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

Science.gov (United States)

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

Total hip replacement surgery in Ethiopia | Gokcen | East and ...

African Journals Online (AJOL)

Background: Total hip replacement (THR) surgery has evolved over years to the point that it has been considered as "the operation of the century". For developed countries, arthroplasty is well established for the management of various joint disorders and has completely revolutionised the treatment of the arthritic hip.

Total hip replacements at Kikuyu Hospital, Kenya | Kingori | East ...

African Journals Online (AJOL)

Background: Total joint arthroplasty is a highly effective procedure that is frequently performed in elderly patients. This is not so in the third world and is not frequently performed. Total hip replacement (THR) relieves the pain and functional disability experienced by patients with moderate to severe arthritis of the hip, ...

Rehabilitation after total joint replacement: a scoping study.

Science.gov (United States)

L Snell, Deborah; Hipango, Julia; Sinnott, K Anne; Dunn, Jennifer A; Rothwell, Alastair; Hsieh, C Jean; DeJong, Gerben; Hooper, Gary

2018-07-01

The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research. We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement. We reviewed this work in the context of outcomes described from previously published research. Thirty individual studies and seven systematic reviews were included, with most research examining the effectiveness of physiotherapy-based exercise rehabilitation after total knee replacement using randomized control trial methods. Rehabilitation after hip and knee replacement whether carried out at the clinic or monitored at home, appears beneficial but type, intensity and duration of interventions were not consistently associated with outcomes. The burden of comorbidities rather than specific rehabilitation approach may better predict rehabilitation outcome. Monitoring of recovery and therapeutic attention appear important but little is known about optimal levels and methods required to maximize outcomes. More work exploring the role of comorbidities and key components of therapeutic attention and the therapy relationship, using a wider range of study methods may help to advance the field. Implications for Rehabilitation Physiotherapy-based exercise rehabilitation after total hip replacement and total knee replacement, whether carried out at the clinic or monitored at home, appears beneficial. Type, intensity, and duration of interventions do not appear consistently associated with outcomes. Monitoring a patient's recovery appears to be an important component. The available research provides limited guidance regarding optimal levels of monitoring needed to achieve gains following hip

Comparing contemporary revision burden among hip and knee joint replacement registries

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Brian J. McGrory, MD, MS

2016-06-01

Conclusions: Revision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.

The tribology of metal-on-metal total hip replacements.

Science.gov (United States)

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.

Optimization of hip joint replacement location to decrease maximum von Mi ses Stress

International Nuclear Information System (INIS)

Pourjamali, H.; Najarian, S.; Katoozian, H. R.

2001-01-01

Hip replacement is used for inoperable femur head injuries and femur fractures where internal fixation can not be used. This operation is one of the most common orthopedic operations that many research have been done about it. Among these we can mention implant and cement materials and composites optimization and also implant shape optimization. This study was designed to optimize artificial hip joint position (placement) to decrease maximal von mi sees stress. First, a model of femur and implant were made and then a computer program was written with the ability to change the position of implant through an acceptable range in the femur. In each of these positions, the program simulated femur and implant according to finite element method and made, applied forces were weight and muscle traction. Our findings show that a small deviation of the implant from femur bone center causes a considerable decrease in von mi sees stress that consequently results in longer maintenance of the implant

Hip Replacement: MedlinePlus Health Topic

Science.gov (United States)

... invasive hip replacement (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Hip Replacement updates ... replacement - precautions Minimally invasive hip replacement Related Health Topics Hip Injuries and Disorders National Institutes of Health ...

STUDY OF FUNCTIONAL RESULTS OF CEMENTED TOTAL HIP REPLACEMENT BY MOORE’S APPROACH

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Arunim

2016-02-01

Full Text Available INTRODUCTION The total hip replacement (THR has probably become the surgical procedure of choice for vide variety of hip joint disabling diseases. The prosthesis used for THR is often grouped into cemented, cement-less and hybrid ones. There has been increasing trends in use of cement-less components citing more number of complications namely loosening, increased infection rate etc. however with additional cost factors as well. We conducted this study to ascertain whether in a developing country like ours should we really switch over to un-cemented hip replacements dreading such complications or can we still use cemented prosthesis with equally good if not better results. METHODS A study of functional results of cemented total hip replacement was done in patients with varied age groups ranging from 40 years to 75 years with the average age being 54.8 years. 20 patients with 21 diseased hips were treated with cemented total hip replacement by Moore’s posterior approach at NSCB Subharti medical college, Meerut, UP from December 2010 to December 2013 and reviewed thereafter with an average follow-up period of 4.2 years. Average surgical time required was one and half hour. Patients were asked to come for follow up on 1st month, 3rd month and 6th month and then every 6 months and were assessed as per modified Harris Hip Score. RESULTS All the patients were evaluated according to the Modified Harris Hip Scoring system. The results showed 14(67% hips with excellent results, 4(19% with good results, and 3(14% hips with fair results. No poor outcome was noted in this study. 2 cases of dislocation (10% were noted one on the 5th post-operative day and the other occurred after the patient was discharged from the institution. CONCLUSIONS The management of diseased and destroyed hips with chronic pain with cemented total hip replacement is effective and gives stable, mobile and painless hip joint to the patient. Functional results are excellent and

Digital correction of magnification in pelvic x rays for preoperative planning of hip joint replacements: Theoretical development and clinical results of a new protocol

International Nuclear Information System (INIS)

The, B.; Diercks, R.L.; Stewart, R.E.; Ooijen, P.M.A. van; Horn, J.R. van

2005-01-01

The introduction of digital radiological facilities leads to the necessity of digital preoperative planning, which is an essential part of joint replacement surgery. To avoid errors in the preparation and execution of hip surgery, reliable correction of the magnification of the projected hip is a prerequisite. So far, no validated method exists to accomplish this. We present validated geometrical models of the x-ray projection of spheres, relevant for the calibration procedure to correct for the radiographic magnification. With help of these models a new calibration protocol was developed. The validity and precision of this procedure was determined in clinical practice. Magnification factors could be predicted with a maximal margin of error of 1.5%. The new calibration protocol is valid and reliable. The clinical tests revealed that correction of magnification has a 95% margin of error of -3% to +3%. Future research might clarify if a strict calibration protocol, as presented in this study, results in more accurate preoperative planning of hip joint replacements

Case Study of a physiotherapy treatment of a patient after total hip replacement

OpenAIRE

Havlíčková, Barbora

2013-01-01

The bachelor's thesis consists of two parts. The general part includes anatomy and kinesiology of the hip joint and also the topic of coxarthrosis as the most common reason for the total hip replacement surgery. An integral part of this part is the elaboration of a rehabilitation plan for patients undergoing such procedure. The practical part of the thesis is conceived a case study of a patient after total hip replacement because of coxarthrosis. Finally, the thesis includes the therapeutic o...

Accelerated avascular necrosis after single intra-articular injection of corticosteroid into the hip joint

OpenAIRE

Kassam, A M

2010-01-01

Avascular necrosis (AVN) involves destruction of the hip joint. Long-term use of steroids has been shown to cause AVN. This article presents a case of intra-articular injection of steroid causing a rapid onset of AVN in the hip joint. Bone histology at time of total hip replacement showed evidence of AVN and no evidence of infection.

Current topics in the radiology of joint replacement surgery

International Nuclear Information System (INIS)

Weissman, B.N.

1990-01-01

Several methods of total hip joint replacement are currently used. Radiographic appearances after cemented, bone ingrowth, press-fit, and bipolar hip prostheses are reviewed. The roles of nuclear medicine and arthrographic procedures for identifying complications are discussed. Total knee prostheses and, in particular, complications related to the patellar component are described.115 references

Telerehabilitation Feasibility in Total Joint Replacement

Directory of Open Access Journals (Sweden)

Mark J. Nelson

2017-11-01

Full Text Available Despite documented benefits, many Total Joint Replacement (TJR patients find it difficult to access rehabilitation following discharge from hospital. One solution to improve access for TJR patients is telerehabilitation. This study aimed to assess the feasibility of introducing a telerehabilitation program for TJR patients.   TJR patients at QEII Jubilee Hospital were invited to complete a questionnaire regarding their access, feelings towards and preferences in using technology. Seventy-five patients were recruited. Most patients had computer access (72% and internet (69% at home. Sixty-five percent of participants were willing to participate in telerehabilitation. A significant difference was found between older and younger patients. Watching videos on an electronic device was the preferred method for a technology-based home exercise program and phone call the preferred method of communication.  Results indicate telerehabilitation in the TJR population is feasible from the perspective of access to, feelings toward, and preferences for technology. Keywords: Hip replacement, Knee replacement, Telerehabilitation, Telemedicine, Total joint replacement

CUSTOM TRIFLANGE ACETABULAR COMPONENTS IN REVISION HIP REPLACEMENT (EXPERIENCE REVIEW

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A. A. Korytkin

2017-01-01

Full Text Available Extensive defects of acetabulum especially accompanied by pelvis discontinuity at the level of acetabulum pose a serious challenge in revision hip replacement and create additional complexity in fixing the acetabular component. One of the perspective options to solve the above issue is the use of custom triflange acetabular components (CTAC designed based on preoperative computer tomography given the specifics of bone defects of the patient. Purpose of the study — to evaluate the outcomes of CTAC use in revision hip replacement.Materials and methods. The authors analyzed treatment outcomes of 12 patients after revision hip replacement using additive techniques of computer simulation and 3D printing CTAC. Follow up period after the surgery averaged 7±3 months (from one to ten months. 7 out of 12 patients had acetabular defects of Paprosky 3B type, 4 patients had defects of Paprosky 3A and in one patient — of Paprosky 2C.Results. Two out of twelve patients had prosthesis dislocations that required revision hip surgery, one of those patients underwent open reduction of dislocation with wound debridement, another patient underwent replacement of articulating couple of acetabular component. Total scores under Harris Hip Score and paint VAS score prior to treatment was 28±7 and 7±1 points respectively, postoperative scores were 76±9 and 3±1 respectively.Conclusion. The application of additive techniques for revision hip replacement in patients with extensive acetabular and pelvic defects allows to make a precise preoperative planning, to restore joint rotation center, to reconstruct bone defects and to securely fix triflange acetabular component that altogether significantly improve treatment outcomes and patients satisfaction with the surgery.

Increased body mass index is a predisposition for treatment by total hip replacement

DEFF Research Database (Denmark)

Jacobsen, Steffen; Sonne-Holm, Stig

2005-01-01

We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip......-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA...

21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral (hemi-hip...

21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular...

Radiography, radionuclide imaging, and asthrography in the evaluation of total hip and knee replacement

International Nuclear Information System (INIS)

Gelman, M.I.; Coleman, R.E.; Stevens, P.M.; Davey, B.W.

1978-01-01

Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis

Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

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Menachem M. Meller

2014-01-01

Full Text Available The prevalence of class III obesity (BMI≥40 kg/m2 in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2 to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference remains high.

Metal-on-metal hip joint tribology.

Science.gov (United States)

Dowson, D; Jin, Z M

2006-02-01

The basic tribological features of metal-on-metal total hip replacements have been reviewed to facilitate an understanding of the engineering science underpinning the renaissance of these hard-on-hard joints. Metal-on-polymer hip replacements operate in the boundary lubrication regime, thus leading to the design guidance to reduce the femoral head diameter as much as is feasible to minimize frictional torque and volumetric wear. This explains why the gold-standard implant of this form from the past half-century had a diameter of only 22.225 mm (7/8 in). Metal-on-metal implants can operate in the mild mixed lubrication regime in which much of the applied load is supported by elastohydrodynamic films. Correct tribological design leads to remarkably low steady state wear rates. Promotion of the most effective elastohydrodynamic films calls for the largest possible head diameters and the smallest clearances that can reasonably be adopted, consistent with fine surface finishes, good sphericity and minimal structural elastic deformation of the cup on its foundations. This guidance, which is opposite in form to that developed for metal-on-polymer joints, is equally valid for solid (monolithic) metallic heads on metallic femoral stems and surface replacement femoral shells. Laboratory measurements of friction and wear in metal-on-metal joints have confirmed their potential to achieve a very mild form of mixed lubrication. The key lies in the generation of effective elastohydrodynamic lubricating films of adequate thickness compared with the composite roughness of the head and cup. The calculation of the film thickness is by no means easy, but the full procedure is outlined and the use of an empirical formula that displays good agreement with calculations based upon the full numerical solutions is explained. The representation of the lambda ratio, lambda, embracing both film thickness and composite roughness, is described.

Risks of hip and knee replacement

Science.gov (United States)

... is normal to lose blood during and after hip or knee replacement surgery. Some people need a ... clot form are higher during and soon after hip or knee replacement surgery. Sitting or lying down ...

Cost-effectiveness of total hip and knee replacements for the Australian population with osteoarthritis: discrete-event simulation model.

Directory of Open Access Journals (Sweden)

Hideki Higashi

Full Text Available BACKGROUND: Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. METHODOLOGY/PRINCIPAL FINDINGS: We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively. However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. CONCLUSIONS/SIGNIFICANCE: Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements.

Influence of Different Hip Joint Centre Locations on Hip and Knee Joint Kinetics and Kinematics During the Squat

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Sinclair Jonathan

2014-12-01

Full Text Available Identification of the hip joint centre (HJC is important in the biomechanical examination of human movement. However, there is yet to be any published information regarding the influence of different HJC locations on hip and knee joint kinetics during functional tasks. This study aimed to examine the influence of four different HJC techniques on 3- D hip and knee joint kinetics/kinematics during the squat. Hip and knee joint kinetics/kinematics of the squat were obtained from fifteen male participants using an eight camera motion capture system. The 3-D kinetics/kinematics of the squat were quantified using four hip joint centre estimation techniques. Repeated measures ANOVAs were used to compare the discrete parameters as a function of each HJC location. The results show that significant differences in joint angles and moment parameters were evident at both the hip and knee joint in the coronal and transverse planes. These observations indicate that when calculating non-sagittal joint kinetics/kinematics during the squat, researchers should carefully consider their HJC method as it may significantly affect the interpretation of their data.

Taking care of your new hip joint

Science.gov (United States)

Hip arthroplasty - precautions; Hip replacement - precautions; Osteoarthritis - hip; Osteoarthritis - knee ... After you have hip replacement surgery, you will need to be careful how you move your hip, especially for the first few months ...

Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

Directory of Open Access Journals (Sweden)

Elaine W Chong

Full Text Available Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003-2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001-2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00-1.49. Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25-12.02. The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured

21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metallic cemented or... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be implanted...

A 5-year profile of the incidence of total joint replacement in South ...

African Journals Online (AJOL)

During this period there was a 28% increase in the number of TJRs performed annually with an average increase of 20% in total hip replacements and 40% in total knee replacements. The number of surgeons involved in joint replacement during the survey period decreased by 7% in state-subsidised institutions but ...

MRI of the hip joint

International Nuclear Information System (INIS)

Czerny, C.; Noebauer-Huhmann, I.M.; Imhof, H.

2005-01-01

Magnetic resonance imaging (MRI) is performed to diagnose many pathologic conditions affecting the hip joint. Either conventional MRI (without contrast enhancement of the joint cavity) or MR arthrography is used to detect and most accurately differentiate hip joint pathologies. Conventional MRI is performed in cases of bone marrow edema, necrosis, arthrosis and especially the so-called ''activated arthrosis'', as well as in inflammatory and tumorous entities. MR arthography, which has only recently become available for use, is excellently suited for diagnosing lesions of the acetabular labrum, cartilage lesions, and free articular bodies. This article provides an overview about MRI characteristics and their accuracy of hip joint diseases and the impact on the therapeutic procedure. (orig.)

Increased body mass index is a predisposition for treatment by total hip replacement

DEFF Research Database (Denmark)

Jacobsen, Steffen; Sonne-Holm, Stig

2005-01-01

-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA...... prevalence was 1.0--2.5% in subjects or=60 years of age. While radiological OA was significantly influenced by hip dysplasia in men and hip dysplasia and age in women, the risk of THR being performed was only influenced by BMI assessed in 1976. Hip......We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip...

Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

DEFF Research Database (Denmark)

Svege, Ida; Nordsletten, Lars; Fernandes, Linda

2015-01-01

Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.......Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown....

Measurement of installation deformation of the acetabulum during prosthetic replacement of a hip joint using digital image correlation

Science.gov (United States)

Lei, Dong; Bai, Pengxiang; Zhu, Feipeng

2018-01-01

Nowadays, acetabulum prosthesis replacement is widely used in clinical medicine. However, there is no efficient way to evaluate the implantation effect of the prosthesis. Based on a modern photomechanics technique called digital image correlation (DIC), the evaluation method of the installation effect of the acetabulum was established during a prosthetic replacement of a hip joint. The DIC method determines strain field by comparing the speckle images between the undeformed sample and the deformed counterpart. Three groups of experiments were carried out to verify the feasibility of the DIC method on the acetabulum installation deformation test. Experimental results indicate that the installation deformation of acetabulum generally includes elastic deformation (corresponding to the principal strain of about 1.2%) and plastic deformation. When the installation angle is ideal, the plastic deformation can be effectively reduced, which could prolong the service life of acetabulum prostheses.

Hip supporting device

DEFF Research Database (Denmark)

2011-01-01

The present invention relates to a device for limiting movements in one or more anatomical joints, such as a device for limiting movement in the human hip joint after hip replacement surgery. This is provided by a device for limiting movement in the human hip joint, said device comprising: at least...

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

Science.gov (United States)

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

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7: Australian Orthopaedic Association National Joint Replacement Registry.

Science.gov (United States)

Brennan, Sharon L; Stanford, Tyman; Wluka, Anita E; Henry, Margaret J; Page, Richard S; Graves, Stephen E; Kotowicz, Mark A; Nicholson, Geoffrey C; Pasco, Julie A

2012-04-30

The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia. Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006-7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Females accounted for 46.9% of the 642 primary THR performed during 2006-7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70-79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Satisfaction with joint replacement in public versus private hospitals: a cohort study.

Science.gov (United States)

Adie, Sam; Dao, Alan; Harris, Ian A; Naylor, Justine M; Mittal, Rajat

2012-09-01

In Australia, the majority of total knee and hip replacement surgeries occur in the private sector. Outcome-based research needs to be inclusive of this sector if the findings are intended to reflect the broader picture. This study compares outcomes up to 1 year post knee and hip replacement between patients treated in the public and private sectors. A prospective, observational study was performed in four high-volume joint replacement centres: two public, two private. Experienced orthopaedic surgeons contributed via their public and private practices. Knee and hip patients were recruited preoperatively. Self-reported questionnaires were completed preoperatively and at 6 and 12 months post-operatively. The primary outcome was satisfaction with surgery. Secondary outcomes included Oxford score, and SF-36 physical and mental component summary scores. Regression modelling was performed to adjust for potential confounders. Three hundred and thirty-one patients (184 public, 147 private; 215 knees, 116 hips) were recruited, with 6- and 12-month follow-up rates of 95% and 89%, respectively. Satisfaction rates were high in both public and private patients (approximately 90%) at 6 and 12 months, but private patients were less likely to be satisfied after adjusting for the strong effect of patient expectation. For both hip and knee cohorts, no between-sector differences were found in either the magnitude or rate of improvement in Oxford score or quality of life post-operatively. Joint replacement outcomes are similar for patients treated in public and private hospitals. Surgeons should manage patient expectation prior to surgery, particularly in private patients. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Hip joint mobility in dancers: preliminary report.

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Drężewska, Marlena; Gałuszka, Renata; Sliwiński, Zbigniew

2012-01-01

The aim of this study was to evaluate the impact of dancing on hip joint mobility and to assess the relationship between active movements of the hips and injuries among dancers, which may be important in planning rehabilitation in this group. The sample comprised 49 dancers (37 women and 12 men) aged 15 to 32 years. The participants were the professional dancers of the Kielce Dance Theatre and members of two youth jazz dance teams from the Kielce Dance Theatre. The active range of motion of the hips was measured in three planes using a goniometer in order to assess the influence of dance training on hip joint mobility. A questionnaire-based survey was also conducted. The range of flexion, extension and external rotation was significantly greater in the group of long-time dancers (p <0.05). There was a significantly greater range of flexion, abduction and external rotation in previously injured hip joints (p<0.05). 1. Injuries to hip joints in dancers may result in increased ranges of motion, which may lead to disturbances of joint stability. 2. Being a long-time dancer and the female gender were associated with an increased range of hip joint motion.

