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PubMed2004

Cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents.

OBJECTIVE: Hip fracture is a common complication of osteoporosis, resulting in significant morbidity and mortality, with a high financial cost to the healthcare system. Hip protectors have been advocated as an effective method to prevent hip fractures in high-risk individuals. This study models the cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents. METHODS: An incremental cost-effectiveness analysis was performed comparing hip protectors to "no treatment" and to "calcium and vitamin D supplements." The study population was a hypothetical cohort of 1000 nursing home residents. A societal perspective, with a lifetime time horizon, was adopted. Data regarding costs, effectiveness, and quality of life measures were collected from the current literature and from Peace Arch Hospital, a community hospital in White Rock, British Columbia, Canada. Sensitivity analysis was performed. RESULTS: Hip protector use was found to be a dominant strategy compared to no treatment and to calcium and vitamin D supplements. Dominance implies lower cost and higher effect, generating cost-effectiveness ratios less than zero. Dominance with respect to cost and effectiveness of hip protectors in preventing hip fractures persisted when the model was subjected to probabilistic sensitivity analysis. CONCLUSION: Cost-effectiveness analysis suggests that hip protectors could save money while preventing hip fractures and improving quality of life in nursing home residents.

Aged↗
PubMed1990

Abduction treatment in late diagnosed congenital dislocation of the hip. Follow-up of 1,010 hips treated with the Frejka pillow 1967-76.

There are many countries such as Poland where treatment of congenital hip dislocation is started late. The purpose of this work was to report our results in this group of children. 1010 hips in 780 children with congenital dislocation of the hip were treated with the Frejka pillow. The early results were evaluated in 830 hips at 15-36 months of age and the late results in 527 hips at a mean age of 14 (10-21) years. 90 percent of the children were treated by the same physician. The age at the onset of the treatment varied from 2 weeks to 24 months, with 12 percent younger than 3 months and 28 percent older than 6 months. The initial degree of dislocation was determined with our own index. Radiographic results were evaluated with a scoring based on four or six parameters. There were 6 percent failures, including lack of reduction or redislocation at the time when the child started to walk. Ischemic necrosis was observed in 14 percent of the hips, with significant permanent sequelae in 5 percent. Indications for surgical treatment of residual dysplasia were found in 4 percent of the hips evaluated early; and in the group evaluated late, still 5 percent of the hips required operation. There was good ability for spontaneous remodeling between the age of 3 and 7 years, whereas around the age of 10, the radiographic appearance of the hip became stabilized. At the end of treatment and at the time when the children started to walk, 59 percent of the early evaluated hips were still insufficiently remodeled; but in cases evaluated late, 95 percent of them had a normal or almost normal radiographic appearance. At that time, the clinical state of the children was satisfactory. The results of treatment depended on the initial degree of displacement. Only when treatment was begun after 5 months of age did the patient's age affect the treatment results. The Frejka pillow successfully reduced and stabilized these hips.

Age Factors↗
PubMed2005

Natural course of the minimally symptomatic nonoperated hip in patients with bilateral hip dysplasia treated with contralateral rotational acetabular osteotomy.

BACKGROUND: The purpose of this study was to investigate the natural course of the minimally symptomatic nonoperated hip in patients with pre-osteoarthritis or early osteoarthritis in bilaterally dysplastic hips. METHODS: The material consisted of 61 patients with bilaterally dysplastic hips who underwent rotational acetabular osteotomy in their symptomatic hip and nonoperative treatment in their asymptomatic or minimally symptomatic hip. The average follow-up was 10.1 years (range 7.0-15.6 years), and the average age at the time of surgery was 38.2 years (range 20-58 years). All patients were divided into two groups by joint congruity of the nonoperated hip at surgery with rotational acetabular osteotomy. RESULTS: On radiographic assessment, 1 of the 35 pre-osteoarthritis hips had developed early osteoarthritis, and 6 of the 26 early osteoarthritis hips had progressed to advanced osteoarthritis. The Kaplan-Meier survivorship analysis for the whole group of nonoperated hips, with radiographic progression of osteoarthritis as the endpoint, predicted a 10-year survival rate of 83.7% (95% confidence interval 70%-98%). Significant differences were observed in the radiographic stage (pre- and early osteoarthritis group, P=0.015) and joint congruity (good and fair group, P=0.005). CONCLUSIONS: If the contralateral nonoperated hip has good joint congruity, minimal symptoms, and no or little radiographic change in patients with pre- or early osteoarthritis and bilateral acetabular dysplasia, the probability of radiographic progression is low.

