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At least 1,477 records · Page 82Linked to original sources
PubMed2003

Predictors of hip joint replacement in new attenders in primary care with hip pain.

BACKGROUND: Studies investigating the factors associated with need for total hip replacement should ideally be based on prospective investigation of new attenders in primary care. AIM: To determine the incidence of listing for total hip replacement, and its predictors, among attenders in primary care with a new episode of hip pain. DESIGN OF STUDY: Prospective multicentre cohort study. SETTING: One hundred and ninety-five patients (mean age = 63 years, 68% female) with new episode of hip pain, attending primary care between November 1994 and October 1997. At the first visit, patients were evaluated for indices of pain and disability, range of hip movement, and radiographic changes of osteoarthritis. METHOD: General practitioner participants were recruited from the membership of the Primary Care Rheumatology Society to recruit all consecutive attenders with a new episode of hip pain. Annual follow-up was carried out to determine which patients were being 'put on a waiting list' for total hip replacement. RESULTS: Seven per cent of patients were put on a waiting list for total hip replacement within 12 months and 23% of patients within four years. At presentation, pain duration, pain severity, (including the need to use a stick) and restriction of internal rotation were the major clinical predictors of being put on a waiting list. Radiographic predictors of osteoarthritis performed similarly to the clinical measures. A simple scoring system based on both radiographic severity and two of the clinical measures was derived that identified groups at high likelihood of being put on a waiting list (sensitivity = 76%) with a low false-positive rate (specificity = 95%). CONCLUSION: New primary care attenders with pain are frequently accepted for total hip replacement soon after their first attendance--a decision that can be predicted by simple clinical measures.

Arthroplasty, Replacement, Hip↗
PubMed2000

Cone prosthesis for the hip joint.

The shape of the proximal segment of the femur must be taken into account when implanting femoral endoprostheses, especially those intended for cementless anchorage. Numerous femoral prostheses are available for the proximally broadly extending, "trumpet-shaped" morphology. However, the femur often has a narrow, more cylindrical configuration, as is frequently seen with dysplastic hip joints, but variants of the anatomical constitution or ethnic variants are also found. Conventional femoral prostheses with a proximal transverse oval or rectangular cross-section are often incorrectly positioned in those cases because they can fracture the narrow bones. In many instances, even a pathological anteversion attachment cannot be adequately corrected. The cone prosthesis is ideal for this morphology when pre-operative planning indicates good contact between the bone cortex and the middle third of the prosthetic stem. The tapered anchorage of the cone stem in the medullary cavity reamed to a cone shape promotes primary stability, which is a fundamental prerequisite for the osseointegration of a coarse blasted titanium implant. The sharp longitudinal ridges on the prosthetic stem, which tend to cut into the bone, ensure extensive rotational stability, which explains why thigh pain is not associated with the cone prosthesis. The cone prosthesis has proved its worth in 635 implants performed over 9 years, with highly satisfactory clinical and X-ray results. The surgical technique is relatively straightforward, and complications are rare. The patients' subjective satisfaction is particularly remarkable. The success of the operation lies in correct preoperative planning, which ensures that the morphology of the selected femur guarantees contact between the bone cortex and the middle third of the prosthetic stem.

Adolescent↗
PubMed2004

A hip joint simulator study of the performance of metal-on-metal joints: Part I: the role of materials.

The use of metal-on-metal low-wearing bearings has promoted great interest in the factors determining the volume of wear debris generated in such joints, including the developing surface replacement alternatives. Twenty-six pairs of low- and high-carbon components in wrought or cast form of 36 mm nominal diameter and exhibiting similar clearances were studied over 5 million test cycles in a 10-station hip joint simulator. Low-carbon cast materials exhibited higher wear than high-carbon cast or wrought materials. Little difference was found in the running-in wear volumes generated by high-carbon wrought or cast materials, but the wrought material exhibited a slight advantage at the smallest diametral clearance considered of 105 microm. Volumetric wear appeared to decrease as the diametral clearance decreased.

Alkaloids↗
PubMed2005

A computer simulation of rotational acetabular osteotomy for dysplastic hip joint: does the optimal transposition of the acetabular fragment exist?