OPTIMAL IMPROVEMENT IN FUNCTION AFTER TOTAL HIP AND KNEE REPLACEMENT: HOW DEEP DO YOU KNOW YOUR PATIENT’S MIND?

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De Caro, M F; Vicenti, G; Abate, A; Picca, G; Leoncini, V; Lomuscio, M; Casalino, A; Solarino, G; Moretti, B

2015-01-01

Osteoarthritis (OA) of the hip and knee causes pain and loss of joint mobility, leading to limitations in physical function. When conservative treatment fails total hip and knee replacement is a cost-effective surgical option. Patients have high expectations regarding functional outcome after these procedures. If such expectations are not met, they may still be dissatisfied with the outcome of a technically successful procedure. Recently, numerous studies reported that psychological factors can influence the outcome of total knee replacement (tkr) and total hip artrhoplasty with total hip replacement (thr). We conducted a prospective study on a consecutive sample of 280 patients affected by hip or knee OA who underwent total joint replacement. At patients’ admission, Harris Hip Score (HHS) and Knee Society Score (KSS) were used to assess pain and function. Furthermore, SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), Coping Orientation to Problems Experienced (BRIEF-COPE) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were administered. Patients had clinical and radio graphical follow up at 1, 3 and 6 months post-operatively. The HHS and KSS values before surgery showed a linear correlation with both SCL-90-R and MMSE. None of the investigated variables influenced post-operative HHS and KSS scores; however, the improvement of functional scores resulted conditioned by SCL-90-R values, VAS score, schooling and MMSE. Psychological factors and mental status in primary total hip and knee replacement can affect outcome and patient satisfaction. Strategies focused on identification and facing of these conditions must be considered to improve outcome of total replacement.

Optimal timing of joint replacement using mathematical programming and stochastic programming models.

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Keren, Baruch; Pliskin, Joseph S

2011-12-01

The optimal timing for performing radical medical procedures as joint (e.g., hip) replacement must be seriously considered. In this paper we show that under deterministic assumptions the optimal timing for joint replacement is a solution of a mathematical programming problem, and under stochastic assumptions the optimal timing can be formulated as a stochastic programming problem. We formulate deterministic and stochastic models that can serve as decision support tools. The results show that the benefit from joint replacement surgery is heavily dependent on timing. Moreover, for a special case where the patient's remaining life is normally distributed along with a normally distributed survival of the new joint, the expected benefit function from surgery is completely solved. This enables practitioners to draw the expected benefit graph, to find the optimal timing, to evaluate the benefit for each patient, to set priorities among patients and to decide if joint replacement should be performed and when.

TOTAL JOINT REPLACEMENT OF THE LOWER EXTREMITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

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Стюарт Б. Гудмэн

2014-03-01

Full Text Available Joint replacement of the lower extremity in Juvenile Idiopathic Arthritis (JIA is becoming more commonly performed worldwide. These young adults experience severe pain and disability from end-stage arthritis, and require joint replacement of the hip or knee to alleviate pain, and restore ambulation and function. These procedures are very challenging from the anesthesia and surgical point of view, due to small overall proportions, numerous bony and other deformities and soft tissue contractures. Joint replacement operations for JIA are best performed by experienced teams, where pre-operative and peri-operative care, and post-operative rehabilitation can be optimized in a collaborative, patient-centered environment.

Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

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Bähr Mathias

2011-05-01

Full Text Available Abstract Introduction Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction. Case presentation We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging. Conclusion To the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

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.

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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

21 CFR 888.3390 - Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis.

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2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metal/polymer... § 888.3390 Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis is a two-part...

21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

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2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) trunnion-bearing... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a two...

Imaging of hip joint arthroplasty

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Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C.

2009-01-01

The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [de

[Efficacy of health education on patients with hip replacement based on the Internet].

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Zhou, Yang; Yang, Tubao; Li, Yinglan; Yu, Jie; Zeng, Biyun

2015-03-01

To evaluate the efficacy of health education on patients with hip replacement based on the Internet, and to establish a new health education model through modern technology. A total of 300 patients with hip replacement from March to August, 2015 were enrolled in this study. The participants were divided into a control group and an experimental group according to months surgeries performed. Traditional education was applied in the control group while the multimedia source material plus the Internet platform of Joint Registration System were applied in the experimental group. Levels of anxiety, degree of satisfaction, and postoperative complications were analyzed. The levels of knowledge, attitude and behavior compliance in the patients of the experimental group were significantly improved, while the levels of postoperative anxiety were decreased compared with those in the control group (PEducation based on the Internet platform of Joint Registration System and the computer video could improve patients' knowledge, attitude, and behavior, which is worthy of clinical spread.

Risk factors for perioperative hyperglycemia in primary hip and knee replacements

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Jämsen, Esa; Nevalainen, Pasi I; Eskelinen, Antti; Kalliovalkama, Jarkko; Moilanen, Teemu

2015-01-01

Background and purpose Background and purpose — Perioperative hyperglycemia has been associated with adverse outcomes in several fields of surgery. In this observational study, we identified factors associated with an increased risk of hyperglycemia following hip and knee replacement. Patients and methods Patients and methods — We prospectively monitored changes in glucose following primary hip and knee replacements in 191 patients with osteoarthritis. Possible associations of patient characteristics and operation-related factors with hyperglycemia (defined as glucose > 7.8 mmol/L in 2 consecutive measurements) and severe hyperglycemia (glucose > 10 mmol/L) were analyzed using binary logistic regression with adjustment for age, sex, operated joint, and anesthesiological risk score. Results Results — 76 patients (40%) developed hyperglycemia, and 48 of them (25% of the whole cohort) had severe hyperglycemia. Glycemic responses were similar following hip replacement and knee replacement. Previously diagnosed diabetes was associated with an increased risk of hyperglycemia and severe hyperglycemia, compared to patients with normal glucose metabolism, whereas newly diagnosed diabetes and milder glucose metabolism disorders had no effect. In patients without previously diagnosed diabetes, increased values of preoperative glycosylated hemoglobin (HbA1c) and fasting glucose on the day of operation were associated with hyperglycemia. Higher anesthesiological risk score—but none of the operation-related factors analyzed—was associated with an increased risk of hyperglycemia. Interpretation Interpretation — Perioperative hyperglycemia is common in primary hip and knee replacements. Previously diagnosed diabetes is the strongest risk factor for hyperglycemia. In patients with no history of diabetes, preoperative HbA1c and fasting glucose on the day of operation can be used to stratify the risk of hyperglycemia. PMID:25409255

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006–7: Australian Orthopaedic Association National Joint Replacement Registry

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Brennan Sharon L

2012-04-01

Full Text Available Abstract Background The utilization of total hip replacement (THR surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD of Victoria, Australia. Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years. Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

A computational parametric study on edge loading in ceramic-on-ceramic total hip joint replacements.

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Liu, Feng; Feng, Li; Wang, Junyuan

2018-07-01

Edge loading in ceramic-on-ceramic total hip joint replacement is an adverse condition that occurs as the result of a direct contact between the head and the cup rim. It has been associated with translational mismatch in the centres of rotation of the cup and head, and found to cause severe wear and early failure of the implants. Edge loading has been considered in particular in relation to dynamic separation of the cup and head centres during a gait cycle. Research has been carried out both experimentally and computationally to understand the mechanism including the influence of bearing component positioning on the occurrence and severity of edge loading. However, it is experimentally difficult to measure both the load magnitude and duration of edge loading as it occurs as a short impact within the tight space of hip joints. Computationally, a dynamic contact model, for example, developed using the MSC ADAMS software for a multi-body dynamics simulation can be particularly useful for calculating the loads and characterising the edge loading. The aim of the present study was to further develop the computational model, and improve the predictions of contact force and the understanding of mechanism in order to provide guidance on design and surgical factors to avoid or to reduce edge loading and wear. The results have shown that edge loading can be avoided for a low range of translational mismatch in the centres of rotation of the cup and head during gait at the level of approximately 1.0 mm for a cup at 45° inclination, keeping a correct cup inclination at 45° is important to reduce the edge loading severity, and edge loading can be avoided for a certain range of translational mismatch of the cup and head centres with an increased swing phase load. Copyright © 2018 Elsevier Ltd. All rights reserved.

Survivorship of Total Hip Joint Replacements Following Isolated Liner Exchange for Wear.

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Vadei, Leone; Kieser, David C; Frampton, Chris; Hooper, Gary

2017-11-01

Liner exchange for articular component wear in total hip joint replacements (THJRs) is a common procedure, often thought to be benign with reliable outcomes. Recent studies, however, suggest high failure rates of liner exchange revisions with significant complications. The primary aim of this study was, therefore, to analyze the survivorship of isolated liner exchange for articular component wear, and secondarily to assess the influence of patient demographics (gender, age, and American Society of Anaesthesiologists [ASA] ratings) on rerevisions following isolated liner exchange for wear. A retrospective review of the 15-year New Zealand Joint Registry (1999-2014) was performed, analyzing the outcomes of isolated liner exchange for articular component wear. The survivorship as defined as rerevision with component exchange was determined and 10-year Kaplan-Meier survivorship curves were constructed. These revision rates were compared to age, gender, and ASA rating groups using a log-rank test. The 10-year survivorship of THJR following liner exchange revision for liner wear was 75.3%. If a rerevision was required, the median time to rerevision was 1.33 years with a rerevision rate of 3.33 per 100 component years (95% confidence interval 2.68-4.08/100 component years). The principle reasons for rerevision were dislocation (48.4%) and acetabular component loosening (20.9%). There was no statistically significant difference in rerevision rates based on gender, age categories, or ASA scores. THJR isolated liner exchange for liner wear is not a benign procedure with a survivorship of 75.3% at 10 years. Surgeons contemplating liner exchange revisions should be cognisant of this risk and should adequately assess component position and stability preoperatively. Copyright © 2017 Elsevier Inc. All rights reserved.

Scintigraphic presentation of hip joint synovial chondromatosis

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Zwas, S T; Friedman, B; Nerubay, J

1988-09-01

A case of hip joint synovial chondromatosis with an unusual scintigraphic pattern is described. This pattern was suggestive of a hip joint destructive reactive articular process or late manifestations of avascular necrosis of the femoral head. Concurrent radiographs were normal, as were laboratory investigations. Follow-up radiographs six months later showed radiolucencies and erosive bone changes in the diseased joint. Surgical and histopathological findings revealed well developed hip synovial chondromatosis (HSC) with thickened synovium and large, loose, cartilaginous bodies occupying and widening the tightened joint space, with destructive secondary juxta articular pressure and bone erosions. This and other scintigraphic patterns in HSC, and the differential diagnosis of the findings in patients with painful hip presentations are discussed.

FIVE YEAR OUTCOMES OF CERAMIC-ОN-CERAMIC AND CERAMIC-ОN-POLYETHYLENE BEARINGS IN HIP JOINT REPLACEMENT

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V. Yu. Murylev

2017-01-01

Full Text Available In view of the increasing number of hip joint replacement volume there remains the key issue of improving prosthesis survivorship which directly depends on the friction couple. Material and methods. The authors have analyzed five year outcomes of two bearing types (head and insert used in hip replacement: ceramic-on-ceramic (CoC in 324 patients and ceramic-on-polyethylene (CoP in 300 patients. Totally 550 patients were operated in the period starting 2010 till 2014, including 74 patients underwent bilateral hip replacement. The authors divided patients based on gender and also into three age groups: 20-40, 41-60 and 61-80 years old. The largest group comprised 156 women aged 41-60 years (28.4%. Additional grouping of patients was made based on gender, age and bearing diameter.36 mm diameter bearing was characterized of the most frequent use. Functional outcomes were assessed by Harris Hip Score. Statistical analysis was made with Statistica 10 software. Statistical significant was observed at p<0.05.Results.28 mm diameter bearing were rarely (19.5% applied and mainly in women which is related to need for use of smaller acetabulum components and inability to implant a larger insert.36 mm diameter bearing were used most frequently, CoC articulation of36 mm was used in men in 34% of cases and in women – in 18.12% of cases.40 mm articulations were implanted in women two times less than in men which is related to a smaller diameter of acetabulum in women. Generally, CoC bearings were implanted more often in men which can be explained by a bigger social demand as well as a higher anti-luxation stability of large diameter bearings. Dislocations of implants occurred in 5 (0.91% patients: in 4 patients with CoP bearingand in one patient with CoC articulation. Four revision procedures (0.64% were made due to deep periprosthetic infection: two surgeries in each group. Harris Hip Score evaluation in CoC group demonstrated excellent and good outcomes in

A prospective study on the risk of glove fingertip contamination during draping in joint replacement surgery.

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Makki, D; Deierl, K; Pandit, A; Trakru, S

2014-09-01

The aim of this prospective study was to investigate the risk of contamination of surgical gloves during preparation and draping in joint replacement surgery. During 46 hip and knee replacement procedures, the gloves of orthopaedic consultants (n=5) and registrars (n=3) were assessed for contamination immediately after draping by impression of gloved fingers on blood agar. Contamination was evaluated by the surgeon's grade, the type of procedure, the role of the assistant and the dominance of the hand. A total of 125 pairs of top gloves were examined (79 pairs from registrars and 46 pairs from consultants). Bacterial contamination was isolated on 19 pairs (15.2%) (16 pairs from registrars and 3 pairs from consultants, p=0.04). Coagulase negative staphylococci were the main isolates and contamination was considered low in all cases (1-5 colonies). Contamination was seen more on the dominant hand (16 gloves from dominant hands and 6 from non-dominant hands, p=0.04), on the index finger and thumb. More contaminated gloves were seen in hip arthroplasty procedures (16 pairs from total hip replacements vs 3 pairs from total knee replacements, p=0.02). Contamination of glove fingertips during draping in joint replacement procedures is more likely to occur among junior surgeons, in hip rather than knee arthroplasty procedures and on the dominant hand. It is therefore essential that surgeons of different grades replace gloves used in draping to avoid exposing patients to the risk of infection.

Sonography for hip joint effusion in adults with hip pain

NARCIS (Netherlands)

S.M. Bierma-Zeinstra (Sita); A.M. Bohnen (Arthur); J.A.N. Verhaar (Jan); A. Prins (Ad); J.S. Lameris; A.Z. Ginai (Abida)

2000-01-01

textabstractOBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general

Modified Design of Pin-on-Ring Tribometer for Hip Joint Prostheses Measurement; Case Study on Salat Activity

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Muhammad Khafidh

2015-02-01

Full Text Available Total hip replacement (THR is one of the most successful orthopedic surgical procedures for replacing a broken hip joint. In THR, wear may occur at the articulating surface of the acetabular cup and the femoral head. In Indonesia, the country with the largest Muslim population in the world, most of the inhabitants do salat (praying every day. THR users are banned from doing salat for fear it will damage the hip joint prostheses. The previous wear calculation methods on the hip joint prostheses use the gravimetric, coordinate measuring machine (CMM, profiler, and geometric method. The disadvantages of the previous methods are that the geometry of the wear patch and the wear volume are only known at the end of the experiment, so they cannot be used to calculate the specific wear rate values in real time. So far, in every modeling of the hip joint prostheses, the values of the specific wear rate are assumed to be constant. This paper reports on the design modification of a pin-on-ring tribometer that is used to measure the wear volumes in hip joint prostheses. The result shows that modifications of the femoral head holder, reciprocating motion, elastic joint, and extra displacement transducer is needed to get the specific wear rate value. The calculation method to find the delta volume that is the value of displacement less than the displacement minimum (δmin is based on a graph, while the calculation method to find the delta volume that is the value of displacement that is more than the displacement minimum (δmin is based on an equation. In the salat test protocol, the longest test time was during the sujud (prostration motion, which took 1034.17 minutes in the experiment.

Sonography for hip joint effusion in adults with hip pain

NARCIS (Netherlands)

Bierma-Zeinstra, S. M.; Bohnen, A. M.; Verhaar, J. A.; Prins, A.; Ginai-Karamat, A. Z.; Laméris, J. S.

2000-01-01

To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a

Magnetic resonance imaging of hip joint cartilage and labrum

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Christoph Zilkens

2011-09-01

Full Text Available Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

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Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

2013-11-01

In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.

Radiography, radionuclide imaging, and asthrography in the evaluation of total hip and knee replacement. [/sup 99m/Tc-phosphate

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Gelman, M.I.; Coleman, R.E.; Stevens, P.M.; Davey, B.W.

1978-09-01

Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis.

Adventure sports and sexual freedom hip replacement: the tripolar hip.

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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

Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty

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Czech Szymon

2017-12-01

Full Text Available An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients’ willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty.

Science.gov (United States)

Czech, Szymon; Hermanson, Jacek; Rodak, Piotr; Stołtny, Tomasz; Rodak, Łukasz; Kasperczyk, Sławomir; Koczy, Bogdan; Mielnik, Michał

2017-12-01

An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients' willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

Computer Assisted Surgery and Current Trends in Orthopaedics Research and Total Joint Replacements

Science.gov (United States)

Amirouche, Farid

2008-06-01

Musculoskeletal research has brought about revolutionary changes in our ability to perform high precision surgery in joint replacement procedures. Recent advances in computer assisted surgery as well better materials have lead to reduced wear and greatly enhanced the quality of life of patients. The new surgical techniques to reduce the size of the incision and damage to underlying structures have been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. Total hip and knee Arthoplasties are at all time high reaching 1.2 million surgeries per year in the USA. Primary joint failures are usually due to osteoarthristis, rheumatoid arthritis, osteocronis and other inflammatory arthritis conditions. The methods for THR and TKA are critical to initial stability and longevity of the prostheses. This research aims at understanding the fundamental mechanics of the joint Arthoplasty and providing an insight into current challenges in patient specific fitting, fixing, and stability. Both experimental and analytical work will be presented. We will examine Cementless total hip arthroplasty success in the last 10 years and how computer assisted navigation is playing in the follow up studies. Cementless total hip arthroplasty attains permanent fixation by the ingrowth of bone into a porous coated surface. Loosening of an ingrown total hip arthroplasty occurs as a result of osteolysis of the periprosthetic bone and degradation of the bone prosthetic interface. The osteolytic process occurs as a result of polyethylene wear particles produced by the metal polyethylene articulation of the prosthesis. The total hip arthroplasty is a congruent joint and the submicron wear particles produced are phagocytized by macrophages initiating an inflammatory cascade. This cascade produces cytokines ultimately implicated in osteolysis. Resulting bone loss both on the acetabular and femoral sides eventually leads to component instability. As

Restriction in participation in leisure activities after joint replacement: an exploratory study.

Science.gov (United States)

Wylde, Vikki; Livesey, Christine; Blom, Ashley W

2012-03-01

currently, assessment of outcomes after joint replacement is predominantly centred on impairment and activity limitation (e.g. walking), with little consideration of participation restriction. structured telephone interviews about participation in leisure activities were conducted with 56 total hip replacement (THR) and 60 total knee replacement (TKR) patients before and 1 year after joint replacement. before surgery, THR patients participated in 209 leisure activities, with an average of four leisure activities per person. TKR patients participated in 171 leisure activities, with an average of three leisure activities per person. The leisure activities were coded into four categories: sports/exercise, hobbies, social activities and holidays. Between 89 and 95% of leisure activities were rated as important by THR and TKR patients prior to surgery. Before surgery, THR patients rated 82% of leisure activities as difficult to perform because of joint problems, which decreased to 25% of leisure activities by 1-year after surgery. TKR patients rated 86% of leisure activities as difficult to perform because of joint problems, which decreased to 32% after surgery. this research highlights that participation in leisure activities is important to patients undergoing joint replacement, but that approximately a quarter of patients are unable to perform their valued leisure activities after surgery.