Adult↗
PubMed1999

Total hip arthroplasty with insertion of the acetabular component without cement in hips with total congenital dislocation or marked congenital dysplasia.

BACKGROUND: End-stage osteoarthritis secondary to total congenital dislocation or severe congenital dysplasia of the hip (class B or C according to the system of Eftekhar or type 2 or 3 according to the system of Hartofilakidis et al.) in adults presents special problems with regard to reconstruction of the hip. The purpose of the present study was to assess the intermediate-term results associated with the use of a porous ingrowth acetabular component for the treatment of these difficult cases. METHODS: We performed a prospective study of a consecutive series of twenty-one patients (twenty-four hips) who had had a primary total hip arthroplasty with use of a hemispherical acetabular component that was inserted without cement and fixed with screws. No patient was lost to follow-up. Three patients (four hips) died, of causes unrelated to the total hip arthroplasty, before a minimum duration of follow-up of five years. None of these patients had had revision. Of the remaining eighteen patients (twenty hips), fifteen were women and three were men. Ten hips had total dislocation, and ten had severe dysplasia. RESULTS: After an average duration of follow-up of eighty-three months (range, sixty-four to 102 months), the average Harris hip score was 90 points (range, 68 to 97 points). No patient had revision, loosening, or migration of the acetabular component; pelvic osteolysis; or a continuous radiolucent line at the mesh-bone interface of the acetabular component. The average rate of polyethylene wear was 0.08 millimeter per year (range, zero to 0.21 millimeter per year). CONCLUSIONS: The porous ingrowth acetabular component that was used in the present study functioned well at the time of the intermediate-term follow-up of this group of patients who had marked congenital dysplasia or total dislocation of the hip. The use of this component decreased the need for structural acetabular grafts. This component appears to perform as well as larger components of this design that have been assessed after similar durations of follow-up.

Adult↗
PubMed2003

Primary total hip arthroplasty with a second-generation cementless total hip prosthesis in patients younger than fifty years of age.

BACKGROUND: The early experience with cementless total hip replacement led to design modifications to increase the initial press-fit and stability of the femoral component, to reduce the diameter of the femoral head, and to improve the acetabular component, including the locking mechanism of the shell and the quality of the polyethylene liner. We performed a prospective study to assess the results in young patients who had been followed for a minimum of eight years after treatment with a primary total hip arthroplasty with a second-generation cementless prosthesis. METHODS: Eighty patients (118 hips) were included in the study. There were fifty-eight men and twenty-two women; the mean age at the time of the operation was 46.8 years (range, twenty-one to forty-nine years). We used a cementless Duraloc series-100 or 1200 acetabular component with or without screw fixation, a polyethylene liner with a 22-mm inner diameter, and a cementless Profile femoral component in all hips. The average duration of follow-up was 9.8 years (range, eight to eleven years). Clinical follow-up (with use of the Harris hip score) and radiographic follow-up were performed at six weeks; at three, six, and twelve months; and yearly thereafter. Linear and volumetric wear were measured, and bone-remodeling and osteolysis were assessed. RESULTS: The average Harris hip score improved from 48.8 points preoperatively to 92 points at the final follow-up examination. The prevalence of transitory thigh pain was 10% (twelve of 118 hips). There was no aseptic loosening. One hip was revised because of recurrent dislocation. The average amount of linear wear was 1.18 mm, and the average wear rate was 0.12 mm/yr. Fourteen hips (12%) had osteolysis in the calcar femorale and eleven hips (9%) had acetabular osteolysis, but all of the osteolytic lesions were <1 cm (2). CONCLUSIONS: The mechanical fixation of the anatomic fit cementless Profile stem was excellent in this study of young patients who were particularly difficult to treat because of a high prevalence of osteonecrosis and developmental dysplasia. Although there was no aseptic loosening of the components and a relatively low prevalence of osteolysis, there was a high rate of linear wear of the polyethylene liner. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.

Adult↗
PubMedDate not supplied

Total hip arthroplasty using femoral head shelf autografts in dysplastic hips. Our experience.

