SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The load of the hip joint is related to the density of bone, thickness of cartilage and pattern of the cancellous bone. The X-rays of the hip joint must provide all information for the calculation of the individual strain and stress.
A novel method for the design of hip joint prostheses based on X-ray films is introduced. Only arcs and straight-lines form figures of hip joint prostheses. Because geometrical tolerances of manufacturing hip joint prostheses matching section are usually not strict, hip joint prostheses can be manufactured without CNC machine tool. Three hip joint prostheses for three different femurs were designed through a program which was developed by the present authors. Approximate marrow cavities of these femurs were simulated according to a standard database about femur. These models of femur marrow cavities were used to verify the hip joint prostheses designed. These hip joint prostheses designed were manufactured and implanted into femurs respectively. Experimental results indicate that the novel method for the design of hip joint prostheses is practicable.
Typically obturator nerve blockade is used to relieve hip pain. It sometimes only has a minor effect in resolving symptoms. This clinical observation led us to examine comprehensively the sensory nerve innervation of formalin-fixed hip joint capsules. Following macroscopic preparation, the area of the hip joint capsule was inspected with the aid of an operating microscope. We discovered a separation between the anterior and posterior sensory innervation of the hip joint capsule. The anteromedial innervation was determined by the articular branches of the obturator n. Additionally, the anterior hip joint capsule was innervated by sensory articular branches from the femoral n. In the posterior part we found articular branches from the sciatic n., which in addition to the articular branches from the nerves to the quadratus femoris m., innervate the postero-medial section of the hip joint capsule. Moreover, articular branches of the superior gluteal n. were found, which innervate the posterolateral section of the hip joint capsule. This anatomical study demonstrates that the obturator n. block is insufficient for the treatment of hip pain. Further investigations will determine if these nn. can be reached percutaneously. Effective neural blockade of the hip joint must include the femoral n., the sciatic n. and the superior gluteal n.
The work is devoted to operative treatment of children with repeated dislocations and ankyloses of the hip joint after operative treatment of congenital dislocation of the hip. The dura mater, demineralized allocups and polymer self-resolving film were used as interlayers. Best results were obtained in arthroplasty with using demineralized allocups, polymer self-resolving film or their combinations.
QUESTION: Will surgical reconstruction of subluxated or dislocated hip joints in children with cerebral palsy lead to stable reduction and painless hips? Is there any positive influence on psychomotoric development of the children and on trunk and pelvic symmetry as well as on daily hygienic care after successful reduction of unstable hip joints in spastic children? MATERIALS AND METHODS: Thirty hip joints in 26 children with cerebral palsy were operated applying the same complex reconstruction method of the hip joint. Fifteen of these children with 17 operated hip joints fulfilled a minimum follow up period of 3 years were evaluated continuously in this study. The parents and physiotherapists answered a questionnaire, all patients were examined clinically and pelvic anteroposterior and lateral radiographs were obtained. RESULTS: The mean age at surgery was 6 years, the minimum follow up 3 years (3-10 years). All hip joints were preoperatively decentered, 6 subluxated, 11 complete dislocated. At follow-up 15 of 17 were persistently reduced. The postoperative results were graded by the parents as excellent and good in eleven, satisfying in four and in two patients as poor. The radiographic evaluation showed an significant improvement of the CE-, AC- and neck shaft angle. CONCLUSION: Reconstruction of decentered hips will lead to stable reduction and painless hips at least in mid term follow-up. Symmetrically centered hip joints are mandatory for a pelvic and spinal symmetry and may contribute for an optimal of psychomotoric development.
INTRODUCTION: Recent studies on osteoarthritis have focused on nociceptive substance P (SP) containing afferent nerve fibres. The effects of SP are known to be mainly mediated by the tachykinin receptor neurokinin 1 (NK1-R). AIM: The aim of the present study was to demonstrate the NK1-R in human joint tissues. METHODS: The hip joint capsule of three patients with painful hip osteoarthritis (Group 1), three patients with femoral neck fracture showing no cartilage destruction (Group 2, controls) and the soft tissue of the fossa acetabuli of Group 1 were resected during hip arthroplasty implantation. The tissue samples were cut into small blocks and immersion-fixed in Zamboni's fixative. The specimens were frozen, cut into 50 microm sections and immunostained using a standard immunohistochemical staining protocol. RESULTS: In Groups 1 and 2 the NK1-receptor was localised in the wall of venous vessels, on Schwann cells of nerve bundles and on nerve fibres. In the osteoarthritis group the staining pattern was similar but the number of NK1-bearing cell structures seemed to be enhanced. CONCLUSIONS: The present study provides the first evidence of NK1-R in the human hip joint. In patients with painful osteoarthritis the density of NK1-R-positive cell structures seemed to be increased. The localisation of the NK1 receptor on different cell types suggests multiple effects of SP in normal and osteoarthritic joints.
