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At least 19 recordsLinked to original sources
PubMed2000

Hip protectors for preventing hip fractures in the elderly.

BACKGROUND: Hip fracture in the elderly is usually the result of a simple fall and hip protectors have been advocated as a means to reduce impact and consequences of such falls. OBJECTIVES: To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, and reference lists of relevant articles were searched, and identified trialists contacted. Date of the most recent search: August 1998. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Five randomised trials involving 1681 participants were included within the review. All studies involved elderly people in nursing homes or residential care, three within the Scandinavian countries, one in Japan and one in the United Kingdom. The two largest studies involving 1409 participants randomised by nursing home or nursing home ward rather than by the individual (cluster randomisation). One study of 141 individuals was primarily a compliance study. Summation of results from four of these studies gave an occurrence of hip fractures of 13/620 (2.1%) for those allocated to wear hip protectors, against 57/920 (6.2%) to those not allocated to wear protectors. However due to the large number of participants allocated by cluster randomisation it was not possible to demonstrate conclusively that this difference between groups was statistically significant. Only one of the 13 hip fractures that occurred in the individuals allocated to wear hip protectors occurred whilst the protector was worn. No significant adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. REVIEWER'S CONCLUSIONS: Hip protectors appear to reduce the risk of hip fracture within a selected population at high risk of sustaining a hip fracture. However, this conclusion is based on four trials of low to moderate quality. As two used cluster randomisation, pooling of data was not possible. The generalisability of the results is unknown beyond high-risk populations. Results from six ongoing trials may clarify this situation. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.

Aged↗
PubMed2000

Extramedullary fixation implants for extracapsular hip fractures.

BACKGROUND: Extramedullary fixation of hip fractures refers to the application of a plate and screws to the lateral side of the proximal femur. OBJECTIVES: To compare different types of extramedullary fixation implants for the surgical treatment of extracapsular hip fracture in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register and reference lists of relevant articles. Date of the most recent search: March 1998. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing extramedullary implants used in the fixation of extracapsular hip fracture in adults. DATA COLLECTION AND ANALYSIS: All three reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results of outcome measures were pooled by comparison. MAIN RESULTS: The methodological quality of all six included trials was poor and in no trial was there clear concealment of allocation. Three trials involving 355 patients compared a fixed nail plate (Jewett or McLaughlin) with the sliding hip screw (SHS). The limited data presented indicated an increased risk of fixation failure outcomes for fixed nail plates. One trial involving 233 patients compared the RAB plate (a fixed angle blade plate with an oblique connecting strut) with the SHS. In this trial both implants had a high incidence of fixation failure. There was a tendency to a lower incidence of cut-out, re-operation, fixation failure, leg shortening, varus deformity and mortality for the RAB plate. None of the differences in these outcomes were statistically significant. One trial involving 100 patients compared the Pugh nail and the SHS. There was no significant difference between implants for the outcome measures reported. One trial involving 176 patients with 182 fractures, compared the Medoff plate with the SHS. A significantly higher mean operative blood loss and longer mean operative time were reported for the Medoff plate. There was however a tendency to a lower risk of fixation failure for unstable trochanteric fractures fixed with the Medoff plate. REVIEWER'S CONCLUSIONS: The fixed nail plate was demonstrated to have to an increased risk of implant breakage and fixation failure in comparison to the SHS. Although the lack of evidence from randomised trials for other outcomes means that a firm conclusion of overall superiority of the SHS cannot be made, the increased fixation failure rate is a major consideration and indicates that the SHS is preferable. Insufficient information is available to draw firm conclusions of the clinical significance of differences between the SHS and either the RAB plate, the Pugh nail or the Medoff plate.

Bone Plates↗
PubMed2000

Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures.

BACKGROUND: Various nerve blocks using local anaesthetic agents have been used in order to reduce pain after hip fracture. OBJECTIVES: To determine the effects of nerve blocks (inserted either pre-operatively, operatively or post-operatively) as part of the treatment for a hip fracture. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, and bibliographies of trial reports were searched. Date of the most recent search: April 1998. SELECTION CRITERIA: Randomised and quasi-randomised trials involving the use of nerve blocks as part of the care of a hip fracture patient. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of an eight item scale, and extracted data. Wherever appropriate, results of outcome measures were pooled. MAIN RESULTS: Six randomised or quasi-randomised trials involving 229 patients were included. One trial related to insertion of a nerve block pre-operatively and the remaining five, to peri-operative insertion. Nerve blocks resulted in a reduction of the quantity of parental or oral analgesia administered to control pain from the fracture/operation or during surgery. It was not possible to demonstrate if this reduction in analgesia use was associated with any clinical benefit. REVIEWER'S CONCLUSIONS: Because of the small number of patients included in this review and the differing type of nerve blocks and timing of insertion, it is not possible to determine if nerve blocks confer any benefit when compared with other analgesic methods as part of the treatment of a hip fracture. Further trials with larger numbers of patients and full reporting of clinical outcomes would be justified.