The present work deals with a series of 28 patients (a total of 31 hips) suffering from coxarthrosis in dysplasia of the hip. All patients had undergone arthroplasty where an autograft of cortico-cancellous bone was taken from the head of the patientís femur. In 21 of these hips the prosthetic components were not cemented while the other 10 cases were. The patients (average age 57 years 5 months) underwent radiography and were clinically evaluated using the Harris Hip Score. The average follow-up was 6 years and 7 months. In the 10 hips which had been cemented, the average pre-operative Harris Hip Score was 46.9 points (range 24-85) while it was 80.5 upon check-up (range 50-98). In the 21 hips which were not cemented the average pre-operative Harris Hip Score was 44.3 points (range 21-62) while, at the time of check-up it was 90.8 (range 60-100). Only in 3 cases (9.67%) did the cotyloid portion require reoperation because of mobilization. In all cases (100%) the graft integrated perfectly with the host bone. The present study provides encouraging data regarding the use of autografts of cortico-cancellous bone taken from the head of the femur during hip replacement in patients with coxarthrosis in dysplasia of the hip. No differences were seen between the cemented and non cemented prostheses.

Acetabulum↗
PubMed1983

Complex total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components.

We analyzed the preoperative and perioperative data on sixty-nine consecutive complex total hip replacements performed in fifty-seven patients using miniature or microminiature custom-made femoral components. The patients' average age was 45.7 years. The preoperative diagnosis was congenital dysplasia or dislocation of the hip in 72 per cent of the hips. Acetabular bone grafts were required in thirty-seven of the sixty-nine hips. Operative complications occurred in thirteen (19 per cent) and postoperative dislocation occurred in eleven (16 per cent) of the sixty-nine hips. Fifty-five hips in forty-seven patients were followed for a minimum of two years, the average follow-up being 4.8 years and the longest, 9.8 years. All acetabular grafts united. Loosening of one or both prosthetic components occurred in ten (18 per cent) of the fifty-five hips (twelve of the 110 components became loose). There were no instances of a stem bending or fracturing, despite the small size of the femoral components. Eight hips (14.5 per cent) had undergone revision, six for painful loose components and two for recurrent dislocation. For the forty-seven hips that were not revised, the average Harris hip score rose from 43 points preoperatively to 80 points postoperatively.

Adolescent↗
PubMed2004

Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people.

OBJECTIVE: To investigate waist circumference (WC), waist-hip ratio, hip circumference and body mass index (BMI) as risk factors for cardiovascular disease in Aboriginal Australians. METHODS: This cohort study included 836 adults aged 20-74 y in a remote Aboriginal community. WC, waist-hip ratio, hip circumference and BMI were obtained from a screening program. The participants were followed for up to 10 y for cardiovascular events. A Cox regression model was used to calculate the rate ratio (RR) and 95% confidence interval (CI) for the first-ever cardiovascular event (fatal and nonfatal). RESULTS: RRs for the first-ever cardiovascular event were 1.31 (95% CI: 1.11, 1.54), 1.29 (95% CI: 1.09,1.53), 1.28 (95% CI: 1.08, 1.52) and 1.10 (95% CI: 0.93, 1.30) per standard deviation increase in WC, BMI, hip circumference and waist-hip ratio, respectively, after adjustment for diabetes mellitus, total cholesterol, systolic blood pressure and smoking status. WC, BMI and hip circumference were significantly associated with cardiovascular risk, independent of other cardiovascular risk factors. Dividing each of the four parameters into quartiles, WC had the highest likelihood statistics (12.76) followed by BMI (11.45), hip circumference (10.57) and waist-hip ratio (3.15) for predicting first CV events. CONCLUSION: WC, BMI and hip circumference are associated with cardiovascular outcome, independent of traditional risk factors. However, WC appears to be a better predictor for cardiovascular risk than other parameters. Waist-hip ratio is not as useful as other measurements.

Adult↗
PubMed2004

Waist and hip circumferences and all-cause mortality: usefulness of the waist-to-hip ratio?