We aimed to determine if there are mechanoreceptors in the hip joint capsule and ligamentum capitis femoris (LCF) of patients with developmental dysplasia of the hip (DDH). We took capsule and LCF biopsies from 20 hips of 20 patients who were operated on because of DDH. The mean age was 10.2 months (range 6-20 months) at the time of surgery. There were 12 girls and eight boys. Teratologic and secondary hip dislocations were not included in this study. Full thickness, 0.5 x 0.5 cm anterior capsule and LCF portions were taken for biopsy specimen. Specimens were stained with hemotoxylin eosin and examined immunohistochemically using monoclonal antibody against S-100 protein. In both analyses no mechanoreceptor was found in any samples of capsule or LCF. In this preliminary study we could not find mechanoreceptors in the local anterior joint capsule and LCF of the hip in children with DDH. We think that additional studies are necessary in order to understand the mechanoreceptor characteristics of the hip joint in children not only with DDH but also in children with healthy hips.
Screw penetration of the hip joint following acetabular fracture reconstruction is a relatively uncommon complication but, if not corrected, may have a catastrophic effect on the postoperative function of the hip joint. Intraoperative radiographs and postoperative standard anteroposterior (AP) radiographs frequently show super-imposition of the screws and acetabulum. Computed tomographic (CT) scanning has been the only diagnostic technique available allowing documentation of screw penetration into the hip joint. CT scan, however, can be performed only after termination of surgery. In search for a radiological view that will help in diagnosing screw penetration into the hip joint both intra- and postoperatively, we undertook a controlled study of 25 patients having either a posterior or extensile lateral surgical approach and six cadaveric specimens. A combination of a cross-table lateral view of the hip and a Judet iliac view proved more informative than AP or Judet obturator views in demonstrating absence or presence of the screw in the hip joint (if the screws were placed along the posterior wall or column). Intraoperative AP radiographs projected as a Judet obturator view were the least helpful in making this determination. When screw penetration is suspected, we recommend the use of intraoperative fluoroscopy in multiple projections or intraoperative arthrogram in the lateral projection of the pelvis. Also, Judet iliac and cross-table lateral radiographs in the operating room while the patient is still under anesthesia might exclude any screw penetration into the hip joint.
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.
Hip joint moments were determined by analogue computer techniques, using as inputs the angles formed by body segments during normal walking. The control algorithm was based on the division of the walking cycle into six stages; each activated by contact of heel, mid-foot and fore-foot. The problem of the accuracy of double differentiation was overcome by means of two filters which amplify the gain at the basic frequency of the walking cycle, while reducing it above 10 Hz. The analogue model gave reasonable results, suggesting that it could be used as an input to a real time microcomputer-based adaptive control system for the maintenance of hip joint balance in an amputee during walking.
5 hip joints with untreated congenital dislocation of the hip were examined for hip movement by ultrasound. With the hip joint flexed, the direction of the dislocated femoral head was posterior to the acetabulum. The dislocated femoral head displaced more posteriorly when the knee joint was extended, with the hip joint held in flexed position. As the dislocated hip was extended, on the other hand, the direction of the dislocated femoral head was anterior to the acetabulum. The dislocated femoral head displaced more anteriorly when the baby tried to bend the hip with the joint held in extended position. These findings indicate that a fetal posture with the hip flexed and the knee extended predisposes to the development of CDH by the action of hamstrings, and that an infant posture with the hip extended is likely to provoke femoral head dislocation by the action of the iliopsoas.
In postmortem examinations 26 hip joints of 23 adult individuals were filled with Ringer's solution in order to furnish data on the relationship between intra-articular pressure, capsular content, and joint position. A tube system was connected to an 18-gauge needle and to a pressure transducer. After instillation of 2.5, 5.0, 7.5, and 10.0 ml of Ringer's solution, intra-articular pressure was recorded in six different joint positions (extension, 45 degrees and 90 degrees flexion, 40 degrees internal and 40 degrees external rotation, and 45 degrees abduction in extension). Intra-articular pressure depends mainly on the position of the joint, with highest values in external and internal rotation and lowest values in 45 degrees flexion. In this last position, the pressure was zero in two of four cases after injection of 10 ml, whereas with external rotation and instillation of 2.5 ml almost 60 kPa was recorded. In extension and after filling with 10 ml the pressure exceeded the level of normal systolic blood pressure in all cases. Under pathologic conditions intra-articular pressure of the hip joint can rise well above arterial pressure and thus eventually compromise vascular supply to the femoral head, even in the presence of only minimal intra-articular effusion.
