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PubMed1978

[The inguinal incision for the open reduction of congenital hip dislocation (author's transl)].

Operative reductions of congenital hip dislocation are sometimes difficult when lateral incisions are used since the medial part of the acetabulum and the lower limbus are difficult to visualize. In the Ludloff technique this part of the acetabulum is seen excellent, but not the lateral part. High dislocations with inverted limbus are difficult to reduce and only with partial excision of the limbus. An inguinal incision beginning lateral at the spina ilica ventralis offers the best view and can be used for all different degrees of dislocation and age groups. The technique is described, the advantages and the rate of avascular necrosis compared with other incisions. Femoral osteotomies and acetabular or pelvic osteotomies should not be done at the same time because of a higher percantage of avascular necrosis. In high dislocaitons shortening osteotomies should not be done in the intertrochanteric region but deeper in the shaft to avoid additional disturbances of the vascular system of the proximal femur.

Femur Head Necrosis↗
PubMed1983

Küntscher nailing in the treatment of femoral fractures in children. Is it completely contraindicated?

Seventeen children between the ages of 6 and 12 years with fractured femoral shafts were treated by Küntscher nailing. They were followed up clinically and radiographically to ascertain if nailing had any long term adverse effects. The following radiographic parameters were considered: --valgus, varus angle; --distance between lesser trochanter and acetabulum; --width of the neck of the femur; --distance between greater trochanter and acetabulum; --intertrochanteric distance. On analysing the results it was found that Küntscher nailing did not give rise to any adverse effects provided it is carried out after 8-9 years of age.

Age Factors↗
PubMedDate not supplied

Six- to 11-year results of total hip arthroplasty in rheumatoid arthritis.

The results of 138 total hip arthroplasties in 98 rheumatoid arthritic patients were reviewed six to 11 years (mean, 7.0 years) after operation. While 96% of the patients were clinically improved as a result of surgery, radiographic analysis suggests that, despite their low functional requirements, this group of patients experiences mechanical loosening and failure with time. Improvements in prosthetic design and cementing technique should contribute to a lowered incidence of mechanical failure in the future. In addition to improvements in technology, the failure rate can be further diminished by recognition of the systemic problems associated with rheumatoid arthritis, e.g., high incidence of infection, osteopenia, and sequelae of multiple joint involvement. In reconstruction of the acetabulum, especially in the presence of protrusio, failure to restore the anatomic position and orientation of the acetabulum predisposes to loosening and migration.

Arthritis, Rheumatoid↗
PubMed1978

Arthrographic findings in Legg-Calvé-Perthes disease and transient synovitis of the hip.

Bilateral arthrography of the hip was performed in thirty-seven patients with unilateral Legg-Calvé-Perthes disease. Measurements made on the plain roentgenograms and on the arthrograms of the diameter of the femoral head, the width of the medial joint space, and the thickness of the acetabular cartilage were compared. The acetabulum-head quotients also were calculated. When present, evidence of flattening of the femoral head cartilage and of pooling of the contrast material also was noted. These data showed that in the early stages of Legg-Calvé-Perthes disease the articular cartilage is thickened, and that the cartilaginous femoral head is deformed and protrudes from the acetabulum. Arthrograms made with the hip in different positions also indicated the extent and location of collapse of the (osteochondroal) femoral head and therefore proved useful as a means to determine the best therapeutic position of the hip to provide coverage of the head. In three patients with severe transient synovitis, thickening of the articular cartilage resembling that seen in Legg-Calvé-Perthes disease was demonstrated.

Cartilage, Articular↗
PubMed1978

Biomechanical aspects of Salter osteotomy.

A mathematical model of a Salter osteotomy in an adult male pelvis reveals that during innominate osteotomy, the center of the hip joint moves distally, posteriorly, and medially. The acetabulum extends by an angle roughly equivalent to the angle of osteotomy opening. Adduction of the acetabulum takes place to a lesser extent. Hip abductors and flexors tighten minmally following innominate osteotomy. Augmentation of abduction occurs as a result of medial acetabular displacement rather than gross alteration of the abductor muscles themselves. Theoretical considerations suggest that the surgeon should strive to obtain maximum correction at the osteotomy site while avoiding levering at the greater sciatic notch.

Adult↗
PubMed1983

Acetabular dysplasia in the adult.