Radiographic study of the hip joint to determine anthropometric parameters for Indian population

International Nuclear Information System (INIS)

Bagaria, Vaibhav; Deshpande, Shirish; Kuthe, Abhay; Rasalkar, Darshana D.; Paunipagar, Bhawan K.; Madhugiri, Tanushree Subhash

2012-01-01

Hip replacement surgeries are on the rise in India. However, for these surgeries, most of the implants used are imported and manufactured entirely to suit the geometrical considerations of the western population. Studies in the past have shown that there are anatomical variations in the hip joint for different ethnic backgrounds and geographical locations. There is paucity of anthropometric hip joint data related to Indian population and anthropometric variations in skeletal geometry between Asian and Western counterparts have not yet been thoroughly reviewed and considered for implant manufacturing. The purpose of this anthropometric study is to determine any anatomical variations in the normal hip joint among the Indian population and to statistically compare the mean values with the existing data on western population. 422 Hip radiographs of 211 individuals (141 males and 70 females) with normal and healthy hip joints were evaluated to obtain the horizontal offset, vertical offset and neck shaft angle. For males, mean neck shaft angle was 127.68° (SD = 3.94), horizontal offset was 34.60 mm (SD = 6.55) and vertical offset was 39.17 mm (SD = 5.86). For females, mean neck shaft angle was 125.92° (SD = 4.75), horizontal offset was 32.96 mm (SD = 7.04) and vertical offset was 36.38 mm (SD = 6.28). When these parameters were compared to the data available from western world, there were significant anatomical variations and it was evident that there is a need to evaluate existing implants in relation to this data and possibly design the implants suited and relevant to Indian population.

An ultrasonographic study on measurement of normal hip joint in Korean

International Nuclear Information System (INIS)

Lim, Hyo Keun; Choo, In Wook; Park, Soo Sung; Han, Man Chung

1989-01-01

The ultrasonography is very useful in evaluation of small amount of effusion in hip joint and has several advantages such as noninvasiveness, easiness, accuracy and no radiation hazard. The data of normal hip joint space and capsule is very important in ultrasonographic evaluation of inflammatory hip joint disease. However, normal ultrasonographic data of hip joint has not been reported except in pediatric age. The purpose of this study was to evaluate and measure normal hip joint space and capsule and to provide the basic data for the clinical application. Healthy 70 males and 70 females who have had no past history and present clinical symptom of hip joint were examined with real time sector scanner (5MHz transducer). Width of hip joint spaces and thickness of joint capsule were obtained and analysed by statistical analysis. The results were as follows: 1. The average width of the hip joint space were 2.6±0.5 mm (right), 2.5±0.5 mm (left) in males and 2.4±0.5 (right), 2.5±0.6 mm (left) in females. There was no significant difference by sex. 2. The widths of the hip joint space were increased with aging and decreased after 6th decade (male) and 5th decade (females). 3. The maximal difference of both hip joint space was 1.2 mm and there was no significant difference in both side by sex and age. 4. The average thicknesses of hip joint capsule were 1.9±0.3 mm (right), 1.8±0.2 mm (left) in males and 1.7±0.3 mm (right), 1.7±0.2 mm (left) in females. There was no significant difference by sex. 5. The thickness of the hip joint capsule were increased with aging and were in plateau after 5th decade (male and female). 6. The maximal difference of both hip joint capsules was 0.9 mm and there was no significant difference in both sides by sex and age. It is therefore, considered that ultrasonography could be a very useful modality in diagnosis of hip joint disease in which the hip joint space and the hip joint capsule are changed by various etiologies

Radiofrequency denervation of the hip joint for pain management: case report and literature review.

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Gupta, Gaurav; Radhakrishna, Mohan; Etheridge, Paul; Besemann, Markus; Finlayson, Robert J

2014-01-01

A 55-year-old male presented with severe pain and functional limitations as a result of left hip osteoarthritis. He had failed multiple treatments while waiting for a hip arthroplasty, including physical therapy, medications, and various intra-articular injections. Thermal radiofrequency lesioning of the obturator and femoral articular branches to the hip joint was offered in the interim. To our knowledge, this is the first report to describe an inferior-lateral approach for lesioning the obturator branch, the clinical application of successive lesions to increase denervation area, and outcomes in a patient receiving a second treatment with previously good results. To discuss relevant and technical factors for this specific case, we reviewed previous literature on hip joint radiofrequency and critically evaluated previous anatomic studies in the context of radiofrequency. The first treatment provided significant benefit for a period of 6 months. A second treatment was employed providing only mild to moderate benefit until his joint replacement surgery 4 months later. Literature review revealed studies of low quality secondary to small sample sizes, patient selection methodology, inclusion of patients with heterogenous etiologies for pain, variable needle placement techniques, and lack of measurement of functional outcomes. Case report and low quality studies in existing literature. Hip joint radiofrequency denervation is a promising avenue for adjunctive treatment of hip pain. Further cadaveric studies are required to clarify a multitude of technical parameters. Once these are well defined, future clinical studies should consider pain, functional, and economic outcomes in their design.

Primary extra-cranial meningioma following total hip replacement

Energy Technology Data Exchange (ETDEWEB)

Campbell, T.J.; Beggs, I. [Royal Infirmary, Department of Radiology, Edinburgh (United Kingdom); Patton, J.T.; Porter, D. [Royal Infirmary, Department of Orthopaedics, Edinburgh (United Kingdom); Salter, D.M.; Al-Nafussi, A. [Royal Infirmary, Department of Pathology, Edinburgh (United Kingdom)

2009-01-15

A 61-year-old man presented with pain at the left hip and decreased mobility 10 years after total hip replacement. Imaging demonstrated a large destructive expansile mass adjacent to the prosthesis. Histological analysis confirmed the presence of an extra-cranial meningioma. Primary tumours after total hip replacement are rare and include soft tissue sarcomas, bone sarcomas and lymphomas. To our knowledge, no previous cases of primary extracranial meningioma have been identified. The imaging features, histology, pathogenesis and differential diagnosis are discussed. (orig.)

Atraumatic Anterior Dislocation of the Hip Joint

Directory of Open Access Journals (Sweden)

Tadahiko Ohtsuru

2015-01-01

Full Text Available Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case.

TOTAL HIP REPLACEMENT IN LEGG-CALVÉ-PERTHES DISEASE

DEFF Research Database (Denmark)

Froberg, Lonnie; Christensen, Finn; Pedersen, Niels Wisbech

2009-01-01

INTRODUCTION Poor long-time results in patients with Legg-Calvé-Perthes disease (LCP) are most often due to degenerative hip disease. The purpose of this study was to investigate if patients with LCP have an increased rate of total hip replacement (THR) compared to sex- and age-matched persons....... MATERIAL AND METHODS 167 LCP patients presented to our institution from 1941 to 1962. All patients were treated conservatively by a Thomas splint. Retrospectively medical records and radiographs were retrieved. Data from the Danish Hip Replacement Register and the Registries of the National Board of Health...... to follow-up and 3) patients with previous surgery to pelvis or lower limbs. 135 patients (156 hips) were enrolled in this study and 32 patients (35 hips) were excluded. RESULTS 20 hips out of 156 hips in patients with LCP have had a THR. Mean age at operation for the women was 50 years and 44 years...

Dialysis-related amyloidosis of the hip joints in long-term hemodialysis patients. MRI findings of hip joints in twelve female hemodialysis patients

International Nuclear Information System (INIS)

Suzuki, Hitoe; Shibuya, Asuka; Ando, Minoru; Akiba, Takashi; Nitta, Kosaku

2007-01-01

We report a female with amyloid arthropathy of the hip joints. She was a 67-year-old woman who had been treated by hemodialysis for 22 years. She had demonstrated a 5-month history of continuous low-grade fever and pain in her left hip and she was finally unable to walk by herself. Findings on X-ray films and MRI of the hip joints suggested avascular necrosis in both femur heads. To palliate symptoms, bipolar surgery on the left hip joint was performed. Pathological examination of bone tissue specimen demonstrated that there was some , β 2 -microglobulin (β 2 -MG)-related amyloid accumulation in the femur head. Based on this clinical experience, we performed MRI screening for amyloid lesions of the hip joints in another 11 asymptomatic female patients undergoing hemodialysis for 20 years or more. Cystic lesions of the hip joints were observed in 8 patients, amyloid arthropathy in 2 patients, and fluid trapped in the joint in 1 patient. Patients with amyloidosis had significantly lower serum β 2 -MG levels than patients without amyloidosis (28.6 mg/L versus 41.4 mg/L; p=0.0339). Our findings show that dialysis-related amyloidosis of the hip joints is one of the potential and significant problems in female patients on long-term hemodialysis therapy. It may be important to screen for this pathological condition in long-term hemodialysis patients. (author)

Stereo-radiographic analysis of loosening processes of alloplastic hip joint replacement

International Nuclear Information System (INIS)

Probst, K.J.

1980-01-01

A computer-aided diagnostic system has been developed by which implant dislocation of an order of 0.2 mm can be detected in all three dimensions. The diagnostic system is based on a point-by-point evaluation of stereoradiographic pictures; precise localisation of the implant relative to its place of insertion is made possible by special mathematical operations which are discussed in detail in the methodical part of the book. The method has been tested in clinical practice in 351 cases (208 patients) in the period between September 1, 1977, and May 31, 1979. By taking functional pictures during adduction and abduction of the extremity carrying the endoprosthesis and then evaluating these pictures, the diagnostic system can detect dislocations of the endoprosthesis inside the bone at a given moment. Also, the fate of hip joints with endoprostheses can be followed in the framework of longitudinal research. The method described here may also help to solve other problems of clinical relevance. The only precondition for this is the imaging of the structures of interest in the X-ray picture. A program to analyze loosening processes of alloplastic knee joint implants is new being worked on which will be of great use to the increasing number of patients with alloplastic knee joint implants. (orig./MG) [de

Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients.

Science.gov (United States)

Sakamoto, Junya; Manabe, Yoshitaka; Oyamada, Joichi; Kataoka, Hideki; Nakano, Jiro; Saiki, Kazunobu; Okamoto, Keishi; Tsurumoto, Toshiyuki; Okita, Minoru

2018-03-25

Referred pain in the anterior knee joint is the most common symptom in hip disease patients. The development of referred pain is considered to be related to dichotomizing peripheral sensory fibers. However, no gross anatomical findings identify any dichotomizing fibers innervating both the hip and knee joints. We dissected the femoral and obturator nerves in human cadavers to investigate the distribution of the articular branches in the hip and knee joints. Fourteen embalmed left lower limbs from 14 Japanese adult cadavers (five from females, nine from males, average age 73.8 ± 14.1 years) were observed macroscopically. The articular branches of the femoral and obturator nerves were dissected at the anterior margin of the groin toward the thigh region. After dissections of the articular nerves of the hip joints, the femoral and obturator nerves were exposed from proximally to distally to identify the articular nerves of the knee joints. The branching pattern of the articular branches in the hip and knee joints was recorded. In six of 14 limbs (42.9%), the femoral nerve supplied articular branches to the anteromedial aspect of both the hip and knee joints. These articular branches were derived from the same bundle of femoral nerve. These gross anatomical findings suggested that dichotomizing peripheral sensory fibers innervate the hip and knee joints and these could relate to the referred pain confirmed in the anterior knee joints of patients with hip disease. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

Hip or knee replacement - in the hospital after

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Hip replacement surgery - after - self-care; Knee replacement surgery - after - self-care ... taking walks in the hallways with help. After knee replacement, some surgeons recommend using a continuous passive ...

Does total hip replacement affect sexual quality of life?

Science.gov (United States)

Harmsen, Rita Th E; Haanstra, Tsjitske M; Sierevelt, Inger N; Jansma, Elise P; Nolte, Peter A; Nicolai, Melianthe P J; Wall, Peter D H; Van Royen, Barend J

2016-05-04

Total Hip Replacement (THR) is an effective treatment for end-stage hip osteoarthritis. Since the introduction of total joint replacement, the effect on the Sexual Quality of Life (SQoL) following THR has been addressed in scant studies. The aim of our study was to systematically review the literature, to summarise effects of THR on patients' SQoL. We searched PubMed, EMBASE and PsycINFO between January 1970 and February 9th, 2015 with search terms including Total Hip, Osteoarthritis, SQoL, and THR. Eligible studies were identified and two independent authors extracted data including details of SQoL, study quality and risk of bias. There were 12 eligible studies, which included a total of 2099 patients with an age range of 20-85 years. The methodological quality of ten studies was rated as low, and of two as moderate. Amongst the majority of patients, SQoL improved after surgery, both in terms of physical-functional and psychosocial well-being. However, changes between pre-operative and postoperative SQoL ranged extensively: for example, Sexual Dysfunction Δ 8-51% and Sexual Activity (SA) Δ 0-77%. Three studies reported that some patients never resumed SA again after surgery. In over 40 years of THR treatment, scant studies have examined the effect of THR on patients' SQoL. This review suggests that SQol improves after THR, although the magnitude of effects varies highly. However, the quality of the supporting evidence was rated as low to moderate. This suggests a need for more high quality evidence about the effects of THR on SQoL.

MRI of the hip joint; MRT des Hueftgelenks

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Czerny, C.; Noebauer-Huhmann, I.M.; Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, Medizinische Univ. Wien (Austria)

2005-12-01

Magnetic resonance imaging (MRI) is performed to diagnose many pathologic conditions affecting the hip joint. Either conventional MRI (without contrast enhancement of the joint cavity) or MR arthrography is used to detect and most accurately differentiate hip joint pathologies. Conventional MRI is performed in cases of bone marrow edema, necrosis, arthrosis and especially the so-called ''activated arthrosis'', as well as in inflammatory and tumorous entities. MR arthography, which has only recently become available for use, is excellently suited for diagnosing lesions of the acetabular labrum, cartilage lesions, and free articular bodies. This article provides an overview about MRI characteristics and their accuracy of hip joint diseases and the impact on the therapeutic procedure. (orig.)

Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

Science.gov (United States)

Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

2016-01-01

Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

21 CFR 888.3340 - Hip joint metal/composite semi-constrained cemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/composite semi-constrained... Hip joint metal/composite semi-constrained cemented prosthesis. (a) Identification. A hip joint metal... hip joint. The device limits translation and rotation in one or more planes via the geometry of its...

Radiological evaluation of failed total hip replacement

International Nuclear Information System (INIS)

Raspa, V.; Aldrovandi, S.; Pompei, G.

1988-01-01

The retrospective study of 50 operated cases of cemented total hip replacement and a review of the literature enabled the authors to define the radiological features of the above-mentioned condition. These features include one or more of the following signs: calcar reabsorption, lacunar erosions, modified relatioships between the prosthesis components, sepsis and loosening, periarticular calcifications dislocation and fracture of prosthesis components. Careful evaluation of these radiological features is extremely important for both an early diagnosis of failed total hip replacement and the choice of an adequate surgical treatment

Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry.

Science.gov (United States)

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.

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

Science.gov (United States)

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.

A case of severe ankylosing spondylitis posted for hip replacement surgery

Directory of Open Access Journals (Sweden)

Nalini Kotekar

2007-01-01

Full Text Available A 50-year-old male patient with history of ankylosing spondylitis (AS for 30 years presented for hip replacement surgery. Airway management in ankylosing spondylitis patients presents the most serious array of intubation and airway hazards imagin-able, which is secondary to decrease in cervical spine mobility and possible temporo-mandibular joint disease. Literatures support definitive airway management and many authors consider regional anaesthesia to be contraindicated. The reasons cited include inability to gain neuraxial access and the need for urgent airway control in case of complication of regional anaesthesia.

The effects of the empowerment education program in older adults with total hip replacement surgery.

Science.gov (United States)

Huang, Tzu-Ting; Sung, Chia-Chun; Wang, Woan-Shyuan; Wang, Bi-Hwa

2017-08-01

To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. A prospective randomized control trial. A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact. © 2017 John Wiley & Sons Ltd.

Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

DEFF Research Database (Denmark)

Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

2008-01-01

BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... after total hip and knee replacement surgery. PATIENTS AND METHODS: Between September 2003 and December 2005, 712 consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit....... Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. RESULTS: 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking...

Radiographic parameters of the hip joint from birth to adolescence

Energy Technology Data Exchange (ETDEWEB)

Than, P.; Kranicz, J.; Bellyei, A. [Dept. of Orthopaedics, Univ. of Pecs, Medical Faculty, Ifjusag utja (Hungary); Sillinger, T. [Dept. of Orthopaedics, Szt Gyorgy County Hospital, Szekesfehervar (Hungary)

2004-03-01

Background: Various qualitative and quantitative radiological geometrical parameters can be of great help when assessing dysplasia of the hip joint and in understanding developmental processes of the infant hip. There are few data on the normal values of the hip joint at different ages. Objective: To perform radiographic measurements on hip joints considered to be anatomically normal and to provide data for each age group, thus describing features of the radiographic development of the hip. Materials and methods: Radiographs were examined from 355 children (age 0-16 years) undergoing examination for scoliosis (long film), urography or plain abdominal radiography. Qualitative and quantitative signs were observed and measured, focusing on the Hilgenreiner, Wiberg and Idelberger angles and the decentric distance. Results: Before the age of 9 years measurable data from neighbouring age groups differed significantly, indicating typical radiological changes of the joint. For the same age range, qualitative changes could also be observed. After 9 years of age, radiological development of the normal hip joint during childhood is much slower. (orig.)

Total knee replacement influences both knee and hip joint kinematics during stair climbing

OpenAIRE

Saari, Tuuli; Tranberg, Roy; Zügner, Roland; Uvehammer, Johan; Kärrholm, Johan

2004-01-01

A gait analysis system was used to evaluate the kinematics of the hip and knee during stair ascending and descending after operation with total knee replacement. Patients with 5° varus/valgus alignment or less were selected randomly to receive either a flat or a concave tibial component with retention of the posterior cruciate ligament. Patients who had more than 5° varus/valgus alignment and/or an extension defect of 10° or more were selected randomly to receive the concave or posterior-stab...

Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

Science.gov (United States)

Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

2015-01-01

Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300

A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

Science.gov (United States)

Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R

2015-05-01

Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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 (pwater 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.

Comparison of hip function and quality of life of total hip arthroplasty and resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint at 5 years.

Science.gov (United States)

Costa, Matthew L; Achten, Juul; Foguet, Pedro; Parsons, Nicholas R

2018-03-12

To compare the medium-term clinical effectiveness of total hip arthroplasty and resurfacing arthroplasty. Single centre, two-arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation. A large teaching hospital in England. 122 patients older than 18 years with severe arthritis of the hip joint, suitable for resurfacing arthroplasty of the hip. Patients were excluded if they were considered to be unable to adhere to trial procedures or complete questionnaires. Total hip arthroplasty (replacement of entire femoral head and neck); hip resurfacing arthroplasty (replacement of the articular surface of femoral head only, femoral neck remains intact). Both procedures replaced the articular surface of the acetabulum. The outcome measures were hip function assessed using the Oxford Hip Score (OHS) and health-related quality of life assessed using the EuroQol (EQ-5D). Patients were followed up annually for a minimum of 5 years. Outcome data were modelled using the generalised estimating equation methodology to explore temporal variations during follow-up. 60 patients were randomly assigned to hip resurfacing arthroplasty and 62 to total hip arthroplasty. 95 (78%) of the 122 original study participants provided data at 5 years. There was a small decrease in both hip functions and quality of life in both groups of patients each year during the 5-year follow-up period. However, there was no evidence of a significant difference between treatments group in the OHS (P=0.333) or the EQ-5D (P=0.501). We previously reported no difference in outcome in the first year after surgery. The current medium-term results also show no evidence of a difference in hip function or health-related quality of life in the 5 years following a total hip arthroplasty versus resurfacing arthroplasty. ISRCTN33354155. UKCRN 4093. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use

Hip Joint Trevor Disease: Literature Review and a Case Report

Directory of Open Access Journals (Sweden)

Mohammad Hallaj Moghadam

2018-01-01

Full Text Available Trevor disease or dysplasia epiphysealis hemimelica (DEH is an extremely rare condition with incidence of about 1:1,000,000. Male to female ratio of reporting case is 3:1, and usually diagnosed between two and eight years old. It usually affects the medial portion of the joint, but lateral involvement is not uncommon. Hip-joint was affected in less than 4% of existing cases in the literature. It would be very important to precisely mange the hip involvement to prevent from further articular cartilage destruction in this very young age. We report an infant boy with isolated DEH of hip. We found a total of 271 cases of DEH that reported between 1926 and 2017.The most sites of involvement are ankle joint and around the knee. Our search reaches out to ten cases of hip involvement. Hip involvement needs a patient specified decision. We observed our patient for three years with a desirable hip joint function.