Hip Fractures↗
PubMed2000

Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures.

BACKGROUND: Cephalocondylic intramedullary nails which are inserted proximally to distally (cephalocondylic) have been used for the surgical treatment of extracapsular hip fractures. OBJECTIVES: To update and expand our review comparing the Gamma nail with the sliding hip screw (SHS) by comparing all cephalocondylic intramedullary nails with extramedullary implants for the surgical treatment of extracapsular hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, select orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists, colleagues and implant manufacturers. Date of the most recent search: June 1998. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results were pooled. MAIN RESULTS: The one trial of 230 patients comparing the Kuntscher-Y nail with the SHS, reported no major difference the outcome aside from a significantly increased number of patients with leg shortening, and a tendency for poorer recovery of mobility in the Kuntscher-Y nail group. Fourteen trials comparing the Gamma nail with the SHS were included, with data available for 1977 patients. The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased re-operation rate. There were no major differences in the incidence of wound infection, mortality or medical complications between implants. Data were inadequate to determine if there were differences for other outcomes. Two trials involving 231 patients compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group: all cases of operative and later fracture of the femur and haematoma occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. REVIEWER'S CONCLUSIONS: Further evidence is required before any conclusions can be drawn on the relative merits of the Kuntscher-Y nail and the SHS. Given the lower complication rate of the SHS in comparison with the Gamma nail, it appears that for trochanteric fractures the SHS is superior. Further evidence is still required to confirm this, as well as to determine if the Gamma nail, or modifications of the Gamma nail, have advantages for selected fracture types (for example, subtrochanteric fractures). From the limited evidence available, IMHS appears to have the same problems as the Gamma nail, but other theoretical advantages of the IHMS can not be ruled out.

Bone Nails↗
PubMed2000

Mobilisation strategies after hip fracture surgery in adults.

BACKGROUND: Post-operative care programmes after hip fracture surgery include strategies for mobilisation, such as early weight bearing, gait retraining and other physical therapy interventions. OBJECTIVES: To evaluate the effects of different mobilisation strategies and programmes after hip fracture surgery. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, Medline, and reference lists of relevant articles were searched. Date of the most recent search: August 1999. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing different mobilisation strategies/programmes after hip fracture surgery. DATA COLLECTION AND ANALYSIS: All reviewers independently assessed trial quality, using a ten item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Each of the four included trials evaluated a different intervention. All had poor and / or poorly reported trial methodology. One trial of 100 patients compared twice daily with once daily physiotherapy. Only limited outcome data were available for checking the claims in the trial report that there was no demonstrable difference in recovery of the two patient groups at nine weeks follow-up. A treadmill gait retraining programme was compared with a conventional gait retraining programme in one trial of 40 patients. More patients in the treadmill group had recovered their pre-fracture level of mobility by the time of hospital discharge, which tended to happen earlier than for the control group. Neither of these differences were statistically significant. One trial of 24 patients compared neuromuscular stimulation of the quadriceps muscle with placebo stimulation. No data were available to test the claims that neuromuscular stimulation improved the recovery of mobility, assessed up to 13 weeks. One trial involving 273 patients with a displaced intracapsular fracture treated by internal fixation compared weight bearing at two weeks after surgery with delayed weight bearing at 12 weeks after surgery. From the limited data available, there were no statistically significant differences between the two methods of treatment for the outcomes of non-union, mortality and overall unfavourable outcome at one year (42/141 versus 50/132; relative risk = 0.79, 95%confidence interval = 0.56 to 1.10). REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine the effects of more frequent physiotherapy, treadmill gait retraining, or neuromuscular stimulation after hip fracture surgery. There is also insufficient evidence to determine the effects of early weight bearing after the internal fixation of an intracapsular proximal femoral fracture.

Adult↗
PubMed1986

The treatment of the painful hip in cerebral palsy by total hip replacement or hip arthrodesis.