Twenty adults (32 hips) with acetabular dysplasia were followed up for an average of 22 years to determine the natural history of the disorder. Initially, all hips had a center-edge (CE) angle of Wiberg of 20 degrees or less and an essentially intact Shenton's line with no roentgenographic evidence of osteoarthritis. Average patient age initially was 43 years (range, 27-57 years) and at final follow-up examination, 65 years. Various parameters of hip integrity were measured, including the CE angle of Wiberg, acetabular angle of Sharp, percentage of the femoral head covered by the acetabulum, acetabular depth, and inclination of the lateral lip of the acetabulum. None of these indicators proved a reliable prognostic aid for predicting the rate at which the osteoarthritis process supervened in any one case.

Adult↗
PubMed1983

Treatment of congenital dislocation of the hip by the Pavlik harness. Mechanism of reduction and usage.

The Pavlik harness was used in the treatment of complete congenital dislocation of one or both hips in a series of infants, on either an outpatient or an inpatient basis. The results in the two groups were compared. For the children treated as outpatients the incidence of avascular necrosis of the femoral head was 7.2 per cent and for the group treated as inpatients the rate was 28 per cent. Application of the Pavlik harness allowed reduction of the hip by shifting the femoral head first to the posterior part of the acetabulum through flexion of the hip, followed by movement of the femoral head anteriorly into the acetabulum through abduction of the hip, which is possible because of stretching of the adductor muscles by the weight of the lower extremity. When the reduction is obtained by forced abduction there is a greater danger of avascular necrosis of the femoral head.

Female↗
PubMed1983

When is arthrography indicated in Legg-Calvé-Perthes disease?

We evaluated plain radiographs and arthrograms of twenty-one children with active Legg-Calvé-Perthes disease in order to determine the value of the arthrography. We found that when epiphyseal protrusion was shown by the arthrograms it could be seen on the plain radiographs as well in all patients. Also, an acetabulum-head index of less than 90 or an acetabulum-head quotient of less than 92 as determined on plain radiographs correlated well with a diagnosis of protrusion. Thus, an arthrogram is not necessary to make the diagnosis of protrusion in most patients. The arthrogram is more useful in delineating changes in the articular surface for prognoses concerning arthritis and in tailoring the treatment to the individual patient.

Child↗
PubMed1982

A cement fixation system for total hip arthroplasty.

To combat the most common and most serious cause of mechanical failure of total hip arthroplastics, namely loosening, a method of improving the insertion of methacrylate is presented, called the cement fixation system. Using the cement gun with the keying hole seal, the methacrylate is pressure injected into the keying holes in the acetabulum. The acetabular cement compactor pressurizes the rest of the cement used in the acetabulum. The medullary canal of the femur is occluded by a bolus of methacrylate delivered to the desired depth by the medullary plug syringe. Thus, the cement is delivered from the plug proximally via the cement gun and femoral cement syringe. Finger packing is not used. The entire femoral cement mass is then pressurized using the femoral cement compactor. This cement fixation system produces higher extrusion pressure, better penetration of the cement, better fixation to the bone and reduces voids, defects, and discontinuities in the methacrylate mantle.

Bone Cements↗
PubMed1982

Femoral head migration after single assembly total hip arthroplasty.

One of the problems of a solid head Moore type prosthesis is acetabular migration. The compound bearing single assembly (Bateman) total hip arthroplasty is supposed to decrease the incidence of this complication. A series of 160 hips reviewed to determine the validity of the single assembly total hip suggested that intrapelvic protrusion developed only in the presence of sepsis. In the present of a dysplastic acetabulum; however, superior migration was a common occurrence unless the acetabulum was significantly deepened.

Adult↗
PubMed1982

[Anatomical and radiological studies of the internal architecture of the hip (author's transl)].

Internal architecture and detailed shapes of the adult pelvis and femur were studied anatomically and radiologically. The measurements of torsion and curvature of the femurs were investigated using the special pattern gauge. The pelvis and femurs were sectioned transversely into several specimens and changing patterns of the osseous column were observed for each specimen. Torsion in the calcar femorale of the femur is reversely correlated with the anteversion and plays an important dynamic role for the internal weight bearing system. Although the central part of the cervical region of the femur is architecturally a fragile part, torsion and curvature of the cervical region form a shape serving the purpose by working in a rational way. There are three groups of osseous beams gathering at the acetabulum of the pelvis. These groups of osseous beams being exposed to the load and force from the perifemoral muscle probably induce torsion of the pelvis. There is a correlation between torsion of the pelvis and the forward-opening angle of the acetabulum.