OBJECTIVE: To investigate whether waist and hip circumferences, in addition to body mass index (BMI), are related to all-cause mortality. We studied these associations and tested the usefulness of the waist-to-hip ratio for mortality prediction. DESIGN: A Danish prospective cohort study with data collected between 1993 and 1997. SUBJECTS: A total of 27 179 men and 29 875 women born in Denmark and aged 50-64 years were followed for a median of 6.8 years. MEASUREMENTS: BMI, waist and hip circumferences at baseline. RESULTS: The associations between hip circumference and all-cause mortality were inverse for both men and women, but only after adjustment for waist circumference, or BMI, or both. The mortality rate ratios of mutually adjusted waist and hip circumferences were 0.63 (95% CI: 0.56, 0.71), and 0.70 (95% CI: 0.63, 0.79) times higher per 10% larger hip circumference in men and women, respectively, and 1.45 (95% CI: 1.34, 1.57) and 1.22 (95% CI: 1.14, 1.31) times higher per 10% larger waist circumference. The adequacy of the waist-to-hip ratio as a substitute for separate measurements of waist and hip circumferences depended on which other variables the analysis was adjusted for, indicating that the waist-to-hip ratio should be used with precaution. CONCLUSION: When mutually adjusted, waist and hip circumferences show opposite associations with all-cause mortality, probably due to different effects of adipose tissue in the abdominal and gluteofemoral regions. The waist-to-hip ratio cannot always capture these relations adequately.

Body Constitution↗
PubMed2005

Salmon calcitonin nasal spray treatment for postmenopausal women after hip fracture with total hip arthroplasty.

The increasing rate of hip fractures is giving rise to a number of socioeconomic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip fractures. Dislocation and aseptic loosening are the major reasons for revisions. An additional problem post-THA is the rate of heterotopic soft tissue calcification after total hip arthroplasty, resulting in severely impaired function, pain, and a reduced range of hip motion. In an open study, 37 women who had undergone cementless total hip arthroplasty after accidental hip fractures were treated twice daily with 200 IU salmon calcitonin nasal spray for 12 months. Simultaneously, the patients received one bag of 1000 mg calcium plus 880 IU vitamin D daily throughout the treatment period of 1 year. A parallel group of 38 women with a similar clinical status in terms of hip fractures and cementless total hip arthroplasty were treated with only one bag of 1000 mg calcium plus 880 IU vitamin D daily through the treatment period. The results of this 12-month clinical trial show that 200 IU salmon calcitonin nasal spray per day promotes general independence from foreign assistance, mobility, and fear of further falls in postmenopausal elderly women following THA. Treatment with a salmon calcitonin nasal spray reduces bone turnover serum markers, loss of further bone density, and pain. Additionally, calcitonin promoted the repair of hip fractures and, as a coincidence finding, was associated with a significantly reduced rate of refractures as well as periprosthetic ossifications.

Administration, Inhalation↗
PubMed2003

Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer.

Infected hip prosthesis, a serious complication of primary total hip arthroplasty (THA), can have severe consequences. We report the treatment outcome of two-stage revision THA for infected hip arthroplasty, including hemiarthroplasty, using an antibiotic-impregnated cement spacer for the interval between the first and second stages. Between 1996 and 2000 we performed this procedure on nine hips in eight patients. Cementless revision THA was performed as the second-stage procedure. Bone defects were restored with frozen allografts. The outcome was evaluated using the hip score of the Japanese Orthopaedic Association (JOA hip score). The mean duration of follow-up was 35.7 months (range 10-55 months). The mean JOA hip score at follow-up improved from 30.1 (range 10-74) to 73.2 (24-96). The mean interval between the first and second stages was 10.1 weeks (range 6-19 weeks). Eight of the nine hips achieved a successful outcome. One hip, with methicillin-resistant Staphylococcus aureus infection, experienced recurrence 4 months after revision THA. This patient was successfully treated 14 months after the first revision THA with a second two-stage procedure using a vancomycin- and arbekacin-impregnated cement spacer and beads. These results suggest that two-stage revision THA using an antibiotic-impregnated cement spacer is a useful technique for treating infected hip arthroplasty.

Aged↗
PubMed2005

Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation.