Pseudotumor of the Hip due to Fungal Prosthetic Joint Infection

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Stefano Artiaco

2013-01-01

Full Text Available Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case of Candida albicans total hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed.

Septic Arthritis of The Hip Joint presenting as Acute Abdomen ...

African Journals Online (AJOL)

These cases illustrate the maxim that any painful movement of the hip joint with associated unexplained fever should raise suspicion of septic arthritis. The close relationship of the hip joint to the pelvis sometimes confuses hip diseases with pelvic pathologies. Key Words: Septic arthritis, acute abdomen, pathological ...

Chronic asymptomatic dislocation of a total hip replacement: a case report

Directory of Open Access Journals (Sweden)

Lidder Surjit

2009-08-01

Full Text Available Abstract Introduction Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly then previously thought. Case presentation A 60-year-old man underwent a right Exeter cemented total hip replacement and was subsequently discharged after appropriate follow-up. He next presented 8 years later complaining of pain in the left groin. An anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement. The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating. He remained pain-free on this side, had 5 cm of true leg length shortening with a good range of movement and was very pleased with his hip replacement. He was later placed on the waiting list for a left total hip replacement. Conclusion This case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement. Furthermore it emphasises that with an increased trend to earlier hospital discharge and shorter follow-up, potential complications may be missed. We urge a low index of suspicion for potential complications and suggest that regular review with radiographic follow-up should be made.

[The hip joint in neuromuscular disorders].

Science.gov (United States)

Strobl, W M

2009-07-01

Physiologic motor and biomechanical parameters are prerequisites for normal hip development and hip function. Disorders of muscle activity and lack of weight bearing due to neuromuscular diseases may cause clinical symptoms such as an unstable hip or reduced range of motion. Disability and handicap because of pain, hip dislocation, osteoarthritis, gait disorders, or problems in seating and positioning are dependent on the severity of the disease, the time of occurrence, and the means of prevention and treatment. Preservation of pain-free and stable hip joints should be gained by balancing muscular forces and by preventing progressive dislocation. Most important is the exact indication of therapeutic options such as movement and standing therapy as well as drugs and surgery.

The relationship of hip joint space to self reported hip pain

DEFF Research Database (Denmark)

Jacobsen, S.; Holm, S.S.; Lund, B.

2004-01-01

OBJECTIVES: (1) To evaluate the effect of pelvic orientation on measurements of hip joint space widths (JSW) in cadaver pelvic radiographs, thereby validating the pelvic radiographs of the Copenhagen City Heart Study: The Osteoarthritis Substudy (CCHS III) cohort of 4.152 subjects, and (2......) to investigate the relationship between minimal JSW and self reported hip pain of the cohort. METHODS: (1) Cadaver pelves and proximal femora of one male and one female donor were mounted in holding devices permitting independent rotation (total arc of 42 degrees), and inclination/reclination (total arc of 24...... degrees). At each 3 degrees increment an anteroposterior radiograph was recorded. Measurements of JSW were performed. (2) Self reported recurrent pain in or around the hip joint during 12 months prior to baseline examinations, and minimum JSW in pelvic radiographs of the cohort were registered...

Failure rate of cemented and uncemented total hip replacements

DEFF Research Database (Denmark)

Makela, K. T.; Matilainen, M.; Pulkkinen, P.

2014-01-01

). Participants 347 899 total hip replacements performed during 1995-2011. Main outcome measures Probability of implant survival (Kaplan-Meier analysis) along with implant survival with revision for any reason as endpoint (Cox multiple regression) adjusted for age, sex, and diagnosis in age groups 55-64, 65......Objective To assess the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older. Design Register study. Setting Nordic Arthroplasty Register Association database (combined data from Sweden, Norway, Denmark, and Finland......-74, and 75 years or older. Results The proportion of total hip replacements using uncemented implants increased rapidly towards the end of the study period. The 10 year survival of cemented implants in patients aged 65 to 74 and 75 or older (93.8%, 95% confidence interval 93.6% to 94.0% and 95.9%, 95...

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

Science.gov (United States)

Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

2015-09-01

Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer semi-constrained cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3350 Hip joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi...

21 CFR 888.3300 - Hip joint metal constrained cemented or uncemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal constrained cemented or uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3300 Hip joint metal constrained cemented or uncemented prosthesis. (a) Identification. A hip joint metal constrained...

COMPLEX FUNCTIONAL ASSESSMENT OF THE HIP JOINT.

Directory of Open Access Journals (Sweden)

Maya S. Krastanova

2015-09-01

Full Text Available Introduction: In relation to the study reporting the effects of applying phased complex rehabilitation in patients with total hip arthroplasty, it has been concluded that the everyday clinical practice in Bulgaria does not apply complex examination, giving an objective picture about the extent of functional status of patients with trauma and diseases of the hip. Aim: The main goal of this report is to present a test which incorporates all known and routine research and in which the total number of points determines the functional status of patients with trauma and diseases of the hip. Material and Methods: Based on the Hip dysfunction and Osteoarthritis Outcome Score, the Harris Hip Score modified test, scale D’Aubigne and Postel and Iowa’s test for complex functional evaluation of the hip joint, we have developed a test including information about the degree of pain; goniometry and manual muscle testing of the hip; locomotor test – type of gait and adjuvants; test for Daily Activities of Life. The test has been developed on the basis of expert assessment by doctors and physiotherapists of the proposed indicators for evaluation and determination of the weighting factors’ contribution to the general condition of the patient. Conclusion: The developed and tested method of complex functional assessment of the hip joint enables our colleagues, dealing with trauma and diseases of the hip, to use it in various research and scientific projects, as well as in general medical practice.

Modern radiological postoperative diagnostics of the hip joint in children and adults

International Nuclear Information System (INIS)

Weber, M.A.; Thierjung, H.; Kloth, J.K.; Egermann, M.

2015-01-01

The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the hip joint following trauma and endoprosthesis implantation. With the increasing number of joint-preserving surgery, e. g. of surgical hip luxation and hip arthroscopy for the treatment of femoroacetabular impingement (FAI), high-resolution imaging of intra-articular pathologies before and after surgery has become increasingly important. In this review article, diagnostic imaging of the hip joint is presented following common trauma surgery and orthopedic surgery interventions. The imaging modalities of projection radiography, CT and MRI including direct MR-arthrography are discussed with regard to their diagnostic capability in the postoperative assessment of the hip joint. Among others topics, imaging is discussed following hip arthroplasty, following surgical hip luxation and arthroscopic interventions for the treatment of FAI, as well as following core decompression for avascular necrosis of the femoral head. Moreover, orthopedic interventions of the hip joint in children and adolescents are presented and the dedicated reporting of postoperative imaging is outlined.

Roentgenography of hip-joint using tubus in infants

International Nuclear Information System (INIS)

Sakuyama, Keiko; Imamura, Keiko; Uji, Teruyuki; Fujikawa, Mitsuhiro; Ishikawa, Toru

1976-01-01

Roentgenography of hip-joint using tubus was discussed. This technique has been made at St. Marianna University, School of Medicine, in order to reduce the exposure dose in x-ray examination of congenital dislocation of hip-joint. The tubus is designed to butterfly-shaped. Only the site which is necessary for roentgenography of hip-joint is exposed, and the sexual gland is outside exposure. The exposure dose of the sexual gland using tubus is 1/10 in female infants and 1/30 in male infants of those without tubus (6.7 mR in male infants, 2.0 mR in female infants). There are some advantages in the tubus: it is clinically used for both sexes as well as reducing exposure doses, and it can be used widely from neonates to infants. (Serizawa, K.)

Hip Joint Effusion-Synovitis Is Associated With Hip Pain and Sports/Recreation Function in Female Professional Ballet Dancers.

Science.gov (United States)

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Cook, Jill

2018-03-23

To compare hip joint effusion-synovitis prevalence in professional ballet dancers with nondancing athletes and to evaluate the relationship between effusion-synovitis and clinical measures and cartilage defects. Case-control study. Elite ballet and sport. Forty-nine professional ballet dancers and 49 age-matched and sex-matched athletes. Group (dancers/athletes), sex, age, years of training, Copenhagen Hip and Groin Outcome Scores (HAGOSs), hip rotation range of motion (ROM), generalized joint hypermobility (GJH), and hip cartilage defect scores. Hip joint effusion-synovitis (absent, grade 1 = 2-4 mm, grade 2 = >4 mm) scored with 3-Tesla magnetic resonance imaging. Hip joint effusion-synovitis was found in 22 (45%) dancers and 13 (26.5%) athletes (P = 0.06). Grade 2 effusion-synovitis was only found in dancers (n = 8, r = 0.31, P = 0.009). The prevalence of effusion-synovitis was similar in men (n = 11, 26%) and women (n = 24, 43%, P = 0.09). Female dancers with effusion-synovitis had lower HAGOS pain (r = 0.63, P = 0.001) and sports/recreation scores (r = 0.66, P = 0.001) compared with those without effusion-synovitis. The HAGOS scores were not related to effusion-synovitis in male dancers or female and male athletes (P > 0.01 for all). Effusion-synovitis was not related to hip ROM, GJH, or cartilage defect scores (P > 0.05 for all). Hip joint effusion-synovitis was related to higher levels of pain and lower sports/recreation function in female ballet dancers. Effusion-synovitis was not related to hip rotation ROM, GJH or cartilage defects. Larger sized joint effusion-synovitis was exclusively found in dancers.

Ethamsylate and blood loss in total hip replacement.

Science.gov (United States)

Keith, I

1979-01-01

Nineteen consecutive patients undergoing total hip replacement under epidural anaesthesia were randomly divided into two groups. The treatment group received 1000 mg of ethamsylate intravenously before induction of anaesthesia. Blood lost during surgery was measured by a colorimetric technique. Closed suction drains were used and all blood lost after operation collected for measurement. Ethamsylate did not decrease the average volumes of blood lost during or after the operation. Neither did it reduce the requirements for blood transfusion. Although there were no side-effects attributable to ethamyslate, there seems to be no indication for its use in total hip replacement under epidural anaesthesia.

The role of MRI in early ankylosing spondylitis: emphasis on the sacroiliac and hip joints

Energy Technology Data Exchange (ETDEWEB)

Kim, Chul Min; Kang, Moo Song; Kim, Chang Soo; Chung, Chun Phil [Maryknoll Hospital, Busan (Korea, Republic of)

1995-05-15

In clinically suspected ankylosing spondylitis of sacroiliac (SIJ) and hip joints with normal or minimal secondary bone change in simple X-ray films, we evaluated the role of MRI in sacroiliac and hip joints. Authors evaluated 11 cases (36 joints; SIJ 14 hip 22) confirmed as ankylosing spondylitis by clinical, laboratory, and radiologic findings, and compared the detectability of involvement of joints by simple X-ray film and MRI. Authors analysed MR findings for the presence of pannus and its signal intensities (SI), change of articular cartilage, bony erosion and sclerosis, subchondral bone cysts, osteophytosis, bone marrow edema, joint effusion, adjacent soft tissue change, and contrast enhancement of pannus. MRI detected not only 20 joints (SIJ 11, hip 9) detected in simple X-ray, but also additional 7 joints (SIJ 3, hip 4). MRI depicted simultaneous involvement of SIJ and hip joints in 5 of 11 cases (SIJ 10 joints, hip 9 joints), and bilateral involvement of SIJ and hip joints in 4 among the 5 cases. MRI also demonstrated pannus, which were not detected in conventional films, as intermediate SI on T1WI and high SI on T2WI, in all 27 joints (SIJ 14, hip 13). Gd-DTPA enhanced T1WI revealed enhancement of pannus in 7 cases (17 joints). MRI was a valuable modality in evaluation of clinically suspected ankylosing spondylitis of SIJ or hip joints with normal or minimal secondary bone change in simple X-ray. Simultaneous evaluation of SIJ and hip joints is suggested in clinically suspected ankylosing spondylitis or other joint diseases.

Systemic distribution of wear debris after hip replacement. A cause for concern?

Science.gov (United States)

Langkamer, V G; Case, C P; Heap, P; Taylor, A; Collins, C; Pearse, M; Solomon, L

1992-11-01

The production of particulate wear debris is a recognised complication of joint arthroplasty, but interest has concentrated on local tissue reactions and a possible association with implant loosening. The fate of wear products in the body remains unknown, although some of the metals used in the construction of orthopaedic implants are known to have toxic and oncogenic properties. We report histological and electron-microscopic evidence from two cases which shows that metallic debris can be identified in the lymphoreticular tissues of the body distant from the hip some years after joint replacement. The increase in the use of total arthroplasty in younger patients, the development of new alloys and the use of porous coatings must raise concern for the long-term effects of the accumulation of wear debris in the body.

Cognitive dysfunction after fast-track hip and knee replacement.

Science.gov (United States)

Krenk, Lene; Kehlet, Henrik; Bæk Hansen, Torben; Solgaard, Søren; Soballe, Kjeld; Rasmussen, Lars Simon

2014-05-01

Postoperative cognitive dysfunction (POCD) is reported to occur after major surgery in as many as 20% of patients, elderly patients may especially experience problems in the weeks and months after surgery. Recent studies vary greatly in methods of evaluation and diagnosis of POCD, and the pathogenic mechanisms are still unclear. We evaluated a large uniform cohort of elderly patients in a standardized approach, after major joint replacement surgery (total hip and knee replacement). Patients were in an optimized perioperative approach (fast track) with multimodal opioid-sparing analgesia, early mobilization, and short length of stay (LOS ≤3 days) and discharged to home. In a prospective multicenter study, we included 225 patients aged ≥60 years undergoing well-defined fast-track total hip or total knee replacement. Patients had neuropsychological testing preoperatively and 1 to 2 weeks and 3 months postoperatively. LOS, pain, opioid use, inflammatory response, and sleep quality were recorded. The practice effect of repeated cognitive testing was gauged using data from a healthy community-dwelling control group (n = 161). Median LOS was 2 days (interquartile range 2-3). The incidence of POCD at 1 to 2 weeks was 9.1% (95% confidence interval [CI], 5.4%-13.1%) and 8.0% (95% CI, 4.5%-12.0%) at 3 months. There was no statistically significant difference between patients with and without early POCD, regarding pain, opioid use, sleep quality, or C-reactive protein response, although the CIs were wide. Patients with early POCD had a higher Mini Mental State Examination score preoperatively (difference in medians 0.5 [95% CI, -1.0% to 0.0%]; P = 0.034). If there was an association between early POCD and late POCD, the sample size was unfortunately too small to verify this (23.6% of patients with early POCD had late onset vs 6.7% in non-POCD group; risk difference 16.9 (95% CI, -2.1% to 41.1%; P = 0.089). The incidence of POCD early after total hip and knee replacement

Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study.

Science.gov (United States)

Eibich, Peter; Dakin, Helen A; Price, Andrew James; Beard, David; Arden, Nigel K; Gray, Alastair M

2018-04-10

To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS). Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases. UK secondary care. Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year. EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement. Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution. Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with

vein thrombosis in elective hip replacement

African Journals Online (AJOL)

A consensus forum was convened to evaluate the economic considerations associated with prophylaxis against thrombo-embolic disease in patients undergoing hip replacement therapy in South Africa. This forum consists of orthopaedic surgeons, vascular surgeons and a statistician. Methods. The forum was instructed to ...

Joint Replacement (Finger and Wrist Joints)

Science.gov (United States)

... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Joint Replacement Email to a friend * required fields ...

Factors influencing health-related quality of life after total hip replacement - a comparison of data from the Swedish and Danish hip arthroplasty registers

DEFF Research Database (Denmark)

Gordon, Max; Paulsen, Aksel; Overgaard, Søren

2013-01-01

of PROs may present difficulties due to cultural differences and differences in the provision of health care. However, in order to understand how these differences affect PROs, common predictors for poor and good outcomes need to be investigated. This cross-sectional study investigates factors influencing......There is an increasing focus on measuring patient-reported outcomes (PROs) as part of routine medical practice, particularly in fields such as joint replacement surgery where pain relief and improvement in health-related quality of life (HRQoL) are primary outcomes. Between-country comparisons...... health-related quality of life (HRQoL) one year after total hip replacement (THR) surgery in Sweden and in Denmark....

Do hip prosthesis related infection codes in administrative discharge registers correctly classify periprosthetic hip joint infection?

DEFF Research Database (Denmark)

Lange, Jeppe; Pedersen, Alma B; Troelsen, Anders

2015-01-01

PURPOSE: Administrative discharge registers could be a valuable and easily accessible single-sources for research data on periprosthetic hip joint infection. The aim of this study was to estimate the positive predictive value of the International Classification of Disease 10th revision (ICD-10...... in future single-source register based studies, but preferably should be used in combination with alternate data sources to ensure higher validity....... decreased to 82% (95% CI: 72-89). CONCLUSIONS: Misclassification must be expected and taken into consideration when using administrative discharge registers for epidemiological research on periprosthetic hip joint infection. We believe that the periprosthetic hip joint infection diagnosis code can be of use...

Evaluation of the magnitude of hip joint deformation in subjects with avascular necrosis of the hip joint during walking with and without Scottish Rite orthosis.

Science.gov (United States)

Karimi, Mohammad Taghi; Mohammadi, Ali; Ebrahimi, Mohammad Hossein; McGarry, Anthony

2017-02-01

The femoral head in subjects with leg calve perthes disease (LCPD) is generally considerably deformed. It is debatable whether this deformation is due to an increase in applied loads, a decrease in bone mineral density or a change in containment of articular surfaces. The aim of this study was to determine the influence of these factors on deformation of the femoral head. Two subjects with LCPD participated in this study. Subject motion and the forces applied on the affected leg were recorded using a motion analysis system (Qualsis TM ) and a Kistler force plate. OpenSim software was used to determine joint contact force of the hip joint whilst walking with and without a Scottish Rite orthosis. 3D Models of hip joints of both subjects were produced by Mimics software. The deformation of femoral bone was determined by Abaqus. Mean values of the force applied on the leg increased while walking with the orthosis. There was no difference between bone mineral density (BMD) of the femoral bone of normal and LCPD sides (p-value>0.05) and no difference between hip joint contact force of normal and LCPD sides. Hip joint containment appeared to decrease follow the use of the orthosis. It can be concluded that the deformation of femoral head in LCPD may not be due to change in BMD or applied load. Although the Scottish Rite orthosis is used mostly to increase hip joint containment, it appears to reduce hip joint contact area. It is recommended that a similar study is conducted using a higher number of subjects. Copyright © 2016 IPEM. All rights reserved.

Infection imaging with 99mTc-biotin in patients with prosthetic hip replacement

International Nuclear Information System (INIS)

Villa, G.; Mariani, G.; Augeri, C.; Pipino, F.; Paganelli, G.; Chinol, M.