Aged↗
PubMedDate not supplied

Premature femoral neck physeal closure in Perthes' disease.

One hundred premature femoral neck physeal closures in 430 hips with Perthes' disease have occurred in two patterns central and lateral. Abnormal physeal growth can be demonstrated early by a narrowed physeal plate with overlying avascular epiphysis and marked metaphyseal reaction below. Subsequently, a bony bridge forms between the metaphysis and epiphysis. If the physeal closure is central, the mature hip will have a short femoral neck, a relatively round femoral head, a trochanter that has overgrown the femoral head, a short leg, and a mildly deformed acetabulum. If the physeal closure is lateral, the mature hip will have a femoral head that is externally tilted as the medial neck lengthens and the lateral neck remains short, a trochanter that has overgrown the femoral head, an oval femoral head, a short leg, and a deformed acetabulum. A physeal arrest is a contraindication for a varus osteotomy because it accentuates the deformity, especially in the greater trochanter. The leg-length discrepancy may be treated by epiphysiodesis of the contralateral femur, when necessary, and the abductor muscle insufficiency may be treated by an exercise program or distal and lateral transfer of the greater trochanter.

Adolescent↗
PubMedDate not supplied

The natural history of congenital dislocation of the hip: a critical review.

Studies of the natural history of congenital dislocation of the hip do not distinguish which particular features indicate a poor prognosis. In complete dislocation we have found that the development of a false acetabulum with thick sclerotic iliac bone more frequently leads to pain than those with little or no bony reaction of the ilium. Congenital dislocation leads to functional disability in all patients but only half have significant pain. Congenital subluxation and dysplasia of the hip are responsible for a high proportion of coxarthrosis. The lack of symptoms, and the subtle physical findings until irreversible degenerative changes occur, makes early diagnosis difficult. When recognized early, correction of the deranged anatomy must be done if coxarthrosis is to be prevented. Concentric hip motion and normal muscular function are essential for proper development of the joint. A reciprocal relation exists between the development of the proximal femur and the acetabulum. Structural abnormality of either eventually leads to joint dysfunction.

Hip Dislocation, Congenital↗
PubMed1995

Total hip replacement in irradiated hips. A retrospective study of 71 cases.

We retrospectively reviewed 56 patients (71 hips) treated by total replacement for severe disability after pelvic irradiation. Symptoms were associated with various radiological lesions due to irradiation, including atraumatic femoral-neck fracture, osteonecrosis of the femoral head or of the acetabulum, and radiation osteitis of the whole pelvis. From 1970 to 1982 we used standard cemented components in 49 hips and had a high rate of acetabular loosening (52%) at a mean follow-up of 69 months. This was probably due to the mechanical insufficiency of irradiated periacetabular bone. From 1983 to 1990 we routinely used acetabular reinforcement rings. The rate of aseptic acetabular loosening in 22 hips at a mean follow-up of 40 months was 19%, but there were two septic loosenings emphasising the risk of infection in these patients. When total replacement is required for an irradiated hip, we recommend reinforcement of the acetabulum using a metallic ring, but there is still an increased risk of infection and in difficult cases such as severe acetabular destruction or soft-tissue or vascular injuries, a Girdlestone procedure may be indicated.

Adult↗
PubMed1995

Biomechanical properties of hip cartilage in experimental animal models.

The material properties of normal adult articular cartilage were determined in the femoral head and acetabulum of baboons, dogs, and bovines, and were compared with those of normal human hip cartilage. In situ creep and recovery indentation experiments were performed using an automated creep indentation apparatus. To curvefit the entire creep curve, a numerical algorithm based on biphasic finite element methods and nonlinear optimization was developed. This effort represents the first successful use of 100% of the creep indentation curve to obtain the mechanical properties of normal articular cartilage. The results show that material properties of articular cartilage exhibit significant topographical variations in the femoral head and acetabulum, and between these two bone structures. Furthermore, significant differences exist in the mechanical properties of hip cartilage among the 4 species. Specifically, in all species the smallest aggregate modulus is found in the inferior aspect of the femoral head. Among all species, human hip cartilage is the stiffest in all test sites; bovine tissue is the softest. Human tissue has the smallest Poisson's ratio and permeability in all test sites. The aggregate modulus of human hip cartilage is closely resembled by that of baboon hip cartilage. Anatomically, canine and baboon hips exhibit similar characteristics to the human hip joint; the bovine hip joint is distinctly different. Based on this study's data, the baboon represents the most appropriate animal model of normal human hip articular cartilage.

