery of the hip, particularly in the presence of severe osteolysis and in younger patients. The isoelastic stem encourages bone reconstruction and cortical thickening in the femoral diaphysis. When there is bone deficiency the cementless acetabulum must always be associated with autoplastic bone grafting.

Biocompatible Materials↗
PubMed1985

Conservative treatment of Legg-Calvé-Perthes condition.

As we continue to learn more about the evolution of Legg-Calvé-Perthes condition, several advantages to early conservative treatment become apparent. First, since it may take as long as 6 months to determine the extent of femoral head involvement in patients who present early in the disease process, nonoperative methods may be used to improve the range of motion and to contain the femoral head within the acetabulum, thus minimizing further deformity. Second, since the duration of treatment need no longer be as extensive as was previously thought, the argument that nonoperative means are unrealistic for patient needs is not valid. Finally, it has been recognized that with moderate sphericity and moderate retention of the shape of the femoral head, as evaluated in relationship to secondary changes in the acetabulum, the patient can reach at least middle age before having significant secondary arthritic problems. A relatively conservative approach is therefore in order for most children whose disease is discovered in the early phases. Of course, it must be recognized that social problems develop in the older child, especially in girls, that contraindicate nonoperative care. Surgical considerations are indicated for many children in the older age group with more than one half of the femoral head involved, as well as in those with unsuccessful nonoperative efforts at containment.

Braces↗
PubMed1979

[A study of the obstacles to reduction in congenital dislocation of the hip (author's transl)].

Investigation on ten patients with typical congenital dislocation of the hip generalized joint laxity indicated the changes in the antero-inferior part of the acetabulum, which are mainly adhesion and narrowing produced by the capsule pulled superoposteriorly, as the major obstacle for successful reduction. Inverted limbus, pulvinar mass and ligamentum teres may represent secondary obstacles mostly due to iatrogenic procedures. The purpose of the closed reduction is to get rid of the obstacles during the conservative treatment. The cause of the failure of conservative treatment of congenital dislocation of the hip is a misjudgement of true reduction, allowing enough cavity for the femoral head in the antero-inferior part of the joint without the presence of the capsule between the femoral head and the acetabular cartilage. To get better understanding of the true reduction, tangential view in the arthrography of the hip joint gives us more precise data about the antero-inferior part of the joint because the acetabulum faces the joint cavity laterally and anteriorly.

Arthrodesis↗
PubMed1982

[Triple juxtacotyloid osteotomy].

The authors have developed a technique of triple innominate osteotomy derived from that describe by Steele. The three osteotomy divisions are made very close to the acetabulum. With this technique the acetabulum can more easily be re-orientated and the pubis and ischium are left intact with their muscle attachments.

Adolescent↗
PubMed1981

[Chondromalacia of the hip].

The authors have shown that the initial phase of coxarthrosis consists purely of cartilaginous lesions, not visible in radiographs. They have studied 200 arthrograms of the hip using a precise technique which is described. They have found cartilaginous lesions both in cases of insufficiency of the lateral wall of the acetabulum, and in cases of insufficiency of the medial wall of the acetabulum. Cartilaginous lesions may range between a simple decrease of articular cartilage height and complete ulceration either on the cephalic or acetabular sides. These lesions may be present at a time when the radiograph is still normal, especially in cases of hip dysplasia. It is concluded that the articular cartilage of the hip may chondromalacic in the same way as in the patello-femoral joint, and that arthrosis may be secondary to this chondromalacia. Arthrography makes early diagnosis possible.

Adult↗