Increased uptake around the hip joint.
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The treatment of 62 cases of infected total joint arthroplasty of the hip is reported. The treatment regimen for each patient was dependent on the general medical condition of the patient and the clinical signs of infection, as well as the type of bacteria, the bony anchorage of the prosthesis and the bone stock of femur and acetabulum. Surgical treatment was one of the following: treatment of the infection leaving the prosthesis in situ; one-stage or two-stage revision arthroplasty; or excision arthroplasty (Girdlestone procedure). There were 11 early and 51 late infections. The commonest bacterium isolated was Staphylococcus epidermidis (30%). The primary success rate of revision of the shaft was somewhat better with cemented than with uncemented prostheses. The overall success rates for cemented and for uncemented shafts were similar (91.5% versus 90%).
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Arthrodesis of the hip has been plagued by high rates of nonunion, and by complications associated with prolonged cast immobilization. To prevent these problems, we devised a procedure for hip arthrodesis using an external fixator in combination with internal fixation at the fusion site. We have treated nine patients with this technique. All of the arthrodeses were solidly united without wound infections at the most recent follow-up. Patients were able to leave their hospital bed and walk on the affected limb with a cane shortly after surgery. This was possible because the external fixator was low in profile, as it was applied from the anterosuperior iliac spine to the femoral shaft, and provided rigid stabilization of the arthrodesis. The technique resulted in a reduction in the period of bed rest, immediate postoperative mobilization, shorter periods of hospitalization, no limitation in the range of knee and ankle motion, improvement in the patient's ability to carry out the personal hygiene, and fewer complications.
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Osteochondrmatosis of the hip is a rare disease in which segments of synovial membrane become cartilaginous. These may calcify or ossify forming osteocartilaginous masses as loose bodies. It occurs most often in young or middle-aged adults and the etiology of the condition is unknown. The diagnosis can be apparent with due consideration on clinical history and proper X-ray examination of the joint. One case of such disease with typical X-ray findings is reported.
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The increase of hip-replacement is also seen in departments of rehabilitation. Among 270 operations during 1974/75 the main age at operations was 50-59 years. Para-articular ossification was more common in men than women. Function was disturbed more often in women, pain more common after operations other than replacement. Unfitness for work and compensation depend on the degree of limitation of mobility and weightbearing related to occupation. Because of relatively common complications and still unsatisfactory postoperative improvement, indication for replacement ought to be more critical. Conservative measures often give astonishingly good results, delay progressive symptoms. Techniques preserving the joint should be exhausted before the proper age for operation is reached.
An 81-year-old woman had severe hip pain after a fall. Radiography was normal, but computed tomography and sonography showed a minor, displaced acetabular fracture and hemarthrosis. Aspiration of 15 ml of blood reduced the intracapsular pressure in the neutral position from 30 kPa to atmospheric pressure with relief of pain and increased joint motion. This case confirms that acetabular fracture may escape radiographic diagnosis and cause hip joint tamponade. Aspiration should be considered as a palliative and possibly therapeutic measure.
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