Animals↗
PubMed1994

Periprosthetic bone mineral density after Mueller and Zweymueller total hip arthroplasties.

To assess the adaptive bone changes in adult human hips after insertion of cemented or uncemented acetabular and femoral components for total hip arthroplasty, a retrospective clinical study using dual energy xray densitometry was conducted. A consecutive homogeneous group of 52 female patients with an average age of 61 years was operated on for unilateral hip osteoarthritis. The types of prosthetic components used were the cemented Mueller and the uncemented Zweymueller socket and stem. Periprosthetic bone mineral density was measured in 7 different zones (Zones I to VII) in hips that were operated on and hips that were not, and the results were compared to quantify periprosthetic bone mineral changes over time. The Zweymueller socket induced bone resorption at the medial and caudal zone of the acetabulum, whereas implantation of the Mueller polyethylene socket was associated with a significant increase in bone mineral density only at the cranial zone of the acetabulum. The stem of the Mueller prosthesis induced bone mass reduction in the lesser trochanter area and in the distal lateral fixation cortex. The Zweymueller stem produced significant bone resorption in the area of the lesser trochanter, and in the medial and lateral distal cortex of the femur. The Mueller and Zweymueller stems induced bone mass increase in the greater trochanter area. These findings were unaffected by the age of the patients. Further improvement in densitometry technology may be of major clinical relevance for early detection of aseptic loosening in total hip arthroplasty.

Adult↗
PubMed1993

[Technical problems in reoperation of hip joint prostheses].

At the Orthopaedic Clinic of the Institute for Postgraduate Medical Training in the course of 10 years (1979-1989) 2340 primary implantations of total endoprostheses of the hip joint were performed. During the same period 168 total endoprostheses of the hip joint and 20 cervico-occipital prostheses were reoperated. The most frequent reason for reoperation was aseptic loosening of the acetabular component. The mean period between operation and reoperation in these patients was 98 months. In the group with loosening of the socket associated with mechanical destruction of the component the mean period which had elapsed since the primary operation was 43 months. In 87% small size sockets were involved. The most serious problem of reoperation of total endoprostheses of the hip joint is replacement of bone defects. During reoperation of acetabular components an isolated defect on the floor of the acetabulum was found in 26%, a defect of the margins in 38% and a combined defect of the margins in 26% of the patients. For treatment of the defects the authors used bone grafts in the majority allogenic grafts were involved which were used to reconstruct the margins and floor of the acetabulum. Metal implants should hold the bone grafts in the desired position and should not serve as a skeleton. Reoperation of the acetabular part of total endoprostheses of the hip joint is easier from the technical aspect; in defects of the upper portion of the femur it is essential to use a very careful procedure and to preserve the skeleton to a maximal extent.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Methylmethacrylate plasma levels during total hip arthroplasty.

Methylmethacrylate (MMA) plasma concentrations were measured in 11 patients scheduled for total hip arthroplasty. After acetabular and after femoral cement implantation, sequential blood samples were withdrawn from pulmonary and radial artery catheters. The peak concentration of MMA (mean +/- standard error of the mean) in pulmonary artery blood occurred two minutes after cement implantation and was significantly higher after acetabulum (5.0 +/- 1.3 micrograms/ml) than after femoral cement insertion (1.9 +/- 0.6 micrograms/ml). The MMA peak in plasma was above 1 micrograms/ml in 13 cases, and the decrease fit a biexponential decay (r = 0.91). The initial half-life was 0.3 +/- 0.1 minutes, and the terminal half-life was 3 +/- 0.7 minutes. The areas under the curve (AUC) were determined for pulmonary (AUCpa) and radial (AUCra) plasma samples, and the ratio (AUCpa - AUCra)/AUCpa was computed: 55.1 +/- 7.8% of MMA was cleared during the transpulmonary passage. These results demonstrate that: (1) MMA could be determined after each cement implantation, (2) MMA plasma concentrations were higher after acetabulum than after femoral cement implantation, and (3) the half-life is short and the total pulmonary clearance is high.

Adult↗