The painful dislocated or subluxated hip in the patient with cerebral palsy presents a difficult problem in management. Twenty-three patients with cerebral palsy who had a painful subluxated or dislocated hip with degenerative changes were operated on at The Hospital for Special Surgery. Eight patients had a unilateral hip arthrodesis. Six had a successful arthrodesis initially, resulting in relief of pain and return to the preoperative functional level. A pseudarthrosis developed in two patients, but both had successful revision surgery, one by a second arthrodesis and the other by a total hip replacement. Thirteen of the fifteen patients with a total hip replacement were pain-free and functioning at a level consistent with their over-all involvement. One patient had migration of the greater trochanter and slight bending of the femoral component, with persistent pain. A second patient had progressive loosening of the femoral component over a period of seven years, but continued to walk with minimum pain. Two patients had a recurrent dislocation, one requiring revision of the femoral component and the other, of the acetabular component. We think that the presence of cerebral palsy, even in the patient with severe involvement, is not a contraindication for either a hip arthrodesis or a total hip replacement for a painful deformed or degenerated hip. These patients should be treated for the pain in the hip, and the presence of the underlying neuromuscular disorder should not deter the appropriate treatment. For unilateral hip disease in patients who are unable to walk and in young, active patients, we recommend hip fusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Three-dimensional pressure distribution of the human hip joint--comparison between normal hips and dysplastic hips.

We developed a system for analyzing the three-dimensional contact pressure distribution in the human hip joint. Hip joint images obtained by computed tomography were loaded into a computer, and the articular surface was reconstructed as a three-dimensional polygonal model. The pressure distribution of this hip model was then analyzed using a rigid-body spring model. Using this system, the three-dimensional pressure distribution in dysplastic hips was compared with that in normal hips. Seven dysplastic hips and five normal hips were analyzed. In the dysplastic hips, the maximum peak pressure was 5.3 MPa, while it was 2.5 MPa in the normal hips. The peak pressure was located at the edge of the acetabulum in the dysplastic hips. This system allowed us to easily and accurately evaluate the mechanical status of the hip joint. For individual patients, the clinical course could be easily predicted and various treatment methods could be examined preoperatively.

Adolescent↗
PubMed2000

General versus spinal/epidural anaesthesia for surgery for hip fractures in adults.

BACKGROUND: The majority of hip fracture patients are treated surgically, requiring anaesthesia. OBJECTIVES: To compare different types of anaesthesia for surgical repair of hip fractures (proximal femoral fractures) in adults. This is primarily regional (spinal or epidural) anaesthesia versus inhalation general anaesthesia, but also includes ketamine anaesthesia versus inhalation general anaesthesia. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, selected orthopaedic and anaesthetic journals and conference proceedings, and reference lists of relevant articles. Date of the most recent search: August 1998. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing different methods of anaesthesia for hip fracture surgery in skeletally mature persons. Trials comparing the use of local nerve blocks are not considered in this review. Neither are trials using different types of drugs or techniques with one type of anaesthesia. The primary outcome was mortality. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a nine item scale, and extracted data. The other two reviewers independently checked these results. Wherever appropriate and possible, results were pooled. MAIN RESULTS: Fifteen trials, involving 2162 patients, which compared regional anaesthesia with general anaesthesia, were included. All trials had methodological flaws. Regional anaesthesia was associated with a decreased mortality at one month (49/766 (6.4%) versus 76/812 (9.4%)) of borderline statistical significance (Peto odds ratio 0.66, 95% confidence interval 0.46 to 0.96)). The results for three month mortality were not statistically significant, although the confidence interval does not exclude the possibility of a clinically relevant reduction (86/726 (11.8%) versus 98/765 (12.8%), Peto odds ratio 0.91, 95% confidence interval 0.67 to 1.24). The reduced numbers at one year, coming exclusively from two studies, preclude any useful conclusions for long term mortality (80/354 (22.6%) versus 78/372 (21.0%), Peto odds ratio 1.10, 95% confidence interval 0.77 to 1.57). Regional anaesthesia was associated with a tendency to a longer operation (weighted mean difference 4.8 minutes, 95% confidence interval 1.1 to 8.6 minutes), and a reduced risk of deep venous thrombosis (39/129 (30%) versus 61/37(76%); Peto odds ratio 0. 41, 95% confidence interval 0.23 to 0.72), although this conclusion is insecure due to possible selection bias in the subgroups in whom this outcome was measured. No other statistically significant differences in outcome were identified. There was insufficient evidence to draw any conclusions from a further two included trials, involving a total of 100 patients, which compared other types of anaesthesia. REVIEWER'S CONCLUSIONS: Regional anaesthesia and general anaesthesia appear to produce comparable results for most of the outcomes studied. Regional anaesthesia may reduce short-term mortality but no conclusions can be drawn for longer term mortality.