BACKGROUND: Total hip arthroplasty in patients with unilateral congenital high dislocation of the hip (Crowe type IV) presents many challenges, including the problem of a marked limb-length discrepancy. The purpose of this retrospective study was to analyze the results of total hip replacement with limb-length equalization in these patients. METHODS: From 1988 to 1996, fifty-six patients (forty-seven women and nine men) with unilateral Crowe type-IV dislocation of the hip were treated with a cementless total hip arthroplasty at a mean age of 35.4 years. The preoperative limb-length discrepancy averaged 4.9 cm. Prior to the total hip arthroplasty, forty-eight patients with a limb-length discrepancy of >4.0 cm underwent iliofemoral distraction with use of an external fixator for eight to seventeen days. The acetabular cup was placed in the anatomical position in every patient. Shortening femoral osteotomies were not required. RESULTS: The iliac fixator pins loosened in six patients. No patient had a pin-site infection, hip joint infection, or nerve palsy. At the time of follow-up, at an average of 147.2 months, the Harris hip score averaged 90.2 points. Overall, the mean lengthening after the total hip arthroplasty was 4.6 cm. There were no revisions of the femoral stem. Nine cups were revised, four because of polyethylene wear and five because of loosening. CONCLUSIONS: We were able to safely place the acetabular cup at the anatomical position without femoral shortening by bringing the femoral head to the normal level preoperatively; thus, we could restore nearly normal limb length. We believe that our twelve-year results are similar to those of total hip arthroplasty in patients without dysplasia.

Adult↗
PubMed1998

Referral patterns of hip pain in patients undergoing total hip replacement.

This study was undertaken to determine the most common referral patterns of hip pain in patients scheduled to undergo primary and revision total hip replacement. The exact location of pain from the hip was recorded prospectively for 323 patients (358 hips) who had primary total hip replacement and for 94 patients who had revision of a loose total hip. Seventy-three percent of patients with primary hip disease had pain in the groin, and 27% had groin pain that referred to the knee. Eighty-nine percent of 57 patients who had femoral component loosening had thigh or knee pain, and all of the 34 patients who had a loose acetabular component with a well-fixed femoral implant had pain in the hip region without distal radiation of pain. These results indicate that in patients who have a painful total hip, thigh pain is highly suggestive of femoral component loosening and pain located around the hip region that does not radiate distally is associated with isolated acetabular component loosening.

Adult↗
PubMed2001

Conversion of hip arthrodesis to total hip arthroplasty.

With the predictably good outcome now found with THA, hip arthrodesis has limited indications today. The procedure still has a role in the case of the young, heavy demand male with an isolated arthritic hip condition, and developments such as the Cobra head plate have considerably improved success rates. However, a long-term hip arthrodesis can have profound effects on a patient's daily function and activities of daily living. In addition, gait pattern is considerably affected as well as other joints such as the lower back, ipsilateral knee, and contralateral hip. Many patients with a hip arthrodesis will eventually require a takedown of the fused hip and conversion to a THA. The primary indications include fusion in malposition, pseudarthrosis, or severe pain in other joints. The surgeon undertaking such a task must be familiar with the arthrodesis techniques that have been used in the past as well as the equipment that may be required to extract the fixation hardware. Clinical assessment with particular attention to leg-length discrepancy, position of the arthrodesis, and function of the abductors is of paramount importance. The surgeon must carefully review preoperative radiographs to plan the procedure. The surgeon must also be aware of the presence of pathology in other joints. After takedown of a hip arthrodesis and conversion to a THA, patients cannot expect the result to equal the success rates of primary THA. Patients generally can expect an improvement in function and mobility. Back pain and ipsilateral knee pain are usually improved postoperatively, but the effect on contralateral hip pain is less predictable. Many patients will continue to show a positive Trendelenburg sign, but further improvement in strength of the hip abductors can be expected with time. Leg-length discrepancy is generally improved substantially after THA. However, a substantial number of patients will require a walking aid postoperatively. Overall, the risk of complications and the rates of revision after converting an arthrodesed hip to a THA are quite high. The procedure can be complex. Consideration should be given to referring these patients to a specialized center under the care of an experienced arthroplasty surgeon if preoperative planning suggests that the conversion will not be straightforward.

Adult↗
PubMed1992

Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology.

Recent studies have suggested that ultrasound examinations may improve diagnostic accuracy in congenital dislocation of the hip, but there is differing opinion whether ultrasound diagnosis should be based on morphology or stability. Ultrasound was added to the routine clinical screening in 1503 newborns (1291 girls and 212 boys). Hip morphology was classified according to Graf (type 1-4), while sonographic stability was based on a modified Barlow maneuver, and classified as stable, elastic deflection (normal finding), unstable (provocating a gap between the femoral head and the acetabulum) and dislocated. Among 80 morphologically dysplastic hips, 73 (91%) were sonographically unstable or dislocated, while seven dysplastic hips were stable. On the other hand, in 49% of the sonographic unstable hips (69 out of 142) the acetabulum was either normal or just physiologically immature. 38 of these hips were left untreated and normalized spontaneously. There was a close correlation between sonographically and clinically determined hip stability (gamma = 0.95). Our study shows that the majority of morphologically dysplastic hips is sonographically unstable or dislocated, but also that morphologically dysplastic hips may be stable. Morphologically normal hips showing minor sonographic instability do probably not require treatment, and thus morphology seems to be an important diagnostic criterion.

