Gender comparisons between unilateral and bilateral landings.

PubMed

Weinhandl, Joshua T; Joshi, Mukta; O'Connor, Kristian M

2010-11-01

The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Among these injuries, those occurring to the ACL are commonly observed during landing maneuvers. The purpose of this study was to determine gender differences in landing strategies during unilateral and bilateral landings. Sixteen male and 17 female recreational athletes were recruited to perform unilateral and bilateral landings from a raised platform, scaled to match their individual jumping abilities. Three-dimensional kinematics and kinetics of the dominant leg were calculated during the landing phase and reported as initial ground contact angle, ranges of motion (ROM) and peak moments. Lower extremity energy absorption was also calculated for the duration of the landing phase. Results showed that gender differences were only observed in sagittal plane hip and knee ROM, potentially due to the use of a relative drop height versus the commonly used absolute drop height. Unilateral landings were characterized by significant differences in hip and knee kinematics that have been linked to increased injury risk and would best be classified as "stiff" landings. The ankle musculature was used more for impact absorption during unilateral landing, which required increased joint extension at touchdown and may increase injury risk during an unbalanced landing. In addition, there was only an 11% increase in total energy absorption during unilateral landings, suggesting that there was a substantial amount of passive energy transfer during unilateral landings.

Worse health-related quality of life and hip function in female patients with elevated chromium levels

PubMed Central

Hussey, Daniel K; Madanat, Rami; Donahue, Gabrielle S; Rolfson, Ola; Muratoglu, Orhun K; Malchau, Henrik

2016-01-01

Background and purpose Blood metal ion levels can be an indicator for detecting implant failure in metal-on-metal (MoM) hip arthroplasties. Little is known about the effect of bilateral MoM implants on metal ion levels and patient-reported outcomes. We compared unilateral patients and bilateral patients with either an ASR hip resurfacing (HR) or an ASR XL total hip replacement (THR) and investigated whether cobalt or chromium was associated with a broad spectrum of patient outcomes. Patients and methods From a registry of 1,328 patients enrolled in a multicenter prospective follow-up of the ASR Hip System, which was recalled in 2010, we analyzed data from 659 patients (311 HR, 348 THR) who met our inclusion criteria. Cobalt and chromium blood metal ion levels were measured and a 21-item patient-reported outcome measures (PROMs) questionnaire was used mean 6 years after index surgery. Results Using a minimal threshold of ≥7 ppb, elevated chromium ion levels were found to be associated with worse health-related quality of life (HRQoL) (p < 0.05) and hip function (p < 0.05) in women. These associations were not observed in men. Patients with a unilateral ASR HR had lower levels of cobalt ions than bilateral ASR HR patients (p < 0.001) but similar levels of chromium ions (p = 0.09). Unilateral ASR XL THR patients had lower chromium and cobalt ion levels (p < 0.005) than bilateral ASR XL THR patients. Interpretation Chromium ion levels of ≥7 ppb were associated with reduced functional outcomes in female MoM patients. PMID:27459602

Relationship between selected measures of strength and hip and knee excursion during unilateral and bilateral landings in women.

PubMed

McCurdy, Kevin; Walker, John; Armstrong, Rusty; Langford, George

2014-09-01

The purpose of this study was to compare the relationship between several measures of single-joint, isometric, eccentric, and squat strength and unilateral and bilateral landing mechanics at the hip and knee in women. Twenty six healthy female subjects with previous athletic experience (height, 165.1 ± 7.01 cm; mass, 60.91 ± 7.14 kg; age, 20.9 ± 1.62 years) participated in this study. Hip and knee mechanics were measured using the MotionMonitor capture system (Innovative Sports Training, Inc.) with 3-dimensional electromagnetic sensors during bilateral (60 cm) and unilateral drop jumps (30 cm). On a separate day, isometric hip extension, external rotation, and abduction strength (lbs) were measured using a handheld dynamometer (Hoggan Health Industries, Inc.). Eccentric and isometric knee strength were measured on the Biodex IV Isokinetic Dynamometer (Biodex Medical Systems, Inc.). Free weight was used to measure the bilateral squat and a modified single-leg squat. The strongest correlations were found between squat strength and knee valgus (-0.77 ≤ r ≤ -0.83) and hip adduction (-0.5 ≤ r ≤ -0.65). After controlling for squat strength, hip external rotation strength and unilateral knee valgus (-0.41), hip abduction strength and bilateral knee valgus (-0.43), and knee flexion strength and bilateral hip adduction (-0.57) remained significant. Eccentric knee flexion strength and unilateral knee internal rotation was the only significant correlation for eccentric strength (-0.40). Squat strength seems to be the best predictor of knee valgus and was consistently related to hip adduction. Isometric and eccentric measures demonstrated few significant correlations with hip and knee excursion while demonstrating a low-to-moderate relationship. Hip and knee flexion and rotation do not seem to be related to strength. Squat strength should receive consideration during risk assessment for noncontact knee injury.

Relationship of unilateral total hip arthroplasty (THA) to contralateral and ipsilateral knee joint degeneration - a longitudinal 3T MRI study from the Osteoarthritis Initiative (OAI).

PubMed

Jungmann, P M; Nevitt, M C; Baum, T; Liebl, H; Nardo, L; Liu, F; Lane, N E; McCulloch, C E; Link, T M

2015-07-01

To evaluate the association of prevalent unilateral total hip arthroplasty (THA) with worsening of degenerative knee abnormalities and clinical outcomes in the ipsilateral and contralateral knee. Both knees of 30 individuals in the Osteoarthritis Initiative (OAI) with unilateral THA (n = 14 left, n = 16 right) at baseline were assessed at baseline and at 4-year follow-up for Whole-organ MR Imaging Scores (WORMS), cartilage T2 relaxation times (only available for right knees), Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores and upper leg isometric strength. Right knees of 30 individuals without THA were analyzed as controls. Contralateral knees were compared to ipsilateral knees with paired t-tests and to control knees with multivariate regression analysis adjusting for covariates. In paired analyses, compared to ipsilateral knees, contralateral knees had higher WORMS total (P = 0.008) and cartilage scores (P = 0.007) at baseline. Over 4 years contralateral knees worsened more on WORMS total score (P = 0.008). Cartilage T2 values were higher in knees contralateral to the THA (baseline, P = 0.02; follow-up, P < 0.001). Contralateral knees had greater declines in knee extension strength (P = 0.04) and had a trend for greater worsening in WOMAC pain, stiffness, function and total scores (P = 0.04-0.09). Similar results were found comparing contralateral knees with control knees in multivariate regression models. Prevalent unilateral THA is associated with an greater progression of degenerative findings for the knee contralateral to THA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Evaluation of local bone turnover in painful hip by 18F-fluoride positron emission tomography.

PubMed

Kobayashi, Naomi; Inaba, Yutaka; Tezuka, Taro; Ike, Hiroyuki; Kubota, So; Kawamura, Masaki; Saito, Tomoyuki

2016-04-01

The diagnosis of painful hip without remarkable radiographic findings is still challenging. In recent years, femoroacetabular impingement (FAI) has been recognized as an important cause of painful hip. The hypothesis of this study was that local bone turnover may be accelerated in painful hip, especially in FAI lesions. To test this, patients with unilateral symptomatic hip underwent F-fluoride PET, which directly correlates with osteoblast activity and therefore bone turnover. In total, 27 patients with unilateral symptomatic painful hip were enrolled. The diagnosis included 15 cam-type FAI cases, six labral tear cases, and six early-stage osteoarthritis cases. The region of interest for cam and pincer lesions was identified and the maximum standardized uptake value (SUVmax) in these regions and the contralateral asymptomatic regions were measured by F-fluoride PET. The SUVmax ratio was defined as symptomatic side SUVmax/asymptomatic side SUVmax. The α angle and center-edge angle were measured by plain radiograph. The SUVmax of both cam and pincer lesions were significantly higher than the SUVmax of the contralateral regions (P<0.0001). The cam SUVmax ratio correlated positively with the α angle (r=0.5, P=0.007). Patients with an α angle of more than or equal to 60° had a significantly higher cam SUVmax ratio than the less than 60° group (P=0.017). This study showed the accelerated local bone turnover in painful hip, partly in FAI cases. Accelerated bone turnover may play a significant role in FAI pathophysiology; therefore, its recognition by imaging modality may contribute toward a more sensitive diagnosis in painful hip.

Outcome after cementless total hip arthroplasty for arthritic hip in patients with residual poliomyelitis: a case series.

PubMed

Cho, Yoon J; Lee, Choong H; Chun, Young S; Rhyu, Kee H

2016-09-29

In this case series, we investigated the outcome of cementless total hip arthroplasty (THA) for advanced hip osteoarthritis in patients with residual poliomyelitis to evaluate its clinical usefulness for these patients. 11 unilateral cementless primary THA were performed to arthritic hips in patients with residual poliomyelitis. 7 were in paralytic and 4 were in nonparalytic limbs. The mean follow-up duration was 79.9 months. Retrospective clinical evaluations with various scores and radiological evaluations were made. Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Short-form (SF)-36 physical scales were significantly improved after the surgery. However, UCLA activity score and SF-36 mental scale were not. Because of remaining leg length discrepancies, all but 1 noted a residual limp. In nonparalytic hip, functional acetabular cup inclination during weight bearing significantly increased from installed inclination. Other than 1 case of posterior dislocation, no complications were observed. Although the overall result itself is excellent, THA for these patients cannot improve limp, physical activity and mental status. Surgeons should be aware of the change of the inclination of acetabular cup during mobilisation, especially for THA in contralateral hip.

Factors Contributing to Pelvis Instability in Female Adolescent Athletes During Unilateral Repeated Partial Squat Activity

PubMed Central

Scarborough, Donna Moxley; Linderman, Shannon; Berkson, Eric M.; Oh, Luke S.

2017-01-01

Objectives: Unilateral partial squat tasks are often used to assess athletes’ lower extremity (LE) neuromuscular control. Single squat biomechanics such as lateral drop of the non-stance limb’s pelvis have been linked to knee injury risk. Yet, there are limited studies on the factors contributing to pelvic instability during the unilateral partial squat such as anatomical alignment of the knee and hip strength. The purpose of this study was 1) to assess the influence of leg dominance on pelvic drop among female athletes during the repeated unilateral partial squat activity and 2) to investigate the contributions that lower limb kinematics and hip strength have on pelvis drop. Methods: 42 female athletes (27= softball pitchers, 15=gymnasts, avg age=16.48 ± 2.54 years) underwent lower limb assessment. The quadriceps angle (Q angle) and the average of 3 trials for hip abduction and extension strength (handheld dynamometer measurements) were used for analyses. 3D biomechanical analysis of the repeated unilateral partial squat activity followed using a 20 motion capture camera system which created a 15 segment model of each subject. The subject stood on one leg at the lateral edge of a 17.78 cm box with hands placed on the hips and squatted so that the free hanging contralateral limb came as close to the ground without contact for 5 continuous repetitions. One trial for each limb was performed. Peak pelvic drop and ankle, knee and hip angles and torques (normalized by weight) at this time point were calculated using Visual 3D (C-Motion) biomechanical software. Paired T-test, Spearman correlations and multiple regression model statistical analyses were performed. Results: Peak pelvic drop during the unilateral partial squat did not differ significantly on the basis of limb dominance (p=0.831, Dom: -3.40 ± 5.10° , ND: -3.46 ± 4.44°). Peak pelvic drop displayed a Spearman correlation with the functional measure of hip abduction/adduction (ABD/ADD) angle (rs= 0.627, p< 0.001) (Figure 1). No association was noted between peak pelvic drop and anatomical measures of Q angle or isometric hip extension strength. A multiple regression was performed to predict pelvis drop angle from the following 6 variables: isometric hip ABD strength, hip ABD/ADD angle, hip internal/external rotation angle, ankle supination/pronation (S/P) angle, height and weight. These variables statistically predicted pelvis drop, F(6,73) = 17.848, p < .0005, R2 = 0.595. The strongest combined predictor variables for pelvic drop in the female athletes were hip abduction/ adduction angle and strength followed by subject’s weight and ankle S/P angle (Table 1). Conclusion: Peak pelvic drop during the repeated unilateral partial squat activity did not correlate significantly with Q angle and hip extension strength. Instead, peak pelvic drop appears more related to a combination of biomechanical limb positioning, hip ABD strength and subject demographics. The regression model run on the repeated unilateral partial squat demonstrates predictive power of this dynamic assessment tool based on kinematic measures across multiple joints. Results could guide clinician screening for excessive pelvic drop in female athletes and based on the predictive model make recommendations for corrective conditioning to help prevent knee injury and guide return to sport following LE surgery. Table 1: Multivariate linear regression model for pelvic drop, Isometric hip strength and lower extremity kinematics during repeated partial squat activity among female athletes. Variable P Isometric hip abduction strength 0.034* Hip Abduction/Adduction Angle <0.001* Hip Internal/External Rotation Angle 0.936 Ankle Internal/External Rotation Angle 0.072 Height 0.398 Weight 0.011* * Level of significance established at p<0.05

Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study.

PubMed

Carling, Malin S; Jeppsson, Anders; Eriksson, Bengt I; Brisby, Helena

2015-03-28

There is a high prevalence of blood product transfusions in orthopedic surgery. The reported prevalence of red blood cell transfusions in unselected patients undergoing hip or knee replacement varies between 21% and 70%. We determined current blood loss and transfusion prevalence in total hip and knee arthroplasty when tranexamic acid was used as a routine prophylaxis, and further investigated potential predictors for excessive blood loss and transfusion requirement. In total, 193 consecutive patients undergoing unilateral hip (n = 114) or knee arthroplasty (n = 79) were included in a prospective observational study. Estimated perioperative blood loss was calculated and transfusions of allogeneic blood products registered and related to patient characteristics and perioperative variables. Overall transfusion rate was 16% (18% in hip patients and 11% in knee patients, p = 0.19). Median estimated blood loss was significantly higher in hip patients (984 vs 789 mL, p < 0.001). Preoperative hemoglobin concentration was the only independent predictor of red blood cell transfusion in hip patients while low hemoglobin concentration, body mass index, and operation time were independent predictors for red blood cell transfusion in knee patients. The prevalence of red blood cell transfusion was lower than previously reported in unselected total hip or knee arthroplasty patients. Routine use of tranexamic acid may have contributed. Low preoperative hemoglobin levels, low body mass index, and long operation increase the risk for red blood cell transfusion.

Manual calf massage and passive ankle motion reduce the incidence of deep vein thromboembolism after total hip arthroplasty.

PubMed

Imai, Norio; Ito, Tomoyuki; Suda, Ken; Miyasaka, Dai; Endo, Naoto

2017-07-01

Venous thromboembolism is one of the general complications following total hip arthroplasty, wherein various preventive treatments have been recommended. Several studies reported that venous thromboembolism incidence after total hip arthroplasty was similar in patients who were administered prophylaxis with a conventional mechanical procedure alone, and those who were administered pharmacological anticoagulation therapy. Therefore, the optimum methods of prophylaxis are still controversial. The purpose of this study was to investigate whether manual calf massage and passive ankle motion could lower the risk for venous thromboembolism after total hip arthroplasty. We retrospectively reviewed the data of 126 consecutive patients undergoing elective primary unilateral total hip arthroplasty wherein manual calf massage and passive ankle motion were performed after the surgery at our hospitals between January and October 2014. The 138 patients of the control group underwent total hip arthroplasty using the same surgical approach and pre- and postoperative protocols without this mechanical prophylaxis between January and December 2013. This mechanical prophylaxis was performed simultaneously 30 times during approximately 10 s; these procedures were repeated thrice immediately after total hip arthroplasty. Duplex ultrasonography was performed to observe the veins of both legs in all the patients on postoperative day 7. The incidence of deep vein thrombosis was 6.52% and 0.79% in the control and manual calf massage and passive ankle motion groups, respectively. The odds ratio for the manual calf massage and passive ankle motion groups was 8.72. Performing this mechanical prophylaxis reduced the incidence of venous thromboembolism after total hip arthroplasty. This mechanical prophylaxis is not only simple and easy, but is also safe and inexpensive. We therefore recommend that manual calf massage and passive ankle motion be performed in patients who will undergo total hip arthroplasty, if deep vein thrombosis does not exist before the surgery. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy?

PubMed

Tsai, Tsung-Yuan; Dimitriou, Dimitris; Li, Jing-Sheng; Kwon, Young-Min

2016-06-01

The objective was to evaluate whether total hip arthroplasty (THA) using haptic robot assistance restores hip geometry better than the free-hand technique. Twelve robot-assisted and 14 free-hand unilateral THA patients underwent CT scan for three-dimensional (3D) hip models. The anteversion, inclination and hip joint centre locations of the native and implanted hips in each patient were quantified and compared. Significant increase of combined anteversion by 19.1 ± 11.7° and 23.5 ± 23.6° and decrease of cup inclination by 16.5 ± 6.0° and 10.2 ± 6.8° were observed in the robot-assisted and the free-hand THAs, respectively. Less variation in the difference of the component orientations (max 11.1 vs 18.3°) and the femoral head centre (max 4.5 vs 6.3 mm) were found in the robot-assisted group. This study demonstrated that neither robot-assisted nor free-hand THAs had fully restored native hip geometry. However, the higher precision of the robot-assisted THA suggested that it has potential utility in restoring the native hip geometry. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Digital templating for THA: a simple computer-assisted application for complex hip arthritis cases.

PubMed

Hafez, Mahmoud A; Ragheb, Gad; Hamed, Adel; Ali, Amr; Karim, Said

2016-10-01

Total hip arthroplasty (THA) is the standard procedure for end-stage arthritis of the hip. Its technical success relies on preoperative planning of the surgical procedure and virtual setup of the operative performance. Digital hip templating is one methodology of preoperative planning for THA which requires a digital preoperative radiograph and a computer with special software. This is a prospective study involving 23 patients (25 hips) who were candidates for complex THA surgery (unilateral or bilateral). Digital templating is done by radiographic assessment using radiographic magnification correction, leg length discrepancy and correction measurements, acetabular component and femoral component templating as well as neck resection measurement. The overall accuracy for templating the stem implant's exact size is 81%. This percentage increased to 94% when considering sizing within 1 size. Digital templating has proven effective, reliable and essential technique for preoperative planning and accurate prediction of THA sizing and alignment.

Different methods of treatment related to the bilateral occurrence of Perthes' disease.

PubMed

Futami, T; Suzuki, S

1997-11-01

We treated 98 consecutive patients with Perthes' disease by a unilateral brace in external rotation, flexion and abduction and a further consecutive 110 by a bilateral cast with the hips in internal rotation and abduction. During treatment in the unilateral brace, six (6.1%) hips on the opposite side developed evidence of Perthes' disease and one developed this after the brace had been removed. In children managed in bilateral casts, no contralateral Perthes' disease was seen. Adequate containment of the femoral head may prevent subsequent changes in the opposite hip.

Anticipatory postural adjustments during lateral step motion in patients with hip osteoarthritis.

PubMed

Tateuchi, Hiroshige; Ichihashi, Noriaki; Shinya, Masahiro; Oda, Shingo

2011-02-01

Patients with hip osteoarthritis (OA) have difficulty with mediolateral postural control. Since the symptom of hip OA includes joint pain, which mostly occurs upon initial movement, patients with hip OA might have disabling problems with movement initiation. This study aimed to identify the movement strategy during the anticipatory postural adjustments in the lateral step motion in patients with hip OA. We studied 18 female subjects with unilateral hip OA and 10 healthy subjects, and measured temporal, kinetic, and kinematic variables. Patients with hip OA required a longer duration of anticipation phase than the control subjects, the total duration of lateral stepping was not different between the groups. Displacement of the center of mass to the supporting (affected) side during the anticipation phase was not different between the two groups. These findings suggest that, in patients with hip OA, the center of mass slowly moved to the affected side. Furthermore, patients with hip OA showed greater shift of the trunk to the supporting side than did the control subjects. These movement characteristics might contribute to the achievement of both protection of the affected hip joint and quickness in the subsequent lateral step in patients with hip OA.

The pubo-femoral distance decreases with Pavlik harness treatment for developmental dysplasia of the hip in newborns.

PubMed

Maranho, Daniel Augusto; Donati, Felipe Nunes; Dalto, Vitor Faeda; Nogueira-Barbosa, Marcello Henrique

2017-09-01

To evaluate the evolution of the ultrasonographic pubo-femoral distance (PFD) before and after Pavlik harness treatment for developmental dysplasia of the hip (DDH) in newborns. Twenty-five patients (16.7 ± 10.4 days; 19 females, six males) diagnosed with DDH and treated using the Pavlik harness were included. Eighteen patients had bilateral, and seven unilateral DDH, with a total of 43 dysplastic hips. The seven non-dysplastic hips in unilateral cases were used for comparison. The PFD was measured in the coronal and axial planes with the hip flexed to approximately 90°, before and after an average of 93 days of treatment. The femoral head coverage was assessed in the coronal plane, and correlated with PFD values. In dysplastic hips, the mean PFD decreased from 6.1 ± 1.8 mm to 3.0 ± 0.7 mm in the axial (adjusted difference, 2.9 mm; p < 0.01), and from 5.9 ± 2.0 to 3.0 ± 0.6 mm in the coronal plane (adjusted difference 2.7 mm; p < 0.01). The femoral head coverage increased from 30.8 to 62.1%, and the mean differences of femoral head coverage and PFD were significantly correlated (p < 0.001). There was no difference between treated dysplastic and non-dysplastic hips. There was high intra- and inter-observer agreement for PFD measurements. The PFD decreased significantly after DDH treatment using the Pavlik harness in newborns, and showed significant correlation with the femoral head coverage improvement. PFD might be a reliable tool for monitoring DDH treatment in newborns treated using the Pavlik harness.

Canine total hip replacement using a cementless threaded cup and stem: a review of 55 cases.

PubMed

Denny, H R; Linnell, M; Maddox, T W; Comerford, E J

2018-06-01

To determine the long-term results and complications associated with the Helica ® cementless hip endoprosthesis system. Retrospective study of 55 consecutive Helica total hip replacements performed between January 2010 and February 2015. A total of 55 total hip replacements were performed in 50 dogs; 45 dogs had unilateral hip replacements, and five had staged bilateral replacements. A total of 23 first-generation short femoral stems were implanted in 22 dogs, of which nine cases (39%) experienced complications and 19 (86%) recovered satisfactorily when revisions were included; 31 second-generation femoral stems were implanted in 28 dogs, of which 10 cases (32%) experienced complications, and 26 (93%) made satisfactory recoveries, including revisions. In 36 dogs for which data were available, postoperative Liverpool Osteoarthritis in Dogs scores were significantly reduced compared to preoperative scores. Complications occurred in a total of 19 cases (34·5%; 95% confidence interval: 22 to 47·1%); the most common was aseptic loosening of the femoral stem [11 cases (20%; 95% confidence interval: 9·4 to 30·6%)]. Following multivariable analysis, no risk factors were identified for overall complications, but there was a significant association of implant type (first-generation short stem) with loosening (odds ratio 4·9, 95% confidence interval: 1·1 to 22·1, P=0·034). This study found the Helica hip endoprosthesis system to be effective in the management of hip dysplasia and osteoarthritis in dogs. Aseptic loosening of the femoral stem remains the most common complication but appears to have been significantly reduced with the introduction of the second-generation stem. © 2018 British Small Animal Veterinary Association.

Hip Strength Testing of Soccer Players With Long-Standing Hip and Groin Pain: What are the Clinical Implications of Pain During Testing?

PubMed

Rafn, Bolette S; Tang, Lars; Nielsen, Martin P; Branci, Sonia; Hölmich, Per; Thorborg, Kristian

2016-05-01

To investigate whether self-reported pain during hip strength testing correlates to a large degree with hip muscle strength in soccer players with long-standing unilateral hip and groin pain. Cross-sectional study. Clinical assessments at Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Denmark. Twenty-four male soccer players with unilateral long-standing hip and groin pain. The soccer players performed 5 reliable hip muscle strength tests (isometric hip flexion, adduction, abduction, isometric hip flexion-modified Thomas test, and eccentric hip adduction). Muscle strength was measured with a hand-held dynamometer, and the players rated the pain during testing on a numerical rating scale (0-10). In 4 tests (isometric hip adduction, abduction, flexion, and eccentric adduction), no significant correlations were found between pain during testing and hip muscle strength (Spearman rho = -0.28 to 0.06, P = 0.09-0.39). Isometric hip flexion (modified Thomas test position) showed a moderate negative correlation between pain and hip muscle strength (Spearman rho = -0.44, P = 0.016). Self-reported pain during testing does not seem to correlate with the majority of hip muscle strength tests used in soccer players with long-standing hip and groin pain.

Performance Demands in Softball Pitching: A Comprehensive Muscle Fatigue Study.

PubMed

Corben, Jeffrey S; Cerrone, Sara A; Soviero, Julie E; Kwiecien, Susan Y; Nicholas, Stephen J; McHugh, Malachy P

2015-08-01

Monitoring pitch count is standard practice in minor league baseball but not in softball because of the perception that fast-pitch softball pitching is a less stressful motion. To examine muscle fatigue after fast-pitch softball performances to provide an assessment of performance demand. Descriptive laboratory study. Bilateral strength measurements (handheld dynamometer) were made on 19 female softball pitchers (mean age [±SD], 15.2 ± 1.2 years) before and after pitching a game (mean number of pitches, 99 ± 21; mean innings pitched, 5 ± 1). A total of 20 tests were performed on the dominant and nondominant sides: forearm (grip, wrist flexion/extension, pronation/supination, elbow flexion/extension), shoulder (flexion, abduction/adduction, external/internal rotation, empty can test), scapula (middle/lower trapezius, rhomboid), and hip (hip flexion/extension, abduction/adduction). Fatigue (percentage strength loss) was categorized based on bilateral versus unilateral presentation using paired t tests: bilateral symmetric (significant on dominant and nondominant and not different between sides), bilateral asymmetric (significant on dominant and nondominant but significantly greater on dominant), unilateral asymmetric (significant on dominant only and significantly greater than nondominant), or unilateral equivocal (significant on dominant only but not different from nondominant). Bilateral symmetric fatigue was evident for all hip (dominant, 19.3%; nondominant, 15.2%) and scapular tests (dominant, 19.2%; nondominant, 19.3%). In general, shoulder tests exhibited bilateral asymmetric fatigue (dominant, 16.9%; nondominant, 11.6%). Forearm tests were more variable, with bilateral symmetric fatigue in the elbow flexors (dominant, 22.5%; nondominant, 19.2%), and wrist flexors (dominant, 21.6%; nondominant, 19.0%), bilateral asymmetric fatigue in the supinators (dominant, 21.8%; nondominant, 15.5%), unilateral asymmetric fatigue in the elbow extensors (dominant, 22.1%; nondominant, 11.3%), and unilateral equivocal fatigue in the pronators (dominant, 18.8%; nondominant, 15.2%) and grip (dominant, 11.4%; nondominant, 6.6%). The mean (±SD) pitch velocity was 49 ± 4 mph, with a small loss of velocity from the first to last inning pitched (3.4% ± 5.0%, P < .01). Fast-pitch softball pitching resulted in profound bilateral fatigue in the hip and scapular muscles, with more selective fatigue in the shoulder and arm muscles. These findings emphasize the importance of strength in the proximal musculature to provide a stable platform for the arm to propel the ball. © 2015 The Author(s).

Bilateral femoral neck stress fractures in military recruits with unilateral hip pain.

PubMed

Moo, Ing How; Lee, Y H D; Lim, K K; Mehta, K V

2016-10-01

Femoral neck stress fractures are rare and can be easily missed and failure to diagnose these injuries early can lead to avascular necrosis, malunion and osteoarthritis. It is important to have a high index of suspicion for femoral neck stress fractures in military recruits. We present three cases of bilateral femoral neck fractures in military recruits, all presenting with unilateral hip symptoms and signs. All the asymptomatic contralateral hips had femoral neck stress fractures diagnosed by screening MRI. Tension type and displaced femoral neck fractures were treated surgically. All the fractures managed healing without complications. Military recruits with unilateral groin pain should have an early referral for MRI hip to rule out femoral neck stress fractures and those military personnel with ipsilateral femoral neck fracture should have MRI of the contralateral hip. Two of the patients had vitamin D deficiency, of which one had elevated parathyroid hormones and low bone mineral density. Our case series highlights the significance of vitamin D deficiency among military recruits. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Matched cohort study of topical tranexamic acid in cementless primary total hip replacement.

PubMed

Sanz-Reig, Javier; Mas Martinez, Jesus; Verdu Román, Carmen; Morales Santias, Manuel; Martínez Gimenez, Enrique; Bustamante Suarez de Puga, David

2018-03-29

Tranexamic acid has been shown to be effective in reducing blood loss after total hip replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use to reduce blood loss after primary total hip replacement and to compare these outcomes with those of a matched control group from a similar cohort that did not have received tranexamic acid. This is a prospective matched control study to assess the effect of a 2 g topical tranexamic acid in 50 mL physiological saline solution in total hip replacement. Primary outcomes were hemoglobin and hematocrit drop, and total blood loss. Secondary outcomes were transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events. We could match 100 patients to a control group. There were no statistical significantly differences between the two groups. The hemoglobin and hematocrit postoperative values were significantly higher in topical tranexamic acid group than in control group (P < 0.001). The mean total blood loss was 769 in topical tranexamic acid group and 1163 in control group with significant differences (P = 0.001), which meant 34% reduction in total blood loss. Length of stay was lower in topical tranexamic acid group. The risk of deep vein thrombosis and pulmonary events did not increase. A single dose of 2 g tranexamic acid in 50 mL physiological saline solution topical administration was effective and safe in reducing bleeding in patients undergoing unilateral primary non-cemented total hip replacement compared to a matched control group.

Osteonecrosis of the hip in patients with aplastic anemia.

PubMed Central

Park, Jeongmi; Jun, Jeongsu; Kim, Yongsik; Lee, Jongwook; Kim, Chunchu; Hahn, Seongtae

2002-01-01

The incidence and clinical and magnetic resonance imaging features of osteonecrosis of the hip were evaluated in patients with aplastic anemia. Two hundred and forty-one patients with aplastic anemia were examined using MR imaging of bone marrow during the five years from 1994 to 1998. Osteonecrosis of the hip was observed on MR imaging in nineteen (15 males and 4 females, mean age 35 yr) of the 241 patients. It was present in both hips in 14 patients, and there were five cases with unilateral occurrence, with a total of 33 involved hips. All except for five hips with associated bone marrow edema revealed increased fatty marrow conversion in the proximal femoral metaphysis. In nine patients, osteonecrosis was detected without any pain. Five patients already had osteonecrosis before any medication was administered. Twelve patients received antilymphocyte globulin, and seven patients received a low dose of steroids before the MR diagnosis of osteonecrosis. Osteonecrosis of the hip frequently develops in patients with aplastic anemia (7.9%), associated with fatty marrow conversion of the proximal femoral metaphysis. PMID:12483006

Displacement of the hip center of rotation after arthroplasty of Crowe III and IV dysplasia: a radiological and biomechanical study.

PubMed

Abolghasemian, Mansour; Samiezadeh, Saeid; Jafari, Davood; Bougherara, Habiba; Gross, Allan E; Ghazavi, Mohammad T

2013-06-01

To study the direction and biomechanical consequences of hip center of rotation (HCOR) migration in Crowe type III and VI hips after total hip arthroplasty, post-operative radiographs and CT scans of several unilaterally affected hips were evaluated. Using a three-dimensional model of the human hip, the HCOR was moved in all directions, and joint reaction force (JRF) and abductor muscle force (AMF) were calculated for single-leg stance configuration. Comparing to the normal side, HCOR had displaced medially and inferiorly by an average of 23.4% and 20.8%, respectively, of the normal femoral head diameter. Significant decreases in JRF (13%) and AMF (46.13%) were observed in a presumptive case with that amount of displacement. Isolated inferior displacement had a small, increasing effect on these forces. In Crowe type III and IV hips, the HCOR migrates inferiorly and medially after THA, resulting in a decrease in JRF, AMF, and abductor muscle contraction force. Copyright © 2013 Elsevier Inc. All rights reserved.

Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement.

PubMed

Reito, Aleksi; Elo, Petra; Nieminen, Jyrki; Puolakka, Timo; Eskelinen, Antti

2016-02-01

There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors. 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles. The prevalence of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that "preoperative diagnosis other than osteoarthrosis" was the strongest predictor of the presence of fatty atrophy. Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty

PubMed Central

Lee, Kyung-Jae; Bae, Ki-Cheor; Cho, Chul-Hyun; Kwon, Doo-Hyun

2009-01-01

Background This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. Methods Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. Results There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. Conclusions The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty. PMID:19885051

Comparison between topical and intravenous administration of tranexamic acid in primary total hip arthroplasty.

PubMed

Ueno, Masaya; Sonohata, Motoki; Fukumori, Norio; Kawano, Shunsuke; Kitajima, Masaru; Mawatari, Masaaki

2016-01-01

Tranexamic acid has been reported to be safer with topical administration than with intravenous administration in total knee arthroplasty. However, the most effective administration route of tranexamic acid in total hip arthroplasty remains controversial. This study compared the effectiveness of topical tranexamic acid administration with that of intravenous tranexamic acid administration in total hip arthroplasty. We retrospectively examined the medical records of 886 patients with osteoarthritis of the hip joint, who had undergone unilateral primary total hip arthroplasty. The patients were divided into a control group (n = 302; did not receive tranexamic acid), topical group (n = 265; topically administered 2 g tranexamic acid in 30 mL normal saline via drain tubes placed in the joint before wound closure along with posterior soft tissue repair), and intravenous group (n = 319; intravenously administered 1 g tranexamic acid before skin incision along with posterior soft tissue repair). Data on blood loss, hemoglobin levels, transfusion rates, and occurrence of deep vein thrombosis and pulmonary embolization were collected. The mean operation times were approximately 40 min in all of the groups. The operation time and intra-operative blood loss were significantly lower in the control group than in the topical and intravenous groups. However, the post-operative blood loss, total blood loss, and decrease in the hemoglobin level were significantly higher in the control group than in the topical and intravenous groups. There were no significant differences in terms of blood loss and systemic complications between the tranexamic acid administration methods. Tranexamic acid reduces both post-operative and total blood loss in total hip arthroplasty. Moreover, a lower amount of tranexamic acid can be used to reduce blood loss in total hip arthroplasty with intravenous tranexamic acid administration than with topical tranexamic acid administration. Therefore, we suggest that tranexamic acid should be intravenously administered pre-operatively and the posterior soft tissue should be repaired to decrease total hip arthroplasty-related complications. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

The effects of age and type of carrying task on lower extremity kinematics

PubMed Central

Gillette, Jason C.; Stevermer, Catherine A.; Miller, Ross H.; Meardon, Stacey A.; Schwab, Charles V.

2009-01-01

The purpose of this study was to determine the effects of age, load amount, and load symmetry on lower extremity kinematics during carrying tasks. Forty-two participants in four age groups (8-10 years, 12-14 years, 15-17 years, and adults) carried loads of 0%, 10%, and 20% body weight (BW) in large or small buckets unilaterally and bilaterally. Reflective markers were tracked to determine total joint ROM and maximum joint angles during the stance phase of walking. Maximum hip extension, hip adduction, and hip internal rotation angles were significantly greater for each of the child/adolescent age groups as compared to adults. In addition, maximum hip internal rotation angles significantly increased when carrying a 20% BW load. The observation that the 8-10 year old age group carried the lightest absolute loads and still displayed the highest maximum hip internal rotation angles suggests a particular necessity in setting carrying guidelines for the youngest children. PMID:20191410

Patients With Chondrolabral Pathology Have Bilateral Functional Impairments 12 to 24 Months After Unilateral Hip Arthroscopy: A Cross-sectional Study.

PubMed

Kemp, Joanne L; Risberg, May Arna; Schache, Anthony G; Makdissi, Michael; Pritchard, Michael G; Crossley, Kay M

2016-11-01

Study Design Cross-sectional study. Background Functional task performance in patients with chondrolabral pathology following hip arthroscopy is unknown. Objectives To investigate in people with chondrolabral pathology following hip arthroscopy (1) the bilateral differences in functional task performance compared to controls, (2) the association of hip muscle strength with functional task performance, and (3) the association of functional task performance scores with good outcome, as measured by International Hip Outcome Tool score. Methods Seventy-one patients who had unilateral hip arthroscopy for hip pain and 60 controls were recruited. Patient-reported outcomes included the 4 subscales of the International Hip Outcome Tool. Hip muscle strength measures included abduction, adduction, extension, flexion, external rotation, and internal rotation. Functional tasks assessed included the single hop test, the side bridge test, and the single-leg rise test. For aim 1, analyses of covariance tests were used. For aim 2, stepwise multiple linear regression analyses were used. For aim 3, receiver operating characteristic curve analyses were used. Results Compared to controls, the chondrolabral pathology group had significantly worse performance on both legs for each of the functional tasks (P<.001). Greater hip abduction strength was moderately associated with better performance on functional tasks in the chondrolabral pathology group (adjusted R 2 range, 0.197-0.407; P<.001). Cutoff values associated with good outcome were 0.37 (hop distance/height) for the single hop, 16 repetitions for the single-leg rise, and 34 seconds for the side bridge test. Conclusion Patients with hip chondrolabral pathology had reduced functional task performance bilaterally 12 to 24 months after unilateral hip arthroscopy when compared to controls. Level of Evidence Therapy/symptom prevalence, level 3b. J Orthop Sports Phys Ther 2016;46(11):947-956. doi:10.2519/jospt.2016.6577.

Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

PubMed Central

Gaida, J; Cook, J; Bass, S; Austen, S; Kiss, Z

2004-01-01

Background: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition. Objectives: To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy. Methods: Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180°/s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero. Results: The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD above zero in the unilateral group (p<0.05). In the unilateral group, leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07), the trunk lean to total lean ratio was 0.63 (0.68) SD below zero (p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below zero (p<0.09). In the unilateral group, the leg with pathology was 0.78 (1.03) SD weaker during eccentric contractions (p<0.07). Conclusions: Unilateral patellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers. PMID:15388543

Complications of porous-coated press-fit cementless total hip replacement in dogs.

PubMed

Kidd, Scott W; Preston, Christopher A; Moore, George E

2016-09-20

To report postoperative complications using a commercially available porous-coated press-fit cementless total hip replacement (THR) system in dogs. Medical records were reviewed for client-owned dogs with hip pathologies requiring THR. A minimum of six-week postoperative orthopaedic examination and orthogonal pelvic radiographs were used to assess outcome and complications in the perioperative period. Referring veterinarian medical records, phone interviews with clients, or both were used to assess long-term functional outcome and complications. Bilateral THR was performed in 36 dogs, and unilateral in 147 dogs, making a total of 219 THR procedures in 183 dogs. A total complication rate of 31.1% (68/219) was observed. A catastrophic complication was observed in 8.2% (n = 18), a major complication in 9.6% (n = 21), and a minor complication in 13.2% (n = 29) of procedures. The most common complications were intra-operative femoral fissure (n = 46), diaphyseal femoral fracture (n = 15), and coxofemoral luxation (n = 9). Full return to function was achieved in 88.1% of procedures with a median follow-up period of 42 months. Porous-coated press-fit cementless collarless total hip replacements have a high complication rate. The majority of complications occur intra-operatively or perioperatively, with few complications occurring beyond 12 weeks postoperatively. Both fissure fractures and diaphyseal femoral fractures carry a favourable prognosis with immediate cerclage wiring and plate fixation, respectively.

Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial.

PubMed

Austin, Matthew S; Urbani, Brian T; Fleischman, Andrew N; Fernando, Navin D; Purtill, James J; Hozack, William J; Parvizi, Javad; Rothman, Richard H

2017-04-19

The value of formal physical therapy after total hip arthroplasty is unknown. With substantial changes that have occurred in surgical and anesthesia techniques, self-directed therapy may be efficacious in restoring function to patients undergoing total hip arthroplasty. We conducted a single-center, randomized trial of 120 patients undergoing primary, unilateral total hip arthroplasty who were eligible for direct home discharge. The experimental group followed a self-directed home exercise program for 10 weeks. The control group received the standard protocol for physical therapy that included in-home visits with a physical therapist for the first 2 weeks followed by formal outpatient physical therapy for 8 weeks. Functional outcomes were measured using validated instruments including the Harris hip score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 Health Survey (SF-36) preoperatively, at 1 month postoperatively, and at 6 to 12 months postoperatively. Of 120 randomized patients, 108 were included in the final analysis. Ten patients (19%) were randomized to unsupervised home exercise and 20 patients (37%) were randomized to formal outpatient therapy crossed over between groups. There was no significant difference in any of the measured functional outcomes between patients receiving formal therapy (n = 54) and those participating in unsupervised home exercise (n = 54) at any time point (HHS, p = 0.82; WOMAC, p = 0.80; and SF-36 physical health, p = 0.90). This randomized trial suggests that unsupervised home exercise is both safe and efficacious for a majority of patients undergoing total hip arthroplasty, and formal physical therapy may not be required. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Hemodynamic stability ensured by a low dose, low volume, unilateral hypobaric spinal block: modification of a technique.

PubMed

Elzinga, L; Marcus, M; Peek, D; Borg, P; Jansen, J; Koster, J; Enk, D

2009-01-01

We report the case of an 89-year-old female with a history of arterial hypertension, intermittent rapid atrial fibrillation and severe aortic valve stenosis, suffering from femoral neck fracture. Hyperbaric unilateral spinal anesthesia is a known technique to obtain stable hemodynamics combined with the possibility of continuous neurologic evaluation and preservation of cognitive functions. Because a hyperbaric unilateral technique can be very painful in case of traumatic hip fracture, a low dose, low volume, unilateral hypobaric spinal block may be an adequate alternative. In the present case report, a unilateral hypobaric spinal anesthesia was performed using 5 mg of bupivacaine in a 1.5 mL volume and a slow and steady, "air-buffered", directed injection technique, to allow an urgent hip arthroplasty. During surgery the patient was kept in the lateral recumbent position. Hemodynamics remained stable throughout the entire procedure without any need for vasoconstrictors. The impact of aortic valve stenosis combined with atrial fibrillation on anesthetic management and our considerations to opt for a unilateral hypobaric spinal anesthesia are discussed.

Intractable bone marrow edema syndrome of the hip.

PubMed

Gao, Fuqiang; Sun, Wei; Li, Zirong; Guo, Wanshou; Kush, Nepali; Ozaki, Koji

2015-04-01

There is a need for an effective and noninvasive treatment for intractable bone marrow edema syndrome of the hip. Forty-six patients with intractable bone marrow edema syndrome of the hip were retrospectively studied to compare the short-term clinical effects of treatment with high-energy extracorporeal shock wave therapy vs femoral head core decompression. The postoperative visual analog scale score decreased significantly more in the extracorporeal shock wave therapy group compared with the femoral head core decompression group (P<.05). For unilateral lesions, postoperative Harris Hip Scores for all hips in the extracorporeal shock wave therapy group were more significantly improved than Harris Hip Scores for all hips in the femoral head core decompression group (P<.05). Patients who underwent extracorporeal shock wave therapy also resumed daily activities significantly earlier. Average overall operative time was similar in both groups. Symptoms disappeared significantly sooner in the extracorporeal shock wave therapy group in patients with both unilateral (P<.01) and bilateral lesions (P<.05). Hospital costs were significantly lower with extracorporeal shock wave therapy compared with femoral head core decompression. The intraoperative fluoroscopy radiation dose was lower in extracorporeal shock wave therapy than in femoral head core decompression for both unilateral (P<.05) and bilateral lesions (P<.01). On magnetic resonance imaging (MRI), bone marrow edema improved in all patients during the follow-up period. After extracorporeal shock wave therapy, all patients remained pain-free and had normal findings on posttreatment radiographs and MRI scans. Extracorporeal shock wave therapy appears to be a valid, reliable, and noninvasive tool for rapidly resolving intractable bone marrow edema syndrome of the hip, and it has a low complication rate and relatively low cost compared with other conservative and surgical treatment approaches. Copyright 2015, SLACK Incorporated.

A systematic review of preoperative determinants of patient-reported pain and physical function up to 2 years following primary unilateral total hip arthroplasty.

PubMed

Lungu, E; Maftoon, S; Vendittoli, P-A; Desmeules, F

2016-05-01

Although generally considered successful, total hip arthroplasty (THA) can yield suboptimal results in terms of pain and function in up to one forth of patients suffering from hip osteoarthritis (OA). A thorough understanding of the determinants of patient-reported pain and function following THA can help plan interventions directed at improving surgical results. Previously published systematic reviews do not permit to confidently identify the determinants of THA outcomes because of unsatisfactory methodological designs. Therefore, we aimed to answer: (1) which preoperative factors are most consistently associated with postoperative patient-reported pain and function up to 2 years following primary unilateral THA for hip OA. Medline, Pubmed, Embase and CINAHL were screened from their respective inception dates until April 2015 using a combination of keywords and MESH terms. Criteria for inclusion were: (1) participants with primary unilateral THA for hip OA followed for at least 3 months with a maximal follow-up of 2 years; (2) validated disease-specific patient-reported outcome measures assessing pain and/or disability; (3) identification of determinants obtained via multivariate analyses. Methodological quality was assessed using a modified version of the methodology checklist for prognostic studies. Twenty-two manuscripts were included. Mean score of the methodological quality was 81.0±10.3% (66.7% to 100%). Among socioeconomic determinants, a lower educational level was significantly related to worse pain and function (3 out of 3 studies evaluating the relationship). Clinical determinants of poor outcomes included preoperative levels of pain and physical function (9 out of 12 studies), higher body mass index (6 out of 10 studies), presence/greater level of comorbidities (7 out of 8), worse general health (4 out of 4 studies) and lower radiographic OA severity (3 out of 4 studies). Study heterogeneity limited the pooled assessment of the strength of associations between the preoperative variables and THA outcomes. Studies with moderate-to-high methodological quality allowed to identify 6 preoperative variables consistently associated with medium term pain and function following THA. This knowledge may assist the management of patients at risk of poor results. Further research is required to clarify the force of associations between determinants and THA outcomes. Level II. Systematic review of cohort studies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Does unilateral hip flexion increase the spinal anaesthetic level during combined spinal–epidural technique?

PubMed Central

Mohta, Medha; Agarwal, Deepti; Sethi, AK

2011-01-01

Needle-through-needle combined spinal–epidural (CSE) may cause significant delay in patient positioning resulting in settling down of spinal anaesthetic and unacceptably low block level. Bilateral hip flexion has been shown to extend the spinal block by flattening lumbar lordosis. However, patients with lower limb fractures cannot flex their injured limb. This study was conducted to find out if unilateral hip flexion could extend the level of spinal anaesthesia following a prolonged CSE technique. Fifty American Society of Anesthesiologists (ASA) I/II males with unilateral femur fracture were randomly allocated to Control or Flexion groups. Needle-through-needle CSE was performed in the sitting position at L2-3 interspace and 2.6 ml 0.5% hyperbaric bupivacaine injected intrathecally. Patients were made supine 4 min after the spinal injection or later if epidural placement took longer. The Control group patients (n=25) lay supine with legs straight, whereas the Flexion group patients (n=25) had their uninjured hip and knee flexed for 5 min. Levels of sensory and motor blocks and time to epidural drug requirement were recorded. There was no significant difference in sensory levels at different time-points; maximum sensory and motor blocks; times to achieve maximum blocks; and time to epidural drug requirement in two groups. However, four patients in the Control group in contrast to none in the Flexion group required epidural drug before start of surgery. Moreover, in the Control group four patients took longer than 30 min to achieve maximum sensory block. To conclude, unilateral hip flexion did not extend the spinal anaesthetic level; however, further studies are required to explore the potential benefits of this technique. PMID:21808396

Asymmetric pelvic and hip rotation in children with bilateral cerebral palsy: uni- or bilateral femoral derotation osteotomy?

PubMed

Niklasch, M; Döderlein, L; Klotz, M C; Braatz, F; Wolf, S I; Dreher, T

2015-02-01

Internal rotation gait is common among children with bilateral cerebral palsy. However, despite bilaterally increased femoral anteversion asymmetric internal rotation gait is often found. Femoral derotation osteotomy (FDO) is commonly performed bilaterally. Variable functional outcomes are reported especially in cases with mild internal hip rotation during gait and abnormal preoperative pelvic rotation. A major question is if a unilateral treatment of the more involved side in asymmetric cases leads to a comparable or even superior outcome. One hundred and nine children with spastic bilateral CP treated with FDO with pre- and 1-year postoperative 3D gait analysis were retrospectively collected. The asymmetry was calculated from the preoperative difference between both limbs in hip rotation obtained by 3D gait analysis. Twenty-eight children with asymmetry larger than 20° were selected and classified into two groups, according to whether they obtained a unilateral or bilateral FDO. Preoperative clinical examination and pre- and postoperative hip and pelvic rotation in gait analysis on the more and the less involved side did not differ significantly between both groups. Interestingly, in both groups, hip rotation did not change significantly in less-involved limbs, although intraoperative derotation averaged 25°. After unilateral FDO a significant change in pelvic rotation resulted, whereas this was not found after bilateral FDO. The results of this study suggest that unilateral FDO in children with asymmetric internal rotation gait leads to a comparable functional outcome compared to bilateral treatment. Furthermore, it was shown for the first time that considering the asymmetry has a positive effect on pelvic rotation. Copyright © 2015 Elsevier B.V. All rights reserved.

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador.

PubMed

Schlegelmilch, Michael; Rashiq, Saifee; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. The average lifetime QALYs (95% CI) gained were 1.46 (1.4-1.5), 2.5 (2.4-2.6), and 2.9 (2.7-3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.

Can Arthroplasty Stem INfluence Outcome? (CASINO): a randomized controlled equivalence trial of 125 mm versus 150 mm Exeter V40 stems in total hip arthroplasty.

PubMed

Hamilton, David F; Ohly, Nicholas E; Gaston, Paul

2018-04-16

The use of shorter length femoral stems during total hip arthroplasty has been suggested to accommodate wider patient femoral geometry and offer maximal bone preservation. However, cemented short-stem designs may increase the risk of varus stem malalignment and influence patient outcomes. CASINO is a multi-centre randomised equivalence trial that will recruit 220 patients undergoing total hip arthroplasty for osteoarthritis at two NHS hospitals in Scotland. Patients will be aged 45-80, undergoing unilateral primary hip arthroplasty, with no plan for contralateral procedure within the study timeframe, and able to comply with the protocol. Participants will be randomised to receive either a short (125 mm) or a standard (150 mm) Exeter V40 stem. The Contemporary acetabular component will be used in all cases. All implants will be cemented. Patient pain, function and satisfaction will be assessed using change from baseline measurement in Oxford Hip Score, Forgotten Joint Score, EQ-5D, pain numerical rating scores, and patient satisfaction questionnaire at baseline and at 1 and 2 years following surgery. Radiographic assessment will evaluate stem position and will be appraised by independent reviewers. Patients will be blind to implant allocation. Stem length may be associated with outcome; however, we can find no randomised trial in which researchers investigated the effect of stem length on patient outcome following cemented total hip arthroplasty. The aim of this trial is to determine if the use of short cemented stems offers equivalent patient outcomes to those achieved following surgery with standard length stems. International Standard Randomised Controlled Trial Number, ISRCTN13154542 , Registered on 30 June 2017.

Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

PubMed

Faucett, Scott C; Genuario, James W; Tosteson, Anna N A; Koval, Kenneth J

2010-02-01

: A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for most analyses, the success of prophylactic fixation was highly sensitive to the effectiveness and the relative morbidity and mortality of the additional procedure. : Prophylactic fixation with a cephalomedullary nail was not found to be cost-effective for the average older woman who sustained a hip fracture. However, it may be appropriate for select patient populations. The study supports the need for basic science and clinical trials investigating the effectiveness of prophylactic fixation for patient populations at higher lifetime risk for contralateral hip fracture.

Migratory Bone Marrow Edema Syndrome of the Hips: A Case Report

PubMed Central

Santoso, A; Ingale, PS; Park, KS

2017-01-01

Migratory bone marrow edema syndrome (BMES) of the hip is a rare entity. We report the case of a 41-year old male with migratory BMES of the hip with eight months interval period between onset of the pain and consultation. This patient was successfully treated non-surgically. It is important to always inform the patient with unilateral BMES of the hip regarding the possibility of future involvement of the contralateral hip. PMID:29326770

Thorax, pelvis and hip pattern in the frontal plane during walking in unilateral transtibial amputees: biomechanical analysis

PubMed Central

Molina-Rueda, Francisco; Alguacil-Diego, Isabel M.; Cuesta-Gómez, Alicia; Iglesias-Giménez, Javier; Martín-Vivaldi, Andrés; Miangolarra-Page, Juan C.

2014-01-01

Background: Lower limb amputees exhibit postural control deficits during standing which can affect their walking ability. Objectives: The primary purpose of the present study was to analyze the thorax, pelvis, and hip kinematics and the hip internal moment in the frontal plane during gait in subjects with Unilateral Transtibial Amputation (UTA). Method: The participants included 25 people with UTA and 25 non-amputees as control subjects. Gait analysis was performed using the Vicon(r) Motion System. We analyzed the motion of the thorax, pelvis, and hip (kinematics) as well as the hip internal moment in the frontal plane. Results: The second peak of the hip abductor moment was significantly lower on the prosthetic side than on the sound side (p=.01) and the control side (right: p=.01; left: p=.01). During middle stance, the opposite side of the pelvis was higher on the prosthetic side compared to the control side (right: p=.01: left: p=.01). Conclusions: The joint internal moment at the hip in the frontal plane was lower on the prosthetic side than on the sound side or the control side. Thorax and pelvis kinematics were altered during the stance phase on the prosthetic side, presumably because there are mechanisms which affect postural control during walking. PMID:25003278

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador

PubMed Central

Schlegelmilch, Michael; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Background Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. Methods We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. Results The average lifetime QALYs (95% CI) gained were 1.46 (1.4–1.5), 2.5 (2.4–2.6), and 2.9 (2.7–3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. Conclusion THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care. PMID:29403664

Relationship between Lateral Femoral Bowing and Varus Knee Deformity Based on Two-Dimensional Assessment of Side-to-Side Differences.

PubMed

Cho, Myung-Rae; Lee, Young Sik; Choi, Won-Kee

2018-03-01

The objective was to evaluate the relationship between side-to-side differences of lateral femoral bowing and varus knee deformity based on two-dimensional (2D) assessment in unilateral total knee arthroplasty (TKA). A total of 143 patients with varus knee osteoarthritis who underwent unilateral TKA were enrolled. We evaluated the side-to-side differences of the frontal lower limb alignment by assessing lateral femoral bowing, anatomical medial distal femoral angle, and anatomical medial proximal tibial angle (aMPTA). The average values of all anatomical indices were significantly different between the operated side and the non-operated side (p＜0.05). The side-to-side difference in hip knee ankle (HKA) angle had a statistically significant correlation with that in lateral femoral bowing (intraclass correlation coefficient, 0.259; p=0.002) and that in aMPTA. Linear regression analysis showed 0.199° of side-to-side difference in lateral femoral bowing was associated with 1° of side-to-side difference in bilateral HKA angle. The side-to-side difference in lateral femoral bowing showed a tendency to increase in proportion to varus knee deformity based on 2D assessment in unilateral TKA patients.

Effects of Imbalanced Muscle Loading on Hip Joint Development and Maturation

PubMed Central

Ford, Caleb A.; Nowlan, Niamh C.; Thomopoulos, Stavros; Killian, Megan L.

2017-01-01

The mechanical loading environment influences the development and maturation of joints. In this study, the influence of imbalanced muscular loading on joint development was studied using localized chemical denervation of hip stabilizing muscle groups in neonatal mice. It was hypothesized that imbalanced muscle loading, targeting either gluteal muscles or quadriceps muscles, would lead to bilateral hip joint asymmetry, as measured by acetabular coverage, femoral head volume and bone morphometry, and femoral-acetabular shape. The contralateral hip joints as well as age-matched, uninjected mice were used as controls. Altered bone development was analyzed using micro-computed tomography, histology, and image registration techniques at postnatal days (P) 28, 56, and 120. This study found that unilateral muscle unloading led to reduced acetabular coverage of the femoral head, lower total volume, lower bone volume ratio, and lower mineral density, at all three time points. Histologically, the femoral head was smaller in unloaded hips, with thinner triradiate cartilage at P28 and thinner cortical bone at P120 compared to contralateral hips. Morphological shape changes were evident in unloaded hips at P56. Unloaded hips had lower trabecular thickness and increased trabecular spacing of the femoral head compared to contralateral hips. The present study suggests that decreased muscle loading of the hip leads to altered bone and joint shape and growth during postnatal maturation. Statement of Clinical Significance: Adaptations from altered muscle loading during postnatal growth investigated in this study have implications on developmental hip disorders that result from asymmetric loading, such as patients with limb-length inequality or dysplasia. PMID:27391299

[A method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck].

PubMed

Chen, Tao; Shang, Xifu; He, Rui; Hu, Fei; Ge, Chang

2012-03-01

To investigate the method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck. The clinical data were analyzed retrospectively from 38 patients undergoing unilateral total hip arthroplasty between April 2005 and December 2010. There were 26 males and 12 females, aged 45-78 years (mean, 62.3 years). Among these cases, there were 11 cases of avascular necrosis of the femoral head, 17 cases of hip osteoarthritis, and 10 cases of femoral neck fracture. Before operation, 29 cases had leg length discrepancy; and the shortened length of the legs was 10-24 mm with an average of 14.5 mm by clinical measurement, and was 11-25 mm with an average of 14.7 mm by X-ray film measurement. The Harris score before operation was 44.0 +/- 3.6. At 1 day after operation, 3 cases had legs lengthening by clinical and X-ray film measurement; limb length difference less than 10 mm was regarded as equal limb length in the other 35 patients (92.1%). All incisions healed by first intention, and no complication of infection or lower limb deep venous thrombosis occurred. In 3 patients who had legs lengthening, 1 patient had abnormal gait and slight limping after increasing heel pad because the lower limb was lengthened by 16 mm, and 2 patients had slight limping. The other patients could walk normally and achieved pain relief of hip. Thirty-six patients were followed up 12-68 months (mean, 43.8 months). The Harris score was 86.7 +/- 2.3 after 6 months, showing significant difference (t = 3.260, P = 0.031) when compared with that before operation. The X-ray films showed no prosthetic loosening or subsidence. For patients with congenital short femoral neck during total hip arthroplasty, the surgeons should pay attention to osteotomy plane determination, limb length measurement, and use of the prosthesis with collar to avoid the lengthening lower limbs.

Comparison of two doses of hypobaric bupivacaine in unilateral spinal anesthesia for hip fracture surgery: 5 mg versus 7.5 mg

PubMed Central

Kahloul, Mohamed; Nakhli, Mohamed Said; Chouchene, Amine; Chebbi, Nidhal; Mhamdi, Salah; Naija, Walid

2017-01-01

Introduction Hip fracture is a frequent and severe disease. Its prognosis depends on the perioperative hemodynamic stability which can be preserved by the unilateral spinal anesthesia especially with low doses of local anesthetics. This study aims to compare the efficacy and hemodynamic stability of two doses of hypobaric bupivacaine (7.5 mg vs 5 mg) in unilateral spinal anesthesia. Methods In this prospective, randomized, double-blind study, 108 patients scheduled for hip fracture surgery under unilateral spinal anesthesia were enrolled to receive either 5 mg (group 1) or 7.5 mg (group 2) of hypobaric bupivacaine. Spinal anesthesia was performed in lateral position. Patients’ socio-demographic characteristics, hemodynamic profile, sensory and motor blocks parameters were recorded. Results Both groups were comparable regarding to demographic data. Two cases of failure occurred in group 1 and one case in group 2 corresponding to a comparable efficiency rates (96.29% and 98.14% respectively; p = 0.5). A higher mean onset and lower mean regression times of sensory block were significantly noted in group 1 (7.79±3.76 min vs 5.75±2.35 min, p < 0.001 and 91.29±31.55 min vs 112.77±18.77 min, p <0.001 respectively). Incidence of bilateralization (29.62% vs 87.03%, p < 0.001), incidence of hypotensive episodes (59.25% vs 92.59%, p < 0.001) and vascular loading (1481.48±411.65 ml vs 2111.11±596.10 ml, p < 0.001) were significantly higher in group 2. Conclusion The dosage of 5mg of hypobaric bupivacaine in unilateral spinal anesthesia is as effective as the dosage of 7.5 mg with lower bilateralization incidence and better hemodynamic stability. PMID:29515726

Comparison of two doses of hypobaric bupivacaine in unilateral spinal anesthesia for hip fracture surgery: 5 mg versus 7.5 mg.

PubMed

Kahloul, Mohamed; Nakhli, Mohamed Said; Chouchene, Amine; Chebbi, Nidhal; Mhamdi, Salah; Naija, Walid

2017-01-01

Hip fracture is a frequent and severe disease. Its prognosis depends on the perioperative hemodynamic stability which can be preserved by the unilateral spinal anesthesia especially with low doses of local anesthetics. This study aims to compare the efficacy and hemodynamic stability of two doses of hypobaric bupivacaine (7.5 mg vs 5 mg) in unilateral spinal anesthesia. In this prospective, randomized, double-blind study, 108 patients scheduled for hip fracture surgery under unilateral spinal anesthesia were enrolled to receive either 5 mg (group 1) or 7.5 mg (group 2) of hypobaric bupivacaine. Spinal anesthesia was performed in lateral position. Patients' socio-demographic characteristics, hemodynamic profile, sensory and motor blocks parameters were recorded. Both groups were comparable regarding to demographic data. Two cases of failure occurred in group 1 and one case in group 2 corresponding to a comparable efficiency rates (96.29% and 98.14% respectively; p = 0.5). A higher mean onset and lower mean regression times of sensory block were significantly noted in group 1 (7.79±3.76 min vs 5.75±2.35 min, p < 0.001 and 91.29±31.55 min vs 112.77±18.77 min, p <0.001 respectively). Incidence of bilateralization (29.62% vs 87.03%, p < 0.001), incidence of hypotensive episodes (59.25% vs 92.59%, p < 0.001) and vascular loading (1481.48±411.65 ml vs 2111.11±596.10 ml, p < 0.001) were significantly higher in group 2. The dosage of 5mg of hypobaric bupivacaine in unilateral spinal anesthesia is as effective as the dosage of 7.5 mg with lower bilateralization incidence and better hemodynamic stability.

Descriptive profile of hip rotation range of motion in elite tennis players and professional baseball pitchers.

PubMed

Ellenbecker, Todd S; Ellenbecker, Gail A; Roetert, E Paul; Silva, Rogerio Teixeira; Keuter, Greg; Sperling, Fabio

2007-08-01

Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. Cohort (cross-sectional) study (prevalence); Level of evidence, 1. Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10 degrees identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5 degrees. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

Undisplaced Intraoperative Fracture Presenting as Early Dislocation with Tapered Wedge Stems in Total Hip Arthroplasty - Case Series and Review of Literature

PubMed Central

Reddy, A V Gurava; Eachempati, Krishna Kiran; Mugalur, Aakash; Suchinder, A; Rao, V B N Prasad; Kamurukuru, Nalanda

2017-01-01

Introduction: Periprosthetic fractures and dislocation in the early post-operative period can be disastrous both for the surgeon and the patient. However, undisplaced periprosthetic fractures presenting with dislocation is uncommon. We describe successful management of two cases (one bilateral dislocation and one unilateral dislocation) of undisplaced iatrogenic fractures in total hip arthroplasty (THA) presenting as early dislocation. Case Report: Case 1 was a 45-year-old female with osteoarthritis of hip secondary to developmental dysplasia of the hip with bilateral early nontraumatic dislocation with bilateral identical periprosthetic fracture. It was managed by revision to long stem and encirclage wiring. Case 2 presented with early dislocation in the 2nd week post THA. We found an intertrochanteric fracture intra-operatively with unstable implant. Acetabular component and femoral component revision were done with reconstruction of the greater trochanter. Discussion: These fractures could be occult iatrogenic fractures characteristic of taper wedge stems which presented as early nontraumatic dislocation in the post-operative period. The prosthesis subsidence, loss of muscle tension and change of version might be the factors leading to dislocation. Conclusion: Unrecognized incomplete intraoperative fracture can occur with tapered wedge uncemented stems which can present as a dislocation in the immediate post-operative period. This will require early revision of the femoral component. PMID:29051875

Modular Neck vs Nonmodular Femoral Stems in Total Hip Arthroplasty-Clinical Outcome, Metal Ion Levels, and Radiologic Findings.

PubMed

Mikkelsen, Rasmus T; Fløjstrup, Marianne; Lund, Christian; Kjærsgaard-Andersen, Per; Skjødt, Thomas; Varnum, Claus

2017-09-01

Modular neck femoral stem (MNFS) for total hip arthroplasty (THA) was introduced to optimize the outcome, but created concerns about pain, elevated blood metal ion levels, and adverse reaction to metal debris such as pseudotumors (PTs), related to corrosion between femoral neck and stem. We compared these outcomes in patients with MNFS or nonmodular femoral stem (NFS) THA. Thirty-three patients with unilateral MNFS THA were compared with 30 patients with unilateral NFS THA. Levels of pain, serum cobalt, serum chromium were determined. Magnetic resonance imaging was performed to describe PT and fatty atrophy of muscles. The MNFS and NFS group had a mean follow-up of 2.3 and 3.1 years, respectively. Four and 13 patients in the MNFS and NFS group had pain, respectively (P = .005). The MNFS group had higher levels of serum cobalt (P < .0001) and chromium (P = .006). PTs were present in both the MNFS (n = 15) and NFS (n = 7) groups (P = .066). PTs were related to serum cobalt (P = .04) but not to pain or serum chromium. Fatty atrophy prevalence in the piriformis and gluteal muscles were higher in patients with MNFS (P = .009 and P = .032, respectively). More patients in the NFS group had pain. Serum cobalt and chromium levels were higher in the MNFS group. Prevalence of PTs was twice as high in the MNFS group, but the difference was insignificant. Copyright © 2017 Elsevier Inc. All rights reserved.

[Post-anesthetic autologous blood donation used in knee and hip arthroplasty].

PubMed

Wei, Wei; Kou, Bolong; Ju, Rongseng

2006-06-01

To explore the clinical application of the postanesthetic autologous donation and the postoperative transfusion during the knee and hip replacement surgeries. Thirty-three patients (17 males, 16 females) admitted for the elective joint replacement surgeries from September 2004 to January 2005 were included in this study. Of the 33 patients, 5 were diagnosed with rheumatoid arthritis, 23 with femoral head necrosis, and 5 with knee osteoarthritis. Immediately after anesthesia, 400 ml of the blood was drawn and transfused after the surgery. The blood pressure was monitored during the blood drawing, postoperative blood parameters were recorded, surgical site drainage and signs of infections were observed, and the other clinical data were collected. Of the 33 patients, 27 only received autologous transfusion, including 21 patients who underwent the unilateral hip replacement and 6 patients who underwent the unilateral knee replacement. All these 6 patients with the unilateral knee replacement received the blood drained from the surgical sites in addition to the blood obtained from the post-anesthetic autologous donation. Another 6 cases with the bilateral hip and knee replacement received the blood drained from the surgical sites, the blood obtained from the post-anesthetic autologous donation and 400 ml of the allogeneic blood transfusion. The blood received postoperatively averaged 650 ml (range, 200-1 150 ml), haemoglobin (Hb) was averaged 88 g/L (68-102 g/L), and Hct was averaged 24.6% (20.5%-31.5%). Hb and Hct were lower after operation than before operation (P < 0.01). Postoperative blood transfusion following the postanesthetic and preoperative autologous donation can be successfully applied to most of the patients undergoing the knee or hip replacement so as to reduce complications of the allogeneic blood transfusion.

Asymptomatic radiographic hip osteoarthritis is associated with gait differences, especially in women: A population-based study.

PubMed

Verlinden, Vincentius J A; de Kruijf, Marjolein; Bierma-Zeinstra, Sita M A; Hofman, Albert; Uitterlinden, André G; Ikram, M Arfan; van Meurs, Joyce B J; van der Geest, Jos N

2017-05-01

Hip and knee osteoarthritis (OA) are debilitating diseases that impair gait at severe stages. Although associations between OA and gait are established for normal walking, little is known about its relation with turning and tandem (heel-to-toe) walking. Furthermore, it is unknown how asymptomatic OA associates with gait, and whether associations differ by sex. We investigated how symptomatic and asymptomatic hip and knee OA associate with gait in community-dwelling individuals. In 2706 participants of a population-based cohort study, gait was assessed by electronic walkway and summarised into seven gait domains. Hip and knee radiographs were graded for radiographic OA (ROA) using the Kellgren and Lawrence (K&L) score. Linear regression was used to investigate associations between ROA and gait. Analyses were repeated including only participants with asymptomatic ROA, defined as a K&L-score of 2 without pain. In total, 177 participants (6.5%) had hip ROA and 441 (16.3%) knee ROA. We found no associations of knee ROA with gait. Hip ROA associated with Rhythm, Tandem, and Turning. Furthermore, unilateral hip ROA associated with larger gait asymmetry and gait differences in osteoarthritic and non-osteoarthritic leg, when compared to people without hip ROA. Associations between hip ROA and gait were generally stronger for women than men. Associations for hip ROA remained after restricting to asymptomatic ROA. Hip ROA, but not knee ROA, associates with gait differences in normal walking, turning, and tandem walking in community-dwelling individuals. These associations differ between the sexes, and are already present for asymptomatic ROA. Copyright © 2017 Elsevier B.V. All rights reserved.

Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?

PubMed

Porter, David; Michael, Shona; Kirkwood, Craig

2007-12-01

To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/ dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Cross-sectional observational study. Posture management services in three centres in the UK. Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. A total of 747 participants were included in the study, aged 6-80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P<0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P=0.007), hips subluxed on the left (P=0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P=0.03) were observed. The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed.

Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?

PubMed Central

Michael, Shona; Kirkwood, Craig

2008-01-01

Objective: To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Design: Cross-sectional observational study. Setting: Posture management services in three centres in the UK. Subjects: Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Main measures: Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. Results: A total of 747 participants were included in the study, aged 6–80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P < 0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P = 0.007), hips subluxed on the left (P = 0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P = 0.03) were observed. Conclusions: The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed. PMID:18042604

Effects of imbalanced muscle loading on hip joint development and maturation.

PubMed

Ford, Caleb A; Nowlan, Niamh C; Thomopoulos, Stavros; Killian, Megan L

2017-05-01

The mechanical loading environment influences the development and maturation of joints. In this study, the influence of imbalanced muscular loading on joint development was studied using localized chemical denervation of hip stabilizing muscle groups in neonatal mice. It was hypothesized that imbalanced muscle loading, targeting either gluteal muscles or quadriceps muscles, would lead to bilateral hip joint asymmetry, as measured by acetabular coverage, femoral head volume and bone morphometry, and femoral-acetabular shape. The contralateral hip joints as well as age-matched, uninjected mice were used as controls. Altered bone development was analyzed using micro-computed tomography, histology, and image registration techniques at postnatal days (P) 28, 56, and 120. This study found that unilateral muscle unloading led to reduced acetabular coverage of the femoral head, lower total volume, lower bone volume ratio, and lower mineral density, at all three time points. Histologically, the femoral head was smaller in unloaded hips, with thinner triradiate cartilage at P28 and thinner cortical bone at P120 compared to contralateral hips. Morphological shape changes were evident in unloaded hips at P56. Unloaded hips had lower trabecular thickness and increased trabecular spacing of the femoral head compared to contralateral hips. The present study suggests that decreased muscle loading of the hip leads to altered bone and joint shape and growth during postnatal maturation. Statement of Clinical Significance: Adaptations from altered muscle loading during postnatal growth investigated in this study have implications on developmental hip disorders that result from asymmetric loading, such as patients with limb-length inequality or dysplasia. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1128-1136, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

[A therapeutic effect analysis of femur first principle and combined anteversion technique during total hip arthroplasty].

PubMed

Wang, X Q; Wu, C S; Sun, S; Wang, J; Li, W; Zhang, W

2018-04-01

Objective: To investigate the situation of hip dislocation with the application of "femur first" principle and "combined anteversion technique" during total hip arthroplasty. Methods: A retrospective analysis has been done on the clinical data about 104 patients(133 hips)who were diagnosed as hip disease and were treated with total hip arthroplasty by the doctors from the Department of Joint Orthorpaedics of Shandong Provincial Hospital Affiliated to Shandong University from June 2014 to June 2016, and all the prostheses applied in the operation were cementless ones.Among them, 65 patients were males, 39 females and their age was 46.6 years (ranging from 23 to 76 years) .And 29 of them underwent bilateral hip operations and 75 unilateral ones.Seventy-six cases of aseptic necrosis of the femoral head in the terminal stage, 28 cases of hip dysplasia and osteoarthritis.Surgical approach: of all the operations, 103 hips were operated on with hardinge approach, 30 with posterolateral approach.During the operation, first of all, the femoral medullary cavity was broached and then the anteversion of intramedullary broacher was measured.After that, the anteversion of the acetabular cup was calculated as 37° minus the anteversion of the broacher, and the acetabular cup was implanted at that angle.The patients' prosthesis combined anteversion, range of motion of the hip joint, operation time, hemorrhage amount, and complications had been kept record.One, three, and six months respectively after the operation, all the patients received outpatient review, and took anteroposterior and lateral position X-ray examination.Harris hip score had been applied to evaluate their hip function before the operation and six months after the operation. Results: All the patients had been operated on smoothly, with the operation time of(57.6±14.5)minutes(36-115 minutes)and hemorrhage amount of (336.5±50.8)ml(180-620 ml). The operation finding showed that the combined anteversion by employing"femur first"principle and combined anteversion techniqueis was (36.6±6.8)°. Also, range of motion of the patients' hip conforms to the D'Lima criterion and no patients had experienced dislocation and some other serious complications.The follow-up ended at August 2017, which lasted for 12.2 months(6-18 months), and 88 cases(119 hips) were interviewed. The Harris hip score for the affected sides of the hip joints 6 months after the surgery was 94.6(86-100). Compared with the score of 29.8(12-43) before surgery, the t -test had proven its statistical significance( t =12.82, P =0.003). Conclusion: Based upon the "femoral first" principle and "combined anteversion technique" during total hip arthroplasty, these operations has been carried out well enough to meet the patients' needs of performing normal daily activities.

Gap Junctions in the Ventral Hippocampal-Medial Prefrontal Pathway Are Involved in Anxiety Regulation

PubMed Central

Schoenfeld, Timothy J.; Kloth, Alexander D.; Hsueh, Brian; Runkle, Matthew B.; Kane, Gary A.; Wang, Samuel S.-H.

2014-01-01

Anxiety disorders are highly prevalent but little is known about their underlying mechanisms. Gap junctions exist in brain regions important for anxiety regulation, such as the ventral hippocampus (vHIP) and mPFC, but their functions in these areas have not been investigated. Using pharmacological blockade of neuronal gap junctions combined with electrophysiological recordings, we found that gap junctions play a role in theta rhythm in the vHIP and mPFC of adult mice. Bilateral infusion of neuronal gap junction blockers into the vHIP decreased anxiety-like behavior on the elevated plus maze and open field. Similar anxiolytic effects were observed with unilateral infusion of these drugs into the vHIP combined with contralateral infusion into the mPFC. No change in anxious behavior was observed with gap junction blockade in the unilateral vHIP alone or in the bilateral dorsal HIP. Since physical exercise is known to reduce anxiety, we examined the effects of long-term running on the expression of the neuronal gap junction protein connexin-36 among inhibitory interneurons and found a reduction in the vHIP. Despite this change, we observed no alteration in theta frequency or power in long-term runners. Collectively, these findings suggest that neuronal gap junctions in the vHIP–mPFC pathway are important for theta rhythm and anxiety regulation under sedentary conditions but that additional mechanisms are likely involved in running-induced reduction in anxiety. PMID:25411496

Effects of calcaneal eversion on three-dimensional kinematics of the hip, pelvis and thorax in unilateral weight bearing.

PubMed

Tateuchi, Hiroshige; Wada, Osamu; Ichihashi, Noriaki

2011-06-01

Understanding the kinematic chain from foot to thorax will provide a better basis for assessment of malalignment of the body. The purpose of this study was to investigate the effects of induced calcaneal eversion on the kinematics of the hip, pelvis and thorax in three dimensions under unilateral weight-bearing. Twenty-eight healthy males were requested to stand on one leg under three conditions: normal (standing directly on the floor), and on wedges producing 5° and 10° calcaneal eversion. Recorded kinematic parameters included the angles of the hip joint, pelvis, and thorax in three dimensions. Eversion induced by wedges produced significant increases in hip flexion, hip medial rotation, pelvic anterior tilt, and thoracic lateral tilt and axial rotation to the standing side. In the frontal plane, pelvic lateral tilt to the standing side was decreased in 5° eversion condition compared with normal condition; conversely, it was increased in 10° eversion condition compared with 5° eversion condition. Arch height was negatively correlated with change in thoracic axial rotation to standing side from the normal to 10° eversion (r=-.528, p<.01). We concluded that induced calcaneal eversion affects the three-dimensional kinematics of the thorax through the hip joint and the pelvis. Copyright © 2011 Elsevier B.V. All rights reserved.

Effect of experimentally reduced distal sensation on postural response to hip abductor/ankle evertor muscle vibration.

PubMed

Glasser, S; Collings, R; Paton, J; Marsden, J

2015-07-01

This study assessed whether postural responses induced by vibratory perturbations of the hip abductors and ankle evertors, were modified when distal tactile sensation was experimentally reduced through cooling. Sixteen healthy subjects were investigated pre and post cooling. Subjects stood with their eyes closed with a stance width of 4 cm. A 2s vibratory stimulus was applied to the left or right hip abductor or ankle evertor muscle. The order of the site and side of the stimulation was randomised. The postural response to hip abductor and ankle evertor vibration was recorded using 3D motion analysis (Codamotion, Leicestershire). Medio-lateral centre of pressure motion was simultaneously recorded during quiet standing via a force plate (Kistler, UK). Pre-cooling people responded to unilateral ankle vibration with an ipsilateral translation and tilt of the pelvis, and an ipsilateral tilt of the trunk. People responded to unilateral hip vibration with a contralateral translation and tilt of the pelvis, and an ipsilateral tilt of the trunk. Following an experimental reduction in distal tactile sensation there was a significant reduction in the amplitude of pelvic tilt in response to ankle vibration (F(6.2)=P<0.05) and a significant increase in amplitude of pelvic tilt in response to hip vibration (F(5.2)=P<0.05). This suggests that the sensitivity to artificial stimulation of hip proprioception increases with distal cooling, possibly indicating a change in the gain/weighting placed upon sensory information from the hips. Copyright © 2015 Elsevier B.V. All rights reserved.

Adverse Outcomes in Infantile Bilateral Developmental Dysplasia of the Hip.

PubMed

Morbi, Abigail H M; Carsi, Belen; Gorianinov, Vitalli; Clarke, Nicholas M P

2015-01-01

It is believed that bilateral developmental dysplasia of the hip (DDH) has poorer outcomes with higher rates of avascular necrosis (AVN) and reintervention, compared with unilateral DDH. However, there is limited evidence in the literature, with few studies looking specifically at bilateral cases. A retrospective review of 36 patients (72 hips) with >4 years of follow-up. Patient population included surgically treated DDH including late presentations and failures of conservative treatment. The dislocated hips underwent either simultaneous closed or 1 open and 1 closed, or sequential open reduction. AVN and secondary procedures were used as endpoints for analysis as well as clinical and radiologic outcomes. At the last follow-up, 33% of hips had radiologic signs of AVN. Those hips that had no ossific nucleus (ON) at the time of surgery had an odds ratio of developing AVN of 3.05 and a statistically significant association between the 2 variables, whereas open/closed or simultaneous/sequential reduction did not increase the risk for AVN. In addition, 45.8% of those hips required further surgery. The estimated odds ratio of needing additional surgery after simultaneous reduction was 4.04. Clinically, 79.2% of the hips were graded as McKay I, whereas radiologically only 38.8% were Severin I. The AVN rate in bilateral DDH treated surgically is greater than the rate noted in unilateral cases from the same institution undergoing identical protocols. There was no difference in AVN rates between simultaneous and sequential or between the first and second hip to be sequentially reduced. Presence of ON decreases the risk for AVN, suggesting that in bilateral cases, awaiting the appearance of the ON is an important tool to reduce the incidence of AVN. IV.