For young patients who have early signs of coxarthrosis resulting from acetabular dysplasia, periacetabular osteotomies for correcting abnormal stress distribution can be useful for preventing the progression of the disease. However, it is difficult to confirm the optimal transposition of the osteotomized acetabular fragment. To deal with this problem, we devised a computer program to support preoperative planning. Hip images obtained by computed tomography were loaded into our program, and a three-dimensional voxel model was created. Then, osteotomy was simulated and the pressure distribution was analyzed with a rigid-body spring analysis (computational nonlinear mechanical analysis). The three-dimensional pressure distributions in seven dysplastic hips were evaluated before and after virtual rotational acetabular osteotomy. A peak pressure was calculated for every 5 degrees of rotation of the acetabular fragment. The peak pressure decreased gradually and increased again afterward, indicating the optimal transposition of the acetabular fragment. The postoperative peak pressure decreased to about 40% in the most improved case. This program allows the hip joint mechanics to be evaluated easily so that the advantages and disadvantages of various surgical methods can be examined biomechanically prior to surgery.

Acetabulum↗
PubMed1998

[Labrum lesions in residual dysplasia of the hip joint. Biomechanical considerations on pathogenesis and treatment].

The capsular-labrum-complex consists of the triangular fibrocartilaginous labrum, which is fixed at the bony acetabular ring and supported by the ligamentum transversum actetabuli in the caudal part. In a normally developed and correctly orientated acetabulum, the femoral head is symmetrically covered by the contact area of the lunate surface. The vertical component of the resultant hip joint force concentrically meets the horizontal weight bearing surface: Evenly distributed compressive forces are transmitted; the capsular-labrum-complex does not have to compensate excessive shear or tension. In contrast, in a "dysplastic" acetabulum the femoral head is poorly covered by the pathologically orientated lunate surface: The lunate surface is sloping in an anterolateral direction, leading to tension and shear on the superolateral capsular-labrum-complex, which becomes a secondary stabilizer ("guide rail") against the decentering femoral head. The vertical component of the resultant hip force eccentrically meets the oblique weight bearing surface, causing extra stress in the labrum: The capsular-labrum-complex is trying to compensate this biomechanical stress with hypertrophy (Type IB). Progressive mechanical decompensation of the capsular-labral-complex might lead to tears (Type IIB) or complete avulsions (Type IIIB) of the labrum. In conclusion labral lesions result from pathobiomechanics caused by residual hip dysplasia (RHD). Logically, the basic therapeutic principle can only be corrective osteotomy.

Acetabulum↗
PubMed1984

Synovial fluid circulation in the hip joint.

Early in our study of the role of incongruency in the hip (Ref. 1) we observed by x-ray screening that, under load, a drop of barium sulphate placed between the articular surfaces spread out between them and a substantial portion was extruded from the intercartilage space into the fossa; all the barium was drawn back as load was reduced. This observation and others (Ref. 2) which demonstrated the location, size and behaviour of intercartilage space with movement and load, prompted exploration of the hypothesis that the space due to joint incongruency serves as a pump to transport synovial fluid in the articular cavity in aid of nutrition and lubrication. This had already been suggested by others (Ref. 3); but none have closely studied the hypothesis. The following is an expansion of this idea, which leads to the concept of a systematic circulation of fluid through the hip joint.

Adult↗
PubMedDate not supplied

Stability of the hip joint after reduction of late-diagnosed congenital dislocation of the hip.

Nine children with late-diagnosed congenital dislocation of the hip underwent ultrasonography for determination of the influence of hip flexion on hip stability after reduction. No medication was used, and the investigation was performed in existing abduction splints during active movements of the leg. Redislocation of the joint was related to the minimal degree of flexion (120, 110, 100, or 90 degrees) permitted by the splint. All hips redislocated when flexion was less than 100 degrees. Five joints need 100 degrees and two 110 degrees of flexion for prevention of redislocation, and two hips required as much as 120 degrees.

Hip Dislocation, Congenital↗
PubMed1992

Cementless prosthesis of the hip joint with "spongy metal" surface. A prospective study.

Our investigations in human specimens and animal experiments show that prostheses with a spongy metal surface can become fixed by bony ingrowth to varying degrees. After consistent clinical and radiological follow-up over 12-65 months (mean 34 months) in a prospective study of 100 consecutive patients in whom 106 cementless total hip replacements had been carried out, we were able to show that after 1 year 82% of patients were pain-free with the prosthesis fixed by bony ingrowth, 8% were pain-free with the prosthesis fixed by dense fibrous tissue and 10% were not pain-free, but did not want revision surgery. Thigh pain decreased steadily from 53% 3 months postoperatively to 6.6% 15 months after operation. We believe that, when the implantation technique is exact, a high percentage of cementless spongy metal prostheses are fixed by bony ingrowth, and that a cementless prosthesis should be implanted only in patients under 60 years of age without osteoporosis.

Female↗