Acetabulum↗
PubMed2004

Chiropractic management of hip pain after conservative hip arthroplasty.

OBJECTIVES: To describe a case involving postsurgical hip pain that was successfully treated with a combination of chiropractic manipulation of the lumbar and pelvic region and low-tech rehabilitation 14 months postsurgery. CLINICAL FEATURES: A 45-year-old man had pain and difficulty with walking. He was diagnosed with bilateral avascular necrosis at the femoral heads. He had successful right hip arthroplasty (HA) surgery at the time of the original diagnosis and had 2 previous surgeries to the left hip joint to treat avascular necrosis, with the latter being hip arthroplasty. He had a chief complaint of left hip pain that radiated down the lateral thigh to the knee with a "clicking" of the hip noted at end range abduction and adduction, as well as an altered gait pattern associated with dysfunction of the left hip. INTERVENTION AND OUTCOME: He was treated with chiropractic manipulative therapy of the lumbar and sacroiliac joints and a rehabilitation program that consisted of in-office and home exercise programs. The patient experienced a decrease in the pain and an improvement in the flexibility and strength that led to an improved gait pattern and decreased pain. Outcomes were measured through active range of motion comparisons and use of the Harris Hip Scale Evaluation. CONCLUSIONS: Treatment of hip pain through chiropractic manipulation and rehabilitation is described. The patient had increases in active ranges of motion and Harris Hip scores. Additional studies should be done to evaluate the effects of chiropractic manipulations on patient outcomes following such surgeries.

Arthroplasty, Replacement, Hip↗
PubMed2004

Assessment of the functional method of hip joint center location subject to reduced range of hip motion.

Motion analysis of the lower extremities usually requires determination of the location of the hip joint center. The results of several recent studies have suggested that kinematic and kinetic variables calculated from motion analysis data are highly sensitive to errors in hip joint center location. "Functional" methods in which the location of the hip joint center is determined from the relative motion of the thigh and pelvis, rather than from the locations of bony landmarks, are promising but may be ineffective when motion is limited. The aims of the present study were to determine whether the accuracy of the functional method is compromised in young and elderly subjects when limitations on hip motion are imposed and to investigate the possibility of locating the hip joint center using data collected during commonly studied motions (walking, sit-to-stand, stair ascent, stair descent) rather than using data from an ad hoc trial in which varied hip motions are performed. The results of the study suggested that functional methods would result in worst-case hip joint center location errors of 26mm (comparable to the average errors previously reported for joint center location based on bony landmarks) when available hip motion is substantially limited. Much larger errors ( approximately 70mm worst-case), however, resulted when hip joint centers were located from data collected during commonly performed motions, perhaps because these motions are, for the most part, restricted to the sagittal plane. It appears that the functional method can be successfully implemented when range of motion is limited but still requires collection of a special motion trial in which hip motion in both the sagittal and frontal planes is recorded.

Adult↗
PubMed2003

Acceptability and compliance with hip protectors in community-dwelling women at high risk of hip fracture.

OBJECTIVES: To determine acceptability and compliance with hip protectors in women at high risk of hip fracture who are living independently in the community. METHODS: Women aged 65 yr and over referred for open access bone densitometry who had femoral neck osteoporosis and a high risk of falling were asked to wear hip protectors. RESULTS: Eighty five women fulfilled the inclusion criteria of whom 32 (38%) found the hip protectors acceptable and agreed to participate. Reasons given by the remaining 53 (62%) for not finding the hip protectors acceptable included discomfort on wearing, dislike of their personal appearance with the hip protectors on, and disagreement about their fracture risk. Participants were more likely to have a family history of osteoporosis (47 vs 26%, respectively) and hip fracture (16 vs 8%) compared with non-participants. At 12 months only about half of the subjects were wearing hip protectors daily. CONCLUSIONS: Our findings suggest that only a minority of community-dwelling women at high risk of hip fracture will wear hip protectors to reduce fracture risk. Their use should be restricted to highly motivated women who should be carefully identified.

Accidental Falls↗