Acute unilateral hip pain in fibrodysplasia ossificans progressiva (FOP).

PubMed

Kaplan, Frederick S; Al Mukaddam, Mona; Pignolo, Robert J

2018-04-01

Flare-ups of the hips are among the most feared and disabling complications of fibrodysplasia ossificans progressiva (FOP) and are poorly understood. In order to better understand the nature of hip flare-ups in FOP, we evaluated 25 consecutive individuals with classic FOP (14 males, 11 females; 3-56years old, median age, 17years old) who presented with acute unilateral hip pain. All 25 individuals were suspected of having a flare-up of the hip based on clinical history and a favorable response to a four day course of high-dose oral prednisone. Ten individuals (40%) experienced rebound symptoms of pain and/or stiffness within seven days after discontinuation of prednisone and all ten subsequently developed heterotopic ossification (HO) or decreased mobility of the affected hip. None of the 14 individuals who experienced sustained relief of symptoms following a course of oral prednisone experienced HO or decreased mobility. Incidental radiographic findings at the time of presentation were multifactoral and included osteochondromas of the proximal femur (18/25; 72%), degenerative arthritis (17/25; 68%), developmental hip dysplasia (15/25; 60%), previously existing heterotopic ossification (12/25; 48%), intra-articular synovial osteochondromatosis (8/25; 32%) or traumatic fractures through pre-existing heterotopic bone (1/25; 4%). Developmental joint pathology may confound clinical evaluation of hip pain in FOP. The most useful modality for suspecting an ossification-prone flare-up of the hip was lack of sustained response to a brief course of oral prednisone. Evaluation of soft tissue edema by ultrasound or magnetic resonance imaging showed promise in identifying ossification-prone flare-ups and warrants further analysis in prospective studies. Copyright © 2017 Elsevier Inc. All rights reserved.

Hip pathology in Majewski osteodysplastic primordial dwarfism type II.

PubMed

Karatas, Ali F; Bober, Michael B; Rogers, Kenneth; Duker, Angela L; Ditro, Colleen P; Mackenzie, William G

2014-09-01

Majewski osteodysplastic primordial dwarfism type II (MOPDII) is characterized by severe prenatal and postnatal growth failure with microcephaly, characteristic skeletal dysplasia, an increased risk for cerebrovascular disease, and insulin resistance. MOPDII is caused by mutations in the pericentrin (PCNT) gene and is inherited in an autosomal-recessive manner. This study aimed to determine the incidence of hip pathology in patients with molecularly confirmed MOPDII and to describe the functional outcomes of surgical treatment. Thirty-three enrolled patients had a clinical diagnosis of MOPDII. Biallelic PCNT mutations or absent pericentrin protein was confirmed in 25 of these patients. Twelve patients (7 female) had appropriate clinical and radiographic records at this institution and were included in this study. The data collected included age at presentation, age at surgery, sex, body weight and height, weight-bearing status at diagnosis, and the clinical examination. Four patients (31%) had coxa vara: 3 unilateral and 1 bilateral. Three unilateral patients had in situ pinning at a mean age 4 years. The patient with bilateral coxa vara had valgus osteotomy at the age of 5 years. Two children had bilateral hip dysplasia and subluxation with no surgery. One patient had bilateral developmental hip dislocations. The patient was treated by open reduction-spica cast and 2 years after surgery, coxa valga was noted. Another patient was diagnosed at an age of 12 years with bilateral avascular necrosis of the hips. Four patients did not have hip pathology. Hip pathology is common among children with MOPDII; coxa vara is the most frequent diagnosis. Routine clinical and radiographic hip evaluation is important. The capital femoral epiphysis appears to slip down along the shaft, giving the appearance of a proximal femoral epiphysiolysis. A hip diagnosed with slipped capital femoral epiphysis in early life may progress to severe coxa vara. Level IV.

Nonspherical femoral head shape (pistol grip deformity), neck shaft angle, and risk of hip osteoarthritis: a case-control study.

PubMed

Doherty, Michael; Courtney, Philip; Doherty, Sally; Jenkins, Wendy; Maciewicz, Rose A; Muir, Kenneth; Zhang, Weiya

2008-10-01

To determine whether 2-dimensional measures of femoral head shape and angle are associated with hip osteoarthritis (OA). We compared cases with symptomatic radiographic hip OA with asymptomatic controls with no radiographic hip OA. On anteroposterior pelvis radiographs, we measured "pistol grip deformity" for each hip (visually categorized as nonspherical, indeterminate, or spherical), the femoral head-to-femoral neck ratio as an interval measure of femoral head shape, and the femoral neck shaft angle. The relative risk of hip OA associated with each feature was estimated using odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for possible confounders using a logistic regression model. Of 1,007 cases, 965 had definite radiographic hip OA; of 1,123 controls, 1,111 had no radiographic OA. The prevalence of pistol grip deformity in at least 1 hip was 3.61% in controls and 17.71% in cases (OR 6.95 [95% CI 4.64-10.41]), and the prevalence of abnormal femoral head-to-femoral neck ratio in at least 1 hip was 3.70% in controls and 24.27% in cases (OR 12.08 [95% CI 8.05-18.15]). The risk of hip OA increased as the femoral head-to-femoral neck ratio decreased (P for trend<0.001) and with each extreme of neck shaft angle (P<0.05). In cases with unilateral hip OA, the prevalence of abnormal femoral head-to-femoral neck ratio in the unaffected hip was 2 times greater than that in controls (OR 1.82 [95% CI 1.07-3.07]); in contrast, an abnormally low, but not abnormally high, neck shaft angle was more common in unaffected hips than in controls (OR 1.79 [95% CI 1.03-3.14]). Our findings indicate that pistol grip deformity is associated with hip OA. The increased prevalence of pistol grip deformity and an abnormally low neck shaft angle in unaffected hips of cases with unilateral OA suggests that they are risk factors for development of hip OA. However, both a nonspherical head shape and an increase in neck shaft angle may occur as a consequence of OA.

What Are Normal Metal Ion Levels After Total Hip Arthroplasty? A Serologic Analysis of Four Bearing Surfaces.

PubMed

Barlow, Brian T; Ortiz, Philippe A; Boles, John W; Lee, Yuo-Yu; Padgett, Douglas E; Westrich, Geoffrey H

2017-05-01

The recent experiences with adverse local tissue reactions have highlighted the need to establish what are normal serum levels of cobalt (Co), chromium (Cr), and titanium (Ti) after hip arthroplasty. Serum Co, Cr, and Ti levels were measured in 80 nonconsecutive patients with well-functioning unilateral total hip arthroplasty and compared among 4 bearing surfaces: ceramic-on-ceramic (CoC); ceramic-on-polyethylene (CoP); metal-on-polyethylene (MoP), and dual mobility (DM). The preoperative and most recent University of California, Los Angeles (UCLA) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared among the different bearing surfaces. No significant difference was found among serum Co and Cr levels between the 4 bearing surface groups (P = .0609 and P = .1577). Secondary analysis comparing metal and ceramic femoral heads demonstrated that the metal group (MoP, modular dual mobility (Stryker Orthopedics, Mahwah, NJ) [metal]) had significant higher serum Co levels compared with the ceramic group (CoC, CoP, MDM [ceramic]) (1.05 mg/L ± 1.25 vs 0.59 mg/L ± 0.24; P = .0411). Spearman coefficient identified no correlation between metal ion levels and patient-reported outcome scores. No serum metal ion level differences were found among well-functioning total hip arthroplasty with modern bearing couples. Significantly higher serum Co levels were seen when comparing metal vs ceramic femoral heads in this study and warrants further investigation. Metal ion levels did not correlate with patient-reported outcome measures. Copyright © 2016 Elsevier Inc. All rights reserved.

Pain distribution in primary care patients with hip osteoarthritis.

PubMed

Poulsen, Erik; Overgaard, Søren; Vestergaard, Jacob T; Christensen, Henrik W; Hartvigsen, Jan

2016-12-01

Hip osteoarthritis (OA) is the most common diagnosis in primary care adult patients presenting with hip pain but pain location and pain distribution in primary care patients with hip OA have been reported inadequately. To describe pain location and pain distribution in primary care patients with clinical and radiographic confirmed hip OA. Primary care patients with unilateral clinical and radiographic hip OA living on the island of Funen, Denmark were recruited from primary care to participate in a randomized clinical trial. At baseline, patients recorded pain intensity using an 11-box numeric rating scale and the distribution of hip pain using a manikin displaying three separate views: front, back and lateral. Pain drawings were analysed using a template to determine the most frequent pain locations and distribution of pain. Pain drawings were completed by 109 patients of which 108 (99%) were valid. The mean age of patients was 65 (SD 9) years and 44% were females. The mean pain intensity was 5.4 (SD 2.0). A total of 77% had marked the greater trochanter area, 53% the groin area, 42% the anterior/lateral thigh area, 38% the buttock area, 17% the knee and 15% the lower leg area. No patients marked pain exclusively in the areas of the knee, posterior thigh or lower leg. The most common pain locations of patients with hip OA presenting to primary care are the greater trochanter, groin, thigh and buttock areas. No patients recorded pain exclusively in the knee or lower leg. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Outcomes of total hip arthroplasty: a study of patients one year postsurgery.

PubMed

Trudelle-Jackson, Elaine; Emerson, Roger; Smith, Sue

2002-06-01

Ex post facto research using prospective analysis of differences between the involved hip and uninvolved hip. To assess outcomes of total hip arthroplasty (THA) by comparing range of motion (ROM), muscle strength, and postural stability in the surgical hip to those of the uninvolved hip 1 year postsurgery. An additional objective was to assess degree of relationship among ROM, strength, and postural stability impairments to a measure of self-assessed function. Most patients who have THA receive physical therapy that consists mainly of self-care instructions and an exercise protocol that emphasizes mobility during the acute phase of recovery. But, outcomes of THA 1 year postsurgery indicate that current physical therapy programs used during the acute phase of recovery do not effectively restore physical and functional performance. Subjects consisted of 11 women and 4 men (mean age +/- standard deviation = 62 +/- 8 years) with unilateral THA performed 1 year prior to data collection. Assessment variables consisted of self-assessment of function and measures of postural stability, muscle strength, and hip ROM. The 12-Item Hip Questionnaire was used for self-assessment of function. Three separate repeated measures MANOVA were used to compare the involved side to the uninvolved side in measures of postural stability, strength, and ROM. The Spearman's rho was used to assess degree of association between the subjects' score of self-assessed function and impairments in strength and postural stability. Measures of postural stability were significantly lower (P < or = 0.01) on the side of the replaced hip. Differences in strength values between the involved and uninvolved sides were not statistically significant. Correlations between scores of self-assessed function and hip abductor and knee extensor strength were statistically significant (r = 0.56, P < or = 0.03). Self-assessed function was not significantly correlated to postural stability impairments. The brief postsurgical rehabilitation program received by patients with THA may not be sufficient. A second phase of rehabilitation implemented 4 months or more after surgery that emphasizes weight bearing and postural stability may be advisable.

Risk of contralateral avascular necrosis (AVN) after total hip arthroplasty (THA) for non-traumatic AVN.

PubMed

Goker, Berna; Block, Joel A

2006-01-01

The risk of developing bilateral disease progressing to total hip arthroplasty (THA) among patients who undergo unilateral THA for non-traumatic avascular necrosis (AVN) remains poorly understood. An analysis of the time-course to contralateral THA, as well as the effects of underlying AVN risk factors, is presented. Forty-seven consecutive patients who underwent THA for AVN were evaluated. Peri-operative and annual post-operative antero-posterior pelvis radiographs were examined for evidence of contralateral involvement. Patient age, weight, height, underlying AVN risk factor(s), date of onset of contralateral hip pain if occurred, and date of contralateral THA if performed, were recorded. Bone scan, computerized tomography and magnetic resonance imaging data were utilized when available. Twenty-one patients (46.6%) underwent contralateral THA for AVN within a median of 9 months after the initial THA (range 0-93, interquartile range 28.5 months). The median follow-up for patients without contralateral THA was 75 months (range 3-109, interquartile range 69 months). Thirty-four patients had radiographic findings of contralateral AVN at study entry; 25 were symptomatic bilaterally at entry and 7 developed contralateral symptoms within a mean time of 12 months (median 10 months, interquartile range 12 months). None of the 13 patients who were free of radiographic evidence of contralateral AVN at study entry developed evidence of AVN during the follow-up. AVN associated with glucocorticoid use was more likely to manifest as bilateral disease than either idiopathic AVN or ethanol-associated AVN (P=0.02 and P=0.03 respectively). Radiographically-evident AVN in the contralateral hip at THA is unlikely to remain asymptomatic for a prolonged period of time. Conversely, asymptomatic contralateral hips without radiographic evidence of AVN are unlikely to develop clinically significant AVN.

A SIX-WEEK SUPERVISED EXERCISE AND EDUCATIONAL INTERVENTION AFTER TOTAL HIP ARTHROPLASTY: A CASE SERIES

PubMed Central

Madara, Kathleen; Zeni, Joseph A

2017-01-01

Background and Purpose Most rehabilitation interventions after total hip arthroplasty (THA) are not designed to return patients to high-levels of physical activity and, thus, low levels of physical activity and residual weakness are common. The purpose of this case series was to describe the feasibility and preliminary efficacy of an exercise and education intervention for patients after THA who have already completed formal outpatient physical therapy. Study Design Case series Case Description Two participants underwent unilateral THA seven (case A) or eight (case B) months prior to the intervention. Individuals participated in 18 treatment sessions that included progressive aerobic and strengthening exercises and meetings with a health coach. Change in function, strength, and self-reported physical activity were measured. Outcomes 12 months after surgery were compared to a historical cohort of patients after THA. Outcome There were no adverse events during the intervention. At the end of the intervention, hip and knee strength on the surgical side increased approximately 30% compared to baseline in both cases. Activity level, and recreational performance, including walking up stairs and hiking uphill (case A), and running and golfing (case B), improved by the end of the intervention. Most changes were maintained at follow-up, although hip strength for case B decreased 27% after discharge from the intervention. Outcomes for both cases exceeded historical averages for patients 12 months after THA, with the exception of strength in case B. Discussion The exercise intervention was well tolerated and without negative effects in two participants. Both participants increased their ability to complete demanding recreational and sports-related activities, physical activity, and demonstrated improved hip abductor and knee extensor strength. Further research is needed to evaluate the implementation and effectiveness of similar interventions after THA. Level of Evidence Level 4 PMID:28515981

Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study.

PubMed

Plenge, U; Nortje, M B; Marais, L C; Jordaan, J D; Parker, R; van der Westhuizen, N; van der Merwe, J F; Marais, J; September, W V; Davies, G L; Pretorius, T; Solomon, C; Ryan, P; Torborg, A M; Farina, Z; Smit, R; Cairns, C; Shanahan, H; Sombili, S; Mazibuko, A; Hobbs, H R; Porrill, O S; Timothy, N E; Siebritz, R E; van der Westhuizen, C; Troskie, A J; Blake, C A; Gray, L A; Munting, T W; Steinhaus, H K S; Rowe, P; van der Walt, J G; Isaacs Noordien, R; Theron, A; Biccard, B M

2018-05-09

A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.

Inter-joint coordination strategies during unilateral stance following first-time, acute lateral ankle sprain: A brief report.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Delahunt, Eamonn

2015-07-01

This investigation combined measures of inter-joint coordination and stabilometry to evaluate eyes-open (condition 1) and eyes-closed (condition 2) static unilateral stance performance in a group of participants with an acute, first-time lateral ankle sprain injury in comparison to a control group. Sixty-six participants with an acute first-time lateral ankle sprain and 19 non-injured controls completed three 20-second unilateral stance task trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb 3-D kinematic data for similarity in the aim of establishing patterns of inter-joint coordination for these groups. Between-group analyses revealed significant differences in stance limb inter-joint coordination strategies for conditions 1 and 2. Injured participants displayed increases in ankle-hip linked coordination compared to controls in condition 1 (sagittal/frontal plane: 0.12 [0.09] vs 0.06 [0.04]; η(2)=.16) and condition 2 (sagittal/frontal plane: 0.18 [0.13] vs 0.08 [0.06]; η(2)=0.37). Participants with acute first-time lateral ankle sprain exhibit a hip-dominant coordination strategy for static unilateral stance compared to non-injured controls. Copyright © 2015 Elsevier Ltd. All rights reserved.

Identification of patients with suboptimal results after hip arthroplasty: development of a preliminary prediction algorithm.

PubMed

Lungu, Eugen; Vendittoli, Pascal-André; Desmeules, François

2015-10-05

The ability to predict preoperatively the identity of patients undergoing hip arthroplasty at risk of suboptimal outcomes could help implement interventions targeted at improving surgical results. The objective was to develop a preliminary prediction algorithm (PA) allowing the identification of patients at risk of unsatisfactory outcomes one to two years following hip arthroplasty. Retrospective data on a cohort of 265 patients having undergone primary unilateral hip replacement (188 total arthroplasties and 77 resurfacing arthroplasties) from 2004 to 2010 were collected from our arthroplasty database. Hip pain and function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected, as well as self-reported hip joint perception after surgery. Demographic and clinical variables recorded at the time of the surgery were considered as potential predictors. Patients were considered as having a suboptimal surgical outcome if they were in the worst quartile of the postoperative total WOMAC score and perceived their operated hip as artificial with minimal or major limitations. The PA was developed using recursive partitioning. Mean postoperative surgical follow-up was 446 ± 171 days. Forty patients (15.1 %) had a postoperative total WOMAC score in the worst quartile (>11.5/100) and perceived their joint as artificial with minimal or major restrictions. A PA consisting of the following variables achieved the most acceptable level of prediction: gender, age at the time of surgery, body mass index (BMI), and three items of the preoperative WOMAC (degree of pain with walking on a flat surface and during the night as well as degree of difficulty with putting socks or stockings). The rule had a sensitivity of 75.0 % (95 % CI: 59.8-85.8), a specificity of 77.8 % (95 % CI: 71.9-82.7), a positive predictive value of 37.5 % (95 % CI: 27.7-48.5), a negative predictive value of 94.6 % (95 % CI: 90.3-97.0) and positive and negative likelihood ratios of 3.38 (95 % CI: 2.49-4.57) and 0.34 (95 % CI: 0.19-0.55) respectively. The preliminary PA shows promising results at identifying patients at risk of significant functional limitations, increased pain and inadequate joint perception after hip arthroplasty. Clinical use should not be implemented before additional validation and refining.

Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking.

PubMed

Attias, M; Bonnefoy-Mazure, A; De Coulon, G; Cheze, L; Armand, S

2016-10-01

Contracture is a permanent shortening of the muscle-tendon-ligament complex that limits joint mobility. Contracture is involved in many diseases (cerebral palsy, stroke, etc.) and can impair walking and other activities of daily living. The purpose of this study was to quantify the reliability of an exoskeleton designed to emulate lower limb muscle contractures unilaterally and bilaterally during walking. An exoskeleton was built according to the following design criteria: adjustable to different morphologies; respect of the principal lines of muscular actions; placement of reflective markers on anatomical landmarks; and the ability to replicate the contractures of eight muscles of the lower limb unilaterally and bilaterally (psoas, rectus femoris, hamstring, hip adductors, gastrocnemius, soleus, tibialis posterior, and peroneus). Sixteen combinations of contractures were emulated on the unilateral and bilateral muscles of nine healthy participants. Two sessions of gait analysis were performed at weekly intervals to assess the reliability of the emulated contractures. Discrete variables were extracted from the kinematics to analyse the reliability. The exoskeleton did not affect normal walking when contractures were not emulated. Kinematic reliability varied from poor to excellent depending on the targeted muscle. Reliability was good for the bilateral and unilateral gastrocnemius, soleus, and tibialis posterior as well as the bilateral hamstring and unilateral hip adductors. The exoskeleton can be used to replicate contracture on healthy participants. The exoskeleton will allow us to differentiate primary and compensatory effects of muscle contractures on gait kinematics. Copyright © 2016 Elsevier B.V. All rights reserved.

Transient osteoporosis of the hip in pregnancy associated with generalized low bone mineral density--a case report.

PubMed

Anai, Takanobu; Urata, Kenichirou; Mori, Atsue; Miyazaki, Fumiko; Okamoto, Sumiaki

2013-01-01

Transient osteoporosis of the hip (TOH) in pregnancy is characterized by severe pain in unilateral or bilateral hips and has been diagnosed as localized osteopenia. However, we evaluated a case of unilateral TOH with generalized profound osteoporosis involving both the hips and the lumbar vertebrae by dual-energy X-ray absorptiometry. The diagnosis was based on the clinical course and confirmed by magnetic resonance imaging. Three-dimensional helical computed tomography (3D-CT), which has not been used in patients with TOH, revealed a markedly thin bilateral proximal femoral cortex, particularly in the symptomatic femoral head. Despite the difference in the severity of bone destruction between the two femora, they both showed the same pattern of damage on 3D-CT. Furthermore, despite continuing treatment with the same dose of alendronate and calcitriol, a high rate of bone mineral density gain, involving both the femora and lumbar vertebrae, was limited to the early postpartum months. A majority of reported female patients with TOH are pregnant. Thus, the association between TOH and pregnancy was not considered to be fortuitous, and chemical or hormonal factors related to pregnancy may play an etiologic role in this disease. The possible etiologies of TOH in pregnancy are also discussed. © 2013 S. Karger AG, Basel.

Muscle power is an important measure to detect deficits in muscle function in hip osteoarthritis: a cross-sectional study.

PubMed

Bieler, Theresa; Magnusson, Stig Peter; Christensen, Helle Elisabeth; Kjaer, Michael; Beyer, Nina

2017-07-01

To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers. Seventy-two patients (60-87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63-82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy. The symptomatic extremity in patients was significantly (p < 0.05, paired t-test) weaker compared with the non-symptomatic extremity for five hip muscles (8-17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%, p < 0.05) comparable to that found in patients, but had no asymmetry in leg extensor power. Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis. Implications for Rehabilitation Even in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present. Between-leg differences in leg extensor power (force × velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry. Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity. Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement.

[IMAGING ANALYSIS OF ACETABULAR CUP POSITIONS IN TOTAL HIP ARTHROPLASTY FOR ADULTS WITH ACETABULAR DYSPLASIA].

PubMed

Sun, Hong; Fang, Shuying; Yang, Zibo; Zhang, Zhiqi; Kang, Yan; Zhang, Ziji; Liao, Weiming; Fu, Ming; Wu, Peihui

2016-11-08

To investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH). Between January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions. Compared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I ( P <0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II ( P <0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV ( P <0.05) in 2008-2012 group. But no significant difference was shown in the other indexes ( P >0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference ( P <0.05), but no significant difference was found in the other indexes ( P >0.05). For adults with acetabular dysplasia, there are high potential risks for unsatisfactory acetabular cup positions during primary THA. So it is necessary to evaluate acetabular deformities and to sum up operative experience so as to improve the accuracy of cups installation.

Chronological changes in functional cup position at 10 years after total hip arthroplasty.

PubMed

Okanoue, Yusuke; Ikeuchi, Masahiko; Takaya, Shogo; Izumi, Masashi; Aso, Koji; Kawakami, Teruhiko

2017-09-19

This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.

The Clinical Severity of Patients Diagnosed With an In-Hospital Pulmonary Embolism Following Modern, Elective Joint Arthroplasty Is Unrelated to the Location of Emboli in the Pulmonary Vasculature.

PubMed

Gonzalez Della Valle, Alejandro; Blanes Perez, Alvaro; Lee, Yuo-Yu; Saboeiro, Gregory R; Konin, Gabrielle P; Endo, Yoshimi; Sharrock, Nigel E; Salvati, Eduardo A

2017-04-01

In the event of a postoperative pulmonary embolism (PE), it is generally believed that patients with centrally located emboli will have worse clinical symptoms than those with segmental or subsegmental ones. We studied if a relationship exists between the clinical severity at the time of PE diagnosis and the location of the emboli within the pulmonary vasculature. All 269 patients who developed an in-hospital, computed tomography pulmonary angiography-proved, PE following elective total hip arthroplasty or total knee arthroplasty in our institution were studied. The clinical severity of the PE was calculated using the Pulmonary Embolism Severity Index (PESI) that classifies patients in 5 classes (class 5: most severe). All computed tomography pulmonary angiographies were re-reviewed to determine the location of the emboli within the pulmonary vasculature (central, segmental, or subsegmental-unilateral or bilateral). The association between PESI and the PE location was examined. The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. There were 180 unilateral and 89 bilateral PE patients. There was no association between the PESI and the location of the emboli within the pulmonary vasculature (P = .32). Patients with bilateral or unilateral lung involvement had similar PESI (P = .78). The PESI, a recognized, validated predictor of mortality after PE was similar in patients with central, segmental, or subsegmental PE; and in patients with unilateral or bilateral lung involvement. The present study may aid clinicians while assessing and discussing the severity of PE symptoms with patients at the time of diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

In vivo implant fixation of carbon fiber-reinforced PEEK hip prostheses in an ovine model.

PubMed

Nakahara, Ichiro; Takao, Masaki; Bandoh, Shunichi; Bertollo, Nicky; Walsh, William R; Sugano, Nobuhiko

2013-03-01

Carbon fiber-reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough-textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone-cement and cement-stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA-coated CFR/PEEK implants, even under load-bearing conditions. Copyright © 2012 Orthopaedic Research Society.

Postural asymmetries in young adults with cerebral palsy.

PubMed

Rodby-Bousquet, Elisabet; Czuba, Tomasz; Hägglund, Gunnar; Westbom, Lena

2013-11-01

The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP). Cross-sectional data of 102 people (63 males, 39 females; age range 19-23 y, median 21 y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman's correlation. At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing). Postural asymmetries correlated to hip dislocations: supine (r(s) =0.48), sitting (r(s) =0.40), standing (r(s) =0.41), and inability to change position: supine (r(s) =0.60), sitting (r(s) =0.73), and standing (r(s) =0.64). Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position. © 2013 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Postural asymmetries in young adults with cerebral palsy

PubMed Central

Rodby-Bousquet, Elisabet; Czuba, Tomasz; Hägglund, Gunnar; Westbom, Lena

2013-01-01

Aim The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP). Methods Cross-sectional data of 102 people (63 males, 39 females; age range 19–23y, median 21y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman’s correlation. Results At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing). Postural asymmetries correlated to hip dislocations: supine (rs=0.48), sitting (rs=0.40), standing (rs=0.41), and inability to change position: supine (rs=0.60), sitting (rs=0.73), and standing (rs=0.64). Conclusions Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position. This article is commented on by Novak on page 974 of this issue. PMID:23834239

The Frank Stinchfield Award. Pulmonary fat embolism in revision hip arthroplasty.

PubMed

Woo, R; Minster, G J; Fitzgerald, R H; Mason, L D; Lucas, D R; Smith, F E

1995-10-01

Unilateral cemented hip hemiarthroplasty was done on 16 dogs who subsequently had revision arthroplasty and who were divided into 1 control and 3 experimental groups: The first group had cement extraction using osteotomes; the second, using a high speed burr; the third, an ultrasonic tool. Hemodynamic and transesophageal echocardiographic monitoring were done. Postmortem pulmonary specimens were examined for differences in the quantity of fat emboli. There was a significant increase in emboli with the ultrasonic tool as compared with osteotomes and high speed burr. There was no significant difference in emboli between the osteotomes and high speed burr. Fat emboli syndrome is related to mechanical compression of the femoral canal. The ultrasonic instrument was unique in its tendency to cause large embolic showers, especially during extraction of the distal cement plug. In these young dogs, minimal hemodynamic changes and no cardiac dysrhythmias occurred, which in part may be attributed to their good health. These changes may remain subclinical for patients with good cardiorespiratory reserve, or may become life threatening for those with poor reserve. By outlining the mechanisms of fat embolism in revision total hip arthroplasty, it may be possible to decrease future morbidity, especially in patients who frequently have cardiopulmonary disease.

A prospective cohort study of the clinical presentation of non-traumatic osteonecrosis of the femoral head: spine and knee symptoms as clinical presentation of hip osteonecrosis.

PubMed

Hauzeur, Jean-Philippe; Malaise, Michel; de Maertelaer, Viviane

2016-07-01

To study the clinical presentation of femoral head osteonecrosis (ONFH). Publications dedicated to this aspect of ONFH are rare. Our aim was to systematically collect and describe the clinical data. A prospective survey was conducted in a cohort of ONFH recruited from a dedicated clinic for osteonecrosis. The history of symptoms, medical management, and physical findings were obtained from 88 patients suffering from 125 ONFH. Subgroups were formed: bilateral versus unilateral ONFH, radiological stages 1-2 (pre-fractured) versus fractured stage 3 versus stage 4. ONFH was bilateral in 63 %, especially in corticosteroid users and in sickle-cell cases. These patients were younger but had similar BMIs compared to the unilateral cases. The pain was mechanical in 79 % of hips and inflammatory in 21 %. Acute pain at the onset was present in 55 % of hips. The localization of this pain was variable, including in the groin, the buttocks, or diffused in the lower limbs. A limp was present in 50 % of the patients, only when one hip was painful. The physical examination of the hip was normal in 31 %, especially in stages 1-2 (55 %). The diagnosis delay was 12 months, with inadequate medical management in 51 % of patients. In ONFH cases, no typical clinical pattern was found. The clinical presentation was very variable, sometimes having spine or knee symptoms with a normal physical examination of the hip. ONFH should be systematically suspected in cases of onset of pain in the pelvis, buttocks, groin, and lower limbs.

Neglected Posterior Dislocation of Hip in Children - A Case Report.

PubMed

Pal, Chandra Prakash; Kumar, Deepak; Sadana, Ashwani; Dinkar, Karuna Shankar

2014-01-01

Traumatic dislocation of the hip in children is a rare injury. We report the outcome of 2 patients of neglected hip dislocation which were treated by open reduction and internal fixation by k-wires. We treat 2 children both girls (one was of 4 years and other was 7 years of age). In both cases dislocation was unilateral and was not associated with any facture. Both cases were of posterior dislocation. in both cases open reduction and internal fixation was done by k wires. Hip spica was applied post operatively in both cases. The k wire was removed at 3 to 4 weeks. Patients were allowed to bear weight from gradual to full weight bearing after 6 weeks. We conclude that open reduction is a satisfactory treatment for neglected hip dislocation. It prevents not only deformity but also maintains limb length.

Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair: A Prospective Randomised Open Trial.

PubMed

Meuret, Pascal; Bouvet, Lionel; Villet, Benoit; Hafez, Mohamed; Allaouchiche, Bernard; Boselli, Emmanuel

2018-04-01

Intraoperative hypotension during hip fracture surgery is frequent in the elderly. No study has compared the haemodynamic effect of hypobaric unilateral spinal anaesthesia (HUSA) and standardised general anaesthesia (GA) in elderly patients undergoing hip fracture surgical repair. We performed a prospective, randomised open study, including 40 patients aged over 75 years, comparing the haemodynamic effects of HUSA (5 mg isobaric bupivacaine with 5 μg sufentanil and 1 mL sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). An incidence of severe hypotension, defined by a decrease in systolic blood pressure of >40% from baseline, was the primary endpoint. The incidence of severe hypotension was lower in the HUSA group compared with that in the GA group (32% vs. 71%, respectively, p=0.03). The median [IQR] ephedrine consumption was lower (p=0.001) in the HUSA group (6 mg, 0-17 mg) compared with that in the GA group (36 mg, 21-57 mg). Intraoperative muscle relaxation and patients' and surgeons' satisfaction were similar between groups. No difference was observed in 5-day complications or 30-day mortality. This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery.

Kinematic Differences During Single-Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain.

PubMed

Lewis, Cara L; Loverro, Kari L; Khuu, Anne

2018-04-01

Study Design Controlled laboratory study, case-control design. Background Despite recognition that femoroacetabular impingement syndrome (FAIS) is a movement-related disorder, few studies have examined dynamic unilateral tasks in individuals with FAIS. Objectives To determine whether movements of the pelvis and lower extremities in individuals with FAIS differ from those in individuals without hip pain during a single-leg step-down, and to analyze kinematic differences between male and female participants within groups. Methods Individuals with FAIS and individuals without hip pain performed a single-leg step-down while kinematic data were collected. Kinematics were evaluated at 60° of knee flexion. A linear regression analysis assessed the main effects of group, sex, and side, and the interaction of sex by group. Results Twenty individuals with FAIS and 40 individuals without hip pain participated. Individuals with FAIS performed the step-down with greater hip flexion (4.9°; 95% confidence interval [CI]: 0.5°, 9.2°) and anterior pelvic tilt (4.1°; 95% CI: 0.9°, 7.3°) than individuals without hip pain. Across groups, female participants performed the task with more hip flexion (6.1°; 95% CI: 1.7°, 10.4°), hip adduction (4.8°; 95% CI: 2.2°, 7.4°), anterior pelvic tilt (5.8°; 95% CI: 2.6°, 9.0°), pelvic drop (1.4°; 95% CI: 0.3°, 2.5°), and thigh adduction (2.7°; 95% CI: 1.3°, 4.2°) than male participants. Conclusion The results of this study suggest that individuals with FAIS have alterations in pelvic motion during a dynamic unilateral task. The noted altered movement patterns in the FAIS group may contribute to the development of hip pain and may be due to impairments that are modifiable through rehabilitation. J Orthop Sports Phys Ther 2018;48(4):270-279. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7794.

Predictors of perioperative blood loss in total joint arthroplasty.

PubMed

Park, Jai Hyung; Rasouli, Mohammad R; Mortazavi, S M Javad; Tokarski, Anthony T; Maltenfort, Mitchell G; Parvizi, Javad

2013-10-02

UPDATE The print version of this article has errors that have been corrected in the online version of this article. In the Materials and Methods section, the sentence that reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 mg/dL or a hematocrit level of at least 33%." in the print version now reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 g/dL or a hematocrit level of at least 33%." in the online version. In Table III, the footnote that reads as "The values are given as the estimate and the standard error in milligrams per deciliter." in the print version now reads as "The values are given as the estimate and the standard error in grams per deciliter." in the online version. Despite advances in surgical and anesthetic techniques, lower-extremity total joint arthroplasty is associated with considerable perioperative blood loss. As predictors of perioperative blood loss and allogenic blood transfusion have not yet been well defined, the purpose of this study was to identify clinical predictors for perioperative blood loss and allogenic blood transfusion in patients undergoing total joint arthroplasty. From 2000 to 2008, all patients undergoing unilateral primary total hip or knee arthroplasty who met the inclusion criteria were enrolled in the study. Perioperative blood loss was calculated with use of a previously validated formula. The predictors of perioperative blood loss and allogenic blood transfusion were identified in a multivariate analysis. Eleven thousand three hundred and seventy-three patients who underwent total joint arthroplasty, including 4769 patients who underwent total knee arthroplasty and 6604 patients who underwent total hip arthroplasty, were evaluated. Multivariate analysis indicated that an increase in blood loss was associated with being male (263.59 mL in male patients who had undergone total hip arthroplasty and 233.60 mL in male patients who had undergone total knee arthroplasty), a Charlson Comorbidity Index of >3 (293.99 mL in patients who had undergone total hip arthroplasty and 167.96 mL in patients who had undergone total knee arthroplasty), and preoperative autologous blood donation (593.51 mL in patients who had undergone total hip arthroplasty and 592.30 mL in patients who had undergone total knee arthroplasty). In patients who underwent total hip arthroplasty, regional anesthesia compared with general anesthesia reduced the amount of blood loss. The risk of allogenic blood transfusion increased with the amount of blood loss in the patients who underwent total hip arthroplasty (odds ratio, 1.43 [95% confidence interval, 1.40 to 1.46]) and the patients who underwent total knee arthroplasty (odds ratio, 1.47 [95% confidence interval, 1.42 to 1.51]), but the risk of blood transfusion increased with the Charlson Comorbidity Index only in patients who underwent total knee arthroplasty (odds ratio, 3.2 [95% confidence interval, 1.99 to 5.15]). The risk of allogenic blood transfusion decreased with preoperative autologous blood donation in patients who underwent total hip arthroplasty (odds ratio, 0.01 [95% confidence interval, 0.01 to 0.02]) and patients who underwent total knee arthroplasty (odds ratio, 0.02 [95% confidence interval, 0.01 to 0.03]). This study identified some clinical predictors for blood loss in patients undergoing total joint arthroplasty that we believe can be used for implementing more effective blood conservation strategies. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

True or apparent leg length discrepancy: which is a better predictor of short-term functional outcomes after total hip arthroplasty?

PubMed

Nakanowatari, Tatsuya; Suzukamo, Yoshimi; Suga, Toshimitsu; Okii, Akira; Fujii, Genji; Izumi, Shin-Ichi

2013-01-01

The associations between leg length discrepancy (LLD) and patient-perceived inequality and functional outcomes after total hip arthroplasty (THA) are unclear in the literature. The aim of this study was to determine the types of LLD after THA and to identify the best predictor of patient-perceived LLD and functional outcome in the short term after THA. We subdivided LLD into true and apparent types and prospectively studied 53 consecutive patients undergoing unilateral primary THA to determine whether there is an association between the type of LLD and functional outcome 2 months after the operation. Apparent LLD was measured by the block test and true LLD was measured by hip radiography. We classified the patients into 4 groups: true, apparent, mixed, and no-LLD groups. The questionnaire included a visual analog scale of pain, the Western Ontario and McMaster Universities Osteoarthritis Index, and patient-perceived inequality. Physical performance was measured using walking speed and the Timed Up and Go test. The apparent and mixed LLD groups had a higher prevalence of patient-perceived inequality than the true and no-LLD groups. The results of physical performance showed that the walking speed of the mixed LLD group and the results of the Timed Up and Go Test of the apparent LLD group were significantly slower than those of the true LLD group. We suggested that the true LLD group may have a weak relationship with functional outcome after THA while the apparent LLD resulting from pelvic obliquity due to hip contracture or scoliosis is correlated with the short-term functional outcome after THA. Apparent LLD can be a better predictor of patient-perceived inequality and physical performance than true LLD.

Depression and anxiety before and after limb length discrepancy correction in patients with unilateral developmental dysplasia of the hip.

PubMed

Liu, Ruiyu; Li, Yongwei; Fan, Lihong; Mu, Mingchao; Wang, Kunzheng; Song, Wei

2015-12-01

Limb length discrepancy (LLD) is common in patients with developmental dysplasia of the hip (DDH) and may influence the psychological status of these patients. The present study aims to investigate depression and anxiety in DDH patients with different extents of LLD and to assess the effect of LLD correction on these two psychological factors. 161 patients with DDH were recruited and divided into two groups based on whether they could perceive LLD preoperatively. The patients who could not perceive LLD were assigned to group N, and those who could perceive LLD were assigned to group P. Depression/anxiety, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and LLD were assessed one week before, six months and two years after total hip arthroplasty (THA). Depression and anxiety were significantly higher in group P patients compared to group N patients. The patients in group N presented significant improvement in depression and anxiety six months after arthroplasty, while DDH patients in group P did two years after arthroplasty. Correlation analyses revealed their improvement was associated with pain relief and improved hip function in both groups of patients and was also related to changes in the perception of LLD in group P patients. Depression and anxiety levels were higher in DDH patients with perceived LLD. Their improvement was related to pain relief and improved hip function following THA. In DDH patients with perceived LLD, a change in the perception of LLD also played a part in their improvement. Copyright © 2015 Elsevier Inc. All rights reserved.

The predictive value of the clinical sign of limited hip abduction for developmental dysplasia of the hip (DDH).

PubMed

Čustović, Svemir; Šadić, Sahmir; Vujadinović, Aleksandar; Hrustić, Asmir; Jašarević, Mahir; Čustović, Amer; Krupić, Ferid

2018-08-01

Aim To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). Methods A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns' hips were performed using the Graf method on their first day of life. Results Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH. Conclusion Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

The Fate of Iliopsoas Muscle in the Long-term Follow-up After Open Reduction of Developmental Dysplasia of the Hip by Medial Approach. Part 1: MRI Evaluation.

PubMed

Yilmaz, Serdar; Aksahin, Ertugrul; Duran, Semra; Bicimoglu, Ali

2017-09-01

There has been little information about the long-term status of the iliopsoas, which is the main flexor of the hip, after iliopsoas tenotomy in the treatment of developmental dysplasia of the hip (DDH). The aim of this study was to assess the status of the iliopsoas muscle and other flexors and extensors of the hip in long-term follow-up with magnetic resonance imaging after complete iliopsoas tenotomy in patients with unilateral DDH treated with open reduction with a medial approach. The study included 20 patients who underwent open reduction with a medial approach for unilateral DDH and had long-term follow-up. Magnetic resonance imaging assessment of iliopsoas, rectus femoris, tensor fasia lata, sartorius, and gluteus maximus muscles was applied and the muscles of the hip that was operated on were compared with the unoperated hip. In addition, the iliopsoas muscle was examined for reattachment and the effect of reattachment was evaluated. The mean age at the time of operation was 10.53±3.61 months (range, 5 to 18 mo), and mean follow-up was 16.65±2.16 years (range, 13 to 20 y). Spontaneous reattachment of the iliopsoas was observed in 18 patients (90%), either in the lesser trochanter (65%) or the superior part of it (25%). There was no significant difference between the hips that were operated on and those that were not with regard to the mean cross-sectional areas (CSA) of the tensor fascia lata, rectus femoris, sartorius, and gluteus maximus muscles. The CSA of the tensor fascia lata, rectus femoris, sartorius, and gluteus maximus muscles showed no significant difference (P>0.05); however, CSA of iliopsoas muscle was significantly reduced in the operated hip (P<0.001). Although the iliopsoas tendon was atrophied after complete iliopsoas tenotomy, it was reattached in 90% of the patients spontaneously in long-term follow-up. There was no statistically significant compensatory hypertrophy in any muscles in response to iliopsoas atrophy. Level IV-Therapeutic.

Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations.

PubMed

Kulkarni, J; Adams, J; Thomas, E; Silman, A

1998-08-01

To investigate the association between amputation, osteoarthritis and osteopenia in male war veterans with major lower limb amputations. Specific questions were to determine whether lower limb amputees following trauma are at subsequent risk of developing osteoarthritis (OA) and osteoporosis of the hip on both the amputated and nonamputated sides. Retrospective cohort study in British Male Second World War veterans with major unilateral lower limb amputations. Seventy-five male Second World War veterans with major lower limb amputations known to be alive were invited to participate from a subregional rehabilitation centre. After exclusions, 44 agreed to attend for examination and radiological screening. The presence of hip OA was determined from a single anterior posterior pelvic X-ray using two approaches: minimum joint space and the Kellgren and Lawrence (K&L) scoring system. Bone mineral density (BMD) was measured by a dual energy X-ray absorptiometry (DXA) scan and prosthetic rehabilitation outcome measures were recorded. Twenty-seven (61%) hips on the amputated side and 10 (23%) on the nonamputated side were positive for OA (based on Kellgren and Lawrence grade of >2). Using a minimum joint space threshold of below 2.5 mm, 24 (55%) hips on the amputation side and 8 (18%) on the nonamputated side were also positive for OA. There was a threefold increased risk of OA for those with above-knee compared to a below-knee amputation. By contrast, from published general population surveys only 4 (11%) cases of hip OA would have been expected on both the amputated and nonamputated hips. There was a significant decrease in femoral neck BMD in the amputated side (p <0.0001) and significantly lower BMD in above-knee amputees than in below-knee amputees (p = 0.0027) as compared to normal age- and sex-matched population. Male war veterans with unilateral major lower limb amputations develop significantly more osteoarthritis of the hip than expected on both ipsi- and contralateral sides. Amputation was also associated with loss of bone density. Above-knee amputees develop significantly more hip osteoarthritis and osteopenia of greater severity in the amputated side than below-knee amputees.

Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair: A Prospective Randomised Open Trial

PubMed Central

Meuret, Pascal; Bouvet, Lionel; Villet, Benoit; Hafez, Mohamed; Allaouchiche, Bernard

2018-01-01

Objective Intraoperative hypotension during hip fracture surgery is frequent in the elderly. No study has compared the haemodynamic effect of hypobaric unilateral spinal anaesthesia (HUSA) and standardised general anaesthesia (GA) in elderly patients undergoing hip fracture surgical repair. Methods We performed a prospective, randomised open study, including 40 patients aged over 75 years, comparing the haemodynamic effects of HUSA (5 mg isobaric bupivacaine with 5 μg sufentanil and 1 mL sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). An incidence of severe hypotension, defined by a decrease in systolic blood pressure of >40% from baseline, was the primary endpoint. Results The incidence of severe hypotension was lower in the HUSA group compared with that in the GA group (32% vs. 71%, respectively, p=0.03). The median [IQR] ephedrine consumption was lower (p=0.001) in the HUSA group (6 mg, 0–17 mg) compared with that in the GA group (36 mg, 21–57 mg). Intraoperative muscle relaxation and patients’ and surgeons’ satisfaction were similar between groups. No difference was observed in 5-day complications or 30-day mortality. Conclusion This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery. PMID:29744247

Clinical study on the unloading effect of hip bracing on gait in patients with hip osteoarthritis.

PubMed

Nérot, Agathe; Nicholls, Micah

2017-04-01

Internal hip abduction moment is a major indicator for hip loading. A new hip bracing concept was designed to unload the cartilaginous area in hip osteoarthritis via an abduction and external rotation force intended to alter the weight bearing area and reduce compression through the joint. To assess the effect of a novel brace on hip rotation in the transverse and coronal planes and on the hip abduction moment. Repeated measures. Gait analysis was performed on 14 subjects with unilateral symptomatic hip osteoarthritis. Pain, joint motion, moments and vertical ground reaction force were compared between the braced and the unbraced (control), randomly assigned, conditions. Nine participants felt an immediate reduction in pain while walking with the hip brace. Peak hip abduction moment significantly decreased on the osteoarthritis side ( p = 0.017). Peak hip adduction ( p = 0.004) and internal rotation ( p = 0.0007) angles significantly decreased at stance with the brace. Wearing the brace would appear to reduce the compressive joint reaction force at the femuroacetabular interface as indicated by a reduction in internal hip abduction moment along with immediate pain reduction in nine participants. Further long-term studies are warranted. Clinical relevance The brace rotates the hip in the transverse and coronal planes, possibly resulting in a decrease in load through the diseased area of cartilage. In some patients, an immediate decrease in pain was experienced. The brace offers an alternative solution for hip osteoarthritis patients not ready for a hip replacement.

Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty.

PubMed

Connelly, James W; Galea, Vincent P; Laaksonen, Inari; Matuszak, Sean J; Madanat, Rami; Muratoglu, Orhun; Malchau, Henrik

2018-04-19

The purpose of this study was to identify which patient and clinical factors are predictive of adverse local tissue reaction (ALTR) and to use these factors to create a highly sensitive algorithm for indicating metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in Articular Surface Replacement (ASR) XL total hip arthroplasty patients. Our secondary aim was to compare our algorithm to existing national guidelines on when to take MARS-MRI in metal-on-metal total hip arthroplasty patients. The study consisted of 137 patients treated with unilateral ASR XL implants from a prospective, multicenter study. Patients underwent MARS-MRI regardless of clinical presentation at a mean of 6.2 (range, 3.3-10.4) years from surgery. Univariate and multivariate analyses were conducted to determine which variables were predictive of ALTR. Predictors were used to create an algorithm to indicate MARS-MRI. Finally, we compared our algorithm's ability to detect ALTR to existing guidelines. We found a visual analog scale pain score ≥2 (odds ratio [OR] = 2.53; P = .023), high blood cobalt (OR = 1.05; P = .023), and male gender (OR = 2.37; P = .034) to be significant predictors of ALTR presence in our cohort. The resultant algorithm achieved 86.4% sensitivity and 60.2% specificity in detecting ALTR within our cohort. Our algorithm had the highest area under the curve and was the only guideline that was significantly predictive of ALTR (P = .014). Our algorithm including patient-reported pain and sex-specific cutoffs for blood cobalt levels could predict ALTR and indicate MARS-MRI in our cohort of ASR XL metal-on-metal patients with high sensitivity. Level II, diagnostic study. Copyright © 2018 Elsevier Inc. All rights reserved.

Patients with Staged Bilateral Total Joint Arthroplasty in Registries: Immortal Time Bias and Methodological Options.

PubMed

van der Pas, Stéphanie L; Nelissen, Rob G H H; Fiocco, Marta

2017-08-02

In arthroplasty data, patients with staged bilateral total joint arthroplasty (TJA) pose a problem in statistical analysis. Subgroup analysis, in which patients with unilateral and bilateral TJA are studied separately, is sometimes considered an appropriate solution to the problem; we aim to show that this is not true because of immortal time bias. We reviewed patients who underwent staged (at any time) bilateral TJA. The logical fallacy leading to immortal time bias is explained through a simple artificial data example. The cumulative incidences of revision and death are computed by subgroup analysis and by landmark analysis based on hip replacement data from the Dutch Arthroplasty Register and on simulated data sets. For patients who underwent unilateral TJA, subgroup analysis can lead to an overestimate of the cumulative incidence of death and an underestimate of the cumulative incidence of revision. The reverse conclusion holds for patients who underwent staged bilateral TJA. Analysis of these patients can lead to an underestimate of the cumulative incidence of death and an overestimate of the cumulative incidence of revision. Immortal time bias can be prevented by using landmark analysis. When examining arthroplasty registry data, patients who underwent staged bilateral TJA should be analyzed with caution. An appropriate statistical method to address the research question should be selected.

Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading.

PubMed

Svehlík, Martin; Kraus, Tanja; Steinwender, Gerhard; Zwick, Ernst B; Linhart, Wolfgang E

2012-06-01

Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait modifications to decrease the load on the affected hip. Forty children with unilateral LCP were divided into three groups based on the time base integral of the hip abductor moments during single stance on the affected side acquired during instrumented 3D gait analysis. X-rays of the affected hip were classified according to Herring and Catterall. Children in the "unloading" group spontaneously adopted a Duchenne-like gait with pelvis elevation, hip abduction and external rotation during single support phase. The "normal-loading" group showed pelvis elevation with a neutral hip position in the frontal plane. In the "overloading" group the pelvis dropped to the swinging limb at the beginning of stance accompanied by prolonged hip adduction. The time base integral of the hip abductor moments during single stance correlated positively with the X-ray classifications of Herring and Catterall, hip abduction angle and age. Older children preferred to walk in hip adduction during single stance, had more impaired hips and tended to overload them. The hip overloading pattern should be avoided in children with LCP. Gait training to unload the hip might become an integral component of conservative treatment in children with LCP.

Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?

PubMed

Al-Amiry, Bariq; Mahmood, Sarwar; Krupic, Ferid; Sayed-Noor, Arkan

2017-09-01

Background Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening ≥10 mm (n = 41) or with reduced global FO >5 mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC ≥0.69). Conclusion Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

Resource utilization and costs before and after total joint arthroplasty.

PubMed

Bozic, Kevin J; Stacey, Brett; Berger, Ariel; Sadosky, Alesia; Oster, Gerry

2012-03-23

The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.). Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test. 14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both p < 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs. $9,632, p < 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs. $1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs. $1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs. $4571, p < 0.01). Mean total costs for the peri-operative period were $36,553. Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.

Transient osteoporosis of pregnancy of the bilateral hips in twin gestation: a case series.

PubMed

Reese, Maria E; Fitzgerald, Colleen; Hynes, Christina

2015-01-01

Transient osteoporosis of pregnancy has been described as a rare, self-limiting disease of unclear etiology that presents as severe pain, which typically affects pregnant women in their third trimester. We describe 3 cases of primigravid pregnant women with twin gestation who reported unilateral hip pain and who were diagnosed with transient osteoporosis of pregnancy of the hip by magnetic resonance imaging. These women were advised to undergo limited weight bearing and activity modification to minimize the risk of fracture. Each patient was able to proceed through her pregnancy, delivery, and postpartum course without complication, with symptom resolution, and return to unrestricted activity. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Reduction of metal artifacts from unilateral hip arthroplasty on dual-energy CT with metal artifact reduction software.

PubMed

Yue, Dong; Fan Rong, Cheng; Ning, Cai; Liang, Hu; Ai Lian, Liu; Ru Xin, Wang; Ya Hong, Luo

2018-07-01

Background The evaluation of hip arthroplasty is a challenge in computed tomography (CT). The virtual monochromatic spectral (VMS) images with metal artifact reduction software (MARs) in spectral CT can reduce the artifacts and improve the image quality. Purpose To evaluate the effects of VMS images and MARs for metal artifact reduction in patients with unilateral hip arthroplasty. Material and Methods Thirty-five patients underwent dual-energy CT. Four sets of VMS images without MARs and four sets of VMS images with MARs were obtained. Artifact index (AI), CT number, and SD value were assessed at the periprosthetic region and the pelvic organs. The scores of two observers for different images and the inter-observer agreement were evaluated. Results The AIs in 120 and 140 keV images were significantly lower than those in 80 and 100 keV images. The AIs of the periprosthetic region in VMS images with MARs were significantly lower than those in VMS images without MARs, while the AIs of pelvic organs were not significantly different. VMS images with MARs improved the accuracy of CT numbers for the periprosthetic region. The inter-observer agreements were good for all the images. VMS images with MARs at 120 and 140 keV had higher subjective scores and could improve the image quality, leading to reliable diagnosis of prosthesis-related problems. Conclusion VMS images with MARs at 120 and 140 keV could significantly reduce the artifacts from hip arthroplasty and improve the image quality at the periprosthetic region but had no obvious advantage for pelvic organs.

A Study to Determine the Best Method of Caring for Certain Short-Stay Surgical Patients at Reynolds Army Community Hospital

DTIC Science & Technology

1988-09-01

Perineoplasty Vaginal cyst, cautery Vaginal web, excision Surgical Patients 95 ORTHOPEDIC Arthrodesis of phalanges Arthroscopy Bone biopsy Bunionectomy...Manipulation of shoulder, knee, or hip Mass excision with scar revision Meniscectomy (if done through arthroscopy ) Metatarsal head, excision unilateral

Reasons for Ninety-Day Emergency Visits and Readmissions After Elective Total Joint Arthroplasty: Results From a US Integrated Healthcare System.

PubMed

Kelly, Matthew P; Prentice, Heather A; Wang, Wei; Fasig, Brian H; Sheth, Dhiren S; Paxton, Elizabeth W

2018-07-01

Previous studies evaluating reasons for 30-day readmissions following total joint arthroplasty (TJA) may underestimate hospital-based utilization of healthcare resources during a patient's episode-of-care. We sought to identify common reasons for 90-day emergency department (ED) visits and hospital readmissions following primary elective unilateral TJA. Patients from July 1, 2012 through June 30, 2015 having primary elective TJA and at least one 90-day postoperative ED-only visit and/or readmission for any reason were identified using the Kaiser Permanente Total Joint Replacement Registry. Chart reviews for ED visits/readmissions included 13 surgical and 11 medical reasons. The 2344 total hips and 5520 total knees were analyzed separately. Incidence of at least one ED visit following total hip arthroplasty (THA) was 13.4% and 4.5% for readmissions. The most frequent reasons for ED visits were swelling (15.6%) and pain (12.8%); the most frequent reasons for readmissions were infection (12.5%) and unrelated elective procedures (9.0%). The incidence of at least one ED visit following total knee arthroplasty (TKA) was 13.8%, and the incidence of readmission was 5.5%. The most frequent reasons for ED visits were pain (15.8%) and swelling (15.6%); the most common readmission reasons were gastrointestinal (19.1%) and manipulation under anesthesia (9.4%). Swelling and pain related to the procedure were the most frequent reasons for 90-day ED visits after both THA and TKA. Readmissions were most commonly due to infection or unrelated procedures for THA and gastrointestinal or manipulation under anesthesia for TKA. Modifications to discharge protocols may help prevent or alleviate these issues, avoiding unnecessary hospital returns. Copyright © 2018 Elsevier Inc. All rights reserved.

Reliability and Validity of the Hip Stability Isometric Test (HipSIT): A New Method to Assess Hip Posterolateral Muscle Strength.

PubMed

Almeida, Gabriel Peixoto Leão; das Neves Rodrigues, Helena Larissa; de Freitas, Bruno Wesley; de Paula Lima, Pedro Olavo

2017-12-01

Study Design Cross-sectional study. Background The Hip Stability Isometric Test (HipSIT) evaluates the strength of the hip posterolateral stabilizers in a position that favors greater activation of the gluteus maximus and gluteus medius and lower activation of the tensor fascia lata. Objectives To check the validity and reliability of the HipSIT and to evaluate the HipSIT in women with patellofemoral pain (PFP). Methods The HipSIT was evaluated with a handheld dynamometer. During testing, the participants were sidelying, with their legs positioned at 45° of hip flexion and 90° of knee flexion. Participants were instructed to raise the knee of the upper leg while keeping the upper and lower heels in contact. To establish reliability and validity, 49 women were tested with the HipSIT by 2 different evaluators on day 1, and then again 7 days later. The strength of the hip extensors, abductors, and external rotators was also evaluated. Twenty women with unilateral PFP were also evaluated. Results The HipSIT has excellent intrarater and interrater reliability. The standard error of measurement was 0.01 kgf/kg, and the minimal detectable change was 0.036 kgf/kg. The HipSIT showed good validity in isolated hip abduction, external rotation, and extension (P<.01). Women with PFP showed a 10% deficit in the HipSIT results for the symptomatic limb (P = .01). Conclusion The HipSIT showed excellent interrater and intrarater reliability, moderate to good validity in women, and was able to identify strength deficits in women with PFP. J Orthop Sports Phys Ther 2017;47(12):906-913. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7274.

The effects of floor incline on lower extremity biomechanics during unilateral landing from a jump in dancers.

PubMed

Pappas, Evangelos; Orishimo, Karl F; Kremenic, Ian; Liederbach, Marijeanne; Hagins, Marshall

2012-05-01

Retrospective studies have suggested that dancers performing on inclined ("raked") stages have increased injury risk. One study suggests that biomechanical differences exist between flat and inclined surfaces during bilateral landings; however, no studies have examined whether such differences exist during unilateral landings. In addition, little is known regarding potential gender differences in landing mechanics of dancers. Professional dancers (N = 41; 14 male, 27 female) performed unilateral drop jumps from a 30 cm platform onto flat and inclined surfaces while extremity joint angles and moments were identified and analyzed. There were significant joint angle and moment effects due to the inclined flooring. Women had significantly decreased peak ankle dorsiflexion and hip adduction moment compared with men. Findings of the current study suggest that unilateral landings on inclined stages create measurable changes in lower extremity biomechanical variables. These findings provide a preliminary biomechanical rationale for differences in injury rates found in observational studies of raked stages.

Retention of Human-Induced Pluripotent Stem Cells (hiPS) With Injectable HA Hydrogels for Vocal Fold Engineering.

PubMed

Imaizumi, Mitsuyoshi; Li-Jessen, Nicole Y K; Sato, Yuka; Yang, David T; Thibeault, Susan L

2017-04-01

One prospective treatment option for vocal fold scarring is regeneration with an engineered scaffold containing induced pluripotent stem cells (iPS). In the present study, we investigated the feasibility of utilizing an injectable hyaluronic acid (HA) scaffold encapsulated with human-iPS cell (hiPS) for regeneration of vocal folds. Thirty athymic nude rats underwent unilateral vocal fold injury. Contralateral vocal folds served as uninjured controls. Hyaluronic acid hydrogel scaffold, HA hydrogel scaffold containing hiPS, and HA hydrogel scaffold containing hiPS with epidermal growth factor (EGF) were injected in both vocal folds immediately after surgery. One and 2 weeks after injection, larynges were excised for histology, immunohistochemistry, and fluorescence in situ hybridization (FISH). Presence of HA hydrogel was confirmed in vocal folds 1 and 2 weeks post injection. The FISH analysis confirmed the presence and viability of hiPS in the injected vocal folds. Histological results demonstrated that vocal folds injected with HA hydrogel scaffold containing EGF demonstrated less fibrosis than those with HA hydrogel only. Human-iPS survived in injured rat vocal folds. The HA hydrogel with hiPS and EGF ameliorated the fibrotic response. Additional work is necessary to optimize hiPS differentiation and further confirm the safety of hiPS for clinical applications.

Does psychological health influence hospital length of stay following total knee arthroplasty? A systematic review.

PubMed

March, Marie K; Harmer, Alison R; Dennis, Sarah

2018-04-25

To systematically review the literature to determine if pre-operative psychological health affected hospital length of stay among adults following primary unilateral total knee arthroplasty. Systematic review. We searched six online databases for original research published until 31 st December 2016 that investigated adults undergoing primary unilateral total knee arthroplasty. Studies were included that used any measure of pre-operative psychological health and reported length of stay, irrespective of study design. We excluded studies that considered participants with cognitive impairment or substance abuse, participants who experienced revision, bilateral or hip surgery, and studies that did not have full text available in English. One review author screened 438 titles and abstracts for inclusion, with a 10% sample of excluded studies reviewed by a second author for adherence to the review protocol, with no violations observed. For all included studies, two authors independently extracted data from each study using a form designed a priori, and independently assessed study quality according to the Joanna Briggs Checklist for Cohort Studies. Due to included study heterogeneity a narrative synthesis was undertaken. Of the seven included studies, five reported statistically significant increases in hospital length of stay among those with worse pre-operative psychological health. These differences were often less than one calendar day, so the clinical significance of these results remains unknown, but the potential to reduce health care costs may still be significant. Adults experiencing worse pre-operative psychological health before total knee arthroplasty may have a longer hospital stay compared to those with unremarkable psychological health. Copyright © 2018. Published by Elsevier Inc.

Efficacy of a Pelvic Lateral Positioner With a Mechanical Cup Navigator Based on the Anatomical Pelvic Plane in Total Hip Arthroplasty.

PubMed

Iwakiri, Kentaro; Kobayashi, Akio; Ohta, Yoichi; Minoda, Yukihide; Takaoka, Kunio; Nakamura, Hiroaki

2017-12-01

The acetabular component orientation in total hip arthroplasty (THA) is of critical importance to the good clinical results. However, traditional widely used cup alignment guides for cup placement are reported to be relatively unreliable. The present study aims at comparing a novel cup alignment guide, which can be attached to our anatomical pelvic plane (APP) pelvic lateral positioner for reducing discrepancies in sagittal pelvic tilt and indicate a targeted cup angle based on the APP, with a conventional cup alignment guide. The subjects were 136 hips of 136 patients who underwent unilateral THA using the APP positioner. The procedure was performed with the conventional cup alignment guide (conventional group; 60 hips) and with the novel cup navigator (mechanical navigator group; 76 hips). Postoperative cup angles and discrepancies of postoperative cup angles (inclination and anteversion angles) from the targeted angles were compared between the 2 groups to evaluate the usefulness of these navigators. The mean cup angles in the conventional group were 39.0° ± 5.3° for the inclination angle and 21.7° ± 6.4° for the anteversion angle, whereas those in the mechanical navigator group were 40.6° ± 3.2° and 18.3° ± 4.6°, respectively (P = .018, P < .0001). The discrepancies from the targeted angles were 3.5° ± 3.1° for the inclination angle and 4.6° ± 3.4° for the anteversion angle in the conventional group and 2.3° ± 2.3° and 3.2° ± 2.7°, respectively, in the mechanical navigator group (P = .020, P = .012). The mechanical cup navigator easily attachable to the APP positioner is a tool that can improve the accuracy of cup placement in a simple, economical, and noninvasive manner in THA via the lateral position. Copyright © 2017 Elsevier Inc. All rights reserved.

Biomechanical differences between unilateral and bilateral landings from a jump: gender differences.

PubMed

Pappas, Evangelos; Hagins, Marshall; Sheikhzadeh, Ali; Nordin, Margareta; Rose, Donald

2007-07-01

To determine the effect of landing type (unilateral vs. bilateral) and gender on the biomechanics of drop landings in recreational athletes. This study used a repeated measures design to compare bilateral and unilateral landings in male and female athletes. A repeated measures multivariate analysis of variance (type of landing*gender) was performed on select variables. Biomechanics laboratory. Sixteen female and 16 male recreational athletes. Kinetic, kinematic, and electromyographic (EMG) data were collected on participants while performing bilateral and unilateral landings from a 40-cm platform. Compared to bilateral landings, subjects performed unilateral landings with increased knee valgus, decreased knee flexion at initial contact, decreased peak knee flexion, decreased relative hip adduction, and increased normalized EMG of the rectus femoris, medial hamstrings, lateral hamstrings, and medial gastrocnemius (P < 0.005). During both types of landing, females landed with increased knee valgus and normalized vertical ground reaction force (VGRF) compared to males (P < 0.009), however, the interaction of landing type*gender was not significant (P = 0.29). Compared to bilateral landings, male and female recreational athletes performed unilateral landings with significant differences in knee kinematic and EMG variables. Female athletes landed with increased knee valgus and VGRF compared to males during both types of landing.

Jump-Landing Biomechanics and Knee-Laxity Change Across the Menstrual Cycle in Women With Anterior Cruciate Ligament Reconstruction

PubMed Central

Bell, David R.; Blackburn, J. Troy; Hackney, Anthony C.; Marshall, Stephen W.; Beutler, Anthony I.; Padua, Darin A.

2014-01-01

Context: Of the individuals able to return to sport participation after an anterior cruciate ligament(ACL) injury, up to 25% will experience a second ACL injury. This population may be more sensitive to hormonal fluctuations, which may explain this high rate of second injury. Objective: To examine changes in 3-dimensional hip and knee kinematics and kinetics during a jump landing and to examine knee laxity across the menstrual cycle in women with histories of unilateral noncontact ACL injury. Design  Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 20 women (age = 19.6 ± 1.3 years, height = 168.6 ± 5.3 cm, mass = 66.2 ± 9.1 kg) with unilateral, noncontact ACL injuries. Intervention(s) Participants completed a jump-landing task and knee-laxity assessment 3 to 5 days after the onset of menses and within 3 days of a positive ovulation test. Main Outcome Measure(s): Kinematics in the uninjured limb at initial contact with the ground during a jump landing, peak kinematics and kinetics during the loading phase of landing, anterior knee laxity via the KT-1000, peak vertical ground reaction force, and blood hormone concentrations (estradiol-β-17, progesterone, free testosterone). Results: At ovulation, estradiol-β-17 (t = −2.9, P = .009), progesterone (t = −3.4, P = .003), and anterior knee laxity (t = −2.3, P = .03) increased, and participants presented with greater knee-valgus moment (Z = −2.6, P = .01) and femoral internal rotation (t = −2.1, P = .047). However, during the menses test session, participants landed harder (greater peak vertical ground reaction force; t = 2.2, P = .04), with the tibia internally rotated at initial contact (t = 2.8, P = .01) and greater hip internal-rotation moment (Z = −2.4, P = .02). No other changes were observed across the menstrual cycle. Conclusions Knee and hip mechanics in both phases of the menstrual cycle represented a greater potential risk of ACL loading. Observed changes in landing mechanics may explain why the risk of second ACL injury is elevated in this population. PMID:24568229

Evaluation of Spine Health and Spine Mechanics in Servicemembers with Traumatic Lower Extremity Amputation or Injury

DTIC Science & Technology

2015-10-01

of proximal compensations (e.g., hip-hiking) to assist with toe clearance (Michaud et al., 2000), or simply because these individuals feel more...related unilateral lower extremity amputation: a long-term survey in a prosthesis center in Iran. Journal of orthopaedic trauma 23(7), 525-530

[APPLICATION AND EFFECTIVENESS OF BIOLOGICAL TYPE ACETABULAR CUP IN ADULT Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP].

PubMed

Xu, Ning; Sun, Junying; Zhao, Xijiang; Wang, Tao

2016-01-01

To investigate the application and effectiveness of the biological type acetabular cup(diameter < 44 mm) in adult Crowe type IV developmental dysplasia of the hip (DDH). Between April 2001 andAugust 2013, biological type acetabular cup was used in total hip arthroplasty for the treatment of Crowe type IV DDH in16 cases (20 hips). There were 3 males and 13 females, aged 31-69 years (mean, 49 years). Unilateral hip was involved in 12cases, and bilateral hips in 4 cases. The patients showed pain of the hip joint and inequality of lower limb (shortening ofaffected limb 1.8-6.0 cm in length, 3.5 cm on average). Acetabular deformity, the relationship and the severity of femoralhead dislocation were comfirmed on the X-ray films. The preoperative Harris score was 34.0 ± 6.9. All patientsachieved healing of incision by first intention, with no complication of infection or neurovascular injury. Sixteen caseswere followed up 4-12 years (mean, 7.5 years). At 2 weeks after operation, dislocation occurred in 2 cases, and were fixedwith plaster for 3 weeks after reduction of the hip. Postoperative X-ray films showed complete reduction of femoral head;the average acetabular coverage of the cup of the weight-bearing area was 98.5% (range, 98.2%-99.1%). The cup from theRanawat triangle was 4.6-7.0 mm (mean, 5.8 mm) in medial shifting, and was 4.5-7.9 mm (mean, 6.2 mm) in elevation,it located at cup lateral surface area inside the iliopectineal line and the Kohler line (< 40%); the cup abduction angle was(45 ± 5)degrees, and the anteversion angle was (10 ± 5)degrees. The other patients had no prosthesis loosening except 1 patient havingextensive acetabular prosthesis loosening because of acetabular osteolysis at 12 years after operation. The hip Harris scorewas significantly improved to 85.0 ± 7.5 at 1 year after operation (t = 14.34, P = 0.01). The acetabular grindingprocess to retain enough bone combined with a small cup of-biological prosthesis treating adult Crowe type IV DDH has theadvantages of satisfactory coverage and initial acetabular fixation, so good early and mid-term effectiveness can be obtained.

Body Mass Index Class Is Independently Associated With Health-Related Quality of Life After Primary Total Hip Arthroplasty: An Institutional Registry-Based Study.

PubMed

McLawhorn, Alexander S; Steinhaus, Michael E; Southren, Daniel L; Lee, Yuo-Yu; Dodwell, Emily R; Figgie, Mark P

2017-01-01

The purpose of this study was to compare the health-related quality of life (HRQoL) of patients across World Health Organization (WHO) body mass index (BMI) classes before and after total hip arthroplasty (THA). Patients with end-stage hip osteoarthritis who received elective primary unilateral THA were identified through an institutional registry and categorized based on the World Health Organization BMI classification. Age, sex, laterality, year of surgery, and Charlson-Deyo comorbidity index were recorded. The primary outcome was the EQ-5D-3L index and visual analog scale (EQ-VAS) scores at 2 years postoperatively. Inferential statistics and regression analyses were performed to determine associations between BMI classes and HRQoL. EQ-5D-3L scores at baseline and at 2 years were statistically different across BMI classes, with higher EQ-VAS and index scores in patients with lower BMI. There was no difference observed for the 2-year change in EQ-VAS scores, but there was a statistically greater increase in index scores for more obese patients. In the regression analyses, there were statistically significant negative effect estimates for EQ-VAS and index scores associated with increasing BMI class. BMI class is independently associated with lower HRQoL scores 2 years after primary THA. While absolute scores in obese patients were lower than in nonobese patients, obese patients enjoyed more positive changes in EQ-5D index scores after THA. These results may provide the most detailed information on how BMI influences HRQoL before and after THA, and they are relevant to future economic decision analyses on the topic. Copyright © 2016 Elsevier Inc. All rights reserved.

Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty

PubMed Central

Sanders, Thomas L.; Maradit Kremers, Hilal; Schleck, Cathy D.; Larson, Dirk R.; Berry, Daniel J.

2017-01-01

Background: Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. Methods: This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. Results: During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Conclusions: Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from bilateral disease processes that selectively affect the young hip, such as osteonecrosis, or structural hip problems, such as acetabular dysplasia or femoroacetabular impingement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:28244910

Hip joint replacement

MedlinePlus

... Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised ...

Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial.

PubMed

Poulsen, E; Hartvigsen, J; Christensen, H W; Roos, E M; Vach, W; Overgaard, S

2013-10-01

To investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI). In a single-center university hospital setting, a total of 118 patients with clinical and radiographic unilateral hip osteoarthritis (OA) from primary care were randomized into one of three groups: PE, PE plus MT or MCI. The PE was taught by a physiotherapist involving five sessions. The MT was delivered by a chiropractor involving 12 sessions and the MCI included a home stretching program. Primary outcome was self-reported pain severity on an 11-box numeric rating scale (NRS) immediately following a 6-week intervention period. Patients were followed for 1 year. Primary analysis included 111 patients (94%). In the combined group (PE + MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points (95% confidence interval (CI) 0.9-2.9) was achieved. Effect size (Cohen's d) for the PE + MT minus the MCI was 0.92 (95% CI 0.41-1.42). Number needed to treat for PE + MT was 3 (95% CI 2-7). No difference was found between the PE and MCI groups, with mean difference 0.0 (95% CI -1.0 to 1.0). At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE + MT was maintained. For primary care patients with OA of the hip, a combined intervention of MT and PE was more effective than a MCI. PE alone was not superior to the MCI. clinicaltrials.govNCT01039337. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Comparison of high, medium and low mobilization forces for increasing range of motion in patients with hip osteoarthritis: A randomized controlled trial.

PubMed

Estébanez-de-Miguel, Elena; Fortún-Agud, María; Jimenez-Del-Barrio, Sandra; Caudevilla-Polo, Santos; Bueno-Gracia, Elena; Tricás-Moreno, José Miguel

2018-05-29

Manual therapy has been shown to increase range of motion (ROM) in hip osteoarthritis (OA). However, the optimal intensity of force during joint mobilization is not known. To compare the effectiveness of high, medium and low mobilization forces for increasing range of motion (ROM) in patients with hip OA and to analyze the effect size of the mobilization. Randomized controlled trial. Sixty patients with unilateral hip OA were randomized to three groups: low, medium or high force mobilization group. Participants received three treatment sessions of long-axis distraction mobilization (LADM) in open packed position and distraction forces were measured at each treatment. Primary outcomes: passive hip ROM assessed before and after each session. pain recorded with Western Ontario and McMaster Universities (WOMAC) pain subscale before and after the three treatment sessions. Hip ROM increased significantly (p < 0.05) in the high-force mobilization group (flexion: 10.6°, extension: 8.0°, abduction:6.4°, adduction: 3.3°, external rotation: 5.6°, internal rotation: 7.6°). These improvements in hip ROM were statistically significant (p < 0.05) compared to the low-force group. There were no significant changes in the low-force and medium-force groups for hip ROM. No significant differences in hip pain were found between treatment groups. A high force LADM in open packed position significantly increased hip ROM in all planes of motion compared to a medium or low force mobilization in patients with hip OA. A specific intensity of force mobilization appears to be necessary for increasing ROM in hip OA. Copyright © 2018 Elsevier Ltd. All rights reserved.

Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

PubMed

Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

2014-12-01

Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

Bilateral and Unilateral Asymmetries of Isokinetic Strength and Flexibility in Male Young Professional Soccer Players

PubMed Central

Daneshjoo, Abdolhamid; Rahnama, Nader; Mokhtar, Abdul Halim; Yusof, Ashril

2013-01-01

This study investigated bilateral and unilateral asymmetries of strength and flexibility in male young professional soccer players. Thirty-six soccer players (age: 18.9 ± 1.4 years) participated in this study. A Biodex Isokinetic Dynamometer was used to assess the hamstring and quadriceps strength at selected speeds of 60°/s, 180°/s and 300°/s. Hip joint flexibility was measured using a goniometer. No difference was observed in conventional strength ratio, dynamic control ratio and fast/slow speed ratio between the dominant and non-dominant legs (p>0.05). All but one of the players (97.2%) had musculoskeletal abnormality (bilateral imbalance > 10%) in one or more specific muscle groups. The dominant leg had greater hip joint flexibility compared with the non-dominant leg (108.8 ± 10.7° versus 104.6 ± 9.8°, respectively). The findings support the hypothesis that physical performance and movement pattern experienced during soccer playing may negatively change the balance of strength in both legs (bilateral strength balance), but not on the same leg of the young male professional soccer players. The results can be helpful for trainers and coaches to decide whether the players need to improve their balance and strength which in turn may prevent injury. It is suggested that in professional soccer training, quadriceps and hamstrings muscle strength, as well as hip joint flexibility should not be overlooked. PMID:23717354

EMG of the hip adductor muscles in six clinical examination tests.

PubMed

Lovell, Gregory A; Blanch, Peter D; Barnes, Christopher J

2012-08-01

To assess activation of muscles of hip adduction using EMG and force analysis during standard clinical tests, and compare athletes with and without a prior history of groin pain. Controlled laboratory study. 21 male athletes from an elite junior soccer program. Bilateral surface EMG recordings of the adductor magnus, adductor longus, gracilis and pectineus as well as a unilateral fine-wire EMG of the pectineus were made during isometric holds in six clinical examination tests. A load cell was used to measure force data. Test type was a significant factor in the EMG output for all four muscles (all muscles p < 0.01). EMG activation was highest in Hips 0 or Hips 45 for adductor magnus, adductor longus and gracilis. EMG activation for pectineus was highest in Hips 90. Injury history was a significant factor in the EMG output for the adductor longus (p < 0.05), pectineus (p < 0.01) and gracilis (p < 0.01) but not adductor magnus. For force data, clinical test type was a significant factor (p < 0.01) with Hips 0 being significantly stronger than Hips 45, Hips 90 and Side lay. BMI (body mass index) was a significant factor (p < 0.01) for producing a higher force. All other factors had no significant effect on the force outputs. Hip adduction strength assessment is best measured at hips 0 (which produced most force) or 45° flexion (which generally gave the highest EMG output). Muscle EMG varied significantly with clinical test position. Athletes with previous groin injury had a significant fall in some EMG outputs. Copyright © 2011 Elsevier Ltd. All rights reserved.

National Comparative Audit of Blood Use in Elective Primary Unilateral Total Hip Replacement Surgery in the UK

PubMed Central

Boralessa, H; Goldhill, DR; Tucker, K; Mortimer, AJ; Grant-Casey, J

2009-01-01

INTRODUCTION Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice. PATIENTS AND METHODS NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards. RESULTS Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1–14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more. CONCLUSIONS Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence-based, transfusion threshold should be used and transfusion of more than one unit should only be given if essential to maintain haemoglobin concentrations above this threshold. PMID:19686612

Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

PubMed Central

Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

2013-01-01

Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in the long term compared with those undergoing cemented or uncemented total hip replacement. This difference persisted after extensive adjustment for confounding factors available in our data. The study results can be applied to matched populations, which exclude patients who are very old and have had complex total hip replacements. Although residual confounding is possible, the observed effect size is large. These findings require validation in external cohorts and randomised clinical trials. PMID:24284336

Experimentally induced cam impingement in the sheep hip.

PubMed

Siebenrock, Klaus A; Fiechter, Ruth; Tannast, Moritz; Mamisch, Tallal C; von Rechenberg, Brigitte

2013-04-01

Sheep hips have a natural non-spherical femoral head similar to a cam-type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam-type femoro-acetabular impingement (FAI) during flexion can be created. We tested the hypotheses that macroscopic lesions of the articular cartilage and an increased Mankin score (MS) can be reproduced by an experimentally induced cam-type FAI in this ovine in vivo model. Furthermore, we hypothesized that the MS increases with longer ambulatory periods. Sixteen sheep underwent unilateral intertrochanteric varus osteotomy of the hip with the non-operated hip as a control. Four sheep were sacrificed after 14, 22, 30, and 38-weeks postoperatively. We evaluated macroscopic chondrolabral alterations, and recorded the MS, based on histochemical staining, for each ambulatory period. A significantly higher prevalence of macroscopic chondrolabral lesions was found in the impingement zone of the operated hips. The MS was significantly higher in the acetabular/femoral cartilage of the operated hips. Furthermore, these scores increased as the length of the ambulatory period increased. Cam-type FAI can be induced in an ovine in vivo model. Localized chondrolabral degeneration of the hip, similar to that seen in humans (Tannast et al., Clin Orthop Relat Res 2008; 466: 273-280; Beck et al., J Bone Joint Surg Br 2005; 87: 1012-1018), can be reproduced. This experimental sheep model can be used to study cam-type FAI. Copyright © 2012 Orthopaedic Research Society.

Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure.