2002-01-01

Full text: Although the incidence of infection in prosthetic hip joint replacements has decreased from about 10-15 % to about 0.5-2 % over the last 20 years, the total number of infections has actually increased because of the large number of patients undergoing the procedure. The most frequent clinical presentation of this complication is functional impairment and pain, with or without fever and other signs and/or symptoms of infection. The main is differentiating true infection from simple loosening with inflammation of the implanted stem. Scintigraphy with radiolabeled autologous leukocytes (WBC) represents the 'gold standard' nuclear medicine procedure for imaging infection. However, this procedure is time-consuming, expensive, and involves some biological hazard. Preliminary data, obtained during validation of the avidin/111In-biotin approach, have suggested some potential of 111ln-biotin per se to accumulate at sites of infection. In this pilot study we explored the potential of 99mTc-biotin as an infection imaging agent in pts with orthopedic infections. N4-lys-biotin was labeled with 1110 MBq. Sixteen pts bearing a total of 20 prosthetic hip replacements were enrolled in the study (9 women and 7 men, mean age 73.2 yrs). Eight pts had previously undergone removal of their hip prosthesis because of infection, while infection was suspected in the remaining 8 pts. Scintigraphy was recorded 20 min, then 1, 4 and 24 hr after the i.v. injection of 99mTc-biotin. Within 48 hrs of the 99mTc-biotin study, all pts also underwent scintigraphy with 99mTc-HMPAO-WBC. Out of the 20 hips evaluated, 15 turned out to be infected while in the remaining 5 cases pain was only caused by bone-prosthetic loosening and/or conditions other than infection. In 12/15 infected sites scintigraphy was concordantly positive with both procedures, 99mTc-biotin yielding higher target-to-nontarget ratios than 99mTc-HMPAO-WBC in 4 cases and similar values in the other cases. Discordant patterns

Joint space width in dysplasia of the hip

DEFF Research Database (Denmark)

Jacobsen, Steffen; Sonne-Holm, Stig; Søballe, K

2005-01-01

In a longitudinal case-control study, we followed 81 subjects with dysplasia of the hip and 136 control subjects without dysplasia for ten years assessing radiological evidence of degeneration of the hip at admission and follow-up. There were no cases of subluxation in the group with dysplasia....... Neither subjects with dysplasia nor controls had radiological signs of ongoing degenerative disease at admission. The primary radiological discriminator of degeneration of the hip was a change in the minimum joint space width over time. There were no significant differences between these with dysplasia...... and controls in regard to age, body mass index or occupational exposure to daily repeated lifting at admission.We found no significant differences in the reduction of the joint space width at follow-up between subjects with dysplasia and the control subjects nor in self-reported pain in the hip...

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

DEFF Research Database (Denmark)

Jensen, Carsten; Roos, Ewa M.; Kjærsgaard-Andersen, Per

2013-01-01

Background: 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...... 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...... measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity (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...

Modern radiological imaging of osteoarthritis of the hip joint with consideration of predisposing conditions

International Nuclear Information System (INIS)

Weber, Marc-Andre; Rehnitz, C.; Merle, C.; Gotterbarm, T.

2016-01-01

Osteoarthritis is the most common disease of the hip joint in adults and has a high socioeconomic impact. This review article discusses the value of three imaging modalities in the diagnosis of osteoarthritis of the hip joint: projection radiography, computed tomography, and magnetic resonance imaging (MRI). Besides established imaging diagnostics of osteoarthritis, this review also outlines new MRI techniques that enable the biochemical analysis of hip joint cartilage and discusses predisposing deformities of the hip joint including femoroacetabular impingement (FAI) with labral pathologies, hip joint dysplasia, malrotation, and, finally, femoral head necrosis, for which early detection and an exact description of the extent and localization of the necrotic area are extremely important. Conventional X-rays remain indispensable for the diagnosis of osteoarthritis, while MRI is able to depict additional early symptoms and signs of activity of the disease. With the increasing number of joint-preserving interventions such as surgical hip luxation and hip joint arthroscopy for treating FAI, high-resolution imaging is gaining further importance for both pre- and postoperative diagnostics because it can accurately recognize early stages of joint damage. With high-resolution MR sequences and MR arthrography, the detailed depiction of the thin cartilaginous coating of the hip joint has become quite possible.

Effects of clinical pathways in the joint replacement: a meta-analysis

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Faggiano F

2009-07-01

Full Text Available Abstract Background A meta-analysis was performed to evaluate the use of clinical pathways for hip and knee joint replacements when compared with standard medical care. The impact of clinical pathways was evaluated assessing the major outcomes of in-hospital hip and knee joint replacement processes: postoperative complications, number of patients discharged at home, length of in-hospital stay and direct costs. Methods Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched. The search was performed from 1975 to 2007. Each study was assessed independently by two reviewers. The assessment of methodological quality of the included studies was based on the Jadad methodological approach and on the New Castle Ottawa Scale. Data analysis abided by the guidelines set out by The Cochrane Collaboration regarding statistical methods. Meta-analyses were performed using RevMan software, version 4.2. Results Twenty-two studies met the study inclusion criteria and were included in the meta-analysis for a total sample of 6,316 patients. The aggregate overall results showed significantly fewer patients suffering postoperative complications in the clinical pathways group when compared with the standard care group. A shorter length of stay in the clinical pathway group was also observed and lower costs during hospital stay were associated with the use of the clinical pathways. No significant differences were found in the rates of discharge to home. Conclusion The results of this meta-analysis show that clinical pathways can significantly improve the quality of care even if it is not possible to conclude that the implementation of clinical pathways is a cost-effective process, because none of the included studies analysed the cost of the development and implementation of the pathways. Based on the results we assume that pathways have impact on the organisation of care if the care process is structured in a standardised way

Confronting hip resurfacing and big femoral head replacement gait analysis

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Panagiotis K. Karampinas

2014-03-01

Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

[Osteoarthritic changes in hip joint in patients with fractures of femoral neck].

Science.gov (United States)

Kravtsov, Vladimir; Saranga, Dan; Kidron, Debora

2013-06-01

Fractures of proximal femur are common among elderly people. They are associated with considerable morbidity and mortality. Identification of etiopathogenetic factors associated with fractures might facilitate prevention. Osteoporosis is commonly present in the heads of femurs. The prevalence of osteoarthritic changes in hip joints is controversial. Some authorities report low prevalence and even speculate on the protective effect of osteoarthritis against fractures. The goal of the study was to examine the association between osteoarthritic changes (radiologic and histologic) and fractures of the neck of the femur. The patient population included 41 patients undergoing replacement of femoral head for subcapital fracture; their ages ranged from 61 - 93 years of age. Radiologic criteria for osteoarthritis included: (a)narrowing of joint space (b) subchondral sclerosis (c) deformation of head of femur (d) subchondra cysts and (e] osteophytes. Osteoarthritic changes, usually mild, were present in 22 (54%) patients, regardless of age and gender The frequency of radioLogical changes was similar to the general population. HistoLogic findings included subchondral fibrosis and subchondral cysts. Mild subchondral fibrosis was present in 78% of cases. The findings support lack of association between osteoarthritic changes in hip joint and fracture of proximal femur, without a protective effect.

Preoperative Education for Hip and Knee Replacement: Never Stop Learning.

Science.gov (United States)

Edwards, Paul K; Mears, Simon C; Lowry Barnes, C

2017-09-01

Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery. As a result, comprehensive clinical pathways incorporating a preoperative education program for elective hip and knee replacement lead to lower hospital length of stay, higher home discharge, lower readmission, and improved cost. In summary, we report convincing evidence that preoperative education classes are an essential element to successful participation in alternative payment models such as the Bundle Payment Care Initiative.

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms

International Nuclear Information System (INIS)

Kassarjian, Ara; Llopis, Eva; Schwartz, Richard B.; Bencardino, Jenny T.

2009-01-01

The purpose of the study was to demonstrate the prevalence of communication between the hip joint and the obturator externus bursa on hip MR arthrography. Following institutional review board approval, 200 hip MR arthrograms in 196 subjects were independently reviewed by two musculoskeletal radiologists. Discrepancies were resolved by adjudication. The presence or absence of communication between the hip joint and the obturator externus bursa was recorded. Associated lesions involving the acetabular labrum and articular cartilage were recorded. The obturator externus bursa was shown to communicate with the hip joint in 11 of the 200 (5.5%) hip MR arthrograms. Of these, six were in men and five were in women. The age range was 15-63 years with a mean age of 34 years. All 11 patients had labral tears. Eight of the 11 had cartilage lesions. The obturator externus bursa can be seen to communicate with the hip joint in 5.5% of hip MR arthrograms. Associated labral and cartilage lesions are common. (orig.)

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms

Energy Technology Data Exchange (ETDEWEB)

Kassarjian, Ara [Corades, S.L., Majadahonda-Madrid (Spain); Massachusetts General Hospital, Division of Musculoksleletal Radiology, Boston, MA (United States); Llopis, Eva [Hospital de la Ribera, Department of Radiology, Alzira (Valencia) (Spain); Schwartz, Richard B. [Longwood MRI Specialists, Brookline, MA (United States); Bencardino, Jenny T. [NYU Department of Radiology, New York, NY (United States)

2009-11-15

The purpose of the study was to demonstrate the prevalence of communication between the hip joint and the obturator externus bursa on hip MR arthrography. Following institutional review board approval, 200 hip MR arthrograms in 196 subjects were independently reviewed by two musculoskeletal radiologists. Discrepancies were resolved by adjudication. The presence or absence of communication between the hip joint and the obturator externus bursa was recorded. Associated lesions involving the acetabular labrum and articular cartilage were recorded. The obturator externus bursa was shown to communicate with the hip joint in 11 of the 200 (5.5%) hip MR arthrograms. Of these, six were in men and five were in women. The age range was 15-63 years with a mean age of 34 years. All 11 patients had labral tears. Eight of the 11 had cartilage lesions. The obturator externus bursa can be seen to communicate with the hip joint in 5.5% of hip MR arthrograms. Associated labral and cartilage lesions are common. (orig.)

Development of explicit criteria for prioritization of hip and knee replacement.

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Escobar, Antonio; Quintana, José M; Bilbao, Amaia; Ibañez, Berta; Arenaza, Juan C; Gutiérrez, Luis; Azkárate, Jesús; Güenaga, Jose I; Vidaurreta, Ignacio

2007-06-01

Among the problems to the publicly funded national health services are the waiting lists. Patients who need elective surgery generally have long waiting times before treatment. We aimed to develop a new prioritization tool for primary hip and knee replacement. Criteria were developed using a modified Delphi panel process. We convened a panel of nine members who scored the scenarios created by the research team and by patient focus groups. We studied the level of agreement among the panelists and the contribution of the variables to the ratings of the panel using linear and logistic regression models. The priority scores of the variables and their levels were synthesized using the optimal scaling and standard linear regression methods. Seven variables, pain on motion, walking functional limitations, abnormal findings on physical examination, pain at rest, other functional limitations, social role, and other pathologies that could improve with joint replacement, were considered to create the different scenarios. The panel scored 192 scenarios. The disagreement among the panelists was very low (1%) with an intra-class correlation coefficient of 0.72. Of the 192 scenarios, 45.8% were scored as urgent, 35.4% as preferred and 18.8% as ordinary. The variables that contributed most to the scores were pain on motion and walking functional limitations. When optimal scaling and regression techniques were applied, similar results were obtained. This tool can evaluate and prioritize patients on a waiting list for hip or knee replacement. We also provide a simple and easy way to use an algorithm to estimate the treatment priority for individual patients.

The use of clinical analysis of movements in evaluation of motor functional status of patients after total hip replacement

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Romakina N.A.

2016-06-01

Full Text Available Aim: to estimate functional status of coxarthrosis in patients requiring total hip replacement of the two hip joints. Material and methods. The biomechanical examination of 94 patients with bilateral primary coxarthrosis before and after total hip replacement was performed using clinical stabilometric software complex. The ability to perceive the mechanical load during standing and walking was evaluated at different stages of the treatment. The difference between the samples was estimated with the use of Mann — Whitney U-test. The rank correlation of biomechanical parameters was measured by Spearman coefficient. Results. It was revealed that the most responsive indicators are the transfer period, the first and second periods of double support and the deviation of the center of pressure relative to the average position in the frontal plane. Conclusion. After surgical treatment there was observed some improvement: the-left-and-right-step asymmetry decrease, rhythm rate increase, improved ability to maintain body balance, jog reactions increase.

Radiological examinations of complications after total hip replacement Pt. 1

International Nuclear Information System (INIS)

Luzsa, Gyoergy; Reti, Peter; Lakatos, Jozsef

1985-01-01

The radiological findings of complications after total hip replacement are summarized by analizing the data of control examinations of the operated patients at the National Institute for Rheumatology and Physiotherapy. In this first part the types of total hip replacements and the radiological methods (native x-ray, fistulography, arthrography, needle biopsy and scintigraphy using sup(99m)Tc isotope) are surveyed, and the radiological findings of the septic surgical complications are described. (author)

Increased expression of damage-associated molecular patterns (DAMPs) in osteoarthritis of human knee joint compared to hip joint.

Science.gov (United States)

Rosenberg, John H; Rai, Vikrant; Dilisio, Matthew F; Sekundiak, Todd D; Agrawal, Devendra K

2017-12-01

Osteoarthritis (OA) is a degenerative disease characterized by the destruction of cartilage. The greatest risk factors for the development of OA include age and obesity. Recent studies suggest the role of inflammation in the pathogenesis of OA. The two most common locations for OA to occur are in the knee and hip joints. The knee joint experiences more mechanical stress, cartilage degeneration, and inflammation than the hip joint. This could contribute to the increased incidence of OA in the knee joint. Damage-associated molecular patterns (DAMPs), including high-mobility group box-1, receptor for advanced glycation end products, and alarmins (S100A8 and S100A9), are released in the joint in response to stress-mediated chondrocyte and cartilage damage. This facilitates increased cartilage degradation and inflammation in the joint. Studies have documented the role of DAMPs in the pathogenesis of OA; however, the comparison of DAMPs and its influence on OA has not been discussed. In this study, we compared the DAMPs between OA knee and hip joints and found a significant difference in the levels of DAMPs expressed in the knee joint compared to the hip joint. The increased levels of DAMPs suggest a difference in the underlying pathogenesis of OA in the knee and the hip and highlights DAMPs as potential therapeutic targets for OA in the future.

Geographic region, socioeconomic position and the utilisation of primary total joint replacement for hip or knee osteoarthritis across western Victoria: a cross-sectional multilevel study of the Australian Orthopaedic Association National Joint Replacement Registry.

Science.gov (United States)

Brennan-Olsen, Sharon; Vogrin, Sara; Holloway, Kara L; Page, Richard S; Sajjad, Muhammad A; Kotowicz, Mark A; Livingston, Patricia M; Khasraw, Mustafa; Hakkennes, Sharon; Dunning, Trish L; Brumby, Susan; Pedler, Daryl; Sutherland, Alasdair; Venkatesh, Svetha; Williams, Lana J; Duque, Gustavo; Pasco, Julie A

2017-11-06

Compared to urban residents, those in rural/regional areas often experience inequitable healthcare from specialist service providers. Independent of small between-area differences in utilisation, socially advantaged groups had the greatest uptake of joint replacement. These data suggest low correlation between 'need' vs. 'uptake' of surgery in rural/regional areas. Compared to urban residents, those in rural and regional areas often experience inequitable healthcare from specialist service providers, often due to geographical issues. We investigated associations between socioeconomic position (SEP), region of residence and utilisation of primary total knee replacement (TKR) and/or total hip replacement (THR) for osteoarthritis. As part of the Ageing, Chronic Disease and Injury study, we extracted data from the Australian Orthopaedic Association National Joint Replacement Registry (2011-2013) for adults that utilised primary TKR (n = 4179; 56% female) and/or THR (n = 3120; 54% female). Residential addresses were matched with the Australian Bureau of Statistics (ABS) 2011 census data: region of residence was defined according to local government areas (LGAs), and area-level SEP (quintiles) defined using an ABS-derived composite index. The ABS-determined control population (n = 591,265; 51% female) excluded individuals identified as cases. We performed multilevel logistic regression modelling using a stratified two-stage cluster design. TKR was higher for those aged 70-79 years (AOR 1.4 95%CI 1.3-1.5; referent = 60-69 years) and in the most advantaged SEP quintile (AOR 2.1, 95%CI 1.8-2.3; referent = SEP quintile 3); results were similar for THR (70-79 years = AOR 1.7, 95%CI 1.5-1.8; SEP quintile 5 = AOR 2.5, 95%CI 2.2-2.8). Total variances contributed by the variance in LGAs were 2% (SD random effects ± 0.28) and 3% (SD ± 0.32), respectively. Independent of small between-LGA differences in utilisation, and in contrast to the expected greater

TOTAL HIP ARTHROPLASTY IN CHILDREN WHO HAVE UNDERGONE ARTHROPLASTY WITH DEMINERALIZED BONE-CARTILAGE ALLOCUPS

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Vladimir E. Baskov

2017-03-01

Full Text Available Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA. Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA. Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100% aged between 15 and 16 years [8 girls (61.5% and 5 boys (38.5%]. The medical histories of all 13 children (100% showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100% underwent a total hip replacement. Upon hip replacement, all 13 patients (100% showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%. Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100% showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100% during the period from 6 to 9 months following total

Total hip arthroplasty in children who have undergone arthroplasty with demineralized bone-cartilage allocups

Directory of Open Access Journals (Sweden)

Vladimir E. Baskov

2017-03-01

Full Text Available Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA. Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA. Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100% aged between 15 and 16 years [8 girls (61.5% and 5 boys (38.5%]. The medical histories of all 13 children (100% showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100% underwent a total hip replacement. Upon hip replacement, all 13 patients (100% showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%. Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100% showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100% during the period from 6 to 9 months following total

Stress And Strain Analysis of The Hip Joint Using FEM

Czech Academy of Sciences Publication Activity Database

Vaverka, M.; Návrat, Tomáš; Vrbka, M.; Florian, Z.; Fuis, Vladimír

2006-01-01

Roč. 14, 4-5 (2006), s. 271-279 ISSN 0928-7329 R&D Projects: GA ČR GA101/05/0136 Institutional research plan: CEZ:AV0Z20760514 Keywords : hip FEM surgace replacement pathological contact pressure stress * hip FEM surgace replacement pathological contact pressure stress Subject RIV: BO - Biophysics

Hip and pelvis diseases on lumbar AP radiographs including both hip joints

Energy Technology Data Exchange (ETDEWEB)

Lim, Hyun Soo; Juhng, Seon Kwan; Kim, Eun A; Kim, Jeong Ho; Song, Ha Heon; Shim, Dae Moo [Wonkwang University School of Medicine, Iksan (Korea, Republic of)

2002-12-01

To determine the frequency of disease, and to evaluate the methods used for lumbar spine radiography in Korea. Sixty university and training hospitals were randomly selected and asked to describe the projections, film size and radiographic techniques employed for routine radiography in patients with suspected disease of the lumbar spine. Plain radiographs of 1215 patients, taken using 14x17 inch film and depicting both hip joints and the lumbar region, were analysed between March 1999 and February 2000. In 15 patients (1.2%), the radiographs revealed hip or pelvic lesion, confirmed as follows: avascular necrosis of the femoral head (n=11, with bilateral lesion in four cases); sustained ankylosing spondylitis (n=2); acetabular dysplasia (n=1); and insufficiency fracture of the pubic rami secondary to osteoporosis (n=1). In 11 or the 20 hospitals which responded, 14{sup x}17{sup f}ilm was being used for lumbar radiography, while in the other nine, film size was smaller. Plain radiography of the lumbar spine including both hip joints, may be a useful way to simultaneously evaluate lesions not only of the lumbar spine but also of the hip and/or pelvis.

Skilled nursing facilities after joint replacement

Science.gov (United States)

... care providers in the weeks before your joint replacement. They can advise you about whether going directly ... of many people who have had a joint replacement? Can they tell you how many? A good ...

A model-based approach to stabilizing crutch supported paraplegic standing by artificial hip joint stiffness.

Science.gov (United States)

van der Spek, Jaap H; Veltink, Peter H; Hermens, Hermie J; Koopman, Bart F J M; Boom, Herman B K

2003-12-01

The prerequisites for stable crutch supported standing were analyzed in this paper. For this purpose, a biomechanical model of crutch supported paraplegic stance was developed assuming the patient was standing with extended knees. When using crutches during stance, the crutches will put a position constraint on the shoulder, thus reducing the number of degrees of freedom. Additional hip-joint stiffness was applied to stabilize the hip joint and, therefore, to stabilize stance. The required hip-joint stiffness for changing crutch placement and hip-joint offset angle was studied under static and dynamic conditions. Modeling results indicate that, by using additional hip-joint stiffness, stable crutch supported paraplegic standing can be achieved, both under static as well as dynamic situations. The static equilibrium postures and the stability under perturbations were calculated to be dependent on crutch placement and stiffness applied. However, postures in which the hip joint was in extension (C postures) appeared to the most stable postures. Applying at least 60 N x m/rad hip-joint stiffness gave stable equilibrium postures in all cases. Choosing appropriate hip-joint offset angles, the static equilibrium postures changed to more erect postures, without causing instability or excessive arm forces to occur.