Adult↗
PubMed1997

Hip-Arg-Phe-, Hip-Phe-Arg- and Hip-His-Leu-cleaving dipeptidyl carboxypeptidases in human adrenal tumors.

Hip-Arg-Phe-, Hip-Phe-Arg- and Hip-His-Leu-cleaving dipeptidyl carboxypeptidase activities were measured in the supernatant (S2) and pellet (P2) fractions obtained by ultracentrifugation of human adrenal tumor preparations. Negligible enzyme activity was found in cortical tumor whereas highly significant activities were present in the P2 fractions of the two pheochromocytoma specimens. The hydrolysis rates, expressed in terms of the percent of added substrate were 58-66%/60 min for Hip-Phe-Arg, 55-58%/60 min for Hip-Arg-Phe and 19-30%/60 min for Hip-His-Leu. The angiotensin-converting enzyme inhibitor, captopril, differentially inhibited the enzyme splitting Hip-His-Leu versus the one cleaving Hip-Arg-Phe; Hip-Phe-Arg is probably the substrate of both. It is concluded that the Hip-Arg-Phe-cleaving enzyme in adrenomedullary tumor is probably identical to the purportedly novel dipeptidyl carboxypeptidase that we detected earlier in rabbit ear artery wall, which converts (Met5)-enkephalin-Arg6,Phe7 to (Met5)-enkephalin.

Adrenal Gland Neoplasms↗
PubMed2003

Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip.

OBJECTIVE: To compare responsiveness of the Harris Hip Score with generic measures (that is, the Short Form-36 (SF-36), and a test of walking speed and pain during walking) in patients with osteoarthritis (OA) of the hip. METHOD: The first 75 cases within the population of a randomised clinical trial on manual therapy and exercise therapy were selected for secondary analysis. Experienced (self reported) recovery by the patients after treatment (five weeks) was used as an external criterion for clinically relevant improvement. Responsiveness was evaluated by comparing responsiveness ratios and receiver operating characteristic curves. RESULTS: The responsiveness ratio for the Harris Hip Score was high (1.70) compared with walking speed (0.45), pain during walking (0.66), and the subscales of the SF-36-"bodily pain" (0.42) and "physical functioning" (0.36). The area under the curve also was highest for the Harris Hip Score (0.92) compared with walking speed (0.71), pain during walking (0.73), and the SF-36 subscales-bodily pain and physical functioning (both 0.66). CONCLUSION: The Harris Hip Score is more responsive than the test of walking speed, pain, and subscales for function of the SF-36 in patients with OA of the hip. The Harris Hip Score seems to be a suitable instrument to evaluate change in hip function in patients with OA of the hip.

Aged↗
PubMed2000

Quantification of progressive joint space narrowing in osteoarthritis of the hip: longitudinal analysis of the contralateral hip after total hip arthroplasty.

OBJECTIVE: The rate of progressive joint space narrowing in the contralateral hip after total hip arthroplasty (THA) for osteoarthritis (OA) and the factors which may predispose patients to more aggressive joint space narrowing remain undefined. The current study sought to evaluate the rate and pattern of, and risk factors for, progressive joint space narrowing in the contralateral hip after THA for OA. METHODS: Each patient who underwent THA for OA in 1984-1985 was followed up longitudinally, and annual anteroposterior (AP) pelvis radiographs were obtained. The radiographic joint space width (JSW) of each contralateral hip joint was quantified, and the rates of JSW narrowing were determined. Evaluation of potential risk factors for accelerated progression of joint space narrowing included age, sex, side of surgery, weight, height, body mass index (BMI), hip pain, etiology of OA, and Kellgren/Lawrence radiographic grade. RESULTS: Ninety-nine patients and 619 AP pelvis radiographs were evaluated. The median initial JSW was 3.48 mm (interquartile range 1.55). JSW declined in a linear manner at a median rate of 0.10 mm/year. The rate of decline between baseline and followup in 20 months was predictive of the overall slope. Two subpopulations were identified. Eighty-five percent of patients maintained a slow decline in JSW (< or =0.2 mm/year), and 15% exhibited an accelerated decline in JSW (>0.2 mm/year). Kellgren/ Lawrence radiographic grade > or =2 and a diagnosis of primary OA were each associated with a more rapid decline in JSW (P = 0.006 and P = 0.02, respectively). Initial JSW, age, sex, weight, height, BMI, and hip pain were not risk factors for rapid decline in JSW. CONCLUSION: Radiographic hip JSW may be reliably quantified and followed up longitudinally using standard AP radiographs. Progression of JSW narrowing in the contralateral hip after THA for OA proceeds in a linear manner over several years. A subpopulation of patients with accelerated narrowing of contralateral JSW may be identified within 20 months, and may represent a suitable population with which to assess the potential efficacy of new disease-modifying agents.