PubMed

Matsumoto, Mikio; Baba, Tomonori; Homma, Yasuhiro; Kobayashi, Hideo; Ochi, Hironori; Yuasa, Takahito; Behrend, Henrik; Kaneko, Kazuo

2015-10-01

The Forgotten Joint Score-12 (FJS-12) is for patients to forget their artificial joint and is reportedly a useful patient-reported outcome tool for artificial joints. The purpose of this study was to determine whether the FJS-12 is as useful as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) in Japan. All patients who visited our hospital's hip joint specialists following unilateral THA from August 2013 to July 2014 were evaluated. Medical staff members other than physicians administered three questionnaires. Items evaluated were (1) the reliability of the FJS-12 and (2) correlations between the FJS-12 and the total and subscale scores of the WOMAC or JHEQ. Of 130 patients, 22 were excluded. Cronbach's α coefficient was 0.97 for the FJS-12. The FJS-12 showed a significantly lower score than the WOMAC or JHEQ (p < 0.01). The FJS-12 was moderately correlated with the total WOMAC score (r = 0.522) and its subscale scores for "stiffness" (r = 0.401) and "function" (r = 0.539) and was weakly correlated with the score for "pain" (r = 0.289). The FJS-12 was favorably correlated with the total JHEQ score (r = 0.686) and its subscale scores (r = 0.530-0.643). The FJS-12 was correlated with and showed reliability similar to that of the JHEQ and WOMAC. The FJS-12, which is not affected by culture or lifestyle, may be useful in Japan.

Test-Retest Reliability of Innovated Strength Tests for Hip Muscles

PubMed Central

Meyer, Christophe; Corten, Kristoff; Wesseling, Mariska; Peers, Koen; Simon, Jean-Pierre; Jonkers, Ilse; Desloovere, Kaat

2013-01-01

The burden of hip muscles weakness and its relation to other impairments has been well documented. It is therefore a pre-requisite to have a reliable method for clinical assessment of hip muscles function allowing the design and implementation of a proper strengthening program. Motor-driven dynamometry has been widely accepted as the gold-standard for lower limb muscle strength assessment but is mainly related to the knee joint. Studies focusing on the hip joint are less exhaustive and somewhat discrepant with regard to optimal participants position, consequently influencing outcome measures. Thus, we aimed to develop a standardized test setup for the assessment of hip muscles strength, i.e. flexors/extensors and abductors/adductors, with improved participant stability and to define its psychometric characteristics. Eighteen participants performed unilateral isokinetic and isometric contractions of the hip muscles in the sagittal and coronal plane at two separate occasions. Peak torque and normalized peak torque were measured for each contraction. Relative and absolute measures of reliability were calculated using the intraclass correlation coefficient and standard error of measurement, respectively. Results from this study revealed higher levels of between-day reliability of isokinetic/isometric hip abduction/flexion peak torque compared to existing literature. The least reliable measures were found for hip extension and adduction, which could be explained by a less efficient stabilization technique. Our study additionally provided a first set of reference normalized data which can be used in future research. PMID:24260550

Guillain-Barré Syndrome presenting as unilateral hip pain in a child.

PubMed

Neocleous, Charalambos; Diakolios, Konstandinos; Adramerina, Alkistis; Varveris, Evangelos; Tsioni, Vasiliki; Machairidou, Konstandina

2015-01-01

The aim of this report is to highlight the importance of close observation and follow-up in children who present with an acutely irritable hip. This is because hip pain is a symptom of not only benign but also severe conditions. Thus, at the time of the initial presentation, hip pain can be misdiagnosed. This report serves as an example for a wide range of doctors such as orthopaedic surgeons, paediatricians, emergency room physicians or primary care physicians, because these are the first-line doctors who treat patients with a painful hip. We herein present a three-year-old child who was admitted to our hospital with pain in the right leg and initially diagnosed with transient synovitis of the hip. An additional examination two days later, after severe deterioration of the clinical picture, revealed that our patient was actually suffering from Guillain-Barré syndrome. Failure to diagnose Guillain-Barré syndrome and initiating prompt treatment is potentially life-threatening. Clinicians should be aware that hip pain could be the presenting complaint of Guillain-Barré syndrome, a syndrome that has many clinical features. Even when all the clinical and laboratory findings indicate a benign condition, Guillain- Barré syndrome should still be considered. Therefore, close observation and follow-up in children who present with an acutely irritable hip is highly recommended. In this way, the potentially catastrophic consequences of more severe conditions can be avoided. Copyright © 2015 by Academy of Sciences and Arts of Bosnia and Herzegovina.

Hip contact forces in asymptomatic total hip replacement patients differ from normal healthy individuals: Implications for preclinical testing.

PubMed

Li, Junyan; Redmond, Anthony C; Jin, Zhongmin; Fisher, John; Stone, Martin H; Stewart, Todd D

2014-08-01

Preclinical durability testing of hip replacement implants is standardised by ISO-14242-1 (2002) which is based on historical inverse dynamics analysis using data obtained from a small sample of normal healthy individuals. It has not been established whether loading cycles derived from normal healthy individuals are representative of loading cycles occurring in patients following total hip replacement. Hip joint kinematics and hip contact forces derived from multibody modelling of forces during normal walking were obtained for 15 asymptomatic total hip replacement patients and compared to 38 normal healthy individuals and to the ISO standard for pre-clinical testing. Hip kinematics in the total hip replacement patients were comparable to the ISO data and the hip contact force in the normal healthy group was also comparable to the ISO cycles. Hip contact forces derived from the asymptomatic total hip replacement patients were comparable for the first part of the stance period but exhibited 30% lower peak loads at toe-off. Although the ISO standard provides a representative kinematic cycle, the findings call into question whether the hip joint contact forces in the ISO standard are representative of those occurring in the joint following total hip replacement. Copyright © 2014. Published by Elsevier Ltd.

Improvement in gait following combined ankle and subtalar arthrodesis.

PubMed

Tenenbaum, Shay; Coleman, Scott C; Brodsky, James W

2014-11-19

This study assessed the hypothesis that arthrodesis of both the ankle and the hindfoot joints produces an objective improvement of function as measured by gait analysis of patients with severe ankle and hindfoot arthritis. Twenty-one patients with severe ankle and hindfoot arthritis who underwent unilateral tibiotalocalcaneal arthrodesis with an intramedullary nail were prospectively studied with three-dimensional (3D) gait analysis at a minimum of one year postoperatively. The mean age at the time of the operation was fifty-nine years, and the mean duration of follow-up was seventeen months (range, twelve to thirty-one months). Temporospatial measurements included cadence, step length, walking velocity, and total support time. The kinematic parameters were sagittal plane motion of the ankle, knee, and hip. The kinetic parameters were sagittal plane ankle power and moment and hip power. Symmetry of gait was analyzed by comparing the step lengths on the affected and unaffected sides. There was significant improvement in multiple parameters of postoperative gait as compared with the patients' own preoperative function. Temporospatial data showed significant increases in cadence (p = 0.03) and walking speed (p = 0.001) and decreased total support time (p = 0.02). Kinematic results showed that sagittal plane ankle motion had decreased, from 13.2° preoperatively to 10.2° postoperatively, in the operatively treated limb (p = 0.02), and increased from 22.2° to 24.1° (p = 0.01) in the contralateral limb. Hip motion on the affected side increased from 39° to 43° (p = 0.007), and knee motion increased from 56° to 60° (p = 0.054). Kinetic results showed significant increases in ankle moment (p < 0.0001) of the operatively treated limb, ankle power of the contralateral limb (p = 0.009), and hip power on the affected side (p = 0.005) postoperatively. There was a significant improvement in gait symmetry (p = 0.01). There was a small loss of sagittal plane motion in the affected limb postoperatively. There were marked increases in gait velocity, ankle moment, and hip motion and power, documenting objective improvements in ambulatory function. The data showed that preoperative ankle motion was greatly diminished. This may suggest that pain is more important than stiffness in asymmetric gait. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

A method to investigate the biomechanical alterations in Perthes' disease by hip joint contact modeling.

PubMed

Salmingo, Remel Alingalan; Skytte, Tina Lercke; Traberg, Marie Sand; Mikkelsen, Lars Pilgaard; Henneberg, Kaj-Åge; Wong, Christian

2017-01-01

Perthes' disease is a destructive hip joint disorder characterized by malformation of the femoral head in young children. While the morphological changes have been widely studied, the biomechanical effects of these changes still need to be further elucidated. The objective of this study was to develop a method to investigate the biomechanical alterations in Perthes' disease by finite element (FE) contact modeling using MRI. The MRI data of a unilateral Perthes' case was obtained to develop the three-dimensional FE model of the hip joint. The stress and contact pressure patterns in the unaffected hip were well distributed. Elevated concentrations of stress and contact pressure were found in the Perthes' hip. The highest femoral cartilage von Mises stress 3.9 MPa and contact pressure 5.3 MPa were found in the Perthes' hip, whereas 2.4 MPa and 4.9 MPa in the healthy hip, respectively. The healthy bone in the femoral head of the Perthes' hip carries additional loads as indicated by the increase of stress levels around the necrotic-healthy bone interface. Identifying the biomechanical changes, such as the location of stress and contact pressure concentrations, is a prerequisite for the preoperative planning to obtain stress relief for the highly stressed areas in the malformed hip. This single-patient study demonstrated that the biomechanical alterations in Perthes' disease can be evaluated individually by patient-specific finite element contact modeling using MRI. A multi-patient study is required to test the strength of the proposed method as a pre-surgery planning tool.

Inter-joint coordination strategies during unilateral stance 6-months following first-time lateral ankle sprain.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Delahunt, Eamonn

2015-02-01

Longitudinal analyses of participants with a history of lateral ankle sprain are lacking. This investigation combined measures of inter-joint coordination and stabilometry to evaluate eyes-open (condition 1) and eyes-closed (condition 2) static unilateral stance performance in a group of participants, 6-months after they sustained an acute, first-time lateral ankle sprain in comparison to a control group. Sixty-nine participants with a 6-month history of first-time lateral ankle sprain and 20 non-injured controls completed three 20-second unilateral stance task trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb 3-dimensional kinematic data for similarity in the aim of establishing patterns of lower-limb inter-joint coordination. The fractal dimension of the stance limb centre of pressure path was also calculated. Between-group analyses revealed significant differences in stance limb inter-joint coordination strategies for conditions 1 and 2, and in the fractal dimension of the centre-of-pressure path for condition 2 only. Injured participants displayed increases in ankle-hip linked coordination compared to controls in condition 1 (sagittal/frontal plane: 0.15 [0.14] vs 0.06 [0.04]; η(2)=.19; sagittal/transverse plane: 0.14 [0.11] vs 0.09 [0.05]; η(2)=0.14) and condition 2 (sagittal/frontal plane: 0.15 [0.12] vs 0.08 [0.06]; η(2)=0.23), with an associated decrease in the fractal dimension of the centre-of-pressure path (injured limb: 1.23 [0.13] vs 1.36 [0.13]; η(2)=0.20). Participants with a 6-month history of first-time lateral ankle sprain exhibit a hip-dominant coordination strategy for static unilateral stance compared to non-injured controls. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats.

PubMed

Kongsgaard, M; Aagaard, P; Roikjaer, S; Olsen, D; Jensen, M; Langberg, H; Magnusson, S P

2006-08-01

Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats. Thirteen subjects performed unilateral eccentric squats on flat-and a 25 degrees decline surface. During the squats, electromyography activity was obtained in eight representative muscles. Also, ankle, knee and hip joint goniometry was obtained. Additionally, patellar tendon strain was measured in vivo using ultrasonography as subjects maintained a unilateral isometric 90 degrees knee angle squat position on either flat or 25 degrees decline surface. Patellar tendon strain was significantly greater (P<0.05) during the squat position on the decline surface compared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (P<0.001, P<0.05). Normalized mean electromyography amplitudes of the knee extensor muscles were significantly greater during the decline compared to the standard squats (P<0.05). Hamstring and calf muscle mean electromyography did not differ, respectively, between standard and decline squats. The use of a 25 degrees decline board increases the load and the strain of the patellar tendon during unilateral eccentric squats. This finding likely explains previous reports of superior clinical efficacy of decline eccentric squats in the rehabilitative management of patellar tendinopathy.

Revision total hip arthroplasty due to pain from hypersensitivity to cobalt-chromium in total hip arthroplasty.

PubMed

Kosukegawa, Ima; Nagoya, Satoshi; Kaya, Mitsunori; Sasaki, Koichi; Sasaki, Mikito; Yamashita, Toshihiko

2011-09-01

We report a case with hypersensitivity to CoCr in total hip arthroplasty coupled with conventional polyethylene and CoCr femoral head. The patient complained of left hip pain and systemic fever, and computed tomography imaging revealed a periprosthetic cystic lesion, so we performed revision total hip arthroplasty using a titanium stem and ceramic head and highly crosslinked polyethylene. Hip pain and cystic lesion disappeared 3 years after revision surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

Physical activity of elderly patients after total hip arthroplasty.

PubMed

Cukras, Zbigniew; Praczko, Katarzyna; Kostka, Tomasz; Jegier, Anna

2007-01-01

Total hip arthroplasty (THA) is the most common method of treatment of severe hip osteoarthritis. There is little data concerning the physical activity of total hip arthroplasty patients in Poland and investigations to explore this area are useful. The aim of the study was to describe the post-operative physical activity of total hip arthroplasty patients. A total of 146 adult people were examined, among which 28 men and 41 women had undergone total hip arthroplasty due to primary osteoarthritis of the hip, while another 32 men and 41 women matched for age who had not undergone hip surgery for osteoarthritis served as controls. The physical activity of study participants was assessed with the 7-Day Physical Activity Recall Questionnaire. All participants were also asked about the type and amount of physical activity they engaged in to maintain good health. Physical activity measured as the total amount of calories expended through physical activity per week was similar in the post-THA patients compared to the controls. The only differences were a smaller amount of calories expended during low-intensity physical activity by men after total hip arthroplasty compared to men who had not undergone surgery for osteoarthritis and a smaller amount of calories expended through high-intensity physical activity by women after total hip arthroplasty compared to female controls. The kinds of recreational physical activity most commonly practised by patients a mean of two years after total hip arthroplasty were marching, bicycling and general body conditioning exercises (usually the continuation of exercises recommended during post-operative rehabilitation). The percentage of post-THA patients undertaking physical activity for the prevention of non-communicable diseases was low. Physical activity should be more effectively encouraged in patients after total hip arthroplasty.

Bacterial infective arthritis of the coxofemoral joint in dogs with hip dysplasia.

PubMed

Benzioni, H; Shahar, R; Yudelevitch, S; Milgram, J

2008-01-01

The objective of this study was to describe seven cases of unilateral bacterial infective coxarthritis from a total of 19 cases of bacterial infective arthritis (BIA), presenting over a two year period. We recorded the history, clinical signs, diagnostic process, treatment and clinical outcome in these cases. The data were obtained from medical records, review of the radiographs, and telephone follow-up with the owners. All of the dogs in this study had severe chronic osteoarthritis secondary to hip dysplasia, which caused periodic hind limb lameness. They were all admitted with severe acute hind-limb lameness. Pelvic radiographs were performed under general anaesthesia shortly after presentation, followed immediately by arthrocentesis of the affected joint. The synovial fluid was evaluated microscopically by direct smear and a sample was sent for culture and sensitivity. An attempt was not made to drain or lavage the affected joint during the course of treatment. The initial choice of antibiotics was empiric and subsequently modified, as required, based on the sensitivity results. Four of the dogs showed a rapid return to weight-bearing after the initiation of antibiotic treatment, and all of the patients returned to their pre-BIA level of function. Neither recurrent infections nor any adverse sequela requiring further intervention were reported by the owners on telephone follow-up.

Total hip arthroplasty of dysplastic hip after previous Chiari pelvic osteotomy.

PubMed

Minoda, Yukihide; Kadowaki, Toru; Kim, Mitsunari

2006-08-01

Many reports have suggested that Chiari pelvic osteotomy would improve the results of acetabular component placement and fixation in subsequent total hip arthroplasty. However, little is known concerning the biomechanical, radiological, and clinical effects of Chiari pelvic osteotomy on subsequent total hip arthroplasty. Ten total hip arthroplasties for developmental dysplasia of the hip after previous Chiari pelvic osteotomy (Chiari group) were compared with 20 total hip arthroplasties for developmental dysplasia of the hip without previous surgery (control group). Preoperative patient demographic data and operative technique were well matched between the groups. The mean duration of follow-up was 3.0 years. Biomechanical, radiological, and clinical evaluations were performed. No acetabular or femoral components exhibited loosening. All patients had good or excellent clinical score according to the Merle d'Aubigne-Postel rating system at the most recent follow-up. Abductor force and joint force were smaller in the Chiari group, although long operative time, more blood loss, and verticalization of joint force were noted in this group. This limited study suggested that Chiari pelvic osteotomy changed the biomechanical features of the hip joint, and that this alteration might have compromised subsequent total hip arthroplasty.

Muscle strength and areal bone mineral density at the hip in women: a cross-sectional study.

PubMed

Pasco, Julie A; Holloway, Kara L; Brennan-Olsen, Sharon L; Moloney, David J; Kotowicz, Mark A

2015-05-24

Muscle strengthening exercises are promoted for building and maintaining a healthy skeleton. We aimed to investigate the relationship between muscle strength and areal bone mineral density (BMD) at the hip in women aged 26-97 years. This cross-sectional study utilises data from 863 women assessed for the Geelong Osteoporosis Study. Measures of hip flexor and abductor strength were made using a hand-held dynamometer (Nicholas Manual Muscle Tester). The maximal measure from three trials on each leg was used for analyses. BMD was measured at the hip using dual energy x-ray absorptiometry (DXA; Lunar DPX-L). Total lean mass, body fat mass and appendicular lean mass were determined from whole body DXA scans. Linear regression techniques were used with muscle strength as the independent variable and BMD as the dependent variable. Models were adjusted for age and indices of body composition. Measures of age-adjusted hip flexor strength and hip abductor strength were positively associated with total hip BMD. For each standard deviation (SD) increase in hip flexor strength, the increase in mean total hip BMD (SD) was 10.4 % (p = 0.009). A similar pattern was observed for hip abductor strength, with an increase in mean total hip BMD of 22.8 % (p = 0.025). All associations between hip muscle strength and total hip BMD were independent of height, but were nullified after adjusting for appendicular lean mass or total lean mass. There was a positive association observed between muscle strength and BMD at the hip. However, this association was explained by measures of lean mass.

What Financial Incentives Will Be Created by Medicare Bundled Payments for Total Hip Arthroplasty?

PubMed

Clement, R Carter; Kheir, Michael M; Soo, Adrianne E; Derman, Peter B; Levin, L Scott; Fleisher, Lee A

2016-09-01

Bundled payments are gaining popularity in arthroplasty as a tactic for encouraging providers and hospitals to work together to reduce costs. However, this payment model could potentially motivate providers to avoid unprofitable patients, limiting their access to care. Rigorous risk adjustment can prevent this adverse effect, but most current bundling models use limited, if any, risk-adjustment techniques. This study aims to identify and quantify the financial incentives that are likely to develop with total hip arthroplasty (THA) bundled payments that are not accompanied by comprehensive risk stratification. Financial data were collected for all Medicare-eligible patients (age 65+) undergoing primary unilateral THA at an academic center over a 2-year period (n = 553). Bundles were considered to include operative hospitalizations and unplanned readmissions. Multivariate regression was performed to assess the impact of clinical and demographic factors on the variable cost of THA episodes, including unplanned readmissions. (Variable costs reflect the financial incentives that will emerge under bundled payments). Increased costs were associated with advanced age (P < .001), elevated body mass index (BMI; P = .005), surgery performed for hip fracture (P < .001), higher American Society of Anaesthesiologists (ASA) Physical Classification System grades (P < .001), and MCCs (Medicare modifier for major complications; P < .001). Regression coefficients were $155/y, $107/BMI point, $2775 for fracture cases, $2137/ASA grade, and $4892 for major complications. No association was found between costs and gender or race. If generalizable, our results suggest that Centers for Medicare and Medicaid Services bundled payments encompassing acute inpatient care should be adjusted upward by the aforementioned amounts (regression coefficients above) for advanced age, increasing BMI, cases performed for fractures, elevated ASA grade, and major complications (as defined by Medicare MCC modifiers). Furthermore, these figures likely underestimate costs in many bundling models which incorporate larger proportions of postdischarge care. Failure to adjust for factors affecting costs may create barriers to care for specific patient populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Prior Image Constrained Compressed Sensing Metal Artifact Reduction (PICCS-MAR): 2D and 3D Image Quality Improvement with Hip Prostheses at CT Colonography.

PubMed

Bannas, Peter; Li, Yinsheng; Motosugi, Utaroh; Li, Ke; Lubner, Meghan; Chen, Guang-Hong; Pickhardt, Perry J

2016-07-01

To assess the effect of the prior-image-constrained-compressed-sensing-based metal-artefact-reduction (PICCS-MAR) algorithm on streak artefact reduction and 2D and 3D-image quality improvement in patients with total hip arthroplasty (THA) undergoing CT colonography (CTC). PICCS-MAR was applied to filtered-back-projection (FBP)-reconstructed DICOM CTC-images in 52 patients with THA (unilateral, n = 30; bilateral, n = 22). For FBP and PICCS-MAR series, ROI-measurements of CT-numbers were obtained at predefined levels for fat, muscle, air, and the most severe artefact. Two radiologists independently reviewed 2D and 3D CTC-images and graded artefacts and image quality using a five-point-scale (1 = severe streak/no-diagnostic confidence, 5 = no streak/excellent image-quality, high-confidence). Results were compared using paired and unpaired t-tests and Wilcoxon signed-rank and Mann-Whitney-tests. Streak artefacts and image quality scores for FBP versus PICCS-MAR 2D-images (median: 1 vs. 3 and 2 vs. 3, respectively) and 3D images (median: 2 vs. 4 and 3 vs. 4, respectively) showed significant improvement after PICCS-MAR (all P < 0.001). PICCS-MAR significantly improved the accuracy of mean CT numbers for fat, muscle and the area with the most severe artefact (all P < 0.001). PICCS-MAR substantially reduces streak artefacts related to THA on DICOM images, thereby enhancing visualization of anatomy on 2D and 3D CTC images and increasing diagnostic confidence. • PICCS-MAR significantly reduces streak artefacts associated with total hip arthroplasty on 2D and 3D CTC. • PICCS-MAR significantly improves 2D and 3D CTC image quality and diagnostic confidence. • PICCS-MAR can be applied retrospectively to DICOM images from single-kVp CT.

Asynchronous slipped capital femoral epiphysis in a patient with a seizure disorder: case report and review of the literature.

PubMed

Patterson, Diana C; Price, Andrew E

2018-05-01

Debate remains about the appropriate treatment of the asymptomatic side following treatment of a unilateral slipped capital femoral epiphysis (SCFE). A 12-year-old boy with a seizure disorder presented with an unstable SCFE on the left hip following a seizure. He underwent percutaneous pinning of the left only. At 8 months postoperatively, he returned with an unstable slip of the right hip, again following a seizure. No literature discussing the treatment of patients with risk of SCFE and seizure disorders was identified. Further study may identify an increased incidence of contralateral slip following an initial slip in this population. If a greater risk exists, contralateral prophylactic fixation at time of index surgery may be indicated.

Tendon Disorders After Total Hip Arthroplasty: Evaluation and Management.

PubMed

Capogna, Brian M; Shenoy, Kartik; Youm, Thomas; Stuchin, Steven A

2017-10-01

Most patients who undergo total hip arthroplasty are very satisfied with their outcomes. However, there is a small subset of patients who have persistent pain after surgery. The etiology of pain after total hip arthroplasty varies widely; however, tendon disorders are a major cause of debilitating pain that often go unrecognized. We performed a literature review to identify the most common tendon pathologies after total hip arthroplasty which include iliopsoas tendinitis, greater trochanteric pain syndrome, snapping hip syndrome, and abductor tendinopathy. We present a simplified approach highlighting the presentation and management of patients with suspected tendinopathies after total hip arthroplasty. These tendinopathies are treatable, and management begins with nonoperative modalities; however, in cases not responsive to conservative management, operative intervention may be necessary. Tendinopathies after total hip arthroplasty sometimes go unrecognized but when treated can result in higher surgeon and patient satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

Genetic evaluation of the total hip score of four populous breeds of dog, as recorded by the New Zealand Veterinary Association Hip Dysplasia Scheme (1991-2011).

PubMed

Soo, M; Sneddon, N W; Lopez-Villalobos, N; Worth, A J

2015-03-01

To use estimated breeding value (EBV) analysis to investigate the genetic trend of the total hip score (to assess canine hip dysplasia) in four populous breeds of dogs using the records from the New Zealand Veterinary Association (NZVA) Canine Hip Dysplasia Scheme database (1991 to 2011). Estimates of heritability and EBV for the NZVA total hip score of individual dogs from the German Shepherd, Labrador Retriever, Golden Retriever and Rottweiler breeds were obtained using restricted maximum likelihood procedures with a within-breed linear animal model. The model included the fixed effects of gender, birth year, birth season, age at scoring and the random effect of animal. The pedigree file included animals recorded between 1990 and 2011. A total of 2,983 NZVA hip score records, from a pedigree of 3,172 animals, were available for genetic evaluation. Genetic trends of the NZVA total hip score were calculated as the regression coefficient of the EBV (weighted by reliabilities) on year of birth. The estimates of heritability for hip score were 0.32 (SE 0.08) in German Shepherd, 0.37 (SE 0.08) in Labrador Retriever, 0.29 (SE 0.08) in Golden Retriever and 0.52 (SE 0.18) in Rottweiler breeds. Genetic trend analysis revealed that only the German Shepherd breed exhibited a genetic trend towards better hip conformation over time, with a decline of 0.13 (SE 0.04) NZVA total hip score units per year (p<0.001). The genetic trends of total hip score for the remaining three breeds were not significantly different from zero (p>0.1). Despite moderate heritability of the NZVA total hip score, there has not been substantial improvement of this trait for the four breeds analysed in the study period. Greater improvement in reducing the prevalence of canine hip dysplasia may be possible if screening were to be compulsory as a requirement for registration of pedigree breeding stock, greater selection pressure were to be applied and selection of breeding stock made on the basis on an individual's EBV rather than the NZVA total hip score alone.

What Incentives Are Created by Medicare Payments for Total Hip Arthroplasty?

PubMed

Clement, R Carter; Soo, Adrianne E; Kheir, Michael M; Derman, Peter B; Flynn, David N; Levin, L Scott; Fleisher, Lee A

2016-09-01

Differences in profitability and contribution margin (CM) between various patient populations may make certain patients particularly attractive (or unattractive) to providers. This study seeks to identify patient characteristics associated with increased profit and CM among Medicare patients undergoing total hip arthroplasty (THA). The expected Medicare reimbursement for consecutive patients of Medicare-eligible age (65+ years) undergoing primary unilateral elective THA (n = 498) was calculated in accordance with Center for Medicare and Medicaid Services policy. Costs were derived from the hospital's cost accounting system. Profit and CM were calculated for each patient as reimbursement less total and variable costs, respectively. Patients were compared based on clinical and demographic factors by univariate and multivariate analyses. Medicare patients undergoing THA generated negative average profits but substantial positive CMs. Lower profit and CM were associated with higher American Society of Anesthesiologists Physical Status Classification (P < .01, P = .03), older age (P < .01), and longer length of stay (P < .01, P = .03). No association was found with gender, body mass index, or race. If our results are generalizable, Medicare patients requiring THA are currently financially attractive, but institutions have a long-term incentive to shift resources to more profitable patients and service lines, which may eventually restrict access to care for this population. THA providers have a financial incentive to favor Medicare patients with younger age, lower American Society of Anesthesiologists Physical Status Classification, and those who can be expected to require relatively short admissions. The Center for Medicare and Medicaid Services must strive to accurately match reimbursement rates to provider costs to avoid inequitable payments to providers and financial incentives discouraging treatment of high-risk patients or other patient subpopulations. Copyright © 2016 Elsevier Inc. All rights reserved.

Measurement Properties of Performance-Specific Pain Ratings of Patients Awaiting Total Joint Arthroplasty as a Consequence of Osteoarthritis

PubMed Central

Stratford, Paul W.; Kennedy, Deborah M.; Woodhouse, Linda J.; Spadoni, Gregory

2008-01-01

Purpose: To estimate the test–retest reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain sub-scale and performance-specific assessments of pain, as well as the association between these measures for patients awaiting primary total hip or knee arthroplasty as a consequence of osteoarthritis. Methods: A total of 164 patients awaiting unilateral primary hip or knee arthroplasty completed four performance measures (self-paced walk, timed up and go, stair test, six-minute walk) and the WOMAC. Scores for 22 of these patients provided test–retest reliability data. Estimates of test–retest reliability (Type 2,1 intraclass correlation coefficient [ICC] and standard error of measurement [SEM]) and the association between measures were examined. Results: ICC values for individual performance-specific pain ratings were between 0.70 and 0.86; SEM values were between 0.97 and 1.33 pain points. ICC estimates for the four-item performance pain ratings and the WOMAC pain sub-scale were 0.82 and 0.57 respectively. The correlation between the sum of the pain scores for the four performance measures and the WOMAC pain sub-scale was 0.62. Conclusion: Reliability estimates for the performance-specific assessments of pain using the numeric pain rating scale were consistent with values reported for patients with a spectrum of musculoskeletal conditions. The reliability estimate for the WOMAC pain sub-scale was lower than typically reported in the literature. The level of association between the WOMAC pain sub-scale and the various performance-specific pain scales suggests that the scores can be used interchangeably when applied to groups but not for individual patients. PMID:20145758

Survey of patient-oriented total hip replacement information on the World Wide Web.

PubMed

Mabrey, J D

2000-12-01

The author conducted an informal survey of materials relating to diseases of the hip and total hip replacement as they appeared on the World Wide Web. The results varied depending on the key words used: hip and replacement yielded 1,818 matches; total hip replacement yielded 1,740 matches; hip replacement yielded 4,565 sites; and hip surgery yielded 1,073 sites. The number of sites for total hip replacement was observed to increase with time, having found an additional 30 sites from an identical search performed only 6 weeks earlier. The nature and quality of these sites varied from well-organized and informative, to personal testaments, to obvious commercial endeavors. Overall, this survey found an abundance of material regarding the hip and hip replacements on the World Wide Web, but orthopaedic societies need to take a more active role in constructing, maintaining, and monitoring these sites to best serve the needs of their patients and their members.

Prevalence of Total Hip and Knee Replacement in the United States.

PubMed

Maradit Kremers, Hilal; Larson, Dirk R; Crowson, Cynthia S; Kremers, Walter K; Washington, Raynard E; Steiner, Claudia A; Jiranek, William A; Berry, Daniel J

2015-09-02

Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States. Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population. The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Hip rotation range of motion in sitting and prone positions in healthy Japanese adults

PubMed Central

Han, Heonsoo; Kubo, Akira; Kurosawa, Kazuo; Maruichi, Shizuka; Maruyama, Hitoshi

2015-01-01

[Purpose] The aim of this study was to elucidate the difference in hip external and internal rotation ranges of motion (ROM) between the prone and sitting positions. [Subjects] The subjects included 151 students. [Methods] Hip rotational ROM was measured with the subjects in the prone and sitting positions. Two-way repeated measures analysis of variance (ANOVA) was used to analyze ipsilateral hip rotation ROM in the prone and sitting positions in males and females. The total ipsilateral hip rotation ROM was calculated by adding the measured values for external and internal rotations. [Results] Ipsilateral hip rotation ROM revealed significant differences between two positions for both left and right internal and external rotations. Hip rotation ROM was significantly higher in the prone position than in the sitting position. Hip rotation ROM significantly differed between the men and women. Hip external rotation ROM was significantly higher in both positions in men; conversely, hip internal rotation ROM was significantly higher in both positions in women. [Conclusion] Hip rotation ROM significantly differed between the sexes and between the sitting and prone positions. Total ipsilateral hip rotation ROM, total angle of external rotation, and total angle of internal rotation of the left and right hips greatly varied, suggesting that hip joint rotational ROM is widely distributed. PMID:25729186

Single-dose radiation therapy for prevention of heterotopic ossification after total hip arthroplasty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Healy, W.L.; Lo, T.C.; Covall, D.J.

1990-12-01

Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700more » centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy.« less

[Proximal femoral varus osteotomy in adults after developmental dysplasia of the hip: long-term results].

PubMed

Rozkydal, Z; Janíček, P; Otiepka, P

2010-01-01

The aim of this retrospective study was to assess the results of varus osteotomy of the proximal femur in adults with coxa valga after developmental dysplasia of the hip (DDH) and to evaluate the efficacy of this method. Thirty hips in 28 patients treated by proximal femoral varus osteotomy in the period from 1983 to 1990 were evaluated. The indication for surgery involved coxa valga (145°-168°) with grade I- III of osteoarthritis and mild acetabular dysplasia. The patient group comprised twenty six women and two men with an average age of 28 years (18 to 42) at the time of surgery. The mean follow-up was 22 years (19 to 26). The preoperative radiographic examination included an AP view of the pelvis, AP views of the hip in neutral and in frog-leg position and AP views of the hip in 30° of abduction and neutral rotation. Varus osteotomy was indicated when the best position of the hip joint was achieved in abduction. The procedure was performed according to M. Müller. Hip assessment was based on the grade of osteoarthritis, CCD angle, Wiberg angle and AHI index. The results were statistically evaluated using the life table analysis of clinical survivorship of osteotomy and the Kaplan- Meier curve. Clinical failure was defined as conversion of osteotomy to total hip replacement (THR). At the latest follow-up of 22 years on the average, 18 patients (19 hips) still had osteotomy and 10 patients (11 hips) had undergone conversion to THR. The life table analysis showed the cumulative proportion of osteotomy with a clinical survivorship of 0.97 at 5 years, 0.75 at 10 and 15 years, and 0.68 at 20 and 25 years after surgery. The cumulative rate of clinical survivorship of osteotomy, as shown by the Kaplan-Meier curve, was 0.89 at 10 years, 0.75 at 20 years and 0.67 at 25 years after surgery. Nineteen patients were satisfied with the osteotomy outcome. The median of Harris hip scores in the patients with osteotomy was 48 points before surgery and 78 points at the latest follow-up. Conversion to THR in 10 patients (11 hips) was done at an average of 12 years after osteotomy. The median values before surgery and at the latest follow-up were: CCD angle, 158° and 118°; Wiberg angle, 13° and 20°; and AHI index, 56 % and 79 %, respectively. The prerequisite for a good result of proximal femoral varus osteotomy is the correct indication, i.e., younger age (18 to 30 years), a lower grade of osteoarthritis, mild dysplasia and a spherical shape of the femoral head. A disadvantage of the procedure is a shortening of the limb. The best indication for femoral varus osteotomy is unilateral coxa valga with a longer leg. This study shows favourable long-term results after isolated proximal femoral varus osteotomy in young adults with developmental dysplasia of the hip. A good function had been preserved in 18 of 28 DDH patients for an average of 22 years.

Transient peripartum osteoporosis of the femoral head in first and third pregnancy.

PubMed

Truszczyńska, Aleksandra; Walczak, Piotr; Rapała, Kazimierz

2012-01-01

The aim of this article was to present transient peripartum femoral head osteoporosis. This very rare condition occurred twice in our patient-a woman in her 30s. The cases described in the literature were mostly unilateral, with bilateral hip involvement noted much less frequently. In our patient, transient osteoporosis occurred in the third trimester of her first pregnancy in the right hip, her second pregnancy was uncomplicated, and in the third trimester of the patient's third pregnancy, osteoporotic changes were noted in the left hip joint. The patient breastfed her first and third babies only 3 wk each. She breastfed her second baby for 4 mo. The diagnostic workup was based on the clinical examination and radiographic/magnetic resonance imaging, which revealed bone marrow edema, and the dual-energy X-ray absorptiometry scans. The treatment consisted in core decompression of the femoral head (foragé), unloading of the hip using crutches as well as administration of calcitonin and calcium supplements. Complete recovery of the femoral heads was achieved. The follow-up time was 7 yr. Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Hip Strength in Patients with Quadriceps Strength Deficits after ACL Reconstruction.

PubMed

Bell, David R; Trigsted, Stephanie M; Post, Eric G; Walden, Courtney E

2016-10-01

Quadriceps strength deficits persist for years after anterior cruciate ligament (ACL) reconstruction, and patients with these deficits often shift torque demands away from the knee extensors to the hip during functional tasks. However, it is not clear how quadriceps strength deficits may affect hip strength. Therefore, the purpose of this study was to investigate differences in lower extremity strength in individuals with ACL reconstruction with differing levels of quadriceps strength asymmetry. Isometric strength was recorded bilaterally in 135 participants (73 control and 62 with unilateral ACL reconstruction, time from surgery = 30.9 ± 17.6 months) from the knee extensors and flexors, hip extensors and abductors, and hip internal and external rotator muscle groups. Symmetry indices (limb symmetry index (LSI)) were created based on quadriceps strength, and subjects with ACL reconstruction were subdivided (high quadriceps (LSI ≥ 90%), n = 37; low quadriceps (LSI < 85%), n = 18). Individual group (control vs high quadriceps vs low quadriceps) by limb (reconstructed/nondominant vs healthy/dominant) repeated-measures ANOVA was used to compare strength (%BW) for each of the six joint motions of interest (knee extensors/flexors, hip abductors/extensors/external, and internal rotators) while controlling for time from surgery. An interaction was observed for quadriceps strength (P < 0.001), and the reconstructed limb in the low quadriceps group was weaker than all other limbs. A main effect for group was observed with the low quadriceps group having greater hip extension (P = 0.007) strength in both limbs compared with the other groups. Knee flexion strength was weaker in the reconstructed limb of the high quadriceps group (P = 0.047) compared with all other groups and limbs. Individuals with ACL reconstruction and involved limb quadriceps weakness have greater hip extension strength in both limbs compared with patients with bilateral strength symmetry and controls.

Short- and long-term clinical outcomes following a standardized protocol of orthopedic manual physical therapy and exercise in individuals with osteoarthritis of the hip: a case series

PubMed Central

Hando, Ben R; Gill, Norman W; Walker, Michael J; Garber, Mathew

2012-01-01

Objectives: Describe short- and long-term outcomes observed in individuals with hip osteoarthritis (OA) treated with a pre-selected, standardized set of best-evidence manual therapy and therapeutic exercise interventions. Methods: Fifteen consecutive subjects (9 males, 6 females; mean age: 52±7.5 years) with unilateral hip OA received an identical protocol of manual therapy and therapeutic exercise interventions. Subjects attended 10 treatment sessions over an 8-week period for manual therapy interventions and performed the therapeutic exercise as a home program. Results: Baseline to 8-week follow-up outcomes were as follows: Harris Hip Scale (HHS) scores improved from 60.3(±10.4) to 80.7(±10.5), Numerical Pain Rating Scale (NPRS) scores improved from 4.3(±1.9) to 2.0(±1.9), hip flexion range of motion (ROM) improved from 99 degrees (±10.6) to 127 degrees (±6.3) and hip internal rotation ROM improved from 19 degrees (±9.1) to 31 degrees (±11.5). Improvements in HHS, NPRS, and hip ROM measures reached statistical significance (P<0.05) at 8-weeks and remained significant at the 29-week follow-up. Mean changes in NPRS and HHS scores exceeded the minimal clinically important difference (MCID) at 8-weeks and for the HHS scores alone at 29 weeks. The 8 and 29 week mean Global Rating of Change scores were 5.1(±1.4) and 2.1(±4.2), respectively. Improved outcomes observed following a pre-selected, standardized treatment protocol were similar to those observed in previous studies involving impairment-based manual therapy and therapeutic exercise for hip OA. Future studies might directly compare the two approaches. Discussion: PMID:24179327

Short- and long-term clinical outcomes following a standardized protocol of orthopedic manual physical therapy and exercise in individuals with osteoarthritis of the hip: a case series.

PubMed

Hando, Ben R; Gill, Norman W; Walker, Michael J; Garber, Mathew

2012-11-01

Describe short- and long-term outcomes observed in individuals with hip osteoarthritis (OA) treated with a pre-selected, standardized set of best-evidence manual therapy and therapeutic exercise interventions. Fifteen consecutive subjects (9 males, 6 females; mean age: 52±7.5 years) with unilateral hip OA received an identical protocol of manual therapy and therapeutic exercise interventions. Subjects attended 10 treatment sessions over an 8-week period for manual therapy interventions and performed the therapeutic exercise as a home program. Baseline to 8-week follow-up outcomes were as follows: Harris Hip Scale (HHS) scores improved from 60.3(±10.4) to 80.7(±10.5), Numerical Pain Rating Scale (NPRS) scores improved from 4.3(±1.9) to 2.0(±1.9), hip flexion range of motion (ROM) improved from 99 degrees (±10.6) to 127 degrees (±6.3) and hip internal rotation ROM improved from 19 degrees (±9.1) to 31 degrees (±11.5). Improvements in HHS, NPRS, and hip ROM measures reached statistical significance (P<0.05) at 8-weeks and remained significant at the 29-week follow-up. Mean changes in NPRS and HHS scores exceeded the minimal clinically important difference (MCID) at 8-weeks and for the HHS scores alone at 29 weeks. The 8 and 29 week mean Global Rating of Change scores were 5.1(±1.4) and 2.1(±4.2), respectively. Improved outcomes observed following a pre-selected, standardized treatment protocol were similar to those observed in previous studies involving impairment-based manual therapy and therapeutic exercise for hip OA. Future studies might directly compare the two approaches.

Unipedal standing exercise and hip bone mineral density in postmenopausal women: a randomized controlled trial.

PubMed

Sakai, Akinori; Oshige, Toshihisa; Zenke, Yukichi; Yamanaka, Yoshiaki; Nagaishi, Hitoshi; Nakamura, Toshitaka

2010-01-01

The aim of this study was to test the effect of unipedal standing exercise on bone mineral density (BMD) of the hip in postmenopausal women. Japanese postmenopausal women (n = 94) were assigned at random to an exercise or control group (no exercise). The 6-month exercise program consisted of standing on a single foot for 1 min per leg 3 times per day. BMD of the hip was measured by dual-energy X-ray absorptiometry. There was no significant difference in age and baseline hip BMD between the exercise group (n = 49) and control group (n = 45). Exercise did not improve hip BMD compared with the control group. Stepwise regression analysis identified old age as a significant determinant (p = 0.034) of increased hip total BMD at 6 months after exercise. In 31 participants aged >/=70 years, the exercise group (n = 20) showed significant increase in the values of hip BMD at the areas of total (p = 0.008), intertrochanteric (p = 0.023), and Ward's triangle (p = 0.032). The same parameters were decreased in the control group (n = 11). The percent changes in hip BMD of the exercise group were not significantly different from those of the control group either in the participants with low baseline hip total BMD (<80% of the young adult mean) or high baseline hip total BMD (> or =80% of the young adult mean). In conclusion, unipedal standing exercise for 6 months did not improve hip BMD in Japanese postmenopausal women. Effect of exercise on hip total BMD was age dependent. In participants aged > or =70 years, the exercise significantly increased hip total BMD.

Reliability and validity of functional performance tests in dancers with hip dysfunction.

PubMed

Kivlan, Benjamin R; Carcia, Christopher R; Clemente, F Richard; Phelps, Amy L; Martin, Robroy L

2013-08-01

Quasi-experimental, repeated measures. Functional performance tests that identify hip joint impairments and assess the effect of intervention have not been adequately described for dancers. The purpose of this study was to examine the reliability and validity of hop and balance tests among a group of dancers with musculoskeletal pain in the hip region. NINETEEN FEMALE DANCERS (AGE: 18.90±1.11 years; height: 164.85±6.95 cm; weight: 60.37±8.29 kg) with unilateral hip pain were assessed utilizing the cross-over reach, medial triple hop, lateral triple hop, and cross-over hop tests on two occasions, 2 days apart. Test-retest reliability and comparisons between the involved and uninvolved side for each respective test were determined. Intra-class correlation coefficients for the functional performance tests ranged from 0.89-0.96. The cross-over reach test had a SEM of 2.79 cm and a MDC of 7.73 cm. The medial and lateral triple hop tests had SEM values of 7.51 cm and 8.17 cm, and MDC values of 20.81 cm and 22.62 cm, respectively. The SEM was 0.15 seconds and the MDC was 0.42 seconds for the cross-over hop test. Performance on the medial triple hop test was significantly less on the involved side (370.21±38.26 cm) compared to the uninvolved side (388.05±41.49 cm); t(18) = -4.33, p<0.01. The side-to-side comparisons of the cross-over reach test (involved mean=61.68±10.9 cm; uninvolved mean=61.69±8.63 cm); t(18) = -0.004, p=0.99, lateral triple hop test (involved mean=306.92±35.79 cm; uninvolved mean=310.68±24.49 cm); t(18) = -0.55, p=0.59, and cross-over hop test (involved mean=2.49±0.34 seconds; uninvolved mean= 2.61±0.42 seconds; t(18) = -1.84, p=0.08) were not statistically different between sides. The functional performance tests used in this study can be reliably performed on dancers with unilateral hip pain. The medial triple hop test was the only functional performance test with evidence of validity in side-to-side comparisons. These results suggest that the medial triple hop test may be a reliable and valid functional performance test to assess impairments related to hip pain among dancers. 3b. Non-consecutive cohort study.

RELIABILITY AND VALIDITY OF FUNCTIONAL PERFORMANCE TESTS IN DANCERS WITH HIP DYSFUNCTION

PubMed Central

Carcia, Christopher R.; Clemente, F. Richard; Phelps, Amy L.; Martin, RobRoy L.

2013-01-01

Study Design: Quasi-experimental, repeated measures. Purpose/Background: Functional performance tests that identify hip joint impairments and assess the effect of intervention have not been adequately described for dancers. The purpose of this study was to examine the reliability and validity of hop and balance tests among a group of dancers with musculoskeletal pain in the hip region. Methods: Nineteen female dancers (age: 18.90±1.11 years; height: 164.85±6.95 cm; weight: 60.37±8.29 kg) with unilateral hip pain were assessed utilizing the cross-over reach, medial triple hop, lateral triple hop, and cross-over hop tests on two occasions, 2 days apart. Test-retest reliability and comparisons between the involved and uninvolved side for each respective test were determined. Results: Intra-class correlation coefficients for the functional performance tests ranged from 0.89-0.96. The cross-over reach test had a SEM of 2.79 cm and a MDC of 7.73 cm. The medial and lateral triple hop tests had SEM values of 7.51 cm and 8.17 cm, and MDC values of 20.81 cm and 22.62 cm, respectively. The SEM was 0.15 seconds and the MDC was 0.42 seconds for the cross-over hop test. Performance on the medial triple hop test was significantly less on the involved side (370.21±38.26 cm) compared to the uninvolved side (388.05±41.49 cm); t(18) = −4.33, p<0.01. The side-to-side comparisons of the cross-over reach test (involved mean=61.68±10.9 cm; uninvolved mean=61.69±8.63 cm); t(18) = −0.004, p=0.99, lateral triple hop test (involved mean=306.92±35.79 cm; uninvolved mean=310.68±24.49 cm); t(18) = −0.55, p=0.59, and cross-over hop test (involved mean=2.49±0.34 seconds; uninvolved mean= 2.61±0.42 seconds; t(18) = −1.84, p=0.08) were not statistically different between sides. Conclusion: The functional performance tests used in this study can be reliably performed on dancers with unilateral hip pain. The medial triple hop test was the only functional performance test with evidence of validity in side-to-side comparisons. These results suggest that the medial triple hop test may be a reliable and valid functional performance test to assess impairments related to hip pain among dancers. Level of Evidence: 3b. Non-consecutive cohort study PMID:24175123

Muscle strength, gait, and balance in 20 patients with hip osteoarthritis followed for 2 years after THA

PubMed Central

Dalén, Nils; Berg, Hans E

2010-01-01

Background Patients with hip osteoarthritis (OA) have muscular weakness, impaired balance, and limp. Deficits in the different limb muscles and their recovery courses are largely unknown, however. We hypothesized that there is persisting muscular weakness in lower limb muscles and an impaired balance and gait 2 years after THA. Patients and methods 20 elderly patients with unilateral OA were assessed before, and 6 and 24 months after surgery for maximal voluntary isometric strength of hip and knee muscles and by gait analysis, postural stability, and clinical scores (HHS, SF-36, EuroQoL). Results Hip muscles showed a remaining 6% weakness compared to the contralateral healthy limb 2 years after THA. Preoperatively and 6 months postoperatively, that deficit was 18% and 12%, respectively. Knee extensors fully recovered a preoperative 27% deficit after 2 years. Gait analysis demonstrated a shorter single stance phase for the OA limb compared to healthy limb preoperatively, that had already recovered at the 6-month follow-up. Balance of two-foot standing showed improvement in both sagittal and lateral sway after operation. All clinical scores improved. Interpretation Muscle strength data demonstrated a slow but full recovery of muscles acting about the knee, but there was still a deficit in hip muscle strength 2 years after THA. Gait and balance recovered after the operation. To accelerate improvement in muscular strength after THA, postoperative training should probably be more intense and target hip abductors. PMID:20367414

Dynamic parameters of three-point crutch gait in female patients after total hip arthroplasty.

PubMed

Murawa, Michał; Dworak, Lechosław B; Kabaciński, Jarosław; Syczewska, Małgorzata; Rzepnicka, Agata

2016-01-01

Patient recovery after a surgical procedure depends, among other factors, on the amount of the body weight with which patient loads lower limb. Research studies report different results of the degree of body weight with which lower limb is loaded during three-point crutch gait. The aim of this study was to evaluate the level of the ground reaction forces (GRF) during crutch gait used by patients after total hip arthroplasty (THA) in the first week after discharge from the orthopaedic units. Ten female patients diagnosed with primary unilateral coxarthrosis participated in a single measurement session. In order to record kinematic and dynamic variables of this gait pattern motion analysis system was used together with two force plates. The static test of body weight distribution between lower limbs was performed on a dual-top stabilometric plate. The average peak values of loading on the operated (O) limb during mid stance and terminal stance of three-point crutch gait were 64.6% and 64.3% of body weight (BW), respectively, whereas in the case of the nonoperated (NO) limb 103.5%BW and 108.8%BW, respectively. The maximum loads on the crutches were significantly higher (by 9%BW) on the NO side as compared to the O side ( p < 0.05). During the static test, average values of body weight distribution on the O and NO limb were 36%BW and 64%BW, respectively. The patients showed surprisingly similar level of loading on the O limb. The weight bearing on the O limb was lower during static trial than during three-point crutch gait.

Bilaterally Primary Cementless Total Hip Arthroplasty for Severe Hip Ankylosis with Ankylosing Spondylitis.

PubMed

Feng, Dong-Xu; Zhang, Kun; Zhang, Yu-Min; Nian, Yue-Wen; Zhang, Jun; Kang, Xiao-Min; Wu, Shu-Fang; Zhu, Yang-Jun

2016-08-01

Total hip arthroplasty is a reliable therapeutic intervention in patients with ankylosing spondylitis, in whom the aims of surgery are to reduce pain, restore hip function and improve quality of life. The current study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with hip ankylosis associated with severe ankylosing spondylitis who underwent bilateral primary total hip arthroplasty using non-cemented components. From June 2008 to May 2012, total hip arthroplasty was performed on 34 hips in 17 patients with bilateral ankylosis caused by ankylosing spondylitis. The study patients included 13 men and 4 women with a mean age of 24.2 years. The mean duration of disease was 8.3 years and the average duration of hip involvement was 7.6 years. All patients had severe hip pain and dysfunction with bilateral bony ankylosis and no range of motion preoperatively and all underwent bilateral cementless total hip arthroplasty performed by a single surgeon. Joint pain, range of motion (ROM), and Harris hip scores were assessed to evaluate the postoperative results. At a mean follow-up of 31.7 months, all patients had experienced significant clinical improvement in function, ROM, posture and ambulation. At the final follow-up, the mean postoperative flexion ROM was 134.4° compared with 0° preoperatively. Similar improvements were seen in hip abduction, adduction, internal rotation and external rotation. Postoperatively, 23 hips were completely pain-free, six had only occasional discomfort, three mild to moderate pain and two severe pain. The average Harris Hip Score improved from 23.7 preoperatively to 65.8 postoperatively. No stems had loosened at the final follow-up in any patient, nor had any revision surgery been required. Bilateral severe hip ankylosis in patients with ankylosing spondylitis can be treated with cementless bilateral synchronous total hip arthroplasty, which can greatly improve hip joint function and relieve pain without significant complications. Provided the overall physical condition of a patient and their economic situation make surgery a feasible option and the surgeon is experienced, this treatment is a worthwhile surgical intervention for bilateral hip bony ankylosis. However, the technically demanding nature of the procedure and potential pre- and post-operative problems should not be underestimated. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Total hip arthroplasty in patients with dwarfism.

PubMed

Sekundiak, Todd D

2005-09-01

Skeletal dysplasia or dwarfism presents in a host of manners. Degenerative hip disease can present as a primary problem secondary to the abnormal growth disturbance or secondarily from the abnormal load distributions through the hip joint itself. Total hip arthroplasty is a successful procedure but sought with increased risks and complications when compared to routine hip arthroplasty. Custom or modular hip implants can help a surgeon manage the abnormal bone morphology seen with this condition.

Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV-Hartofilakidis Type 3 Developmental Dysplasia of the Hip.

PubMed

Binazzi, Roberto

2015-05-01

High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term. Copyright © 2014 Elsevier Inc. All rights reserved.

Patient experience in fast-track hip and knee arthroplasty--a qualitative study.

PubMed

Specht, Kirsten; Kjaersgaard-Andersen, Per; Pedersen, Birthe D

2016-03-01

To explore the lived experience of patients in fast-track primary unilateral total hip and knee arthroplasty from the first visit at the outpatient clinic until discharge. Fast-track has resulted in increased effectiveness, including faster recovery and shorter length of stay to about two days after hip and knee arthroplasty. However, the patient perspective in fast-track with a median length of stay of less than three days has been less investigated. A qualitative design. A phenomenological-hermeneutic approach was used, inspired by Paul Ricoeur's theory of narrative and interpretation. Eight patients were included. Semi-structured interviews and participant observation were performed. Three themes emerged: dealing with pain; feelings of confidence or uncertainty - the meaning of information; and readiness for discharge. Generally, the patients were resistant to taking analgesics and found it difficult to find out when to take supplementary analgesics; therefore, nursing staff needed enough expertise to take responsibility. Factors that increased patients' confidence: information about fast-track, meeting staff before admission and involving relatives. In contrast, incorrect or conflicting information and a lack of respect for privacy led to uncertainty. In preparing for early discharge, sufficient pain management, feeling well-rested and optimal use of time during hospitalisation were important. The study shows the importance of dealing with pain and getting the right information and support to have confidence in the fast-track programme, to be ready for discharge and to manage postoperatively at home. In fast-track focusing on early discharge, there is an increased need for evidence-based nursing practice, including a qualified judgement of what is best for the patient in certain situations. The knowledge should be gleaned from: research; the patients' expertise, understanding and situation; and nurses' knowledge, skills and experience. © 2015 John Wiley & Sons Ltd.

Primary total hip replacement for displaced subcapital fractures of the femur.

PubMed

Taine, W H; Armour, P C

1985-03-01

The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for arthritis, and these were associated with a posterior approach to the hip. Only seven revision operations have been required. Of 57 patients who were interviewed an average of 42 months after replacement, 62% had excellent or good results as assessed by the Harris hip score. All the others had major systemic disease which affected their assessment. This inadequacy of current systems of hip assessment is discussed. It is concluded that total hip replacement is the best management for a selected group of patients with this injury, and that further prospective studies are indicated.

[Case-control study on methods of limb length control in hip arthroplasty].

PubMed

Zhang, Yang-yang; Zuo, Jian-lin; Gao, Zhong-li

2016-02-01

To introduce a new measuring tool for measuring postoperative limb length exactly, and to provide a convenient and effective method to control limb length after total hip replacement. From January 2013 to September 2014, 102 patients undergoing primary unilateral hip replacement were divided into two groups: experimental group and control group. There were 51 patients in the experimental group, including 25 males and 26 females, ranging in age from 37 to 92 years old, with an average of 60.41 years old. The patients in experimental group were treated with new method to control limb length. Other 51 patients in the control group, including 27 males and 24 females, ranging in age from 35 to 87 years old, with an average of 61.00 years old. The patients in the control group were treated with normal methods such as shuck test or limb touching. All the patients were operated by the same experienced surgeon. In the experimental group,total hip arthroplasties (THA) were performed on 35 patients with avascular necrosis of the femoral head or femoral neck fracture, and 16 patients were treated with hemiarthroplasty (HA). In the control group, 38 patients received THA and 13 patients received HA. On the anterior-posterior X-ray radiograph, several indexes were measured as follows: the distance of bilateral femoral offset (a), the height from tip of great trochanter to the rotation center of the femoral head (b) and the vertical distance between the top of the minor trochanter and the two tear drops line (c). The leg length discrepancy can be assessed with three parameters as follows: d1, the absolute value of the difference between the bilateral a values; d2, the difference between the bilateral b values; d3, the difference between the bilateral c values. The SPSS 21.0 was applied for the statistical analysis. In the experimental and control groups, d1 were 4.49 mm and 7.32 mm (P = 0.013); d2 were 2.37 mm and 4.32 mm (P = 0.033); d3 were 3.32 mm and 6.08 mm (P = 0.031). The values of d1, d2 and d3 in the experimental group were significant smaller than those in the control group. The new measuring tool and method can be used to control the limb length and offset effectively during operation.

Modular femoral component for conversion of previous hip surgery in total hip arthroplasty.

PubMed

Goldstein, Wayne M; Branson, Jill J

2005-09-01

The conversion of previous hip surgery to total hip arthroplasty creates a durable construct that is anatomically accurate. Most femoral components with either cemented or cementless design have a fixed tapered proximal shape. The proximal femoral anatomy is changed due to previous hip surgery for fixation of an intertrochanteric hip fracture, proximal femoral osteotomy, or a fibular allograft for avascular necrosis. The modular S-ROM (DePuy Orthopaedics Inc., Warsaw, Ind) hip stem accommodates these issues and independently prepares the proximal and distal portion of the femur. In preparation and implantation, the S-ROM hip stem creates less hoop stresses on potentially fragile stress risers from screws and thin bone. The S-ROM hip stem also prepares a previously distorted anatomy by milling through cortical bone that can occlude the femoral medullar canals and recreate proper femoral anteversion and reduces the risk of intraoperative or postoperative periprosthetic fracture due to the flexible titanium-slotted stem. The S-ROM femoral stem is recommended for challenging total hip reconstructions.

Expanded clinical spectrum of spondylocarpotarsal synostosis syndrome and possible manifestation in a heterozygous father.

PubMed

Mitter, Diana; Krakow, Deborah; Farrington-Rock, Claire; Meinecke, Peter

2008-03-15

We report on a 5-year-old boy with spondylocarpotarsal synostosis (SCT) syndrome who presents with disproportionate short stature, thoracic scoliosis, pes planus, dental enamel hypoplasia, unilateral conductive hearing loss and mild facial dysmorphisms. Radiographs showed abnormal segmentation of the spine with block vertebrae and carpal synostosis. In addition to the typical phenotype of SCT syndrome, he showed pronounced delay of carpal bone age and bilateral epiphyseal dysplasia of the proximal femora. The patient's father has mild short stature and unilateral hip dysplasia. Molecular studies of the filamin B gene (FLNB) revealed a homozygous mutation in the index patient while both parents were heterozygous for the mutation. In this report we expand the phenotype of SCT syndrome in a patient with a causal FLNB mutation. (c) 2008 Wiley-Liss, Inc.

[Revision hip arthroplasty by Waldemar Link custom-made total hip prosthesis].

PubMed

Medenica, Ivica; Luković, Milan; Radoicić, Dragan

2010-02-01

The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score--7.1). We performed total rearthroplasty by a custom-made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score--87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specificaly for a patient) and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects.

Medium-term results of ceramic-on-polyethylene Zweymüller-Plus total hip arthroplasty.

PubMed

Li, H; Zhang, S; Wang, X M; Lin, J H; Kou, B L

2017-08-01

The need for better durability and longevity in total hip arthroplasty for patients with various hip joint diseases remains a challenge. This study aimed to obtain medium-term results at a follow-up of >10 years for Zweymüller-Plus total hip arthroplasty with ceramic-on-polyethylene bearing. A retrospective study was conducted to review the results after a minimum of 12.4 years of 207 consecutive total hip arthroplasties in 185 patients in Peking University People's Hospital in China using the Zweymüller SL-Plus stem in combination with the Bicon-Plus threaded cup and ceramic-on-polyethylene bearing between October 1994 and April 2000. During the study period, two patients (2 hips) died and 25 patients (28 hips) were lost to follow-up. Two hips were revised for aseptic loosening of the Bicon-Plus cup. The mean clinical and radiological follow-up was 14.1 years (range, 12.4-16.5 years) for the remaining 156 patients (175 hips). The mean (standard deviation) Harris Hip score for the 175 hips increased significantly from 39.3 (3.8) preoperatively to 94.1 (2.5) postoperatively at a mean follow-up of 14.1 years (P<0.05). Focal osteolysis was observed in seven (4.0%) of 175 stems and three (1.7%) of 175 cups. The Kaplan-Meier survival with revision for any reason as the end-point was 99.03% (95% confidence interval, 95%-100%). The high survival rate of the cementless Zweymüller-Plus system with ceramic-on-polyethylene bearing at mid-term follow-up makes this total hip arthroplasty system reliable for patients with various hip joint diseases.

Abdominal adiposity is the main determinant of the C-reactive response to injury in subjects undergoing inguinal hernia repair

PubMed Central

2013-01-01

Background Obesity and serum C-reactive protein (CRP) (a sensitive marker of inflammatory activity) are associated with most chronic diseases. Abdominal adiposity along with age is the strongest determinant of baseline CRP levels in healthy subjects. The mechanism of the association of serum CRP with disease is uncertain. We hypothesized that baseline serum CRP is a marker of inflammatory responsiveness to injury and that abdominal adiposity is the main determinant of this responsiveness. We studied the effect of abdominal adiposity, age and other environmental risk factors for chronic disease on the CRP response to a standardised surgical insult, unilateral hernia repair to not only test this hypothesis but to inform the factors which must be taken into account when assessing systemic inflammatory responses to surgery. Methods 102 male subjects aged 24-94 underwent unilateral hernia repair by a single operator. CRP was measured at 0, 6, 24 and 48 hrs. Response was defined as the peak CRP adjusted for baseline CRP. Results Age and waist:hip ratio (WHR) were associated both with basal CRP and CRP response with similar effect sizes after adjustment for a wide-range of covariates. The adjusted proportional difference in CRP response per 10% increase in WHR was 1.50 (1.17-1.91) p = 0.0014 and 1.15(1.00-1.31) p = 0.05 per decade increase in age. There was no evidence of important effects of other environmental cardiovascular risk factors on CRP response. Conclusion Waist:hip ratio and age need to be considered when studying the inflammatory response to surgery. The finding that age and waist:hip ratio influence baseline and post-operative CRP levels to a similar extent suggests that baseline CRP is a measure of inflammatory responsiveness to casual stimuli and that higher age and obesity modulate the generic excitability of the inflammatory system leading to both higher baseline CRP and higher CRP response to surgery. The mechanism for the association of baseline CRP and waist:hip ratio to chronic disease outcomes could be through this increase in inflammatory system excitability. PMID:23391158

The effect of total hip and hip resurfacing arthroplasty on vertical ground reaction force and impulse symmetry during a sit-to-stand task.

PubMed

Caplan, N; Stewart, S; Kashyap, S; Banaszkiewicz, P; St Clair Gibson, A; Kader, D; Ewen, A

2014-12-01

The aim of this study was to determine the influence of total hip arthroplasty and hip resurfacing arthroplasty on limb loading symmetry before, and after, hip reconstruction surgery during a sit-to-stand task. Fourteen patients were recruited that were about to receive either a total hip prosthesis (n=7) or a hip resurfacing prosthesis (n=7), as well as matched controls. Patients performed a sit-to-stand movement before, 3 months after, and 12 months after surgery. Peak vertical ground reaction force and impulse were measured for each leg, from which ground reaction force and impulse symmetry ratios were calculated. Before surgery, hip resurfacing patients showed a small asymmetry which was not different to normal for ground reaction force (0.88(0.28) vs. 1.00(0.11); p=0.311) or impulse (0.87(0.29) vs. 0.99(0.09); p=0.324) symmetry ratios. Total hip patients offloaded their affected hip by 30% in terms of impulse symmetry ratio (0.71(0.36) vs. 0.99(0.23); p=0.018). At 3 months following surgery asymmetries were seen that were different to normal in both hip resurfacing patients for ground reaction force (0.77(0.16); p=0.007), and total hip patients for ground reaction force (0.70(0.15); p=0.018) and impulse (0.72(0.16); p=0.011) symmetry ratios. By 12 months after surgery total hip patients regained a symmetrical loading pattern for both ground reaction force (0.95(0.06); p=0.676) and impulse (1.00(0.06); p=0.702) symmetry ratios. Hip resurfacing patients, however, performed the task by overloading their operated hip, with impulse symmetry ratio being larger than normal (1.16(0.16); p=0.035). Physiotherapists should appreciate the need for early recovery of limb loading symmetry as well as subsequent differences in the responses observed with different prostheses. Copyright © 2014 Elsevier Ltd. All rights reserved.

Does the Hip Capsule Remain Closed After Hip Arthroscopy With Routine Capsular Closure for Femoroacetabular Impingement? A Magnetic Resonance Imaging Analysis in Symptomatic Postoperative Patients.

PubMed

Weber, Alexander E; Kuhns, Benjamin D; Cvetanovich, Gregory L; Lewis, Paul B; Mather, Richard C; Salata, Michael J; Nho, Shane J

2017-01-01

The purpose of this study was to examine the hip capsule in a subset of symptomatic patients who underwent capsular closure during hip arthroscopy. All patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) with routine capsular closure between January 1, 2012, and December 31, 2015, were eligible. Only patients with unilateral surgery and a postoperative magnetic resonance imaging (MRI; ordered for persistent symptoms) were included. Four independent reviewers evaluated each hip capsule for thickness and the absence or presence of defects. During the study, 1,463 patients had hip arthroscopy for FAI with routine capsular closure, and 53 (3.6%) underwent a postoperative MRI. Fourteen of the 53 were excluded owing to revision status or additional procedures. The final study population included 39 patients (23 female patients and 16 male patients), with an average patient age of 31.7 ± 11.4 years and an average body mass index of 23.3 ± 2.9. There were 3 (7.5%) capsular defects, and the intraclass correlation coefficient (ICC) was 0.82. The operative hip capsule was significantly thicker in the zone of capsulotomy, and subsequent repair as compared with the unaffected, contralateral hip capsule (5.0 ± 1.2 mm vs 4.6 ± 1.4 mm; P = .02), ICC 0.83. Additionally, males had thicker hip capsules as compared with their female counterparts, on the operative side (5.4 ± 1.1 mm vs 4.5 ± 1.2 mm; P = .02) and the nonoperative side (4.8 ± 1.6 mm vs 4.1 ± 0.9 mm; P = .08). In a subset of symptomatic patients after hip arthroscopy for FAI, the majority (92.5%) of the repaired hip capsules remained closed at greater than 1 year of follow-up. The hip capsule adjacent to the capsulotomy and subsequent repair is thickened compared with the same location on the contralateral, nonoperative hip. Aside from gender, patient-related and FAI-related factors do not correlate with capsular thickness nor do they seem to correlate with the propensity to develop a capsular defect. Level IV, prognostic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Bearing Change to Metal-On-Polyethylene for Ceramic Bearing Fracture in Total Hip Arthroplasty; Does It Work?

PubMed

Lee, Soong Joon; Kwak, Hong Suk; Yoo, Jeong Joon; Kim, Hee Joong

2016-01-01

We evaluated the short-term to midterm results of reoperation with bearing change to metal-on-polyethylene (MoP) after ceramic bearing fracture in ceramic-on-ceramic total hip arthroplasty. Nine third-generation ceramic bearing fractures (6 heads and 3 liners) were treated with bearing change to MoP. Mean age at reoperation was 52.7 years. Mean follow-up was 4.3 years. During follow-up, 2 of 3 liner-fractured hips and 1 of 6 head-fractured hips showed radiologic signs of metallosis and elevated serum chromium levels. Re-reoperation with bearing rechange to a ceramic head was performed for the hips with metallosis. One liner-fractured hip had periprosthetic joint infection. Dislocation occurred in 3 hips. From our experience, bearing change to MoP is not a recommended treatment option for ceramic bearing fracture in total hip arthroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

Living history in current orthopaedic hip surgery: intrapelvic teflon granuloma after total hip replacement.

PubMed

Gheorghiu, Daniel; Peter, Viju; Lynch, Martin

2010-02-01

The teflon hip arthroplasty design was used by Sir John Charnley in the early 60's but was taken off the market due to high complication rates. A case is reported of an intrapelvic granuloma after total hip arthroplasty following the use of a teflon socket. This appears to be the last surviving patient treated by Sir John Charnley using a Teflon hip socket design.

Worse self-reported outcomes but no limitations in performance-based measures in patients with long-standing hip and groin pain compared with healthy controls.

PubMed

Wörner, Tobias; Sigurðsson, Haraldur B; Pålsson, Anders; Kostogiannis, Ioannis; Ageberg, Eva

2017-01-01

This study aimed to evaluate patient-reported outcomes as well as lower extremity and trunk muscle function in patients with long-standing hip and groin pain, in comparison with matched, healthy controls. It was hypothesized that patients with long-standing hip and groin pain would report more deficiency on the Copenhagen Hip and Groin Outcome Score (HAGOS) and have worse outcomes on performance-based measures than healthy controls. Nineteen patients with long-standing hip and groin pain and 19 healthy, activity level-, age-, gender-, and weight-matched controls were assessed with the HAGOS for self-reported outcomes, and a parallel squat (w/kg), single-leg triple jump (cm), single-leg rise (n), barbell roll-out (% of height), and plank test (s) for performance-based measures. Independent sample t test was performed to assess between-group differences. The paired t test was used to analyse between-limb differences in unilateral performance tasks. The patients had worse scores than the controls in all HAGOS subscales (p ≤ 0.001), while no statistically significant differences were observed for any performance measure between groups or between symptomatic and non-symptomatic limbs. Despite significant self-reported functional limitations on the HAGOS, there were no significant differences between groups in performance-based strength or power measures. The results of this study highlight the need to identify performance-based measures, sensitive to functional deficiencies in patients with long-standing hip and groin pain in order to complement the clinical picture obtained by patient-reported outcomes such as the HAGOS. III.

Should gram stains have a role in diagnosing hip arthroplasty infections?

PubMed

Johnson, Aaron J; Zywiel, Michael G; Stroh, D Alex; Marker, David R; Mont, Michael A

2010-09-01

The utility of Gram stains in diagnosing periprosthetic infections following total hip arthroplasty has recently been questioned. Several studies report low sensitivity of the test, and its poor ability to either confirm or rule out infection in patients undergoing revision total hip arthroplasty. Despite this, many institutions including that of the senior author continue to perform Gram stains during revision total hip arthroplasty. We assessed the sensitivity, specificity, accuracy, and positive and negative predictive values of Gram stains from surgical-site samplings taken from procedures on patients with both infected and aseptic revision total hip arthroplasties. A review was performed on patients who underwent revision total hip arthroplasty between 2000 and 2007. Eighty-two Gram stains were performed on patients who had infected total hip arthroplasties and underwent revision procedures. Additionally, of the 410 revision total hip arthroplasties performed on patients who were confirmed infection-free, 120 Gram stains were performed. Patients were diagnosed as infected using multiple criteria at the time of surgery. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated from these Gram stain results. The Gram stain demonstrated a sensitivity and specificity of 9.8% and 100%, respectively. In this series, the Gram stain had a negative predictive value of 62%, a positive predictive value of 100%, and an accuracy of 63%. Gram stains obtained from surgical-site samples had poor sensitivity and poor negative predictive value. Based on these findings, as well as those of other authors, we believe that Gram stains should no longer be considered for diagnosing infections in revision total hip arthroplasty. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Sexual activity after total hip replacement in Korean patients: how they do, what they want, and how to improve.

PubMed

Yoon, Byung-Ho; Lee, Kyung-Hag; Noh, Serae; Ha, Yong-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

2013-12-01

Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial.

Sexual Activity after Total Hip Replacement in Korean Patients: How They Do, What They Want, and How to Improve

PubMed Central

Yoon, Byung-Ho; Lee, Kyung-Hag; Noh, Serae; Ha, Yong-Chan; Koo, Kyung-Hoi

2013-01-01

Background Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Methods Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Results Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Conclusions Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial. PMID:24340146

Bone-preserving total hip arthroplasty in avascular necrosis of the hip-a matched-pairs analysis.

PubMed

Merschin, David; Häne, Richard; Tohidnezhad, Mersedeh; Pufe, Thomas; Drescher, Wolf

2018-07-01

Short-stem hip arthroplasty has the potential advantage of femoral bone stock preservation, especially in view of the expected revisions in the often relatively young patients. Despite short-stem hip prosthesis are increasingly used for total hip arthroplasty, there are no sufficient mid- and long-term results especially for patients with avascular femoral head osteonecrosis. The present study investigates mid-term functional results as well as the revision rate following implantation of a short-stem prosthesis. In the period 06/2005 until 12/2013, a total of 351 short-stem hip prostheses were implanted. The study included 331 complete data sets. A retrospective analysis was performed using the Oxford Hip Score. All revisions were registered. In a total of 331 prostheses, the Oxford Hip Score was "excellent" in 66.2%, "good" in 12.7%, "fair" in 13.0%, and "poor" in 8.2% with a mean follow-up of 57.4 months (SD ± 29.8; range 24-115). In 26 cases, aseptic osteonecrosis of the hip was the indication (7.9%). The Oxford Hip Score was "excellent" in 66.7%, "good" in 0.0%, "fair" in 20.8%, and "poor" in 12.5%. The cumulated five year survival rate was 96.7%. In mid-term observation, the Metha® short-stem prosthesis shows no disadvantage in functional outcome and in survival time compared to a standard hip stem. Providing a correct indication, the Metha® short stem is a valuable option in total hip arthroplasty for younger patients with avascular osteonecrosis of the femoral head. Evaluation has shown no significant differences between aseptic osteonecrosis and other indications.

Motion of the center of gravity of the body in clinical evaluation of gait.

PubMed

Tesio, L; Civaschi, P; Tessari, L

1985-04-01

The motion of the center of gravity during walking was analyzed in five hemiplegic subjects and eleven subjects affected by unilateral hip arthritis. In the hemiplegic subjects and 6 subjects with hip arthritis the transfer between kinetic and potential energy (with a passive pendular motion) was found to be 9-95% greater during the step performed on the affected limb ("pathological" step); as a consequence, the muscular work done during this step was 7-81% of the work done during the step performed on the second limb ("normal" step). Qualitatively similar gait anomalies were recorded in all hemiplegic subjects with hypertonus of the paretic limb: these subjects had to lift the spastic limb as a whole during the normal step, with the consequence that the center of gravity was lifted 0.6-3 cm more than during the pathological step. In contrast, various motor patterns were found in patients with hip arthritis. During the pathological step the center of gravity reached a height 0.5-3 cm greater in 7 subjects, 1 cm smaller in one subject, and about the same height reached during the normal step in 3 subjects. This was consistent with the various motor deficits caused by hip arthritis.

Quantitative measurement and analysis for detection and treatment planning of developmental dysplasia of the hip

NASA Astrophysics Data System (ADS)

Liu, Xin; Lu, Hongbing; Chen, Hanyong; Zhao, Li; Shi, Zhengxing; Liang, Zhengrong

2009-02-01

Developmental dysplasia of the hip is a congenital hip joint malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Conventionally, physicians made diagnoses and treatments only based on findings from two-dimensional (2D) images by manually calculating clinic parameters. However, anatomical complexity of the disease and the limitation of current standard procedures make accurate diagnosis quite difficultly. In this study, we developed a system that provides quantitative measurement of 3D clinical indexes based on computed tomography (CT) images. To extract bone structure from surrounding tissues more accurately, the system firstly segments the bone using a knowledge-based fuzzy clustering method, which is formulated by modifying the objective function of the standard fuzzy c-means algorithm with additive adaptation penalty. The second part of the system calculates automatically the clinical indexes, which are extended from 2D to 3D for accurate description of spatial relationship between femurs and acetabulum. To evaluate the system performance, experimental study based on 22 patients with unilateral or bilateral affected hip was performed. The results of 3D acetabulum index (AI) automatically provided by the system were validated by comparison with 2D results measured by surgeons manually. The correlation between the two results was found to be 0.622 (p<0.01).

Hip Rotation Range of Motion in People With and Without Low Back Pain Who Participate in Rotation-Related Sports

PubMed Central

Van Dillen, Linda R.; Bloom, Nancy J.; Gombatto, Sara P.; Susco, Thomas M.

2008-01-01

Objective To examine whether passive hip rotation motion was different between people with and without low back pain (LBP) who regularly participate in sports that require repeated rotation of the trunk and hips. We hypothesized that people with LBP would have less total hip rotation motion and more asymmetry of motion between sides than people without LBP. Design Two group, case-control. Setting University-based musculoskeletal analysis laboratory. Participants Forty-eight subjects (35 males, 13 females; mean age: 26.56±7.44 years) who reported regular participation in a rotation-related sport participated. Two groups were compared; people with LBP (N=24) and people without LBP (N=24; NoLBP). Main outcome measures Data were collected on participant-related, LBP-related, sport-related and activity-related variables. Measures of passive hip rotation range of motion were obtained. The differences between the LBP and NoLBP groups were examined. Results People with and without a history of LBP were the same with regard to all participant-related, sport-related and activity-related variables. The LBP group had significantly less total rotation (P=.035) and more asymmetry of total rotation, right hip versus left hip, (P=.022) than the NoLBP group. Left total hip rotation was more limited than right total hip rotation in the LBP group (P=.004). There were no significant differences in left and right total hip rotation for the NoLBP group (P=.323). Conclusions Among people who participate in rotation-related sports, those with LBP had less overall passive hip rotation motion and more asymmetry of rotation between sides than people without LBP. These findings suggest that the specific directional demands imposed on the hip and trunk during regularly performed activities may be an important consideration in deciding which impairments may be most relevant to test and to consider in prevention and intervention strategies. PMID:19081817

Unilateral retinitis pigmentosa and cone-rod dystrophy

PubMed Central

Farrell, Donald F

2009-01-01

Purpose: The purpose of this paper is to report 14 new cases of unilateral retinitis pigmentosa and three new cases of cone-rod dystrophy and to compare the similarities and dissimilarities to those found in the bilateral forms of these disorders. Methods: A total of 272 cases of retinitis pigmentosa and 167 cases of cone-rod dystrophy were studied by corneal full field electroretinograms and electrooculograms. The student t-test was used to compare categories. Results: The percentage of familial and nonfamilial cases was the same for the bilateral and unilateral forms of the disease. In our series, unilateral retinitis pigmentosa makes up approximately 5% of the total population of retinitis pigmentosa, while unilateral cone-rod dystrophy makes up only about 2% of the total. In the familial forms of unilateral retinitis pigmentosa the most common inheritance pattern was autosomal dominant and all affected relatives had bilateral disease. Conclusion: Unilateral retinitis pigmentosa and cone-rod dystrophy appear to be directly related to the more common bilateral forms of these disorders. The genetic mechanisms which account for asymmetric disorders are not currently understood. It may be a different unidentified mutation at a single loci or it is possible that nonlinked mutations in multiple loci account for this unusual disorder. PMID:19668577

[Comparison of early clinical effects of two hip prosthesis designs between ceramics to ceramics and metal to polyethylene].