Dislocation of total hip replacement in patients with fractures of the femoral neck.

Science.gov (United States)

Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

2009-04-01

Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. We included 713 consecutive hips in a series of 698 patients (573 females) who had undergone a primary total hip replacement (n = 311) for a non-pathological, displaced femoral neck fracture (Garden III or IV) or a secondary total hip replacement (n = 402) due to a fracture-healing complication after a femoral neck fracture. We used Cox regression to evaluate factors associated with prosthetic dislocation after the operation. Age, sex, indication for surgery, the surgeon's experience, femoral head size, and surgical approach were tested as independent factors in the model. The overall dislocation rate was 6%. The anterolateral surgical approach was associated with a lower risk of dislocation than the posterolateral approach with or without posterior repair (2%, 12%, and 14%, respectively (p replacement in patients with femoral neck fractures.

Effects of hip joint position and intra-capsular volume on hip joint intra-capsular pressure: a human cadaveric model

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Tse Paul

2009-04-01

Full Text Available Abstract Background Increase in hip intra-capsular pressure has been implicated in various hip pathologies, such as avascular necrosis complicating undisplaced femoral neck fracture. Our study aimed at documenting the relationship between intra-capsular volume and pressure in various hip positions. Methods Fifty-two cadaveric hips were studied. An electronic pressure-monitoring catheter recorded the intra-capsular hip pressure after each instillation of 2 ml of normal saline and in six hip positions. Results In neutral hip position, the control position for investigation, intra-capsular pressure remained unchanged when its content was below 10 ml. Thereafter, it increased exponentially. When the intra-capsular volume was 12 ml, full abduction produced a 2.1-fold increase (p = 0.028 of the intra-capsular hip joint pressure; full external rotation and full internal rotation increased the pressure by at least 4-fold (p Conclusion Intra-capsular pressure increases with its volume, but with a wide variation with different positions. It would be appropriate to recommend that hips with haemarthrosis or effusion should be positioned in 45-degree flexion.

Use of Autoplasma in the Prevention of Venous Thromboses during Endoprosthetic Replacement of the Hip Joint

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S. A. Kravtsov

2009-01-01

Full Text Available Hip joint endoprosthetic replacement (HJER leads to hemodynamic disorders and massive intraoperative hemorrhage and presents a high risk (30—55% of cases for postoperative deep vein thrombosis in the lower extremity, at the same time the possibility (12—22% of massive pulmonary thromboembolism (PTE is ruled out. So the choice of infusion-transfusion therapy is of paramount importance in these patients. The authors studied the efficiency of normovolemic hemodilution with the autoplasma (patented in the Russian Federation in treating massive perioperative hemorrhage in patients undergoing HJER and in reducing postoperative thrombotic events. It was compared with infusion therapy comprising hydroxyethyl starch (130/0.4. All the patients had spinal anesthesia and standard postoperative analgesia in an intensive care unit. The administration of autologous fresh frozen plasma resulted in a 15% reduction in intraoperative blood loss, by increasing the coagulation potential and platelet aggregability. Postoperatively, there was an overall increase in the hypercoagulation potential, both the plasma link and platelet aggregability, in both groups. The use of autologous plasma by elevating the concentration of natural anticoagulants (AT III by 9% could prevent 35 and 75% rises in soluble fibrin monomer complexes and D-dimer. In two patients from the comparative group, the postoperative period was complicated by the development of occlusive thrombosis of the femoral vein. Key words: intraoperative hemodilution, auto-plasma, vein thromboses.

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

Science.gov (United States)

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.

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

NARCIS (Netherlands)

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

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

The prevalence of predisposing deformity in osteoarthritic hip joints

DEFF Research Database (Denmark)

Klit, Jakob; Gosvig, Kasper; Jacobsen, Steffen

2011-01-01

relationship in both sexes with the clinical presentation. The study cohort which fulfilled these inclusion criteria consisted of 322 females (149 right hips and 173 left hips) and 162 males (77 right hips and 85 left hips) with osteoarthritis. We found an overall prevalence of predisposing hip deformities...... in females of 62.4% and in males of 78.9%. Minor and major deformities showed the same prevalence. Both sexes had a comparable prevalence of minor and major hip joint deformity, except for pistol grip deformity, which was more prevalent in men. We concluded that 'idiopathic osteoarthritis' is uncommon......, and that even minor predisposing deformities are associated with hip osteoarthritis....

Revision Total Hip Arthoplasty: Factors Associated with Re-Revision Surgery

OpenAIRE

Khatod, M; Cafri, G; Inacio, MCS; Schepps, AL; Paxton, EW; Bini, SA

2015-01-01

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 revi...

The Effect of Hypotensive Anesthesia on Hepatic Function in Hip Replacement

OpenAIRE

Zagrekov V.I.; Zhirova T.A.; Ezhov I.Y.; Taranyuk А.V.

2011-01-01

The objective of the work is to assess the influence of spinal and epidural anesthesia with controlled hypotensive effect on hepatic function in patients in total hip replacement. Materials and Methods. There has been studied the dynamics of hepatic enzymes and bilirubin indexes in 80 patients in hip replacement. Depending on the anesthesia method, three groups were considered: with spinal and epidural anesthesia with controlled hypotensive effect and normotensive spinal anesthesia using ...

Cystic lesion around the hip joint

Science.gov (United States)

Yukata, Kiminori; Nakai, Sho; Goto, Tomohiro; Ikeda, Yuichi; Shimaoka, Yasunori; Yamanaka, Issei; Sairyo, Koichi; Hamawaki, Jun-ichi

2015-01-01

This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments. PMID:26495246

Dislocation of total hip replacement in patients with fractures of the femoral neck

OpenAIRE

Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

2009-01-01

Background Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. Patients and methods We included 713 consecutive hips in a series of 698 p...

Evaluation of a new methodology to simulate damage and wear of polyethylene hip replacements subjected to edge loading in hip simulator testing.

Science.gov (United States)

Partridge, Susan; Tipper, Joanne L; Al-Hajjar, Mazen; Isaac, Graham H; Fisher, John; Williams, Sophie

2018-05-01

Wear and fatigue of polyethylene acetabular cups have been reported to play a role in the failure of total hip replacements. Hip simulator testing under a wide range of clinically relevant loading conditions is important. Edge loading of hip replacements can occur following impingement under extreme activities and can also occur during normal gait, where there is an offset deficiency and/or joint laxity. This study evaluated a hip simulator method that assessed wear and damage in polyethylene acetabular liners that were subjected to edge loading. The liners tested to evaluate the method were a currently manufactured crosslinked polyethylene acetabular liner and an aged conventional polyethylene acetabular liner. The acetabular liners were tested for 5 million standard walking cycles and following this 5 million walking cycles with edge loading. Edge loading conditions represented a separation of the centers of rotation of the femoral head and the acetabular liner during the swing phase, leading to loading of the liner rim on heel strike. Rim damage and cracking was observed in the aged conventional polyethylene liner. Steady-state wear rates assessed gravimetrically were lower under edge loading compared to standard loading. This study supports previous clinical findings that edge loading may cause rim cracking in liners, where component positioning is suboptimal or where material degradation is present. The simulation method developed has the potential to be used in the future to test the effect of aging and different levels of severity of edge loading on a range of cross-linked polyethylene materials. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1456-1462, 2018. © 2017 Wiley Periodicals, Inc.

The Infection Rate of Metal-on-Metal Total Hip Replacement Is Higher When Compared to Other Bearing Surfaces as Documented by the Australian Orthopaedic Association National Joint Replacement Registry.

Science.gov (United States)

Huang, Phil; Lyons, Matt; O'Sullivan, Michael

2018-02-01

Despite the well-documented decline in the use of metal-on-metal (MoM) implants over the last decade, there are still controversies regarding whether all MoM implants are created equally. Complications such as elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) and pseudotumours have all been well documented, but recent studies suggest increased risk of infection with MoM bearing surfaces. Most of these studies however have small patient numbers. The purpose of this study was to examine the cumulative incidence of revision for infection of MoM bearing surfaces in primary hip arthroplasty at a national and single-surgeon level. Data was collected from the Australian Orthopaedic Association National Joint Replacement Registry, which contains over 98% of all arthroplasties performed in Australia since 2001. The cumulative incidence of revision for infection was extracted at a national level and single-surgeon level. Two hundred seventy-six thousand eight hundred seventy-eight subjects were documented in the Australian registry. The 10-year cumulative percent revision for infection of MoM bearing surfaces in primary total hip replacement (THR) was 2.5% at a national level, compared to 0.8% for other bearing surfaces. The senior author contributed 1755 subjects with 7-year follow-up and a cumulative percent revision for infection of MoM bearing surfaces in primary THR of 36.9%, compared to 2.0% for other bearing surfaces. The cumulative percent of revision of MoM bearing surfaces is higher compared to other bearing surfaces; this is especially pronounced in cumulative percent of revision for infection. There was a higher cumulative percent of revision for infection in MoM bearings surfaces (in particular, large-head MoM) compared to other bearing surfaces at both the national and individual-surgeon level.

Knee joint replacement

Science.gov (United States)

... to make everyday tasks easier. Practice using a cane, walker , crutches , or a wheelchair correctly. On the ... ask your doctor Knee joint replacement - discharge Preventing falls Preventing falls - what to ask your doctor Surgical ...

Inter-joint coordination between hips and trunk during downswings: Effects on the clubhead speed.

Science.gov (United States)

Choi, Ahnryul; Lee, In-Kwang; Choi, Mun-Taek; Mun, Joung Hwan

2016-10-01

Understanding of the inter-joint coordination between rotational movement of each hip and trunk in golf would provide basic knowledge regarding how the neuromuscular system organises the related joints to perform a successful swing motion. In this study, we evaluated the inter-joint coordination characteristics between rotational movement of the hips and trunk during golf downswings. Twenty-one right-handed male professional golfers were recruited for this study. Infrared cameras were installed to capture the swing motion. The axial rotation angle, angular velocity and inter-joint coordination were calculated by the Euler angle, numerical difference method and continuous relative phase, respectively. A more typical inter-joint coordination demonstrated in the leading hip/trunk than trailing hip/trunk. Three coordination characteristics of the leading hip/trunk reported a significant relationship with clubhead speed at impact (r joint coordination strategies have the great potential to use a biomechanical guideline to improve the golf swing performance of unskilled golfers.

Continuous quality improvement program for hip and knee replacement.

Science.gov (United States)

Marshall, Deborah A; Christiansen, Tanya; Smith, Christopher; Squire Howden, Jane; Werle, Jason; Faris, Peter; Frank, Cy

2015-01-01

Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program. A validated, evidence-based clinical pathway that measures quality across the continuum of care was adopted. Working collaboratively, multidisciplinary experts embedded the CQI program into everyday practices in clinics across Alberta. Currently, 83% of surgeons participate in the CQI program, representing 95% of the total volume of hip and knee surgeries. Biannual reports provide feedback to improve care processes, infrastructure planning, and patient outcomes. CQI programs evaluating health care services inform choices to optimize care and improve efficiencies through continuous knowledge translation. © The Author(s) 2014.

21 CFR 888.3410 - Hip joint metal/polymer or ceramic/polymer semiconstrained resurfacing cemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer or ceramic/polymer... Devices § 888.3410 Hip joint metal/polymer or ceramic/polymer semiconstrained resurfacing cemented prosthesis. (a) Identification. A hip joint metal/polymer or ceramic/polymer semi-constrained resurfacing...

Identification of the Cause of the Stem Neck Fracture in the Hip Joint Endoprosthesis

Science.gov (United States)

Ryniewicz, A. M.; Bojko, Ł.; Ryniewicz, A.; Pałka, P.; Ryniewicz, W.

2018-02-01

Endoprosthesis stem fractures are among the rarest complications that occur after hip joint arthroplasty. The aim of this paper is to evaluate the causes of the fractures of the Aura II stem neck, which is an element of an endoprosthesis implanted in a patient. In order to achieve it, a radiogram was evaluated, the FEM analysis was carried out for the hip joint replaced using the Aura II prosthesis and scanning tests as well as a chemical analysis were performed for the focus of fatigue. The tests performed indicate that the most probable causes leading to the fatigue fracture of the Aura II stem under examination were material defects in the process of casting and forging (forging the material with delamination and the presence of brittle oxides and carbides) that resulted in a significant reduction of strength and resistance to corrosion. In the light of an unprecedented stem neck fracture, this information should be an indication for non-destructive tests of ready-made stems aiming to discover the material and technological defects that may arise in the process of casting and drop forging.

Analgesia after total hip replacement: epidural versus psoas ...

African Journals Online (AJOL)

tive analgesia following total hip replacement surgery. The research design was a ... matoma, intra-abdominal injury and pain due to spasm of the lumbar paravertebral ..... 2. Brown DL. Spinal, epidural, and caudal anesthesia In: Miller RD, ed.

Development of HIP bonding procedure and mechanical properties of HIP bonded joints for reduced activation ferritic steel F-82H

International Nuclear Information System (INIS)

Oda, Masahiro; Kurasawa, Toshimasa; Kuroda, Toshimasa; Hatano, Toshihisa; Takatsu, Hideyuki

1997-03-01

Structural materials of blanket components in fusion DEMO reactors will receive a neutron wall load more than 3-5MW/m 2 as well as exposed by surface heat flux more than 0.5MW/m 2 . A reduced activation ferritic steel F-82H has been developed by JAERI in collaboration with NKK from viewpoints of resistance for high temperature and neutron loads and lower radioactivity. This study intends to obtain basic performance of F-82H to establish the fabrication procedure of the first wall and blanket box by using Hot Isostatic Pressing (HIP) bonding. Before HIP bonding tests, effects of heat treatment temperature and surface roughness on mechanical properties of joints were investigated in the heat treatment tests and diffusion bonding tests, respectively. From these results, the optimum HIP bonding conditions and the post heat treatment were selected. Using these conditions, the HIP bonding tests were carried out to evaluate HIP bondability and to obtain mechanical properties of the joints. Sufficient HIP bonding performance was obtained under the temperature of 1040degC, the compressive stress of 150MPa, the holding time of 2h, and the surface roughness ∼μ m. Mechanical properties of HIP bonded joints with these conditions were similar to those of as-received base metal. An oxide formation on the surface to be bonded would need to be avoided for sufficient bonding. The bonding ratio, Charpy impact value and fatigue performance of the joints strongly depended on the HIP conditions, especially temperature, while micro-structure, Vickers hardness and tensile properties had little dependence on the HIP temperature. The surface roughness strongly affected the bonding ratio and would be required to be in the level of a few μ m. In the HIP bonding test of the welded material, the once-melted surface could be jointed by the HIP bonding under the above-mentioned procedure. (J.P.N.)

Current knowledge and importance of dGEMRIC techniques in diagnosis of hip joint diseases

Energy Technology Data Exchange (ETDEWEB)

Zilkens, Christoph; Krauspe, Ruediger; Bittersohl, Bernd [University of Duesseldorf, Medical Faculty, Department of Orthopedic Surgery, Duesseldorf (Germany); Tiderius, Carl Johann [Lund University Hospital, Department of Orthopedic Surgery, Lund (Sweden)

2015-08-15

Accurate assessment of early hip joint cartilage alterations may help optimize patient selection and follow-up of hip joint preservation surgery. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is sensitive to the glycosaminoglycan content in cartilage that is lost early in the development of osteoarthritis (OA). Hence, the dGEMRIC technique holds promise for the development of new diagnostic and therapeutic procedures. However, because of the location of the hip joint deep within the body and due to the fairly thin cartilage layers that require high spatial resolution, the diagnosis of early hip joint cartilage alterations may be problematic. The purpose of this review is to outline the current status of dGEMRIC in the assessment of hip joint cartilage. A literature search was performed with PubMed, using the terms ''cartilage, osteoarthritis, hip joint, MRI, and dGEMRIC'', considering all levels of studies. This review revealed that dGEMRIC can be reliably used in the evaluation of early stage cartilage pathology in various hip joint disorders. Modifications in the technique, such as the operation of three-dimensional imaging and dGEMRIC after intra-articular contrast medium administration, have expanded the range of application. Notably, the studies differ considerably in patient selection and technical prerequisites. Furthermore, there is a need for multicenter prospective studies with the required technical conditions in place to establish outcome based dGEMRIC data to obtain, in conjunction with clinical data, reliable threshold values for normal and abnormal cartilage, and for hips that may benefit from conservative or surgical treatment. (orig.)

Current knowledge and importance of dGEMRIC techniques in diagnosis of hip joint diseases

International Nuclear Information System (INIS)

Zilkens, Christoph; Krauspe, Ruediger; Bittersohl, Bernd; Tiderius, Carl Johann

2015-01-01

Accurate assessment of early hip joint cartilage alterations may help optimize patient selection and follow-up of hip joint preservation surgery. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is sensitive to the glycosaminoglycan content in cartilage that is lost early in the development of osteoarthritis (OA). Hence, the dGEMRIC technique holds promise for the development of new diagnostic and therapeutic procedures. However, because of the location of the hip joint deep within the body and due to the fairly thin cartilage layers that require high spatial resolution, the diagnosis of early hip joint cartilage alterations may be problematic. The purpose of this review is to outline the current status of dGEMRIC in the assessment of hip joint cartilage. A literature search was performed with PubMed, using the terms ''cartilage, osteoarthritis, hip joint, MRI, and dGEMRIC'', considering all levels of studies. This review revealed that dGEMRIC can be reliably used in the evaluation of early stage cartilage pathology in various hip joint disorders. Modifications in the technique, such as the operation of three-dimensional imaging and dGEMRIC after intra-articular contrast medium administration, have expanded the range of application. Notably, the studies differ considerably in patient selection and technical prerequisites. Furthermore, there is a need for multicenter prospective studies with the required technical conditions in place to establish outcome based dGEMRIC data to obtain, in conjunction with clinical data, reliable threshold values for normal and abnormal cartilage, and for hips that may benefit from conservative or surgical treatment. (orig.)

Sequential use of technetium 99m MDP and gallium 67 citrate imaging in the evaluation of painful total hip replacement

International Nuclear Information System (INIS)

Horoszowski, H.; Ganel, A.; Kamhin, M.; Zaltman, S.; Farine, I.

1980-01-01

Fourteen patients with 20 total hip joint replacements were studied for 14 painful prosthetic hips. Clinical examination, plain film radiographs and 99 Tcsup(m)-methylene diphosphonate bone scans failed to differentiate between infection and mechanical loosening of a prosthesis. Sequential use of 99 Tcsup(m)-methylene diphosphonate and 67 Ga-citrate bone scans were performed in an attempt to discover underlying infectious process. Increased focal uptake of both radiopharmaceuticals over the same hip indicated an infectious process responsible for prosthetic loosening. There were no false positive gallium examinations. Sequential use of 99 Tcsup(m)-phosphate compounds and 67 Ga-citrate is recommended for differentiation between mechanical loosening of a prosthesis and loosening of a prosthesis secondary to an infectious process. (U.K.)

21 CFR 888.3358 - Hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer/metal semi-constrained... Devices § 888.3358 Hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis. (a) Identification. A hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis is a device...

Apixaban versus enoxaparin for thromboprophylaxis after hip replacement

DEFF Research Database (Denmark)

Lassen, Michael Rud; Gallus, Alexander; Raskob, Gary E

2010-01-01

There are various regimens for thromboprophylaxis after hip replacement. Low-molecular-weight heparins such as enoxaparin predominantly inhibit factor Xa but also inhibit thrombin to some degree. Orally active, specific factor Xa inhibitors such as apixaban may provide effective thromboprophylaxis...