OBJECTIVE: To evaluate hip joint laxity in 10 breeds of dogs via 2 radiographic techniques. ANIMALS: 500 clinically normal dogs. DESIGN: Prospective study. PROCEDURE: Radiographs obtained via routine hip joint evaluations performed in sedated dogs of 10 popular breeds were randomly selected from a database. Measurements of distraction index (DI) and hip-extended index (HEI) on 1 hip joint radiograph randomly chosen from each dog were made. RESULTS: Mean age of dogs was 20.7 months. Mean HEI was 0.17 (range, 0.0 to 0.72) and mean DI was 0.44 (range, 0.07 to 0.96). Borzois had uniformly tight hip joints as judged by use of both methods and were considered the gold standard by which hip joint laxity was judged (all Borzois had DI < or = 0.32). Overall, DI was significantly greater than HEI. Within each breed, mean DI was always greater than mean HEI. Significant differences were detected among breeds for HEI; however, compared with DI, the magnitude of differences among breeds was less. CONCLUSIONS AND CLINICAL RELEVANCE: Distraction radiography detected the greatest range and magnitude of passive hip laxity in the 10 breeds of dogs. The difference in values between breeds known to have high prevalence of canine hip dysplasia and those in Borzois was greater for DI than for HEI. Breeds must be evaluated individually because of inherent differences in hip joint laxity.
For grasping hip joint function objectively and planning an adequate program for individual use in rehabilitation during and after the treatment for hip joint impairments, the octagonal diagram of the correct distribution of the hip joint muscle strength will be useful. The muscle strength was measured in the eight directions using the Cybex-II on the U.B.X.T. table not only on the peak torque but also on the maximum work and the maximum work/sec in eighty healthy subjects, forty of each male and female. No difference of the muscle strength between the dominant and the non-dominant legs of both male and female has shown. In the percentage of the values of the muscle strength, there are differences between the peak torque, the maximum work value and the maximum work/sec. The data obtained from this investigation will be available to judge the degree of hip joint impairment, and to make a better therapeutic program for the patients.
In a study of 280 hips in 140 normal fetuses, sixty-five of the ninety-two hips of forty-six fetuses between the ages of twelve weeks and term showed morphological variants, yet they were neither subluxated nor dislocated and showed no statistically significant morphological differences from normal joints. The vazriants observed included flattening (fourteen hips) or rounding-off of the rim of the labrum (nine hips), localized dips in the labrum (twenty hips), folding of the labrum (six hips), capsular folds (four hips), extension of the pulvinar pad between the joint surfaces (six hips), and kinking of the ligament of the head of the femur (seven hips). The localization of these variants in the anterosuperior quadrant of the acetabulum was highly significant (p < 0.001), but there was no significant relationship to sex or side of involvement. A significant relationship to age, on the other hand, was evident since the frequency of these minor morphological variations in the fetal hip joint appeared to increase with age. Considering all 140 fetuses, the ones with variant hips formed 55 per cent of all of those older than twenty-eight weeks and only 23 per cent of those younger than twenty-eight weeks (p = 0.007). I suggest that some of these variants are subclinical manifestations of congenital hip disease.
The innervation of the canine hip joint has become increasingly important in the treatment of hip dysplasia and hip arthrosis, since investigations proved that simple removal of periosteum around attachment of hip joint capsule, called denervation results in an instant analgesia and allows the dog to regain joyful freedom of movement. A macroscopic-anatomic examination of 16 canine hips furnished new findings and knowledge in the field of veterinary medicine on the sensitive innervation of the canine hip joint capsule. Accordingly, the craniolateral area of hip joint capsule is innervated by rami articulares of N. glutaeus cranialis, the caudolateral area by rami articulares of N. ischiadicus and the medial area by rami articulares of N. femoralis.
Many disorders of the hip can be treated with a suitable osteotomy based on the improvement of mechanical conditions in the hip joint. These operations, such as osteotomies are very complex. The surface replacement has also been developed as an alternative to a total hip replacement for young and more active people. It is up-to-date to concern with biomechanics of pathological hips and it is necessary to supplement the existing clinical findings with the results of mechanical analyses. Several finite element (FE) models are presented in this paper. The first one offers solutions to the strain-stress analysis of the physiological hip. The second one represents dysplastic hip joint. Another two computational models of both hips of a young patient were created (FE model of physiological hip and pathological hip affected by Perthes disease with a deformed shape of the femoral head). Also a computational model is presented, which enables us to investigate strain and stress parameters in the hip joint with applied surface replacement. The strain and stress analysis was performed by means of finite element method (FEM) in ANSYS system.
The deep infection of a hip joint (after operative treatment of a fracture, after corrective osteotomy or as a haemtogeneous joint infection) is a severe, locally and systemically dangerous sickness; her treatment ist difficult because of the multifactorial genesis. In the accident hospital of Tübingen were treated 35 empyemas of hip joint (excluding after implantation of a prosthesis) within 10 years. The therapeutic management normally needs three steps: 1. Control of acute empyema or septicaemia (Debridement, Drainage, antibiotic treatment) 2. Achievement of fracture or osteotomy stability (by changing of osteosynthesis or bone-grafting under continuous drainage) 3. Definitive healing by removing of metal, resection of a destroyed or necrotic femoral head, by arthrodesis of the joint or--in special cases--by implantation of a prosthesis. In this way it was possible to control all of the 35 deep hip joint infections and to maintain function in 28 cases. Within the follow up (in the average 4 years) all the patients were free of infection.