PubMed

Yang, Li-qing; Li, Xi; Fu, Qin; Wang, Cheng

2013-07-01

To retrospectively study early therapeutic effects of the ceramics to ceramics prosthesis design in treating hip disease. From October 2007 to September 2010, 42 patients (44 hips) with hip disease underwent replacement of total hip. Hip prosthesis designs included the Pinnacle ceramics to ceramics and the Duraloc metal to polyethylene,produced by DePuy Company, all were non-bone cement type of artificial hip joint. Twenty patients (22 hips) were performed with ceramics to ceramics total hip prosthesis (CoC group, there were 12 males and 8 females, aged from 21 to 49 years) and 22 patients (22 hips) were performed with metal to polyethylene total hip prosthesis (MoP group, there were 13 males and 9 females, aged from 42 to 55 years). All the surgical approachs were posterolateral, and the routine anticoagulation and the corresponding functional exercise were performed after operation. The follow-up time was 6 months at least including clinical and radiographic observation. Measured the motion of joint and evaluated the function of hip joint according to Harris classification. All clinical effects were satisfactory and no dislocation ,loosening,infection, deep venous thrombosis and other complications occurred. There was no statistical significance in Harris scoring and the motion of joint between two groups before and after operation (P>0.05). The clinical effect of ceramics to ceramics prosthesis design in improving clinical symptoms and the motion of joint is coordinate with metal to polyethylene total hip prosthesis, however, its advantages and long-term efficacy need further observing. The ceramics to ceramics prosthesis design may be a good choice for the young patients with hip disease because of its good wear resistance.

Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines

PubMed Central

Kim, Yeesuk; Cho, Hong-Man; Park, Kyung-Soon; Yoon, Pil Whan; Nho, Jae-Hwi; Kim, Sang-Min; Lee, Kyung-Jae; Moon, Kyong-Ho

2016-01-01

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty. PMID:27536639

Comparison of ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Hip Arthroplasty.

PubMed

Churchill, Jessica L; Puca, Kathleen E; Meyer, Elizabeth S; Carleton, Matthew C; Truchan, Susan L; Anderson, Michael J

2016-12-01

Use of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA. Retrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network. In our cohort, 711 received EACA, 445 received TXA, and 643 (control group) received no antifibrinolytic. Both antifibrinolytic groups had significantly fewer patients receiving red blood cell (RBC) transfusions when compared with control group (EACA 6.8% [P < .0001], TXA 9.7% [P < .0001] vs control group 24.7%). Average number of RBC units per patient were similar for EACA and TXA (0.11 units/patient and 0.15 units/patient, respectively), and both were significantly lower than the control group (0.48 units/patient, P < .0001). No significant difference was noted in mean RBC units per patient and percentage of patients transfused between EACA and TXA groups (P = .144, P = .074). Logistic regression showed no difference between EACA and TXA when adjusting for age, gender, higher severity of illness levels, admission hemoglobin, performing surgeon, and hospital. Medication acquisition cost for EACA averaged $2.70 per surgery compared with TXA at $39.58 per surgery. Intraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Lean mass and fat mass predict bone mineral density in middle-aged individuals with noninsulin-requiring type 2 diabetes mellitus.

PubMed

Moseley, Kendall F; Dobrosielski, Devon A; Stewart, Kerry J; De Beur, Suzanne M Jan; Sellmeyer, Deborah E

2011-05-01

Despite high bone mineral density (BMD), persons with type 2 diabetes are at greater risk of fracture. The relationship between body composition and BMD in noninsulin-requiring diabetes is unclear. The aim was to examine how fat and lean mass independently affect the skeleton in this population. Subjects for this cross-sectional analysis were men (n = 78) and women (n = 56) aged 40-65 years (56 ± 6 years) with uncomplicated, noninsulin-requiring type 2 diabetes. Total body fat and lean mass, total body, hip and lumbar spine BMD were measured with dual energy X-ray absorptiometry. Magnetic resonance imaging measured total abdominal, visceral and subcutaneous (SQ) fat. Subjects had normal all-site BMD and were obese to overweight (body mass index 29-41 kg/m(2)) with controlled diabetes (HbA1c women 6·6 ± 1·2%, men 6·7 ± 1·6%). Lean mass was positively associated with total body, hip, femoral neck and hip BMD in both sexes. Fat mass, abdominal total and SQ fat were associated with total body and hip BMD in women. In multivariate analyses adjusted for sex, lean mass significantly predicted total, hip and femoral neck BMD in men and women. In unadjusted models, lean mass continued to predict BMD at these sites in men; fat mass also predicted total body, femoral and hip BMD in women. In men and women with uncomplicated, noninsulin-requiring diabetes, lean mass significantly predicted BMD at the total body, hip and femoral neck. Further research is needed to determine whether acquisition or maintenance of lean mass in T2DM can prevent hip fracture in this at-risk population. © 2011 Blackwell Publishing Ltd.

The Epidemiology and Demographics of Hip Dysplasia

PubMed Central

Loder, Randall T.; Skopelja, Elaine N.

2011-01-01

The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing. PMID:24977057

Joint contact forces can be reduced by improving joint moment symmetry in below-knee amputee gait simulations.

PubMed

Koelewijn, Anne D; van den Bogert, Antonie J

2016-09-01

Despite having a fully functional knee and hip in both legs, asymmetries in joint moments of the knee and hip are often seen in gait of persons with a unilateral transtibial amputation (TTA), possibly resulting in excessive joint loading. We hypothesize that persons with a TTA can walk with more symmetric joint moments at the cost of increased effort or abnormal kinematics. The hypothesis was tested using predictive simulations of gait. Open loop controls of one gait cycle were found by solving an optimization problem that minimizes a combination of walking effort and tracking error in joint angles, ground reaction force and gait cycle duration. A second objective was added to penalize joint moment asymmetry, creating a multi-objective optimization problem. A Pareto front was constructed by changing the weights of the objectives and three solutions were analyzed to study the effect of increasing joint moment symmetry. When the optimization placed more weight on moment symmetry, walking effort increased and kinematics became less normal, confirming the hypothesis. TTA gait improved with a moderate increase in joint moment symmetry. At a small cost of effort and abnormal kinematics, the peak hip extension moment in the intact leg was decreased significantly, and so was the joint contact force in the knee and hip. Additional symmetry required a significant increase in walking effort and the joint contact forces in both hips became significantly higher than in able-bodied gait. Copyright © 2016 Elsevier B.V. All rights reserved.

Treatment of Crowe Type-IV Hip Dysplasia Using Cementless Total Hip Arthroplasty and Double Chevron Subtrochanteric Shortening Osteotomy: A 5- to 10-Year Follow-Up Study.

PubMed

Li, Xigong; Lu, Yang; Sun, Junying; Lin, Xiangjin; Tang, Tiansi

2017-02-01

The purpose of this study was to evaluate the functional and radiographic results of patients with Crowe type-IV hip dysplasia treated by cementless total hip arthroplasty and double chevron subtrochanteric osteotomy. From January 2000 to February 2006, cementless total hip arthroplasty with a double chevron subtrochanteric shortening osteotomy was performed on 18 patients (22 hips) with Crowe type-IV dysplasia. The acetabular cup was placed in the position of the anatomic hip center, and subtrochanteric femoral shortening osteotomy was performed with the use of a double chevron design. The clinical and radiographic outcomes were reviewed with a mean follow-up of 6.5 years (5-10 years). The mean amount of femoral subtrochanteric shortening was 38 mm (25-60 mm). All osteotomy sites were healed by 3-6 months without complications. The mean Harris Hip Score improved significantly from 47 points (35-65 points) preoperatively to 88 points (75-97 points) at the final follow-up. The Trendelenburg sign was corrected from a positive preoperative status to a negative postoperative status in 12 of 22 hips. No acetabular and femoral components have loosened or required revision during the period of follow-up. Cementless total hip arthroplasty using double chevron subtrochanteric osteotomy allowed for restoration of anatomic hip center with safely functional limb lengthening, achieved correction of preoperative limp, and good functional and radiographic outcomes for 22 Crowe type-IV dislocation hips at the time of the 5- to 10-year follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.

Compatibility of the totally replaced hip. Reduction of wear by amorphous diamond coating.

PubMed

Santavirta, Seppo

2003-12-01

Particulate wear debris in totally replaced hips causes adverse local host reactions. The extreme form of such a reaction, aggressive granulomatosis, was found to be a distinct condition and different from simple aseptic loosening. Reactive and adaptive tissues around the totally replaced hip were made of proliferation of local fibroblast like cells and activated macrophages. Methylmethacrylate and high-molecular-weight polyethylene were shown to be essentially immunologically inert implant materials, but in small particulate form functioned as cellular irritants initiating local biological reactions leading to loosening of the implants. Chromium-cobalt-molybdenum is the most popular metallic implant material; it is hard and tough, and the bearings of this metal are partially self-polishing. In total hip implants, prerequisites for longevity of the replaced hip are good biocompatibility of the materials and sufficient tribological properties of the bearings. The third key issue is that the bearing must minimize frictional shear at the prosthetic bone-implant interface to be compatible with long-term survival. Some of the approaches to meet these demands are alumina-on-alumina and metal-on-metal designs, as well as the use of highly crosslinked polyethylene for the acetabular component. In order to avoid the wear-based deleterious properties of the conventional total hip prosthesis materials or coatings, the present work included biological and tribological testing of amorphous diamond. Previous experiments had demonstrated that a high adhesion of tetrahedral amorphous carbon coatings to a substrate can be achieved by using mixing layers or interlayers. Amorphous diamond was found to be biologically inert, and simulator testing indicated excellent wear properties for conventional total hip prostheses, in which either the ball or both bearing surfaces were coated with hydrogen-free tetrahedral amorphous diamond films. Simulator testing with such total hip prostheses showed no measurable wear or detectable delamination after 15,000,000 test cycles corresponding to 15 years of clinical use. The present work clearly shows that wear is one of the basic problems with totally replaced hips. Diamond coating of the bearing surfaces appears to be an attractive solution to improve longevity of the totally replaced hip.

Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up.

PubMed

Wiig, O; Terjesen, T; Svenningsen, S

2008-10-01

This nationwide prospective study was designed to determine prognostic factors and evaluate the outcome of different treatments of Perthes' disease. A total of 28 hospitals in Norway were instructed to report all new cases of Perthes' disease over a period of five years and 425 patients were reported and followed for five years. Of these, 368 with unilateral disease were included in the present study. The hips were classified radiologically according to a modified two-group Catterall classification and the lateral pillar classification. A total of 358 patients (97%) attended the five-year follow-up, when a modified three-group Stulberg classification was used as a radiological outcome measure. For patients over six years of age at diagnosis and with more than 50% necrosis of the femoral head (152 patients), the surgeons at the different hospitals had chosen one of three methods of treatment: physiotherapy (55 patients), the Scottish Rite abduction orthosis (26), and proximal femoral varus osteotomy (71). Of these hips, 146 (96%) were available for the five-year follow-up. The strongest predictor of outcome was femoral head involvement of more or less than 50% (odds ratio (OR) = 7.76, 95% confidence interval (CI) 2.82 to 21.37), followed by age at diagnosis (OR = 0.98, 95% CI 0.92 to 0.99) and the lateral pillar classification (OR = 0.62, 95% CI 0.40 to 0.98). In children over six years at diagnosis with more than 50% of femoral head necrosis, proximal femoral varus osteotomy gave a significantly better outcome than orthosis (p = 0.001) or physiotherapy (p = 0.001). There was no significant difference between the physiotherapy and orthosis groups (p = 0.36), and we found no difference in outcome after any of the treatments in children under six years (p = 0.73). We recommend proximal femoral varus osteotomy in children aged six years and over at the time of diagnosis with hips having more than 50% femoral head necrosis. The abduction orthosis should be abandoned in Perthes' disease.

Do cobalt and chromium levels predict osteolysis in metal-on-metal total hip arthroplasty?

PubMed

Renner, Lisa; Schmidt-Braekling, Tom; Faschingbauer, Martin; Boettner, Friedrich

2016-12-01

Serum metal ions are part of the regular follow-up routine of patients with metal-on-metal total hip arthroplasties (MoM-THA). Increased cobalt levels have been suggested to indicate implant failure and corrosion. (1) Is there a correlation between the size of the osteolysis measured on a CT scan and metal ion levels? (2) Can metal ion levels predict the presence of osteolysis in MoM-THA? (3) Are cobalt and chromium serum levels or the cobalt-chromium-ratio diagnostic for osteolysis? CT scans of patients (n = 75) with a unilateral MoM-THA (Birmingham Hip System, Smith & Nephew, TN, USA) implanted by a single surgeon were reviewed to determine the presence of osteolysis. Statistical analysis was performed to detect its association with metal ion levels at the time of the imaging exam. The incidence of osteolysis was the same in men and women (35.6 vs 35.7 %). The cobalt-chromium-ratio correlates with the size of the osteolysis on the CT scan and the femoral component size in the overall study population (p = 0.050, p = 0.001) and in men (p = 0.002, p = 0.001) but not in women (p = 0.312, p = 0.344). The AUC for the cobalt-chromium-ratio to detect osteolysis was 0.613 (p = 0.112) for the overall population, 0.710 for men (p = 0.021) and 0.453 (p = 0.684) for women. The data suggest that a cut off level of 1.71 for the cobalt-chromium-ratio has a sensitivity of 62.5 % and specificity of 72.4 % to identify male patients with osteolysis. The disproportional increase of cobalt over chromium, especially in male patients with large component sizes can not be explained by wear alone and suggests that other processes (corrosion) might contribute to metal ion levels and might be more pronounced in patients with larger component sizes.

The effect of severity of unilateral vestibular dysfunction on symptoms, disabilities and handicap in vertiginous patients.

PubMed

Bamiou, D E; Davies, R A; McKee, M; Luxon, L M

1999-02-01

This study compares the symptoms, disabilities and handicap, as assessed by means of a questionnaire, in two groups of patients with a unilateral peripheral vestibular disorder: those with a total canal paresis and those with a partial canal paresis, as judged by the duration parameter using the Fitzgerald Hallpike caloric test in the absence of optic fixation. The results of the study indicate that the severity of dizziness, the Dizziness Index (severity x frequency) and the overall level of disabilities related to visual vertigo are less severe in unilateral profound or total loss of vestibular function than in unilateral mild vestibular loss.

Comparison of outcome measures and complication rates following three different approaches for primary total hip arthroplasty: a pragmatic randomised controlled trial.

PubMed

Talia, Adrian J; Coetzee, Cassandra; Tirosh, Oren; Tran, Phong

2018-01-08

Total hip arthroplasty is one of the most commonly performed surgical procedures worldwide. There are a number of surgical approaches for total hip arthroplasty and no high-level evidence supporting one approach over the other. Each approach has its unique benefits and drawbacks. This trial aims to directly compare the three most common surgical approaches for total hip arthroplasty. This is a single-centre study conducted at Western Health, Melbourne, Australia; a large metropolitan centre. It is a pragmatic, parallel three-arm, randomised controlled trial. Sample size will be 243 participants (81 in each group). Randomisation will be secure, web-based and managed by an independent statistician. Patients and research team will be blinded pre-operatively, but not post-operatively. Intervention will be either direct anterior, lateral or posterior approach for total hip arthroplasty, and the three arms will be directly compared. Participants will be aged over 18 years, able to provide informed consent and recruited from our outpatients. Patients who are having revision surgery or have indications for hip replacement other than osteoarthritis (i.e., fracture, malignancy, development dysplasia) will be excluded from the trial. The Oxford Hip Score will be determined for patients pre-operatively and 6 weeks, 6, 12 and 24 months post-operatively. The Oxford Hip Score at 24 months will be the primary outcome measure. Secondary outcome measures will be dislocation, infection, intraoperative and peri-prosthetic fracture rate, length of hospital stay and pain level, reported using a visual analogue scale. Many studies have evaluated approaches for total hip arthroplasty and arthroplasty registries worldwide are now collecting this data. However no study to date has compared these three common approaches directly in a randomised fashion. No trial has used patient-reported outcome measures to evaluate success. This pragmatic study aims to identify differences in patient perception of total hip arthroplasty depending on surgical approach. Australian New Zealand Clinical Trials Registry, ACTRN12617000272392 . Registered on 22 February 2017.

Cementless total hip arthroplasty with a double chevron subtrochanteric shortening osteotomy in patients with Crowe type-IV hip dysplasia.

PubMed

Li, Xigong; Sun, Junying; Lin, Xiangjin; Xu, Sanzhong; Tang, Tiansi

2013-06-01

The authors describe a modified double chevron subtrochanteric shortening osteotomy combined with cementless total hip arthroplasty for Crowe type-IV hip dysplasia. Shortening the femur allows to relax the shortened musculature. This operation was performed in 18 patients (22 hips) between January 2000 and February 2006. The mean follow-up period was 5.6 years (range: 3 to 8 years). The mean amount of femoral subtrochanteric shortening was 38 mm (range: 25 to 60 mm). The mean Harris hip score improved from 47 (range: 35 to 65) preoperatively to 88 points (range: 75 to 97) at final follow-up. The Trendelenburg sign was corrected from positive to negative in 12 of 22 hips. No acetabular or femoral components loosened or required revision during the follow-up period. All osteotomy sites healed in 3 to 6 months without complications. Cementless total hip arthroplasty using the modified double chevron subtrochanteric osteotomy provided good short- to midterm results in all 22 Crowe type-IV hip dislocations. Moreover, it restored the anatomic hip center and the limb length, which contributed to correction of the preoperative limp.

Long-term outcome of total hip arthroplasty in patients with haemophilia.

PubMed

Strauss, A C; Rommelspacher, Y; Nouri, B; Bornemann, R; Wimmer, M D; Oldenburg, J; Pennekamp, P H; Schmolders, J

2017-01-01

Besides the target joints (elbow, knee and ankle), the hip is one of the commonly affected joints in haemophilic arthropathy. Hip arthroplasty is the therapy of choice after failure of conservative treatment. There are only limited data on long-term results after primary total hip arthroplasty (THA). The aim of this retrospective study was to analyse clinical outcome and complication rate after total hip replacement in patients with severe haemophilic arthropathy. Forty-three patients with haemophilia (PWH), one patient with von Willebrand disease and one patient with a Factor-VII-deficiency undergoing 49 total hip arthroplasties, were evaluated in a retrospective study. Harris hip score (HHS), range of motion (ROM), pain status (visual analogue scale, VAS) complication rate and patient satisfaction were assessed at a mean follow-up of 11.5 years (range: 3-32). HSS, ROM and VAS improved significantly combined with high patient satisfaction. In total, three (6.1%) periprosthetic infections and five (10.2%) aseptic implant loosenings occurred after THA leading to revision arthroplasty. In two (4.1%) cases, a pseudotumour and one (2.0%) periarticular ossification had to be resected after THA. Total hip replacement in PWH leads to a significant increase of function, reduction of pain and a high satisfaction. Due to the relatively high complication rate (infections and aseptic loosening) compared to patients without haemophilia, an individual assessment of the risk-benefit ratio from surgical and haemostaseological point of view is needed. © 2016 John Wiley & Sons Ltd.

An initial experience with hip resurfacing versus cementless total hip arthroplasty.

PubMed

Arndt, Justin Michael; Wera, Glenn D; Goldberg, Victor M

2013-07-01

Hip resurfacing is an alternative to total hip arthroplasty. We aimed to compare an experienced hip surgeon's initial clinical results of hip resurfacing with a new cementless total hip arthroplasty (THA). The first 55 consecutive hip resurfacing arthroplasties were compared to 100 consecutive cementless THAs using a cylindrical tapered femoral stem. The learning curve between the two procedures was compared utilizing the incidence of reoperation, complications, Harris Hip Scores (HHS), and implant survivorship. The reoperation rate was significantly higher (p = 0.019) for hip resurfacing (14.5%) versus THA (4%). The overall complication rate between the two groups was not significantly different (p = 0.398). Preoperative HHS were similar between the two groups (p = 0.2). The final mean HHS was similar in both the resurfacing and THA groups (96 vs. 98.3, respectively, p < 0.65). Kaplan-Meier survival analysis with an endpoint of reoperation suggests complications occurred earlier in the resurfacing group versus the THA group (log-rank test, p = 0.007). In comparison to our initial experience with a cementless THA stem, operative complications occur earlier and more often after hip resurfacing during the learning period. The clinical outcomes in both groups however are similar at 5 year follow-up.

Total Hip Arthroplasty Using a Polished Tapered Cemented Stem in Hereditary Multiple Exostosis

PubMed Central

Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko

2016-01-01

A 61-year-old Japanese man underwent right total hip arthroplasty for hereditary multiple exostosis. At first presentation, he had suffered from coxalgia for a long time. On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck. He had also developed coxarthrosis and severe pain of the hip joint. The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis. Therefore, total hip arthroplasty using a cemented polished tapered stem was performed via a direct lateral approach. Using a cemented polished tapered stem allowed us to deal with the femoral bone transformation and bone substance defectiveness due to exostosis and also minimized the invasiveness of the operation. PMID:27127668

Total hip arthroplasty for Crowe IV hip without subtrochanteric shortening osteotomy -a long term follow up study.

PubMed

Kawai, Toshiyuki; Tanaka, Chiaki; Kanoe, Hiroshi

2014-03-10

Several authors reported encouraging results of total hip arthroplasty (THA) for Crowe IV hips performed using shortening osteotomy. However, few papers have documanted the results of THA for Crowe IV hips without shortening osteotomy. The aim of the present study was to assess the long term-results of cemented THAs for Crowe group IV hips performed without subtrochanteric shortening osteotomy. We have assessed the long term results of 27 cemented total hip arthroplasty (THA) performed without subtrochanteric osteotomy for Crowe group IV hip. All THAs were performed via transtrochanteric approach. After a mean follow-up of 10.6 (6 to 17.9) years, 25 hips (92.6%) had survived without revision surgery and survivorship analysis gave a survival rate of 96.3% at 10 years with any revision surgery as the end point. Although mean limb lengthening was 3.2 (1.0 to 5.1) cm, no hips developed nerve palsy. Complications occurred in four hips, necessitating revision surgery in two. Among the four complications, three involved the greater trochanter, two of which occurred in cases where braided cables had been used to reattach the greater trochanter. Although we encountered four complications, including three trochanteric problems, our findings suggest that THA without subtrochanteric shortening osteotomy can provide satisfactory long-term results in patients with Crowe IV hip.

Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis.

PubMed

Deleuran, Thomas; Overgaard, Søren; Vilstrup, Hendrik; Jepsen, Peter

2016-06-01

Background and purpose - There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods - We used nationwide healthcare data to identify all Danish residents diagnosed with cirrhosis in 1994-2011, and matched them 1:5 by age and sex to non-cirrhotic reference individuals from the general population. We excluded people with a previous total hip arthroplasty, a previous hip fracture, or a previous diagnosis of avascular necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks. Results - We included 25,421 cirrhosis patients and 114,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients' HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6-17), yet their 5-year risk of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%. Interpretation - Cirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients.

Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis

PubMed Central

Deleuran, Thomas; Overgaard, Søren; Vilstrup, Hendrik; Jepsen, Peter

2016-01-01

Background and purpose There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods We used nationwide healthcare data to identify all Danish residents diagnosed with cirrhosis in 1994–2011, and matched them 1:5 by age and sex to non-cirrhotic reference individuals from the general population. We excluded people with a previous total hip arthroplasty, a previous hip fracture, or a previous diagnosis of avascular necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks. Results We included 25,421 cirrhosis patients and 114,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients’ HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6–17), yet their 5-year risk of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%. Interpretation Cirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients. PMID:26900635

Investigation of Association Between Hip Osteoarthritis Susceptibility Loci and Radiographic Proximal Femur Shape

PubMed Central

Thiagarajah, Shankar; Wilkinson, J. Mark; Panoutsopoulou, Kalliope; Day‐Williams, Aaron G.; Cootes, Timothy F.; Wallis, Gillian A.; Loughlin, John; Arden, Nigel; Birrell, Fraser; Carr, Andrew; Chapman, Kay; Deloukas, Panos; Doherty, Michael; McCaskie, Andrew; Ollier, William E. R.; Rai, Ashok; Ralston, Stuart H.; Spector, Timothy D.; Valdes, Ana M.; Wallis, Gillian A.; Mark Wilkinson, J.; Zeggini, Eleftheria

2015-01-01

Objective To test whether previously reported hip morphology or osteoarthritis (OA) susceptibility loci are associated with proximal femur shape as represented by statistical shape model (SSM) modes and as univariate or multivariate quantitative traits. Methods We used pelvic radiographs and genotype data from 929 subjects with unilateral hip OA who had been recruited previously for the Arthritis Research UK Osteoarthritis Genetics Consortium genome‐wide association study. We built 3 SSMs capturing the shape variation of the OA‐unaffected proximal femur in the entire mixed‐sex cohort and for male/female‐stratified cohorts. We selected 41 candidate single‐nucleotide polymorphisms (SNPs) previously reported as being associated with hip morphology (for replication analysis) or OA (for discovery analysis) and for which genotype data were available. We performed 2 types of analysis for genotype–phenotype associations between these SNPs and the modes of the SSMs: 1) a univariate analysis using individual SSM modes and 2) a multivariate analysis using combinations of SSM modes. Results The univariate analysis identified association between rs4836732 (within the ASTN2 gene) and mode 5 of the female SSM (P = 0.0016) and between rs6976 (within the GLT8D1 gene) and mode 7 of the mixed‐sex SSM (P = 0.0003). The multivariate analysis identified association between rs5009270 (near the IFRD1 gene) and a combination of modes 3, 4, and 9 of the mixed‐sex SSM (P = 0.0004). Evidence of associations remained significant following adjustment for multiple testing. All 3 SNPs had previously been associated with hip OA. Conclusion These de novo findings suggest that rs4836732, rs6976, and rs5009270 may contribute to hip OA susceptibility by altering proximal femur shape. PMID:25939412

Insufficient acetabular version increases blood metal ion levels after metal-on-metal hip resurfacing.

PubMed

Hart, Alister J; Skinner, John A; Henckel, Johann; Sampson, Barry; Gordon, Fabiana

2011-09-01

Many factors affect the blood metal ion levels after metal-on-metal (MOM) hip arthroplasty. The main surgically adjustable variable is the amount of coverage of the head provided by the cup which is a function of the inclination and version angles. However, most studies have used plain radiographs which have questionable precision and accuracy, particularly for version and large diameter metal heads; further, these studies do not simultaneously assess version and inclination. Thus the relationship between version and blood metal ions levels has not been resolved. We determined whether cup inclination and version influence blood metal ion levels while adjusting for age at assessment, gender, body mass index, horizontal femoral offset, head size, manufacturer hip type, and Oxford hip score. We prospectively followed 100 individuals (51 females, 49 males) with unilateral MOM hip resurfacing who underwent clinical assessment, CT scanning, and blood metal ion measurement. Multiple regression analysis was used to determine which variables were predictors of blood metal ion levels and to model the effect of these variables. Only cup inclination, version angles, and gender influenced blood cobalt or chromium levels. Cobalt and chromium levels positively correlated with inclination angle and negatively correlated with version angle. The effect of changes in version angle was less than for inclination angle. Based on our observations, we developed a formula to predict the effect of these parameters on metal ion levels. Our data suggest insufficient cup version can cause high blood metal ions after MOM hip arthroplasty. We were unable to show that excessive version caused high levels. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Hip Abductor Strengthening Improves Physical Function Following Total Knee Replacement: One-Year Follow-Up of a Randomized Pilot Study.

PubMed

Harikesavan, Karvannan; Chakravarty, Raj D; Maiya, Arun G; Hegde, Sanjay P; Y Shivanna, Shivakumar

2017-01-01

Total knee replacement (TKR) is the commonest surgical procedure for patients with severe pain and impaired physical function following end stage knee osteoarthritis. The hip abductors are well renowned in stabilization of the trunk and hip during walking, maintaining the lower limb position, and transferring the forces from the lower limbs to the pelvis. To assess the efficacy of hip abductor strengthening exercise on functional outcome using performance based outcome measures following total knee replacement. An observer blinded randomized pilot trial design was conducted at Manipal hospital, Bangalore, India. Participants designated for elective TKR were randomized to experimental group hip abductor strengthening along with standard rehabilitation (n=10) or control group standard rehabilitation alone (n=10). Participants followed for one year to assess physical function using performance based outcomes, such as timed up and go test, single leg stance test, six minute walk test, knee extensor strength and hip abductor strength. Eighteen participants with a mean age of 63.1 ± 5.5 years (8 Males and 10 Females) completed the study. Improvement in hip abduction strength, single leg stand test was superior in hip abductor strengthening group at 3 months and 1 year when compared to standard rehabilitation alone. Hip abductor strengthening showed superior improvements in single leg stance test and six minute walk test. Hip abductor strengthening exercises has the potential to improve physical function following total knee replacement.

Hip Abductor Strengthening Improves Physical Function Following Total Knee Replacement: One-Year Follow-Up of a Randomized Pilot Study

PubMed Central

Harikesavan, Karvannan; Chakravarty, Raj D.; Maiya, Arun G; Hegde, Sanjay P.; Y. Shivanna, Shivakumar

2017-01-01

Background: Total knee replacement (TKR) is the commonest surgical procedure for patients with severe pain and impaired physical function following end stage knee osteoarthritis. The hip abductors are well renowned in stabilization of the trunk and hip during walking, maintaining the lower limb position, and transferring the forces from the lower limbs to the pelvis. Objective: To assess the efficacy of hip abductor strengthening exercise on functional outcome using performance based outcome measures following total knee replacement. Methods: An observer blinded randomized pilot trial design was conducted at Manipal hospital, Bangalore, India. Participants designated for elective TKR were randomized to experimental group hip abductor strengthening along with standard rehabilitation (n=10) or control group standard rehabilitation alone (n=10). Participants followed for one year to assess physical function using performance based outcomes, such as timed up and go test, single leg stance test, six minute walk test, knee extensor strength and hip abductor strength. Result: Eighteen participants with a mean age of 63.1 ± 5.5 years (8 Males and 10 Females) completed the study. Improvement in hip abduction strength, single leg stand test was superior in hip abductor strengthening group at 3 months and 1 year when compared to standard rehabilitation alone. Conclusion: Hip abductor strengthening showed superior improvements in single leg stance test and six minute walk test. Hip abductor strengthening exercises has the potential to improve physical function following total knee replacement. PMID:28567148

[Treatment of adult avascular necrosis of femoral head by transplanting iliac bone flap with deep iliac circumflex vessels and cancellous bone].

PubMed

Yu, Zhiliang; Zhang, Ning; Yang, Yi; Wang, Bin; Gao, Shuo; Zhao, Xiaoyong

2013-07-01

To investigate the effectiveness of transplanting iliac bone flap with deep iliac circumflex vessels and cancellous bone for the treatment of adult avascular necrosis of the femoral head (ANFH). A retrospective analysis was made on the clinical data of 685 patients (803 hips) with ANFH, who underwent iliac bone flap transplantation with deep iliac circumflex vessels and cancellous bone between March 2002 and January 2010. There were 489 males (580 hips) and 196 females (223 hips) with a mean age of 40.4 years (range, 18-63 years), including 567 unilateral cases (303 left hips and 264 right hips) and 118 bilateral cases. The causes of ANFH included alcohol-induced in 223 cases, steroid-induced in 179 cases, alcohol + steroid-induced in 21 cases, traumatic in 136 cases, acetabular dysplasia in 8 cases, bone cyst in 5 cases, septic arthritis in 2 cases, joint tuberculosis in 3 cases, rheumatoid arthritis in 5 cases, and idiopathic in 103 cases. According to Steinberg staging, 211 hips were rated as stage II, 513 hips as stage III, and 79 hips as stage IV. The preoperative Harris hip score was 60.30 +/- 7.02. Fat necrosis occurred in 2 cases after operation, primary healing of incision was obtained in the other cases; delayed infection, lower extremity deep vein thrombosis, and pulmonary embolism occurred in 2 cases, respectively. All patients were followed up 36-60 months (mean, 49 months). Harris hip score at last follow-up (83.50 +/- 7.31) was significantly higher than that at preoperation (t= -2 266.980, P=0.000), and the scores were significantly higher than those at preoperation in different stages (P < 0.05). The results were excellent in 523 hips, good in 185 hips, fair in 65 hips, and poor in 30 hips, and the excellent and good rate was 88.2%. X-ray examination showed bone fusion of transplanted bone flap and bone graft with an average of 4.2 months (range, 3-6 months); according to Steinberg staging, imaging stable rate was 78.3% (629/803) at last follow-up. Iliac bone flap transplantion with deep iliac circumflex vessels and cancellous bone has the advantages of complete decompression of the femoral head, exact flap blood supply, improved blood supply of the femoral head, new support for the femoral head, and participation of osteoinductive effect for the treatment of adult ANFH, so it is an effective treatment for the retention of the femoral head.

The operation of the century: total hip replacement.

PubMed

Learmonth, Ian D; Young, Claire; Rorabeck, Cecil

2007-10-27

In the 1960s, total hip replacement revolutionised management of elderly patients crippled with arthritis, with very good long-term results. Today, young patients present for hip-replacement surgery hoping to restore their quality of life, which typically includes physically demanding activities. Advances in bioengineering technology have driven development of hip prostheses. Both cemented and uncemented hips can provide durable fixation. Better materials and design have allowed use of large-bore bearings, which provide an increased range of motion with enhanced stability and very low wear. Minimally invasive surgery limits soft-tissue damage and facilitates accelerated discharge and rehabilitation. Short-term objectives must not compromise long-term performance. Computer-assisted surgery will contribute to reproducible and accurate placement of implants. Universal economic constraints in healthcare services dictate that further developments in total hip replacement will be governed by their cost-effectiveness.

[Radiographic appraisal between metal and bone interosculate backfill after total hip arthroplasty with trabecular metal cup].

PubMed

Li, Wei; Zhou, Yi-Xin; Wu, Jian; Xu, Hui; Ji, Song-Jie

2009-02-15

To evaluate the bone refilling in the interface between the trabecular metal (TM) acetabular shell and the bone surface according to consecutive X film measuring after surgery. From July 2006 to July 2007, 35 patients (40 hips) accepted total hip replacement using trabecular metal monoblock acetabular cup system (TM). The cup was made of a ellipse shaped press fit Tantalum shell and high cross-linked PE liner (Longevity) with 28 mm inner diameter. The patients demography was: 16 male (20 hips), 19 female (20 hips), 5 bilateral hip replacements, age from 41 - 71 (mean 53), including 18 avascular necrosis hips, 16 osteoarthritis hips (including those secondary to a dysplasia hip), 4 avascular necrosis hips after femoral neck fracture, 2 Ankylosis Spondylitis. All the 40 total hip replacements used posterior approach, using hemispherical acetabular reamer and 2 mm press fit of final metal shell without screw fixation. The consecutive X film was taken at the end time of surgery and 2, 6, 12, 24 weeks, and 12 months. The clinical results was evaluate according to Harris scoring system, and the standard pelvis AP X film was measured at the interface between metal shell and the acetabular bone surface, witch was divided into five regions (A, B, C, D, E). Totally 32 patients (37 hips) were followed with average 8.7 months (7 - 12 months). The Harris before surgery was 50.5 (32 - 85), promoted to 91.0 (72 - 100), including 29 excellent, 6 good, 2 fair, and the total excellent and good rate was 94.6%. Complications include 4 patients leg length discrepancy from 1 - 2 cm, 3 patients moderate thigh pain and released after conservative therapy. No infection and dislocation was found. Twenty-one patients (23 hips) were found lucent line at the bone-metal interface from 1 - 5 mm, most common in B region and BC boundary than C, D, and CD boundary. All the patients followed was found the lucent line disappeared and refilled with bone at X film 24 weeks after surgery, however, no patients was found osteolysis and cup migration. The trabecular metal has strong capacity of bone conductive and bone inducement.

Long-term result of cementless femoral stem in avascular necrosis of the hip.

PubMed

Cheung, Kin W; Chiu, Kwok H; Chung, Kwong Y

2015-01-01

Avascular necrosis (AVN) of the hip may have extensive involvement of the proximal femur which may affect boney ingrowth into cementless femoral stems. From 1994 to 2004, 182 total hip arthroplasties (in 144 patients, 117 AVN hips and 65 non-AVN hips) were performed using hydroxyapatite coated femoral stems. All patients were followed up prospectively. Mean age was 51 years and mean follow-up 14.7 years (range 9.7-19.1 years). Four stems were revised because of aseptic loosening, 3 in AVN group and 1 in non-AVN group. The overall mechanical failure rate was 2.2%, the mechanical failure rate in AVN and non-AVN group was 2.6% and 1.5% respectively (p = 1). The 19.1 year survival using revision for aseptic loosening as an endpoint for AVN and non-AVN patients were 97.1% and 96.2% respectively (p = 0.654). Stable boney ingrowth was present in 99.5% hips. This study represents 1 of the largest series reporting the long-term follow-up of the use of cementless femoral stems in treating AVN of the hip. We report excellent long-term survival of cementless total hip arthroplasty used in managing AVN of the hip and is comparable to that seen in non-AVN total hip arthroplasty.

Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement.

PubMed

Kang, Alan C L; Gooding, Andrew J; Coates, Mark H; Goh, Tony D; Armour, Paul; Rietveld, John

2010-06-01

Femoroacetabular impingement has become a well-recognized entity predisposing to acetabular labral tears and chondral damage, and subsequently development of osteoarthritis of the hip joint. In the authors' experience, it is common to see bony abnormalities predisposing to femoroacetabular impingement in the contralateral asymptomatic hips in patients with unilateral femoroacetabular impingement. This study was undertaken to investigate the prevalence of bony abnormalities predisposing to femoroacetabular impingement in asymptomatic individuals without exposing study participants to unnecessary radiation. Cross-sectional study; Level of evidence, 4. Fifty individuals (100 hip joints), ranging from 15 to 40 years of age, who were seen at a local hospital between March and August 2008 with abdominal trauma or nonspecific abdominal pain in whom abdominal computed tomography was performed to aid diagnosis were prospectively studied. These patients were not known to have any history of hip-related problems. Raw data from the abdominal computed tomography scan, performed on a 64-slice multidetector computed tomography scanner, were reformatted using bone algorithm into several different planes. Several measurements and observations of the hip joints were made in relation to femoroacetabular impingement. The 100 hip joints from 50 patients with no history of hip problems demonstrated that 39% of the joints (31% of female, 48% of male joints) have at least 1 morphologic aspect predisposing to femoroacetabular impingement. The majority (66% to 100% ) of the findings were bilateral; 33% of female and 52% of male asymptomatic participants in our study had at least 1 predisposing factor for femoroacetabular impingement in 1 or both of their hip joints. Based on the data collected from this study, the acetabular crossover sign had a 71% sensitivity and 88% specificity for detecting acetabular retroversion. Nonquantitative assessment of the femoral head at the anterior, anterolateral, and lateral head/neck junctions demonstrated that 74% of the joints had an aspherical femoral head. The study demonstrated substantial prevalence of bony characteristics predisposing to femoroacetabular impingement in asymptomatic individuals according to the established measurement parameters in current literature.

Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review.

PubMed

Hopley, Colin; Stengel, Dirk; Ekkernkamp, Axel; Wich, Michael

2010-06-11

To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Systematic review and meta-analysis of randomised trials, quasirandomised trials, and cohort studies. Medline, Embase, Cochrane register of controlled trials, publishers' databases, and manual search of bibliographies. Randomised controlled trials, quasirandomised trials, and cohort studies (retrospective and prospective) comparing hemiarthroplasty with total hip arthroplasty for treating displaced femoral neck fractures in patients aged more than 60 years. Relative risks, risk differences, and mean differences from each trial, aggregated using random effects models. Analyses were stratified for experimental and non-experimental designs, and two way sensitivity analyses and tests for interaction were done to assess the influence of various criteria of methodological quality on pooled estimates. 3821 references were identified. Of the 202 full papers inspected, 15 were included (four randomised controlled trials, three quasirandomised trials, and eight retrospective cohort studies, totalling 1890 patients). Meta-analysis of 14 studies showed a lower risk of reoperation after total hip arthroplasty compared with hemiarthroplasty (relative risk 0.57, 95% confidence interval 0.34 to 0.96, risk difference 4.4%, 95% confidence interval 0.2% to 8.5%), although this effect was mainly driven by investigations without concealed treatment allocation. Total hip arthroplasty consistently showed better ratings in the Harris hip score (three studies, 246 patients, weighted mean difference 5.4, 95% confidence interval 2.7 to 8.2) after follow-up periods of 12 to 48 months. The standardised mean difference of different scores from five studies was 0.42 (95% confidence interval 0.24 to 0.61), indicating a medium functional advantage of total hip arthroplasty over hemiarthroplasty. Total hip arthroplasty was associated with a slightly higher risk of dislocation (relative risk 1.48, 95% confidence interval 0.89 to 2.46) and general complications (1.14, 0.87 to 1.48). Single stage total hip arthroplasty may lead to lower reoperation rates and better functional outcomes compared with hemiarthroplasty in older patients with displaced femoral neck fractures. However, heterogeneity across the available trials and distinct subgroup effects preclude definitive statements and require further research in this area.

Predictors for Long-Term Hip Survivorship Following Acetabular Fracture Surgery: Importance of Gap Compared with Step Displacement.

PubMed

Verbeek, Diederik O; van der List, Jelle P; Tissue, Camden M; Helfet, David L

2018-06-06

Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following acetabular fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty. Patients who had acetabular fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (<50 years old). The critical CT cutoff value for total hip arthroplasty conversion was 5 mm for gap and 1 mm for step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of <5 mm compared with 56.5% for a gap of ≥5 mm (p < 0.001) and 80.0% for a step of <1.0 mm versus 65.5% for a step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p < 0.001) were independently associated with conversion to total hip arthroplasty in all patients. In the subgroup of younger patients, only a step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty. Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual gaps, only step displacement (≥1 mm) appeared to be associated with this outcome. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The efficacy of modified direct lateral versus posterior approach on gait function and hip muscle strength after primary total hip arthroplasty at 12months follow-up. An explorative randomised controlled trial.

PubMed

Rosenlund, Signe; Broeng, Leif; Overgaard, Søren; Jensen, Carsten; Holsgaard-Larsen, Anders

2016-11-01

The lateral and the posterior approach are the most commonly used procedures for total hip arthroplasty. Due to the detachment of the hip abductors, lateral approach is claimed to cause reduced hip muscle strength and altered gait pattern. However, this has not been investigated in a randomised controlled trial. The aim was to compare the efficacy of total hip arthroplasty performed by lateral or posterior approach on gait function and hip muscle strength up to 12months post-operatively. We hypothesised that posterior approach would be superior to lateral approach. Forty-seven patients with primary hip osteoarthritis were randomised to total hip arthroplasty with either posterior or lateral approach and evaluated pre-operatively, 3 and 12months post-operatively using 3-dimensional gait analyses as objective measures of gait function, including Gait Deviation Index, temporo-spatial parameters and range of motion. Isometric maximal hip muscle strength in abduction, flexion and extension was also tested. Post-operatively, no between-group difference in gait function was observed. However, both hip abductor and flexor muscle strength improved more in the posterior approach group: -0.20(Nm/kg)[95%CI:-0.4 to 0.0] and -0.20(Nm/kg)[95%CI:-0.4 to 0.0], respectively. Contrary to our first hypothesis, the overall gait function in the posterior approach group did not improve more than in the lateral approach group. However, in agreement with our second hypothesis, patients in the posterior approach group improved more in hip abductor and flexor muscle strength at 12months. Further investigation of the effect of reduced maximal hip muscle strength on functional capacity is needed. ClinicalTrials.gov. No.: NCT01616667. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cemented total hip replacement cable debris and acetabular construct durability.

PubMed

Altenburg, Aaron J; Callaghan, John J; Yehyawi, Tameem M; Pedersen, Douglas R; Liu, Steve S; Leinen, Jessica A; Dahl, Kevin A; Goetz, Devon D; Brown, Thomas D; Johnston, Richard C

2009-07-01

Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric reattachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan-Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% +/- 9% and 83% +/- 7% for the cable and wire groups, respectively, at twenty years (p = 0.03). Because cable trochanteric attachment led to significantly greater polyethylene wear, osteolysis, acetabular loosening, and acetabular revision, presumably due to third-body metallic debris generation in this cemented total hip replacement construct, surgeons should be aware of the deleterious effects of third-body debris and avoid the use of potential debris generators in the total hip arthroplasty construct. If cable is used and fretting is recognized, especially with intra-articular migration of metallic material or nonunion of the greater trochanter, consideration should be given to cable removal.

Total hip replacement for hip fracture: Surgical techniques and concepts.

PubMed

Coomber, Ross; Porteous, Matthew; Hubble, Matthew J W; Parker, Martyn J

2016-10-01

When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications, morbidity and perioperative mortality. Consideration should be made to performing the THR in a laminar flow theatre, by a surgeon experienced in total hip arthroplasty, using an anterolateral approach, cementing the implant in place, using a large head size and with repair of the joint capsule. Combined Ortho-geriatric care is recommended with similar post-operative rehabilitation to elective THR patients but with less expectation of short length of stay and consideration for fracture prevention measures. Copyright © 2016. Published by Elsevier Ltd.

Estimation of wear in total hip replacement using a ten station hip simulator.

PubMed

Brummitt, K; Hardaker, C S

1996-01-01

The results of hip simulator tests on a total of 16 total hip joints, all of them 22.25 mm Charnley designs, are presented. Wear at up to 6.75 million cycles was assessed by using a coordinate measuring machine. The results gave good agreement with clinical estimates of wear rate on the same design of joint replacement from a number of sources. Good agreement was also obtained when comparison was made with the published results from more sophisticated simulators. The major source of variation in the results was found to occur in the first million cycles where creep predominates. The results of this study support the use of this type of simplified simulator for estimating wear in a total hip prosthesis. The capability to test a significant number of joints simultaneously may make this mechanism preferable to more complex machines in many cases.

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system.

PubMed

Clark, P; Carlos, F; Barrera, C; Guzman, J; Maetzel, A; Lavielle, P; Ramirez, E; Robinson, V; Rodriguez-Cabrera, R; Tamayo, J; Tugwell, P

2008-03-01

This study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP). To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts' opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. The total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US$ 97,058,159 for the acute treatment alone ($4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. Costs of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.

Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement

PubMed Central

Czyżewska, Anna; Walesiak, Katarzyna; Krawczak, Karolina; Cabaj, Dominika; Górecki, Andrzej

2014-01-01

Introduction The World Health Organization (WHO) claimed osteoarthritis as a civilization-related disease. The effectiveness of preoperative physiotherapy among patients suffering hip osteoarthritis (OA) at the end of their conservative treatment is rarely described in the literature. The aim of this study was to assess the quality of life and musculoskeletal health status of patients who received preoperative physiotherapy before total hip replacement (THR) surgery within a year prior to admission for a scheduled THR and those who did not. Material and methods Forty-five patients, admitted to the Department of Orthopaedics and Traumatology of Locomotor System for elective total hip replacement surgery, were recruited for this study. The assessment consisted of a detailed interview using various questionnaires: the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 36-Item Short Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS), as well as physical examination. Patients were assigned to groups based on their attendance of preoperative physiotherapy within a year prior to surgery. Results Among patients who received preoperative physiotherapy a significant improvement was found for pain, daily functioning, vitality, psychological health, social life, and (active and passive) internal rotation (p < 0.05). Conclusions Patients are not routinely referred to physiotherapy within a year before total hip replacement surgery. This study confirmed that pre-operative physiotherapy may have a positive influence on selected musculoskeletal system status indicators and quality of life in hip osteoarthritis patients awaiting surgery. PMID:25395951

Spine–hip relations in patients with hip osteoarthritis

PubMed Central

Rivière, Charles; Lazic, Stefan; Dagneaux, Louis; Van Der Straeten, Catherine; Cobb, Justin; Muirhead-Allwood, Sarah

2018-01-01

Patients with hip osteoarthritis often have an abnormal spine-hip relation (SHR), meaning the presence of a clinically deleterious spine-hip and/or hip-spine syndrome. Definition of the individual SHR is ideally done using the EOS® imaging system or, if not available, with conventional lumbopelvic lateral radiographs. By pre-operatively screening patients with abnormal SHR, it is possible to refine total hip replacement (THR) surgical planning, which may improve outcomes. An important component of the concept of kinematically aligned total hip arthroplasty (KA THA) consists of defining the optimal acetabular cup design and orientation based on the assessment of an individual’s SHR, and use of the transverse acetabular ligament to adjust the cup positioning. The Bordeaux classification might advance the understanding of SHR and hopefully help improve THR outcomes. Cite this article: EFORT Open Rev 2018;3:39-44. DOI: 10.1302/2058-5241.3.170020 PMID:29657844

A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

PubMed

Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

2016-07-25

BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (p<0.001), increased ranges of motion and muscle strength, and reduced use of medicines (NASAIDs) (p<0.001). A correlation was found between the degree of degenerative deforming lesions and the effects of the treatment process (p<0.01). CONCLUSIONS 1. The rehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

Experimental validation of finite element modelling of a modular metal-on-polyethylene total hip replacement.

PubMed

Hua, Xijin; Wang, Ling; Al-Hajjar, Mazen; Jin, Zhongmin; Wilcox, Ruth K; Fisher, John

2014-07-01

Finite element models are becoming increasingly useful tools to conduct parametric analysis, design optimisation and pre-clinical testing for hip joint replacements. However, the verification of the finite element model is critically important. The purposes of this study were to develop a three-dimensional anatomic finite element model for a modular metal-on-polyethylene total hip replacement for predicting its contact mechanics and to conduct experimental validation for a simple finite element model which was simplified from the anatomic finite element model. An anatomic modular metal-on-polyethylene total hip replacement model (anatomic model) was first developed and then simplified with reasonable accuracy to a simple modular total hip replacement model (simplified model) for validation. The contact areas on the articulating surface of three polyethylene liners of modular metal-on-polyethylene total hip replacement bearings with different clearances were measured experimentally in the Leeds ProSim hip joint simulator under a series of loading conditions and different cup inclination angles. The contact areas predicted from the simplified model were then compared with that measured experimentally under the same conditions. The results showed that the simplification made for the anatomic model did not change the predictions of contact mechanics of the modular metal-on-polyethylene total hip replacement substantially (less than 12% for contact stresses and contact areas). Good agreements of contact areas between the finite element predictions from the simplified model and experimental measurements were obtained, with maximum difference of 14% across all conditions considered. This indicated that the simplification and assumptions made in the anatomic model were reasonable and the finite element predictions from the simplified model were valid. © IMechE 2014.

Kinematic analysis of hip and knee rotation and other contributors to ballet turnout.

PubMed

Quanbeck, Amy E; Russell, Jeffrey A; Handley, Sara C; Quanbeck, Deborah S

2017-02-01

Turnout, or external rotation (ER) of the lower extremities, is essential in ballet. The purpose of this study was to utilise physical examination and a biomechanical method for obtaining functional kinematic data using hip and knee joint centres to identify the relative turnout contributions from hip rotation, femoral anteversion, knee rotation, tibial torsion, and other sources. Ten female dancers received a lower extremity alignment assessment, including passive hip rotation, femoral anteversion, tibial torsion, weightbearing foot alignment, and Beighton hypermobility score. Next, turnout was assessed using plantar pressure plots and three-dimensional motion analysis; participants performed turnout to ballet first position on both a plantar pressure mat and friction-reducing discs. A retro-reflective functional marker motion capture system mapped the lower extremities and hip and knee joint centres. Mean total turnout was 129±15.7° via plantar pressure plots and 135±17.8° via kinematics. Bilateral hip ER during turnout was 49±10.2° (36% of total turnout). Bilateral knee ER during turnout was 41±5.9° (32% of total turnout). Hip ER contribution to total turnout measured kinematically was less than expected compared to other studies, where hip ER was determined without functional kinematic data. Knee ER contributed substantially more turnout than expected or previously reported. This analysis method allows precise assessment of turnout contributors.

Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports.

PubMed

Ke, Xijian; Li, Ji; Liu, Yong; Wu, Xi; Mei, Wei

2017-06-26

Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block. Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations. The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.

Revision total hip arthoplasty: factors associated with re-revision surgery.

PubMed

Khatod, Monti; Cafri, Guy; Inacio, Maria C S; Schepps, Alan L; Paxton, Elizabeth W; Bini, Stefano A

2015-03-04

The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty. A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revision total hip arthroplasty for aseptic reasons from April 1, 2001, to December 31, 2010. The end point of interest was re-revision total hip arthroplasty. Risk factors evaluated for re-revision total hip arthroplasty included: patient risk factors (age, sex, body mass index, race, and general health status), implant risk factors (fixation type, bearing surface, femoral head size, and component replacement), and surgeon risk factors (volume and experience). A multivariable Cox proportional hazards model was used. Six hundred and twenty-nine revision total hip arthroplasties with sixty-three (10%) re-revisions were evaluated. The mean cohort age (and standard deviation) was 57.0 ± 12.4 years, the mean body mass index (and standard deviation) was 29.5 ± 6.1 kg/m(2), and most of the patients were women (64.5%) and white (81.9%) and had an American Society of Anesthesiologists score of <3 (52.9%). The five-year implant survival after revision total hip arthroplasty was 86.8% (95% confidence interval, 83.57% to 90.25%). In adjusted models, age, total number of revision surgical procedures performed by the surgeon, fixation, and bearing surface were associated with the risk of re-revision. For every ten-year increase in patient age, the hazard ratio for re-revision decreases by a factor of 0.72 (95% confidence interval, 0.58 to 0.90). For every five revision surgical procedures performed by a surgeon, the risk of revision decreases by a factor of 0.93 (95% confidence interval, 0.86 to 0.99). At the time of revision, a new or retained cemented femoral implant or all-cemented hip implant increases the risk of revision by a factor of 3.19 (95% confidence interval, 1.22 to 8.38) relative to a retained or new uncemented hip implant. A ceramic on a highly cross-linked polyethylene bearing articulation decreases the hazard relative to metal on highly cross-linked polyethylene by a factor of 0.32 (95% confidence interval, 0.11 to 0.95). Metal on constrained bearing increases the hazard relative to metal on highly cross-linked polyethylene by a factor of 3.32 (95% confidence interval, 1.16 to 9.48). When evaluating patient, implant, and surgical factors at the time of revision total hip arthroplasty, age, surgeon experience, implant fixation, and bearing surfaces had significant impacts on the risk of re-revision. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Characteristics and Trends of Published Adult Hip Research over the Last Decade

PubMed Central

Kwak, Hong Suk; Yoon, Pil Whan; Park, Moon Seok; Kim, Hee Joong

2015-01-01

Purpose We designed this study to demonstrate recent trends in the proportion of adult hip research in orthopedics, to identify countries leading the adult hip research, and to evaluate the relationship between the economic power of the countries and their contributions. Materials and Methods Studies published in seven select orthopedic journals were retrieved from PubMed. Among them, we determined the number of adult hip studies. The countries-of-origin of adult hip studies, and the economic power of the countries were investigated. Results A total of 7218 orthopedic publications and 1993 (27.6%) addressed adult hip research were identified. Adult hip studies increased from 313 (23.7%) in 2000 to 555 (27.9%) in 2011. Twenty-five countries accounted for 97.6% of the total number of adult hip studies, and gross domestic product correlated with publication volume (Spearman's rho, 0.723; p=0.000). Conclusion Researchers from a limited number of developed countries have published their studies in the adult hip discipline. PMID:25510756

Carrying asymmetric loads during stair negotiation.

PubMed

Wang, Junsig; Gillette, Jason

2017-03-01

Individuals often carry items in one hand instead of both hands during activities of daily living. The combined effects of carrying asymmetric loads and stair negotiation may create even higher demands on the low back and lower extremity. The purpose of this study was to investigate the effect of symmetric and asymmetric loading conditions on L5/S1 and lower extremity moments during stair negotiation. Twenty-two college students performed stair ascent and stair descent on a three-step staircase (step height 18.5cm, tread depth 29.5cm) at preferred pace under five load conditions: no load, 10% body weight (BW) unilateral load, 20% BW unilateral load, 10% BW bilateral load, and 20% BW bilateral load. Video cameras and force platforms were used to collect kinematic and kinetic data. Inverse dynamics was used to calculate frontal plane moments for the L5/S1 and lower extremity. A 20% BW unilateral load resulted in significantly higher peak L5/S1 lateral bending, hip abduction, and external knee varus moments than nearly all other loading conditions during stair ascent and stair descent. Therefore, we suggest potential benefits when carrying symmetrical loads as compared to an asymmetric load in order to decrease the frontal joint moments, particularly at 20% BW load. Copyright © 2017 Elsevier B.V. All rights reserved.

Joint Kinetics and Kinematics During Common Lower Limb Rehabilitation Exercises.

PubMed

Comfort, Paul; Jones, Paul Anthony; Smith, Laura Constance; Herrington, Lee

2015-10-01

Unilateral body-weight exercises are commonly used to strengthen the lower limbs during rehabilitation after injury, but data comparing the loading of the limbs during these tasks are limited. To compare joint kinetics and kinematics during 3 commonly used rehabilitation exercises. Descriptive laboratory study. Laboratory. A total of 9 men (age = 22.1 ± 1.3 years, height = 1.76 ± 0.08 m, mass = 80.1 ± 12.2 kg) participated. Participants performed the single-legged squat, forward lunge, and reverse lunge with kinetic data captured via 2 force plates and 3-dimensional kinematic data collected using a motion-capture system. Peak ground reaction forces, maximum joint angles, and peak sagittal-joint moments. We observed greater eccentric and concentric peak vertical ground reaction forces during the single-legged squat than during both lunge variations (P ≤ .001). Both lunge variations demonstrated greater knee and hip angles than did the single-legged squat (P < .001), but we observed no differences between lunges (P > .05). Greater dorsiflexion occurred during the single-legged squat than during both lunge variations (P < .05), but we noted no differences between lunge variations (P = .70). Hip-joint moments were greater during the forward lunge than during the reverse lunge (P = .003) and the single-legged squat (P = .011). Knee-joint moments were greater in the single-legged squat than in the reverse lunge (P < .001) but not greater in the single-legged squat than in the forward lunge (P = .41). Ankle-joint moments were greater during the single-legged squat than during the forward lunge (P = .002) and reverse lunge (P < .001). Appropriate loading progressions for the hip should begin with the single-legged squat and progress to the reverse lunge and then the forward lunge. In contrast, loading progressions for the knee and ankle should begin with the reverse lunge and progress to the forward lunge and then the single-legged squat.

Primary total hip replacement versus hip resurfacing - hospital considerations.

PubMed

Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz

2011-01-01

Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients.

Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study.

PubMed

Burgers, P T P W; Hoogendoorn, M; Van Woensel, E A C; Poolman, R W; Bhandari, M; Patka, P; Van Lieshout, E M M

2016-06-01

The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness. The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi- or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data. Data of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %. The main cost determinants for hemi- or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.

Pre-fracture individual characteristics associated with high total health care costs after hip fracture.

PubMed

Schousboe, J T; Paudel, M L; Taylor, B C; Kats, A M; Virnig, B A; Dowd, B E; Langsetmo, L; Ensrud, K E

2017-03-01

Older women with pre-fracture slow walk speed, high body mass index, and/or a high level of multimorbidity have significantly higher health care costs after hip fracture compared to those without those characteristics. Studies to investigate if targeted health care interventions for these individuals can reduce hip fracture costs are warranted. The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims. Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture. Median total health care costs for 1 year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1 year after hip fracture were 14 % higher ($5256, 95 % CI $156 to $10,356) in those with walk speed <0.6 m/s compared to ≥1.0 m/s, 25 % higher ($9601, 95 % CI $3314 to $16,069) in those with body mass index ≥30 kg/m 2 compared to 20 to 24.9 mg/kg 2 , and 21 % higher ($7936, 95 % CI $346 to $15,526) for those with seven or more compared to no comorbid medical conditions. Pre-fracture poor mobility, obesity, and multiple comorbidities are associated with higher total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.

Revision hip preservation surgery with hip arthroscopy: clinical outcomes.

PubMed

Domb, Benjamin G; Stake, Christine E; Lindner, Dror; El-Bitar, Youseff; Jackson, Timothy J

2014-05-01

To analyze and report the clinical outcomes of a cohort of patients who underwent revision hip preservation with arthroscopy and determine predictors of positive and negative outcomes. During the study period from April 2008 to December 2010, all patients who underwent revision hip preservation with arthroscopy were included. This included patients who had previous open surgery and underwent revision with arthroscopy. Patient-reported outcome (PRO) scores were obtained preoperatively and at 3-month, 1-year, 2-year, and 3-year follow-up time points. Any revision surgeries and conversions to total hip arthroplasty were noted. A multiple regression analysis was performed to look for positive and negative predictive factors for improvement in PROs after revision hip arthroscopy. Forty-seven hips in 43 patients had completed 2 years' follow-up or needed total hip arthroplasty. The mean length of follow-up was 29 months (range, 24 to 47 months). Of the hips, 31 (66%) had either unaddressed or incompletely treated femoroacetabular impingement. There was a significant improvement in all PRO scores at a mean of 29 months after revision (P < .0001). The visual analog scale score improved from 7.3 ± 1.5 to 3.9 ± 2.5 (P < .0001). Improvements in the Non-Arthritic Hip Score of at least 10 points and 20 points were found in 28 hips (65%) and 19 hips (44%), respectively. Four hips in 3 patients required conversion to total hip arthroplasty. Positive predictive factors for PRO improvement were previous open surgery, pincer impingement, cam impingement, symptomatic heterotopic ossification, and segmental labral defects treated with labral reconstruction. On the basis of multiple PROs, revision hip preservation with hip arthroscopy can achieve moderately successful outcomes and remains a viable treatment strategy after failed primary hip preservation surgery. Preoperative predictors of success after revision hip arthroscopy include segmental labral defects, unaddressed or incompletely addressed femoroacetabular impingement, heterotopic ossification, and previous open surgery. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip Arthroplasty: A Computer-Based Cost-Utility Model.

PubMed

Barlow, Brian T; McLawhorn, Alexander S; Westrich, Geoffrey H

2017-05-03

Dislocation remains a clinically important problem following primary total hip arthroplasty, and it is a common reason for revision total hip arthroplasty. Dual mobility (DM) implants decrease the risk of dislocation but can be more expensive than conventional implants and have idiosyncratic failure mechanisms. The purpose of this study was to investigate the cost-effectiveness of DM implants compared with conventional bearings for primary total hip arthroplasty. Markov model analysis was conducted from the societal perspective with use of direct and indirect costs. Costs, expressed in 2013 U.S. dollars, were derived from the literature, the National Inpatient Sample, and the Centers for Medicare & Medicaid Services. Effectiveness was expressed in quality-adjusted life years (QALYs). The model was populated with health state utilities and state transition probabilities derived from previously published literature. The analysis was performed for a patient's lifetime, and costs and effectiveness were discounted at 3% annually. The principal outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to explore relevant uncertainty. In the base case, DM total hip arthroplasty showed absolute dominance over conventional total hip arthroplasty, with lower accrued costs ($39,008 versus $40,031 U.S. dollars) and higher accrued utility (13.18 versus 13.13 QALYs) indicating cost-savings. DM total hip arthroplasty ceased being cost-saving when its implant costs exceeded those of conventional total hip arthroplasty by $1,023, and the cost-effectiveness threshold for DM implants was $5,287 greater than that for conventional implants. DM was not cost-effective when the annualized incremental probability of revision from any unforeseen failure mechanism or mechanisms exceeded 0.29%. The probability of intraprosthetic dislocation exerted the most influence on model results. This model determined that, compared with conventional bearings, DM implants can be cost-saving for routine primary total hip arthroplasty, from the societal perspective, if newer-generation DM implants meet specific economic and clinical benchmarks. The differences between these thresholds and the performance of other contemporary bearings were frequently quite narrow. The results have potential application to the postmarket surveillance of newer-generation DM components. Economic and decision analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

Calcaneal Scoring as an Adjunct to Modified Oxford Hip Scores: Prediction of Contralateral Slipped Capital Femoral Epiphysis.

PubMed

Nicholson, Allen D; Huez, Coridon M; Sanders, James O; Liu, Raymond W; Cooperman, Daniel R

2016-03-01

In 2 recent studies, modified Oxford hip scores of 16 through 18 have been shown to predict an extremely high risk of contralateral slipping in unilateral slipped capital femoral epiphysis (SCFE). However, the modified Oxford system is not widely used. This may be due, in part, to the complexity of the scoring system, difficulty in viewing all 5 radiographic features on a single x-ray and phenotypic variation in the features. Ossification of the calcaneal apophysis provides an osteologic marker of skeletal maturation in relation to peak height velocity and has been described previously. We examine the value of the calcaneal apophyseal ossification sequence for predicting modified Oxford hip scores. We examined 279 pelvis and matching foot x-rays that were taken at the same session from 94 healthy children aged 3 to 18 years. A fellowship-trained pediatric orthopaedist determined the modified Oxford hip score for each hip radiograph. The calcaneal x-rays had been previously graded. Modified Oxford hip scores were compared with calcaneal scores for each set of matched hip and calcaneal x-rays. Stage 0 to 2 calcanei had 94% of corresponding hip radiographs rated as modified Oxford scores of 16 to 18. Stage 3 calcanei had 54% rated as 16 to 18 and 31% rated as scores 19 to 21. Stage 4 calcanei had 31% rated as scores 19 to 21, and 68% rated as scores 22 to 26. Stage 5 calcanei had 100% rated as 22 to 26. Using data from Popejoy and colleagues' study, the weighted risk of contralateral SCFE was 94% for calcaneal stage 0, 86.5% for calcaneal stage 1, 90.3% for calcaneal stage 2, 55.8% for calcaneal stage 3, 6.1% for calcaneal stage 4, and 0 for calcaneal stage 5. Calcaneal stages 0 to 3 correspond entirely to modified Oxford scores indicating elevated risk of contralateral SCFE. The calcaneal scoring system has potential for adjunctive use with the modified Oxford score for prediction of contralateral SCFE.

Cemented Total Hip Replacement Cable Debris and Acetabular Construct Durability

PubMed Central

Altenburg, Aaron J.; Callaghan, John J.; Yehyawi, Tameem M.; Pedersen, Douglas R.; Liu, Steve S.; Leinen, Jessica A.; Dahl, Kevin A.; Goetz, Devon D.; Brown, Thomas D.; Johnston, Richard C.

2009-01-01

Background: Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Methods: Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric reattachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. Results: The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan-Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% ± 9% and 83% ± 7% for the cable and wire groups, respectively, at twenty years (p = 0.03). Conclusions: Because cable trochanteric attachment led to significantly greater polyethylene wear, osteolysis, acetabular loosening, and acetabular revision, presumably due to third-body metallic debris generation in this cemented total hip replacement construct, surgeons should be aware of the deleterious effects of third-body debris and avoid the use of potential debris generators in the total hip arthroplasty construct. If cable is used and fretting is recognized, especially with intra-articular migration of metallic material or nonunion of the greater trochanter, consideration should be given to cable removal. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. PMID:19571089

New mouse model of skeletal muscle atrophy using spiral wire immobilization.

PubMed

Onda, Akiko; Kono, Hajime; Jiao, Qibin; Akimoto, Takayuki; Miyamoto, Toshikazu; Sawada, Yasuhiro; Suzuki, Katsuhiko; Kusakari, Yoichiro; Minamisawa, Susumu; Fukubayashi, Toru

2016-10-01

Disuse-induced skeletal muscle atrophy is a serious concern; however, there is not an effective mouse model to elucidate the molecular mechanisms. We developed a noninvasive atrophy model in mice. After the ankle joints of mice were bandaged into a bilateral plantar flexed position, either bilateral or unilateral hindlimbs were immobilized by wrapping in bonsai steel wire. After 3, 5, or 10 days of immobilization of the hip, knee, and ankle, the weight of the soleus and plantaris muscles decreased significantly in both bilateral and unilateral immobilization. MAFbx/atrogin-1 and MuRF1 mRNA was found to have significantly increased in both muscles, consistent with disuse-induced atrophy. Notably, the procedure did not result in either edema or necrosis in the fixed hindlimbs. This method allows repeated, direct access to the immobilized muscle, making it a useful procedure for concurrent application and assessment of various therapeutic interventions. Muscle Nerve 54: 788-791, 2016. © 2016 Wiley Periodicals, Inc.

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

PubMed Central

Upile, Tahwinder; Elmiyeh, Behrad; Jerjes, Waseem; Prasad, Vyas; Kafas, Panagiotis; Abiola, Jesuloba; Youl, Bryan; Epstein, Ruth; Hopper, Colin; Sudhoff, Holger; Rubin, John

2009-01-01

Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia. PMID:19852852

Nearly total absence of pulmonary perfusion with corresponding technetium-99m MDP and gallium-67 uptake in a patient with mediastinal neuroblastoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Garty, I.; Koren, A.; Moguilner, G.

1985-08-01

A case of unilateral nearly total hypoperfusion of the left lung in a 13-month-old girl is presented. The combination of the lung hypoperfusion and accumulation of the Tc-99m MDP and Ga-67 citrate in the same area suggested the preoperative diagnosis of mediastinal neuroblastoma. Explorative thoracotomy revealed the presence of a neuroblastoma compressing the left lung pedicle. The described scintigraphic appearance in the pediatric age group is suggested as typical of mediastinal neuroblastoma. This pathology should be included in the following gamuts in nuclear medicine: unilateral decrease or absent lung perfusion, unilateral diffuse chest uptake of Ga-67 citrate, and unilateral pulmonarymore » uptake in bone scintigraphy.« less

Hip Squeaking after Ceramic-on-ceramic Total Hip Arthroplasty

PubMed Central

Wu, Guo-Liang; Zhu, Wei; Zhao, Yan; Ma, Qi; Weng, Xi-Sheng

2016-01-01

Objective: The present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise. Data Sources: The data analyzed in this review were based on articles from PubMed and Web of Science. Study Selection: The articles selected for review were original articles and reviews found based on the following search terms: “total hip arthroplasty”, “ceramic-on-ceramic”, “hip squeaking”, and “hip noise.” Results: The mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors. Conclusions: Most studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified. PMID:27453238

Evaluation of Hip Internal and External Rotation Range of Motion as an Injury Risk Factor for Hip, Abdominal and Groin Injuries in Professional Baseball Players

PubMed Central

Ma, Richard; Zhou, Hanbing; Thompson, Matthew; Dawson, Courtney; Nguyen, Joseph; Coleman, Struan

2015-01-01

Normal hip range of motion (ROM) is essential in running and transfer of energy from lower to upper extremities during overhead throwing. Dysfunctional hip ROM may alter lower extremity kinematics and predispose athletes to hip and groin injuries. The purpose of this study is characterize hip internal/external ROM (Arc) and its effect on the risk of hip, hamstring, and groin injuries in professional baseball players. Bilateral hip internal and external ROM was measured on all baseball players (N=201) in one professional organization (major and minor league) during spring training. Players were organized according to their respective positions. All injuries were documented prospectively for an entire MLB season (2010 to 2011). Data was analyzed according to position and injuries during the season. Total number of players (N=201) with an average age of 24±3.6 (range=17-37). Both pitchers (N=93) and catchers (N=22) had significantly decreased mean hip internal rotation and overall hip arc of motion compared to the positional players (N=86). Players with hip, groin, and hamstring injury also had decreased hip rotation arc when compared to the normal group. Overall, there is a correlation between decreased hip internal rotation and total arc of motion with hip, hamstring, and groin injuries. PMID:26793294

Task-specificity of bilateral anticipatory activation of the deep abdominal muscles in healthy and chronic low back pain populations.

PubMed

Massé-Alarie, Hugo; Beaulieu, Louis-David; Preuss, Richard; Schneider, Cyril

2015-02-01

Cross-sectional study of lumbopelvic muscle activation during rapid limb movements in chronic low back pain (CLBP) patients and healthy controls. Controversy exists over whether bilateral anticipatory activation of the deep abdominal muscles represents a normal motor control strategy prior to all rapid limb movements, or if this is simply a task-specific strategy appropriate for only certain movement conditions. To assess the onset timing of the transversus abdominis/internal oblique muscles (TrA/IO) during two rapid limb movement tasks with different postural demands - bilateral shoulder flexion in standing, unilateral hip extension in prone lying - as well as differences between CLBP and controls. Twelve CLBP and 13 controls performed the two tasks in response to an auditory cue. Surface EMG was acquired bilaterally from five muscles, including TrA/IO. In both groups, 50% of bilateral shoulder flexion trials showed bilateral anticipatory TrA/IO activation. This was rare, however, in unilateral hip extension for which only the TrA/IO contralateral to the moving leg showed anticipatory activation. The only significant difference in lumbo-pelvic muscle onset timing between CLBP and controls was a delay in semitendinosus activation during bilateral shoulder flexion in standing. Our data suggest that bilateral anticipatory TrA/IO activation is a task-specific motor control strategy, appropriate for only certain rapid limb movement conditions. Furthermore, the presence of altered semitendinosus onset timing in the CLBP group during bilateral shoulder flexion may be reflective of other possible lumbo-pelvic motor control alterations among this population. Copyright © 2014 Elsevier B.V. All rights reserved.

Invariant hip moment pattern while walking with a robotic hip exoskeleton

PubMed Central

Lewis, Cara L.; Ferris, Daniel P.

2011-01-01

Robotic lower limb exoskeletons hold significant potential for gait assistance and rehabilitation; however, we have a limited understanding of how people adapt to walking with robotic devices. The purpose of this study was to test the hypothesis that people reduce net muscle moments about their joints when robotic assistance is provided. This reduction in muscle moment results in a total joint moment (muscle plus exoskeleton) that is the same as the moment without the robotic assistance despite potential differences in joint angles. To test this hypothesis, eight healthy subjects trained with the robotic hip exoskeleton while walking on a force-measuring treadmill. The exoskeleton provided hip flexion assistance from approximately 33% to 53% of the gait cycle. We calculated the root mean squared difference (RMSD) between the average of data from the last 15 minutes of the powered condition and the unpowered condition. After completing three 30-minute training sessions, the hip exoskeleton provided 27% of the total peak hip flexion moment during gait. Despite this substantial contribution from the exoskeleton, subjects walked with a total hip moment pattern (muscle plus exoskeleton) that was almost identical and more similar to the unpowered condition than the hip angle pattern (hip moment RMSD 0.027, angle RMSD 0.134, p<0.001). The angle and moment RMSD were not different for the knee and ankle joints. These findings support the concept that people adopt walking patterns with similar joint moment patterns despite differences in hip joint angles for a given walking speed. PMID:21333995

Frost decreases content of sugars, ascorbic acid and some quercetin glycosides but stimulates selected carotenes in Rosa canina hips.

PubMed

Cunja, Vlasta; Mikulic-Petkovsek, Maja; Zupan, Anka; Stampar, Franci; Schmitzer, Valentina

2015-04-15

Primary and secondary metabolites of Rosa canina hips were determined by HPLC/MS during ripening and after frost damage. Rose hips were harvested six times from the beginning of September until the beginning of December. Color parameters a*, b* and L* decreased during maturation. Glucose and fructose were the predominant sugars representing up to 92% total sugars, and citric acid was the major organic acid detected in rose hips (constituting up to 58% total organic acids). Total sugar and ascorbic acid content significantly decreased after frost damage; from 42.2 to 25.9 g 100 g(-1) DW for sugars and from 716.8 to 176.0 mg 100 g(-1) DW for ascorbic acid. Conversely, β-carotene and lycopene levels increased in frostbitten rose hips to 22.1 and 113.2 mg 100 g(-1) DW, respectively. In addition to cyanidin-3-glucoside (highest level in hips was 125.7 μg 100 g (-1) DW), 45 different phenolic compounds have been identified. The most abundant were proanthocyanidins (their levels amounted up to 90% of total flavanol content) and their content showed no significant differences during maturation. The levels of catechin, phloridzin, flavanones and several quercetin glycosides were highest on the first three sampling dates and decreased after frost. Antioxidant capacity similarly decreased in frostbitten rose hips. Total phenolic content increased until the third sampling and decreased on later samplings. Copyright © 2015 Elsevier GmbH. All rights reserved.

A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements.

PubMed

Burke, Neil G; Green, Connor; McHugh, Gavin; McGolderick, Niall; Kilcoyne, Carol; Kenny, Patrick

2012-08-01

It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing. 124 patients (62 total hip replacements and 62 total knee replacements) were randomly selected to have either a standard adhesive dressing or jubilee method dressing. The number of dressing changes, incidence of blistering, leakage, appearance of inflammation, infection rate and the average stay in hospital was recorded for each patient. The jubilee dressing significantly reduced the rate of blistering, leakage and number of dressing changes when compare to a traditional adhesive dressing (p < 0.05). The rate of inflammation and average length of stay in hospital was not significantly different between the two groups. The authors recommend the use of this dressing for total hip and total knee arthroplasty procedures due to the associated lower complication rate. Copyright © 2012 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Callosal disconnection syndrome in a left-handed patient due to infarction of the total length of the corpus callosum.

PubMed

Lausberg, H; Göttert, R; Münssinger, U; Boegner, F; Marx, P

1999-03-01

We report on a left-handed patient with an ischemic infarction affecting exclusively the total length of the corpus callosum. This lesion clinically correlated with an almost complete callosal disconnection syndrome as described in callosotomy subjects, including unilateral verbal anosmia, hemialexia, unilateral ideomotor apraxia, unilateral agraphia, unilateral tactile anomia, unilateral constructional apraxia, lack of somesthetic transfer and dissociative phenomena. Despite the patient's left-handedness, his pattern of deficits was similar to the disconnection syndrome found in right-handers. Our report focusses on motor dominance and praxis. We followed-up the improvement in left apraxia and investigated the ability to initiate and learn a new visuo-motor skill. The results permit two tentative assumptions: (1) that the improvement in left apraxia was due to a compensatory increase in ipsilateral proximal muscle control, and (2) that motor dominance, i.e. the competence to initiate and learn a new movement pattern, was hemispherically dissociable from manual dominance in the sense of praxis control.

Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence.

PubMed

Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Schwindel, Leslie; Domb, Benjamin G

2014-10-01

The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m(2). Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. Level IV, systematic review of Level II to V studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Total hip arthroplasty through anterior "minimal invasive" approach].

PubMed

Moerenhout, Kevin G; Cherix, Stéphane; Rüdiger, Hannes A

2012-12-19

Total hip replacement has seen a tremendous development and has become one of the most successful surgical interventions in orthopaedics. While during the first decades of development of total hip arthroplasty the fixation of the implant into the bone was the main concern, the focus has shifted towards surgical technique and soft tissue handling. In order to avoid permanent soft tissue damage, muscular dysfunction and concerns in regards to cosmetics, minimal invasive and anatomic approaches have been developed. We here provide a short overview on various methods of total hip replacements and we describe our technique through a minimal invasive direct anterior approach. While muscle and nerve damage is minimal, this technique allows for a rapid rehabilitation and is associated with an excellent functional outcome and a minimal risk for dislocation.

Digital versus analogue preoperative planning of total hip arthroplasties: a randomized clinical trial of 210 total hip arthroplasties.

PubMed

The, Bertram; Verdonschot, Nico; van Horn, Jim R; van Ooijen, Peter M A; Diercks, Ron L

2007-09-01

The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized radiographs by the surgeon who performed the arthroplasty the next day. The main outcome was accuracy of the preoperative plan. Secondary outcomes were operation time and a radiographic assessment of the arthroplasty. Digital preoperative plans were more accurate in planning the cup (P < .05) and scored higher on the postoperative radiologic assessment of cemented cup (P = .03) and stem (P < .01) components. None of the other comparisons reached statistical significance. We conclude that digital plans slightly outperform analogue plans.

[Local infiltration analgesia in total joint replacement].

PubMed

de Jonge, Tamás; Görgényi, Szabolcs; Szabó, Gabriella; Torkos, Miklós Bulcsú

2017-03-01

Total hip and knee replacment surgeries are characterized by severe postoperative pain. Local infiltration analgesia is proved to be very effective. However this method has not been widely used in Hungary. To evaluate the efficacy of the local infiltration analgesia with modified components in patients underwent total hip or knee replacement surgery. Data of 99 consecutive patients underwent primary total hip or knee replacement surgery were evaluated prospectively. In all the 99 surgeries modified local infiltration analgesia was applied. Postoperative pain reported on a visual analog scale was recorded as well as the need for further analgetics during the first 18 hours after surgery. The cost of the analgetic drugs was calculated. The control group comprised 97 consecutive patients underwent total hip or knee replacement, where local infiltration analgesia was not applied. Statistical analysis was done. Patients received local infiltration analgesia reported significantly less pain (p<0.001). The need for postoperatively given analgetics was almost 50% less, and the cost of all postoperative analgetics was 47% less than in the control group. In total hip and knee replacement surgeries the modified local infiltration analgesia decreases postoperative pain effectively and contribute to the early mobilization of the patients. Orv. Hetil., 2017, 158(9), 352-357.

Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties.

PubMed

Camurcu, Yalkin; Sofu, Hakan; Buyuk, Abdul Fettah; Gursu, Sarper; Kaygusuz, Mehmet Akif; Sahin, Vedat

2015-09-01

The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (P<0.05). Infection was eradicated in 39 hips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success. Copyright © 2015 Elsevier Inc. All rights reserved.

LOWER EXTREMITY KINEMATICS IN RUNNING ATHLETES WITH AND WITHOUT A HISTORY OF MEDIAL SHIN PAIN

PubMed Central

Reiman, Michael P.

2012-01-01

Purpose/Background: Medial shin pain (MSP) is a common complaint that may stop an athlete from running. No previous study has identified deficits in pelvic, hip or knee motion as potential contributing factors to MSP. The purpose of this study was to investigate the differences in kinematics during running between uninjured athletes and those with MSP. Secondary analyses investigated differences in limbs between groups and differences between sexes. Methods: This case-control study investigated fourteen runners aged 18–40 years old with a history of unilateral MSP and fourteen runner controls. Three dimensional lower quarter kinematics were captured as runners ran on a treadmill. Specifically, peak hip internal rotation (IR), frontal plane pelvic tilt (PT) excursion, and knee flexion were examined. Results: Groups were similar in age, mass, height, and training mileage. Subjects with a history of MSP demonstrated significantly greater frontal plane PT (P = 0.002, Effect size = 0.55) and peak hip IR (P = 0.004, Effect size = 0.51); and less knee flexion (P = 0.02, Effect size = 0.46) than the control group. No significant difference was found in kinematics of the MSP group during their involved side stance phase as compared to their non-involved side. Conclusions: Runners with MSP displayed greater PT excursion, peak hip IR, and decreased knee flexion while running as compared to a control group. These results should help guide treatment for the running athlete that experiences MSP. Level of Evidence: 3b PMID:22893855

Lower extremity kinematics in running athletes with and without a history of medial shin pain.

PubMed

Loudon, Janice K; Reiman, Michael P

2012-08-01

Medial shin pain (MSP) is a common complaint that may stop an athlete from running. No previous study has identified deficits in pelvic, hip or knee motion as potential contributing factors to MSP. The purpose of this study was to investigate the differences in kinematics during running between uninjured athletes and those with MSP. Secondary analyses investigated differences in limbs between groups and differences between sexes. This case-control study investigated fourteen runners aged 18-40 years old with a history of unilateral MSP and fourteen runner controls. Three dimensional lower quarter kinematics were captured as runners ran on a treadmill. Specifically, peak hip internal rotation (IR), frontal plane pelvic tilt (PT) excursion, and knee flexion were examined. Groups were similar in age, mass, height, and training mileage. Subjects with a history of MSP demonstrated significantly greater frontal plane PT (P = 0.002, Effect size = 0.55) and peak hip IR (P = 0.004, Effect size = 0.51); and less knee flexion (P = 0.02, Effect size = 0.46) than the control group. No significant difference was found in kinematics of the MSP group during their involved side stance phase as compared to their non-involved side. Runners with MSP displayed greater PT excursion, peak hip IR, and decreased knee flexion while running as compared to a control group. These results should help guide treatment for the running athlete that experiences MSP. 3b.

A comparative analysis of warfarin and low-dose heparin as thromboembolism prophylaxis in total hip replacement patinets.

PubMed Central

Ritter, M A; HamiltonCW

1975-01-01

Warfarin, low-dose heparin, or a combination of low-dose heparin and hydrocortisone was administered to 300 patients undergoing total hip replacement. The lowest incidence of thromboembolic (5 per cent) was attained with Warfarin. Further investigation into the method of administration of low-dose heparin is necessary before it can be used effectively as thromboembolism prophylaxis in total hip replacement patients. The addition of hydrocortisone was not found useful. PMID:1138642

Predicting high blood metal ion concentrations following hip resurfacing.

PubMed

Matharu, Gulraj S; Berryman, Fiona; Brash, Lesley; Pynsent, Paul B; Treacy, Ronan B C; Dunlop, David J

2015-01-01

To determine whether gender, femoral head size, acetabular inclination, and time since surgery predicted high blood metal ion concentrations following Birmingham Hip Resurfacing (BHR). BHR patients with unilateral bearings at one specialist centre with blood cobalt and chromium concentrations measured up to May 2013 were included. This comprised a mixed (at-risk) group including symptomatic patients and asymptomatic individuals with specific clinical and/or radiological findings. Blood sampling was at a mean of 7.5 years (range 1-15.4 years) postoperatively. Of 319 patients (mean age 49.3 years; 53% male), blood metal ions greater than 7 µg/l were observed in 9% (n = 28). Blood metal ions were significantly higher in females (p<0.001), femoral head sizes ≤48 mm (p<0.01), and cup inclinations >55° (p<0.001). Linear regression demonstrated femoral head size was responsible for the highest proportion of variance in blood metal ions (cobalt p<0.001, R2 = 8%; chromium p<0.001, R2 = 11%). Analysis of femoral head size and inclination together demonstrated 36% of BHRs with head sizes of 38-44 mm and inclination >55° had blood metal ions >7 µg/l. BHR 10-year survival for this at-risk group was 91% (95% confidence intervals 86.0%-95.0%) with 30 hips revised. If blood metal ions are used to screen hip resurfacing patients for adverse reactions to metal debris it is recommended those with small femoral head sizes (38-44 mm) and high acetabular inclinations (>55°) are targeted. These findings require validation in other cohorts as they may not be applicable to all hip resurfacing devices given the differences in radial clearance, coverage arc, and metallurgy.

Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture.

PubMed

Hébert-Losier, Kim; Schelin, Lina; Tengman, Eva; Strong, Andrew; Häger, Charlotte K

2018-03-01

Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop-jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts. Subjects with unilateral ACL ruptures treated more than two decades ago (17-28years) conservatively with physiotherapy (ACL PT , n=26) or in combination with reconstructive surgery (ACL R , n=28) and healthy-knee controls (n=25) performed 40-cm drop-jumps. Three-dimensional knee, hip, and trunk kinematics were analyzed during Rebound, Flight, and Landing phases. Curves were time-normalized and compared between groups (injured and non-injured legs of ACL PT and ACL R vs. non-dominant and dominant legs of controls) and within groups (between legs) using functional analysis of variance methods. Compared to controls, ACL groups exhibited less knee and hip flexion on both legs during Rebound and greater knee external rotation on their injured leg at the start of Rebound and Landing. ACL R also showed less trunk flexion during Rebound. Between-leg differences were observed in ACL R only, with the injured leg more internally rotated at the hip. Overall, kinematic curves were similar between ACL R and ACL PT . However, compared to controls, deviations spanned a greater proportion of the drop-jump movement at the hip in ACL R and at the knee in ACL PT . Trunk and bilateral leg kinematics during double-leg drop-jumps are still compromised long after ACL-rupture care, independent of treatment. Curve analyses indicate the presence of distinct compensatory mechanisms in ACL PT and ACL R compared to controls. Copyright © 2018 Elsevier B.V. All rights reserved.

Association Between Genetic Polymorphisms and Pain Sensitivity in Patients with Hip Osteoarthritis.

PubMed

Olesen, Anne E; Nielsen, Lecia M; Feddersen, Søren; Erlenwein, Joachim; Petzke, Frank; Przemeck, Michael; Christrup, Lona L; Drewes, Asbjørn M

2018-06-01

Factors such as age, gender, and genetic polymorphisms may explain individual differences in pain phenotype. Genetic associations with pain sensitivity have previously been investigated in osteoarthritis patients, with a focus on the P2X7, TRPV1, and TACR1 genes. However, other genes may play a role as well. Osteoarthritis is a common joint disease, and many patients suffering from this disease are thought to have increased sensitivity to noxious stimuli resulting from sensitization in the nociceptive system. The aim of this study was to investigate if genetic variants of mu, kappa, and delta opioid receptor genes (OPRM1, OPRK1, and OPRD1) and the catechol-O-methyltransferase gene (COMT) influenced the pain phenotype in patients with osteoarthritis. The frequencies of 17 polymorphisms were examined. Pain sensitivity was assessed preoperatively by (1) hip rotation, (2) contact heat stimulation, (3) conditioned pain modulation effect, and (4) pressure stimulation at the tibia in both the affected and the unaffected leg. Ninety-two patients (mean age 66 years) with unilateral hip osteoarthritis were included in the study. Carriage of the OPRM1 rs589046T allele was found to be associated with increased pain ratings during hip rotation (P = 0.04) and increased conditioned pain modulation (P = 0.049). Carriage of the OPRD1 rs2234918C allele was found to be associated with an increased pain detection threshold to contact heat stimulation (P = 0.001). No other associations were found (all P > 0.05). Results from the present study suggest that, in patients with hip osteoarthritis, genetic variants in OPRM1 and OPRD1 may contribute to the pain phenotype. © 2017 World Institute of Pain.

Two biomechanical strategies for locomotor adaptation to split-belt treadmill walking in subjects with and without transtibial amputation.

PubMed

Selgrade, Brian P; Toney, Megan E; Chang, Young-Hui

2017-02-28

Locomotor adaptation is commonly studied using split-belt treadmill walking, in which each foot is placed on a belt moving at a different speed. As subjects adapt to split-belt walking, they reduce metabolic power, but the biomechanical mechanism behind this improved efficiency is unknown. Analyzing mechanical work performed by the legs and joints during split-belt adaptation could reveal this mechanism. Because ankle work in the step-to-step transition is more efficient than hip work, we hypothesized that control subjects would reduce hip work on the fast belt and increase ankle work during the step-to-step transition as they adapted. We further hypothesized that subjects with unilateral, trans-tibial amputation would instead increase propulsive work from their intact leg on the slow belt. Control subjects reduced hip work and shifted more ankle work to the step-to-step transition, supporting our hypothesis. Contrary to our second hypothesis, intact leg work, ankle work and hip work in amputees were unchanged during adaptation. Furthermore, all subjects increased collisional energy loss on the fast belt, but did not increase propulsive work. This was possible because subjects moved further backward during fast leg single support in late adaptation than in early adaptation, compensating by reducing backward movement in slow leg single support. In summary, subjects used two strategies to improve mechanical efficiency in split-belt walking adaptation: a CoM displacement strategy that allows for less forward propulsion on the fast belt; and, an ankle timing strategy that allows efficient ankle work in the step-to-step transition to increase while reducing inefficient hip work. Copyright © 2017 Elsevier Ltd. All rights reserved.

Lateral hip pain: findings from magnetic resonance imaging and clinical examination.

PubMed

Woodley, Stephanie J; Nicholson, Helen D; Livingstone, Vicki; Doyle, Terence C; Meikle, Grant R; Macintosh, Janet E; Mercer, Susan R

2008-06-01

Prospective cross-sectional study. To examine the radiological and physical therapy diagnoses of lateral hip pain (LHP), and determine the validity of selected clinical variables for predicting gluteal tendon pathology. LHP is frequently encountered by clinicians. Further investigation is required to establish the specific pathologies implicated in the cause of LHP, and which clinical tests are useful in the assessment of this problem. Forty patients with unilateral LHP underwent a physical therapy examination followed by magnetic resonance imaging (MRI) studies. Three radiologists analyzed the images of both hips for signs of pathology. Interobserver reliability of the image analyses, the agreement between the physical therapy and radiological diagnoses, and the validity of the clinical tests were examined. Gluteus medius tendon pathology, bursitis, osteoarthritis and gluteal muscle atrophy (predominantly affecting gluteus minimus) were all implicated in the imaging report of LHP. While prevalent in symptomatic hips, abnormalities were also identified in asymptomatic hips, particularly relating to the diagnosis of bursitis. The strength of agreement between radiologists was variable and little agreement existed between the physical therapy and radiological diagnoses of pathology. Nine of the 26 clinical variables examined in relation to gluteal tendon pathology had likelihood ratios above 2.0 or below 0.5, but the associated 95% confidence intervals were large. The diagnosis of LHP is challenging and our results highlight some problems associated with the use of MRI as a diagnostic reference standard. This factor, together with the imprecise point estimates of the likelihood ratios, means that no firm conclusions can be made regarding the diagnostic utility of the clinical tests used in the assessment of gluteal tendon pathology.

The reliability of a maximal isometric hip strength and simultaneous surface EMG screening protocol in elite, junior rugby league athletes.

PubMed

Charlton, Paula C; Mentiplay, Benjamin F; Grimaldi, Alison; Pua, Yong-Hao; Clark, Ross A

2017-02-01

Firstly to describe the reliability of assessing maximal isometric strength of the hip abductor and adductor musculature using a hand held dynamometry (HHD) protocol with simultaneous wireless surface electromyographic (sEMG) evaluation of the gluteus medius (GM) and adductor longus (AL). Secondly, to describe the correlation between isometric strength recorded with the HHD protocol and a laboratory standard isokinetic device. Reliability and correlational study. A sample of 24 elite, male, junior, rugby league athletes, age 16-20 years participated in repeated HHD and isometric Kin-Com (KC) strength testing with simultaneous sEMG assessment, on average (range) 6 (5-7) days apart by a single assessor. Strength tests included; unilateral hip abduction (ABD) and adduction (ADD) and bilateral ADD assessed with squeeze (SQ) tests in 0 and 45° of hip flexion. HHD demonstrated good to excellent inter-session reliability for all outcome measures (ICC (2,1) =0.76-0.91) and good to excellent association with the laboratory reference KC (ICC (2,1) =0.80-0.88). Whilst intra-session, inter-trial reliability of EMG activation and co-activation outcome measures ranged from moderate to excellent (ICC (2,1) =0.70-0.94), inter-session reliability was poor (all ICC (2,1) <0.50). Isometric strength testing of the hip ABD and ADD musculature using HHD may be measured reliably in elite, junior rugby league athletes. Due to the poor inter-session reliability of sEMG measures, it is not recommended for athlete screening purposes if using the techniques implemented in this study. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report

PubMed Central

2011-01-01

ABSTRACT Purpose: The purpose of this case study is to describe the management of a female patient with chronic left low back pain and sacroiliac joint pain (LBP/SIJP) using unique unilateral exercises developed by the Postural Restoration Institute (PRI) to address pelvic asymmetry and left hip capsule restriction, which is consistent with a Right Handed and Left Anterior Interior Chain pattern of postural asymmetry. Client Description: The client was 65-year-old woman with a 10-month history of constant left LBP/SIJP and leg pain. Intervention: The patient was seen six times to correct pelvic position/posture and left hip posterior capsule restriction via (1) muscle activation (left hamstrings, adductor magnus, and anterior gluteus medius) and (2) left hip adduction to lengthen the left posterior capsule/ischiofemoral ligament. Stabilization exercises included bilateral hamstrings, gluteus maximus, adductors, and abdominals to maintain pelvic position/posture. Measures and Outcome: Left Ober's test (initially positive) was negative at discharge. Pain as measured on the Numeric Pain Rating Scale (initially 1/10 at best and 8/10 at worst) was 0/10–0/10 at discharge. Oswestry Disability Index score (initially 20%) was 0% at discharge. The patient no longer had numbness in her left leg, and sexual intercourse had become pain free. Implications: Interventions to restore and maintain the optimal position of pelvis and hip (femoral head in the acetabulum) may be beneficial for treating patients with chronic LBP/SIJP. The patient's pain was eliminated 13 days after she first performed three exercises to reposition the pelvis and restore left posterior hip capsule extensibility and internal rotation. PMID:22379254

Relationship between Physical Impairments and Movement Patterns During Gait in Patients With End-stage Hip Osteoarthritis

PubMed Central

Zeni, Joseph; Pozzi, Federico; Abujaber, Sumayah; Miller, Laura

2014-01-01

Patients with hip osteoarthritis demonstrate limited range of motion, muscle weakness and altered biomechanics; however, few studies have evaluated the relationships between physical impairments and movement asymmetries. The purpose of this study was to identify the physical impairments related to movement abnormalities in patients awaiting total hip arthroplasty. We hypothesized that muscle weakness and pain would be related to greater movement asymmetries. Fifty-six subjects who were awaiting total hip arthroplasty were enrolled. Pain was assessed using a 0 to 10 scale, range of motion was assessed with the Harris Hip Score and isometric hip abductor strength was tested using a hand-held dynamometer. Trunk, pelvis and hip angles and moments in the frontal and sagittal planes were measured during walking using three dimensional motion analysis. During gait, subjects had 3.49 degrees less peak hip flexion and 8.82 degrees less extension angles (p<0.001) and had 0.03 Nm/k*m less hip abduction moment on the affected side (p=0.043). Weaker hip muscles were related to greater pelvis (r=−0.291) and trunk (r=−0.332) rotations in the frontal plane. These findings suggest that hip weakness drives abnormal movement patterns at the pelvis and trunk in patients with hip osteoarthritis to a greater degree than hip pain. PMID:25492583

Hip and knee replacement in osteogenesis imperfecta.

PubMed

Papagelopoulos, P J; Morrey, B F

1993-04-01

Five total hip and three total knee arthroplasties were performed, from 1969 to 1990, in six patients who had osteogenesis imperfecta. The patients who had a hip arthroplasty were followed for a mean of seven years, and those who had a knee arthroplasty, for a mean of ten years. Postoperatively, all had relief of pain and were able to walk; one patient used a walker and two used a cane. The only postoperative complication was an intrapelvic protrusion of the acetabular component six years after a bipolar hip replacement.

Lower Lean Mass Measured by Dual-Energy X-ray Absorptiometry (DXA) is Not Associated with Increased Risk of Hip Fracture in Women: The Framingham Osteoporosis Study.

PubMed

McLean, Robert R; Kiel, Douglas P; Berry, Sarah D; Broe, Kerry E; Zhang, Xiaochun; Cupples, L Adrienne; Hannan, Marian T

2018-01-05

Although muscle mass influences strength in older adults, it is unclear whether low lean mass measured by dual-energy X-ray absorptiometry (DXA) is an independent risk factor for hip fracture. Our objective was to determine the association between DXA lean mass and incident hip fracture risk among 1978 women aged 50 years and older participating in the Framingham Study Original and Offspring cohorts. Leg and total body lean mass (kg) were assessed from whole-body DXA scans collected in 1992-2001. Hip fracture follow-up extended from DXA assessment to the occurrence of fracture, death, drop-out, or end of follow-up in 2007. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) estimating the relative risk of hip fracture associated with a 1-kg increase in baseline lean mass. Mean age was 66 years (range 50-93). Over a median of 8 years of follow-up, 99 hip fractures occurred. In models adjusted for age, height, study cohort, and percent total body fat, neither leg (HR 1.11; 95% CI 0.94, 1.31) nor total body (HR 1.06; 95% CI 0.99, 1.13) lean mass were associated with hip fracture. After further adjustment for femoral neck bone mineral density, leg lean mass results were similar (HR 1.10; 95% CI 0.93, 1.30). In contrast, 1 kg greater total body lean mass was associated with 9% higher hip fracture risk (HR 1.09; 95% CI 1.02, 1.18). Our findings suggest that in women, lower lean mass measured by DXA is not associated with increased risk of hip fracture.

The Bimetric cementless total hip replacement: 7-18 year follow-up assessing the influence of acetabular design on survivorship.

PubMed

Russell, R C; Ghassemi, A; Dorrell, J H; Powles, D P

2009-08-01

The purpose of this study was to evaluate the mid- to long-term survivorship of Bimetric cementless total hip replacement and assess how it is affected by the acetabular design. This was a retrospective analysis of 127 Bimetric cementless total hip replacements in 110 patients with a follow-up of 7-18 years. A single design stem and three different cementless metal-backed acetabular designs were used. Patients were assessed clinically using the Harris hip score and radiologically by independent review of current hip radiographs. There was only one case of aseptic loosening of the femoral stem. The earliest acetabular design showed a high failure rate whilst the latter two designs showed a 96% survivorship at a mean of 9.5 years. We conclude that a combination of the bimetric stem with either of the latter acetabular cup designs has a good mid- to long-term performance.

ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury.

PubMed

Markström, Jonas L; Tengman, Eva; Häger, Charlotte K

2018-02-01

Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACL R ), solely physiotherapy (ACL PT ), and controls (CTRL). Between-leg kinematic differences within groups were also investigated. Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACL R , 34 ACL PT ) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics. Significant group effects during both Take-off and Landing were found, with ACL PT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACL R and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACL R also presented different kinematics to ACL PT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL. Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury. Prospective cohort study, Level II.

The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

PubMed

Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

2018-02-21

In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize actual operating margins.

Asymmetry of the leg alignment affects trunk bending in the coronal plane after unilateral total knee arthroplasty.

PubMed

Harato, Kengo; Yoshida, Hiroki; Otani, Toshiro

2013-08-01

Unilateral total knee arthroplasty (TKA) would produce asymmetric changes of lower extremity in patients with bilateral varus deformity. Our purpose was to investigate whether asymmetry of the leg alignment would affect trunk bending in the coronal plane after unilateral TKA. Twenty patients (mean 76 years old) with bilateral end-stage knee osteoarthritis (OA) participated. Spine images during relaxed standing were obtained on pre- and postoperative day 21. As a result, the shoulder tilted more to the TKA side and the pelvis inclined more to the contralateral OA side. These results suggested that the trunk would bend away from the contralateral OA side after unilateral TKA in patients with bilateral end-stage knee OA and varus deformity. Asymmetry of the leg alignment led to asymmetric trunk bending. Copyright © 2013 Elsevier Inc. All rights reserved.

The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty.

PubMed

Restrepo, Camilo; Post, Zachary D; Kai, Brandon; Hozack, William J

2010-03-01

The ceramic-on-ceramic bearing for total hip arthroplasty has an extremely low wear rate and demonstrates minimal inflammatory response in comparison with other bearing choices. However, acoustic emissions such as squeaking and clicking are being reported as annoying complications related to its use. The cause or causes of this phenomenon have not been determined. The purpose of the present study was to evaluate the possibility that design aspects of the femoral component may be a contributing factor to the etiology of squeaking associated with the ceramic-on-ceramic bearing total hip arthroplasty. We retrospectively reviewed 266 consecutive patients (304 hips) who had undergone total hip arthroplasty with use of ceramic-on-ceramic bearings. The first 131 consecutive patients (152 hips) (Group 1) received a hydroxyapatite-coated stem composed of titanium-aluminum-vanadium alloy with a C-taper neck geometry and robust midsection with an anteroposterior diameter of 13 mm. The second 135 consecutive patients (152 hips) (Group 2) also received a hydroxyapatite-coated stem, but in that group the stem was composed of titanium-molybdenum-zirconium-iron alloy, with a V-40 neck geometry and a midsection with an anteroposterior thickness of only 10 mm. All 304 hips received the same cup, composed of titanium-aluminum-vanadium alloy. Demographic characteristics, such as age, sex, height, weight, and body mass index, were similar in both groups. Data regarding the presence of squeaking were obtained prospectively. Patients who were seen for clinical follow-up either expressed the squeaking phenomenon themselves or were asked about it by the physician. Patients who were not seen at a recent clinical follow-up visit were contacted by telephone and were asked specifically about squeaking that might be associated with the hip replacement. Only patients with confirmed squeaking noise were included in the present study. Postoperative radiographs, the Short Form-36 health survey, the Harris hip score, and office or telephone interviews of the patient were used to determine the overall outcome of the procedure. The prevalence of squeaking was seven times higher for patients who received the titanium-molybdenum-zirconium-iron-alloy stem (twenty-seven patients, twenty-eight hips [18.4%]) than in those who received the titanium-aluminum-vanadium-alloy stem (three patients, four hips [2.6%]); this difference was significant (p < 0.0001). Our study suggests that different stem alloys, stem geometries, or neck geometries can have an impact on the frequency of squeaking following a ceramic-on-ceramic total hip arthroplasty.

Prosthetic ankle push-off work reduces metabolic rate but not collision work in non-amputee walking.

PubMed

Caputo, Joshua M; Collins, Steven H

2014-12-03

Individuals with unilateral below-knee amputation expend more energy than non-amputees during walking and exhibit reduced push-off work and increased hip work in the affected limb. Simple dynamic models of walking suggest a possible solution, predicting that increasing prosthetic ankle push-off should decrease leading limb collision, thereby reducing overall energy requirements. We conducted a rigorous experimental test of this idea wherein ankle-foot prosthesis push-off work was incrementally varied in isolation from one-half to two-times normal levels while subjects with simulated amputation walked on a treadmill at 1.25 m · s(-1). Increased prosthesis push-off significantly reduced metabolic energy expenditure, with a 14% reduction at maximum prosthesis work. In contrast to model predictions, however, collision losses were unchanged, while hip work during swing initiation was decreased. This suggests that powered ankle push-off reduces walking effort primarily through other mechanisms, such as assisting leg swing, which would be better understood using more complete neuromuscular models.

Prosthetic ankle push-off work reduces metabolic rate but not collision work in non-amputee walking

NASA Astrophysics Data System (ADS)

Caputo, Joshua M.; Collins, Steven H.

2014-12-01

Individuals with unilateral below-knee amputation expend more energy than non-amputees during walking and exhibit reduced push-off work and increased hip work in the affected limb. Simple dynamic models of walking suggest a possible solution, predicting that increasing prosthetic ankle push-off should decrease leading limb collision, thereby reducing overall energy requirements. We conducted a rigorous experimental test of this idea wherein ankle-foot prosthesis push-off work was incrementally varied in isolation from one-half to two-times normal levels while subjects with simulated amputation walked on a treadmill at 1.25 m.s-1. Increased prosthesis push-off significantly reduced metabolic energy expenditure, with a 14% reduction at maximum prosthesis work. In contrast to model predictions, however, collision losses were unchanged, while hip work during swing initiation was decreased. This suggests that powered ankle push-off reduces walking effort primarily through other mechanisms, such as assisting leg swing, which would be better understood using more complete neuromuscular models.

Prosthetic ankle push-off work reduces metabolic rate but not collision work in non-amputee walking

PubMed Central

Caputo, Joshua M.; Collins, Steven H.

2014-01-01

Individuals with unilateral below-knee amputation expend more energy than non-amputees during walking and exhibit reduced push-off work and increased hip work in the affected limb. Simple dynamic models of walking suggest a possible solution, predicting that increasing prosthetic ankle push-off should decrease leading limb collision, thereby reducing overall energy requirements. We conducted a rigorous experimental test of this idea wherein ankle-foot prosthesis push-off work was incrementally varied in isolation from one-half to two-times normal levels while subjects with simulated amputation walked on a treadmill at 1.25 m·s−1. Increased prosthesis push-off significantly reduced metabolic energy expenditure, with a 14% reduction at maximum prosthesis work. In contrast to model predictions, however, collision losses were unchanged, while hip work during swing initiation was decreased. This suggests that powered ankle push-off reduces walking effort primarily through other mechanisms, such as assisting leg swing, which would be better understood using more complete neuromuscular models. PMID:25467389

Contemporary Strategies for Rapid Recovery Total Hip Arthroplasty.

PubMed

Stambough, Jeffrey B; Beaulé, Paul E; Nunley, Ryan M; Clohisy, John

2016-01-01

Over the past several years, rapid recovery protocols for total hip arthroplasty have evolved in parallel with advancements in pain management, regional anesthesia, focused rehabilitation, and the patient selection process. As fiscal pressures from payers of health care increase, surgical outcomes and complications are being scrutinized, which evokes a sense of urgency for arthroplasty surgeons as well as hospitals. The implementation of successful accelerated recovery pathways for total hip arthroplasty requires the coordinated efforts of surgeons, practice administrators, anesthesiologists, nurses, physical and occupational therapists, case managers, and postacute care providers. To optimize performance outcomes, it is important for surgeons to select patients who are eligible for rapid recovery. The fundamental tenets of multimodal pain control, regional anesthesia, prudent perioperative blood management, venous thromboembolic prophylaxis, and early ambulation and mobility should be collectively addressed for all patients who undergo primary total hip replacement.

Manual therapy intervention for a patient with a total hip arthroplasty revision.

PubMed

Howard, Paul D; Levitsky, Beth

2007-12-01

Case report. A 73-year-old active woman with a total hip arthroplasty, who later had revision surgery, developed left hip and buttock pain 2 years after the revision surgery, subsequent to lifting her foot while seated. This movement was performed so that her spouse could assist her in putting on her sock and shoe. During the first physical therapy session, the patient exhibited a forward-flexed trunk posture and difficulty weight bearing on the involved lower limb. The patient was successfully treated with manual therapy techniques and a home exercise program. The manual therapy techniques included long-axis hip distraction, lateral hip distraction, posterior-to-anterior hip joint mobilization, and a contract-relax proprioceptive neuromuscular facilitation technique. The patient's home program consisted of long-axis hip distraction, performed by her spouse, and standing lower limb pendular movements into flexion and extension. Pain scale ratings, posture and gait observations, strength, range of motion, and return to functional activities served as outcome measures. After 1 physical therapy visit, in which manual therapy techniques were utilized, the patient had a significant decrease in hip symptoms. The patient and spouse were compliant with the home exercise program and continued with physical therapy for 3 more visits, and the patient ultimately became symptom free. The patient returned to all previous activities, including household chores, cooking, and a walking program. The patient was contacted at 6 months, 1 year, and 4 years, and reported no recurrences of hip or buttock symptoms. Manual therapy techniques and home exercises described in this case report were apparently effective in eliminating symptoms and returning this patient, who had total hip arthroplasty and revision surgery 2 years earlier, to all previous functional activities after a dressing incident produced hip and buttock symptoms.

Calcaneal stress fracture: an adverse event following total hip and total knee arthroplasty: a report of five cases.

PubMed

Miki, Takaaki; Miki, Takahito; Nishiyama, Akihiro

2014-01-15

Stress fractures have been reported to occur in the pubis, femoral neck, proximal part of the tibia, and fabella during the postoperative period following total knee or total hip arthroplasty. However, to our knowledge, calcaneal stress fractures after total hip or total knee arthroplasty have not been reported in the English-language literature. Most orthopaedic surgeons are not familiar with calcaneal stress fractures that may occur in elderly patients after a total knee or total hip arthroplasty. We retrospectively reviewed the clinical features, imaging findings, and bone mineral content of the proximal part of the femur and the distal end of the radius in five patients who had a calcaneal stress fracture after a total knee or total hip arthroplasty. All patients were women with a mean age of 76.8 years. All fractures occurred in the calcaneus on the same side as the arthroplasty. The fracture appeared at a mean of 10.2 weeks postoperatively. All patients reported heel pain on walking. Swelling and local heat were found in four and three patients, respectively. Pain was elicited by squeezing the calcaneus in all patients. Early radiographs had normal findings in two patients, and an irregular sclerotic line appeared later in the radiographs of all patients. All fractures were treated conservatively. Four fractures healed uneventfully, but one fracture displaced. All patients had osteoporosis. Calcaneal stress fractures during the postoperative period following total knee or total hip arthroplasty may not be as rare as previously thought. Because clinical symptoms of the fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis. Magnetic resonance imaging or repeated radiographs may be necessary to make the correct diagnosis when no abnormality is apparent on the initial radiograph.

Invariant hip moment pattern while walking with a robotic hip exoskeleton.

PubMed

Lewis, Cara L; Ferris, Daniel P

2011-03-15

Robotic lower limb exoskeletons hold significant potential for gait assistance and rehabilitation; however, we have a limited understanding of how people adapt to walking with robotic devices. The purpose of this study was to test the hypothesis that people reduce net muscle moments about their joints when robotic assistance is provided. This reduction in muscle moment results in a total joint moment (muscle plus exoskeleton) that is the same as the moment without the robotic assistance despite potential differences in joint angles. To test this hypothesis, eight healthy subjects trained with the robotic hip exoskeleton while walking on a force-measuring treadmill. The exoskeleton provided hip flexion assistance from approximately 33% to 53% of the gait cycle. We calculated the root mean squared difference (RMSD) between the average of data from the last 15 min of the powered condition and the unpowered condition. After completing three 30-min training sessions, the hip exoskeleton provided 27% of the total peak hip flexion moment during gait. Despite this substantial contribution from the exoskeleton, subjects walked with a total hip moment pattern (muscle plus exoskeleton) that was almost identical and more similar to the unpowered condition than the hip angle pattern (hip moment RMSD 0.027, angle RMSD 0.134, p<0.001). The angle and moment RMSD were not different for the knee and ankle joints. These findings support the concept that people adopt walking patterns with similar joint moment patterns despite differences in hip joint angles for a given walking speed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Minimally invasive hip arthroplasty: what role does patient preconditioning play?

PubMed

Pour, Aidin Eslam; Parvizi, Javad; Sharkey, Peter F; Hozack, William J; Rothman, Richard H

2007-09-01

The benefits of minimally invasive total hip arthroplasty continue to be debated. The objective of this study was to investigate the role of patient education, accelerated rehabilitation, and improved pain control on the outcome of total hip arthroplasty performed through a small incision. One hundred patients undergoing total hip arthroplasty at our institution were randomized into one of four groups on the basis of the size of the incision, preoperative counseling, the type of preoperative and postoperative rehabilitation, and the analgesia protocol. The operative parameters, complications, time to discharge to home, functional improvement, and patient satisfaction were assessed. The demographic distribution among the four groups was similar. The extent of functional improvement at the time of discharge to home, patient satisfaction, and walking ability at the time of discharge were better in patients who had received an accelerated preoperative and postoperative rehabilitation regimen regardless of the size of the incision. There was no difference in estimated blood loss, mean operative time, transfusion needs, or complications among the groups. This study highlights the importance of factors such as family education, patient preconditioning, preemptive analgesia, and accelerated preoperative and postoperative rehabilitation in influencing the outcome of total hip arthroplasty. The aforementioned factors, and not the surgical technique per se, may play a major role in imparting the better outcome after minimally invasive total hip arthroplasty that has been reported by various investigators.

[Progress assessment of rehabilitation in patients after hip replacement. Preliminary report].

PubMed

Labecka, Monika; Pingot, Mariusz; Pingot, Julia; Woldańiska-Okońska, Marta

2014-01-01

Coxarthrosis is one of the most common diseases of the motor system. We distinguish primary and secondary coxarthrosis. The premises for total hip replacement include pain, damage to the surface of the acetabulum and the head of the hip, relative shortening of the limb, gluteal, femur and crus muscle atrophy and gait dysfunctions. The aim of this paper is to present the influence of rehabilitation on the improvement of physical ability, especially in respect to quality of gait and antianalgesic efficacy of the physical therapy in patients after total hip replacement. The study was carried out in 37 patients aged 35-72 (mean of age--53.78 +/- 9.92). The group consisted'of 21 women and 16 men. After the total hip replacement, all the patients underwent physical therapy which involved application of laser radiation on the postoperative scar, whirpool and classic massage of the operated limb, exercises in non-weight bearing and weight-bearing exercises and gait reeducation. Modified Laitinen Pain Indicator Questionnaire, Visual Analogue Scale-VAS and the standardized mobility test--Timed-Up-And-Go test were used in the study. The statistical analysis was carried out with the use of the STATYSTIKA 5 PL computer program. The results reached point to the analgesic efficacy of the physical therapy and a better gait quality. Multifactor physical therapy after total hip replacement shows analgesic action. Appropriate selection of exercises and physical treatment have positive influence on gait reeducation in patients after total hip replacement. The Timed Up and Go test may be used in functional assessment of gait in patients with musculoskeletal disorders.

A new system of computer-assisted navigation leading to reduction in operating time in uncemented total hip replacement in a matched population.

PubMed

Chaudhry, Fouad A; Ismail, Sanaa Z; Davis, Edward T

2018-05-01

Computer-assisted navigation techniques are used to optimise component placement and alignment in total hip replacement. It has developed in the last 10 years but despite its advantages only 0.3% of all total hip replacements in England and Wales are done using computer navigation. One of the reasons for this is that computer-assisted technology increases operative time. A new method of pelvic registration has been developed without the need to register the anterior pelvic plane (BrainLab hip 6.0) which has shown to improve the accuracy of THR. The purpose of this study was to find out if the new method reduces the operating time. This was a retrospective analysis of comparing operating time in computer navigated primary uncemented total hip replacement using two methods of registration. Group 1 included 128 cases that were performed using BrainLab versions 2.1-5.1. This version relied on the acquisition of the anterior pelvic plane for registration. Group 2 included 128 cases that were performed using the newest navigation software, BrainLab hip 6.0 (registration possible with the patient in the lateral decubitus position). The operating time was 65.79 (40-98) minutes using the old method of registration and was 50.87 (33-74) minutes using the new method of registration. This difference was statistically significant. The body mass index (BMI) was comparable in both groups. The study supports the use of new method of registration in improving the operating time in computer navigated primary uncemented total hip replacements.

Primary cementless total hip arthroplasty with second-generation metal-on-metal bearings: a concise follow-up, at a minimum of seventeen years, of a previous report.

PubMed

Lass, R; Grübl, A; Kolb, A; Domayer, S; Csuk, C; Kubista, B; Giurea, A; Windhager, R

2014-03-05

Second-generation, metal-on-metal bearings were introduced in 1988, to reduce wear and avoid polyethylene particle-induced osteolysis from total hip arthroplasty. In 2007, we reported the long-term results of ninety-eight patients (105 hips) who underwent primary cementless total hip arthroplasty involving the use of a prosthesis with a high-carbide-concentration, metal-on-metal articulating surface between November 1992 and May 1994. The present study gives an update on this patient cohort. At a minimum of seventeen years postoperatively, forty-nine patients (fifty-two hips) were available for follow-up examination. We retrospectively evaluated clinical and radiographic results as well as serum metal concentration. The mean patient age at the time of the index arthroplasty was fifty-six years. Three cups (6% of the hips) and one stem (2% of the hips) were revised because of aseptic loosening of the implants combined with focal osteolysis. At the time of the latest follow-up evaluation, the mean Harris hip score was 88.8 points, and the mean University of California Los Angeles (UCLA) activity score was 6.7 points. The cumulative rate of implant survival, with aseptic failure as the end point, was 93.0% at 18.8 years. The median serum cobalt concentration in patients whose hip implant was the only source of cobalt was 0.70 μg/L (range, 0.4 to 5.1 μg/L), showing no increase in the value as noted at a minimum of ten years of follow-up. The clinical and radiographic results of our study, which, to our knowledge, represent the longest duration of follow-up for a series of cementless total hip arthroplasties with use of a 28-mm metal-on-metal bearing, continue to be comparable with the results observed for other hard-on-hard bearings.

Non-sedentary Lifestyle Can Reduce Hip Fracture Risk among Older Caucasians Adults: The Adventist Health Study-2.

PubMed

Lousuebsakul-Matthews, Vichuda; Thorpe, Donna; Knutsen, Raymond; Beeson, W Larry; Fraser, Gary E; Knutsen, Synnove F

2015-01-01

The beneficial effect of physical activity on reducing hip fracture risk has been supported in many previous studies. The present cohort study explores the relationship between total daily physical activity expressed as MET-hour/day and hip fracture risk among men over 50 years of age and postmenopausal women (n=22,836). Associations between self-reported hip fracture incidence and total daily physical activity and selected lifestyle factors were assessed using Cox proportional hazard regression. In gender-specific multivariable models, total activity above average (≥ 51 MET-hours per day for men, ≥ 48 MET-hours per day for women) compared to those with sedentary lifestyle (< 40 MET-hours per day) reduced the risk of hip fracture by 60% among men (HR=0.40, 95%CI: 0.23-0.70) (Ptrend=0.002) and 48% among women (HR=0.52, 95%CI: 0.32-0.84) (Ptrend=0.01). Our findings suggest that a moderate level of physical activity and avoiding a sedentary lifestyle can reduce the risk of hip fracture among the elderly.

The effectiveness of inpatient physical therapy compared to outpatient physical therapy in older adults after total hip replacement in the post-discharge period: a systematic review.

PubMed

Klugarova, Jitka; Klugar, Miloslav; Mareckova, Jana; Gallo, Jiri; Kelnarova, Zuzana

2016-01-01

Total hip replacement is the most effective and safest method for treating severe degenerative, traumatic and other diseases of the hip joint. Total hip replacement can reliably relieve pain and improve function in the majority of patients for a period of 15 to 20 years or more postoperatively. Physical therapy follows each total hip replacement surgery. Physical therapy protocols after total hip replacement in the post-discharge period vary widely in terms of setting (inpatient, outpatient), content (the particular set of exercises used), and frequency (e.g. daily versus twice a week). In current literature, there is no systematic review which has compared the effectiveness of inpatient and outpatient physical therapy in patients after total hip replacement in the post-discharge period. The objective of this systematic review was to compare the effectiveness of inpatient physical therapy with outpatient physical therapy on the quality of life and gait measures in older adults after total hip replacement in the post-discharge period. This review considered studies that include older adults (over 65 years) who have had total hip replacement and are in the post-discharge period. Adults with bilateral or multiple simultaneous surgeries and also patients who have had hemiarthroplasty of the hip joint were excluded.This review considered studies that included any type of physical therapy delivered in inpatient settings provided by professionals with education in physical therapy. Inpatient physical therapy delivered at any frequency and over any duration was included.This review considered studies that included as a comparator any type of physical therapy delivered in outpatient settings provided by professionals with education in physical therapy or no physical therapy.This review considered studies that included the following primary and secondary outcomes. The primary outcome was quality of life, assessed by any validated assessment tool. The secondary outcome was measures of gait assessed by any valid methods.This review considered both experimental and observational study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies for inclusion. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 12 databases. Studies published in all languages and any date were considered for inclusion in this review. Assessment of methodological quality was not conducted as no studies were identified that met the inclusion criteria. Data extraction and synthesis was not performed because no studies were included in this systematic review. During to the three-step search strategy 4330 papers were identified. The primary and secondary reviewer independently retrieved 42 potentially relevant papers according to the inclusion criteria by title and abstract screening. Following assessment of full text all of the retrieved papers were excluded based on the inclusion criteria. There is no scientific evidence comparing the effectiveness of inpatient physical therapy with outpatient physical therapy in older patients after total hip replacement in the post-discharge period. This systematic review has identified gaps in the literature for comparing the effectiveness of inpatient physical therapy with and outpatient physical therapy on the quality of life and gait measures in older adults after total hip replacement in the post-discharge period. Prospective randomized double blind multicenter controlled trials are needed to answer this important clinical question.

Effects of thromboprophylactic doses of apixaban and rivaroxaban on coagulation and thrombin generation in association with total hip replacement.

PubMed

Helin, Tuukka A; Virtanen, Lauri; Manninen, Mikko; Leskinen, Jarkko; Leppilahti, Juhana; Joutsi-Korhonen, Lotta; Lassila, Riitta

2017-05-01

Factor Xa inhibitors (FXaI) apixaban and rivaroxaban are used for thromboprophylaxis after major elective orthopaedic surgery. Because few patient sample studies exist, we postoperatively assessed patients undergoing unilateral total hip arthroplasty, including 22 treated with apixaban (2.5 mg BID) and 20 treated with rivaroxaban (10 mg OD). We collected blood samples before and 3 h after drug intake at 4 time points, preoperatively, as well as on day 1, week 1 (day 2-8) and day 28 post-operation. APTT and PT were immediately analysed. Calibrated anti-FXa activity, Russel's Viper Venom Time (RVVT) and thrombin generation (TG; Calibrated Automated Thrombogram ® ) captured the effects of FXaI on coagulation and TG. APTT and PT remained within the reference interval throughout, and did not correlate with FXaI levels (PT R 2  = 0.44, APTT R 2  = 0.07). Mean apixaban concentration at the peak varied by eightfold (19-153 ng/mL), but rivaroxaban only by 1.5-fold (111-183 ng/mL). Rivaroxaban, but not apixaban prolonged RVVT at peak levels. Both FXaIs had a prolonged lag time of TG (p < 0.001). Rivaroxaban decreased ETP peak at all time points and reached a minimum at day 28 (540 nM/min at rivaroxaban 184 ng/mL, p < 0.001), while rivaroxaban trough levels were low and ETP values normal. However, with apixaban, after an initial decrease, ETP did not differ between peak and trough levels until decreasing on day 28 at peak (990 nM/min at apixaban 112 ng/mL, p = 0.005). In conclusion, due to different dosing and pharmacology rivaroxaban and apixaban distinctly inhibited TG under postoperative conditions.

Comparison of gait after Syme and transtibial amputation in children: factors that may play a role in function.

PubMed

Jeans, Kelly A; Karol, Lori A; Cummings, Donald; Singhal, Kunal

2014-10-01

Preservation of maximal limb length during amputation is often recommended to maximize the efficiency and symmetry of gait. The goals of this study were to determine (1) whether there are gait differences between children with a Syme (or Boyd) amputation and those with a transtibial-level amputation, and (2) whether the type of prosthetic foot affects gait and PODCI (Pediatric Outcomes Data Collection Instrument) outcomes. Sixty-four patients (age range, 4.7 to 19.2 years) with unilateral below-the-knee prosthesis use (forty-one in the Syme group and twenty-three in the transtibial group) underwent gait analysis and review of data for the involved limb. The twelve prosthetic foot types were categorized as designed for a high, medium, or low activity level (e.g., Flex foot, dynamic response foot, or SACH). Statistical analyses were conducted. Kinematic differences of <4° in total prosthetic ankle motion and 8° in external hip rotation were seen between the Syme and transtibial groups. Ankle power was greater in the transtibial group, whereas the Syme group had greater coronal-plane hip power (p < 0.05). Prosthetic ankle motion was significantly greater in the high compared with the medium and low-performance feet. However, the PODCI happiness score was higher in patients with low compared with medium-performance feet (p < 0.05). Small differences in prosthetic ankle motion and power were found between children with Syme and transtibial amputations. Ankle motion was greater in patients using high-performance feet (9% of the total cohort) compared with medium-performance (59%) and low-performance (31%) feet. Despite the increased ankle motion achieved with high-performance dynamic feet, this advantage was not reflected in peak power of the prosthetic ankle or the PODCI sports/physical functioning subscale. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial.

PubMed

Calatayud, Joaquin; Casaña, Jose; Ezzatvar, Yasmin; Jakobsen, Markus D; Sundstrup, Emil; Andersen, Lars L

2017-09-01

The benefits of preoperative training programmes compared with alternative treatment are unclear. The purpose of this study was to evaluate the effectiveness of a high-intensity preoperative resistance training programme in patients waiting for total knee arthroplasty (TKA). Forty-four subjects (7 men, 37 women) scheduled for unilateral TKA for osteoarthritis (OA) during 2014 participated in this randomized controlled trial. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), a 10-cm visual analogue scale (VAS), isometric knee flexion, isometric knee extension, isometric hip abduction, active knee range of motion and functional tasks (Timed Up and Go test and Stair ascent-descent test) were assessed at 8 weeks before surgery (T1), after 8 weeks of training (T2), 1 month after TKA (T3) and finally 3 months after TKA (T4). The intervention group completed an 8-week training programme 3 days per week prior to surgery. Isometric knee flexion, isometric hip abduction, VAS, WOMAC, ROM extension and flexion and all the functional assessments were greater for the intervention group at T2, T3 and T4, whereas isometric knee extension was greater for this group at T2 and T4 compared with control. The present study supports the use of preoperative training in end-stage OA patients to improve early postoperative outcomes. High-intensity strength training during the preoperative period reduces pain and improves lower limb muscle strength, ROM and functional task performance before surgery, resulting in a reduced length of stay at the hospital and a faster physical and functional recovery after TKA. The present training programme can be used by specialists to speed up recovery after TKA. I.

Bilateral total hip arthroplasty in Morquio-Brailsford's syndrome: a report of two cases.

PubMed

Tassinari, Enrico; Boriani, Luca; Traina, Francesco; Dallari, Dante; Toni, Aldo; Giunti, Armando

2008-09-01

We report two cases of bilateral cementless total hip arthroplasty in two young women affected by Morquio-Brailsford syndrome. Morquio-Brailsford disease belongs to the mucopolysaccharidoses; it shows growth retardation with disproportional dwarfism. Usually patients are affected by a severe joint degeneration from their 2nd or 3rd decade. Young age, severe dysplasia, and joint size are the main technical problems for a total hip replacement. Accurate radiographic and CT planning allows the use of standard prostheses instead of custom-made ones.

A Multi-centre Study to Assess the Long-term Performance of the Summit™ Hip in Primary Total Hip Replacement

ClinicalTrials.gov

2016-08-03

Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

Are the anatomy textbooks wrong? A clinical patho-anatomic study of foveal vessels in the round ligament of the hip.

PubMed

Barrington, John W; Sodhi, Nipun; Ali, Muzaffar; Khlopas, Anton; Sultan, Assem A; Kee, James R; Holmes, Kristopher A; Hariri, Omar; Newman, Jared M; Mont, Michael A

2017-12-01

The foveal vessels of the ligamentum teres are an anterior branch of the posterior division of the obturator artery, providing blood to the capitis of the femoral head. However, the basic anatomic description of foveal vasculature in the ligamentum teres of the hip is widely variable, with some studies reporting that the vessels are not patent in roughly one third of all adults. Therefore, the purpose of this study was to evaluate the status of foveal vessels in primary total hip arthroplasty (THA) patients. Specifically, we evaluated: (I) if the foveal vessels were intact; and we (II) correlated foveal vessel status with (i) patient demographics, including gender and age; as well as (ii) perioperative data, such as operative time and blood loss. The macroscopic status of the foveal vessels in the ligamentum teres femoris was documented in 266 patients at the time of primary unilateral THA performed between August 2015 and April 2017. The vessels were considered to be intact if active bleeding was directly visible from the acetabular stump of the severed ligamentum teres femoris. Demographics including age, gender, and preoperative diagnosis were collected. The perioperative outcome variables included estimated blood loss (EBL) and operative time. Foveal vessel status defined as intact or not intact, was also correlated with patient demographics and perioperative data. A student's t -test was used to compare the continuous variables and a chi square test was used for categorical variables. The foveal vessels were intact in 161 patients (61%) and not intact in 105 patients (39%). The mean age for patients with intact foveal vessels was found to be 64 years (range, 18 to 94 years) vs. 65 years (range, 29 to 94 years) (P>0.05) for not intact. No correlation was found between preoperative diagnosis, gender, operative time, and EBL and foveal vessel status. The results of this clinical patho-anatomic study of the foveal vessels in the ligamentum teres femoris of the hip refutes the polarized claims of prior anatomy texts that document the vessels as either "absent in adults" or "always intact." Rather, the results of this study reveal an alternate option: that foveal vessels can be present and either be intact (61%) or not intact (39%). No correlation was found between age, gender, operative time, and EBL and foveal vessel status.

The History of Biomechanics in Total Hip Arthroplasty.

PubMed

Houcke, Jan Van; Khanduja, Vikas; Pattyn, Christophe; Audenaert, Emmanuel

2017-01-01

Biomechanics of the hip joint describes how the complex combination of osseous, ligamentous, and muscular structures transfers the weight of the body from the axial skeleton into the appendicular skeleton of the lower limbs. Throughout history, several biomechanical studies based on theoretical mathematics, in vitro , in vivo as well as in silico models have been successfully performed. The insights gained from these studies have improved our understanding of the development of mechanical hip pathologies such as osteoarthritis, hip fractures, and developmental dysplasia of the hip. The main treatment of end-stage degeneration of the hip is total hip arthroplasty (THA). The increasing number of patients undergoing this surgical procedure, as well as their demand for more than just pain relief and leading an active lifestyle, has challenged surgeons and implant manufacturers to deliver higher function as well as longevity with the prosthesis. The science of biomechanics has played and will continue to play a crucial and integral role in achieving these goals. The aim of this article, therefore, is to present to the readers the key concepts in biomechanics of the hip and their application to THA.

Total hip arthroplasty in dwarfism. A case report.

PubMed

De Fine, Marcello; Traina, Francesco; Palmonari, Massimo; Tassinari, Enrico; Toni, Aldo

2008-05-01

In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early age. In these patients a joint replacement is a demanding procedure due to the peculiar joint deformity and the small size of the bones. We present a case of a bilateral hip replacement in a dwarf patient. In order to reduce intraoperative complications and improve the joint kinematics a thorough preoperative planning was performed by a CT based computerised system. On the basis of the planning we chose a conical shaped stem that enable as to restore limb length and offset with a low risk of femoral fracture. In conclusion, we consider total hip replacement in dwarfism a safe and effective procedure if an accurate preoperative planning is performed.

The epidemiology of bearing surface usage in total hip arthroplasty in the United States.

PubMed

Bozic, Kevin J; Kurtz, Steven; Lau, Edmund; Ong, Kevin; Chiu, Vanessa; Vail, Thomas P; Rubash, Harry E; Berry, Daniel J

2009-07-01

Hard-on-hard bearings offer the potential to improve the survivorship of total hip arthroplasty implants. However, the specific indications for the use of these advanced technologies remain controversial. The purpose of this study was to characterize the epidemiology of bearing surface utilization in total hip arthroplasty in the United States with respect to patient, hospital, geographic, and payer characteristics. The Nationwide Inpatient Sample database was used to analyze bearing type and demographic characteristics associated with 112,095 primary total hip arthroplasties performed in the United States between October 1, 2005, and December 31, 2006. The prevalence of each type of total hip arthroplasty bearing was calculated for population subgroups as a function of age, sex, census region, payer class, and hospital type. The most commonly reported bearing was metal-on-polyethylene (51%) followed by metal-on-metal (35%) and ceramic-on-ceramic (14%). Metal-on-polyethylene bearings were most commonly reported in female Medicare patients who were sixty-five to seventy-four years old, while metal-on-metal and ceramic-on-ceramic bearings were most commonly reported in privately insured male patients who were less than sixty-five years old. Thirty-three percent of patients over sixty-five years old had a hard-on-hard bearing reported. There was substantial regional variation in bearing usage; the highest prevalence of metal-on-polyethylene bearings was reported in the Northeast and at nonteaching hospitals, and the highest prevalence of metal-on-metal bearings was reported in the South and at teaching hospitals. The usage of total hip arthroplasty bearings varies considerably by patient characteristics, hospital type, and geographic location throughout the United States. Despite uncertain advantages in older patients, hard-on-hard bearings are commonly used in patients over the age of sixty-five years. Further study is necessary to define the appropriate indications for these advanced technologies in total hip arthroplasty.

Cementless total hip arthroplasty for severely dislocated hips previously treated with Schanz osteotomy of the proximal femur.

PubMed

Akman, Yunus Emre; Yavuz, Umut; Çetinkaya, Engin; Gür, Volkan; Gül, Murat; Demir, Bilal

2018-03-01

We report the short-term outcomes of total hip arthroplasty(THA) in patients previously treated with Schanz osteotomy (SO). Eighteen patients [2 male, 16 female; mean age, 55.4 (range, 50-66) years] who had undergone THA after SO were retrospectively evaluated. Clinical evaluation was performed based on the Harris hip score. Radiological evaluation was performed using full-length radiographs of the lower extremities, pelvis, and hip. The mean follow-up period was 30.8 (range, 18-56) months. Mean femoral shortening was 3.7 (range, 2-5) cm. Perioperative complications occurred in 4 (22.2%) patients. Nonunion was not found at the osteotomy sites. No dislocation was observed. The Trendelenburg sign was positive for five (27.7%) patients, postoperatively. The mean Harris hip score improved from 42.7 to 78.7 (p < 0.05). THA for hips previously treated with SO is technically demanding. If careful preoperative planning is performed, successful treatment can be achieved.

Complication Rates for Hip Arthroscopy Are Underestimated: A Population-Based Study.

PubMed

Truntzer, Jeremy N; Hoppe, Daniel J; Shapiro, Lauren M; Abrams, Geoffrey D; Safran, Marc

2017-06-01

To identify major and minor complication rates associated with hip arthroscopy from a payer-based national database and compare with the rates reported in the existing literature. Patients who underwent hip arthroscopy between 2007 and 2014 were identified using PearlDiver, a publicly available database. Rates of major and minor complications, as well as conversion to total hip arthroscopy (THA), were determined by using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9), codes. Incidence rates of select major complications across the entire database were used as a comparison group. Statistical significance was set at P < .05. Of 18 million patients screened from 2007 to 2014, a total of 2,581 hip arthroscopies were identified. The rates of major and minor complications within a 1-year postoperative period were 1.74% and 4.22%, respectively. Complications included heterotopic ossification (2.85%), bursitis (1.23%), proximal femur fracture (1.08%), deep vein thrombosis (0.79%), and hip dislocation (0.58%). The rate of conversion to THA within 1 year was 2.85%. When compared to rates in the general population, the relative risks [RRs] of requiring a THA (age <50 years, RR = 57.66, P < .001; age >50 years, RR = 22.05, P < .001), sustaining a proximal femur fracture (age <50 years, RR = 18.02, P < .001; age >50 years, RR = 2.23, P < .001), or experiencing a hip dislocation (RR 19.60, P < .001) at 1 year after hip arthroscopy were significantly higher in all age groups. Higher major complication rates after hip arthroscopy were observed using a national payer-based database than previously reported in the literature, especially in regard to hip dislocations and proximal femur fractures. Rates of total hip arthroplasty were similar to prior studies, whereas the rates of revision hip arthroscopy were higher. Level IV, case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Treatment of primary hip osteoarthritis for the primary care physician and the indications for total hip arthroplasty.

PubMed

Levine, Mathew E; Nace, James; Kapadia, Bhaveen H; Issa, Kimona; Banerjee, Samik; Cherian, Jeffery J; Mont, Michael A

2013-01-01

Osteoarthritis is a degenerative condition that commonly affects knees and hips with an annual incidence of 88 in 100,000 people in the United States. The purpose of this study was to review the clinical presentation of osteoarthritis of the hip as well as the available management options. We reviewed the recent literature in regard to epidemiology, presentation, and treatment options available to patients. Nonoperative treatments include weight loss and low-impact, aerobic exercises. Along with weight loss and exercise, nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics, and intra-articular steroid injections have been used to improve patient's symptoms. Surgical intervention is a viable option; however, indications such as severe pain that is refractory to nonsurgical management, osteophytes, or joint space narrowing on radiographic films, or impairment of function should be present. The most common surgical option, total hip arthroplasty, has been shown to improve a patient's physical and psychological well-being. However, inherent risks are present with surgery and these should be addressed with the patient so a sound decision can be made. Osteoarthritis of the hip can be bothersome to patients, but physicians can begin management with lifestyle changes or pharmaceuticals. In the event nonoperative measures fail to markedly improve quality of life, total hip arthroplasty remains a viable option.

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.

PubMed

Anderson, David R; Dunbar, Michael; Murnaghan, John; Kahn, Susan R; Gross, Peter; Forsythe, Michael; Pelet, Stephane; Fisher, William; Belzile, Etienne; Dolan, Sean; Crowther, Mark; Bohm, Eric; MacDonald, Steven J; Gofton, Wade; Kim, Paul; Zukor, David; Pleasance, Susan; Andreou, Pantelis; Doucette, Steve; Theriault, Chris; Abianui, Abongnwen; Carrier, Marc; Kovacs, Michael J; Rodger, Marc A; Coyle, Doug; Wells, Philip S; Vendittoli, Pascal-Andre

2018-02-22

Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge. We performed a multicenter, double-blind, randomized, controlled trial involving patients who were undergoing total hip or knee arthroplasty. All the patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism (the primary effectiveness outcome) and bleeding complications, including major or clinically relevant nonmajor bleeding (the primary safety outcome). A total of 3424 patients (1804 undergoing total hip arthroplasty and 1620 undergoing total knee arthroplasty) were enrolled in the trial. Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban group (difference, 0.06 percentage points; 95% confidence interval [CI], -0.55 to 0.66; P<0.001 for noninferiority and P=0.84 for superiority). Major bleeding complications occurred in 8 patients (0.47%) in the aspirin group and in 5 (0.29%) in the rivaroxaban group (difference, 0.18 percentage points; 95% CI, -0.65 to 0.29; P=0.42). Clinically important bleeding occurred in 22 patients (1.29%) in the aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 0.30 percentage points; 95% CI, -1.07 to 0.47; P=0.43). Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).

Reliability and concurrent validity of the Dutch hip and knee replacement expectations surveys

PubMed Central

2010-01-01

Background Preoperative expectations of outcome of total hip and knee arthroplasty are important determinants of patients' satisfaction and functional outcome. Aims of the study were (1) to translate the Hospital for Special Surgery Hip Replacement Expectations Survey and Knee Replacement Expectations Survey into Dutch and (2) to study test-retest reliability and concurrent validity. Methods Patients scheduled for total hip (N = 112) or knee replacement (N = 101) were sent the Dutch Expectations Surveys twice with a 2 week interval to determine test-retest reliability. To determine concurrent validity, the Expectation WOMAC was sent. Results The results for the Dutch Hip Replacement Expectations Survey revealed good test-retest reliability (ICC 0.87), no bias and good internal consistency (alpha 0.86) (N = 72). The correlation between the Hip Expectations Score and the Expectation WOMAC score was 0.59 (N = 86). The results for the Dutch Knee Replacement Expectations Survey revealed good test-retest reliability (ICC 0.79), no bias and good internal consistency (alpha 0.91) (N = 46). The correlation with the Expectation WOMAC score was 0.52 (N = 57). Conclusions Both Dutch Expectations Surveys are reliable instruments to determine patients' expectations before total hip or knee arthroplasty. As for concurrent validity, the correlation between both surveys and the Expectation WOMAC was moderate confirming that the same construct was determined. However, patients scored systematically lower on the Expectation WOMAC compared to the Dutch Expectation Surveys. Research on patients' expectations before total hip and knee replacement has only been performed in a limited amount of countries. With the Dutch Expectations Surveys it is now possible to determine patients' expectations in another culture and healthcare setting. PMID:20958990

Reliability and concurrent validity of the Dutch hip and knee replacement expectations surveys.

PubMed

van den Akker-Scheek, Inge; van Raay, Jos J A M; Reininga, Inge H F; Bulstra, Sjoerd K; Zijlstra, Wiebren; Stevens, Martin

2010-10-19

Preoperative expectations of outcome of total hip and knee arthroplasty are important determinants of patients' satisfaction and functional outcome. Aims of the study were (1) to translate the Hospital for Special Surgery Hip Replacement Expectations Survey and Knee Replacement Expectations Survey into Dutch and (2) to study test-retest reliability and concurrent validity. Patients scheduled for total hip (N = 112) or knee replacement (N = 101) were sent the Dutch Expectations Surveys twice with a 2 week interval to determine test-retest reliability. To determine concurrent validity, the Expectation WOMAC was sent. The results for the Dutch Hip Replacement Expectations Survey revealed good test-retest reliability (ICC 0.87), no bias and good internal consistency (alpha 0.86) (N = 72). The correlation between the Hip Expectations Score and the Expectation WOMAC score was 0.59 (N = 86). The results for the Dutch Knee Replacement Expectations Survey revealed good test-retest reliability (ICC 0.79), no bias and good internal consistency (alpha 0.91) (N = 46). The correlation with the Expectation WOMAC score was 0.52 (N = 57). Both Dutch Expectations Surveys are reliable instruments to determine patients' expectations before total hip or knee arthroplasty. As for concurrent validity, the correlation between both surveys and the Expectation WOMAC was moderate confirming that the same construct was determined. However, patients scored systematically lower on the Expectation WOMAC compared to the Dutch Expectation Surveys. Research on patients' expectations before total hip and knee replacement has only been performed in a limited amount of countries. With the Dutch Expectations Surveys it is now possible to determine patients' expectations in another culture and healthcare setting.

Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial.

PubMed

Harsten, Andreas; Hjartarson, Hjörtur; Toksvig-Larsen, Sören

2012-06-01

Perioperative oral carbohydrate intake is beneficial to general surgery patients. Total hip arthroplasty is a common surgical procedure, and even a moderate improvement in patient outcome could have a significant effect on the resources needed for these patients. However, few studies have focused on the effects of carbohydrate intake on orthopaedic patients. The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty. The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate. A randomised, double-blind, controlled trial. This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery. Sixty ASA physical status I-III patients scheduled for elective total hip arthroplasty were included. Exclusion criteria were obesity, diabetes, prior hip surgery to the same hip, ongoing infection, immunological deficiency or age less than 50 or more than 80 years. Patients were given 400 ml of either an oral 12.5% carbohydrate solution or a placebo beverage (flavoured water) 1.5 h before and 2 h after surgery. Visual analogue scales were used to score six discomfort parameters. Immediately prior to surgery, the carbohydrate-treated patients were less hungry (median score 9.5 vs. 22 mm) and experienced less nausea (0 vs. 1.5 mm) (P< 0.05). Postoperatively, patients in the carbohydrate group experienced less pain at 12, 16 and 20 h (median scores 20, 30 and 34 vs. 7, 5 and 0 mm; P<0.05). This study shows that there is limited benefit from administering oral carbohydrate prior to total hip arthroplasty.

Total Hip Arthroplasty in Haemophilic Patients with Modern Cementless Implants.

PubMed

Carulli, Christian; Felici, Irene; Martini, Caterina; Civinini, Roberto; Linari, Silvia; Castaman, Giancarlo; Innocenti, Massimo

2015-10-01

Hip arthropathy due to recurrent haemarthrosis in patients with haemophilia can be disabling. When severe degeneration occurs, total hip arthroplasty is indicated. Reported outcomes are variable and out of date. The aim of this study is to evaluate the survivorship of Total Hip Arthroplasty performed in a patient population with modern cementless implants. Twenty-three haemophilic patients were treated and followed by a multidisciplinary team dedicated to haemophilia. The mean age was 40.6 years. No failures or complications were recorded at a mean follow-up of 8.1 years (range: 3.1-13.7). A multidisciplinary team and the use of modern cementless implants may represent the keys to achieve good outcomes, fewer complications, and better survivorship in the approach to these difficult cases. Copyright © 2015 Elsevier Inc. All rights reserved.

Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report.

PubMed

Chun, Young Soo; Juh, Hyung Suk; Cho, Yoon Je; Rhyu, Kee Hyung

2015-09-01

Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.

Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report

PubMed Central

Chun, Young Soo; Juh, Hyung Suk; Cho, Yoon Je

2015-01-01

Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture. PMID:27536622

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.

PubMed

Bayliss, Lee E; Culliford, David; Monk, A Paul; Glyn-Jones, Sion; Prieto-Alhambra, Daniel; Judge, Andrew; Cooper, Cyrus; Carr, Andrew J; Arden, Nigel K; Beard, David J; Price, Andrew J

2017-04-08

Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery. We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery. We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3-95·9) and 20-year rate was 85·0% (83·2-86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8-96·4), and 20-year implant survival rate was 89·7% (87·5-91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9-39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years. Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process. Oxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

A Multicenter Approach Evaluating the Impact of Vitamin E-Blended Polyethylene in Cementless Total Hip Replacement

PubMed Central

Jäger, Marcus; van Wasen, Andrea; Warwas, Sebastian; Landgraeber, Stefan; Haversath, Marcel; Group, VITAS

2014-01-01

Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant material itself over a time period of 15 years. PMID:25002933

Use of a constrained tripolar acetabular liner to treat intraoperative instability and postoperative dislocation after total hip arthroplasty: a review of our experience.

PubMed

Callaghan, John J; O'Rourke, Michael R; Goetz, Devon D; Lewallen, David G; Johnston, Richard C; Capello, William N

2004-12-01

Constrained acetabular components have been used to treat certain cases of intraoperative instability and postoperative dislocation after total hip arthroplasty. We report our experience with a tripolar constrained component used in these situations since 1988. The outcomes of the cases where this component was used were analyzed for component failure, component loosening, and osteolysis. At average 10-year followup, for cases treated for intraoperative instability (2 cases) or postoperative dislocation (4 cases), the component failure rate was 6% (6 of 101 hips in 5 patients). For cases where the constrained liner was cemented into a fixed cementless acetabular shell, the failure rate was 7% (2 of 31 hips in 2 patients) at 3.9-year average followup. Use of a constrained liner was not associated with an increased osteolysis or aseptic loosening rate. This tripolar constrained acetabular liner provided total hip arthroplasty construct stability in most cases in which it was used for intraoperative instability or postoperative dislocation.

The Bimetric cementless total hip replacement: 7–18 year follow-up assessing the influence of acetabular design on survivorship

PubMed Central

Ghassemi, A.; Dorrell, J. H.; Powles, D. P.

2008-01-01

The purpose of this study was to evaluate the mid- to long-term survivorship of Bimetric cementless total hip replacement and assess how it is affected by the acetabular design. This was a retrospective analysis of 127 Bimetric cementless total hip replacements in 110 patients with a follow-up of 7–18 years. A single design stem and three different cementless metal-backed acetabular designs were used. Patients were assessed clinically using the Harris hip score and radiologically by independent review of current hip radiographs. There was only one case of aseptic loosening of the femoral stem. The earliest acetabular design showed a high failure rate whilst the latter two designs showed a 96% survivorship at a mean of 9.5 years. We conclude that a combination of the bimetric stem with either of the latter acetabular cup designs has a good mid- to long-term performance. PMID:18551293

Kinematic, muscular, and metabolic responses during exoskeletal-, elliptical-, or therapist-assisted stepping in people with incomplete spinal cord injury.

PubMed

Hornby, T George; Kinnaird, Catherine R; Holleran, Carey L; Rafferty, Miriam R; Rodriguez, Kelly S; Cain, Julie B

2012-10-01

Robotic-assisted locomotor training has demonstrated some efficacy in individuals with neurological injury and is slowly gaining clinical acceptance. Both exoskeletal devices, which control individual joint movements, and elliptical devices, which control endpoint trajectories, have been utilized with specific patient populations and are available commercially. No studies have directly compared training efficacy or patient performance during stepping between devices. The purpose of this study was to evaluate kinematic, electromyographic (EMG), and metabolic responses during elliptical- and exoskeletal-assisted stepping in individuals with incomplete spinal cord injury (SCI) compared with therapist-assisted stepping. Design A prospective, cross-sectional, repeated-measures design was used. Participants with incomplete SCI (n=11) performed 3 separate bouts of exoskeletal-, elliptical-, or therapist-assisted stepping. Unilateral hip and knee sagittal-plane kinematics, lower-limb EMG recordings, and oxygen consumption were compared across stepping conditions and with control participants (n=10) during treadmill stepping. Exoskeletal stepping kinematics closely approximated normal gait patterns, whereas significantly greater hip and knee flexion postures were observed during elliptical-assisted stepping. Measures of kinematic variability indicated consistent patterns in control participants and during exoskeletal-assisted stepping, whereas therapist- and elliptical-assisted stepping kinematics were more variable. Despite specific differences, EMG patterns generally were similar across stepping conditions in the participants with SCI. In contrast, oxygen consumption was consistently greater during therapist-assisted stepping. Limitations Limitations included a small sample size, lack of ability to evaluate kinetics during stepping, unilateral EMG recordings, and sagittal-plane kinematics. Despite specific differences in kinematics and EMG activity, metabolic activity was similar during stepping in each robotic device. Understanding potential differences and similarities in stepping performance with robotic assistance may be important in delivery of repeated locomotor training using robotic or therapist assistance and for consumers of robotic devices.

Editorial Commentary: Hip Arthroscopy Plays a Role in Painful Hip Resurfacing Arthroplasty but a Prearthroscopy Diagnosis Is Critical to Outcome.

PubMed

Rossi, Michael J

2016-03-01

Whereas hip arthroscopy plays a role in the investigation and treatment of the painful hip resurfacing arthroplasty, a diagnosis before arthroscopy is critical to improved outcome. The rate of conversion to total hip arthroplasty jumps from 7% to 37% when a pre-arthroscopy diagnosis is not known. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Better early functional outcome after short stem total hip arthroplasty? A prospective blinded randomised controlled multicentre trial comparing the Collum Femoris Preserving stem with a Zweymuller straight cementless stem total hip replacement for the treatment of primary osteoarthritis of the hip

PubMed Central

van Oldenrijk, Jakob; Scholtes, Vanessa A B; van Beers, Loes W A H; Geerdink, Carel H; Niers, Bob B A M; Runne, Wouter; Bhandari, Mohit; Poolman, Rudolf W

2017-01-01

Objectives Primary aim was to compare the functional results at 3 months and 2 years between short and conventional cementless stem total hip arthroplasty (THA). Secondary aim was to determine the feasibility of a double-blind implant-related trial. Design A prospective blinded randomised controlled multicentre trial in patients with osteoarthritis of the hip. All patients, research assistants, clinical assessors, investigators and data analysts were blinded to the type of prosthesis. Population: 150 patients between 18 and 70 years with osteoarthritis of the hip, 75 in the short stem and 75 in the conventional stem group. Mean age: 60 years (SD 7). Interventions: the Collum Femoris Preserving short stem versus the Zweymuller Alloclassic conventional stem. Main outcome measures The Dutch version of the Hip Disability and Osteoarthritis Outcome Score (HOOS). Secondary outcomes measures: Harris Hip Score, the Physical Component Scale of the SF12, the Timed Up and Go test, Pain and the EQ-5D. Feasibility outcomes: continued blinding, protocol adherence and follow-up success rate. Results No significant difference between the two groups. Mean HOOS total score in the short stem group increased 32.7 points from 36.6 (95% CI 32.9 to 40.2) preoperatively to 69.3 (95% CI 66.4 to 72.1) at 3 months follow-up. Mean HOOS total score in the conventional straight stem group increased 36.3 points from 37.1 (95% CI 33.9 to 40.3) preoperatively to 73.4 (95% CI 70.3 to 76.4) at 3 months follow-up. 91.2% of patients remained blinded at 2 years follow-up. Both protocol adherence and follow-up success rate were 98%. Conclusions Functional result at 3 months and 2 years after short stem THA is not superior to conventional cementless THA. There were more perioperative and postoperative complications in the short stem group. Direct comparison of two hip implants in a double-blinded randomised controlled trial is feasible. Trial registration number NTR1560. PMID:29042371

Protective Effect of High Protein and Calcium Intake on the Risk of Hip Fracture in the Framingham Offspring Cohort

PubMed Central

Sahni, Shivani; Cupples, L Adrienne; Mclean, Robert R; Tucker, Katherine L; Broe, Kerry E; Kiel, Douglas P; Hannan, Marian T

2010-01-01

The effect of protein on bone is controversial, and calcium intake may modify protein's effect on bone. We evaluated associations of energy-adjusted tertiles of protein intake (ie, total, animal, plant, animal/plant ratio) with incident hip fracture and whether total calcium intake modified these associations in the Framingham Offspring Study. A total of 1752 men and 1972 women completed a baseline food frequency questionnaire (1991–1995 or 1995–1998) and were followed for hip fracture until 2005. Hazard ratios (HRs) were estimated using Cox proportional hazards regression adjusting for confounders. Baseline mean age was 55 years (SD 9.9 years, range 26 to 86 years). Forty-four hip fractures occurred over 12 years of follow-up. Owing to significant interaction between protein (total, animal, animal/plant ratio) and calcium intake (p interaction range = .03 to .04), stratified results are presented. Among those with calcium intakes less than 800 mg/day, the highest tertile (T3) of animal protein intake had 2.8 times the risk of hip fracture [HR = 2.84, 95% confidence interval (CI) 1.20–6.74, p = .02] versus the lowest tertile (T1, p trend = .02). In the 800 mg/day or more group, T3 of animal protein had an 85% reduced hip fracture risk (HR = 0.15, 95% CI 0.02–0.92, p = .04) versus T1 (p trend = .04). Total protein intake and the animal/plant ratio were not significantly associated with hip fracture (p range = .12 to .65). Our results from middle-aged men and women show that higher animal protein intake coupled with calcium intake of 800 mg/day or more may protect against hip fracture, whereas the effect appears reversed for those with lower calcium intake. Calcium intake modifies the association of protein intake and the risk of hip fracture in this cohort and may explain the lack of concordance seen in previous studies. © 2010 American Society for Bone and Mineral Research. PMID:20662074

[Relative effect per patient (REPP)--outcome groups for total hip replacement and total knee replacement].

PubMed

Huber, J; Dabis, E; Zumstein, M D; Hüsler, J

2013-06-01

The outcome of orthopaedic surgery such as total hip replacement (THR) or total knee replacement (TKR) is commonly given by the change in mean scores on patient-reported outcome measures (Prom's). This may give the impression that all enrolled patients have experienced an improvement. But the Swedish hip registry and other studies report a reduction of complaints in 80-85 % of patients ("responders"), with the remainder (approximately one in six) remaining unchanged or reporting worse complaints ("non-responders"). According to Cohen, the degree of success in the "responders" group can be subdivided into excellent, good and moderate. For a given treatment, a total of 5 different outcome groups can therefore be defined: excellent, good, moderate, unchanged and worse. Allocation to the groups is based on the "relative effect per patient" (REPP). The REPP is calculated as the base-line score minus the post-treatment score divided by the baseline score. The maximum possible REPP is 1; a REPP of 0 means no effect and a negative REPP means deterioration. Allocation to the outcome groups is as follows: excellent 0.95 to 1 REPP, good 0.5 to 0.95 REPP, moderate over 0.2 to 0.5 REPP, unchanged -0.2 to 0.2 REPP and worse below -0.2 REPP. Our local arthroplasty register was used to evaluate the 1-year outcomes of THR and TKR patients operated between March 2003 and November 2008, using WOMAC scores and EuroQoL scores. Only patients with complete data sets and unilateral THR/TKR were included. The success rate given by the REPP method was compared with that of the "responder rate" method defined by the OMERACT-OARSI criteria. With the WOMAC questionnaire, outcomes were as follows (THR/TKR): excellent 29/14 %, good 51/54 %, moderate 11/13 %, unchanged at 5/12 %, worse 4/7 %. The corresponding values for the EuroQoL were (THR/TKR): excellent 16/6 %, good 41/42 %, moderate 25/28 %, unchanged 12/16 %, worse 6/8 %. For THR, success rates were 92 % using the "responder rate" method (OMERACT-OARSI criteria) and 91 % using the REPP method with the WOMAC. Calculation of the REPP and the subsequent allocation to outcome groups is simple. The distribution of outcomes depends on the intervention (THR results better than TKR) and the patient questionnaire used (better results with a condition-specific than a generic questionnaire). The proportion of "unchanged" and "moderate" outcomes was greater with the generic questionnaire than with the condition-specific questionnaire, while the proportion of "worse" outcomes was similar for the two instruments. Partitioning of the degree of success into sub-groups, based on the REPP, provides more information for both the patient and the orthopaedic surgeon. Georg Thieme Verlag KG Stuttgart · New York.

Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report.

PubMed

Cushman, Daniel; Rho, Monica E

2015-07-01

Case report. Proximal hamstring tendinopathy in runners is characterized by pain with passive hip flexion with the knee extended, active hip extension, and pain with sitting. Relatively little literature exists on the condition, and publications on nonsurgical treatment protocols are even more scarce. Surgical intervention, which comprises the majority of literature for treatment of this condition, is an option for cases that fail to respond to nonsurgical treatment. The patient was a 34-year-old, otherwise healthy male triathlete with unilateral proximal hamstring tendinopathy diagnosed by ultrasound, who had pain only with running and prolonged sitting. After he failed to respond to 4 weeks of eccentric knee flexion and lumbopelvic musculature strengthening exercises, an eccentric hip extensor strengthening program using a treadmill was initiated. This treadmill exercise was performed on a daily basis, in addition to a lumbopelvic musculature strengthening program. The patient noted a decrease in pain within 2 weeks of initiating the new exercise, and was able to return to gradual running after 4 weeks and to speed training after 12 weeks. He returned to competition shortly thereafter and had no recurrence for 12 months after the initiation of therapy. His score on the Victorian Institute of Sport Assessment-proximal hamstring tendons improved from 23 on initial presentation to 83 at 12 weeks after the initiation of therapy. We described the management of a triathlete with subacute proximal hamstring tendinopathy, who responded well to nonsurgical treatment using eccentric hip extension strengthening using a treadmill. Therapy, level 4.

Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report

PubMed Central

CUSHMAN, DANIEL; RHO, MONICA E.