Adult↗
PubMed2000

Bone mineral density, hip axis length and risk of hip fracture in men: results from the Cornwall Hip Fracture Study.

Bone mineral density (BMD) and hip axis length (HAL) are important determinants of fracture risk in women. There are, however, few data concerning their predictive risk in men. The aim of this study was to determine the relationship between BMD, HAL and the risk of hip fracture in men. A case-control design was used. Cases were men aged 50 years and over with a minimal-trauma hip fracture admitted to the Royal Cornwall Hospital, Truro, during 1995-1997. Controls were recruited from a large general practice within the catchment area of the hospital. Subjects were invited for assessment of BMD at the lumbar spine and proximal femur, using dual-energy X-ray absorptiometry. HAL was assessed using machine software. Data concerning BMD were available in 62 fracture cases and 100 controls. After adjusting for age, height and weight, a reduction in BMD was associated with a significant increase in the risk of hip fracture [odds ratio (OR) 1.8-4.0 per standard deviation (SD) reduction, depending on site]. HAL was similar in both fracture and control groups (12.0 cm vs 12.0 cm). After adjusting for height, there was no association between HAL and the risk of hip fracture (OR per 1 SD increase in HAL = 0.9; 95% confidence interval 0.6, 1.3). Compared with those with a cervical fracture (n = 31), those with an intertrochanteric fracture (n = 31) had lower BMD at all skeletal sites, though this was significant for the trochanteric site only. It is concluded that BMD though not hip axis length is a risk factor for low-trauma hip fracture in Caucasian men.

Aged↗
PubMed1999

Concordance between hip ultrasonography and hip arthrography in the assessment of developmental dysplasia of the hip.

Controversy exists regarding the possibility of predicting hip reducibility in the congenitally dislocated hip, with arthrography still regarded as the gold standard in this situation. This study aims at assessing the degree of concordance between ultrasonography and arthrography in the detection of anatomic elements obstructing hip reduction. Forty-nine hips were studied both by ultrasonography and arthrography. Three anatomic sources of obstruction to reduction were assessed in each hip: ligamentum teres hypertrophy, inverted labrum, and the presence of soft tissue in the acetabulum. For each variable, congruence between ultrasound and arthrography was measured by kappa analysis. Values > 0.40 expressed sufficient concordance, and they were detected with regard to inverted labrum and the presence of soft tissue in the acetabulum. The results of this study suggest that ultrasonography may be considered a reliable technique for the prediction of the main causes of obstruction in the congenitally dislocated hip, such as inverted labrum and soft tissue in the acetabulum.

Arthrography↗
PubMed1982

Anterolateral compared to posterior approach in total hip arthroplasty: differences in component positioning, hip strength, and hip motion.

In order to identify the functional advantages or disadvantages between the anterolateral and the posterior approaches to total hip arthroplasty, measurements of prosthetic position, hip-muscle strength, and hip joint mobility were made after Müller total hip arthroplasty without osteotomy in 52 patents operated through a posterior approach and 41 patients operated through an anterolateral approach. Men and women who had the posterior approach had less prosthetic component anteversion and longer neck lengths, with resultant more lateral and distal placement of the greater trochanter than groups with the anterolateral approach. Groups with the posterior approach had more normal hip abductor-muscle strength and more inward rotation on the operated side than group with the anterolateral approach. Groups with the anterolateral approach had more outward rotation on the operated side than groups with the posterior approach. These differences in function were related to the surgical approach rather than to differences in component position. An understanding of these observations should be used for selection of the surgical approach for the patient on an individual basis.

Biomechanical Phenomena↗
PubMed1998

Total hip reconstruction in the anatomically distorted hip. Cemented versus hybrid total hip arthroplasty.