2015-01-01

STUDY DESIGN Case report. BACKGROUND Proximal hamstring tendinopathy in runners is characterized by pain with passive hip flexion with the knee extended, active hip extension, and pain with sitting. Relatively little literature exists on the condition, and publications on nonsurgical treatment protocols are even more scarce. Surgical intervention, which comprises the majority of literature for treatment of this condition, is an option for cases that fail to respond to nonsurgical treatment. CASE DESCRIPTION The patient was a 34-year-old, otherwise healthy male triathlete with unilateral proximal hamstring tendinopathy diagnosed by ultrasound, who had pain only with running and prolonged sitting. After he failed to respond to 4 weeks of eccentric knee flexion and lumbopelvic musculature strengthening exercises, an eccentric hip extensor strengthening program using a treadmill was initiated. This treadmill exercise was performed on a daily basis, in addition to a lumbopelvic musculature strengthening program. OUTCOMES The patient noted a decrease in pain within 2 weeks of initiating the new exercise, and was able to return to gradual running after 4 weeks and to speed training after 12 weeks. He returned to competition shortly thereafter and had no recurrence for 12 months after the initiation of therapy. His score on the Victorian Institute of Sport Assessment-proximal hamstring tendons improved from 23 on initial presentation to 83 at 12 weeks after the initiation of therapy. DISCUSSION We described the management of a triathlete with subacute proximal hamstring tendinopathy, who responded well to nonsurgical treatment using eccentric hip extension strengthening using a treadmill. LEVEL OF EVIDENCE Therapy, level 4. PMID:25996362

/sup 99m/Tc-methylene diphosphonate bone imaging in the evaluation of total hip prostheses

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weiss, P.E.; Mall, J.C.; Hoffer, P.B.

1979-12-01

A retrospective study was performed to determine the accuracy of /sup 99m/Tc-methylene diphosphonate bone imaging in the evaluation of total hip arthroplasty for loosening and/or infection. Using focally increased activity at the tip of the femoral component or in the region of the acetabular component as a criterion, the examination was 77% specific and 100% sensitive for loosening and/or infection. A possible explanation for the increased uptake at the tip of the femoral component and the role of this examination in the management of a painful total hip prosthesis are discussed.

Hemorrhagic iliopsoas bursitis complicating well-functioning ceramic-on-ceramic total hip arthroplasty.

PubMed

Park, Kyung Soon; Diwanji, Sanket R; Kim, Hyung Keun; Song, Eun Kyoo; Yoon, Taek Rim

2009-08-01

Iliopsoas bursitis has been increasingly recognized as a complication of total hip arthroplasty and is usually associated with polyethylene wear. Here, the authors report a case of hemorrhagic iliopsoas bursitis complicating an otherwise well-functioning ceramic-on-ceramic arthroplasty performed by minimal invasive modified 2-incision technique. The bursitis in turn resulted in femoral nerve palsy and femoral vein compression. In this report, there was no evidence to support that the bursitis was due to an inflammatory response to ceramic wear particles or any other wear particles originating from the total hip arthroplasty.

Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties.

PubMed

Boomsma, Martijn F; Edens, Mireille A; Van Lingen, Christiaan P; Warringa, Niek; Ettema, Harmen B; Verheyen, Cees C P M; Maas, Mario

2015-08-01

After implantation of a metal-on-metal total hip arthroplasty (MoM THA), a large incidence of pseudotumor formation has been described recently. Several centers have invited patients for follow-up in order to screen for pseudotumor formation. The spectrum of abnormalities found by CT in MoM THA patients can be unfamiliar to radiologists and orthopedic surgeons. Previously, a CT five-point grading scale has been published. In this paper, a simplification into a three-point classification system gives insight in the morphological distinction of abnormalities of the postoperative hip capsule in MoM implants in relation to the decision for revision. The reliability of this simplified classification regarding intra- and interrater reliability and its association with revision rate is investigated and discussed. All patients who underwent MoM THA in our hospital were invited for screening. Various clinical measures and CT scan were obtained in a cross-sectional fashion. A decision on revision surgery was made shortly after screening. CT scans were read in 582 patients, of which 82 patients were treated bilaterally. CT scans were independently single read by two board-certified radiologists and classified into categories I-V. In a second meeting, consensus was obtained. Categories were subsequently rubricated in class A (categories I and II), B (category III), and C (categories IV and V). Intra- and inter-radiologist agreement on MoM pathology was assessed by means of the weighted Cohen's kappa. Categorical data were presented as n (%), and tested by means of Fisher's exact test. Continuous data were presented as median (min-max) and tested by means of Mann-Whitney U test (two group comparison) or Kruskal-Wallis test (three group comparison). Logistic regression analysis was performed in order to study independence of CT class for association with revision surgery. Univariate statistically significant variables were entered in a multiple model. All statistical analysis was performed two-tailed using alpha 5% as the significance level. In total, 664 scores from 664 MoM hips obtained by two observers were available for analyses. Interobserver reliability for the non-simplified version (I-V) was κw = 0.71 (95% CI: 0.62-0.79), which indicates good agreement between the two musculoskeletal radiologists. Intra- and interobserver reliability for the simplified version (A-C) were respectively κw 0.78 (95% CI: 0.68-0.87), and κw = 0.71 (95% CI: 0.65-0.76). This indicates good agreement within and between the two observers. The simplified A-C version is significantly associated with revision exclusively due to MoM pathology, in both patients with unilateral MoM THA (p < 0.001) and patients with bilateral MoM THA (p < 0.044). The simplified A-C version is associated with several clinical measures. In patients with unilateral MoM THA, with or without contralateral THA, in situ time (p < 0.008), cobalt and chromium (p < 0.001) were statistically significant. In patients with bilateral MoM, cobalt (p < 0.001) and chromium (p < 0.027) were statistically significant. Revision is significantly associated with cup size (p < 0.001), anteversion of the cup (p < 0.004), serum ion levels of cobalt and chromium (p < 0.001) and the adapted classification system (p < 0.001). In univariate logistic regression analysis on revision, cup, anteversion of the cup, cobalt-chromium ion serum levels, and the simplified (A-C) CT category system were statistically significant. The simplified (A-C) CT category system was an independent associate of revision, in several multiple logistic regression models. The presented simplified CT grading system (A-C) in its first clinical validation on 48- and 64-multislice systems is reliable, showing good intra- and interrater reliability and is independently associated with revision surgery.

Expect the best, prepare for the worst: surgeon and patient expectation of the outcome of primary total hip and knee replacement.

PubMed Central

Moran, M.; Khan, A.; Sochart, D. H.; Andrew, G.

2003-01-01

A cross-sectional study of 100 surgeons and 370 patients awaiting primary total hip or knee replacement was carried out. Oxford hip or knee score questionnaires were sent to the surgeons and patients. They were asked to predict the level of symptoms expected 6 months following surgery. The Oxford scores derive a value of 12-60, with a greater score indicating worsening symptoms. The mean pre-operative score was 45.12 for the hip patients and 42.96 for the knee patients, and the patients expected this to drop to 23.70 and 25.66, respectively, 6 months' postoperatively. This was a significant difference for both groups. The surgeons expected the patients to have a mean postoperative score of 20.91 for the hip group and 22.19 for the knee group. The surgeons' scores were significantly lower than those from the patients. There was a significant difference between the patients' and surgeons' expectations of the results of total knee and hip replacement surgery. The surgeons expected better results than the patients. We believe that this is the first study that directly compares surgeon and patient expectations of lower limb arthroplasty. PMID:12831497

A Randomised Multi-centre Study to Compare the Long-term Performance of the Future Hip to 3 Other Implants in Primary Total Hip Replacement

ClinicalTrials.gov

2016-10-06

Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

Estimating prevalence of osteoporosis: examples from industrialized countries.

PubMed

Wade, S W; Strader, C; Fitzpatrick, L A; Anthony, M S; O'Malley, C D

2014-01-01

In nine industrialized countries in North America, Europe, Japan, and Australia, country-specific osteoporosis prevalence (estimated from published data) at the total hip or hip/spine ranged from 9 to 38 % for women and 1 to 8 % for men. In these countries, osteoporosis affects up to 49 million individuals. Standardized country-specific prevalence estimates are scarce, limiting our ability to anticipate the potential global impact of osteoporosis. This study estimated the prevalence of osteoporosis in several industrialized countries (USA, Canada, five European countries, Australia, and Japan) using the World Health Organization (WHO) bone mineral density (BMD)-based definition of osteoporosis: BMD T-score assessed by dual-energy x-ray absorptiometry ≤-2.5. Osteoporosis prevalence was estimated for males and females aged 50 years and above using total hip BMD and then either total hip or spine BMD. We compiled published location-specific data, using the National Health and Nutrition Examination Survey (NHANES) III age and BMD reference groups, and adjusted for differences in disease definitions across sources. Relevant NHANES III ratios (e.g., male to female osteoporosis at the total hip) were applied where data were missing for countries outside the USA. Data were extrapolated from geographically similar countries as needed. Population counts for 2010 were used to estimate the number of individuals with osteoporosis in each country. For females, osteoporosis prevalence ranged from 9 % (UK) to 15 % (France and Germany) based on total hip BMD and from 16 % (USA) to 38 % (Japan) when spine BMD data were included. For males, prevalence ranged from 1 % (UK) to 4 % (Japan) based on total hip BMD and from 3 % (Canada) to 8 % (France, Germany, Italy, and Spain) when spine BMD data were included. Up to 49 million individuals met the WHO osteoporosis criteria in a number of industrialized countries in North America, Europe, Japan, and Australia.

Impact of the Holocaust on the Rehabilitation Outcome of Older Patients Sustaining a Hip Fracture.

PubMed

Mizrahi, Eliyahu H; Lubart, Emilia; Heymann, Anthony; Leibovitz, Arthur

2017-04-01

Holocaust survivors report a much higher prevalence of osteoporosis and fracture in the hip joint compared to those who were not Holocaust survivors. To evaluate whether being a Holocaust survivor could affect the functional outcome of hip fracture in patients 64 years of age and older undergoing rehabilitation. A retrospective cohort study compromising 140 consecutive hip fracture patients was conducted in a geriatric and rehabilitation department of a university-affiliated hospital. Being a Holocaust survivor was based on registry data. Functional outcome was assessed by the Functional Independence Measure (FIM)TM at admission and discharge from the rehabilitation ward. Data were analyzed by t-test, chi-square test, and linear regression analysis. Total and motor FIM scores at admission (P = 0.004 and P = 0.006, respectively) and total and motor FIM gain scores at discharge (P = 0.008 and P = 0.004 respectively) were significantly higher in non-Holocaust survivors compared with Holocaust survivors. A linear regression analysis showed that being a Holocaust survivor was predictive of lower total FIM scores at discharge (β = -0.17, P = 0.004). Hip fracture in Holocaust survivors showed lower total, motor FIM and gain scores at discharge compared to non-Holocaust survivor patients. These results suggest that being a Holocaust survivor could adversely affect the rehabilitation outcome following fracture of the hip and internal fixation.

Endoscopic resection of acetabular screw tip to decompress sciatic nerve following total hip arthroplasty.

PubMed

Yoon, Sun-Jung; Park, Myung-Sik; Matsuda, Dean K; Choi, Yun Ho

2018-06-04

Sciatic nerve injuries following total hip arthroplasty are disabling complications. Although degrees of injury are variable from neuropraxia to neurotmesis, mechanical irritation of sciatic nerve might be occurred by protruding hardware. This case shows endoscopic decompression for protruded acetabular screw irritating sciatic nerve, the techniques described herein may permit broader arthroscopic/endoscopic applications for management of complications after reconstructive hip surgery. An 80-year-old man complained of severe pain and paresthesias following acetabular component revision surgery. Physical findings included right buttock pain with radiating pain to lower extremity. Radiographs and computed tomography imaging showed that the sharp end of protruded screw invaded greater sciatic foramen anterior to posterior and distal to proximal direction at sciatic notch level. A protruding tip of the acetabular screw at the sciatic notch was decompressed by use of techniques gained from experience performing endoscopic sciatic nerve decompression. The pre-operative pain and paresthesias resolved post-operatively after recovering from anesthesia. This case report describes the first documented endoscopic resection of the tip of the acetabular screw irritating sciatic nerve after total hip arthroplasty. If endoscopic resection of an offending acetabular screw can be performed in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in several complications management after total hip arthroplasty.

Effects of health intervention program on cardiometabolic risk profiles from health evaluation center in Asian population: a longitudinal study and propensity analysis.

PubMed

Liu, Chuan-Chuan; Hung, Chung-Lieh; Shih, Shou-Chuan; Ko, Hung-Ju; Chang, Ray-E

2015-08-20

Health intervention program (HIP) based on diet and lifestyle modifications had been shown to improve cardiovascular risks. The effects of such program on a variety of cardiometabolic outcome measures conducted in a strict analysis remained relatively unexplored. A total of 2,660 participants (mean age: 43.3 ± 10 years, 63.6% male) underwent annual health survey from our health evaluation department. We implemented health intervention program (HIP) in which diet and lifestyle modifications including smoking cessation and advised physical activities were introduced. We further studied the effects of HIP on several cardiometabolic outcome measures including Framingham, metabolic scores and renal function in terms of Egfr with a mean follow-up period of 38.5 months. Propensity score (PS) matching (HIP vs non-HIP group) was used to avoid effects of case selection bias. Totally 1,004 (502 subjects for each group) left after PS matching protocol (both HIP and non-HIP group). The HIP group showed significant decline of waist circumference (-1.46 ± 0.61, p = 0.016), post-prandial glucose (-6.77 ± 2.06, p = 0.001), and total cholesterol level (-4.42 ± 2.15, p = 0.04), with borderline increase in eGFR (1.72 ± 0.94, p = 0.068) after an average of 1.91 ± 1.14 year follow up period. Exercise behavior significantly increased for those who received HIP when compared to the non-HIP group (44.6 vs 52.4 %, p = 0.014). PS matching and difference-in-difference (DID) analysis further confirmed the beneficial effects of ATP III reduction by HIP (-0.36 ± 0.06, p < 0.05). We demonstrated in our study that several cardiometabolic profiles can be substantially improved after health intervention introduction at the health evaluation center, supporting the beneficial evidence of such health intervention programs implementation based on primary prevention view points.

[Results and experiences of conversion of hip arthrodesis ].

PubMed

Schuh, A; Zeiler, G; Werber, S

2005-03-01

With the predictably good outcome of total hip arthroplasty today (THA), hip arthrodesis currently has limited indications. Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and ipsilateral knee due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires conversion of a fused hip to a THA. The results and experiences of conversions of a hip arthrodesis into a THA are reported. Between 1 January 1985 and 31 December 2001 conversion of a previously performed arthrodesis of the hip to THA was carried out in a total of 45 patients; 34 patients could be followed up after the conversion to THA after a mean of 77.5 months (min.: 24, max.: 208). The primary indications for the conversion were low back pain (n=21) and ipsilateral knee pain (n=13). The mean age at the time of THA was 75.3 years (min.: 32, max.: 74). The mean time interval between the arthrodesis and the conversion to THA was 30.4 years (min.: 5, max.: 66). Of 34 hips, 29 (85%) were either pain free or had minimal pain. Complications included one persisting sciatic nerve palsy, two superficial infections, two periprosthetic fractures, and two heterotopic ossifications IV degrees with one recurrence of ankylosis and one marked reduction of motion. Revision arthroplasty was performed in four hips. Postoperatively 7 patients showed no limping, 11 showed a slight limp, and 17 a pronounced limp. Recurrent dislocations occurred in one patient. We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. There is a high rate of complications after conversion of a hip arthrodesis to a total hip arthroplasty. These issues must be carefully considered and discussed with the patient before any conversion procedure.

Intraoperative neurophysiological responses in epileptic patients submitted to hippocampal and thalamic deep brain stimulation.

PubMed

Cukiert, Arthur; Cukiert, Cristine Mella; Argentoni-Baldochi, Meire; Baise, Carla; Forster, Cássio Roberto; Mello, Valeria Antakli; Burattini, José Augusto; Lima, Alessandra Moura

2011-12-01

Deep brain stimulation (DBS) has been used in an increasing frequency for treatment of refractory epilepsy. Acute deep brain macrostimulation intraoperative findings were sparsely published in the literature. We report on our intraoperative macrostimulation findings during thalamic and hippocampal DBS implantation. Eighteen patients were studied. All patients underwent routine pre-operative evaluation that included clinical history, neurological examination, interictal and ictal EEG, high resolution 1.5T MRI and neuropsychological testing. Six patients with temporal lobe epilepsy were submitted to hippocampal DBS (Hip-DBS); 6 patients with focal epilepsy were submitted to anterior thalamic nucleus DBS (AN-DBS) and 6 patients with generalized epilepsy were submitted to centro-median thalamic nucleus DBS (CM-DBS). Age ranged from 9 to 40 years (11 males). All patients were submitted to bilateral quadripolar DBS electrode implantation in a single procedure, under general anesthesia, and intraoperative scalp EEG monitoring. Final electrode's position was checked postoperatively using volumetric CT scanning. Bipolar stimulation using the more proximal and distal electrodes was performed. Final standard stimulation parameters were 6Hz, 4V, 300μs (low frequency range: LF) or 130Hz, 4V, 300μs (high frequency range: HF). Bilateral recruiting response (RR) was obtained after unilateral stimulation in all patients submitted to AN and CM-DBS using LF stimulation. RR was widespread but prevailed over the fronto-temporal region bilaterally, and over the stimulated hemisphere. HF stimulation led to background slowing and a DC shift. The mean voltage for the appearance of RR was 4V (CM) and 3V (AN). CM and AN-DBS did not alter inter-ictal spiking frequency or morphology. RR obtained after LF Hip-DBS was restricted to the stimulated temporal lobe and no contralateral activation was noted. HF stimulation yielded no visually recognizable EEG modification. Mean intensity for initial appearance of RR was 3V. In 5 of the 6 patients submitted to Hip-DBS, an increase in inter-ictal spiking was noted unilaterally immediately after electrode insertion. Intraoperative LF stimulation did not modify temporal lobe spiking; on the other hand, HF was effective in abolishing inter-ictal spiking in 4 of the 6 patients studied. There was no immediate morbidity or mortality in this series. Macrostimulation might be used to confirm that the hardware was working properly. There was no typical RR derived from each studied thalamic nuclei after LF stimulation. On the other hand, absence of such RRs was highly suggestive of hardware malfunction or inadequate targeting. Thalamic-DBS (Th-DBS) RR was always bilateral after unilateral stimulation, although they somehow prevailed over the stimulated hemisphere. Contrary to Th-DBS, Hip-DBS gave rise to localized RR over the ipsolateral temporal neocortex, and absence of this response might very likely be related to inadequate targeting or hardware failure. Increased spiking was seen over temporal neocortex during hippocampal electrode insertion; this might point to the more epileptogenic hippocampal region in each individual patient. We did not notice any intraoperative response difference among patients with temporal lobe epilepsy with or without MTS. The relationship between these intraoperative findings and seizure outcome is not yet clear and should be further evaluated. 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Hip Replacement - Multiple Languages

MedlinePlus

... Hip Replacement - العربية (Arabic) Bilingual PDF Health Information Translations Chinese, Simplified (Mandarin dialect) (简体中文) Expand Section Total ... Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Chinese, Traditional (Cantonese dialect) (繁體中文) Expand Section Total ...

Preventative Therapeutics for Heterotopic Ossification

DTIC Science & Technology

2015-10-01

in the general population undergoing invasive surgeries such as total hip arthroplasty . There is also a congenital form of it that can affect...insults and can also occur in patients undergoing invasive surgeries, including total hip arthroplasty (6). HO is very common in our wounded service

A comparison between patient recall and concurrent measurement of preoperative quality of life outcome in total hip arthroplasty.

PubMed

Howell, Jonathan; Xu, Min; Duncan, Clive P; Masri, Bassam A; Garbuz, Donald S

2008-09-01

The objective is to evaluate the reliability of patients' recall of preoperative pain and function during the immediate postoperation period after total hip arthroplasty. A prospective cohort of 104 patients completed a survey about their quality of life before operation, and recalled preoperative status at 3 days, 6 weeks, and 12 weeks after operation. Quality of life was measured by the Western Ontario and McMaster University Osteoarthritis Index, the Oxford-12 hip score, and the 12-item Short-Form score. The intraclass correlation coefficient and Spearman correlation coefficient were used to compare preoperative quality of life scores to the scores recalled. The reliability of recall remained high up to 3 months postoperation. Patients are able to accurately recall their preoperative function for up to 3 months after total hip arthroplasty.

No Exacerbation of Knee Joint Pain and Effusion Following Preoperative Progressive Resistance Training in Patients Scheduled for Total Knee Arthroplasty: Secondary Analyses From a Randomized Controlled Trial.

PubMed

Skoffer, Birgit; Dalgas, Ulrik; Maribo, Thomas; Søballe, Kjeld; Mechlenburg, Inger

2017-11-09

Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion. To examine whether preoperative PRT initiated 5 weeks prior to TKA would exacerbate pain and knee effusion, and would allow a progressively increased training load throughout the training period that would subsequently increase muscle strength. Secondary analyses from a randomized controlled trial. University Hospital and a Regional Hospital. A total of 30 patients who were scheduled for TKA due to osteoarthritis and assigned as the intervention group. Patients underwent unilateral PRT (3 sessions per week). Exercise loading was 12 repetitions maximum (RM) with progression toward 8 RM. The training program consisted of 6 exercises performed unilaterally. Before and after each training session, knee joint pain was rated on an 11-point scale, effusion was assessed by measuring the knee joint circumference, and training load was recorded. The first and last training sessions were initiated by 1 RM testing of unilateral leg press, unilateral knee extension, and unilateral knee flexion. The median pain change score from before to after each training session was 0 at all training sessions. The average increase in knee joint effusion across the 12 training sessions was a mean 0.16 cm ± 0.23 cm. No consistent increase in knee joint effusion after training sessions during the training period was found (P = .21). Training load generally increased, and maximal muscle strength improved as follows: unilateral leg press: 18% ± 30% (P = .03); unilateral knee extension: 81% ± 156% (P < .001); and unilateral knee flexion: 53% ± 57% (P < .001). PRT of the affected leg initiated shortly before TKA does not exacerbate knee joint pain and effusion, despite a substantial progression in loading and increased muscle strength. Concerns for side effects such as pain and effusion after PRT seem unfounded. To be determined. Copyright © 2017. Published by Elsevier Inc.

High prevalence of noise following Delta ceramic-on-ceramic total hip arthroplasty.

PubMed

Salo, P P; Honkanen, P B; Ivanova, I; Reito, A; Pajamäki, J; Eskelinen, A

2017-01-01

We evaluated the short-term functional outcome and prevalence of bearing-specific generation of audible noise in 301 patients (336 hips) operated on with fourth generation (Delta) medium diameter head, ceramic-on-ceramic (CoC) total hip arthroplasties (THAs). There were 191 female (63%) and 110 male patients (37%) with a mean age of 61 years (29 to 78) and mean follow-up of 2.1 years (1.3 to 3.4). Patients completed three questionnaires: Oxford Hip Score (OHS), Research and Development 36-item health survey (RAND-36) and a noise-specific symptom questionnaire. Plain radiographs were also analysed. A total of three hips (0.9%) were revised. There were 52 patients (54 hips, 17%) who reported noise, and in 25 (48%) of them the noise was frequently heard. In the multiple regression analysis, the only independent risk factor for noise was a specific THA brand, with a threefold increased risk (95% confidence intervals 1.39 to 6.45, p = 0.005) of noise compared with the reference THA brand. Patients with noisy hips had lower median OHS (43 versus 46.5, p = 0.002) and their physical functioning (p = 0.021) subscale in RAND-36 was reduced. Noise was surprisingly common in this population. Cite this article: Bone Joint J 2017;99-B:44-50. ©2017 The British Editorial Society of Bone & Joint Surgery.

Comparison of Blood Loss After Total Hip Arthroplasty Between Ankylosing Spondylitis and Osteoarthritis.

PubMed

Li, Jia; Zhao, Jinzhu; He, Chongru; Tong, Wenwen; Zou, Yuming; Xu, Weidong

2016-07-01

This study was conducted to compare the blood loss during primary total hip arthroplasty (THA) between ankylosing spondylitis (AS) and hip osteoarthritis (OA). We reviewed 120 THAs in 68 patients comprising 3 groups: AS with total bony ankylosis of the hips (ASB), AS with stiff hips (ASS), and OA. Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, surgical complications, hospitalization cost, and length of stay (LOS) were collected and analyzed among ASB, ASS, and OA groups. The patients of the ASB and ASS groups were much younger and thinner than those of the OA group. There were no significant differences in the preoperative values of activated partial thromboplastin time, prothrombin time, and international normalized ratio among the 3 groups (all P > .05). The intraoperative blood loss, volume of drainage, hidden blood loss, transfusion rate, transfusion reactions, and hospitalization cost in the ASB group were significantly higher than in the other 2 groups, although not significantly different between the ASS and OA groups (P > .05). Both AS and OA can cause hyperosteogeny to the hips, but ASB patients have more serious symptoms in their affected hips. This may cause more blood loss in THA surgery because of bone surface bleeding. The reason that ASB patients suffered more blood loss may be related to the high difficulty and long duration of the operation. Copyright © 2016 Elsevier Inc. All rights reserved.

Extensive Surgical Wound Lavage Reduces the Incidence and Severity of Heterotopic Ossification in Primary Total Hip Replacement: A Study of 175 Hip Replacements.

PubMed

Kantak, Avadhoot P; Shah, Nirav N

2017-12-01

One of the local factors contributing to the formation of heterotopic ossification includes bone debris generated during the surgery. This risk can be partially nullified by use of saline wash. Our research aim was to ascertain if extensive intraoperative lavage can reduce the incidence and severity of heterotopic ossification in primary total hip arthroplasty. A retrospective case control radiological study of 145 patients (175 hip replacements). The control group received minimal intra-operative lavage (<1,000 mL); consisted of 90 primary hip replacements. The index group received extensive saline lavage (>3,000 mL), and included 85 primary hip replacements. Brooker classification was used to grade radiographs at one year for development of heterotopic ossification. Sixty-six patients in control group had heterotopic ossification, with six showing a significant grade (grade 3 or 4). Thirty-five patients in the index group had heterotopic ossification with no incidence of severe grade. Majority patients in the index group showed a predominantly grade 1 heterotopic ossification; 28 out of 35, as compared to 37 out of 66 in control group. There was a statistically significant difference in the incidence ( P <0.05) as well as severity of heterotopic ossification between the groups ( P <0.05). We conclude that use of extensive lavage during total hip replacement reduces the incidence as well as severity of heterotopic ossification.

Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial.

PubMed

Fukuda, Thiago Yukio; Rossetto, Flavio Marcondes; Magalhães, Eduardo; Bryk, Flavio Fernandes; Lucareli, Paulo Roberto Garcia; de Almeida Aparecida Carvalho, Nilza

2010-11-01

Randomized clinical trial. To investigate the influence of strengthening the hip abductor and lateral rotator musculature on pain and function of females with patellofemoral pain syndrome (PFPS). Hip muscle weakness in women athletes has been the focus of many recent studies and is suggested as an important impairment to address in the conservative treatment of women with PFPS. However, it is still not well established if strengthening these muscles is associated with clinical improvement in pain and function in sedentary females with PFPS. Seventy females (average±SD age, 25±07 years), with a diagnosis of unilateral PFPS, were distributed randomly into 3 groups: 22 females in the knee exercise group, who received a conventional treatment that emphasized stretching and strengthening of the knee musculature; 23 females in the knee and hip exercise group, who performed exercises to strengthen the hip abductors and external rotators in addition to the same exercises performed by those in the knee exercise group; and of the 25 females who did not receive any treatment. The females of the nontreatment group (control) were instructed to maintain their normal daily activities. An 11-point numerical pain rating scale (NPRS) was used to assess pain during stair ascent and descent. The lower extremity functional scale (LEFS) and the anterior knee pain scale (AKPS) were used to assess function. The single-limb single hop test was also used as a functional outcome to measure preintervention and 4-week postintervention function. The 3 groups were homogeneous prior to treatment in respect to demographic, pain, and functional scales data. Both the knee exercise and the knee and hip exercise groups showed significant improvement in the LEFS, the AKPS, and the NPRS, when compared to the control group (P<.05 and P<.001, respectively). But, when we considered minimal clinically important differences, only the knee and hip exercise group demonstrated mean improvements in AKPS and pain scores that were large enough to be clinically meaningful. For the single-limb single hop test, both groups receiving an intervention showed greater improvement than the control group, but there was no difference between the 2 interventions (P>.05). Rehabilitation programs focusing on knee strengthening exercises and knee strengthening exercises supplemented by hip strengthening exercises were both effective in improving function and reducing pain in sedentary women with PFPS. Improvements of pain and function were greater for the group that performed the hip strengthening exercises, but the difference was significant only for pain rating while descending stairs. Therapy, level 1b-.

MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip.

PubMed

Nori, Madhavi; Marupaka, Sravan Kumar; Alluri, Swathi; Md, Naseeruddin; Irfan, Kazi Amir; Jampala, Venkateshwarlu; Apsingi, Sunil; Eachempati, Krishna Kiran

2015-12-01

Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined. To study pre and post core decompression MRI changes in avascular necrosis of hip. This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version. Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location. Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip.

Minimum ten-year results of primary bipolar hip arthroplasty for degenerative arthritis of the hip.

PubMed

Pellegrini, Vincent D; Heiges, Bradley A; Bixler, Brian; Lehman, Erik B; Davis, Charles M

2006-08-01

Bipolar hip arthroplasty has been advocated by some as an alternative to total hip arthroplasty for the treatment of degenerative arthritis of the hip. We sought to assess the results of this procedure at our institution after a minimum duration of follow-up of ten years. We retrospectively reviewed a consecutive series of 152 patients (173 hips) who underwent primary bipolar hemiarthroplasty for the treatment of symptomatic degenerative arthritis of the hip with a cementless femoral component between 1983 and 1987. Of the original cohort of 152 patients, ninety-two patients (104 hips) were available for clinical and radiographic review at a mean of 12.2 years postoperatively. At the time of the latest follow-up, self-administered Harris hip questionnaires were used to assess pain, mobility, activity level, and overall satisfaction with the procedure. Biplanar hip radiographs were made to evaluate bipolar shell migration, osteolysis, and femoral stem fixation. At the time of the latest follow-up, nineteen patients (nineteen hips) had undergone revision to total hip arthroplasty because of mechanical failure, and three patients (three hips) were awaiting revision because of symptomatic radiographic mechanical failure. Twelve acetabular revisions were performed or scheduled for the treatment of pelvic osteolysis or protrusio acetabuli secondary to component migration. Acetabular reconstruction required bone-grafting, an oversized shell, and/or a pelvic reconstruction ring. The overall rate of mechanical failure was 21.2% (twenty-two of 104 hips), with 91% (twenty) of the twenty-two failures involving the acetabular component. Reaming of the acetabulum at the time of the index arthroplasty was associated with a 6.4-fold greater risk of revision. The rate of implant survival, with revision because of mechanical failure as the end point, was 94.2% for femoral components and 80.8% for acetabular components at a mean of 12.2 years. Of the remaining sixty-nine patients (eighty-one hips) in whom the original prosthesis was retained, seventeen patients (24.6%) rated the pain as moderate to severe. Nearly 30% of patients with an intact prosthesis required analgesics on a regular basis. Radiographs were available for fifty-eight hips (including all of the hips with moderate to severe pain) after a minimum duration of follow-up of ten years; twenty-eight of these fifty-eight hips had radiographic evidence of acetabular component migration. This bipolar cup, when used for hemiarthroplasty in patients with symptomatic arthritis of the hip, was associated with unacceptably high rates of pain, migration, osteolysis, and the need for revision to total hip arthroplasty, especially when the acetabulum had been reamed. To the extent that these findings can be generalized to similar implant designs with conventional polyethylene, we do not recommend bipolar hemiarthroplasty as the primary operative treatment for degenerative arthritis of the hip.

Impact of Tranexamic Acid in Total Knee and Total Hip Replacement.

PubMed

Boyle, Jaclyn A; Soric, Mate M

2017-02-01

To evaluate the net clinical benefit of tranexamic acid use in patients undergoing total knee or total hip replacement. This is a retrospective study of patients undergoing total knee or total hip replacement. The primary outcome was the net clinical benefit of tranexamic acid use. Secondary outcomes included length of stay, incidence of venous thromboembolism, change in hemoglobin, and number of units of blood transfused. Four hundred and six patients were screened for inclusion and 327 patients met inclusion criteria; 174 patients received tranexamic acid versus 153 patients who received usual care. Tranexamic acid demonstrated a positive net clinical benefit versus usual care (40.8% vs 13.7%, P < .01) but did not affect length of stay (3.39 vs 3.37 days, respectively, P = .76). Venous thromboembolism was comparable between groups (2.3% vs 0.7%, P = .38). Average change in hemoglobin and need for transfusion were lower in the treatment group versus the usual care group, respectively (3.46 vs 4.26 mg/dL, P < .01). Tranexamic acid demonstrated a significant benefit in decreasing change in hemoglobin as well as the need for blood transfusion with no increase in the risk of venous thromboembolism in patients undergoing total knee or total hip replacement.

One step HIP canning of powder metallurgy composites

NASA Technical Reports Server (NTRS)

Juhas, John J. (Inventor)

1990-01-01

A single step is relied on in the canning process for hot isostatic pressing (HIP) powder metallurgy composites. The binders are totally removed while the HIP can of compatible refractory metal is sealed at high vacuum and temperature. This eliminates outgassing during hot isostatic pressing.

The cementless Bicontact stem in a prospective dual-energy X-ray absorptiometry study.

PubMed

Lerch, Matthias; Kurtz, Agnes; Windhagen, Henning; Bouguecha, Anas; Behrens, Bernd A; Wefstaedt, Patrick; Stukenborg-Colsman, Christina M

2012-11-01

The cementless Bicontact total hip arthroplasty (THA) system (AESCULAP AG, Tuttlingen, Germany) was introduced in 1986/1987 and has been in successful clinical use in an unaltered form up to today. Although good long-term results with the Bicontact stem have been published, it is questionable whether the implant provides the criteria for a state-of-the-art stem regarding proximal bone stock preservation. The purpose of the study was to monitor the periprosthetic bone mineral density (BMD) in a prospective two-year follow-up dual-energy X-ray absorptiometry (DEXA) study. After power analysis, a consecutive series of 25 patients with unilateral Bicontact stem implantation was examined clinically and underwent DEXA examinations. Scans of seven regions of interest were taken preoperatively and at one week, six months, and one and two years. One patient required stem revision due to a deep infection. The Harris Hip Score increased significantly by 44 points. The most significant bone loss was observed in the calcar region (R7) in the first six months (-19.2 %). It recovered in the following 18 months to -8.5 %. The BMD in the greater trochanter dropped significantly after six months and remained stable at this level. BMD exceeded baseline values in distal regions and even more in the lesser trochanter region after two years. We conclude that the Bicontact stem provides adequate proximal bone stock preservation. We observed some signs of stress shielding at the tip of the stem, which is inevitable to some degree in THA with cementless straight stems. However, in this prospective DEXA investigation, we showed that proximal off-loading does not occur after THA with the Bicontact system. Thus, we believe that this stem is still a state-of-the-art implant.

[Hip resurfacing arthroplasty].

PubMed

Witzleb, W-C; Knecht, A; Beichler, T; Köhler, T; Günther, K-P

2004-11-01

In comparison to stemmed total hip replacements, hip resurfacing offers advantages especially in joint stability and amount of femoral bone resection. After the poor results achieved with this concept that were mainly caused by failure of the materials used, reintroduction of the metal-on-metal bearing initiated a renaissance. This bearing, the cementless cup, and the improved surgical technique led to better short- to medium-term results. Revision and complication rates are now comparable to conventional total hip replacements. The functional capacity of the method is higher. Because long-term results are not available, however, questions remain, for instance, the consequences of the higher metal ion serum concentrations or the impossibility of changing the inlay when femoral revision becomes necessary.

Novel cemented cup-holding technique while performing total hip arthroplasty with navigation system.

PubMed

Takai, Hirokazu; Takahashi, Tomoki

2017-09-01

Recently, navigation systems have been more widely utilized in total hip arthroplasty. However, almost all of these systems have been developed for cementless cups. In the case of cemented total hip arthroplasty using a navigation system, a special-ordered cemented holder is needed. We propose a novel cemented cup-holding technique for navigation systems using readily available articles. We combine a cementless cup holder with an inverted cementless trial cup. The resulting apparatus is used as a cemented cup holder. The upside-down cup-holding technique is useful and permits cemented cup users to utilize a navigation system for placement of the acetabular component.

[Gluteal compartment syndrome after total hip replacement. A presentation of two cases].

PubMed

Villalba, J; Solernou, X

2013-01-01

Many postoperative complications have been described after a total hip arthroplasty, with early and acute, as well as late, complications being reported. Two cases of compartment syndrome of the buttock are described following a hybrid total hip arthroplasty (cemented stem and press-fit and screwed acetabulum) performed on 2 patients of 60 and 68 years old, both diagnosed and treated 24-48 hours after the surgery. Both cases had a primary prosthesis with no previous significant pathological findings. This condition is still rare, and few cases have been described at the medical literature. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

Stabilization of a three-dimensional limit cycle walking model through step-to-step ankle control.

PubMed

Kim, Myunghee; Collins, Steven H

2013-06-01

Unilateral, below-knee amputation is associated with an increased risk of falls, which may be partially related to a loss of active ankle control. If ankle control can contribute significantly to maintaining balance, even in the presence of active foot placement, this might provide an opportunity to improve balance using robotic ankle-foot prostheses. We investigated ankle- and hip-based walking stabilization methods in a three-dimensional model of human gait that included ankle plantarflexion, ankle inversion-eversion, hip flexion-extension, and hip ad/abduction. We generated discrete feedback control laws (linear quadratic regulators) that altered nominal actuation parameters once per step. We used ankle push-off, lateral ankle stiffness and damping, fore-aft foot placement, lateral foot placement, or all of these as control inputs. We modeled environmental disturbances as random, bounded, unexpected changes in floor height, and defined balance performance as the maximum allowable disturbance value for which the model walked 500 steps without falling. Nominal walking motions were unstable, but were stabilized by all of the step-to-step control laws we tested. Surprisingly, step-by-step modulation of ankle push-off alone led to better balance performance (3.2% leg length) than lateral foot placement (1.2% leg length) for these control laws. These results suggest that appropriate control of robotic ankle-foot prosthesis push-off could make balancing during walking easier for individuals with amputation.

Changes in the activity of trunk and hip extensor muscles during bridge exercises with variations in unilateral knee joint angle.

PubMed

Kim, Juseung; Park, Minchul

2016-09-01

[Purpose] This study compared abdominal and hip extensor muscle activity during a bridge exercise with various knee joint angles. [Subjects and Methods] Twenty-two healthy male subjects performed a bridge exercise in which the knee joint angle was altered. While subjects performed the bridge exercise, external oblique, internal oblique, gluteus maximus, and semitendinosus muscle activity was measured using electromyography. [Results] The bilateral external and internal oblique muscle activity was significantly higher at 0° knee flexion compared to 120°, 90°, and 60°. The bilateral gluteus maximus muscle activity was significantly different at 0° of knee flexion compared to 120°, 90°, and 60°. The ipsilateral semitendinosus muscle activity was significantly increased at 90° and 60° of knee flexion compared to 120°, and significantly decreased at 0° knee flexion compared with 120°, 90°, and 60°. The contralateral semitendinosus muscle activity was significantly higher at 60° of knee flexion than at 120°, and significantly higher at 0° of knee flexion than at 120°, 90°, and 60°. [Conclusion] Bridge exercises performed with knee flexion less than 90° may be used to train the ipsilateral semitendinosus. Furthermore, bridge exercise performed with one leg may be used to train abdominal and hip extensor muscles.

Modes of failure of Osteonics constrained tripolar implants: a retrospective analysis of forty-three failed implants.

PubMed

Guyen, Olivier; Lewallen, David G; Cabanela, Miguel E

2008-07-01

The Osteonics constrained tripolar implant has been one of the most commonly used options to manage recurrent instability after total hip arthroplasty. Mechanical failures were expected and have been reported. The purpose of this retrospective review was to identify the observed modes of failure of this device. Forty-three failed Osteonics constrained tripolar implants were revised at our institution between September 1997 and April 2005. All revisions related to the constrained acetabular component only were considered as failures. All of the devices had been inserted for recurrent or intraoperative instability during revision procedures. Seven different methods of implantation were used. Operative reports and radiographs were reviewed to identify the modes of failure. The average time to failure of the forty-three implants was 28.4 months. A total of five modes of failure were observed: failure at the bone-implant interface (type I), which occurred in eleven hips; failure at the mechanisms holding the constrained liner to the metal shell (type II), in six hips; failure of the retaining mechanism of the bipolar component (type III), in ten hips; dislocation of the prosthetic head at the inner bearing of the bipolar component (type IV), in three hips; and infection (type V), in twelve hips. The mode of failure remained unknown in one hip that had been revised at another institution. The Osteonics constrained tripolar total hip arthroplasty implant is a complex device involving many parts. We showed that failure of this device can occur at most of its interfaces. It would therefore appear logical to limit its application to salvage situations.

Investigation into three dimensional hip anatomy in anterior dislocation after THA. Influence of the position of the hip rotation centre.

PubMed

Sariali, Elhadi; Klouche, Shahnez; Mamoudy, Patrick

2012-07-01

The components position is a major factor under the surgeon's control in determining the risk of dislocation post total hip arthroplasty. The aim of this study was to investigate the proper three-dimensional components position including the centre of rotation in the case of anterior dislocation. Among 1764 consecutive patients who underwent total hip arthroplasty using a direct anterior approach, 27 experienced anterior dislocation. The three-dimensional hip anatomy was investigated in 12 patients who were paired with 12 patients from the same initial cohort who did not experience dislocation and also with 36 control patients with osteoarthritis. A pelvic Cartesian referential was defined to perform the acetabular analysis. The coordinates were expressed as percentages of the pelvic width, height and depth. The anteversion angles were measured. The hip centre of rotation was significantly shifted medially and posteriorly in the dislocation group when compared to the non-dislocation group and also to the control group. There was no significant difference in component angular position between the dislocation-group and the non-dislocation group. However, the stem anteversion in the dislocation group was increased in comparison to the mean natural femoral anteversion of the control group. A medial and posterior displacement of the hip rotation centre was found to correlate to anterior dislocation post total hip arthoplasty. These results suggest the importance of an accurate restoration of the centre of rotation, whilst avoiding an excessive acetabular reaming which may induce a medial and a posterior displacement. III comparative non randomised. Copyright © 2011 Elsevier Ltd. All rights reserved.

A case report of idiopathic iliopsoas hematoma which occurred soon after transfer to the wheelchair after total hip arthroplasty.

PubMed

Okumura, Tomoo; Fujita, Hiroshi; Harada, Hideto; Nishimura, Ryuuichi; Tominaga, Tomohiro

2017-02-01

A 79-year-old woman was diagnosed with osteoarthritis of the left hip and scheduled for total hip arthroplasty. As two lesions were detected in branches of the coronary arteries, she was treated with catheter treatment. The patient was receiving anticoagulant treatment, which was suspended eight days before the operation; however, heparin was started at 6 days before the operation and was stopped 9 hours before the operation. On the 2nd postoperative day soon after transfer to the wheel chair, she was feeling unwell and was suffering from severe pain in her left buttock and left thigh. Her blood pressure had decreased to 70 mmHg. During abdominal contrast-enhanced CT, a hematoma was detected in the left iliopsoas muscle. Catheter therapy was started by the cardiovascular department and bleeding had stopped spontaneously. The patient was able to walk with a cane and was discharged on the 40th postoperative day. THA: total hip arthroplasty, CT: computed tomography, JOA score: Japanese Orthopaedic Association hip score, HA: hydroxyapatite, PMMA: polymethyl-methacrylate, APTT: activated partial thromboplastin time.

Joint Kinetics and Kinematics During Common Lower Limb Rehabilitation Exercises

PubMed Central

Comfort, Paul; Jones, Paul Anthony; Smith, Laura Constance; Herrington, Lee

2015-01-01

Context  Unilateral body-weight exercises are commonly used to strengthen the lower limbs during rehabilitation after injury, but data comparing the loading of the limbs during these tasks are limited. Objective  To compare joint kinetics and kinematics during 3 commonly used rehabilitation exercises. Design  Descriptive laboratory study. Setting  Laboratory. Patients or Other Participants  A total of 9 men (age = 22.1 ± 1.3 years, height = 1.76 ± 0.08 m, mass = 80.1 ± 12.2 kg) participated. Intervention(s)  Participants performed the single-legged squat, forward lunge, and reverse lunge with kinetic data captured via 2 force plates and 3-dimensional kinematic data collected using a motion-capture system. Main Outcome Measure(s)  Peak ground reaction forces, maximum joint angles, and peak sagittal-joint moments. Results  We observed greater eccentric and concentric peak vertical ground reaction forces during the single-legged squat than during both lunge variations (P ≤ .001). Both lunge variations demonstrated greater knee and hip angles than did the single-legged squat (P < .001), but we observed no differences between lunges (P > .05). Greater dorsiflexion occurred during the single-legged squat than during both lunge variations (P < .05), but we noted no differences between lunge variations (P = .70). Hip-joint moments were greater during the forward lunge than during the reverse lunge (P = .003) and the single-legged squat (P = .011). Knee-joint moments were greater in the single-legged squat than in the reverse lunge (P < .001) but not greater in the single-legged squat than in the forward lunge (P = .41). Ankle-joint moments were greater during the single-legged squat than during the forward lunge (P = .002) and reverse lunge (P < .001). Conclusions  Appropriate loading progressions for the hip should begin with the single-legged squat and progress to the reverse lunge and then the forward lunge. In contrast, loading progressions for the knee and ankle should begin with the reverse lunge and progress to the forward lunge and then the single-legged squat. PMID:26418958

Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty.

PubMed

Lee, Y K; Ha, Y C; Yoo, J-I; Jo, W L; Kim, K-C; Koo, K H

2017-06-01

We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

Patient-oriented Functional Results of Total Femoral Endoprosthetic Reconstruction Following Oncologic Resection

PubMed Central

Jones, Kevin B.; Griffin, Anthony M.; Chandrasekar, Coonoor R.; Biau, David; Babinet, Antoine; Deheshi, Benjamin; Bell, Robert S.; Grimer, Robert J.; Wunder, Jay S.; Ferguson, Peter C.

2011-01-01

Background and Objectives Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry. Methods 54 TFR patients were identified from 3 institutional prospective databases. 41 had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n=27 were compared between groups and to cohorts of PFR (n=31) and DFR (n=85) patients using the Mann-Whitney U test. Results Follow-up averaged 4 years. Mechanical complications included 5 hip dislocations and 1 femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3±17.8, statistically decreased from DFR (p=0.002) and PFR patients (p=0.036). No significant differences were detected between patients in the fixed-hinge (n=18) and rotating-hinge (n=9) groups (p = 0.944), or total hip (n=8) and hemiarthroplasty (n=19) groups (p=0.633). Conclusions TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants. PMID:21695701

The tribology of metal-on-metal total hip replacements.

PubMed

Scholes, S C; Unsworth, A

2006-02-01

Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.

Fibroblast growth factor 23, bone mineral density, and risk of hip fracture among older adults: the cardiovascular health study.

PubMed

Jovanovich, Anna; Bùzková, Petra; Chonchol, Michel; Robbins, John; Fink, Howard A; de Boer, Ian H; Kestenbaum, Bryan; Katz, Ronit; Carbone, Laura; Lee, Jennifer; Laughlin, Gail A; Mukamal, Kenneth J; Fried, Linda F; Shlipak, Michael G; Ix, Joachim H

2013-08-01

Fibroblast growth factor 23 (FGF23) is a phosphaturic hormone that also inhibits calcitriol synthesis. Our objective was to evaluate the relationships of plasma FGF23 concentrations with bone mineral density (BMD) and hip fracture in community-dwelling older adults. Linear regression and Cox proportional hazard models were used to examine the associations of plasma FGF23 concentrations with BMD and incident hip fracture, respectively. Analyses were also stratified by chronic kidney disease. Participants included 2008 women and 1329 men ≥65 years from the 1996 to 1997 Cardiovascular Health Study visit. Dual x-ray absorptiometry measured total hip (TH) and lumbar spine (LS) BMD in 1291 participants. Hip fracture incidence was assessed prospectively through June 30, 2008 by hospitalization records in all participants. Women had higher plasma FGF23 concentrations than men (75 [56-107] vs 66 [interquartile range = 52-92] relative units/mL; P < .001). After adjustment, higher FGF23 concentrations were associated with greater total hip and lumbar spine BMD in men only (β per doubling of FGF23 = 0.02, with 95% confidence interval [CI] = 0.001-0.04 g/cm(2), and 0.03 with 95% CI = 0.01-0.06 g/cm(2)). During 9.6 ± 5.1-11.0 years of follow-up, 328 hip fractures occurred. Higher FGF23 concentrations were not associated with hip fracture risk in women or men (adjusted hazard ratio = 0.95, with 95% CI = 0.78-1.15, and 1.09 with 95% CI = 0.82-1.46 per doubling of FGF23). Results did not differ by chronic kidney disease status (P > .4 for interactions). In this large prospective cohort of community-dwelling older adults, higher FGF23 concentrations were weakly associated with greater lumbar spine and total hip BMD but not with hip fracture risk.

Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications

PubMed Central

Tak, Igor; Engelaar, Leonie; Gouttebarge, Vincent; Barendrecht, Maarten; Van den Heuvel, Sylvia; Kerkhoffs, Gino; Langhout, Rob; Stubbe, Janine; Weir, Adam

2017-01-01

Background Whether hip range of motion (ROM) is a risk factor for groin pain in athletes is not known. Objectives To systematically review the relationship between hip ROM and groin pain in athletes in cross-sectional/case–control and prospective studies. Study design Systematic review, prospectively registered (PROSPERO) according to PRISMA guidelines. Methods Pubmed, Embase, CINAHL and SPORTDiscus were systematically searched up to December 2015. Two authors performed study selection, data extraction/analysis, quality assessment (Critical Appraisal Skills Programme) and strength of evidence synthesis. Results We identified seven prospective and four case–control studies. The total quality score ranged from 29% to 92%. Heterogeneity in groin pain classification, injury definitions and physical assessment precluded data pooling. There was strong evidence that total rotation of both hips below 85° measured at the pre-season screening was a risk factor for groin pain development. Strong evidence suggested that internal rotation, abduction and extension were not associated with the risk or presence of groin pain. Conclusion Total hip ROM is the factor most consistently related to groin pain in athletes. Screening for hip ROM is unlikely to correctly identify an athlete at risk of developing groin pain because of the small ROM differences found and poor ROM measurement properties. PMID:28432076

[Optimizing primary total hip replacement--a technique to effect saving of manpower].

PubMed

Huber, J F; Rink, M; Broger, I; Zumstein, M; Ruflin, G B

2003-01-01

Development of a standardized surgical technique for total hip replacement thereby saving manpower (one assistant) by using a retractor system. Total hip replacement is performed with the patient in a true lateral position on a tunnel cushion. By means of a direct lateral approach the pelvitrochanteric muscles are partially detached using an omega-shaped cut. The Bookwalter retractor is fixed dorsally on the operating table. The ring is centered keeping the greater trochanter in the middle. The Hohmann retractors are fixed to the ring to sufficiently expose the acetabulum. To insert the femoral stem the ring needs to be opened dorsally and the patient's leg is bent 90 degrees in the hip and the knee over the tunnel cushion. The muscles inserting at the greater trochanter are retracted by a separate Hohmann retractor with weight. In a case control study with matched pairs the patients treated with this technique were compared with those treated in supine position with the transgluteal approach. The number of assistants required and the operating time were assessed. All the hip replacements with the patient in side position were performed with one assistant, in supine position with two assistants. The operating time did not differ significantly (supine position 110 min/side position 112 min). The complication rate in both groups was comparable (one secondary wound healing, one transient ischalgia). The process of total hip replacement can be optimized. The described technique allows to spare one surgical assistant without prolonging the operating time.

[EFFECTIVENESS OF BILATERAL TOTAL HIP AND KNEE ARTHROPLASTY FOR SEVERE INFLAMMATORY ARTHROPATHIES].

PubMed

Li, Xin; Li, Heng; Ni, Ming; Li, Xiang; Song, Xinggui; Kong, Xiangpeng; Li, Yucong; Chen, Jiying

2016-11-08

To evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies. Between September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint. One-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones ( P <0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of >2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up ( P >0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint ( P <0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found ( P >0.05). A combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.

The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients

PubMed Central

2010-01-01

Objective To assess the incidence of total hip arthroplasty (THA) in osteoarthritic patients who were treated by arthroscopic debridement and to evaluate factors that might influence the time interval from the first hip arthroscopy to THA. Design Retrospective clinical series Methods Follow-up data and surgical reports were retrieved from 564 records of osteoarthritic patients that have had hip arthroscopy between the years 2002 to 2009 with a mean follow-up time of 3.2 years (range, 1-6.4 years). The time interval between the first hip arthroscopy to THA was modelled as a function of patient age; level of cartilage damage; procedures performed and repeated arthroscopies with the use of multivariate regression analysis. Results Ninety (16%) of all participants eventually required THA. The awaiting time from the first arthroscopy to a hip replacement was found to be longer in patients younger than 55 years and in a milder osteoarthritic stage. Patients that experienced repeated hip scopes had a longer time to THA than those with only a single procedure. Procedures performed concomitant with debridement and lavage did not affect the time interval to THA. Conclusions In our series of arthroscopic treatment of hip osteoarthritis, 16% required THA over a period of 7 years. Factors that influence the time to arthroplasty were age, degree of osteoarthritis and recurrent procedures. PMID:20670440

Activation of the hip adductor muscles varies during a simulated weight-bearing task.

PubMed

Hides, Julie A; Beall, Paula; Franettovich Smith, Melinda M; Stanton, Warren; Miokovic, Tanja; Richardson, Carolyn

2016-01-01

To investigate the pattern of muscle activation of the individual hip adductor muscles using a standardised simulated unilateral weight-bearing task. A repeated measures design. Laboratory. 20 healthy individuals (11 females, 9 males) participated in the study. Age ranged from 20 to 25 years. Surface electromyography recordings from adductor magnus and adductor longus muscles were taken at levels representing 10-50% of body weight during a simulated weight-bearing task. Electromyography (EMG) data were normalised to maximal voluntary isometric contraction. The adductor magnus was recruited at significantly higher levels than the adductor longus muscle during a simulated weight-bearing task performed across 10-50% of body weight (p < 0.01). Adductor magnus and adductor longus muscles are recruited to different extents during a simulated weight-bearing task. This information should be considered when selecting exercises for management and prevention of groin strains. Closed chain exercises with weight-bearing through the lower limb are more likely to recruit the adductor magnus muscle over the adductor longus muscle. Copyright © 2015 Elsevier Ltd. All rights reserved.

Association between unilateral or bilateral mastectomy and breast cancer death in patients with unilateral ductal carcinoma.

PubMed

Agarwal, Shailesh; Pappas, Lisa; Agarwal, Jayant

2017-01-01

Utilization of bilateral mastectomy for unilateral breast cancer is increasing despite cost and surgical risks with conflicting reports of survival benefit. Current studies evaluating death after bilateral mastectomy have included patients treated both with breast conservation therapy and unilateral mastectomy. In this study, we directly compared breast cancer-specific death of patients who underwent bilateral or unilateral mastectomy for unilateral breast cancer using a matched cohort analysis. This was an observational study of women diagnosed with unilateral breast cancer from 1998 through 2002, using the Surveillance, Epidemiology, and End Results (SEER) database. A 4-to-1 matched cohort of patients was selected including 14,075 patients. Mortality of the groups was compared using Cox proportional hazards models for cause-specific death. A total of 41,510 patients diagnosed with unilateral breast cancer were included. Unilateral mastectomy was performed in 93% of patients, while bilateral mastectomy was performed in the remaining 7% of patients. When 4-to-1 matching was performed, 11,260 unilateral mastectomy and 2,815 bilateral mastectomy patients were included. Patients with bilateral mastectomy did not have a significantly lower hazard of breast cancer-specific death when compared with patients with unilateral mastectomy (hazard ratio: 0.92 vs 1.00, p =0.11). Bilateral mastectomy did not provide a clinically or statistically significant breast cancer-specific mortality benefit over unilateral mastectomy based on a matched cohort analysis of a nationwide population database. These findings should be interpreted in the context of patient preference and alternative benefits of bilateral mastectomy.

Association between unilateral or bilateral mastectomy and breast cancer death in patients with unilateral ductal carcinoma

PubMed Central

Agarwal, Shailesh; Pappas, Lisa; Agarwal, Jayant

2017-01-01

Background Utilization of bilateral mastectomy for unilateral breast cancer is increasing despite cost and surgical risks with conflicting reports of survival benefit. Current studies evaluating death after bilateral mastectomy have included patients treated both with breast conservation therapy and unilateral mastectomy. In this study, we directly compared breast cancer–specific death of patients who underwent bilateral or unilateral mastectomy for unilateral breast cancer using a matched cohort analysis. Methods This was an observational study of women diagnosed with unilateral breast cancer from 1998 through 2002, using the Surveillance, Epidemiology, and End Results (SEER) database. A 4-to-1 matched cohort of patients was selected including 14,075 patients. Mortality of the groups was compared using Cox proportional hazards models for cause-specific death. Results A total of 41,510 patients diagnosed with unilateral breast cancer were included. Unilateral mastectomy was performed in 93% of patients, while bilateral mastectomy was performed in the remaining 7% of patients. When 4-to-1 matching was performed, 11,260 unilateral mastectomy and 2,815 bilateral mastectomy patients were included. Patients with bilateral mastectomy did not have a significantly lower hazard of breast cancer–specific death when compared with patients with unilateral mastectomy (hazard ratio: 0.92 vs 1.00, p=0.11). Conclusion Bilateral mastectomy did not provide a clinically or statistically significant breast cancer–specific mortality benefit over unilateral mastectomy based on a matched cohort analysis of a nationwide population database. These findings should be interpreted in the context of patient preference and alternative benefits of bilateral mastectomy. PMID:29180900

Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture.

PubMed

Karagiannis, A; Papakitsou, E; Dretakis, K; Galanos, A; Megas, P; Lambiris, E; Lyritis, G P

2006-02-01

Increased mortality after a hip fracture has been associated with age, sex, and comorbidity. In order to estimate the long-term mortality with reference to hip fracture type, we followed 499 patients older than 60 years who had been treated surgically for a unilateral hip fracture for 10 years. At admission, patients with femoral neck fractures (n = 172) were 2 years younger than intertrochanteric patients (77.6 +/- 7.7 [SD] vs. 79.9 +/- 7.4 [SD], P = 0.001) and had a greater prevalence of heart failure (57% vs. 40.3%, P = 0.03). Similar mortality rates were observed at 1 year in both types of fracture (17.9% vs. 11.3%, log rank test P = 0.112). Mortality rates were significantly higher for intertrochanteric fractures at 5 years (48.8% vs. 34.7%, P = 0.01) and 10 years (76% vs. 58%, P = 0.001). Patients 60-69 years old with intertrochanteric fractures had significantly higher 10-year mortality than patients of similar age with femoral neck fractures (P = 0.008), while there was no difference between the groups aged 70-79 (P > 0.3) and 80-89 (P = 0.07). Women were less likely to die in 5 years (relative risk [RR] = 0.57, 95% confidence interval [CI] 0.41-0.79, P = 0.0007) and 10 years (RR = 0.65, 95% CI 0.49-0.85, P = 0.002). Age, sex, the type of fracture, and the presence of heart failure were independent predictors of 10-year mortality (Cox regression model P < 0.0001). The intertrochanteric type was independently associated with 1.37 (95% CI 1.03-1.83) times higher probability of death at 10 years (P = 0.002). In conclusion, the type of fracture is an independent predictor of long-term mortality in patients with hip fractures, and the intertrochanteric type yields worse prognosis.

The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up: Short title: Ossis custom 3D-Printed tri-flanged acetabular implant.

PubMed

Kieser, David C; Ailabouni, Ramez; Kieser, Sandra C J; Wyatt, Michael C; Armour, Paul C; Coates, Mark H; Hooper, Gary J

2018-05-01

Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed. Patient mean age was 68 years and follow-up was 38 months (minimum 24 months). 10 patients were excluded from the outcome analysis; 2 patients died, 1 required revision for deep infection and 7 were lost to follow-up. Of the 36 patients included, 21 had severe osteolysis. 7 were revised for infection, 3 for tumoural defects, 3 for metallosis, 1 for dysplasia and 1 for trauma (Paprosky 2a [n=6], 2b [n=2], 2c [n=5], 3a [n=6], 3b [n=11], pelvic dissociation [n=6]). OHS significantly improved postoperatively (16-8-48.4 p=0.027). Postoperative functional scores were good (WOMAC 98; HHS 79). The biomechanical hip centre was restored in all patients. 1 patient had early implant migration with subsequent stabilisation. 2 patients had radiographs concerning for failure of osteointegration. 1 patient had recurrent dislocations. The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.

Trends in the phenotypic hip status of selected breeds of dog as measured by the New Zealand Veterinary Association Hip Dysplasia scheme (1990-2008).

PubMed

Worth, A J; Bridges, J P; Jones, G

2011-03-01

To determine whether there has been improvement in the phenotypic hip dysplasia status in four susceptible dog breeds as measured by the New Zealand Veterinary Association (NZVA) Canine Hip Dysplasia (CHD) scheme. A retrospective analysis of the NZVA CHD database was performed using records of all German Shepherd dogs, Labrador Retrievers, Golden Retrievers and Rottweilers that had undergone evaluation for hip dysplasia between 1990 and 2008. The effect of date of birth on the total hip score was analysed using linear regression, including the covariates of age and gender. When a significant effect of date of birth on total score was noted, ordinal logistic regression was performed to determine the probability of different grades of the Norberg angle and subluxation scores by year of birth; these categories being most indicative of laxity of the coxofemoral joint. Given the known heritability of hip phenotype, determined using radiological measurements, the hypothesis was that if sufficient selection pressure has been applied there would have been a trend towards a lower total score over time. For Labrador Retrievers (n=1,451), Golden Retrievers (n=896) and Rottweilers (n=313), there was no effect of date of birth on total score over the period of the study (p>0.1). For German Shepherd dogs (n=1,087), there was a significant trend to a lower total score over time (p=0.0003). However the actual size of the effect was small. Ordinal logistic regression on the Norberg angle and subluxation scores for German Shepherd dogs demonstrated a significant lowering of grade in both of these measures of hip laxity. This study failed to show significant improvement in the phenotypic hip status of three out of the four most populous large-dog breeds in the NZVA CHD database. Even in the German Shepherd dog, the trend towards a lower total score did not represent a substantial change. Lack of evidence of phenotypic improvement may be due to insufficient selection pressure over the course of the study, selective usage of the scheme (and thus a biased sample), or deficiencies within the NZVA CHD scoring method itself. Greater improvement might be possible if use of the scheme (or an equivalent) is made a compulsory requirement for registration of pedigree breeding stock, if greater selection pressure is applied and/or if pedigree data are included to enable estimations of breeding value.

Lunar phase does not influence perioperative complications in total hip arthroplasty.

PubMed

Ficklscherer, Andreas; Angermann, Alexander; Weber, Patrick; Wegener, Bernd; Pietschmann, Matthias; Müller, Peter

2012-02-29

Lunar calendars, publishing recommendations for daily life, are gaining more and more attention in Germany, where 10.5% of the population believe in lunar effects on disease. A widespread and often heard belief is that a full moon has the most negative effects on surgical outcome. The present study evaluates the effects of lunar phase on perioperative complications in total hip arthroplasty. We performed a retrospective study with 305 patients being provided with a primary hip arthroplasty. To identify possible influences of the lunar phase on perioperative complications we investigated data such as operation length, blood loss and course of C-reactive protein that were collected during the patients' stay in the hospital and allocated them to moon illumination. There were no significant differences in all collected data concerning the lunar phase (p > 0.05). Although not statistically significant, there were fewer operations during the full moon phase. Therefore there is no evidence that lunar phase has an effect on perioperative complications in total hip arthroplasty. Fewer, though not significantly fewer, operations were performed during the full moon phase. Although this was not a prospective randomized trial, the statistical magnitude of the results does not support any recommendations for scheduling patients for total hip arthroplasty at any particular day of the lunar phase.

The Role of Hip Arthroscopy in Investigating and Managing the Painful Hip Resurfacing Arthroplasty.

PubMed

Mei-Dan, Omer; Pascual-Garrido, Cecilia; Moreira, Brett; McConkey, Mark O; Young, David A

2016-03-01

To determine the safety and efficacy of hip arthroscopy performed in the peripheral compartment as a diagnostic and therapeutic treatment option for patients with hip pain after hip resurfacing surgery. Indications for hip arthroscopy after hip resurfacing included patients with a symptomatic hip-resurfaced arthroplasties who did not respond to nonoperative treatment. Patients who underwent a hip arthroscopy after a painful hip resurfacing were included with a minimum of 1 year follow-up. Subgroup analysis was performed according to whether an established diagnosis was made before arthroscopic intervention or not. Subjective measures were based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, and results were calculated and analyzed. We included 68 patients (26 male [38%] and 42 female [62%]) who underwent subsequent hip arthroscopy from a population of 978 consecutive hip-resurfaced arthroplasties performed between 1999 and 2010. The average age was 58 (range, 37 to 78 years). The mean follow-up after hip arthroscopy was 3.4 years (range, 12 months to 5.8 years). Patients who had an established diagnosis (n = 41) before hip arthroscopy showed statistical improvement in their WOMAC scores (7 to 2, P < .001). Only 3 (7%) of these 41 patients failed and were converted to a total hip replacement (THR); however, patients who did not have an established diagnosis (n = 27) before undergoing hip arthroscopy showed statistical worsening of the WOMAC (15 to 21, P = .002). Ten (37%) of these 27 patients without a diagnosis failed and needed to be converted to a THR. A significant correlation was found between the collections found on ultrasound (psoas bursa and/or in the hip joint) and the need for synovectomy (P = .01). The overall revision rate to THR after hip resurfacing in our group of patients was 1.3% (n = 13). Female patients were more likely to require postresurfacing hip arthroscopy with 42 (60%) female to only 26 (40%) male patients undergoing this procedure. In our study population, 70% (14/21, P < .05) of patients with hip pain caused by severe metal synovial reaction or metal-on-metal reaction were women. A total of 5 (7%) patients had minor-to-mild complications after hip arthroscopy. Hip arthroscopy is a safe surgical treatment option for those patients with a painful hip resurfacing arthroplasty. Having an accurate diagnosis before hip arthroscopy improves the likelihood a good outcome. Level IV - therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The influence of early or delayed provision of ankle-foot orthoses on pelvis, hip and knee kinematics in patients with sub-acute stroke: A randomized controlled trial.

PubMed

Nikamp, Corien D M; van der Palen, Job; Hermens, Hermie J; Rietman, Johan S; Buurke, Jaap H

2018-06-01

Compensatory pelvis, hip- and knee movements are reported after stroke to overcome insufficient foot-clearance. Ankle-foot orthoses (AFOs) are often used to improve foot-clearance, but the optimal timing of AFO-provision post-stroke is unknown. Early AFO-provision to prevent foot-drop might decrease the development of compensatory movements, but it is unknown whether timing of AFO-provision affects post-stroke kinematics. 1) To compare the effect of AFO-provision at two different points in time (early versus delayed) on frontal pelvis and hip, and sagittal hip and knee kinematics in patients with sub-acute stroke. Effects were assessed after 26 weeks; 2) To study whether possible changes in kinematics or walking speed during the 26-weeks follow-up period differed between both groups. An explorative randomized controlled trial was performed, including unilateral hemiparetic patients maximal six weeks post-stroke with indication for AFO-use. Subjects were randomly assigned to AFO-provision early (at inclusion) or delayed (eight weeks later). 3D gait-analysis with and without AFO was performed in randomized order. Measurements were performed in study-week 1, 9, 17 and 26. Twenty-six subjects (15 early, 11 delayed) were analyzed. After 26 weeks, no differences in kinematics were found between both groups for any of the joint angles, both for the without and with AFO-condition. Changes in kinematics during the 26-weeks follow-up period did not differ between both groups for any of the joint angles during walking without AFO. Significant differences in changes in walking speed during the 26-weeks follow-up were found (p = 0.034), corresponding to the first eight weeks after AFO-provision. Results indicate that early or delayed AFO-use post-stroke does not influence pelvis, hip and knee movements after 26 weeks, despite that AFO-use properly corrected drop-foot. AFOs should be provided to improve drop-foot post-stroke, but not with the intention to influence development of compensatory patterns around pelvis and hip. Copyright © 2018 Elsevier B.V. All rights reserved.

The results of a proximally-coated cementless femoral component in total hip replacement: a five- to 12-year follow-up.

PubMed

Kim, Y-H

2008-03-01

This study reviewed the results of a cementless anatomical femoral component to give immediate post-operative stability, and with a narrow distal section in order not to contact the femoral cortex in the diaphysis, ensuring exclusively metaphyseal loading. A total of 471 patients (601 hips) who had a total hip replacement between March 1995 and February 2002 were included in the study. There were 297 men and 174 women. The mean age at the time of operation was 52.7 years (28 to 63). Clinical and radiological evaluation were performed at each follow-up. Bone densitometry was carried out on all patients two weeks after operation and at the final follow-up examination. The mean follow-up was 8.8 years (5 to 12). The mean pre-operative Harris hip score was 41 points (16 to 54), which improved to a mean of 96 (68 to 100) at the final follow-up. No patient complained of thigh pain at any stage. No acetabular or femoral osteolysis was observed and no hip required revision for aseptic loosening of either component. Deep infection occurred in two hips (0.3%) which required revision. One hip (0.2%) required revision of the acetabular component for recurrent dislocation. Bone mineral densitometry revealed a minimal bone loss in the proximal femur. This cementless anatomical femoral component with metaphyseal loading but without distal fixation produced satisfactory fixation and encourages proximal femoral loading.

Perioperative morbidity and mortality of total hip replacement in liver transplant recipients: a 7-year single-center experience.

PubMed

Aminata, Iman; Lee, Soo-Ho; Chang, Jae-Suk; Lee, Choon-Sung; Chun, Jae-Myeung; Park, Jin-Woong; Pawaskar, Aditya; Jeon, In-Ho

2012-12-15

This study aims to evaluate perioperative mortality and morbidity after total hip replacement in liver transplant recipients and suggesting safety guidelines. Hip replacement surgery is one of the most common elective surgeries even for organ transplant recipients. However, there is a paucity of literature addressing the morbidity and complications of hip replacement surgery for liver transplant recipients. We analyzed retrospectively 33 arthroplasty cases in 20 liver transplant recipients carried out in a single center from 2005 to 2011. All perioperative clinical and laboratory data were evaluated together with early and late morbidity and mortality. Of 2253 liver transplant recipients, 20 (0.9%) patients underwent 33 total hip arthroplasties. Thirty-two arthroplasties were performed for avascular necrosis of the femoral head, whereas only one was performed for osteoarthritis. There was no death, liver failure, or infection within 30 days after surgery. Three patients showed elevated liver enzyme more than 5 times the normal value, but it eventually decreased to normal within 1 week. Of 33 cases of arthroplasty, postoperative blood transfusion was needed in 14 cases with 1 case receiving more than 4 U. On long-term follow-up, no patients have developed periprosthetic fracture, implant loosening, or liver failure. All patients showed good to excellent postoperative Harris hip score. In this series, we can infer that hip replacement surgery in liver transplantation patients is safe and gives a reliably good result. Some preoperative conditions should be obtained to reduce postoperative morbidity.

Prospective analyses of female urinary incontinence symptoms following total hip arthroplasty.

PubMed

Okumura, Keiko; Yamaguchi, Kumiko; Tamaki, Tatsuya; Oinuma, Kazuhiro; Tomoe, Hikaru; Akita, Keiichi

2017-04-01

Some patients with hip osteoarthritis report that urinary incontinence (UI) is improved following total hip arthroplasty (THA). However, the type and severity of UI remain unclear. In this study, we hypothesize that both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) are improved after THA. We assess the characteristics of UI and discuss the anatomical factors related to UI and THA for improved treatment outcome. Fifty patients with UI who underwent direct anterior-approach THA were evaluated. Type of UI was assessed using four questionnaires: Core Lower Urinary Tract Symptom Score (CLSS), Urogenital Distress Inventory Short Form (UDI-6), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Uroflowmetry and postvoid residual urine were measured using ultrasound technology. Hip-joint function was evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM). Of the 50 patients, 21 had SUI, 16 had mixed urinary incontinence (MUI), and eight had urgency urinary incontinence (UUI). In total, 36 patients were better than improved (72 %). The rate of cured and improved was 76 % for SUI, 100 % MUI, and 50 % UUI. The improvement of ROM was more significant in cured or improved patients than in stable or worse patients. Improvement in mild UI may be an added benefit for those undergoing THA for hip-joint disorders. These data suggest that for patients with hip-joint disorder, hip-joint treatment could prove to also be a useful treatment for UI.

Association between contact hip stress and RSA-measured wear rates in total hip arthroplasties of 31 patients.

PubMed

The, Bertram; Hosman, Anton; Kootstra, Johan; Kralj-Iglic, Veronika; Flivik, Gunnar; Verdonschot, Nico; Diercks, Ron

2008-01-01

The main concern in the long run of total hip replacements is aseptic loosening of the prosthesis. Optimization of the biomechanics of the hip joint is necessary for optimization of long-term success. A widely implementable tool to predict biomechanical consequences of preoperatively planned reconstructions still has to be developed. A potentially useful model to this purpose has been developed previously. The aim of this study is to quantify the association between the estimated hip joint contact force by this biomechanical model and RSA-measured wear rates in a clinical setting. Thirty-one patients with a total hip replacement were measured with RSA, the gold standard for clinical wear measurements. The reference examination was done within 1 week of the operation and the follow-up examinations were done at 1, 2 and 5 years. Conventional pelvic X-rays were taken on the same day. The contact stress distribution in the hip joint was determined by the computer program HIPSTRESS. The procedure for the determination of the hip joint contact stress distribution is based on the mathematical model of the resultant hip force in the one-legged stance and the mathematical model of the contact stress distribution. The model for the force requires as input data, several geometrical parameters of the hip and the body weight, while the model for stress requires as input data, the magnitude and direction of the resultant hip force. The stress distribution is presented by the peak stress-the maximal value of stress on the weight-bearing area (p(max)) and also by the peak stress calculated with respect to the body weight (p(max)/W(B)) which gives the effect of hip geometry. Visualization of the relations between predicted values by the model and the wear at different points in the follow-up was done using scatterplots. Correlations were expressed as Pearson r values. The predicted p(max) and wear were clearly correlated in the first year post-operatively (r = 0.58, p = 0.002), while this correlation is weaker after 2 years (r = 0.19, p = 0.337) and 5 years (r = 0.24, p = 0.235). The wear values at 1, 2 and 5 years post-operatively correlate with each other in the way that is expected considering the wear velocity curve of the whole group. The correlation between the predicted p(max) values of two observers who were blinded for each other's results was very good (r = 0.93, p < 0.001). We conclude that the biomechanical model used in this paper provides a scientific foundation for the development of a new way of constructing preoperative biomechanical plans for total hip replacements.

Effect of Body Mass Index on Complications and Reoperations After Total Hip Arthroplasty.

PubMed

Wagner, Eric R; Kamath, Atul F; Fruth, Kristin M; Harmsen, William S; Berry, Daniel J

2016-02-03

High body mass index (BMI) is associated with increased rates of complications after total hip arthroplasty. Studies to date have evaluated risk mainly as a dichotomous variable according to BMI thresholds. The purpose of this paper was to characterize the risk of complications and implant survival according to BMI as a continuous variable. Using prospectively collected data from our institutional total joint registry, we analyzed 21,361 consecutive hips (17,774 patients) treated with primary total hip arthroplasty between 1985 and 2012 at a single institution. The average BMI at the time of surgery was 28.7 kg/m(2) (range, 15 to 69 kg/m(2)). Estimates of revision surgery and common complications associated with BMI were analyzed using the Kaplan-Meier method of assessing survivorship, with associations of outcomes assessed using a Cox model. Utilizing smoothing spline parameterization, we found that reoperation (p < 0.001) and implant revision or removal rates (p = 0.002) increased with increasing BMI. Increasing BMI was associated with increased rates of early hip dislocation (p = 0.02), wound infection, and, most strikingly, deep periprosthetic infection (a hazard ratio of 1.09 per unit of BMI >25 kg/m(2); p < 0.001). However, we found no association between increasing BMI and any revision for mechanical failure of the implant or between increasing BMI and revision for aseptic implant loosening. There was an inverse correlation between increasing BMI and risk of revision for bearing wear. The rates of reoperation, implant revision or removal, and common complications after total hip arthroplasty were strongly associated with BMI. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Analysis of laterality and percentage of tumor involvement in 1386 prostatectomized specimens for selection of unilateral focal cryotherapy.

PubMed

Mouraviev, Vladimir; Mayes, Janice M; Madden, John F; Sun, Leon; Polascik, Thomas J

2007-04-01

In total, 1386 paraffin embedded radical prostatectomy specimens from patients with clinically localized prostate cancer (PCa) excised between 2002-06 were analyzed. Pathologic assessment paid particular attention to laterality and percentage of tumor involvement (PTI) along with pathologic Gleason Score (pGS). Completely unilateral cancers were identified in 254 (18.3%) patients, and in 39% cases of them the signs of clinically significant PCa were revealed. The majority of unilateral tumors (72%) were low volume with a PTI of < or =5. This study suggests that only a select group of men diagnosed with PCa have completely unilateral cancers that would be amenable to focal ablation therapy targeting 1 lobe. Further study is needed to develop predictive models for those patients likely to have small, unilateral cancers that may be amenable to focal therapy.

The cost analysis of cemented versus cementless total hip replacement operations on the NHS.

PubMed

Kallala, R; Anderson, P; Morris, S; Haddad, F S

2013-07-01

In a time of limited resources, the debate continues over which types of hip prosthesis are clinically superior and more cost-effective. Orthopaedic surgeons increasingly need robust economic evidence to understand the full value of the operation, and to aid decision making on the 'package' of procedures that are available and to justify their practice beyond traditional clinical preference. In this paper we explore the current economic debate about the merits of cemented and cementless total hip replacement, an issue that continues to divide the orthopaedic community.

Simulated studies of wear and friction in total hip prosthesis components with various ball sizes and surface finishes

NASA Technical Reports Server (NTRS)

Swikert, M. A.; Johnson, R. L.

1976-01-01

Experiments were conducted on a newly designed total hip joint simulator. The apparatus closely simulates the complex motions and loads of the human hip in normal walking. The wear and friction of presently used appliance configurations and materials were determined. A surface treatment of the metal femoral ball specimens was applied to influence wear. The results of the investigation indicate that wear can be reduced by mechanical treatment of metal femoral ball surfaces. A metallographic examination and surface roughness measurements were made.

The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol.

PubMed

Jensen, Carsten; Roos, Ewa M; Kjærsgaard-Andersen, Per; Overgaard, Søren

2013-01-14

The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone. A prospective, blinded, parallel-group multi-center trial (2 sites), with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score), and patient's global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed. To our knowledge, this is the first randomized clinical trial comparing a patient education plus supervised exercise program to patient education alone in hip osteoarthritis patients with an indication for surgery on the time to total hip replacement. NCT01697241.

Ultrasound-guided Radiofrequency Lesioning of the Articular Branches of the Femoral Nerve for the Treatment of Chronic Post-arthroplasty Hip Pain.

PubMed

Kim, David J; Shen, Shiqian; Hanna, George M

2017-02-01

Total hip arthroplasty (THA) is a common surgical treatment for several conditions of the hip. While the majority of patients obtain satisfactory results, many develop chronic post-arthroplasty hip pain that can be difficult to treat. We evaluate the effectiveness of cooled (60°C) radiofrequency lesioning of the articular branches of the femoral nerve (ABFN) as a minimally invasive treatment for patients suffering from chronic post-arthroplasty hip pain. This treatment has never been described previously in this population. Case report. Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School. A 59-year-old woman with long-standing osteoarthritis of the right hip who underwent primary total hip arthroplasty and presented with chronic post-arthroplasty hip pain Intervention: Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance Outcome Measure: Functional ability and numeric rating scale (NRS) scores at rest and with activity. Prior to intervention, the patient reported severe disruption in daily activities, sleep, and relationships; NRS scores at rest and with activity were 4/10 and 10/10, respectively. At 4 weeks following intervention, the patient reported significant improvement in functional ability and NRS scores decreased to 1/10 and 2/10, respectively. At 6 months, the patient's NRS scores at rest and with activity were 0/10 and 1/10, respectively. At 24-month follow-up, the patient continued to endorse significant pain relief with NRS scores at rest and with activity of 0 - 1/10 and 1 - 2/10, respectively. There were no side effects or complications including motor weakness, sensory loss, and neuralgias. Although the patient obtained good results from the intervention, the description of the study is from a single case report. Further study is necessary to investigate the widespread use of this technique and its outcomes. Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance is both an effective and minimally invasive intervention for chronic post-arthroplasty hip pain. Key words: Radiofrequency lesioning, articular branches, femoral nerve, post-arthoplasty, total hip arthoplasty, hip pain, chronic pain.