Recent reports in the literature strongly support the idea that cement is the optimum form of fixation of the femoral component in total hip replacement. For hybrid total hip arthroplasty, we used a cemented cup instead of an uncemented cup since this was inevitable in cases of poorly developed acetabulum. The uncemented cone femoral component is also beneficial in cases of extremely narrow and cylindrical configuration of the medullary cavity of untreated congenital dislocation of the hips (CDH) and tuberculosis or septic arthritis in childhood. We reviewed the clinical result of a consecutive series of patients with cemented total hip arthroplasty (THA) compared with recent studies on hybrid reconstruction using survivorship analysis. This subsequent study involved a hybrid uncemented Wagner cone femoral component and a cemented acetabular component with roof reinforcement by additional impacted cancellous allograft with hydroxyapatite (HA). We believe that early failure of the cemented components was due to an adverse effect of thin cement mantles around cemented femoral stems as well as the cemented cup in THA. In addition, 8 patients who received our modification of the Charnley CDH component had poor results even though we reduced the stem geometry and thickness. Furthermore, intraoperative fracture and splitting of the proximal femur was a major complication during implantation. Contrary to expectations, the results of these hybrid reconstructions were extremely encouraging (average follow-up period of 2-4.5 years). In addition to our experience of the cemented versus hybrid THA involving the uncemented Wagner femoral component, we have determined positive indications for the untreated and severely distorted anatomy of bilateral CDH for which surgical interventions for reconstruction were not recommended before.

Adult↗
PubMed2001

Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987-99.

We studied the rates of revision for 53,698 primary total hip replacements (THRs) in nine different groups of disease. Factors which have previously been shown to be associated with increased risk of revision, such as male gender, young age, or certain types of uncemented prosthesis, showed important differences between the diagnostic groups. Without adjustment for these factors we observed an increased risk of revision in patients with paediatric hip diseases and in a small heterogeneous 'other' group, compared with patients with primary osteoarthritis. Most differences were reduced or disappeared when an adjustment for the prognostic factors was made. After adjustment, an increased relative risk (RR) of revision compared with primary osteoarthritis was seen in hips with complications after fracture of the femoral neck (RR = 1.3, p = 0.0005), in hips with congenital dislocation (RR = 1.3, p = 0.03), and in the heterogenous 'other' group. The analyses were also undertaken in a more homogenous subgroup of 16,217 patients which had a Charnley prosthesis implanted with high-viscosity cement. The only difference in this group was an increased risk for revision in patients who had undergone THR for complications after fracture of the femoral neck (RR = 1.5, p = 0.0005). THR for diagnoses seen mainly among young patients had a good prognosis, but they had more often received inferior uncemented implants. If a cemented Charnley prosthesis is used, the type of disease leading to THR seems in most cases to have only a minor influence on the survival of the prosthesis.

Adolescent↗
PubMed1980

Intertrochanteric osteotomy and total hip replacement for bilateral osteoarthritis of the hip: consideration of the nonoperated-on hip.

In early stages of osteoarthritis, osteotomy produced a satisfactory result with no adverse effects and significant improvement in the nonoperated-on contralateral hip. In many cases of unilateral osteotomy in a group with preoperative radiologic scores above 70, the function was either improved or unchanged in the nonoperated-on hip. In many cases with scores below 70, there was deterioration of joint structure. Bilateral osteotomy is recommended only in the cases with preoperative radiologic scores below 70. Osteotomy was prescribed on the contralateral hip within a short period of time after aarthroplasty. Deterioration occurred in some contralateral nonoperated-on hips when the preoperative clinical scores were high, while improvement generally occurred when preoperative scores were low.

Adult↗
PubMed1996

[The biomechanics of the hip joint using new diagnostic aspects in the field of hip joint dysplasia. Constructive criticism of hip dysplasia diagnosis and present marketable breeding methods with an outlook on future perspectives and possibilities. Part I].

In absence of basic canine hip biomechanics, a specific, consequent three dimensional concept to evaluate the coxofemoral joint was developed for the dog. With the help of a new method to radiologically demonstrate the hip in a physiological standing position several new clinically relevant aspects could be further investigated. For example the breed specific anatomical differences in the hip, and dynamics and the background on "iatrogenic luxations" in HD diagnostics could be shown. The caudal luxation and the growth abnormalities of the hip and their consequences on the whole leg (antetorsion syndrome) as a consequence of inadequate breeding could be demonstrated.

Animals↗