Is There an Association Between Borderline-to-mild Dysplasia and Hip Osteoarthritis? Analysis of CT Osteoabsorptiometry.

PubMed

Irie, Tohru; Takahashi, Daisuke; Asano, Tsuyoshi; Arai, Ryuta; Terkawi, Muhammad Alaa; Ito, Yoichi M; Iwasaki, Norimasa

2018-07-01

The definitive treatment of borderline-to-mild dysplasia remains controversial. A more comprehensive understanding of the etiology of osteoarthritis (OA) and clarification of any possible association between borderline-to-mild dysplasia and the pathogenesis of OA are essential. (1) Does the distribution of acetabular subchondral bone density increase according to dysplasia severity? (2) Is there an association between borderline-to-mild dysplasia and OA pathogenesis? We evaluated bilateral hips of patients with developmental dysplasia of the hip who underwent eccentric rotational acetabular osteotomy (ERAO) for inclusion in the dysplasia group and contralateral hips of patients with unilateral idiopathic osteonecrosis of the femoral head (ONFH) who underwent curved intertrochanteric varus osteotomy (CVO) for the control group. ERAO was performed in 46 patients and CVO was performed in 32 patients between January 2013 and August 2016 at our institution. All patients underwent bilateral hip CT. The study included 55 hips categorized according to dysplasia severity: (1) borderline-mild, 19 hips (15° ≤ lateral center-edge angle [LCEA] < 25°); (2) moderate, 20 hips (5° ≤ LCEA < 15°); (3) severe, 16 hips (LCEA < 5°); and (4) control, 15 hips. Thirty-seven dysplastic hips (age < 15 or > 50 years old, prior hip surgery, subluxation, aspherical femoral head, cam deformity, and radiographic OA) and 17 control hips (age < 15 or > 50 years old, bilateral ONFH, LCEA < 25° or ≥ 35°, cam deformity, and radiographic OA) were excluded. CT-osteoabsorptiometry (OAM) predicts physiologic biomechanical conditions in joints by evaluating subchondral bone density. We evaluated the distribution of subchondral bone densities in the acetabulum with CT-OAM, dividing the stress distribution map into six segments: anteromedial, anterolateral, centromedial, centrolateral, posteromedial, and posterolateral. We calculated the percentage of high-density area, which was defined as the upper 30% of Hounsfield units values in each region and compared least square means difference estimated by the random intercept model among the four groups. In all regions, the percentage of high-density area did not differ between the borderline-mild group and the control (eg, anterolateral, 16.2 ± 5.6 [95% CI, 13.4 to 18.9] versus 15.5 ± 5.7 [95% CI, 12.4 to 18.5, p = 0.984]; centrolateral, 39.1 ± 5.7 [95% CI, 36.4 to 41.8] versus 39.5 ± 4.7 [95% CI, 36.6 to 42.5, p = 0.995]; posterolateral, 10.9 ± 5.2 [95% CI, 8.0 to 13.8] versus 15.1 ± 6.8 [95% CI, 11.7 to 18.5, p = 0.389]). In the anterolateral region, a smaller percentage of high-density area was observed in the borderline-mild group than in both the moderate group (16.2 ± 5.6 [95% CI, 13.4-18.9] versus 28.2 ± 5.1 [95% CI, 25.5-30.9], p < 0.001) and the severe group (16.2 ± 5.6 [95% CI, 13.4-18.9] versus 22.2 ± 6.8 [95% CI, 19.2-25.2, p = 0.026). Our results suggest that the cumulative hip stress distribution in borderline-to-mild dysplasia was not concentrated on the lateral side of the acetabulum, unlike severe dysplasia. Based on the stress distribution pattern, our results may suggest that there is no association between borderline-to-mild dysplasia and the pathogenesis of OA. Further studies are needed to evaluate the association between borderline-to-mild dysplasia and instability of the hip.

Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calvé-Perthes disease.

PubMed

Terjesen, Terje; Wiig, Ola; Svenningsen, Svein

2012-09-01

In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%. We asked whether (1) femoral osteotomy improves femoral head sphericity at followup in all patients with more than 50% femoral head necrosis or in selected groups only and (2) there is a critical age between 6.0 and 10.0 years over which femoral osteotomy does not improve the prognosis. We treated 70 patients with unilateral LCPD, age at diagnosis of more than 6.0 years, and femoral head necrosis of more than 50% with varus femoral osteotomy between 1996 and 2000. We classified necrosis using the Catterall classification. We established a control group of 51 similar children who received physiotherapy. At the 5-year followup visit, the hips were graded according to femoral head shape: spherical, ovoid, or flat. At 5-year followup, there was no difference between the treatment groups in radiographic outcome in Catterall Group 3 hips. In Catterall Group 4 hips, femoral head sphericity was better in the osteotomy group, with flat femoral heads in 14% compared to 75% after physiotherapy. The same trend toward better head sphericity occurred when the lateral pillar classification was used. In children aged 6.0 to 10.0 years, in whom the whole femoral head is affected, femoral head sphericity 5 years after femoral osteotomy was better than that after physiotherapy.

Methodological Challenges of Multiple-Component Intervention: Lessons Learned from a Randomized Controlled Trial of Functional Recovery After Hip Fracture

PubMed Central

Peterson, Margaret G.E.; Cornell, Charles N.; MacKenzie, C. Ronald; Robbins, Laura; Horton, Roberta; Ganz, Sandy B.; Ruchlin, Hirsch S.; Russo, Pamela Williams; Paget, Stephen A.; Charlson, Mary E.

2006-01-01

We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-component intervention designed to improve functional recovery after hip fracture. One hundred seventy-six patients who underwent surgery for a primary unilateral hip fracture were assigned randomly to receive usual care (control arm, n = 86) or a brief motivational videotape, supportive peer counseling, and high-intensity muscle-strength training (intervention arm, n = 90). Between-group differences on the physical functioning, role-physical, and social functioning domains of the SF-36 were assessed postoperatively at 6 months. At the end of the trial, 32 intervention and 27 control patients (34%) completed the 6-month outcome assessment. Although patient compliance with all three components of the intervention was uneven, over 90% of intervention patients were exposed to the motivational videotape. Intervention patients experienced a significant (P = 0.03) improvement in the role-physical domain (mean change, −11 ± 33) compared to control patients (mean change, −37 ± 41). Change in general health (P = 0.2) and mental health (P = 0.1) domain scores was also directionally consistent with the study hypothesis. Although our findings are consistent with previous reports of comprehensive rehabilitation efforts for hip fracture patients, the trial was undermined by high attrition and the possibility of self-selection bias at 6-month follow-up. We discuss the methodological challenges and lessons learned in conducting a randomized controlled trial that sought to implement and assess the impact of a complex intervention in a population that proved difficult to follow up once they had returned to the community. PMID:18751772

Is there a relationship between preferred posture and positioning in early life and the direction of subsequent asymmetrical postural deformity in non ambulant people with cerebral palsy?

PubMed

Porter, David; Michael, Shona; Kirkwood, Craig

2008-09-01

It has been suggested that asymmetrical positioning of an infant with reduced mobility may lead to postural deformity becoming established over time. However, evidence to support or question this line of thinking is lacking. Therefore, the aim of this retrospective cohort study was to test the association between asymmetrical positioning in the first 12 months of life and the subsequent direction of postural deformity in non-ambulant people with cerebral palsy. The direction of scoliosis, pelvic obliquity and windswept hip pattern and also the side of unilateral hip subluxation/dislocation were determined for 246 young people ranging in age from 1 year and 2 months to 19 years (median age 10 years and 3 months). Parents/carers of the participants were interviewed to establish holding and feeding positions and preferred lying posture adopted in early life. Univariate analyses and multivariate logistic regression analyses were carried out. The study provided evidence of an association between asymmetrical lying posture adopted in the first year of life and the direction of the subsequent pattern of postural deformity. If the child's head had been rotated to the right during supine lying, it was more likely that the scoliosis would be convex to the left, pelvic obliquity would be lower on the left, windswept hip pattern would be to the right and hip subluxation/dislocation would occur on the left. The likelihood of the deformities occurring in the same direction was also increased if consistent side lying on the right had been preferred. Clinicians should be aware of positioning for children with severe disabilities particularly those who prefer supine lying with their head rotated to the side and those who prefer consistent side lying.

Effect of an eccentrically biased hamstring strengthening home program on knee flexor strength and the length-tension relationship.

PubMed

Orishimo, Karl F; McHugh, Malachy P

2015-03-01

The purposes of this study were to document relative activation intensities of the hamstrings and gluteus maximus during 4 eccentric hamstring strengthening exercises and to assess the effects of a short-term strengthening program comprised of these exercises on knee flexor strength and the length-tension relationship. Twelve healthy subjects participated in this study. Electromyographic (EMG) activities from the biceps femoris, semitendinosus, and gluteus maximus were recorded as subjects performed (a) standing hip extension with elastic resistance, (b) trunk flexion in single limb stance (diver), (c) standing split (glider), and (d) supine sliding bridge (slider). Baseline isometric knee flexor strength was measured at 90, 70, 50, and 30° of flexion at the knee with the subject seated and the hip flexed to 50° from horizontal. After completing the 4-week training program, strength tests were repeated. Repeated-measures analysis of variance were used to compare EMG activity between muscles and to assess angle-specific strength improvements. Hamstring activity exceeded gluteus maximus activity for resisted hip extension, glider, and slider exercises (p < 0.001) but not for the diver (p = 0.087). Hamstring activation was greatest during the slider and resisted hip extension and lowest during the glider and the diver. Knee flexor strength improved by 9.0% (p = 0.005) but was not angle specific (training by angle p = 0.874). The short-term home training program effectively targeted the hamstrings and resulted in strength gains that were similar at short and long muscle lengths. These data demonstrate that hamstring strength can be improved using eccentrically biased unilateral exercises without the use of weights or other equipments.

Intravenous Tranexamic Acid Bolus plus Infusion Is Not More Effective than a Single Bolus in Primary Hip Arthroplasty: A Randomized Controlled Trial.

PubMed

Zufferey, Paul J; Lanoiselée, Julien; Chapelle, Céline; Borisov, Dmitry B; Bien, Jean-Yves; Lambert, Pierre; Philippot, Rémi; Molliex, Serge; Delavenne, Xavier

2017-09-01

Preoperative administration of the antifibrinolytic agent tranexamic acid reduces bleeding in patients undergoing hip arthroplasty. Increased fibrinolytic activity is maintained throughout the first day postoperation. The objective of the study was to determine whether additional perioperative administration of tranexamic acid would further reduce blood loss. This prospective, double-blind, parallel-arm, randomized, superiority study was conducted in 168 patients undergoing unilateral primary hip arthroplasty. Patients received a preoperative intravenous bolus of 1 g of tranexamic acid followed by a continuous infusion of either tranexamic acid 1 g (bolus-plus-infusion group) or placebo (bolus group) for 8 h. The primary outcome was calculated perioperative blood loss up to day 5. Erythrocyte transfusion was implemented according to a restrictive transfusion trigger strategy. The mean perioperative blood loss was 919 ± 338 ml in the bolus-plus-infusion group (84 patients analyzed) and 888 ± 366 ml in the bolus group (83 patients analyzed); mean difference, 30 ml (95% CI, -77 to 137; P = 0.58). Within 6 weeks postsurgery, three patients in each group (3.6%) underwent erythrocyte transfusion and two patients in the bolus group experienced distal deep-vein thrombosis. A meta-analysis combining data from this study with those of five other trials showed no incremental efficacy of additional perioperative administration of tranexamic acid. A preoperative bolus of tranexamic acid, associated with a restrictive transfusion trigger strategy, resulted in low erythrocyte transfusion rates in patients undergoing hip arthroplasty. Supplementary perioperative administration of tranexamic acid did not achieve any further reduction in blood loss.

[Unusual infection complication of total hip arthroplasty].

PubMed

Jány, R; Vojtassák, J; Lisý, M; Almási, J

2005-01-01

Authors present the case history of a 66-year old patient after repeated reimplantations of the THA with a deep infect caused by a rare aetiological agent (Serratia marcescens) associated with a pyogenic sinus. They describe the disease history, therapeutic procedure, complications associated with the surgery as well as postoperative course after the reimplantation of a customized total hip replacement. In the conclusion they state that in case of an infected total hip arthroplasty the treatment is focused on the salvage of the infection process and preservation of the function of the affected limb. Of essential importance is surgical revision with a radical removal of necrotic tissues and hardware in combination with an intensive parenteral antibiotic administration.

Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity.

PubMed

Mallet, C; Abitan, A; Vidal, C; Holvoet, L; Mazda, K; Simon, A-L; Ilharreborde, B

2018-02-01

Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. IV.

Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity

PubMed Central

Mallet, C.; Abitan, A.; Vidal, C.; Holvoet, L.; Mazda, K.; Simon, A.-L.; Ilharreborde, B.

2018-01-01

Abstract Purpose Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. Methods All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. Results A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Conclusion Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. Level of Evidence IV PMID:29456754

Optimum frequency of exercise for bone health: randomised controlled trial of a high-impact unilateral intervention.

PubMed

Bailey, Christine A; Brooke-Wavell, Katherine

2010-04-01

Exercise can increase bone strength, but to be effective in reducing fracture risk, exercise must be feasible enough to be adopted into daily life and influence potentially vulnerable skeletal sites such as the superolateral cortex of the femoral neck, where thinning is associated with increased fracture risk. Brief, high-impact exercise increases femoral neck bone density but the optimal frequency of such exercise and the location of bone accrual is unknown. This study thus examined (1) the effectiveness of different weekly frequencies of exercise on femoral neck BMD and (2) whether BMD change differed between hip sites using a high-impact, unilateral intervention. Healthy premenopausal women were randomly assigned to exercise 0, 2, 4, or 7 days/week for 6 months. The exercise intervention incorporated 50 multidirectional hops on one randomly selected leg. BMD was measured by DXA at baseline and after 6 months of exercise. Changes in the exercise leg were compared between groups using ANCOVA, with change in the control leg and baseline BMD as covariates. RM-MANOVA was conducted to determine whether bone changes from exercise differed between hip sites. 61 women (age 33.6+/-11.1 years) completed the intervention. Compliance amongst exercisers was 86.7+/-10.6%. Peak ground reaction forces during exercise increased from 2.5 to 2.8 times body weight. The change in femoral neck BMD in the exercise limb (adjusted for change in the control limb and baseline BMD) differed between groups (p=0.015), being -0.3% (-1.2 to 0.6), 0.0% (-1.0 to 1.0), 0.9% (-0.1 to 2.0) and 1.8% (0.8 to 2.8) in those exercising 0, 2, 4 and 7 days per week, respectively. When BMD changes at upper neck, lower neck and trochanter were compared using RM-MANOVA, a significant exercise effect was observed (p=0.048), but this did not differ significantly between sites (p=0.439) despite greatest mean increases at the upper femoral neck. Brief, daily hopping exercises increased femoral neck BMD in premenopausal women but less frequent exercise was not effective. Brief high-impact exercise may have a role in reducing hip fragility, but may need to be performed frequently for optimal response. Copyright 2009 Elsevier Inc. All rights reserved.

Survivorship analysis of failure pattern after revision total hip arthroplasty.

PubMed

Retpen, J B; Varmarken, J E; Jensen, J S

1989-12-01

Failure, defined as established indication for or performed re-revision of one or both components, was analyzed using survivorship methods in 306 revision total hip arthroplasties. The longevity of revision total hip arthroplasties was inferior to that of previously reported primary total hip arthroplasties. The overall survival curve was two-phased, with a late failure period associated with aseptic loosening of one or both components and an early failure period associated with causes of failure other than loosening. Separate survival curves for aseptic loosening of femoral and acetabular components showed late and almost simultaneous decline, but with a tendency toward a higher rate of failure for the femoral component. No differences in survival could be found between the Stanmore, Lubinus standard, and Lubinus long-stemmed femoral components. A short interval between the index operation and the revision and intraoperative and postoperative complications were risk factors for early failure. Young age was a risk factor for aseptic loosening of the femoral component. Intraoperative fracture of the femoral shaft was not a risk factor for secondary loosening. No difference in survival was found between primary cemented total arthroplasty and primary noncemented hemiarthroplasty.

Usefulness of postoperative hip irradiation in the prevention of heterotopic bone formation in a high risk group of patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

MacLennan, I.; Keys, H.M.; Evarts, C.M.

1984-01-01

Heterotopic ossification is a complication of total hip arthroplasty in 14 to 30% of patients. Significant functional impairment will occur in up to 28% of patients with ectopic bone. The high risk group includes those with preexisting heterotopic bone in either hip, those suffering from hypertrophic osteoarthritis or ankylosing spondylitis and patients who have had multiple procedures on the hip. Fifty-eight patients (67 hips) were irradiated after surgical removal of ectopic bone (53 hips) or received radiation prophylaxis of heterotopic ossification (14 hips). Ninety-five percent of patients had either no bone visible or insignificant amounts of ectopic bone visible onmore » postoperative hip X-rays. Only 5% of patients showed significant persistence of ectopic bone. Postoperative hip function was dramatically improved compared to preoperative function in all patients treated. The importance of early commencement of irradiation is emphasized.« less

Dynamic Hip Kinematics During the Golf Swing After Total Hip Arthroplasty.

PubMed

Hara, Daisuke; Nakashima, Yasuharu; Hamai, Satoshi; Higaki, Hidehiko; Ikebe, Satoru; Shimoto, Takeshi; Yoshimoto, Kensei; Iwamoto, Yukihide

2016-07-01

Although most surgeons allow their patients to play golf after total hip arthroplasty (THA), the effect on the implant during the golf swing is still unclear. To evaluate hip kinematics during the golf swing after THA. Descriptive laboratory study. Eleven hips in 9 patients who underwent primary THA were analyzed. All patients were right-handed recreational golfers, and these 11 hips included 6 right hips and 5 left hips. Periodic radiographic images of the golf swing were taken using a flat-panel x-ray detector. Movements of the hip joint and components were assessed using 3-dimensional-to-2-dimensional model-to-image registration techniques. Liner-to-neck contact and translation of the femoral head with respect to the acetabular cup (cup-head translation) were examined. Hip kinematics, orientation of components, and maximum cup-head translation were compared between patients with and without liner-to-neck contact. On average, the golf swing produced approximately 50° of axial rotation in both lead and trail hips. Liner-to-neck contact was observed in 4 hips with elevated rim liners (2 lead hips and 2 trail hips) at maximum external rotation. Neither bone-to-bone nor bone-to-implant contact was observed at any phases of the golf swing in any of the hips. Four hips with liner-to-neck contact had significantly larger maximum external rotation (37.9° ± 7.0° vs 20.6° ± 9.9°, respectively; P = .01) and more cup anteversion (26.5° ± 6.1° vs 10.8° ± 8.9°, respectively; P = .01) than hips without liner-to-neck contact. No significant differences between hips with and without contact were found for cup inclination (42.0° ± 2.5° vs 38.1° ± 5.5°, respectively; P = .22), combined anteversion (45.3° ± 8.9° vs 51.4° ± 7.9°, respectively; P = .26), or maximum cup-head translation (1.3 ± 0.3 mm vs 1.5 ± 0.4 mm, respectively; P = .61). In this analysis, the golf swing did not produce excessive hip rotation or cup-head translation in any hips. However, liner-to-neck contact during the golf swing was observed in 36% of the hips, with unknown effects on the long-term results. Golf is an admissible sport after THA because dynamic hip stability was observed. However, the implant position, especially cup anteversion and the use of elevated rim liners, promoted liner-to-neck contact. © 2016 The Author(s).

A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis.

PubMed

Hu, S; Zhang, Z-Y; Hua, Y-Q; Li, J; Cai, Z-D

2009-07-01

We performed a meta-analysis to evaluate the relative efficacy of regional and general anaesthesia in patients undergoing total hip or knee replacement. A comprehensive search for relevant studies was performed in PubMed (1966 to April 2008), EMBASE (1969 to April 2008) and the Cochrane Library. Only randomised studies comparing regional and general anaesthesia for total hip or knee replacement were included. We identified 21 independent, randomised clinical trials. A random-effects model was used to calculate all effect sizes. Pooled results from these trials showed that regional anaesthesia reduces the operating time (odds ratio (OR) -0.19; 95% confidence interval (CI) -0.33 to -0.05), the need for transfusion (OR 0.45; 95% CI 0.22 to 0.94) and the incidence of thromboembolic disease (deep-vein thrombosis OR 0.45, 95% CI 0.24 to 0.84; pulmonary embolism OR 0.46, 95% CI 0.29 to 0.80). Regional anaesthesia therefore seems to improve the outcome of patients undergoing total hip or knee replacement.

Basic Science Considerations in Primary Total Hip Replacement Arthroplasty

PubMed Central

Mirza, Saqeb B; Dunlop, Douglas G; Panesar, Sukhmeet S; Naqvi, Syed G; Gangoo, Shafat; Salih, Saif

2010-01-01

Total Hip Replacement is one of the most common operations performed in the developed world today. An increasingly ageing population means that the numbers of people undergoing this operation is set to rise. There are a numerous number of prosthesis on the market and it is often difficult to choose between them. It is therefore necessary to have a good understanding of the basic scientific principles in Total Hip Replacement and the evidence base underpinning them. This paper reviews the relevant anatomical and biomechanical principles in THA. It goes on to elaborate on the structural properties of materials used in modern implants and looks at the evidence base for different types of fixation including cemented and uncemented components. Modern bearing surfaces are discussed in addition to the scientific basis of various surface engineering modifications in THA prostheses. The basic science considerations in component alignment and abductor tension are also discussed. A brief discussion on modular and custom designs of THR is also included. This article reviews basic science concepts and the rationale underpinning the use of the femoral and acetabular component in total hip replacement. PMID:20582240

Cell therapy versus simultaneous contralateral decompression in symptomatic corticosteroid osteonecrosis: a thirty year follow-up prospective randomized study of one hundred and twenty five adult patients.

PubMed

Hernigou, Philippe; Dubory, Arnaud; Homma, Yasuhiro; Guissou, Isaac; Flouzat Lachaniette, Charles Henri; Chevallier, Nathalie; Rouard, Hélène

2018-05-09

Symptomatic osteonecrosis related to corticosteroids has a high risk of progression to collapse in absence of treatment. The purposes of this study were to evaluate the results of autologous bone marrow grafting of the symptomatic hip in adult patients with osteonecrosis and to compare the results with core decompression alone in the contralateral symptomatic hip. A total of 125 consecutive patients (78 males and 47 females) with bilateral osteonecrosis (ON) and who had both hips symptomatic and at the same stage on each side (stage I or II) were included in this study from 1988 to 1998. The volume of osteonecrosis was measured with MRI in both hips; the smaller size ON was treated with core decompression, and the contralateral hip with the larger ON was treated with percutaneous mesenchymal cell (MSC) injection obtained from bone marrow concentration. The average total number of MSCs (counted as number of colony forming units-fibroblast) injected in each hip was 90,000 ± 25,000 cells (range 45,000 to 180,000 cells). At the most recent FU (average 25 years after the first surgery, range 20 to 30 years), among the 250 hips included in the study, 35 hips (28%) had collapsed at the most recent follow-up after bone marrow grafting, and 90 (72%) after core decompression (CD). Ninety-five hips (76%) in the CD group underwent total hip replacement and 30 hips (24%) in the bone marrow graft group (p < 0.0001). Hips undergoing only CD were approximately three times more likely to undergo a primary THA (odds ratio: 10.0278; 95% CI: 5.6117 to 17.9190; p < 0.0001) as compared with hips undergoing an initial bone marrow grafting. For the 90 hips treated with bone marrow injection and without collapse, the mean volume of repair evaluated by MRI at the most recent follow-up was 16.4 cm 3 (range 12 to 21 cm 3 ) corresponding to a decrease of the pre-operative average volume from 22.4 cm 3 (range 35-15 cm 3 ) to 6 cm 3 (range 12-0 cm 3 ); as percentage of the volume of the femoral head, the decrease moved from 44.8 to 12%. Core decompression with bone marrow injection improved the outcome of the disease as compared with core decompression alone in the same patient.

Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013.

PubMed

Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E; Jevsevar, David S

2017-03-01

Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay. Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity. From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed. Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift toward younger population groups, reduction in length of stay remains an important target for procedure-level cost containment under emerging payment models.

Reliability of the Melbourne assessment of unilateral upper limb function.

PubMed

Randall, M; Carlin, J B; Chondros, P; Reddihough, D

2001-11-01

This study examines the reliability of the Melbourne Assessment of Unilateral Upper Limb Function: a quantitative test of quality of movement in children with neurological impairment. The assessment was administered to 20 children aged from 5 to 16 years (mean age 9 years 10 months, SD 2 years 10 months) who had various types and degrees of cerebral palsy (CP). The performances of the 20 children during assessment were videotaped for subsequent scoring by 15 occupational therapists. Scores were analyzed for internal consistency of test items, inter- and intrarater reliability of scorings of the same videotapes, and test-retest reliability using repeat videotaping. Results revealed very high internal consistency of test items (alpha=0.96), moderate to high agreement both within and between raters for all test items (intraclass correlations of at least 0.7) apart from item 16 (hand to mouth and down), and high interrater reliability (0.95) and intrarater reliability (0.97) for total test scores. Test-retest results revealed moderate to high intrarater reliability for item totals (mean of 0.83 and 0.79) for each rater and high reliability for test totals (0.98 and 0.97). These findings indicate that the Melbourne Assessment of Unilateral Upper Limb Function is a reliable tool for measuring the quality of unilateral upper-limb movement in children with CP.

Evidence to suggest that women's sexual behavior is influenced by hip width rather than waist-to-hip ratio.

PubMed

Simpson, Victoria J; Brewer, Gayle; Hendrie, Colin A

2014-10-01

Waist-to-hip ratio (WHR) is an important ornament display that signals women's health and fertility. Its significance derives from human development as a bipedal species. This required fundamental changes to hip morphology/musculature to accommodate the demands of both reproduction and locomotion. The result has been an obstetric dilemma whereby women's hips are only just wide enough to allow the passage of an infant. Childbirth therefore poses a significant hip width related threat to maternal mortality/risk of gynecological injury. It was predicted that this would have a significant influence on women's sexual behavior. To investigate this, hip width and WHR were measured in 148 women (M age = 20.93 + 0.17 years) and sexual histories were recorded via questionnaire. Data revealed that hip width per se was correlated with total number of sexual partners, total number of one night stands, percentage of sexual partners that were one night stands, number of sexual partners within the context of a relationship per year sexually active, and number of one night stands per year sexually active. By contrast, WHR was not correlated with any of these measures. Further analysis indicated that women who predominantly engaged in one night stand behavior had wider hips than those who did not. WHR was again without effect in this context. Women's hip morphology has a direct impact on their risk of potentially fatal childbirth related injury. It is concluded that when they have control over this, women's sexual behavior reflects this risk and is therefore at least in part influenced by hip width.

Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes

PubMed Central

Cvetanovich, Gregory L.; Heyworth, Benton E.; Murray, Kerri; Yen, Yi-Meng; Kocher, Mininder S.; Millis, Michael B.

2015-01-01

To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery. PMID:27011852

Comparison of two different rehabilitation programmes for thrust plate prosthesis: a randomized controlled study.

PubMed

Unver, Bayram; Karatosun, Vasfi; Gunal, Izge; Angin, Salih

2004-02-01

Weight bearing after total hip arthroplasty is postponed in order to prevent early loosening, but this negatively affects the rehabilitation programme. For the force transfer characteristics of thrust plate prosthesis (TPP), a new type of hip prosthesis used without cement is similar to the normal hip. We evaluated the possibilities of early weight bearing after TPP by comparing early partial with early full weight bearing. Randomized controlled study. Department of orthopaedics and traumatology in a university hospital. Sixty hips of 51 patients who underwent total hip arthroplasty with TPP were randomly assigned into two groups. Both groups received accelerated rehabilitation programmes: group 1 with early partial weight bearing and group 2 with early full weight bearing. Patients were evaluated by a blind observer preoperatively, at three months after surgery by clinical (measurement of range of hip motion (universal goniometry), muscle strength (Manual Muscle Test), functional test (6-minute walk test), hip function (Harris Hip Scoring System)) and radiographical parameters and one year after surgery by clinical (Harris Hip Scoring System) and radiographical parameters. Group 2 performed transfer activities earlier, had more walking distance at the time of discharge and shorter hospital stay than group 1. At three months, Harris Hip Score, muscle strength, 6-minute walk test, and duration of crutch use were significantly (p < 0.05) in favour of group 2. None of the patients in either group showed signs of loosening one year after the operation. These results suggest that patients with TPP can tolerate an accelerated rehabilitation programme with early weight bearing and will gain the goals of rehabilitation earlier.

A Pilot Study of Augmented Reality Technology Applied to the Acetabular Cup Placement During Total Hip Arthroplasty.

PubMed

Ogawa, Hiroyuki; Hasegawa, Seiichirou; Tsukada, Sachiyuki; Matsubara, Masaaki

2018-06-01

We developed an acetabular cup placement device, the AR-HIP system, using augmented reality (AR). The AR-HIP system allows the surgeon to view an acetabular cup image superimposed in the surgical field through a smartphone. The smartphone also shows the placement angle of the acetabular cup. This preliminary study was performed to assess the accuracy of the AR-HIP system for acetabular cup placement during total hip arthroplasty (THA). We prospectively measured the placement angles using both a goniometer and AR-HIP system in 56 hips of 54 patients undergoing primary THA. We randomly determined the order of intraoperative measurement using the 2 devices. At 3 months after THA, the placement angle of the acetabular cup was measured on computed tomography images. The primary outcome was the absolute value of the difference between intraoperative and postoperative computed tomography measurements. The measurement angle using AR-HIP was significantly more accurate in terms of radiographic anteversion than that using a goniometer (2.7° vs 6.8°, respectively; mean difference 4.1°; 95% confidence interval, 3.0-5.2; P < .0001). There was no statistically significant difference in terms of radiographic inclination (2.1° vs 2.6°; mean difference 0.5°; 95% confidence interval, -1.1 to 0.1; P = .13). In this pilot study, the AR-HIP system provided more accurate information regarding acetabular cup placement angle than the conventional method. Further studies are required to confirm the utility of the AR-HIP system as a navigation tool. Copyright © 2018 Elsevier Inc. All rights reserved.

Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection.

PubMed

Jones, Kevin B; Griffin, Anthony M; Chandrasekar, Coonoor R; Biau, David; Babinet, Antoine; Deheshi, Benjamin; Bell, Robert S; Grimer, Robert J; Wunder, Jay S; Ferguson, Peter C

2011-11-01

Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry. Fifty-four TFR patients were identified from three institutional prospective databases. Forty-one had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n = 27 were compared between groups and to cohorts of PFR (n = 31) and DFR (n = 85) patients using the Mann-Whitney U-test. Follow-up averaged 4 years. Mechanical complications included five hip dislocations and one femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3 ± 17.8, statistically decreased from DFR (P = 0.002) and PFR patients (P = 0.036). No significant differences were detected between patients in the fixed-hinge (n = 18) and rotating-hinge (n = 9) groups (P = 0.944), or total hip (n = 8) and hemiarthroplasty (n = 19) groups (P = 0.633). TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants. Copyright © 2011 Wiley Periodicals, Inc.

Extended application of WISH type S-form hip brace for patients with bilateral painful hip osteoarthritis: report of two cases.

PubMed

Sato, Takahisa; Yamaji, Takehiko; Inose, Hideyuki; Sato, Ena; Yoshikawa, Ayako; Usuda, Shigeru; Watanabe, Hideomi

2009-06-01

Dynamic lateral instability of the femoral head develops in patients with osteoarthritis (OA) of the hip. Recently we have developed a hip brace, called the WISH-type hip brace, and showed successful response of the patients quantitatively. However, a negligible effect was observed in patients with bilateral involvement. Here, we extended the application of the WISH-type hip brace for two patients with bilateral OA joints. The resultant WISH-type hip brace with two S-form portions for bilateral thighs provided good recovery in hip function. Interestingly Timed Up & Go (TUG) test performed for one patient revealed a positive effect of the brace on the functional mobility. To the best of our knowledge, this is the first report elucidating the therapeutic effect of brace therapy with bilateral hip stabilization from hip functional and functional mobility points of view. Application of the present brace should be taken into account for patients with painful bilateral hip OA before easy application of invasive surgery such as total hip arthroplasty.

UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons.

PubMed

Werner, J; Hägglund, M; Waldén, M; Ekstrand, J

2009-12-01

Groin injury is a common injury in football and a complicated area when it comes to diagnosis and therapy. There is a lack of comprehensive epidemiological data on groin injuries in professional football. To investigate the incidence, pattern and severity of hip and groin injuries in professional footballers over seven consecutive seasons. Prospective cohort study. European professional football. During the 2001/2 to 2007/8 seasons, between nine and 17 clubs per season (23 clubs in total) were investigated, accounting for 88 club seasons in total. Time loss injuries and individual exposure during club and national team training sessions and matches were recorded. Injury incidence. A total of 628 hip/groin injuries were recorded, accounting for 12-16% of all injuries per season. The total injury incidence was 1.1/1000 h (3.5/1000 match hours vs 0.6/1000 training hours, p<0.001) and was consistent over the seasons studied. Eighteen different diagnostic entities were registered, adductor (n = 399) and iliopsoas (n = 52) related injuries being the most common. More than half of the injuries (53%) were classified as moderate or severe (absence of more than a week), the mean absence per injury being 15 days. Reinjuries accounted for 15% of all registered injuries. In the 2005/6 to 2007/8 seasons, 41% of all diagnoses relied solely on clinical examination. Hip/groin injuries are common in professional football, and the incidence over consecutive seasons is consistent. Hip/groin injuries are associated with long absences. Many hip/groin diagnoses are based only on clinical examination.

Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty

PubMed Central

Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P.; Sköldenberg, Olof

2016-01-01

Abstract Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery. A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7–21). The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events. During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0–10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05–1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06–1.11). Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

3D printing technology used in severe hip deformity.

PubMed

Wang, Shanshan; Wang, Li; Liu, Yan; Ren, Yongfang; Jiang, Li; Li, Yan; Zhou, Hao; Chen, Jie; Jia, Wenxiao; Li, Hui

2017-09-01

This study was designed to assess the use of a 3D printing technique in total hip arthroplasty (THA) for severe hip deformities, where new and improved approaches are needed. THAs were performed from January 2015 to December 2016. Bioprosthesis artificial hip joints were used in both conventional and 3D printing hip arthroplasties. A total of 74 patients (57 cases undergoing conventional hip replacements and 17 undergoing 3D printing hip replacements) were followed-up for an average of 24 months. The average age of the patients was 62.7 years. Clinical data between the patients treated with different approaches were compared. Results showed that the time to postoperative weight bearing and the Harris scores of the patients in the 3D printing group were better than those for patients in the conventional hip replacement group. Unfortunately, the postoperative infection and loosening rates were higher in the 3D printing group. However, there were no significant differences in femoral neck anteversion, neck shaft, acetabular or sharp angles between ipsilateral and contralateral sides in the 3D printing group (P>0.05). The femoral neck anteversion angle was significantly different between the two sides in the conventional hip replacement group (P<0.05). Based on these results, we suggest that the 3D printing approach provides a better short-term curative effect that is more consistent with the physiological structure and anatomical characteristics of the patient, and we anticipate that its use will help improve the lives of many patients.

Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis

PubMed Central

Choi, Yoowang; Kim, Jun-Shik

2009-01-01

Despite improvements in the quality of alumina ceramics, osteolysis has been reported anecdotally after total hip arthroplasty (THA) with use of a contemporary alumina-on-alumina ceramic bearing. The purpose of this study was to evaluate the clinical and radiographic outcomes of THA using alumina-on-alumina ceramic bearing and to determine osteolysis using radiographs and computed tomographic (CT) scans in young patients. Consecutive primary cementless THA using alumina-on-alumina ceramic bearing were performed in 64 patients (93 hips) who were younger than 45 years of age with femoral-head osteonecrosis. There were 55 men (84 hips) and nine women (nine hips). Average age was 38.2 (range 24–45) years. Average follow-up was 11.1 (range 10–13) years. Preoperative Harris Hip Score was 52.9 (range 22–58) points, which improved to 96 (range 85−100) points at the final follow-up examination. Two of 93 hips (2%) had clicking or squeaking sound. No hip had revision or aseptic loosening. Radiographs and CT scans demonstrated that no acetabular or femoral osteolysis was detected in any hip at the latest follow-up. Contemporary cementless acetabular and femoral components with alumina-on-alumina ceramic bearing couples function well with no osteolysis at a ten year minimum and average of 11.1-year follow-up in this series of young patients with femoral-head osteonecrosis. PMID:19784647

MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip

PubMed Central

Marupaka, Sravan Kumar; Alluri, Swathi; MD, Naseeruddin; Irfan, Kazi Amir; Jampala, Venkateshwarlu; Apsingi, Sunil; Eachempati, Krishna Kiran

2015-01-01

Introduction Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined. Aim To study pre and post core decompression MRI changes in avascular necrosis of hip. Materials and Methods This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version. Results Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location. Conclusion Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip. PMID:26816966

Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review.

PubMed

Sardana, Vandit; Philippon, Marc J; de Sa, Darren; Bedi, Asheesh; Ye, Lily; Simunovic, Nicole; Ayeni, Olufemi R

2015-10-01

To identify the indications and outcomes in patients undergoing revision hip arthroscopy. The electronic databases Embase, Medline, HealthStar, and PubMed were searched from 1946 to July 19, 2014. Two blinded reviewers searched, screened, and evaluated the data quality of the studies using the Methodological Index for Non-Randomized Studies scale. Data were abstracted in duplicate. Agreement and descriptive statistics are presented. Six studies were included (3 prospective case series and 3 retrospective chart reviews), with a total of 448 hips examined. The most common indications for revision hip arthroscopy included residual femoroacetabular impingement (FAI), labral tears, and chondral lesions. The mean interval between revision arthroscopy and the index procedure was 25.6 months. Overall, the modified Harris Hip Score improved by a mean of 33.6% (19.3 points) from the baseline score at 1-year follow-up. In 14.6% of patients, further surgical procedures were required, including re-revision hip arthroscopy (8.0%), total hip replacement (5.6%), and hip resurfacing (1.0%). Female patients more commonly underwent revision hip arthroscopy (59.7%). The current evidence examined in this review supports revision hip arthroscopy as a successful intervention to improve functional outcomes (modified Harris Hip Score) and relieve pain in patients with residual symptoms after primary FAI surgery, although the outcomes are inferior when compared with a matched cohort of patients undergoing primary hip arthroscopy for FAI. The main indication for revision is a candidate who has symptoms due to residual cam- or pincer-type deformity that was either unaddressed or under-resected during the index operation. However, it is important to consider that the studies included in this review are of low-quality evidence. Surgeons should consider incorporating a minimum 2-year follow-up for individuals after index hip-preservation surgery because revisions tended to occur within this time frame. Level IV, systematic review of Level III and IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Radiographic cup position following posterior and lateral approach to total hip arthroplasty. An explorative randomized controlled trial.

PubMed

Kruse, Christine; Rosenlund, Signe; Broeng, Leif; Overgaard, Søren

2018-01-01

The two most common surgical approaches to total hip arthroplasty are the posterior approach and lateral approach. The surgical approach may influence cup positioning and restoration of the offset, which may affect the biomechanical properties of the hip joint. The primary aim was to compare cup position between posterior approach and lateral approach. Secondary aims were to compare femoral offset, abductor moment arm and leg length discrepancy between the two approaches. Eighty patients with primary hip osteoarthritis were included in a randomized controlled trial and assigned to total hip arthroplasty using posterior approach or lateral approach. Postoperative radiographs from 38 patients in each group were included in this study for measurement of cup anteversion and inclination. Femoral offset, cup offset, total offset, abductor moment arm and leg length discrepancy were measured on preoperative and postoperative radiographs in 28 patients in each group. We found that mean anteversion was 5° larger in the posterior approach group (95% CI, -8.1 to -1.4; p = 0.006), while mean inclination was 5° less steep (95% CI, 2.7 to 7.2; p<0.001) compared with the lateral approach group. The posterior approach group had a larger mean femoral offset of 4.3mm (95% CI, -7.4 to -1.3, p = 0.006), mean total offset of 6.3mm (95% CI, -9.6 to -3; p<0.001) and mean abductor moment arm of 4.8mm (95% CI, -7.6 to -1.9; p = 0.001) compared with the lateral approach group. We found a larger cup anteversion but less steep cup inclination in the posterior approach group compared with the lateral approach group. Femoral offset and abductor moment arm were restored after total hip arthroplasty using lateral approach but significantly increased when using posterior approach.

Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis.

PubMed

Dagnino, Augusto; Ursino, Nicola; Ripamonti, Carlo A M; Fiorentini, Carlo E; Scelsi, Michele; D'Ambrosi, Riccardo; Portinaro, Nicola M

2017-12-01

Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year.

Medium-term outcome in patients treated with total hip arthroplasty using a modular femoral stem.

PubMed

Dagnino, Augusto; Grappiolo, Guido; Benazzo, Franco M; Learmonth, Ian D; Spotorno, Lorenzo; Portinaro, Nicola

2012-01-01

The clinical, radiographic and quality of life results of total hip arthroplasty using the MODULUS cementless modular femoral stem were reviewed. 48 patients who had a total hip arthroplasty using the MODULUS femoral stem were identified. Six had bilateral procedures, resulting in 60 hips with complete clinical and radiographic data. Mean age at implantation was 50 years (range 33 to 82). Mean follow-up was 59 months (range 50 months to 73). There were two early post-operative dislocations (within 2 days). One patient required further surgery to remove heterotopic bone. Mean Harris Hip Score increased from 37 points preoperatively (range, 7 to 66) to 89 points at final review (range, 65 to 100 points). Radiographic evaluation revealed that all implants were stable without evidence of osteolysis but three patients (5%) exhibited heterotopic ossification. Quality of life was evaluated with the SF36. The physical component increased from 29.2 points (range, 18.5 to 46.0) to 51.7 points (range 42.9 to 60.6) and the mental component from 375 points (range, 19.5 to 50.0) to 50 points (range 32,8 to 62.0).

Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis

PubMed Central

Dagnino, Augusto; Ursino, Nicola; Ripamonti, Carlo A. M.; Fiorentini, Carlo E.; Scelsi, Michele; D'Ambrosi, Riccardo; Portinaro, Nicola M.

2017-01-01

Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year. PMID:29270564

Association Between Pseudotumor Formation and Patient Factors in Metal-on-Metal Total Hip Arthroplasty Population.

PubMed

Kleeman, Lindsay T; Goltz, Daniel; Seyler, Thorsten M; Mammarappallil, Joseph G; Attarian, David E; Wellman, Samuel S; Bolognesi, Michael P

2018-07-01

Pseudotumor formation from metal-on-metal (MoM) hip implants is associated with implant revision. The relationship between pseudotumor type and patient outcomes is unknown. We retrospectively reviewed patients with a MoM total hip arthroplasty and metal artifact reduction sequence magnetic resonance imaging. Pseudotumors were graded using a validated classification system by a fellowship-trained radiologist. Patient demographics, metal ion levels, and implant survival were analyzed. Pseudotumors were present in 49 hips (53%). Thirty-two (65%) pseudotumors were cystic thin walled, 8 (16%) were cystic thick walled, and 9 (18%) were solid masses. Patients with pseudotumors had high offset stems (P = .030) but not higher metal ion levels. Patients with thick-walled cystic or solid masses were more likely to be symptomatic (P = .025) and were at increased risk for revision (P = .004) compared to patients with cystic lesions. Pseudotumor formation is present in 53% of patients with a MoM total hip arthroplasty, of which 40% were asymptomatic. Patients with thick-walled cystic and solid lesions were more likely to be symptomatic and undergo revision. Copyright © 2018 Elsevier Inc. All rights reserved.

Preoperative anaemia is associated with increased allogeneic pack red cell transfusion in revision hip and knee joint arthroplasty: a retrospective analysis of 5387 patients over a 10-year period at a single high volume centre.

PubMed

Kasivisvanathan, R; Ramesh, V; Rao Baikady, R; Nadaraja, S

2016-08-01

To estimate the prevalence of preoperative World Health Organization (WHO) defined anaemia in patients presenting for revision hip and knee arthroplasty and its association with transfusion of allogeneic packed red blood cells (PRBC). Studies have mainly investigated the prevalence of preoperative anaemia in primary and not revision hip and knee joint arthroplasty. An analysis of a prospectively collected patient data for 5387 patients having revision hip or knee arthroplasty over a 10-year period at a single high volume centre was conducted. Logistic regression was used to assess whether the presence of WHO defined preoperative anaemia as well as other risk factors were associated with inpatient allogeneic PRBC transfusion. There were 5387 patients assessed of which 3021 (56·01%) patients had revision total hip replacements and 2366 (43·09%) had revision total knee arthroplasty. Of these patients 1956 (36·03%) had preoperative WHO defined anaemia. A total of 2034 (37·08%) patients received at least one unit of allogeneic PRBC during their primary hospital admission. In the final model preoperative WHO defined anaemia was independently associated with allogeneic PRBC transfusion in hip and knee revision surgery OR 4·042 (4·012-4·072 95% CI) CONCLUSIONS: Preoperative anaemia is common in patients presenting for revision hip and knee arthroplasty and independently associated with transfusion of allogeneic PRBC. © 2016 British Blood Transfusion Society.

[Survey on the use and behaviour of metal-metal hip replacements in Spain].

PubMed

Calcerrada, N; Fernández-Vega, A; Valls-León, C; Garcia-Cimbrelo, E

2016-01-01

Following medical device alerts published in different countries of problems with metal-on-metal total hip replacements, the Spanish Agency of Medicines and Medical Devices (AEMPS) in collaboration with the Spanish Hip Society Surgery designed a national survey to gather information on the use and behaviour of these hip implants. The survey consisted of a questionnaire sent by e-mail to 283 clinical centre recipients of metal-on-metal hips to be filled in by surgeons with expertise in the field. A total of 257 questionnaires were completed. The response rate of the clinical centres was 36.7%. A total of 97.7% of the responses reported that clinical and radiological follow-ups are carried out, and 79.6% undertook metal ion analyses (chromium and cobalt). A large majority (83.6%) of the responders who had who used surface implants, and 70% of those with large-head implants reported peri-operative complications. The most common complication was pain (25% with surface implants and 30.8% with large-head implants). Currently 80.8% of those responding were considering abandoning implanting of these hip replacements. Despite the many limitations to this study, the survey has allowed us to obtain in a quick first view of the implant scenario of Metal on Metal hip implants in Spain, and to determine the type of patient implanted, the time of implantation, and the experience/expertise of the surgeons, and the type of follow-up carried out. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

Mortality After Total Knee and Total Hip Arthroplasty in a Large Integrated Health Care System.

PubMed

Inacio, Maria C S; Dillon, Mark T; Miric, Alex; Navarro, Ronald A; Paxton, Elizabeth W

2017-01-01

The number of excess deaths associated with elective total joint arthroplasty in the US is not well understood. To evaluate one-year postoperative mortality among patients with elective primary and revision arthroplasty procedures of the hip and knee. A retrospective analysis was conducted of hip and knee arthroplasties performed in 2010. Procedure type, procedure volume, patient age and sex, and mortality were obtained from an institutional total joint replacement registry. An integrated health care system population was the sampling frame for the study subjects and was the reference group for the study. Standardized 1-year mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. A total of 10,163 primary total knee arthroplasties (TKAs), 4963 primary total hip arthroplasties (THAs), 606 revision TKAs, and 496 revision THAs were evaluated. Patients undergoing primary THA (SMR = 0.6, 95% CI = 0.4-0.7) and TKA (SMR = 0.4, 95% CI = 0.3-0.5) had lower odds of mortality than expected. Patients with revision TKA had higher-than-expected mortality odds (SMR = 1.8, 95% CI = 1.1-2.5), whereas patients with revision THA (SMR = 0.9, 95% CI = 0.4-1.5) did not have higher-than-expected odds of mortality. Understanding excess mortality after joint surgery allows clinicians to evaluate current practices and to determine whether certain groups are at higher-than-expected mortality risk after surgery.

Metal-on-Metal Hip Retrieval Analysis: A Case Report

PubMed Central

Pace, Thomas B.; Rusaw, Kara A.; Minette, Lawrence J.; Shirley, Brayton R.; Snider, Rebecca G.; DesJardins, John D.

2013-01-01

This is a case report involving a single case with severe bone and soft tissue destruction in a young male patient with a 10-year-metal on-metal total hip arthroplasty. Following complete aseptic erosion of the affected hip greater trochanter and abductor muscles, the hip was revised for recurrent instability. Histological examination of the patient's periprosthetic tissues, serological studies, and review of recent medical reports of similar cases were used to support an explanation of the destructive process and better contribute to our understanding of human reaction to metal debris in some patients following metal-on-metal hip arthroplasty. PMID:23840999

Conversion of hip fusion to total hip arthroplasty: clinical, radiological outcomes and complications in 40 hips.

PubMed

Celiktas, Mustafa; Kose, Ozkan; Turan, Adil; Guler, Ferhat; Ors, Cagri; Togrul, Emre

2017-01-01

The purpose of this retrospective study is to report the clinical and radiological outcome of total hip arthroplasty in patients with previous hip arthrodesis. We retrospectively reviewed 28 (40 hips) prospectively followed patients in whom ankylosed hips were converted to total hip arthroplasty (THA) between 2010 and 2014 in our institution. The average age at the time of the conversion operation was 40.8 ± 9.8 years (range 24-62). The ankylosis had lasted 20.4 ± 13.0 years (range 3-56) before conversion surgery. The etiology of the ankylosis was septic arthritis in 10 (25%), post-traumatic hip osteoarthritis in 8 (20%), developmental hip dysplasia in 6 (15%), rheumatoid arthritis in 6 (15%), primary osteoarthritis in 5 (12.5%) and ankylosing spondylitis in 5 (12.5%) hips. The indications for arthroplasty were intractable low back pain in 14 (50%), hip pain in 24 (85.7%), and ipsilateral knee pain in 19 (67.8%) patients. Harris Hip Score (HHS) was used to rate the clinical results before and after the surgery. Radiographic evaluations included component malposition and loosening. All complications during the study period were recorded. The mean follow-up period was 39.9 ± 10.6 months (range 24-60). The mean preoperative HHS was 33.3 ± 8.6 (range 18-50) and the mean HHS at the final follow-up was 74.9 ± 8.6 (range 52-97). There was a statistically significant increase in HHS (p = 0.0001). HHS was excellent in 1, good in 6, fair in 14 and poor in 7 patients. Increase in HHS was lower than 20 points in one patient (18 points), and one patient required two-staged exchange procedure due to deep infection. Thus, according to our success criteria (increase in HHS more than 20 points, radiographically stable implant, and no further surgical reconstruction), 92.8% (26/28) of patients had benefit from the surgery. Trendelenburg sign was positive in 12 hips. There was limb length inequality in 11 patients (mean 0.5 cm, range 1-3 cm). No patients had heterotopic ossification, sciatic nerve palsy or dislocation. There were five intra-operative fractures of the greater trochanter that were treated with cable wiring. One patient had trochanteric avulsion injury and was treated with trochanteric grip and cables. One patient (2.5%) had deep infection one year after the conversion THA and was treated with two-staged exchange procedure. Conversion hip arthroplasty is an effective treatment method which provides functional recovery and patient satisfaction. However, a proper surgical technique and planning is necessary to minimize the complications.

Female Sex Is a Risk Factor for Failure of Hip Arthroscopy Performed for Acetabular Retroversion

PubMed Central

Poehling-Monaghan, Kirsten L.; Krych, Aaron J.; Levy, Bruce A.; Trousdale, Robert T.; Sierra, Rafael J.

2017-01-01

Background: The success of hip surgery in treating acetabular retroversion depends on the severity of the structural deformity and on selecting the correct patient for open or arthroscopic procedures. Purpose: To compare a group of patients with retroverted hips treated successfully with hip arthroscopy with a group of patients with retroverted hips that failed arthroscopic surgery, with special emphasis on (1) patient characteristics, (2) perioperative radiographic parameters, (3) intraoperative findings and concomitant procedures, and (4) patient sex. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed the charts of 47 adult patients (47 hips) with acetabular retroversion who had undergone hip arthroscopy. Retroversion was based on the presence of an ischial spine sign in addition to either a crossover or posterior wall sign on a well-positioned anteroposterior pelvic radiograph. A total of 24 hips (50%) (16 females, 8 males; mean patient age, 31 years) had failed arthroscopy, defined as modified Harris Hip Score (mHHS) <80 or need for subsequent procedure. Twenty-three hips (8 females, 15 males; mean patient age, 29 years) were considered successful, defined as having no subsequent procedures and an mHHS >80 at the time of most recent follow-up. Perioperative variables, radiographic characteristics, and intraoperative findings were compared between the groups, in addition to a subgroup analysis based on sex. Results: The mean follow-up for successful hips was 30 months (SD, 11 months), with a mean mHHS of 95. In the failure group, 6 patients required subsequent procedures (4 anteverting periacetabular osteotomies and 2 total hip arthroplasties). The mean overall time to failure was 21 months, and the mean time to a second procedure was 24 months (total hip arthroplasty, 29.5 months; periacetabular osteotomy, 21.2 months); 18 hips failed on the basis of a low mHHS (mean, 65; range, 27-79) at last follow-up. Factors significantly different between the success and failure groups included patient sex, with males being more likely than females to have a successful outcome (P < .02), as well as undergoing femoral osteoplasty (P < .02). Intraoperative variables that were associated with worse outcome included isolated labral debridement (P < .002). In a subgroup analysis, males were more likely than their female counterparts to have a successful outcome with both isolated cam and combined cam-pincer resection (P < .05). Level of crossover correction on postoperative radiographs had no correlation with outcome. Conclusion: Acetabular retroversion remains a challenging pathoanatomy to treat arthroscopically. If hip arthroscopy is to be considered in select cases, we recommend labral preservation when possible. Male patients with correction of cam deformities did well, while females with significant retroversion appeared to be at greater risk for failure of arthroscopic treatment. PMID:29164164

The influence of optimism on functionality after total hip replacement surgery.

PubMed

Balck, Friedrich; Lippmann, Maike; Jeszenszky, Csilla; Günther, Klaus-Peter; Kirschner, Stephan

2016-08-01

Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery. © The Author(s) 2015.

[Modern tribology in total hip arthroplasty: pros and cons].

PubMed

Gómez-García, F

2014-01-01

The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty.

Patient Satisfaction Reporting After Total Hip Arthroplasty: A Systematic Review.

PubMed

Kahlenberg, Cynthia A; Nwachukwu, Benedict U; Schairer, William W; Steinhaus, Michael E; Cross, Michael B

2017-05-01

This review evaluated the quality of patient satisfaction reporting after total hip arthroplasty. The initial search of the MEDLINE database yielded 755 studies. Twenty-four met the inclusion criteria. Most studies provided level III or IV evidence (n=15, 62.5%). The most common method used to assess satisfaction was the 10-point visual analog scale (7 studies, 29.2%), followed by an ordinal satisfaction scale (6 studies, 25.0%). The quality of evidence was poor, and the methods used to assess satisfaction were not standardized. Further research is needed to define the factors that affect patient satisfaction after total hip arthroplasty and how satisfaction is best measured. [Orthopedics. 2017; 40(3):e400-e404.]. Copyright 2017, SLACK Incorporated.

Dissociation of modular total hip arthroplasty at the neck-stem interface without dislocation.

PubMed

Kouzelis, A; Georgiou, C S; Megas, P

2012-12-01

Modular femoral and acetabular components are now widely used, but only a few complications related to the modularity itself have been reported. We describe a case of dissociation of the modular total hip arthroplasty (THA) at the femoral neck-stem interface during walking. The possible causes of this dissociation are discussed. Successful treatment was provided with surgical revision and replacement of the modular neck components. Surgeons who use modular components in hip arthroplasties should be aware of possible early complications in which the modularity of the prostheses is the major factor of failure.

Determining Health-Related Quality-of-Life Outcomes Using the SF-6D Following Total Hip Arthroplasty.

PubMed

Elmallah, Randa K; Chughtai, Morad; Adib, Farshad; Bozic, Kevin J; Kurtz, Steven M; Mont, Michael A

2017-03-15

Following total hip arthroplasty, patients' perception of their postoperative improvement and health plays a large role in satisfaction with and success of the surgical procedure. The Short Form-6D (SF-6D) is a health-related quality-of-life measure that assigns numerical value to the perception of patients' own health. The purpose was to determine SF-6D values of patients after total hip arthroplasty, to determine whether score changes were clinically relevant, and to compare these with postoperative functional improvements. We evaluated 188 patients who underwent primary total hip arthroplasty at 7 institutions and who had a mean age of 69 years (range, 47 to 88 years) and a mean body mass index of 28.8 kg/m (range, 19.8 to 38.9 kg/m). The SF-6D values were obtained from patients' SF-36 scores, and clinical relevance of value changes was determined using effect size. Using previous research, effect sizes were considered small between 0.2 and 0.5, moderate between 0.6 to 0.8, and large at >0.8. Clinical correlation was assessed using the Lower-Extremity Activity Scale and Harris hip scores. Patients were assessed preoperatively and postoperatively at 6 months and 1, 2, 3, and 5 years. The SF-6D scores improved from preoperatively and achieved significance (p < 0.05) at all points. The effect size demonstrated good clinical relevance up to the latest follow-up: 1.27 at 6 months, 1.30 at 1 year, 1.07 at 2 years, 1.08 at 3 years, and 1.05 at 5 years. The Lower-Extremity Activity Scale improved at all follow-up points from preoperatively to 1.8 at 6 months, 2.0 at 1 year, 1.8 at 2 years, 1.5 at 3 years, and 1.6 points at 5 years. The Harris hip score improved to 38 points at 6 months, 40 points at 1 year, 38 points at 2 years, 39 points at 3 years, and 41 points at 5 years postoperatively. The improvements in the Lower-Extremity Activity Scale and the Harris hip score significantly positively correlated (p < 0.01) with the SF-6D scores at all time points. SF-6D scores after total hip arthroplasty correlate with functional outcomes and have clinical relevance, as demonstrated by their effect size. Incorporating this straightforward and easy-to-use measurement tool when evaluating patients following total hip arthroplasty will facilitate future cost-utility analyses. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

[Poldi-Čech cemented femoral stem in total hip arthroplasty after 25 years].

PubMed

Rozkydal, Z; Janíček, P

2010-08-01

The aim of the study was to evaluate the results of Poldi-Čech femoral stem implantation in primary total hip arthroplasty after 25 years. A group of 65 patients (90 hips) with Poldi-Čech total hip arthroplasty carried out between 1974 and 1984 was evaluated at the end of 2009. The mean follow-up of all patients was 28 years (25 to 35). There were seven men and 58 women. The mean age at the time of implantation was 43 years (26 to 60) and at the latest follow-up it was 72 years. In all patients the cemented UHMW PE acetabular component (RCH 1000) was used together with AKV Ultra 2 Poldi steel femoral stems (1st, 2nd and 3rd generations). The stem was a monoblock with a 32-mm head. The evaluation of the results was based on the Harris hip score and X ray with an A-P view of the pelvis and the affected hip. Statistical analysis was made using the life-table method. At the latest follow up the mean Harris score was 69.7 points (40 to 88). There were 69 hips with an original Poldi-Čech femoral component still in situ, 64 of them were stable and five with radiological evidence of aseptic loosening. Five patients had undergone Girdlestone resection arthroplasty for septic loosening. Thirteen patients (16 hips) had femoral stem revision. The cumulative proportion of clinical survivorship of the Poldi-Čech femoral stem, with revision for any reason as the endpoint, .was 0.93 at 6 years, 0.84 at 12 years, and 0.77 at 18, 24 and 30 years after the index surgery. Radiographic findings revealed 64 hips with stable stems, five hips with ;aseptic loosening (probable, 0 possible, 2, definite, 3). Six- teen hips were after revision surgery for aseptic loosening of the stem and five hips were after Girdlestone resection arthroplasty for septic failure. The cumulative proportion of radiological survivorship of the Poldi-Čech femoral stem with any reason as the endpoint was 0.92 at 6 years, 0.78 at 12 years, 0.72 at 18 years, 0.69 at 24 years and 0.69 at 30 years. The Poldi-Čech stem with its anatomical shape and a highly polished surface meets the principles of successful composite beam stems. Its disadvantage is a valgus neck- shaft angle of 140° giving lower femoral offset and the risk of development of valgus deformity of the ipsilateral knee. In most cases osteolysis, radiolucent lines and bone rarefaction of the femur resulted from polyethylene wear of the acetabular component. This study demonstrates a long-term survivorship of the Poldi-Čech femoral component in patients undergoing total hip arthroplasty 25 to 35 years ago.

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

PubMed

Kurtz, Steven M; Ong, Kevin L; Lau, Edmund; Bozic, Kevin J

2014-04-16

Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure. Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates. The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total knee arthroplasty were lower. Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.

Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial.

PubMed

Schache, Margaret B; McClelland, Jodie A; Webster, Kate E

2016-06-13

Total knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis. However, muscle weakness and functional limitations persist despite assistance from post-operative rehabilitation programs that traditionally focus on quadriceps strengthening and range of movement exercises. Hip abductor muscle weakness is evident in knee osteoarthritis and hip muscle strengthening reduces knee pain in this group. Following TKA, people with weak hip abductor strength perform more poorly on measures of physical function. However, very little is known of the effectiveness of including hip abductor strengthening exercises in post-operative rehabilitation. The aim of this trial is to compare the effects of targeted hip abductor strengthening to those of traditional care in a TKA rehabilitation program on muscle strength, patient reported outcomes and functional performance measures. This protocol describes a single-blinded randomized controlled trial, where 104 participants referred for inpatient rehabilitation following TKA will be recruited. Participants will be randomized using computer-generated numbers to one of two groups: usual care or usual care with additional hip strengthening exercises. Participants will attend physiotherapy daily during their inpatient length of stay, and will then attend between six and eight physiotherapy sessions as an outpatient. Primary outcomes are isometric hip abductor strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes are stair climb test, 6 min walk test, timed up and go, 40 m fast-paced walk test, 30 second chair stand test, isometric quadriceps strength, Lower Extremity Functional Scale (LEFS) and SF-12. Outcome measures will be recorded at baseline (admission to inpatient rehabilitation), and then 3 weeks, 6 weeks and 6 months post admission to rehabilitation. The findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation. This will then determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty. The trial protocol was registered with the Australian Clinical Trial Registry ( ACTRN12615000863538 ) on 18 August 2015.

Surgical dislocation of the hip and the management of femoroacetabular impingement: results of the Christchurch experience.

PubMed

Kempthorne, Joshua T; Armour, Paul C; Rietveld, John A; Hooper, Gary J

2011-06-01

Surgical dislocation of the hip has been developed to deal with the problems causing femoroacetabular impingement (FAI). This is a relatively recent procedure that was historically reserved for larger areas specializing in hip surgery. We hypothesized that surgical dislocation can be used for symptomatic FAI in a typical Australasian tertiary orthopaedic centre with acceptable results. This prospective study reviews the results of 53 surgical dislocations in this setting, looking particularly at functional outcomes and early complications. There were significant improvements in the Western Ontario and McMaster University Osteoarthritis Index score at 1, 2, 3 and 4 years post-operatively. Western Ontario and McMaster University Osteoarthritis Index scores increased by 23, 28, 34 and 35 points, respectively (P 0.0039). There was no significant improvement in hip range of motion. There were two (4%) early failures with conversion to total hip arthroplasty, and no cases of post-operative avascular necrosis of the femoral head. We believe that as the diagnosis of FAI and conservative nonarthroplasty surgery of the hip gains wider acceptance, it will become a procedure that should be offered to all appropriate patients in an attempt to delay or limit total hip arthroplasty in this young age group.

Lessons learned from study of congenital hip disease in adults.

PubMed

Hartofilakidis, George; Lampropoulou-Adamidou, Kalliopi

2016-12-18

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term "congenital hip disease" and its classification as dysplasia, low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease, which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD, especially those with low and high dislocation, are: Wide exposure, restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

Pre-operative digital templating in cemented hip hemiarthroplasty for neck of femur fractures.

PubMed

Kwok, Iris H Y; Pallett, Scott J C; Massa, Edward; Cundall-Curry, Duncan; Loeffler, Mark D

2016-03-01

Pre-operative digital templating allows the surgeon to foresee any anatomical anomalies which may lead to intra-operative problems, and anticipate appropriate instruments and implants required during surgery. Although its role is well-established in successful elective total hip arthroplasty, little work has been done on its use in hip hemiarthroplasty in neck of femur fractures. We describe our initial experience of digital templating in 40 consecutive patients who have undergone cemented hip hemiarthroplasty, assessing templating accuracy between templated implant sizes to actual implant sizes. 81% of implanted heads were templated to within two head sizes, and 89% of implanted stems were templated to within two sizes. Although there was a moderately strong correlation of 0.52 between templated and actual head sizes, this correlation was not demonstrated in femoral stem sizes. Mean leg length discrepancy was -2.5mm (S.D. 8.5), and the mean difference in femoral offset between the operated and non-operated hip was -1mm (S.D. 4.4). Digital templating is a useful adjunct to the surgeon in pre-operative planning of hip hemiarthroplasty in the restoration of leg length and femoral offset. However, its accuracy is inferior to that of elective total hip arthroplasty. Copyright © 2016 Elsevier Ltd. All rights reserved.

[The incidence of osteopenia and osteoporosis in patients with cementless total hip arthroplasty].

PubMed

Lacko, M; Schreierová, D; Čellár, R; Vaško, G

2015-01-01

The aim of the study was to evaluate the incidence of osteopenia and osteoporosis in the patients elected to cementless total hip replacement. The group evaluated comprised 100 patients with primary or secondary forms of coxarthrosis who underwent cementless total hip arthroplasty (THA). The results of densitometric examination of the lumbar spine and proximal femur were analysed. Based on the lowest T-score value, the patients were divided into three groups, i.e., fist, normal bone density; second, osteopenia; third, osteoporosis. Clinical examination included patient medical history, Harris hip scores and visual analogue scale assessment for pain intensity; the Kellgren-Lawrence classification was used to measure the grade of hip osteoarthritis; blood tests were made to assess the levels of total calcium, ionised calcium, phosphorus, vitamin D and the markers of bone resorption and formation. Osteoporosis was found in 32 and osteopenia in 21 patients; 47 patients had normal bone density. Osteoporosis was detected in the lumbar spine of 21 patients, in the proximal femur of nine patients and at both sites in two patients. In 13 patients this diagnosis was made for the fist time. The patients with osteoporosis had a significantly lower body mass index. There were no differences in the other characteristics, i.e., age, functional, radiological and laboratory findings, among the groups; all three showed the mean vitamin D concentration below the lowest level of its physiological range. Insufficient vitamin D levels were found in 54 women and 18 men. Of all patients, only 13 women and four men took vitamin D supplements. DISCUSSION Osteoarthritis and osteoporosis are the most frequent complex musculoskeletal diseases. Several studies have suggested that these disorders are mutually exclusive. This assumption has been based on the absence of radiographic evidence of osteoarthritis seen in many elderly patients with femoral neck fractures. Our relatively frequent findings of osteopenia and osteoporosis in this study show that patients with osteoarthritis may not be protected from the development of generalised osteoporosis. Our results are compared with the relevant literature data and potential effects of osteoporosis and vitamin D deficiency on total hip arthroplasty are discussed. Hip osteoarthritis does not reduce the risk of generalised osteoporosis. We found a relative high incidence of osteopenia and osteoporosis as well as vitamin D deficiency in patient with advanced form of hip osteoarthritis.

Issues relating to long-term follow-up in hip arthroplasty surgery: a review of 598 cases at 7 years comparing 2 prostheses using revision rates, survival analysis, and patient-based measures.

PubMed

Dawson, J; Jameson-Shortall, E; Emerton, M; Flynn, J; Smith, P; Gundle, R; Murray, D

2000-09-01

We reviewed 598 cemented Charnley and Hi-nek total hip arthroplasties at 7 years. Data were obtained from general practitioners, hospital medical notes, microfilm, and patient questionnaires. Outcome measures were revision rates, survival analysis, 12-item Oxford Hip Score, and satisfaction ratings. There were 471 Charnley (79%) and 127 Hi-nek (21%) total hip arthroplasties; 139 deaths (23%) occurred, and 5 (<1%) were lost to follow-up. Characteristics of the Charnley and Hi-nek patient groups were similar, with more information missing for Charnley cases. Revision rates were Charnley, 37 (8%), and Hi-nek, 6 (5%) (not significant). Survival analysis revealed no difference between the 2 groups (P = .23). The patients' median Oxford Hip Score was low/good (19), slightly worse for the Hi-nek group (not significant). Taking all evidence together, neither implant was outperforming the other at 7 years.

Effect of screw fixation on acetabular component alignment change in total hip arthroplasty.

PubMed

Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Shibanuma, Nao; Kurosaka, Masahiro

2014-06-01

The use of screws can enhance immediate cup fixation, but the influence of screw insertion on cup position has not previously been measured. The purpose of this study was to quantitatively evaluate the effect of intra-operative screw fixation on acetabular component alignment that has been inserted with the use of a navigation system. We used a navigation system to measure cup alignment at the time of press-fit and after screw fixation in 144 hips undergoing total hip arthroplasty. We also compared those findings with factors measured from postoperative radiographs. The mean intra-operative change of cup position was 1.78° for inclination and 1.81° for anteversion. The intra-operative change of anteversion correlated with the number of screws. The intra-operative change of inclination also correlated with medial hip centre. The insertion of screws can induce changes in cup alignment, especially when multiple screws are used or if a more medial hip centre is required for rigid acetabular fixation.

Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry.

PubMed

Lenguerrand, E; Whitehouse, M R; Beswick, A D; Jones, S A; Porter, M L; Blom, A W

2017-06-01

We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article : E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391-398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. © 2017 Lenguerrand et al.

A comparison of the diagnostic accuracy of MARS MRI and ultrasound of the painful metal-on-metal hip arthroplasty.

PubMed

Siddiqui, Imran A; Sabah, Shiraz A; Satchithananda, Keshthra; Lim, Adrian K; Cro, Suzie; Henckel, Johann; Skinner, John A; Hart, Alister J

2014-08-01

Metal artifact reduction sequence (MARS) MRI and ultrasound scanning (USS) can both be used to detect pseudotumors, abductor muscle atrophy, and tendinous pathology in patients with painful metal-on-metal (MOM) hip arthroplasty. We wanted to determine the diagnostic test characteristics of USS using MARS MRI as a reference for detection of pseudotumors and muscle atrophy. PatienTS AND METHODS: We performed a prospective cohort study to compare MARS MRI and USS findings in 19 consecutive patients with unilateral MOM hips. Protocolized USS was performed by consultant musculoskeletal radiologists who were blinded regarding clinical details. Reports were independently compared with MARS MRI, the imaging gold standard, to calculate predictive values. The prevalence of pseudotumors on MARS MRI was 68% (95% CI: 43-87) and on USS it was 53% (CI: 29-76). The sensitivity of USS in detecting pseudotumors was 69% (CI 39-91) and the specificity was 83% (CI: 36-97). The sensitivity of detection of abductor muscle atrophy was 47% (CI: 24-71). In addition, joint effusion was detected in 10 cases by USS and none were seen by MARS MRI. We found a poor agreement between USS and MARS MRI. USS was inferior to MARS MRI for detection of pseudotumors and muscle atrophy, but it was superior for detection of joint effusion and tendinous pathologies. MARS MRI is more advantageous than USS for practical reasons, including preoperative planning and longitudinal comparison.

Atrophy of the quadriceps muscle in children with a painful hip.

PubMed

Robben, S G; Lequin, M H; Meradji, M; Diepstraten, A F; Hop, W C

1999-09-01

The objective of this study was to determine the degree of muscle wasting of various components of the quadriceps muscle in children with a painful hip. Between January 1994 and September 1997, 327 consecutive children with a unilateral painful hip and/or limping were evaluated prospectively with ultrasonography. Quadriceps thickness was measured on both sides. Moreover, muscle thickness was measured in 59 control subjects. The patients were divided into eight groups; transient synovitis (n = 134), Perthes' disease (n = 35), slipped capital femoral epiphysis (n = 5), osteomyelitis (n = 4), aspecific synovitis (n = 5), rheumatoid arthritis (n = 3) and miscellaneous (n = 16). In 125 patients, no sonographic and radiological abnormalities were found and during follow-up the symptoms disappeared ('no pathology' group). Ipsilateral muscle wasting was present in all patient groups, whereas the control subjects showed no significant difference in muscle thickness between legs. The degree of muscle wasting was compared between transient synovitis, the 'no pathology' group, Perthes' disease and control subjects. For both quadriceps and vastus intermedius muscles, there was a significant difference between these groups, except between control subjects and the 'no pathology' group. For the rectus femoris muscle, there was a significant difference between these groups, except between transient synovitis and 'no pathology'. Muscle wasting showed a positive correlation with duration of symptoms and pre-existing muscle mass. In conclusion, different diseases show different degrees of muscle wasting, and there are different patterns of muscle wasting of various components of the quadriceps femoris muscle.

Post-Discharge Care Duration, Charges, and Outcomes Among Medicare Patients After Primary Total Hip and Knee Arthroplasty.

PubMed

Ponnusamy, Karthikeyan E; Naseer, Zan; El Dafrawy, Mostafa H; Okafor, Louis; Alexander, Clayton; Sterling, Robert S; Khanuja, Harpal S; Skolasky, Richard L

2017-06-07

In April 2016, the U.S. Centers for Medicare & Medicaid Services initiated mandatory 90-day bundled payments for total hip and knee arthroplasty for much of the country. Our goal was to determine duration of care, 90-day charges, and readmission rates by discharge disposition and U.S. region after hip or knee arthroplasty. Using the 2008 Medicare Provider Analysis and Review database 100% sample, we identified patients who had undergone elective primary total hip or knee arthroplasty. We collected data on patient age, sex, comorbidities, U.S. Census region, discharge disposition, duration of care, 90-day charges, and readmission. Multivariate regression was used to assess factors associated with readmission (logistic) and charges (linear). Significance was set at p < 0.01. Patients undergoing 138,842 total hip arthroplasties were discharged to home (18%), home health care (34%), extended-care facilities (35%), and inpatient rehabilitation (13%); patients undergoing 329,233 total knee arthroplasties were discharged to home (21%), home health care (38%), extended-care facilities (31%), and inpatient rehabilitation (10%). Patients in the Northeast were more likely to be discharged to extended-care facilities or inpatient rehabilitation than patients in other regions. Patients in the West had the highest 90-day charges. Approximately 70% of patients were discharged home from extended-care facilities, whereas after inpatient rehabilitation, >50% of patients received home health care. Among those discharged to home, 90-day readmission rates were highest in the South (9.6%) for patients undergoing total hip arthroplasty and in the Midwest (8.7%) and the South (8.5%) for patients undergoing total knee arthroplasty. Having ≥4 comorbidities, followed by discharge to inpatient rehabilitation or an extended-care facility, had the strongest associations with readmission, whereas the region of the West and the discharge disposition to inpatient rehabilitation had the strongest association with higher charges. Among Medicare patients, discharge disposition and number of comorbidities were most strongly associated with readmission. Inpatient rehabilitation and the West region had the strongest associations with higher charges. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Use of Hip Arthroscopy and Risk of Conversion to Total Hip Arthroplasty: A Population-Based Analysis.

PubMed

Schairer, William W; Nwachukwu, Benedict U; McCormick, Frank; Lyman, Stephen; Mayman, David

2016-04-01

To use population-level data to (1) evaluate the conversion rate of total hip arthroplasty (THA) within 2 years of hip arthroscopy and (2) assess the influence of age, arthritis, and obesity on the rate of conversion to THA. We used the State Ambulatory Surgery Databases and State Inpatient Databases for California and Florida from 2005 through 2012, which contain 100% of patient visits. Hip arthroscopy patients were tracked for subsequent primary THA within 2 years. Out-of-state patients and patients with less than 2 years follow-up were excluded. Multivariate analysis identified risks for subsequent hip arthroplasty after arthroscopy. We identified 7,351 patients who underwent hip arthroscopy with 2 years follow-up. The mean age was 43.9 ± 13.7 years, and 58.8% were female patients. Overall, 11.7% of patients underwent THA conversion within 2 years. The conversion rate was lowest in patients aged younger than 40 years (3.0%) and highest in the 60- to 69-year-old group (35.0%) (P < .001). We found an increased risk of THA conversion in older patients and in patients with osteoarthritis or obesity at the time of hip arthroscopy. Patients treated at high-volume hip arthroscopy centers had a lower THA conversion rate than those treated at low-volume centers (15.1% v 9.7%, P < .001). Hip arthroscopy is performed in patients of various ages, including middle-aged and elderly patients. Older patients have a higher rate of conversion to THA, as do patients with osteoarthritis or obesity. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Screws are not needed when secure interference fit of uncemented acetabular components is adequate: a 5- to 15-year follow-up with clinical and radiological analysis.

PubMed

García-Rey, Eduardo

2017-05-12

Even with good surgical preparation, adequate primary stability of the acetabular component is not always achieved after primary total hip replacement (THR). We hypothesise that adequate bone preparation for appropriate cortical loading would allow us to avoid screw use. A total of 791 uncemented cups were analysed to compare the need for screws to obtain primary fixation in 5 different designs. Arthritic hips with inflammatory arthritis or severe congenital hip disease were excluded. A press-fit technique was first tried in all hips and screws were only used when strictly needed. Radiological acetabular shape and postoperative cup position were assessed in all hips. The mean follow-up was 9.6 (5-15) years. Screws were required in 155 hips (19.6%). We could not detect any difference in the percentage of screw use between designs. We found that female patients (odds ratio [OR] 2.06; 95% confidence interval [CI], 1.41-3.02) and cups with a greater distance to the hip rotation centre on the postoperative radiograph (OR 1.69; 95% CI, 1.17-2.45) had a higher risk for screw use. A greater anteversion of the cup had a lower risk for screw use (OR 0.96; 95% CI, 0.94-0.99). At latest follow-up no hips had needed revision for aseptic loosening. Good intraoperative technique is not enough to avoid screw use since more accurate cup position and reconstruction of the hip rotation centre are required for an adequate interference fit. A press-fit technique can provide similar mid-term results to screw use in hips without severe deformities.

Comparison of Downstream Health Care Utilization, Costs, and Long-Term Opioid Use: Physical Therapist Management Versus Opioid Therapy Management After Arthroscopic Hip Surgery.

PubMed

Rhon, Daniel I; Snodgrass, Suzanne J; Cleland, Joshua A; Greenlee, Tina A; Sissel, Charles D; Cook, Chad E

2018-05-01

Physical therapy and opioid prescriptions are common after hip surgery, but are sometimes delayed or not used. The objective of this study was to compare downstream health care utilization and opioid use following hip surgery for different patterns of physical therapy and prescription opioids. The design of this study was an observational cohort. Health care utilization was abstracted from the Military Health System Data Repository for patients who were 18 to 50 years old and were undergoing arthroscopic hip surgery between 2004 and 2013. Patients were grouped into those receiving an isolated treatment (only opioids or only physical therapy) and those receiving both treatments on the basis of timing (opioid first or physical therapy first). Outcomes included overall health care visits and costs, hip-related visits and costs, additional surgeries, and opioid prescriptions. Of 1870 total patients, 82.7% (n = 1546) received physical therapy only, 71.6% (n = 1339) received prescription opioids, and 1073 (56.1%) received both physical therapy and opioids. Because 24 patients received both opioids and physical therapy on the same day, they were eventually removed the final timing-of-care analysis. Adjusted hip-related mean costs were the same in both groups receiving isolated treatments (${\\$}$11,628 vs ${\\$}$11,579), but the group receiving only physical therapy had significantly lower overall total health care mean costs (${\\$}$18,185 vs ${\\$}$23,842) and fewer patients requiring another hip surgery. For patients receiving both treatments, mean hip-related downstream costs were significantly higher in the group receiving opioids first than in the group receiving physical therapy first (${\\$}$18,806 vs ${\\$}$16,955) and resulted in greater opioid use (7.83 vs 4.14 prescriptions), greater total days' supply of opioids (90.17 vs 44.30 days), and a higher percentage of patients with chronic opioid use (69.5% vs 53.2%). Claims data were limited by the accuracy of coding, and observational data limit inferences of causality. Physical therapy first was associated with lower hip-related downstream costs and lower opioid use than opioids first; physical therapy instead of opioids was associated with less total downstream health care utilization. These results need to be validated in prospective controlled trials.

Practical Repair Method for Unilateral Cleft Lips: Straight-Line Advanced Release Technique.

PubMed

Baek, Rong-Min; Choi, Jun-Ho; Kim, Baek-Kyu

2016-04-01

Straight-line closure repair of unilateral cleft lips was first introduced in the 1840s, and since then, many different techniques have been attempted for cleft repair. However, these methods have several disadvantages and are difficult to adopt. In this study, we describe our novel technique, known as Straight-Line Advanced Release Technique (StART), and its application in treating several cases of unilateral cleft lip. The preoperative design of the surgical method is drawn on the skin, the vermilion, and the oral mucosa. A total of 13 points are marked (points 0-12). The A flap, B flap, triangular flap, M (medial mucosal) flap, and L (lateral mucosal) flap are designed. After completion of the preoperative marking, the wide dissection is performed to separate the orbicularis oris muscle completely from the abnormally inserted bony structure and the enveloped skin-mucosal flap. The freed orbicularis oris muscle is then reconstructed with full width. After all planes of the lip wound are closed, a straight vertical skin suture line is achieved without any unnecessary transverse scar. Unilateral cleft lip repair using StART was conducted in 145 patients between 1993 and 2012. Cases of microform cleft lip were excluded. A total of 21 patients (14%) required a secondary operation on the lip after the first unilateral cheiloplasty. In all patients, satisfactory surgical outcomes were obtained with an indistinct straight-lined scar and a well-aligned lip contour. To acquire a natural and balanced shape in unilateral cleft lip repair, we recommend the novel StART.

The association between lower extremity energy absorption and biomechanical factors related to anterior cruciate ligament injury.

PubMed

Norcross, Marc F; Blackburn, J Troy; Goerger, Benjamin M; Padua, Darin A

2010-12-01

Greater total energy absorption by the lower extremity musculature during landing may reduce stresses placed on capsuloligamentous tissues with differences in joint contributions to energy absorption potentially affecting anterior cruciate ligament injury risk. However, the relationships between energy absorption and prospectively identified biomechanical factors associated with non-contact anterior cruciate ligament injury have yet to be demonstrated. Sagittal plane total, hip, knee and ankle energy absorption, and peak vertical ground reaction force, anterior tibial shear force, knee flexion and knee valgus angles, and internal hip extension and knee varus moments were measured in 27 individuals (14 females, 13 males) performing double leg jump landings. Correlation coefficients assessed the relationships between energy absorption during three time intervals (initial impact phase, terminal phase, and total landing) and biomechanical factors related to anterior cruciate ligament injury. More favorable values of biomechanical factors related to non-contact anterior cruciate ligament injury were associated with: 1) Lesser total (R(2)=0.178-0.558), hip (R(2)=0.229-0.651) and ankle (R(2)=0.280), but greater knee (R(2)=0.147) energy absorption during the initial impact phase; 2) Greater total (R(2)=0.170-0.845), hip (R(2)=0.599), knee (R(2)=0.236-0.834), and ankle (R(2)=0.276) energy absorption during the terminal phase of landing; and 3) Greater knee (R(2)=0.158-0.709), but lesser hip (R(2)=0.309) and ankle (R(2)=0.210-0.319) energy absorption during the total landing period. These results suggest that biomechanical factors related to anterior cruciate ligament injury are influenced by both the magnitude and timing of lower extremity energy absorption during landing. Copyright © 2010 Elsevier Ltd. All rights reserved.

Huntingtin interacting protein 1 as a histopathologic adjunct in the diagnosis of Merkel cell carcinoma.

PubMed

Marghalani, Siham; Feller, John Kyle; Mahalingam, Meera; Mirzabeigi, Marjan

2015-06-01

Huntington interacting protein 1 (HIP1), an antiapoptotic protein normally expressed in the brain, is highly expressed in Merkel cell carcinomas (MCCs). Given this, the aim of the current study was to ascertain the value of HIP1 as a histopathologic adjunct in the diagnosis of MCC. In this retrospective study, archival material from 26 cases with a diagnosis of MCC and/or neuroendocrine carcinoma were retrieved from the pathology files of the Skin Pathology Laboratory (Boston University School of Medicine, Boston, MA, USA). Histopathologic sections of all cases were re-reviewed and the diagnosis confirmed. All patient data were de-identified. Immunohistochemical studies were performed using antibodies to HIP1 and cytokeratins (CK) 20 and 7. A semiquantitative scoring system for immunohistochemical expression of HIP1 was utilized by deriving a cumulative score (based on percentage positivity of cells and intensity of expression). Using a cut-off total score of 3 or more as positive, the total number of positive cases was 22 for HIP1, 24 for CK20, and 11 for CK7. Comparing the results of HIP1 and CK20, there were four discordant pairs (three positive for CK20 but negative for HIP1 and one positive for HIP1 but negative for CK20). McNemar's test indicated that there was no statistical significance (P = 0.625), thereby implying a close agreement between the expression of HIP1 and CK20 in these neuroendocrine neoplasms. © 2014 The International Society of Dermatology.

Ultrasound screening of periarticular soft tissue abnormality around metal-on-metal bearings.

PubMed

Nishii, Takashi; Sakai, Takashi; Takao, Masaki; Yoshikawa, Hideki; Sugano, Nobuhiko

2012-06-01

Although metal hypersensitivity or pseudotumors are concerns for metal-on-metal (MoM) bearings, detailed pathologies of patterns, severity, and incidence of periprosthetic soft tissue lesions are incompletely understood. We examined the potential of ultrasound for screening of periarticular soft tissue lesions around MoM bearings. Ultrasound examinations were conducted in 88 hips (79 patients) with MoM hip resurfacings or MoM total hip arthroplasties with a large femoral head. Four qualitative ultrasound patterns were shown, including normal pattern in 69 hips, joint-expansion pattern in 11 hips, cystic pattern in 5 hips, and mass pattern in 3 hips. Hips with the latter 3 abnormal patterns showed significantly higher frequency of clinical symptoms, without significant differences of sex, duration of implantation, head sizes, and cup abduction/anteversion angles, compared with hips with normal pattern. Ultrasound examination provides sensitive screening of soft tissue reactions around MoM bearings and may be useful in monitoring progression and defining treatment for periarticular soft tissue abnormalities. Copyright © 2012 Elsevier Inc. All rights reserved.

Photobiomodulation therapy (PBMT) on acute pain and inflammation in patients who underwent total hip arthroplasty-a randomized, triple-blind, placebo-controlled clinical trial.

PubMed

Langella, Luciana Gonçalves; Casalechi, Heliodora Leão; Tomazoni, Shaiane Silva; Johnson, Douglas Scott; Albertini, Regiane; Pallotta, Rodney Capp; Marcos, Rodrigo Labat; de Carvalho, Paulo de Tarso Camillo; Leal-Junior, Ernesto Cesar Pinto

2018-06-16

When conservative treatments fail, hip osteoarthritis (OA), a chronic degenerative disease characterized by cartilage wear, progressive joint deformity, and loss of function, can result in the need for a total hip arthroplasty (THA). Surgical procedures induced tissue trauma and incite an immune response. Photobiomodulation therapy (PBMt) using low-level laser therapy (LLLT) and/or light-emitting diode therapy (LEDT) has proven effective in tissue repair by modulating the inflammatory process and promoting pain relief. Therefore, the aim of this study was to analyze the immediate effect of PBMt on inflammation and pain of patients undergoing total hip arthroplasty. The study consisted of 18 post-surgical hip arthroplasty patients divided into two groups (n = 9 each) placebo and active PBMt who received one of the treatments in a period from 8 to 12 h following THA surgery. PBMt (active or placebo) was applied using a device consisting of nine diodes (one super-pulsed laser of 905 nm, four infrared LEDs of 875 nm, and four red LEDs 640 nm, 40.3 J per point) applied to 5 points along the incision. Visual analog scale (VAS) and blood samples for analysis of the levels of the cytokines TNF-α, IL-6, and IL-8 were recorded before and after PBMt application. The values for the visual analog scale as well as those in the analysis of TNF-α and IL-8 serum levels decreased in the active PBMt group compared to placebo-control group (p < 0.05). No decrease was observed for IL-6 levels. We conclude that PBMt is effective in decreasing pain intensity and post-surgery inflammation in patients receiving total hip arthroplasty.

Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial.

PubMed

Howie, Donald W; Holubowycz, Oksana T; Middleton, Robert

2012-06-20

The use of larger femoral heads has been proposed to reduce the risk of dislocation after total hip arthroplasty, but there is a lack of evidence to support this proposal. The aim of this multicenter randomized controlled trial was to determine whether the incidence of dislocation one year after total hip arthroplasty is significantly lower in association with the use of a 36-mm femoral head articulation as compared with a 28-mm articulation. Six hundred and forty-four middle-aged and elderly patients undergoing primary or revision arthroplasty were randomized intraoperatively to receive either a 36 or 28-mm metal femoral head on highly cross-linked polyethylene. Patients who were at high risk of dislocation (including those with dementia and neuromuscular disease) and those undergoing revision for the treatment of recurrent hip dislocation or infection were excluded. Patients were stratified according to other potential risk factors for dislocation, including diagnosis and age. Diagnosis of hip dislocation required confirmation by a physician and radiographic evidence of a dislocation. Overall, at one year of follow-up, hips with a 36-mm femoral head articulation had a significantly lower incidence of dislocation than did those with a 28-mm articulation (1.3% [four of 299] compared with 5.4% [seventeen of 316]; difference, 4.1% [95% confidence interval, 1.2% to 7.2%]) when controlling for the type of procedure (primary or revision) (p = 0.012). The incidence of dislocation following primary arthroplasty was also significantly lower for hips with a 36-mm femoral head articulation than for those with a 28-mm articulation (0.8% [two of 258] compared with 4.4% [twelve of 275]; difference, 3.6% [95% confidence interval, 0.9% to 6.8%]) (p = 0.024). The incidence of dislocation following revision arthroplasty was 4.9% (two of forty-one) for hips with a 36-mm articulation and 12.2% (five of forty-one) for hips with a 28-mm articulation; this difference was not significant with the relatively small sample size of the revision group (difference, 7.3% [95% confidence interval, -5.9% to 21.1%]) (p = 0.273). Compared with a 28-mm femoral head articulation, a larger 36-mm articulation resulted in a significantly decreased incidence of dislocation in the first year following primary total hip arthroplasty. However, before a 36-mm metal-on-highly cross-linked polyethylene articulation is widely recommended, the incidence of late dislocation, wear, periprosthetic osteolysis, and liner fracture should be established.

Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures.

PubMed

Clarke-Jenssen, John; Westberg, Marianne; Røise, Olav; Storeggen, Stein Arne Øvre; Bere, Tone; Silberg, Ingunn; Madsen, Jan Erik

2017-11-01

Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures. We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1-14.1) years after an operatively treated acetabular fracture. The median age was 54 (11-82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years. Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre. Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present. Copyright © 2017 Elsevier Ltd. All rights reserved.

Handball Practice Enhances Bone Mass in Specific Sites Among Prepubescent Boys.

PubMed

Missawi, Kawther; Zouch, Mohamed; Chakroun, Yosra; Chaari, Hamada; Tabka, Zouhair; Bouajina, Elyès

2016-01-01

This investigation's purpose is to focus on the effects of practicing handball for at least 2 yr on bone acquisition among prepubescent boys. One hundred prepubescent boys aged 10.68 ± 0.85 yr were divided into 2 groups: 50 handball players (HP group) and 50 controls (C group). Bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) were evaluated by using dual-photon X-ray absorptiometry on the whole body, lumbar spine (L2-L4), legs, arms, femoral necks, hips and radiuses. Results showed greater values of BMD in both right and left femoral neck and total hip in handball players than in controls. In addition, handball players had higher values of legs and right total hip BMC than controls without any obvious variation of BA measurement in all sites between groups. All results of the paired t-test displayed an obviously marked variation of bone mass parameters between the left and right sides in the trained group without any marked variation among controls. Data showed an increased BMD of the supporting sites between the left and the right leg among handball players. However, "BMC" results exhibited higher values in the right than in the left total hip, and in the right total radius than in the left correspondent site. In addition, differences in the "BA" measurements were observed in the left total hip and in the right arm. Specific bone sites are markedly stimulated by handball training in prepubescent boys. Copyright © 2016 International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

[Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head].

PubMed

Li, Ji; Li, Zhongli; Su, Xiangzheng; Liu, Chunhui; Zhang, Hao; Wang, Ketao

2017-09-01

To evaluate the effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head (ONFH). Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompression combined with hip arthroscopy in 39 cases (53 hips, group A) or with drilling decompression alone in 52 cases (74 hips, group B). The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups ( P >0.05). All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [(73.3±10.6) minutes] than in group B [(41.5±7.2) minutes] ( t =8.726, P =0.000). Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months (mean, 39.3 months) in group A and 24-48 months (mean, 34.6 months) in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups ( t =-4.247, P =0.029) and when compared with preoperative values in 2 groups ( t =-10.327, P =0.001; t =-8.216, P =0.008). X-ray films showed that the collapse of the femoral head was observed in 6 hips (1 hip at stage Ⅰand 5 hips at stage Ⅱ) in group A, and in 16 hips (4 hips at stageⅠand 12 hips at stage Ⅱ) in group B; and hip arthroplasty was performed. The total effective rates were 88.68% (47/53) in group A and 78.38% (58/74) in group B, respectively; showing significant difference between 2 groups ( χ 2 =5.241, P =0.041). Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, delaying the need for total hip arthroplasty in patients with early ONFH.

The Exercise Plus Program for Older Women Post Hip Fracture: Participant Perspectives

ERIC Educational Resources Information Center

Resnick, Barbara; Orwig, Denise; Wehren, Lois; Zimmerman, Sheryl; Simpson, Marjorie; Magaziner, Jay

2005-01-01

Purpose: The purpose of this study was to explore the experiences of older women post hip fracture who were exposed to a motivational intervention, the Exercise Plus Program, intended to increase adherence to exercise. Design and Methods: This study used a naturalistic inquiry. We interviewed a total of 70 older women, 12 months post hip fracture,…

Effect of cup inclination on predicted contact stress-induced volumetric wear in total hip replacement.

PubMed

Rijavec, B; Košak, R; Daniel, M; Kralj-Iglič, V; Dolinar, D

2015-01-01

In order to increase the lifetime of the total hip endoprosthesis, it is necessary to understand mechanisms leading to its failure. In this work, we address volumetric wear of the artificial cup, in particular the effect of its inclination with respect to the vertical. Volumetric wear was calculated by using mathematical models for resultant hip force, contact stress and penetration of the prosthesis head into the cup. Relevance of the dependence of volumetric wear on inclination of the cup (its abduction angle ϑA) was assessed by the results of 95 hips with implanted endoprosthesis. Geometrical parameters obtained from standard antero-posterior radiographs were taken as input data. Volumetric wear decreases with increasing cup abduction angle ϑA. The correlation within the population of 95 hips was statistically significant (P = 0.006). Large cup abduction angle minimises predicted volumetric wear but may increase the risk for dislocation of the artificial head from the cup in the one-legged stance. Cup abduction angle and direction of the resultant hip force may compensate each other to achieve optimal position of the cup with respect to wear and dislocation in the one-legged stance for a particular patient.

Achieving Consensus on Total Joint Replacement Trial Outcome Reporting Using the OMERACT Filter: Endorsement of the Final Core Domain Set for Total Hip and Total Knee Replacement Trials for Endstage Arthritis.

PubMed

Singh, Jasvinder A; Dowsey, Michelle M; Dohm, Michael; Goodman, Susan M; Leong, Amye L; Scholte Voshaar, Marieke M J H; Choong, Peter F

2017-11-01

Discussion and endorsement of the OMERACT total joint replacement (TJR) core domain set for total hip replacement (THR) and total knee replacement (TKR) for endstage arthritis; and next steps for selection of instruments. The OMERACT TJR working group met at the 2016 meeting at Whistler, British Columbia, Canada. We summarized the previous systematic reviews, the preliminary OMERACT TJR core domain set and results from previous surveys. We discussed preliminary core domains for TJR clinical trials, made modifications, and identified challenges with domain measurement. Working group participants (n = 26) reviewed, clarified, and endorsed each of the inner and middle circle domains and added a range of motion domain to the research agenda. TJR were limited to THR and TKR but included all endstage hip and knee arthritis refractory to medical treatment. Participants overwhelmingly endorsed identification and evaluation of top instruments mapping to the core domains (100%) and use of subscales of validated multidimensional instruments to measure core domains for the TJR clinical trial core measurement set (92%). An OMERACT core domain set for hip/knee TJR trials has been defined and we are selecting instruments to develop the TJR clinical trial core measurement set to serve as a common foundation for harmonizing measures in TJR clinical trials.

Association of Body Weight and Body Mass Index with Bone Mineral Density in Women and Men from Kosovo.

PubMed

Rexhepi, Sylejman; Bahtiri, Elton; Rexhepi, Mjellma; Sahatciu-Meka, Vjollca; Rexhepi, Blerta

2015-08-01

Body weight and body mass index (BMI) are considered potentially modifiable determinants of bone mass. Therefore, the aim of this study was to explore the association between body weight and body mass index (BMI) with total hip and lumbar spine bone mineral density (BMD). This cross-sectional study included a population of 100 women and 32 men from Kosovo into three BMI groups. All the study subjects underwent dual-energy X-ray absorptiometry (DXA) measurements. Total hip BMD levels of obese menopausal and premenopausal women and men were significantly higher compared to overweight or normal weight subjects, while lumbar spine BMD levels of only menopausal women and men were higher among obese subjects. Age-adjusted linear regression analysis showed that BMI is a significant independent associate of lumbar spine and total hip BMD in menopausal women and men. Despite positive association between BMI and lumbar spine and total hip BMD in menopausal women, presence of more obese and osteoporotic subjects among menopausal women represent a population at risk for fractures because of poor balance and frequent falls; therefore, both obesity and osteoporosis prevention efforts should begin early on in life.

[Minimally invasive approaches to hip and knee joints for total joint replacement].

PubMed

Rittmeister, M; König, D P; Eysel, P; Kerschbaumer, F

2004-11-01

The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.

Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly.

PubMed

Gary, Joshua L; Lefaivre, Kelly A; Gerold, Frank; Hay, Michael T; Reinert, Charles M; Starr, Adam J

2011-10-01

Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed. Patients aged 60 or older treated with percutaneous reduction and fixation of acetabular fractures between 1994 and 2007 were selected. 79 consecutive patients with 80 fractures were identified. Rate of conversion to total hip arthroplasty were used to construct a Kaplan-Meier curve showing survivorship of the native hip joint after treatment. 75 fractures had adequate clinical follow-up with a mean of 3.9 years (range 0.5-11.9 years). Average blood loss was 69 cc and there were no postoperative infections. 19/75 (25%) were converted to total hip arthroplasty at a mean time of 1.4 years after the index procedure. Survivorship analysis demonstrated a cumulative survival of 65% at 11.9 years of follow-up. There were no conversions to arthroplasty beyond 4.7 years postoperatively. There were no statistically significant associations between conversion to arthroplasty and age, sex, closed vs. limited open reduction, and simple vs. complex fracture pattern. Percutaneous fixation is a viable treatment option for patients age 60 or greater with acetabular fractures. Rates of conversion to total hip arthroplasty are comparable to open treatment methods and if conversion is required, soft tissues are preserved for future surgery. Copyright © 2010 Elsevier Ltd. All rights reserved.

Early failure of total hip replacements implanted at distant hospitals to reduce waiting lists.

PubMed Central

Ciampolini, Jac; Hubble, Matthew J. W.

2005-01-01

AIM: In the years 1990-1993, in an effort to reduce waiting-list time, a small number of patients were sent from Exeter to hospitals in London to undergo elective total hip replacement. No medium- or long-term follow-up was arranged. Our aim was to audit the outcome of these hip replacements. PATIENTS AND METHODS: Review of the records of the referring medical practices, Regional Health Authority, local orthopaedic hospital and the distant centres at which the surgery was performed identified 31 cases. A total of 27 hip replacements in 24 patients were available for clinical and radiological review. RESULTS: 12 (44%) hips have so far required revision surgery, at a mean of 6.5 years. Of these, three (11%) have been for deep infection. A further three hips (11%) are radiologically loose and are being closely monitored. Two patients (7%) suffered permanent sciatic nerve palsy. CONCLUSIONS: Patients whose surgery was performed locally over a similar time period have a published failure rate of only 4.9%. This difference is highly statistically significant (P < 0.001). The causes for such a difference in outcome were analysed and include surgical technique, implant selection and absence of follow-up. In the light of this evidence, we would like to urge the government to address waiting list problems by investing in the local infrastructure. Expanding those facilities where properly audited and fully accountable surgeons operate must be the way forward. PMID:15720905

Celecoxib versus ibuprofen in the prevention of heterotopic ossification following total hip replacement: a prospective randomised trial.

PubMed

Saudan, M; Saudan, P; Perneger, T; Riand, N; Keller, A; Hoffmeyer, P

2007-02-01

We examined whether a selective cyclooxygenase-2 (COX-2) inhibitor (celecoxib) was as effective as a non-selective inhibitor (ibuprofen) for the prevention of heterotopic ossification following total hip replacement. A total of 250 patients were randomised to receive celecoxib (200 mg b/d) or ibuprofen (400 mg t.d.s) for ten days after surgery. Anteroposterior radiographs of the pelvis were examined for heterotopic ossification three months after surgery. Of the 250 patients, 240 were available for assessment. Heterotopic ossification was more common in the ibuprofen group (none 40.7% (50), Brooker class I 46.3% (57), classes II and III 13.0% (16)) than in the celecoxib group (none 59.0% (69), Brooker class I 35.9% (42), classes II and III 5.1% (6), p=0.002). Celecoxib was more effective than ibuprofen in preventing heterotopic bone formation after total hip replacement.

Hip protector compliance: a 13-month study on factors and cost in a long-term care facility.

PubMed

Burl, Jeffrey B; Centola, James; Bonner, Alice; Burque, Colleen

2003-01-01

To determine if a high compliance rate for wearing external hip protectors could be achieved and sustained in a long-term care population. A 13-month prospective study of daytime use of external hip protectors in an at-risk long-term care population. One hundred-bed not-for-profit long-term care facility. Thirty-eight ambulatory residents having at least 1 of 4 risk factors (osteoporosis, recent fall, positive fall screen, previous fracture). The rehabilitation department coordinated an implementation program. Members of the rehabilitation team met with eligible participants, primary caregivers, families, and other support staff for educational instruction and a description of the program. The rehabilitation team assumed overall responsibility for measuring and ordering hip protectors and monitoring compliance. By the end of the third month, hip protector compliance averaged greater than 90% daily wear. The average number of falls per month in the hip protector group was 3.9 versus 1.3 in nonparticipants. Estimated total indirect staff time was 7.75 hours. The total cost of the study (hip protectors and indirect staff time) was 6,300 US dollars. High hip protector compliance is both feasible and sustainable in an at-risk long-term care population. Achieving high compliance requires an interdisciplinary approach with one department acting as a champion. The cost of protectors could be a barrier to widespread use. Facilities might be unable to cover the cost until the product is paid for by third-party payers.

Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture: a randomized, controlled study.

PubMed

Kang, Hyun; Ha, Yong-Chan; Kim, Jin-Yun; Woo, Young-Cheol; Lee, Jae-Sung; Jang, Eui-Chan

2013-02-20

Appropriate pain management affects outcome after hip fracture surgery. Although multimodal pain management is commonly used for pain control for patients undergoing elective surgery, few studies have evaluated its use in those undergoing hip fracture surgery. This prospective randomized study was designed to determine the clinical value of multimodal pain management with preemptive pain medication and intraoperative periarticular multimodal drug injections in patients undergoing bipolar hip hemiarthroplasty. Of eighty-two cognitively intact elderly patients about to undergo bipolar hemiarthroplasty after a hip fracture, forty-three were randomly assigned to receive preemptive pain medication and intraoperative periarticular injections (Group I) and thirty-nine were assigned to not receive preemptive medication and injections (Group II). These two groups were compared with regard to the pain level on postoperative days one, four, and seven; at discharge; and when they started walking and standing exercises. Total amounts of fentanyl used, the frequency of use of patient-controlled analgesia, patient satisfaction at discharge, and perioperative complications were recorded. Group I had a lower pain level than Group II on postoperative days one and four, but no intergroup difference in pain level was observed on postoperative day seven. The total amount of fentanyl used and the frequency of use of patient-controlled analgesia were also lower in Group I. Patient satisfaction at discharge was higher in Group I. No significant intergroup differences were found in the times until the patients walked or performed standing exercises or in the complications. Multimodal pain management provides additional pain relief until the fourth postoperative day, improves patient satisfaction at discharge, and reduces total narcotic consumption for postoperative pain management after hip hemiarthroplasty for hip fractures.

Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology.

PubMed

Taljanovic, Mihra S; Graham, Anna R; Benjamin, James B; Gmitro, Arthur F; Krupinski, Elizabeth A; Schwartz, Stephanie A; Hunter, Tim B; Resnick, Donald L

2008-05-01

To correlate the amount of bone marrow edema (BME) calculated by magnetic resonance imaging(MRI) with clinical findings, histopathology, and radiographic findings, in patients with advanced hip osteoarthritis(OA). The study was approved by The Institutional Human Subject Protection Committee. Coronal MRI of hips was acquired in 19 patients who underwent hip replacement. A spin echo (SE) sequence with four echoes and separate fast spin echo (FSE) proton density (PD)-weighted SE sequences of fat (F) and water (W) were acquired with water and fat suppression, respectively. T2 and water:fat ratio calculations were made for the outlined regions of interest. The calculated MRI values were correlated with the clinical, radiographic, and histopathologic findings. Analyses of variance were done on the MRI data for W/(W + F) and for T2 values (total and focal values) for the symptomatic and contralateral hips. The values were significantly higher in the study group. Statistically significant correlations were found between pain and total W/(W + F), pain and focal T2 values, and the number of microfractures and calculated BME for the focal W/(W + F) in the proximal femora. Statistically significant correlations were found between the radiographic findings and MRI values for total W/(W + F), focal W/(W + F) and focal T2 and among the radiographic findings, pain, and hip movement. On histopathology, only a small amount of BME was seen in eight proximal femora. The amount of BME in the OA hip, as measured by MRI, correlates with the severity of pain, radiographic findings, and number of microfractures.

Ipsilateral and contralateral foot pronation affect lower limb and trunk biomechanics of individuals with knee osteoarthritis during gait.

PubMed

Resende, Renan A; Kirkwood, Renata N; Deluzio, Kevin J; Hassan, Elizabeth A; Fonseca, Sérgio T

2016-05-01

Lateral wedges have been suggested for the treatment of individuals with knee osteoarthritis, but it may have undesirable effects on the biomechanics of gait through increased foot pronation. This study investigated the effects of increased unilateral foot pronation on the biomechanics of individuals with knee osteoarthritis during gait. Biomechanical data of twenty individuals with knee osteoarthritis were collected while they walked in three conditions: i) flat sandals; ii) wedged sandal on the knee osteoarthritis limb and flat sandal on the healthy limb; and iii) flat sandal on the osteoarthritis and wedged sandal on the healthy limb. Knee pain and comfort were evaluated. Principal Component Analysis followed by ANOVA was implemented to identify differences between conditions. The wedged sandal on the osteoarthritis limb increased rearfoot eversion (P<0.001; ES=0.79); increased shank rotation range of motion (P<0.001; ES=0.70); reduced knee internal rotation moment (P<0.001; ES=0.83); reduced hip internal rotation moment (P=0.001; ES=0.66); increased ipsilateral trunk lean (P=0.031; ES=0.47); and increased trunk rotation range of motion (P=0.001; ES=0.69). Walking with the wedged sandal on the healthy limb increased hip (P=0.003; ES=0.61) and knee (P=0.002; ES=0.63) adduction moments. Individuals reported greater comfort walking with the flat sandals (P=0.004; ES=0.55). Increased unilateral foot pronation of the knee osteoarthritis and healthy limbs causes lower limb and trunk mechanical changes that may overload the knee and the lower back, such as increased knee adduction moment, shank rotation and trunk lateral lean. Foot motion of both lower limbs should be evaluated and care must be taken when suggesting lateral wedges for individuals with knee osteoarthritis. Copyright © 2016 Elsevier Ltd. All rights reserved.

Kinematic, Muscular, and Metabolic Responses During Exoskeletal-, Elliptical-, or Therapist-Assisted Stepping in People With Incomplete Spinal Cord Injury

PubMed Central

Kinnaird, Catherine R.; Holleran, Carey L.; Rafferty, Miriam R.; Rodriguez, Kelly S.; Cain, Julie B.

2012-01-01

Background Robotic-assisted locomotor training has demonstrated some efficacy in individuals with neurological injury and is slowly gaining clinical acceptance. Both exoskeletal devices, which control individual joint movements, and elliptical devices, which control endpoint trajectories, have been utilized with specific patient populations and are available commercially. No studies have directly compared training efficacy or patient performance during stepping between devices. Objective The purpose of this study was to evaluate kinematic, electromyographic (EMG), and metabolic responses during elliptical- and exoskeletal-assisted stepping in individuals with incomplete spinal cord injury (SCI) compared with therapist-assisted stepping. Design A prospective, cross-sectional, repeated-measures design was used. Methods Participants with incomplete SCI (n=11) performed 3 separate bouts of exoskeletal-, elliptical-, or therapist-assisted stepping. Unilateral hip and knee sagittal-plane kinematics, lower-limb EMG recordings, and oxygen consumption were compared across stepping conditions and with control participants (n=10) during treadmill stepping. Results Exoskeletal stepping kinematics closely approximated normal gait patterns, whereas significantly greater hip and knee flexion postures were observed during elliptical-assisted stepping. Measures of kinematic variability indicated consistent patterns in control participants and during exoskeletal-assisted stepping, whereas therapist- and elliptical-assisted stepping kinematics were more variable. Despite specific differences, EMG patterns generally were similar across stepping conditions in the participants with SCI. In contrast, oxygen consumption was consistently greater during therapist-assisted stepping. Limitations Limitations included a small sample size, lack of ability to evaluate kinetics during stepping, unilateral EMG recordings, and sagittal-plane kinematics. Conclusions Despite specific differences in kinematics and EMG activity, metabolic activity was similar during stepping in each robotic device. Understanding potential differences and similarities in stepping performance with robotic assistance may be important in delivery of repeated locomotor training using robotic or therapist assistance and for consumers of robotic devices. PMID:22700537

The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly.

PubMed

Guo, Jiong Jiong; Yang, Huilin; Qian, Haixin; Huang, Lixin; Guo, Zhongxing; Tang, Tiansi

2010-03-01

It has been well recognized that malnutrition causes wounds to heal inadequately and incompletely. Malnutrition is often observed in the elderly, and it appears to be more severe in patients with hip fracture than in the general aging population. Few prospective studies give a detailed account of the identification and classification of nutritional status in the elderly. The objective of this study was to evaluate the effects of different nutritional measurements on wound healing status after hip fracture in the elderly. From September 2002 to December 2007, 207 hip fracture patients older than 60 y treated surgically were reviewed for preoperative nutritional status. There were 81 males and 126 females with an average age of 75.93 y (62-91 y); 131 cases with femoral neck fractures, 76 cases with intertrochanteric fractures. Parameters indicative of nutritional status (serum albumin, serum transferrin, serum pre-albumin, and total lymphocyte count levels) at the time of admission were assessed, along with anthropometric measurements, Rainey MacDonald nutritional index, and MNA tool. Suture removal was performed on postoperative day 14. Delayed wound healing complicated 46 (22.2%) of the 207 cases. The preoperative serum transferring total lymphocyte count levels, MNA total score, and Rainey MacDonald nutritional index were significantly lower for patients who subsequently had delayed wound healing. When all variables were subjected to multivariate analysis, only total lymphocyte count levels and MNA total score showed significant value in predicting which patients would have delayed wound healing. Through prophylactic antibiotics and adherence to strict aseptic precautions, on follow-up, wound healing was normal in all patients. Patients at risk for delayed wound healing problems after hip fracture can be identified using relatively inexpensive laboratory test such as TLC and MNA tool. The clinician must be aware of the risk values of both measurements. We believe this information is particularly important before planning procedures of hip fractures in the elderly. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty : is it safe? a systematic review.

PubMed

Pereira, L C; Kerr, J; Jolles, B M

2016-08-01

Using a systematic review, we investigated whether there is an increased risk of post-operative infection in patients who have received an intra-articular corticosteroid injection to the hip for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection to the hip and infection following subsequent THA were identified from databases for the period between 1990 to 2013. Retrieved articles were independently assessed for their methodological quality. A total of nine studies met the inclusion criteria. Two recommended against a steroid injection prior to THA and seven found no risk with an injection. No prospective controlled trials were identified. Most studies were retrospective. Lack of information about the methodology was a consistent flaw. The literature in this area is scarce and the evidence is weak. Most studies were retrospective, and confounding factors were poorly defined or not addressed. There is thus currently insufficient evidence to conclude that an intra-articular corticosteroid injection administered prior to THA increases the rate of infection. High quality, multicentre randomised trials are needed to address this issue. Cite this article: Bone Joint J 2016;98-B:1027-35. ©2016 The British Editorial Society of Bone & Joint Surgery.

[Influence of Training of Orthopaedic Surgeons on Clinical Outcome after Total Hip Arthroplasty in a High Volume Endoprosthetic Centre].

PubMed

Osmanski-Zenk, Katrin; Finze, Susanne; Lenz, Robert; Bader, Rainer; Mittelmeier, Wolfram

2018-06-26

The study aims to evaluate whether the postoperative outcome and the probability of complications of patients with total hip arthroplasty increases significantly when surgeons in training are in charge, assisted by a high volume surgeon, compared to a highly experienced orthopaedic surgeon, within the context of a high volume hospital certified to EndoCert. 192 patients with a primary hip arthroplasty were included. To assess the outcome, the Harris Hip Score, WOMAC, SF-36 and EuroQol-5D were surveyed pre- and 12 months postoperatively. As complications we considered the quality indicators defined by EndoCert. We found significant improvements in the postoperative score values with the qualifications of the surgeon in charge, even when a high volume surgeon or a surgeon in training was responsible. If a surgeon in training is assisted by a highly experienced surgeon, the risk of complications does not increase, although the operating time was significantly increased. Both the surgeon in training as well as the arthroplasty patient benefit from implementing the EndoCert system, because the postoperative outcome and the complication probability is independent of the qualifcation of the operating orthopaedic surgeon performing total hip arthroplasty when assisted by an experienced surgeon. Georg Thieme Verlag KG Stuttgart · New York.

The Relationship Between Maximum Unilateral Squat Strength and Balance in Young Adult Men and Women

PubMed Central

McCurdy, Kevin; Langford, George

2006-01-01

The purpose of this study was to determine the relationship between unilateral squat strength and measures of static balance to compare balance performance between the dominant and non-dominant leg. Seventeen apparently healthy men (mean mass 90.5 ± 20.9 kg and age 21.7 ± 1.8 yrs) and 25 women (mean mass 62.2 ± 14.5 kg and age 21.9 ± 1.3 yrs) completed the study. Weight bearing unilateral strength was measured with a 1RM modified unilateral squat on the dominant and non-dominant leg. The students completed the stork stand and wobble board tests to determine static balance on the dominant and non-dominant leg. Maximum time maintained in the stork stand position, on the ball of the foot with the uninvolved foot against the involved knee with hands on the hips, was recorded. Balance was measured with a 15 second wobble board test. No significant correlations were found between the measurements of unilateral balance and strength (r values ranged between -0.05 to 0.2) for the men and women. Time off balance was not significantly different between the subjects’ dominant (men 1.1 ± 0.4 s; women 0.3 ± 0.1 s) and non-dominant (men 0.9 ± 0.3 s; women 0.3 ± 0.1 s) leg for the wobble board. Similar results were found for the time balanced during the stork stand test on the dominant (men 26.4 ± 6.3 s; women 24.1 ± 5.6 s) and non-dominant (men 26.0 ± 5.7 s; women 21.3 ± 4.1 s) leg. The data indicate that static balance and strength is unrelated in young adult men and women and gains made in one variable after training may not be associated with a change in performance of the other variable. These results also suggest that differences in static balance performance between legs can not be determined by leg dominance. Similar research is needed to compare contralateral leg balance in populations who participate in work or sport activities requiring repetitive asymmetrical use. A better understanding of contralateral balance performance will help practitioners make evaluative decisions during the rehabilitation process. Key Points 1RM unilateral squat strength is unrelated to measures of unilateral static balance in young adult men and women Static balance is similar between the dominant and non-dominant leg in young adult men and women Side-to-side differences in balance warrant assessment and training to correct imbalances prior to participation in activities that present a high risk for injury. PMID:24260001

Computer-assisted hip and knee arthroplasty. Navigation and active robotic systems: an evidence-based analysis.

PubMed

2004-01-01

The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of computer assisted hip and knee arthroplasty. The two computer assisted arthroplasty systems that are the topics of this review are (1) navigation and (2) robotic-assisted hip and knee arthroplasty. Computer-assisted arthroplasty consists of navigation and robotic systems. Surgical navigation is a visualization system that provides positional information about surgical tools or implants relative to a target bone on a computer display. Most of the navigation-assisted arthroplasty devices that are the subject of this review are licensed by Health Canada. Robotic systems are active robots that mill bone according to information from a computer-assisted navigation system. The robotic-assisted arthroplasty devices that are the subject of this review are not currently licensed by Health Canada. The Cochrane and International Network of Agencies for Health Technology Assessment databases did not identify any health technology assessments on navigation or robotic-assisted hip or knee arthroplasty. The MEDLINE and EMBASE databases were searched for articles published between January 1, 1996 and November 30, 2003. This search produced 367 studies, of which 9 met the inclusion criteria. NAVIGATION-ASSISTED ARTHROPLASTY: Five studies were identified that examined navigation-assisted arthroplasty.A Level 1 evidence study from Germany found a statistically significant difference in alignment and angular deviation between navigation-assisted and free-hand total knee arthroplasty in favour of navigation-assisted surgery. However, the endpoints in this study were short-term. To date, the long-term effects (need for revision, implant longevity, pain, functional performance) are unknown.(1)A Level 2 evidence short-term study found that navigation-assisted total knee arthroplasty was significantly better than a non-navigated procedure for one of five postoperative measured angles.(2)A Level 2 evidence short-term study found no statistically significant difference in the variation of the abduction angle between navigation-assisted and conventional total hip arthroplasty.(3)Level 3 evidence observational studies of navigation-assisted total knee arthroplasty and unicompartmental knee arthroplasty have been conducted. Two studies reported that "the follow-up of the navigated prostheses is currently too short to know if clinical outcome or survival rates are improved. Longer follow-up is required to determine the respective advantages and disadvantages of both techniques."(4;5) ROBOTIC-ASSISTED ARTHROPLASTY: Four studies were identified that examined robotic-assisted arthroplasty.A Level 1 evidence study revealed that there was no statistically significant difference between functional hip scores at 24 months post implantation between patients who underwent robotic-assisted primary hip arthroplasty and those that were treated with manual implantation.(6)Robotic-assisted arthroplasty had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure.(6)Patients who underwent robotic-assisted hip arthroplasty had a higher dislocation rate and more revisions.(6)Robotic-assisted arthroplasty may prove effective with certain prostheses (e.g., anatomic) because their use may result in less muscle detachment.(6)An observational study (Level 3 evidence) found that the incidence of severe embolic events during hip relocation was lower with robotic arthroplasty than with manual surgery.(7)An observational study (Level 3 evidence) found that there was no significant difference in gait analyses of patients who underwent robotic-assisted total hip arthroplasty using robotic surgery compared to patients who were treated with conventional cementless total hip arthroplasty.(8)An observational study (Level 3 evidence) compared outcomes of total knee arthroplasty between patients undergoing robotic surgery and patients who were historical controls. Brief, qualitative results suggested that there was much broader variation of angles after manual total knee arthroplasty compared to the robotic technique and that there was no difference in knee functional scores or implant position at the 3 and 6 month follow-up.(9).

Computer-Assisted Hip and Knee Arthroplasty. Navigation and Active Robotic Systems

PubMed Central

2004-01-01

Executive Summary Objective The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of computer assisted hip and knee arthroplasty. The two computer assisted arthroplasty systems that are the topics of this review are (1) navigation and (2) robotic-assisted hip and knee arthroplasty. The Technology Computer-assisted arthroplasty consists of navigation and robotic systems. Surgical navigation is a visualization system that provides positional information about surgical tools or implants relative to a target bone on a computer display. Most of the navigation-assisted arthroplasty devices that are the subject of this review are licensed by Health Canada. Robotic systems are active robots that mill bone according to information from a computer-assisted navigation system. The robotic-assisted arthroplasty devices that are the subject of this review are not currently licensed by Health Canada. Review Strategy The Cochrane and International Network of Agencies for Health Technology Assessment databases did not identify any health technology assessments on navigation or robotic-assisted hip or knee arthroplasty. The MEDLINE and EMBASE databases were searched for articles published between January 1, 1996 and November 30, 2003. This search produced 367 studies, of which 9 met the inclusion criteria. Summary of Findings Navigation-Assisted Arthroplasty Five studies were identified that examined navigation-assisted arthroplasty. A Level 1 evidence study from Germany found a statistically significant difference in alignment and angular deviation between navigation-assisted and free-hand total knee arthroplasty in favour of navigation-assisted surgery. However, the endpoints in this study were short-term. To date, the long-term effects (need for revision, implant longevity, pain, functional performance) are unknown.(1) A Level 2 evidence short-term study found that navigation-assisted total knee arthroplasty was significantly better than a non-navigated procedure for one of five postoperative measured angles.(2) A Level 2 evidence short-term study found no statistically significant difference in the variation of the abduction angle between navigation-assisted and conventional total hip arthroplasty.(3) Level 3 evidence observational studies of navigation-assisted total knee arthroplasty and unicompartmental knee arthroplasty have been conducted. Two studies reported that “the follow-up of the navigated prostheses is currently too short to know if clinical outcome or survival rates are improved. Longer follow-up is required to determine the respective advantages and disadvantages of both techniques.”(4;5) Robotic-Assisted Arthroplasty Four studies were identified that examined robotic-assisted arthroplasty. A Level 1 evidence study revealed that there was no statistically significant difference between functional hip scores at 24 months post implantation between patients who underwent robotic-assisted primary hip arthroplasty and those that were treated with manual implantation.(6) Robotic-assisted arthroplasty had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure.(6) Patients who underwent robotic-assisted hip arthroplasty had a higher dislocation rate and more revisions.(6) Robotic-assisted arthroplasty may prove effective with certain prostheses (e.g., anatomic) because their use may result in less muscle detachment.(6) An observational study (Level 3 evidence) found that the incidence of severe embolic events during hip relocation was lower with robotic arthroplasty than with manual surgery.(7) An observational study (Level 3 evidence) found that there was no significant difference in gait analyses of patients who underwent robotic-assisted total hip arthroplasty using robotic surgery compared to patients who were treated with conventional cementless total hip arthroplasty.(8) An observational study (Level 3 evidence) compared outcomes of total knee arthroplasty between patients undergoing robotic surgery and patients who were historical controls. Brief, qualitative results suggested that there was much broader variation of angles after manual total knee arthroplasty compared to the robotic technique and that there was no difference in knee functional scores or implant position at the 3 and 6 month follow-up.(9) PMID:23074452

Translation, cross-cultural adaptation, and psychometric properties of the German version of the hip disability and osteoarthritis outcome score.

PubMed

Blasimann, Angela; Dauphinee, Sharon Wood; Staal, J Bart

2014-12-01

Clinical measurement. To translate and cross-culturally adapt the Hip disability and Osteoarthritis Outcome Score (HOOS) from English into German, and to study its psychometric properties in patients after hip surgery. There is no specific hip questionnaire in German that not only measures symptoms and function but also contains items about hip-related quality of life. The translation and cross-cultural adaptation involved forward translation, harmonization, cognitive debriefing, back translation, and comparison to the original HOOS following international guidelines. The German version was tested in 51 Swiss inpatients 8 weeks after different types of hip surgery, mainly total hip replacement. The mean age of the participants was 62.5 years, and the age range was from 27 to 87 years. Thirty (58.8%) of the participants were women. Internal consistency and test-retest reliability were estimated using Cronbach alpha and intraclass correlation coefficients for agreement. For construct validity, total scores of the German HOOS were correlated with those of the Western Ontario and McMaster Universities Osteoarthritis Index. The HOOS was also compared to the Medical Outcomes Study 36-Item Short-Form Health Survey. Cronbach alpha values for all German HOOS subscales were between .87 and .93. For test-retest reliability, the intraclass correlation coefficient for agreement was 0.85 for the total scores of the German HOOS. The Spearman rho for the Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning subscale compared to the sum of all HOOS subscales was 0.71, and that for the Medical Outcomes Study 36-Item Short-Form Health Survey physical component summary was 0.97. The German HOOS has demonstrated adequate reliability and validity. Use of the German HOOS is recommended for assessment of patients after hip surgery, with the proviso that additional psychometric testing should be done in future research.

Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients.

PubMed

Berger, Richard A; Sanders, Sheila A; Thill, Elizabeth S; Sporer, Scott M; Della Valle, Craig

2009-06-01

Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consecutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices. Thirty-eight patients required some additional intervention outside the pathway to resolve nausea, hypotension, or sedation prior to discharge. There were no readmissions for pain, nausea, or hypotension yet there was one readmission for fracture and nine emergency room evaluations in the three month perioperative period. This anesthetic and rehabilitation protocol allowed outpatient total hip arthroplasty to be routinely performed in these consecutive patients undergoing primary total hip arthroplasty. With current reimbursement approaches the modest savings to the hospital in length of stay may be outweighed by the additional costs of personnel, thereby making this outpatient system more expensive to implement. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

How much arthritis is too much for hip arthroscopy: a systematic review.

PubMed

Domb, Benjamin G; Gui, Chengcheng; Lodhia, Parth

2015-03-01

The purpose of this study was to determine the extent of preoperative osteoarthritis (OA) that precludes benefit from hip arthroscopy by systematically reviewing the literature on hip arthroscopy in the setting of OA. We searched the Medline and PubMed databases using the following Medical Subject Heading terms: arthritis, osteoarthritis, chondral damage, chondral injury, chondral delamination, and hip arthroscopy. Two authors independently reviewed the literature and included articles if they were in the English language; commented on preoperative factors, parameters, physical examination, or diagnostic testing that may be evidence of cartilage damage and/or arthritis; contained outcome data on patients undergoing hip arthroscopy; and had a sample size of at least 10 patients with arthritic changes in the hip. We excluded review articles, technique articles, articles with overlapping patient populations, articles with hip arthroscopy used as an adjunct to an open procedure, articles with inflammatory and septic arthritis, and articles with a mean age younger than 18 years. Our search identified 518 articles, of which 15 met the inclusion and exclusion criteria. Two thousand fifty-one hips underwent arthroscopy at a mean patient age of 40.2 years. Of these, 1,195 hips had signs of OA. There were 345 conversions to total hip arthroplasty/surface replacement arthroplasty. Of these patients, 274 had OA. Eight patient-reported outcome instruments were used. Factors influencing outcomes were preoperative OA, age, chondral damage, femoroacetabular impingement, and duration of symptoms. Current evidence is insufficient to define a cutoff for how much arthritis is too much for hip arthroscopy. However, this analysis shows that patients with a Tönnis grade of 1 or greater or a joint space of 2 mm or less are less likely to benefit from hip arthroscopy and more likely to require conversion to total hip arthroplasty/surface replacement arthroplasty. Postoperative scores on patient-reported outcome instruments are lower in the arthritic population at follow-up compared with their nonarthritic counterparts. Level IV, systematic review of Level III and IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Short-term curative effects of Tantalum rod treatment in early avascular necrosis].

PubMed

Ye, Fu-Sheng; Ni, Zhe-Ji; Chu, Xiao-Bing; He, Bang-Jian; Li, Ju; Tong, Pei-Jian

2013-08-01

To explore the recent clinical curative effect of Tantalum rod in treating the early avascular necrosis. From January 2008 to November 2008, the 25 patients (39 hips) with early avascular necrosis accepted tantalum rod placement and included 9 males (11 hips) and 16 females (28 hips) with an average age of 37 years old ranging from 18 to 74 years old. Four patients (6 hips) caused by Alcoholic, 6 patients (8 hips) by hormone, 2 cases (2 hips) by traumatic, 13 cases (23 hips) by idiopathic. Steinberg preoperative stage involved 7 hips in period I, 24 hips in period II, 8 hips in period III. Curative effect analysis included preoperative and postoperative Harris score, radiographic changes and hip replacement for follow-up to accept the end of the femoral head survival rate. All patients were followed up for 6 to 47 months (averaged 37.4 months). All 12 hips imaging appeard progress,including tantalum rod exit in 1 hip, hip hemiarthroplasty collapse in 3 hips, the area increased to avascular necrosis in 8 hips. Six hips accepted total hip replacement, including imaging progress in 5 hips (41.7%, 5/12), no imaging progress in 1 hip (3.7%,1/27). All hips' Kaplan-Meier survival curves showed 6-month survival rate was (97.4 +/- 2.5)% after tantalum stick insertion, 1-year survival rate was (94.7 +/- 3.6), and 2-year survival rate was (88.6 +/- 5.4)%, 3-year survival rate was (72.5 +/- 11.2). It is effective for treatment of avascular necrosis of femoral head in Steinberg I and II by Tantalum rod, and it can effectively relieve femoral head replacement time.

Hospital costs associated with laparoscopic and open inguinal herniorrhaphy.

PubMed

Spencer Netto, Fernando; Quereshy, Fayez; Camilotti, Bruna G; Pitzul, Kristen; Kwong, Josephine; Jackson, Timothy; Penner, Todd; Okrainec, Allan

2014-01-01

The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs. Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827). In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.

Etidronate

MedlinePlus

... the skeleton) in people who have had total hip replacement surgery (surgery to replace the hip joint with an artificial joint) or in people ... 8 ounces [180 to 240 mL]) of plain water while you are sitting or standing. Sit or ...

Hip fracture prevalence in grandfathers is associated with reduced cortical cross-sectional bone area in their young adult grandsons.

PubMed

Rudäng, Robert; Ohlsson, Claes; Odén, Anders; Johansson, Helena; Mellström, Dan; Lorentzon, Mattias

2010-03-01

Parent hip fracture prevalence is a known risk factor for osteoporosis. The role of hip fracture prevalence in grandparents on areal bone mineral density (aBMD) and bone size in their grandsons remains unknown. The objective of the study was to examine whether hip fracture prevalence in grandparents was associated with lower aBMD and reduced cortical bone size in their grandsons. This was a population-based cohort study in Sweden. Subjects included 1015 grandsons (18.9 +/- 0.6) (mean +/- sd) and 3688 grandparents. aBMD, cortical bone size, volumetric bone mineral density and polar strength strain index of the cortex in the grandsons in relation to hip fracture prevalence in their grandparents were measured. Grandsons of grandparents with hip fracture (n = 269) had lower aBMD at the total body, radius, and lumbar spine, but not at the hip, as well as reduced cortical cross-sectional area at the radius (P < 0.05) than grandsons of grandparents without hip fracture. Subgroup analysis demonstrated that grandsons of grandfathers with hip fracture (n = 99) had substantially lower aBMD at the lumbar spine (4.9%, P < 0.001) and total femur (4.1%, P = 0.003) and lower cortical cross-sectional area of the radius (4.1%, P < 0.001) and tibia (3.3%, P < 0.011). Adjusting bone variables for grandson age, weight, height, smoking, calcium intake, and physical activity and taking grandparent age at register entry, years in register, and grandparent sex into account strengthened or did not affect these associations. Family history of a grandfather with hip fracture was associated with reduced aBMD and cortical bone size in 19-yr-old men, indicating that patient history of hip fracture in a grandfather could be of value when evaluating the risk of low bone mass in men.

HIP AND GLENOHUMERAL PASSIVE RANGE OF MOTION IN COLLEGIATE SOFTBALL PLAYERS

PubMed Central

Plummer, Hillary; Brambeck, Allison

2016-01-01

Background and Purpose Range of motion deficits at the hip and glenohumeral joint (GHJ) may contribute to the incidence of injury in softball players. With injury in softball players on the rise, softball related studies in the literature are important. The purpose of this study was to examine hip and GHJ passive range of motion (PROM) patterns in collegiate softball players. Hypothesis It was hypothesized that the position players would exhibit significantly different PROM patterns than pitchers. Additionally, position players would exhibit significantly different side-to-side differences in PROM for both the hip and GHJ compared to pitchers. Study Design Prospective cohort study. Methods Forty-nine collegiate softball players (19.63 ± 1.15 years; 170.88 ± 8.08 cm; 72.96 ± 19.41 kg) participated. Passive hip and GHJ internal (IR) and external rotation (ER) measures were assessed. Glenohumeral PROM was measured with the participants supine with the arm abducted to 90 °. The measurements were recorded when the scapula began to move or a firm capsular end-feel was achieved. The hip was positioned in 90 ° of flexion and passively rotated until a capsular end-feel was achieved. Total PROM was calculated by taking the sum of IR and ER for both the hip and GHJ. Results No significant side-to-side PROM differences were observed in pitchers, at the GHJ or hip joint. Position players throwing side hip IR was significantly greater than the non-throwing side hip (p = 0.002). The non-throwing side hip had significantly greater ER compared to the throwing side hip (p = 0.002). When examining side-to-side differences at the GHJ, IR was significantly greater in the non-throwing shoulder (p = 0.047). No significant differences in total range of motion of the hip and GHJ were observed. Conclusion In the current study, position players displayed side-to-side differences in hip and GHJ IR PROM while no statistically significant differences were observed in the softball pitchers. The findings of the current study add to the body of literature related to PROM in throwing athletes, additionally these are the first hip IR and ER PROM data presented in softball players. Level of Evidence Level 3 PMID:27757286

Bone Remodeling in Acetabular Reconstruction Using a Kerboull-Type Reinforcement Device and Structural Bone-Grafting in Total Hip Arthroplasty.

PubMed

Oe, Kenichi; Iida, Hirokazu; Tsuda, Kohei; Nakamura, Tomohisa; Okamoto, Naofumi; Ueda, Yusuke

2017-03-01

The purpose of this study was to identify the long-term durability of the Kerboull-type reinforcement device (KT plate) in acetabular reconstruction for massive bone defects, assessing the remodeling of structural bone grafts. This study retrospectively evaluated 106 hips that underwent acetabular reconstruction using a KT plate between November 2000 and December 2010. Thirty-eight primary total hip arthoplasties (THAs) and 68 revised THAs were performed, and the mean duration of clinical follow-up was 8 years (5-14 years). Regarding reconstructing the acetabular bone defects, autografts were used in 37 hips, allografts in 68 hips, and A-W glass ceramics in 2 hips. One hip exhibited radiological migration and no revision for aseptic loosening. The mean Merle d'Aubigné Clinical Score improved from 7.5 points (4-12 points) preoperatively to 10.9 points (9-18 points) at the last follow-up. The Kaplan-Meier survival rate for radiological migration of primary and revised THAs at 10 years was 100% and 97% (95% confidence interval: 96%-100%), respectively. Bone remodeling was evaluated using the radiological demarcation at the bone-to-bone interface, and an improvement of 100% in primary THAs and 94% in revised THAs was observed. For massive bone defects, acetabular reconstruction using the KT plate with a structural bone grafting can yield successful results. Copyright © 2016 Elsevier Inc. All rights reserved.

Cross-cultural adaptation and validation of the Turkish version of Oxford hip score.

PubMed

Tuğay, Baki Umut; Tuğay, Nazan; Güney, Hande; Hazar, Zeynep; Yüksel, İnci; Atilla, Bülent

2015-06-01

The purpose of this study was to translate the Oxford hip score (OHS) into Turkish and to evaluate the psychometric properties by testing the internal consistency, reproducibility, construct validity, and responsiveness in patients with hip osteoarthritis (OA). Oxford hip score was translated and culturally adapted according to the guidelines in the literature. Seventy patients (mean age 61.45 ± 9.29 years) with hip osteoarthritis participated in the study. Patients completed the Turkish Oxford hip score (OHS-TR), the Short-Form 36 (SF-36), and Western Ontario and McMaster Universities Index (WOMAC). Internal consistency was tested using Cronbach's α coefficient. Patients completed OHS-TR questionnaire twice in 7 days for determining the reproducibility. Correlation between the total results of both tests was determined by the Pearson correlation coefficient and intraclass correlation coefficient (ICC). Validity was assessed by calculating the Pearson correlation coefficient between the OHS-TR and WOMAC and SF-36 scores. Floor and ceiling effects were analyzed. The internal consistency was high (Cronbach's α 0.93). The construct validity showed a significant correlation between the OHS-TR and WOMAC and related SF-36 domains (p < 0.001). The ICC's ranged between 0.80 and 0.99. There was no floor or ceiling effect in total OHS-TR score. The OHS-TR questionnaire is valid, reliable, and responsive for the Turkish-speaking patients with hip OA.

Prevalence and severity of hip and groin pain in sub-elite male football: a cross-sectional cohort study of 695 players.

PubMed

Thorborg, K; Rathleff, M S; Petersen, P; Branci, S; Hölmich, P

2017-01-01

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub-elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1-4) were included. Players completed in the beginning of the new season (July-Sept 2011) a self-reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45-52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26-36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub-elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Analysis of the kinematics of different hip simulators used to study wear of candidate materials for the articulation of total hip arthroplasties.

PubMed

Ramamurti, B S; Estok, D M; Jasty, M; Harris, W H

1998-05-01

We developed an analytical technique to determine the paths traced by specific points on the femoral head against the acetabulum in the human hip joint during gait. The purpose of the study was to apply this technique to the mechanical hip simulators chosen to conduct wear tests on polymeric acetabular liners used in total hip replacements. These simulators differ from one another in the type of motion produced, apart from other variables such as type of lubricant and head position. Due to the variation in the kinematics between the machines, the paths traced by the points on the femoral head against the acetabular liner ranged from simple linear traces to figure-8 loops and quasi-elliptical paths during a single simulator cycle. The distances traveled by these points during the same period also varied appreciably among the different hip simulator designs. These results are important when combined with other studies that have shown that kinematics can play an important role in the outcome of in vitro wear experiments. The kinematic differences quantified in this study can partially explain the substantial differences in wear data reported from different simulator designs and also underscore the usefulness of the technique described in this study in judging the results from different hip simulator experiments.

Assessment of reliability, validity, responsiveness and minimally important change of the German Hip dysfunction and osteoarthritis outcome score (HOOS) in patients with osteoarthritis of the hip.

PubMed

Arbab, Dariusch; van Ochten, Johannes H M; Schnurr, Christoph; Bouillon, Bertil; König, Dietmar

2017-12-01

Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures. The intention of this study was to evaluate reliability, validity, responsiveness and minimally important change of the German version of the Hip dysfunction and osteoarthritis outcome score (HOOS). The German HOOS was investigated in 251 consecutive patients before and 6 months after total hip arthroplasty. All patients completed HOOS, Oxford-Hip Score, Short-Form (SF-36) and numeric scales for pain and disability. Test-retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German HOOS demonstrated excellent test-retest reliability with intraclass correlation coefficient values > 0.7. Cronbach´s alpha values demonstrated strong internal consistency. As hypothesized, HOOS subscales strongly correlated with corresponding OHS and SF-36 domains. All subscales showed excellent (effect size/standardized response means > 0.8) responsiveness between preoperative assessment and postoperative follow-up. The HOOS and all subdomains showed higher changes than the minimal detectable change which indicates true changes. The German version of the HOOS demonstrated good psychometric properties. It proved to be valid, reliable and responsive to the changes instrument for use in patients with hip osteoarthritis undergoing total hip replacement.

Three-Dimensional Analysis of the Contact Pattern between the Cortical Bone and Femoral Prosthesis after Cementless Total Hip Arthroplasty

PubMed Central

Mishima, Hajime; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

2016-01-01

The cementless stem Excia (B. Braun, Melsungen, Germany) implant has a rectangular cross-sectional shape with back-and-forth flanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial fixation and early bone formation. Here, the conformity of the Excia stem to the femoral canal morphology was three-dimensionally assessed using computed tomography. Forty-three patients (45 hips) were examined after primary total hip arthroplasty with a mean follow-up of 27 ± 3 months (range: 24–36 months). Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83% (20/24 hips) of those occurring within 3 months after surgery. First- (n = 12 hips), second- (n = 32), and third- (n = 1) degree stress shielding were observed. The stem was typically in contact with the cortical bone in the anterolateral mid-portion (100%) and posteromedial distal portions (85%). Stress shielding did not progress, even in cases where the stems were in contact with the distal portions. The anterior flange was in contact with the bone in all cases. The stability of the mid-lateral portion with the dicalcium phosphate dihydrate coating and the anterior flange may have inhibited the progression of stress shielding beyond the second degree. PMID:26881087

A Comparison of Right Unilateral and Sequential Bilateral Repetitive Transcranial Magnetic Stimulation for Major Depression: A Naturalistic Clinical Australian Study.

PubMed

Galletly, Cherrie A; Carnell, Benjamin L; Clarke, Patrick; Gill, Shane

2017-03-01

A great deal of research has established the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. However, questions remain about the optimal method to deliver treatment. One area requiring consideration is the difference in efficacy between bilateral and unilateral treatment protocols. This study aimed to compare the effectiveness of sequential bilateral rTMS and right unilateral rTMS. A total of 135 patients participated in the study, receiving either bilateral rTMS (N = 57) or right unilateral rTMS (N = 78). Treatment response was assessed using the Hamilton depression rating scale. Sequential bilateral rTMS had a higher response rate than right unilateral (43.9% vs 30.8%), but this difference was not statistically significant. This was also the case for remission rates (33.3% vs 21.8%, respectively). Controlling for pretreatment severity of depression, the results did not indicate a significant difference between the protocols with regard to posttreatment Hamilton depression rating scale scores. The current study found no statistically significant differences in response and remission rates between sequential bilateral rTMS and right unilateral rTMS. Given the shorter treatment time and the greater safety and tolerability of right unilateral rTMS, this may be a better choice than bilateral treatment in clinical settings.

Adventure sports and sexual freedom hip replacement: the tripolar hip.

PubMed

Pritchett, James W

2018-01-01

Certain athletic activities and lifestyles require a completely stable and very mobile hip. Total hip replacement with a natural femoral head size and two mobile-bearing surfaces (i.e., a "tripolar" prosthesis) is the most stable prosthesis. Elegant design and wear-resistant bearing surfaces are the keys to long-term implant survivorship. The hypothesis is that a ceramic-coated tripolar prosthesis using highly cross-linked polyethylene can provide full function and complete stability with low wear. This study sought to determine: (1) patient-reported outcomes, (2) functional outcomes, (3) implant survivorship and complications, and (4) postoperative sexual limitations. Between 1998 and 2011, the author performed 160 primary total hip replacements using tripolar prostheses in patients participating in adventure sports and other physically demanding activities. The institutional review board approved this study. The inclusion criteria were patients who needed unrestricted activity and who were not candidates for or did not choose hip resurfacing. Patients were followed every second year and assessed with radiographs, Harris Hip Score, WOMAC, SF-12, and UCLA functional outcome scores. Patients were asked about symptoms of instability and satisfaction with their hip replacement. Patients were asked both preoperatively and 2 years postoperatively four questions about their sexual activity. Mean follow-up was 11 years. At 2 years' postoperatively, 98% of patients reported their satisfaction as excellent or good and 99% were not limited for sexual activity following surgery. Seventy-four percent of patients reported they were recovered within 6 weeks of surgery. There were no dislocations. There were three revision procedures for implant loosening, infection, and periprosthetic fracture, but there were no failures of the tripolar articulation. The mean postoperative UCLA score was the highly athletic score of 8. There were no signs of osteolysis, wear, or metal sensitivity reactions. The range of motion achieved, sexual, and functional outcomes were higher than with other types of total hip replacement. This ceramic-coated tripolar prosthesis using highly cross-linked polyethylene provides full function, complete stability, and low wear to younger, active patients, thus confirming the hypothesis and clinical relevance.

Retrospective Analysis for Genetic Improvement of Hip Joints of Cohort Labrador Retrievers in the United States: 1970–2007

PubMed Central

Lust, George; Zhu, Lan; Zhang, Zhiwu; Todhunter, Rory J.

2010-01-01

Background Canine Hip Dysplasia (CHD) is a common inherited disease that affects dog wellbeing and causes a heavy financial and emotional burden to dog owners and breeders due to secondary hip osteoarthritis. The Orthopedic Foundation for Animals (OFA) initiated a program in the 1960's to radiograph hip and elbow joints and release the OFA scores to the public for breeding dogs against CHD. Over last four decades, more than one million radiographic scores have been released. Methodology/Principal Findings The pedigrees in the OFA database consisted of 258,851 Labrador retrievers, the major breed scored by the OFA (25% of total records). Of these, 154,352 dogs had an OFA hip score reported between 1970 and 2007. The rest of the dogs (104,499) were the ancestors of the 154,352 dogs to link the pedigree relationships. The OFA hip score is based on a 7-point scale with the best ranked as 1 (excellent) and the worst hip dysplasia as 7. A mixed linear model was used to estimate the effects of age, sex, and test year period and to predict the breeding value for each dog. Additive genetic and residual variances were estimated using the average information restricted maximum likelihood procedure. The analysis also provided an inbreeding coefficient for each dog. The hip scores averaged 1.93 (±SD = 0.59) and the heritability was 0.21. A steady genetic improvement has accrued over the four decades. The breeding values decreased (improved) linearly. By the end of 2005, the total genetic improvement was 0.1 units, which is equivalent to 17% of the total phenotypic standard deviation. Conclusion/Significance A steady genetic improvement has been achieved through the selection based on the raw phenotype released by the OFA. As the heritability of the hip score was on the low end (0.21) of reported ranges, we propose that selection based on breeding values will result in more rapid genetic improvement than breeding based on phenotypic selection alone. PMID:20195372

Hip fusion takedown to a total hip arthroplasty-is it worth it? A systematic review.

PubMed

Jauregui, Julio J; Kim, Joseph K; Shield, William P; Harb, Matthew; Illical, Emmanuel M; Adib, Farshad; Maheshwari, Aditya V

2017-08-01

Patients with surgically or spontaneously fused hips are often dissatisfied with their overall function and the debilitating effect on adjacent joints. Therefore, in properly selected patients, hip fusion-takedown and conversion to total hip arthroplasty (THA) can result in improved function and decreased pain. We aimed to (1) evaluate the indications for conversion, (2) evaluate the clinical outcomes, (3) analyze the overall complications, and (4) identify the overall satisfaction following the procedure. A systematic and comprehensive literature search was performed to analyze studies evaluating conversion of hip fusion to THA. After reviewing 3,882 studies, 27 total studies (1,104 hips) met our inclusion/exclusion criteria and were included in our final analysis. A weighted mean of rates was determined for each complication, including infection, instability, loosening, nerve-related, abductor-related, venous thrombotic event, and revision. The study population consisted of 53.2% male and 46.8% female subjects. The mean age at time of conversion was 52 years (range 36-65 years), the mean time until follow-up was 9.2 years (range 2.5-17.3), and the mean duration of arthrodesis was 27.7 years (range 11-40.2). As measured by Harris Hip Score, overall clinical outcomes improved from 58.1 points (range 42.4-70 points) pre-operatively to 80.0 (range 62-93.5) post-operatively. The specific complication rates were 5.3% (range 0-43.6%) for infection, 2.6% (range 0-15.4%) for instability, 6.2% (range 0-17.2%) for loosening, 4.7% (range 0-13%) for nerve-related complications, 13.1% (range 0-87%) for abductor-related complications, and 1.2% (range 0-13%) for venous thrombotic events. The revision rate was 12.0% (range 0-43.6%). Takedown of a fused-hip can be a challenging procedure. Although patients can benefit functionally, both patients and surgeons need to be aware of the complications and increased risk of further revision procedures, which should be an important part of the pre-operative discussion.

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study.

PubMed

Eitzen, Ingrid; Fernandes, Linda; Nordsletten, Lars; Risberg, May Arna

2012-12-20

Existent biomechanical studies on hip osteoarthritic gait have primarily focused on the end stage of disease. Consequently, there is no clear consensus on which specific gait parameters are of most relevance for hip osteoarthritis patients with mild to moderate symptoms. The purpose of this study was to explore sagittal plane gait characteristics during the stance phase of gait in hip osteoarthritis patients not eligible for hip replacement surgery. First, compared to healthy controls, and second, when categorized into two subgroups of radiographic severity defined from a minimal joint space of ≤/>2 mm. Sagittal plane kinematics and kinetics of the hip, knee and ankle joint were calculated for total joint excursion throughout the stance phase, as well as from the specific events initial contact, midstance, peak hip extension and toe-off following 3D gait analysis. In addition, the Western Ontario and McMaster Universities Osteoarthritis Index, passive hip range of motion, and isokinetic muscle strength of hip and knee flexion and extension were included as secondary outcomes. Data were checked for normality and differences evaluated with the independent Student's t-test, Welch's t-test and the independent Mann-Whitney U-test. A binary logistic regression model was used in order to control for velocity in key variables. Fourty-eight hip osteoarthritis patients and 22 controls were included in the final material. The patients walked significantly slower than the controls (p=0.002), revealed significantly reduced joint excursions of the hip (p<0.001) and knee (p=0.011), and a reduced hip flexion moment at midstance and peak hip extension (p<0.001). Differences were primarily manifested during the latter 50% of stance, and were persistent when controlling for velocity. Subgroup analyses of patients with minimal joint space ≤/>2 mm suggested that the observed deviations were more pronounced in patients with greater radiographic severity. The biomechanical differences were, however, not reflected in self-reported symptoms or function. Reduced gait velocity, reduced sagittal plane joint excursion, and a reduced hip flexion moment in the late stance phase of gait were found to be evident already in hip osteoarthritis patients with mild to moderate symptoms, not eligible for total hip replacement. Consequently, these variables should be considered as key features in studies regarding hip osteoarthritic gait at all stages of disease. Subgroup analyses of patients with different levels of radiographic OA further generated the hypothesis that the observed characteristics were more pronounced in patients with a minimal joint space ≤2 mm.

Histopathology of femoral head donations: a retrospective review of 6161 cases.

PubMed

Mackie, Katherine E; Zhou, Ziqiang; Robbins, Peter; Bulsara, Max; Zheng, Ming H

2011-08-17

Although total hip arthroplasty is one of the most common orthopaedic surgical procedures, it remains unclear whether histopathological examination of the excised femoral head adds to the quality of patient care. We propose that assessment of femoral heads resected during total hip arthroplasty and donated for allograft use may provide a profile of femoral head pathology that benefits total hip arthroplasty patients and bone donors. We retrospectively analyzed the histological findings reported for 6161 femoral heads donated for allograft use between 1993 and 2006. Specimens obtained during total hip arthroplasty and specimens donated at death were reviewed. Follow-up investigations that resulted from abnormal histopathological findings were also reviewed. The Western Australian Cancer Registry was used to determine whether patients with a suspected neoplasm were subsequently diagnosed with such a disease. A retrospective review of the histopathological findings was conducted to evaluate and reclassify all previous observations of abnormalities. One hundred and five femoral heads demonstrated abnormal or reactive histopathological features not reported prior to surgery and were rejected for allograft use. A reactive lymphocytic infiltrate, most likely due to osteoarthritis, was the most commonly identified feature (forty-five cases). Other features observed in twenty-seven cases were also most likely due to the presence of severe osteoarthritis. Ten femoral heads demonstrated plasmacytosis, which may have been related to osteoarthritis. Two patients were diagnosed with Paget's disease, and two, with rheumatoid arthritis. Nineteen patients had a suspected neoplasm. Of these nineteen, eight cases of non-Hodgkin's lymphoma or chronic lymphocytic leukemia and one case of myelodysplastic syndrome were confirmed on further investigation. One subsequently confirmed malignancy was detected per 770 femoral heads examined. Our findings indicate that, even with a detailed medical history and careful physical examination, clinically important diseases including neoplasms and Paget's disease are observed in patients diagnosed with osteoarthritis prior to total hip arthroplasty. Histological examination plays an integral role in quality assurance in femoral head banking, and it also represents a possible early diagnostic test for bone and bone-marrow-related diseases in patients undergoing total hip arthroplasty.

Late diagnosis and surgical treatment of patients diagnosed with unilateral congenital cataract at Fundación Visión, in Asuncion, Paraguay.

PubMed

Zegarra, Manuel; Burga, Gisella Harumi; Lansingh, Van; Samudio, Margarita; Duarte, Edgar; Ferreira, Rocio; Dorantes, Yesenia; Ginés, Juan Carlos; Zepeda, Luz

2014-10-01

Purpose: Providing data on the late diagnosis and surgical treatment of patients who underwent surgery for total unilateral congenital cataract. Methods: Systematic retrospective review of the medical record of all patients between 0 and 16 years old with total unilateral congenital cataract who underwent surgery at Fundación Vision between January 2010 and July 2012. Results: Medical records of 37 patients (51 % females) were studied, age was 7.4 (± 4.9) years (average ± SD) and 62% lived on Departamento Central (the most populated region from Paraguay). A total of 97.3% patients underwent late surgical treatment and 86.5% received a late diagnosis. The average time elapsed between the diagnosis and the surgical treatment was one month, and 62.2% of the patients underwent surgery within six months from the diagnosis. Conclusion: This study evidences that most of the patients in our series had a late treatment as a result of a late diagnosis. Based on these results we recommend establishing strategies to improve the early detection and surgical treatment of the newborns.

The V-Y flap technique in complicated and recurrent pilonidal sinus disease.

PubMed

Koca, Yavuz Savas; Yıldız, Ihsan; Ugur, Mustafa; Barut, Ibrahim

2018-01-01

This study presents early and long term (5 years) outcome of 61 complicated pilonidal sinus disease cases undergoing V-Y advancement flap method together with the literature data. Data of 336 patients undergoing surgery for pilonidal sinus disease between 2008 and 2012 were retrospectively analyzed. Patients with defect size ≥ 10 cm, and more than one subcutaneous sinus tunnels were assumed to have complicated pilonidal sinus disease. A total of 61 patients were included in the study. Age, gender, type of surgery, duration of hospitalization, time of drain removal, pre-operative complications, and relapse rates at post-operative 5th year were analyzed. Of the 66 patients, 51 underwent unilateral V-Y advancement and 10 patients had bilateral V-Y plasty. Mean duration of operations was 66.87±18.37 minutes for total, 61.02±12.30 minutes for unilateral V-Y plasty, and 96.70±15.04 minutes for bilateral V-Y plasty. Hemovac drains were removed at 5.59±1.91 days averagely, 5.16±1.37 in unilateral group, and 7.80±2.74 in bilateral V-Y plasty group. Of the 4 patients who developed wound site infection, 2 had unilateral and 2 had bilateral V-Y flap advancement. Postoperative hematomas developed in 2 patients with unilateral flap and one patient with bilateral flapss. Seroma occurred in 2 patients with unilateral flap and one patient with bilateral flaps. Dehiscence developed two patients, one patient from each group. The mean duration of hosptalization was 5.98±2.21 days; 5.49±1.52 in unilateral group, and 8.50±3.34 in bilateral group. Early or late relapse was not seen in any groups. V-Y advancement flap technique can be applied as an efficient method in the treatment of complicated pilonidal sinus disease due to low relapse and complication rates. Advancement flap, Complicated pilonidal sinus, Pilonidal sinus, V-Y flap.

Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up.

PubMed

Fukuda, Thiago Yukio; Melo, William Pagotti; Zaffalon, Bruno Marcos; Rossetto, Flavio Marcondes; Magalhães, Eduardo; Bryk, Flavio Fernandes; Martin, Robroy L

2012-10-01

Randomized controlled trial. To determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome (PFPS). Recent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS. However, there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises. Fifty-four sedentary women between 20 and 40 years of age, with a diagnosis of unilateral PFPS, were randomly assigned knee exercise (KE) or knee and hip exercise (KHE). The women in the KE group (n = 26; mean age, 23 years) performed a 4-week conventional knee-stretching and -strengthening program. The women in the KHE group (n = 28; mean age, 22 years) performed the same exercises as those in the KE group, as well as strengthening exercises for the hip abductors, lateral rotators, and extensors. An 11-point numeric pain rating scale, the Lower Extremity Functional Scale, the Anterior Knee Pain Scale, and a single-hop test were used as outcome measures at baseline (pretreatment) and 3, 6, and 12 months posttreatment. At baseline, demographic, pain, and functional assessment data were similar between groups. Those in the KHE group had a higher level of function and less pain at 3, 6, and 12 months compared to baseline (P<.05). In contrast, the KE group had reduced pain only at the 3- and 6-month follow-ups (P<.05), without any changes in Lower Extremity Functional Scale, Anterior Knee Pain Scale, or hop testing (P>.05) through the course of the study. Compared to the KE group, the KHE group had less pain and better function at 3, 6, and 12 months posttreatment (P<.05). For the Lower Extremity Functional Scale, the between-group difference in change scores from baseline at 3, 6, and 12 months posttreatment favored the KHE group by 22.0, 22.0, and 20.8 points, respectively. Knee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS.

Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis.

PubMed

Augustsson, J; Thomeé, R; Lindén, C; Folkesson, M; Tranberg, R; Karlsson, J

2006-04-01

A fatiguing exercise protocol was combined with single-leg hop testing to improve the possibilities of evaluating the effects of training or rehabilitation interventions. In the first test-retest experiment, 11 healthy male subjects performed two trials of single-leg hops under three different test conditions: non-fatigued and following fatiguing exercise, which consisted of unilateral weight machine knee extensions at 80% and 50%, respectively, of 1 repetition maximum (1 RM) strength. Intraclass correlation coefficients ranged from 0.75 to 0.98 for different hop test conditions, indicating that all tests were reliable. For the second experiment, eight healthy male subjects performed the fatiguing exercise protocol to investigate how fatigue influences lower-extremity joint kinematics and kinetics during single-leg hops. Hip, knee and ankle joint angles, moments and powers, as well as ground-reaction forces were recorded with a six-camera, motion-capture system and a force platform. Recovery of hop performance following the fatiguing exercise was also measured. During the take-off for the single-leg hops, hip and knee flexion angles, generated powers for the knee and ankle joints, and ground-reaction forces decreased for the fatigued hop conditions compared with the non-fatigued condition (P<0.05). Compared with landing during the non-fatigued condition, hip moments and ground-reaction forces were lower for the fatigued hop conditions (P<0.05). The negative joint power was two to three times greater for the knee than for the hip and five to 10 times greater for the knee than for the ankle during landing for all test conditions (P<0.05). Most measured variables had recovered three minutes post-exercise. It is concluded that the fatiguing exercise protocol combined with single-leg hop testing was a reliable method for investigating functional performance under fatigued test conditions. Further, subjects utilized an adapted hop strategy, which employed less hip and knee flexion and generated powers for the knee and ankle joints during take-off, and less hip joint moments during landing under fatigued conditions. The large negative power values observed at the knee joint during the landing phase of the single-leg hop, during which the quadriceps muscle activates eccentrically, indicate that not only hop distance but also the ability to perform successful landings should be investigated when assessing dynamic knee function.