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

OpenAIRE

?yp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; W?ostowska, Ewa; Stanis?awska, Iwona; Szypu?a, Jan; Tomaszewski, Wies?aw

2016-01-01

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/Methods A total of 192 patients (the mean age 61.03?10.89) suffering from hip osteoarthritis (OA) were evaluated before an...

Bioceramics for Hip Joints: The Physical Chemistry Viewpoint

Directory of Open Access Journals (Sweden)

Giuseppe Pezzotti

2014-06-01

Full Text Available Which intrinsic biomaterial parameter governs and, if quantitatively monitored, could reveal to us the actual lifetime potential of advanced hip joint bearing materials? An answer to this crucial question is searched for in this paper, which identifies ceramic bearings as the most innovative biomaterials in hip arthroplasty. It is shown that, if in vivo exposures comparable to human lifetimes are actually searched for, then fundamental issues should lie in the physical chemistry aspects of biomaterial surfaces. Besides searching for improvements in the phenomenological response of biomaterials to engineering protocols, hip joint components should also be designed to satisfy precise stability requirements in the stoichiometric behavior of their surfaces when exposed to extreme chemical and micromechanical conditions. New spectroscopic protocols have enabled us to visualize surface stoichiometry at the molecular scale, which is shown to be the key for assessing bioceramics with elongated lifetimes with respect to the primitive alumina biomaterials used in the past.

EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT

Directory of Open Access Journals (Sweden)

V. M. Mashkov

2012-01-01

Full Text Available Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group, one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group. During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.

Renal function after elective total hip replacement

DEFF Research Database (Denmark)

Perregaard, Helene; Damholt, Mette B; Solgaard, Søren

2016-01-01

Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI and the prevale......Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI...... and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study...... involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013...

[Range of Hip Joint Motion and Weight of Lower Limb Function under 3D Dynamic Marker].

Science.gov (United States)

Xia, Q; Zhang, M; Gao, D; Xia, W T

2017-12-01

To explore the range of reasonable weight coefficient of hip joint in lower limb function. When the hip joints of healthy volunteers under normal conditions or fixed at three different positions including functional, flexed and extension positions, the movements of lower limbs were recorded by LUKOtronic motion capture and analysis system. The degree of lower limb function loss was calculated using Fugl-Meyer lower limb function assessment form when the hip joints were fixed at the aforementioned positions. One-way analysis of variance and Tamhane's T2 method were used to proceed statistics analysis and calculate the range of reasonable weight coefficient of hip joint. There were significant differences between the degree of lower limb function loss when the hip joints fixed at flexed and extension positions and at functional position. While the differences between the degree of lower limb function loss when the hip joints fixed at flexed position and extension position had no statistical significance. In 95% confidence interval, the reasonable weight coefficient of hip joint in lower limb function was between 61.05% and 73.34%. Expect confirming the reasonable weight coefficient, the effects of functional and non-functional positions on the degree of lower limb function loss should also be considered for the assessment of hip joint function loss. Copyright© by the Editorial Department of Journal of Forensic Medicine

Friction in total hip joint prosthesis measured in vivo during walking.

Science.gov (United States)

Damm, Philipp; Dymke, Joern; Ackermann, Robert; Bender, Alwina; Graichen, Friedmar; Halder, Andreas; Beier, Alexander; Bergmann, Georg

2013-01-01

Friction-induced moments and subsequent cup loosening can be the reason for total hip joint replacement failure. The aim of this study was to measure the in vivo contact forces and friction moments during walking. Instrumented hip implants with Al2O3 ceramic head and an XPE inlay were used. In vivo measurements were taken 3 months post operatively in 8 subjects. The coefficient of friction was calculated in 3D throughout the whole gait cycle, and average values of the friction-induced power dissipation in the joint were determined. On average, peak contact forces of 248% of the bodyweight and peak friction moments of 0.26% bodyweight times meter were determined. However, contact forces and friction moments varied greatly between individuals. The friction moment increased during the extension phase of the joint. The average coefficient of friction also increased during this period, from 0.04 (0.03 to 0.06) at contralateral toe off to 0.06 (0.04 to 0.08) at contralateral heel strike. During the flexion phase, the coefficient of friction increased further to 0.14 (0.09 to 0.23) at toe off. The average friction-induced power throughout the whole gait cycle was 2.3 W (1.4 W to 3.8 W). Although more parameters than only the synovia determine the friction, the wide ranges of friction coefficients and power dissipation indicate that the lubricating properties of synovia are individually very different. However, such differences may also exist in natural joints and may influence the progression of arthrosis. Furthermore, subjects with very high power dissipation may be at risk of thermally induced implant loosening. The large increase of the friction coefficient during each step could be caused by the synovia being squeezed out under load.

Friction in total hip joint prosthesis measured in vivo during walking.

Directory of Open Access Journals (Sweden)

Philipp Damm

Full Text Available Friction-induced moments and subsequent cup loosening can be the reason for total hip joint replacement failure. The aim of this study was to measure the in vivo contact forces and friction moments during walking. Instrumented hip implants with Al2O3 ceramic head and an XPE inlay were used. In vivo measurements were taken 3 months post operatively in 8 subjects. The coefficient of friction was calculated in 3D throughout the whole gait cycle, and average values of the friction-induced power dissipation in the joint were determined. On average, peak contact forces of 248% of the bodyweight and peak friction moments of 0.26% bodyweight times meter were determined. However, contact forces and friction moments varied greatly between individuals. The friction moment increased during the extension phase of the joint. The average coefficient of friction also increased during this period, from 0.04 (0.03 to 0.06 at contralateral toe off to 0.06 (0.04 to 0.08 at contralateral heel strike. During the flexion phase, the coefficient of friction increased further to 0.14 (0.09 to 0.23 at toe off. The average friction-induced power throughout the whole gait cycle was 2.3 W (1.4 W to 3.8 W. Although more parameters than only the synovia determine the friction, the wide ranges of friction coefficients and power dissipation indicate that the lubricating properties of synovia are individually very different. However, such differences may also exist in natural joints and may influence the progression of arthrosis. Furthermore, subjects with very high power dissipation may be at risk of thermally induced implant loosening. The large increase of the friction coefficient during each step could be caused by the synovia being squeezed out under load.

Prosthetic hip joint infection due to Campylobacter fetus.

OpenAIRE

Bates, C J; Clarke, T C; Spencer, R C

1994-01-01

A case of postoperative prosthetic hip joint infection due to Campylobacter fetus subsp. fetus is described. Difficulties in isolation and antimicrobial susceptibility testing of this organism are discussed.

Use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement

International Nuclear Information System (INIS)

Sylvester, J.E.; Greenberg, P.; Selch, M.T.; Thomas, B.J.; Amstutz, H.

1988-01-01

Formation of heterotopic bone (HTB) following total hip replacement may partially or completely ankylose the joint space, causing pain and/or limiting the range of motion. Patients at high risk for formation of HTB postoperatively include those with previous HTB formation, heterotopic osteoarthritis, and active rheumatoid spondylitis. Patients in these high risk groups have a 63-69% incidence of post-operative HTB formation, usually seen radiographically by 2 months post-operation. From 1980-1986 twenty-nine hips in 28 consecutively treated patients were irradiated post-operatively at the UCLA Center for the Health Sciences. The indication for irradiation was documented HTB formation previously in 26 of the 27 hips presented below. From 1980-1982 patients received 20 Gray (Gy) in 2 Gy fractions; from 1982-1986 the dose was reduced to 10 Gy in 2 Gy fractions. Twenty-seven hips in 26 patients completed therapy and were available for evaluation, with a minimum of 2 month follow-up, and a median follow-up of 12 months. Three of 27 hips developed significant HTB (Brooker grade III or IV) post-operatively, whereas 5 of 27 hips developed minor, nonsymptomatic HTB (Brooker grade I). When irradiation was begun by postoperative day 4, 0 of 17 hips formed significant HTB. If irradiation began after post-operative day 4, 3 of 10 hips formed significant HTB (Brooker grade III or IV). These 3 hips received doses of 10 Gy in one hip and 20 Gy in the other 2 hips. There were no differences in the incidence or severity of side effects in the 10 Gy vs. the 20 Gy treatment groups. Eighteen hips received 10 Gy, 8 hips 20 Gy and, 1 hip 12 Gy. In conclusion, 10 Gy in 5 fractions appears as effective as 20 Gy in 10 fractions at preventing post-operative formation of HTB. For optimal results, treatment should begin as early as possible prior to post-operative day 4

21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular...

21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented acetabular...

Managing infection in the revision total hip replacement patient.

Science.gov (United States)

Halley, D K

1993-01-01

Deep infection is one of the most devastating complications in total hip replacement. This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment. Basic fundamentals of antibiotic therapy are reviewed. In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient.

Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in Total Hip Replacement

Directory of Open Access Journals (Sweden)

Vasileios Sakellariou

2014-09-01

Full Text Available Developmental dysplasia of the hip (DDH or congenital hip dysplasia (CDH is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is hallenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

Distribution of polyethylene wear particles and bone fragments in periprosthetic tissue around total hip joint replacements

Czech Academy of Sciences Publication Activity Database

Zolotarevova, E.; Entlicher, G.; Pavlova, Ewa; Šlouf, Miroslav; Pokorný, D.; Veselý, F.; Gallo, J.; Sosna, A.

2010-01-01

Roč. 6, č. 9 (2010), s. 3595-3600 ISSN 1742-7061 R&D Projects: GA MŠk 2B06096 Institutional research plan: CEZ:AV0Z40500505 Keywords : joint replacement * polyethylene * wear particles distribution Subject RIV: CD - Macromolecular Chemistry Impact factor: 4.824, year: 2010

Patient-reported outcome of hip resurfacing arthroplasty and standard total hip replacement after short-term follow-up

DEFF Research Database (Denmark)

Nissen, Nina; Douw, Karla; Overgaard, Søren

2011-01-01

The purpose of this study was to investigate patientreported outcome in terms of satisfaction in two study groups that had undergone hip resurfacing arthro-plasty (HRA) or total hip replacement (THR). The procedure consists of placing a hollow, mushroom-shaped metal cap over the femoral head whil...... a matching metal cup is placed in the acetabulum (pelvis socket)....

OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis

DEFF Research Database (Denmark)

Dobson, F; Hinman, R S; Roos, Ewa M.

2013-01-01

To recommend a consensus-derived set of performance-based tests of physical function for use in people diagnosed with hip or knee osteoarthritis (OA) or following joint replacement.......To recommend a consensus-derived set of performance-based tests of physical function for use in people diagnosed with hip or knee osteoarthritis (OA) or following joint replacement....

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

Science.gov (United States)

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

DIFFICULTIeS OF TOTAL HIP REPLACEMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS (case report

Directory of Open Access Journals (Sweden)

R. M. Tikhilov

2016-01-01

Full Text Available A distinctive feature of patients with ankylosing spondylitis is the formation of hip ankylosis in an extremely unfavorable functional position combined with upset of sagittal balance of the body along with a thoracolumbar kyphosis. Treatment of these patients poses considerable technical difficulties and is often associated with complications. The authors report a clinical case of a female 40 years old patient with confirmed rhizomelic spondylitis. The patient mainly complained of fixed malposition of the right lower extremity (hip ankylosis in extreme 1450 flexion and 1500 abduction combined with a severe fixed spine deformity (thoracic kyphosis 920, lumbar lordosis 170. Considering significant sagittal balance disorder it was decided to go for a two-stage procedure. Total hip arthroplasty of the right joint was performed at the first stage. At the second stage the authors corrected thoracolumbar spinal deformity by Th12 (type PSO 4 and L2 (type PSO 3 wedge resections and converging resected vertebral bodies by a multilevel fixation system with transpedicular support elements. The interval between the stages was 11 months. Two-stage treatment of this patient al-lowed to avoid adverse postoperative complications and to achieve a significant functional improvement in one year after treatment started. The sum of points before and after the treat-ment amounted respectively to 46 and 79 on Harris Hip Score, 17 and 38 points on Oxford Hip Score (OHS. To summarize, comprehensive treatment with planning of all subsequent steps prior to hip replacement is the method of choice for avoidance of postoperative complications in patients with ankylosing spondylitis accompanied by a significant upset of sagittal balance.

Hip joint kinetics in the table tennis topspin forehand: relationship to racket velocity.

Science.gov (United States)

Iino, Yoichi

2018-04-01

The purpose of this study was to determine hip joint kinetics during a table tennis topspin forehand, and to investigate the relationship between the relevant kinematic and kinetic variables and the racket horizontal and vertical velocities at ball impact. Eighteen male advanced table tennis players hit cross-court topspin forehands against backspin balls. The hip joint torque and force components around the pelvis coordinate system were determined using inverse dynamics. Furthermore, the work done on the pelvis by these components was also determined. The peak pelvis axial rotation velocity and the work done by the playing side hip pelvis axial rotation torque were positively related to the racket horizontal velocity at impact. The sum of the work done on the pelvis by the backward tilt torques and the upward joint forces was positively related to the racket vertical velocity at impact. The results suggest that the playing side hip pelvis axial rotation torque exertion is important for acquiring a high racket horizontal velocity at impact. The pelvis backward tilt torques and upward joint forces at both hip joints collectively contribute to the generation of the racket vertical velocity, and the mechanism for acquiring the vertical velocity may vary among players.

Identification of the Cause of the Stem Neck Fracture in the Hip Joint Endoprosthesis

Directory of Open Access Journals (Sweden)

Ryniewicz A.M.

2018-02-01

Full Text Available Endoprosthesis stem fractures are among the rarest complications that occur after hip joint arthroplasty. The aim of this paper is to evaluate the causes of the fractures of the Aura II stem neck, which is an element of an endoprosthesis implanted in a patient. In order to achieve it, a radiogram was evaluated, the FEM analysis was carried out for the hip joint replaced using the Aura II prosthesis and scanning tests as well as a chemical analysis were performed for the focus of fatigue. The tests performed indicate that the most probable causes leading to the fatigue fracture of the Aura II stem under examination were material defects in the process of casting and forging (forging the material with delamination and the presence of brittle oxides and carbides that resulted in a significant reduction of strength and resistance to corrosion. In the light of an unprecedented stem neck fracture, this information should be an indication for non-destructive tests of ready-made stems aiming to discover the material and technological defects that may arise in the process of casting and drop forging.

A Report Of Two Cases Of Uncemented Total Hip Replacement In ...

African Journals Online (AJOL)

This is a report of two sickle cell patients (HbSS) with advanced osteoarthritis of the right hip. The patients were in Ficat and Arlet\\'s stage 3 and 4 respectively. Both were females aged 23 and 46 years and they had uncemented hydroxyapatite coated omnifit (Stryker Howmedica Osteonics) total hip prosthetic replacement.

Changes of the hip joints associated with chronic subluxation and dislocation: CT and plain radiography analysis

International Nuclear Information System (INIS)

Yang, Ik; Ryu, Kyung Nam; Lee, Sun Wha; Choi, Woo Suk; Lee, Eil Seong

1993-01-01

Secondary osteoarthritis of the hip joint is a common disease and is frequently followed by chronic subluxation and dislocation. Twenty four cases of the secondary osteoarthritis associated with chronic subluxation and dislocation of the hip joints were evaluated with plain radiography and computed tomography. We retrospectively analyzed 1) the osteoarthritis and calcification of the acetabular labrum, 2) the thickness of the quadrilateral plate of the ilium, and 3) anteroposterior diameter of the acetabulum. The changes of the hip joints in subluxation (n=14) revealed ossification of the acetabular labrum in 12 cases (86%), thickening of the quadrilateral plate of the ilium in 11 cases (78%) but anteroposterior diameter of the acetabulum was not changed. The changes of the hip joints in dislocation (n=10) revealed no evidence of the ossification of the acetabular labrum, thickening of the quadrilateral plate of the ilium in 10 cases (100%) and decreased anteroposterior diameter of the acetabulum. We conclude that CT findings of subluxation and dislocation of the hip joints can be helpful in the evaluation of the secondary osteoarthritis of the hip joints

Normal radiological unossified hip joint space and femoral head size development during growth in 675 children and adolescents.

Science.gov (United States)

Wegener, Veronika; Jorysz, Gabriele; Arnoldi, Andreas; Utzschneider, Sandra; Wegener, Bernd; Jansson, Volkmar; Heimkes, Bernhard

2017-03-01

Evaluation of hip joint space width during child growth is important to aid in the early diagnosis of hip pathology in children. We established reference values for hip joint space and femoral head size for each age. Hip joint space development during growth was retrospectively investigated medial and cranial in 1350 hip joints of children using standard anteroposterior supine plain pelvic radiographs. Maximum capital femoral epiphysis diameter and femoral radii were further more investigated. Hip joint space values show a slow decline during growth. Joint space was statistically significantly (p < 0.006) larger in boys than girls. Our hip joint space measurements on supine subjects seem slightly larger than those reported by Hughes on standing subjects. Evaluation of the femoral head diameter and the radii showed a size curve quite parallel to the known body growth charts. Radii medial and perpendicular to the physis are not statistically significantly different. We recommend to compare measurements of hip joint space at two locations to age dependent charts using the same imaging technique. During growth, a divergence in femoral head size from the expected values or loss of the spherical shape should raise the question of hip disorder. Clin. Anat. 30:267-275, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Chronic arthritis of the hip joint: an unusual complication of an inadequately treated fistula-in-ano

Science.gov (United States)

Raghunath, Rajat; Varghese, Gigi; Simon, Betty

2014-01-01

We report a case of chronic arthritis of the right hip joint in an otherwise healthy young male athlete as a complication of inadequately treated anal fistula. A young male athlete presented with symptoms of right hip pain and difficulty in walking and intermittent fever for 2 months. He had a history of perianal abscess drainage. On examination he was found to have a tender right hip joint with severe restriction of movements. He was also found to have a partially drained right ischiorectal abscess. X-ray and MRI of the hip joint revealed chronic arthritis of the right hip joint, which was communicating with a complex fistula-in-ano. He underwent a diversion sigmoid colostomy and right ischiorectal abscess drainage along with appropriate antibiotics with a plan for definitive hip joint procedure later. He was lost to follow-up and succumbed to severe perianal sepsis within a few months. PMID:25414226

Effect of Ti interlayer on the bonding quality of W and steel HIP joint

Energy Technology Data Exchange (ETDEWEB)

Wang, Ji-Chao [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Science Island Branch of Graduate School, University of Science & Technology of China, Hefei, 230031 (China); Wang, Wanjing, E-mail: wjwang@ipp.ac.cn [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Wei, Ran; Wang, Xingli; Sun, Zhaoxuan [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Science Island Branch of Graduate School, University of Science & Technology of China, Hefei, 230031 (China); Xie, Chunyi; Li, Qiang [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Luo, Guang-Nan [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Science Island Branch of Graduate School, University of Science & Technology of China, Hefei, 230031 (China); Hefei Center for Physical Science and Technology, Hefei, 230022 (China); Hefei Science Center of Chinese Academy of Sciences, Hefei, 230027 (China)

2017-03-15

Tungsten (W) and steel bonding is one of the key technologies for blanket First Wall (FW) manufacture in thermal fusion reactor. The W/Steel joints are prone to fail without interlayer for the different thermo physical properties. To study the effect of titanium (Ti) interlayer on the bonding quality of W and steel joints, W/Steel Hot Isostatic Pressing (HIP) experiments with Ti interlayer were conducted under 930 °C, 100 MPa for 2 h. Intermetallics caused by atom interdiffusion would affect the bonding quality of W/Ti/Steel HIP joints, the bonding quality was evaluated by microstructure analysis and mechanical tests. All the HIP joints were well bonded and results showed no intermetallics occurred between W/Ti interfaces, meanwhile multiply phases were found between Ti/Steel interfaces. Shear tests indicated when Ti thickness was 100–500 μm, the maximum shear strength of W/Ti/Steel HIP joints would be up to around 151 MPa. Charpy impact tests showed the W/Ti/Steel HIP joints all broke in a brittle manner and the maximum Charpy impact energy was ∼0.192 J. Nano-indentation tests demonstrated W/Ti interfaces could be enhanced by solid solution hardening and formation of brittle phases has conducted high hardness across the Ti/Steel interfaces.

Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture

International Nuclear Information System (INIS)

Geijer, Mats; Dunker, Dennis; Collin, David; Goethlin, Jan H.

2012-01-01

Background. A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. Purpose. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. Material and Methods. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. Results. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Conclusion. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign

Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture

Energy Technology Data Exchange (ETDEWEB)

Geijer, Mats (Center for Medical Imaging and Physiology, Skaane University Hospital, Lund University, Lund (Sweden)), Email: mats@geijer.info; Dunker, Dennis; Collin, David; Goethlin, Jan H. (Department of Radiology, Sahlgrenska University Hospital, Moelndal (Sweden))

2012-03-15

Background. A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. Purpose. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. Material and Methods. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. Results. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Conclusion. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign

US Assessment of Hip Joint Synovitis in Rheumatic Diseases A comparison with MR imaging

International Nuclear Information System (INIS)

Soini, I.; Kotaniemi, A.; Kautiainen, H.; Kauppi, M.

2003-01-01

Purpose: To assess the significance of ultrasonography (US) in detecting hip joint synovitis in patients with rheumatic diseases. Material and Methods: Forty patients with rheumatic disease and suspected hip joint synovitis underwent MRI and US of the hip joint. In addition to the throughout MRI evaluation, the anterior collum-capsule distance (CCD) was determined by both MRI and US. Thirteen healthy volunteers were examined with MRI to establish the criteria for normal findings in MRI when classifying hip joints to those with synovitis and those without. MRI was used as a gold standard. Results: Synovitis was found using MRI in 31 hips of 22 patients (9 patients had bilateral synovitis). The intraclass correlation was 0.61 between MRI and US in measuring CCD. In classifying hip joint synovitis with US, the sensitivity of the method was 87% and specificity 42%, when the CCD criterion for synovitis was determined to be 7 mm. If the cut-off point was raised to 9 mm, the sensitivity decreased to 61% while specificity increased to 94%. A difference in CCD of 1 mm between the hips as an additional criterion for synovitis increased the number of false-positive findings. Conclusion: Measurement of CCD with US proved to be a rather inaccurate method to point out synovitis in rheumatic patients when using MRI as a reference. The main reason for this result was the thickened capsule, which US could not differentiate from a thickened synovium

Imaging of hip joint arthroplasty; Bildgebung bei Hueftgelenkendoprothesen

Energy Technology Data Exchange (ETDEWEB)

Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C. [Univ.-Klinik fuer Radiodiagnostik, Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie, Wien (Austria)

2009-05-15

The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [German] Dem Hueftgelenk als groesstem Gelenk des menschlichen Koerpers kommt eine besondere Bedeutung in der muskuloskelettalen Radiologie zu. Entsprechend wichtig ist auch die radiologische Beurteilung von Hueftgelenkendoprothesen, die z. B. infolge degenerativer Gelenkerkrankungen, einer Hueftkopfnekrose oder einer Fraktur eingesetzt werden. Die Projektionsradiographie ist weiterhin die primaere Modalitaet zur Beurteilung von Hueftgelenkendoprothesen, direkt postoperativ und zur laengerfristigen Verlaufskontrolle. Diese Methode erlaubt in der Mehrzahl der Faelle eine suffiziente Antwort auf die Frage nach Lockerung, periprothetischer Fraktur oder Prothesenmaterialbruch, Luxation, Infektion und Weichteilkalzifikation

A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint.

Science.gov (United States)

Achten, Juul; Parsons, Nick R; Edlin, Richard P; Griffin, Damian R; Costa, Matthew L

2010-01-14

Hip replacement (arthroplasty) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint. For older patients, several designs of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money. However, in younger more active patients, there is approximately a 50% failure rate at 25 years for traditional implants. Hip resurfacing is a relatively new arthroplasty technique. In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified, including the risk of femoral neck fracture and collapse of the head of the femur. The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty. Secondary aims include assessment of complication rates for both procedures as well cost effectiveness. All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study. A randomisation sequence will be produced and administered independently. After consenting, all patients will be clinically reviewed and hip function, quality of life and physical activity level will be assessed through questionnaires. The allocated surgery will then be performed with the preferred technique of the surgeon. Six weeks post-operation hip function will be assessed and complications recorded. Three, six and 12 months post-operation hip function, quality of life and physical activity level will be assessed. Additional information about patients' out-of-pocket expenses will also be collected. Current Controlled Trials ISRCTN33354155. UKCLRN portfolio ID 4093.

Principles of human joint replacement design and clinical application

CERN Document Server

Buechel, Frederick F

2015-01-01

This book is written for the users and designers of joint replacements. In its second extended edition it conveys to the reader the knowledge accumulated by the authors during their forty year effort on the development of replacement devices for the lower limb for the purpose of aiding the reader in their design and evaluation of joint replacement devices. The early chapters describe the engineering, scientific and medical principles needed for replacement joint evaluation. One must understand the nature and performance of the materials involved and their characteristics in vivo, i.e. the response of the body to implant materials. It is also essential to understand the response of the implants to applied loading and motion, particularly in the hostile physiological environment. A chapter describes the design methodology now required for joint replacement in the USA and EU countries. The remaining chapters provide a history of joint replacement, an evaluation of earlier and current devices and sample case hist...

Influence of Minimally Invasive Total Hip Replacement on Hip Reaction Forces and Their Orientations

NARCIS (Netherlands)

Weber, Tim; Al-Munajjed, Amir A.; Verkerke, Gijsbertus Jacob; Dendorfer, Sebastian; Renkawitz, Tobias

2014-01-01

Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a

Risk factors for urinary retention after hip or knee replacement: a cohort study

OpenAIRE

Griesdale, Donald E. G.; Neufeld, Jeremy; Dhillon, Dale; Joo, Jennifer; Sandhu, Supna; Swinton, Frank; Choi, Peter T.

2011-01-01

Introduction In 2006, our provincial government initiated a program to reduce wait times for total hip or knee replacements by referring patients to a single tertiary-care centre. This program provided an opportunity to identify risk factors for perioperative complications as part of a continuing quality improvement project. We report the risk of postoperative urinary retention after hip and knee replacements and the risk factors associated with this complication. Methods After local Research...

Joint Moment-Angle Properties of the Hip Extensors in Subjects With and Without Patellofemoral Pain.

Science.gov (United States)

Kindel, Curtis; Challis, John

2018-04-01

Strength deficits of hip extension in individuals with patellofemoral syndrome are commonly reported in literature. No literature to date has examined these deficits with variable positions of the knee and hip; altering knee angle alters the length and therefore potentially the force produced by the biarticular muscles. Beyond strength, neuromuscular control can also be assessed through the analysis of isometric joint moment steadiness. Subjects consisted of a group of individuals with patellofemoral syndrome (n = 9), and a group of age- and size-matched controls with no symptoms (n = 9). Maximum isometric joint moments for hip extension were measured at 4 points within the joint's range of motion, at 2 different knee positions (0° and 90°) for each group. The joint moment signals were analyzed by computing signal Coefficient of Variation (CV). The results indicate that no significant differences were found between the groups of subjects for the hip extension moments when the knee was extended. However, there was a significant difference between the groups for the joint moments of hip extension with the knee flexed at all 4 hip positions. Results also showed hip extension CV values to be significantly higher in the patellofemoral group compared with the control group, indicating greater signal noise and therefore poorer neuromuscular control of the hip extensor musculature. This study demonstrated that individuals with patellofemoral syndrome have reduced hip extension strength and reduced neuromuscular control with the knee flexed compared with a control group. These results have implications for the etiology of patellofemoral syndrome and its rehabilitation.

Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement

Directory of Open Access Journals (Sweden)

Narlaka Jayasekera

2015-01-01

Full Text Available Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results.

Weight-bearing radiography in total hip replacement

International Nuclear Information System (INIS)

Turula, K.B.; Haajanen, J.; Friberg, O.; Lindholm, T.S.; Tallroth, K.

1985-01-01

Serial anteroposterior (AP) radiographs of the weight-bearing pelvis and hips were taken of 29 patients with total hip replacement (THR). For constant positioning the patient stands with straight knees on a board with a block between the heels. A U-shaped mercury level strapped to the patient provides a horizontal reference line on the radiograph. On the average, individual variation of pelvic tilt in serial films was 1 0 and pelvic rotation 3.5 0 confirming satisfactory reproducibility. The horizontal reference enables estimation of pre- and postoperative leg length inequality (LLI) and of the angle of the acetabular cup (AA). Reproducibility allows assessment of the exact position of the femoral component and quantitative evaluation of radiolucency and bone resorption around the prosthetic implant in the follow-up of THR. (orig.)

Bicentric bipolar hip prosthesis: A radiological study of movement at the interprosthetic joint

Directory of Open Access Journals (Sweden)

Anil Kumar Rai

2011-01-01

Full Text Available Background: The bipolar hip prostheses after some time functions as a unipolar device. There is a need to change the design of bipolar hip prostheses to make it function as a bipolar device over a prolonged period of time. A bicentric bipolar hip prosthesis was used as an implant for various conditions of the hip. We evaluated the movement of this newly developed prosthesis at the interprosthetic joint radiologically at periodic intervals. Materials and Methods: Fifty two cases were operarted with the Bicentric bipolar prosthesis for indications like fracture neck of femur and various other diseases of the hip and were followed up with serial radiographs at periodic intervals to evaluate, what fraction of the total abduction at the hip was occurring at the interprosthetic joint. Results: In cases of intracapsular fracture neck of femur, the percentage of total abduction occurring at the interprosthetic joint at 3 months follow-up was 33.74% (mean value of all the patients, which fell to 25.66% at 1.5 years. In indications for bipolar hemireplacement other than fracture neck of femur, the percentage of total abduction occurring at the interprosthetic joint at 3 months follow-up was 71.71% (mean value and at 1.5 years it was 67.52%. Conclusion: This study shows the relative preservation of inner bearing movement in the bipolar hip prosthesis with time probably due its refined design. Further refinements are needed to make the prosthesis work better in patients of intracapsular fracture neck femur.

One-year incidence of prosthetic joint infection in total hip arthroplasty

DEFF Research Database (Denmark)

Gundtoft, P H; Pedersen, A B; Schønheyder, H C

2017-01-01

OBJECTIVE: To examine the trend of Prosthetic Joint Infections (PJI) following primary total hip arthroplasty (THA) and the antimicrobial resistance of the bacteria causing these infections. MATERIALS AND METHODS: We identified a population-based cohort of patients in the Danish Hip Arthroplasty...

Cost-effectiveness of enhanced recovery in hip and knee replacement: a systematic review protocol.

Science.gov (United States)

Murphy, Jacqueline; Pritchard, Mark G; Cheng, Lok Yin; Janarthanan, Roshni; Leal, José

2018-03-14

Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways. A systematic review will be conducted using MEDLINE, EMBASE, Econlit and the National Health Service Economic Evaluations Database. Separate search strategies were developed for each database including terms relating to hip and knee replacement/arthroplasty, economic evaluations, decision modelling and quality of life measures.We will extract peer-reviewed studies published between 2000 and 2017 reporting economic evaluations of preoperative, perioperative or postoperative enhanced recovery interventions within hip or knee replacement. Economic evaluations alongside cohort studies or based on decision models will be included. Only studies with patients undergoing elective replacement surgery of the hip or knee will be included. Data will be extracted using a predefined pro forma following best practice guidelines for economic evaluation, decision modelling and model validation.Our primary outcome will be the cost-effectiveness of enhanced recovery (entire pathway and individual components) in terms of incremental cost per quality-adjusted life year. A narrative synthesis of all studies will be presented, focussing on cost-effectiveness results, study design, quality and validation status. This systematic review is exempted from ethics approval because the work is carried out on published documents. The results of the review will be

Evaluation of risk factors for degenerative joint disease associated with hip dysplasia in dogs

International Nuclear Information System (INIS)

Smith, G.K.; Popovitch, C.A.; Gregor, T.P.; Shofer, F.S.

1995-01-01

Passive coxofemoral joint laxity of dogs, as quantitated by a distraction-stress radiographic method, may have important prognostic value in determining susceptibility to hip dysplasia. Data from 151 dogs, representing 13 breeds, were included in a logistic regression model to evaluate the contribution of factors such as age, breed, weight, sex, distraction index, and Norberg angle to the risk of developing degenerative joint disease (DJD) of the coxofemoral joint. Of the factors studied, the amount of passive hip laxity, as quantitated by the distraction index, was the most significant (P < 0.0001) determinant of the risk to develop DJD of the coxofemoral joint. In the longitudinal and cross-sectional components of the study, distraction index was a significant (P < 0.001) risk factor for DJD, irrespective of age at evaluation (4, 12, or 24 months). The strength of the hip laxity:DJD correlation increased with the age of dog. In contrast, the Norberg angle, a measure of hip laxity on the standard hip-extended radiograph, was not found to be a significant risk factor for DJD, either in the longitudinal or cross-sectional analyses. Breed-specific probability curves of DJD susceptibility indicated that German Shepherd Dogs had a significantly (P < 0.05) greater risk of developing DJD than did the pool of non-German Shepherd Dogs. The information derived from this statistical model will help to scientifically characterize the role of passive hip laxity as a component in the pathogenesis of DJD of the coxofemoral joint

Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation: A systematic review and meta-analysis.

Science.gov (United States)

Domínguez-Navarro, Fernando; Igual-Camacho, Celedonia; Silvestre-Muñoz, Antonio; Roig-Casasús, Sergio; Blasco, José María

2018-05-01

Balance and proprioceptive deficits are frequently persistent after total joint replacement, limiting functionality and involving altered movement patterns and difficulties in walking and maintaining postural control among patients. The goal of this systematic review was to evaluate the short- and mid-term effects of proprioceptive and balance training for patients undergoing total knee and hip replacement. This is a systematic review of literature. MEDLINE, Embase, Cochrane Library, PEDro, and Scopus were the databases searched. The review included randomized clinical trials in which the experimental groups underwent a training aimed at improving balance and proprioception, in addition to conventional care. The studies had to assess at least one of the following outcomes: self-reported functionality or balance (primary outcomes), knee function, pain, falls, or quality of life. Eight trials were included, involving 567 participants. The quantitative synthesis found a moderate to high significant effect of balance and proprioceptive trainings on self-reported functionality and balance after total knee replacement. The effects were maintained at mid-term in terms of balance alone. Conversely, preoperative training did not enhance outcomes after total hip arthroplasty. The synthesis showed that, in clinical terms, balance trainings are a convenient complement to conventional physiotherapy care to produce an impact on balance and functionality after knee replacement. If outcomes such as improvement in pain, knee range of movement, or patient quality of life are to be promoted, it would be advisable to explore alternative proposals specifically targeting these goals. Further research is needed to confirm or discard the current evidence ultimately, predominantly in terms of the effects on the hips and those yielded by preoperative interventions. Copyright © 2018 Elsevier B.V. All rights reserved.

Influence of Total Knee Arthroplasty on Gait Mechanics of the Replaced and Non-Replaced Limb During Stair Negotiation.

Science.gov (United States)

Standifird, Tyler W; Saxton, Arnold M; Coe, Dawn P; Cates, Harold E; Reinbolt, Jeffrey A; Zhang, Songning

2016-01-01

This study compared biomechanics during stair ascent in replaced and non-replaced limbs of total knee arthroplasty (TKA) patients with control limbs of healthy participants. Thirteen TKA patients and fifteen controls performed stair ascent. Replaced and non-replaced knees of TKA patients were less flexed at contact compared to controls. The loading response peak knee extension moment was greater in control and non-replaced knees compared with replaced. The push-off peak knee abduction moment was elevated in replaced limbs compared to controls. Loading and push-off peak hip abduction moments were greater in replaced limbs compared to controls. The push-off peak hip abduction moment was greater in non-replaced limbs compared to controls. Future rehabilitation protocols should consider the replaced knee and also the non-replaced knee and surrounding joints. Copyright © 2016 Elsevier Inc. All rights reserved.

Kinematic relationship between rotation of lumbar spine and hip joints during golf swing in professional golfers.

Science.gov (United States)

Mun, Frederick; Suh, Seung Woo; Park, Hyun-Joon; Choi, Ahnryul

2015-05-14

Understanding the kinematics of the lumbar spine and hip joints during a golf swing is a basic step for identifying swing-specific factors associated with low back pain. The objective of this study was to examine the kinematic relationship between rotational movement of the lumbar spine and hip joints during a golf swing. Fifteen professional golfers participated in this study with employment of six infrared cameras to record their golf swings. Anatomical reference system of the upper torso, pelvis and thigh segments, and the location of each hip and knee joint were defined by the protocols of the kinematic model of previous studies. Lumbar spine and hip joint rotational angle was calculated utilizing the Euler angle method. Cross-correlation and angle-angle plot was used to examine the degree of kinematic relationship between joints. A fairly strong coupling relationship was shown between the lumbar spine and hip rotational movements with an average correlation of 0.81. Leading hip contribution to overall rotation was markedly high in the early stage of the downswing, while the lumbar spine contributed greater towards the end of the downswing; however, the relative contributions of the trailing hip and lumbar spine were nearly equal during the entire downswing. Most of the professional golfers participated in this study used a similar coordination strategy when moving their hips and lumbar spine during golf swings. The rotation of hips was observed to be more efficient in producing the overall rotation during the downswing when compared to the backswing. These results provide quantitative information to better understand the lumbar spine and hip joint kinematic characteristics of professional golfers. This study will have great potential to be used as a normal control data for the comparison with kinematic information among golfers with low back pain and for further investigation of golf swing-specific factors associated with injury.

Associations between alpha angle and herniation pit on MRI revisited in 185 asympomatic hip joints

Energy Technology Data Exchange (ETDEWEB)

Lee, Eun Chae; Choi, Jung Ah [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2015-12-15

To evaluate the association between alpha angle and herniation pit on MRI in asymptomatic hip joints and their associations with demographic variables.Hip MRI of 185 asymptomatic hip joints of 105 adults (age 18 to 80 years) from September 2011 through December 2012 were retrospectively studied. Alpha angles were measured on oblique axial MR images by 2 observers. Herniation pit was determined by 1 observer. Size measures, prevalence, and statistical analyses were conducted regarding its association with age, gender, laterality (right or left hip). Intra- and inter-observer agreements were determined by intra-class correlation coefficient. The prevalence of herniation pit in asymptomatic hips was 21.6%. The range of alpha angle was 27.6-65.0 degrees. Seventeen and 16 out of 185 (9.1% and 8.6%) hip joints showed alpha angle of ≥ 55 degrees in first and second measurement sessions, respectively. There was no association between alpha angle ≥ 55 and presence of herniation pit. There was no association between alpha angle ≥ 55 and the size of herniation pit. Inter-observer agreement of alpha angle was 0.485 between first measurements of first vs. second observer, respectively. Intra-observer agreement of alpha angle was 0.654, respectively. Forty (21.6%) of 185 hip joints (35 of 105 patients, 33.3%) had herniation pit, with no difference according to age, gender, or laterality of hip joint. There is no association between alpha angle ≥ 55 degrees and presence of herniation pit or demographic variables.

Enhancing the CuCrZr/316L HIP-joint by Ni electroplating

Energy Technology Data Exchange (ETDEWEB)

Wei, R. [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Science Island Branch of Graduate School, University of Science & Technology of China, Hefei, 230031 (China); Zhao, S.X., E-mail: sxzhao@impcas.ac.cn [Institute of Modern Physics, Chinese Academy of Science, Lanzhou, 730000 (China); Dong, H.; Che, H.Y. [Advanced Technology and Materials Co. Ltd., Beijing, 100081 (China); Li, Q.; Wang, W.J.; Wang, J.C.; Wang, X.L.; Sun, Z.X. [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Luo, G.-N. [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei, 230031 (China); Science Island Branch of Graduate School, University of Science & Technology of China, Hefei, 230031 (China); Hefei Center for Physical Science and Technology, Hefei, 230022 (China); Hefei Science Center of Chinese Academy of Sciences, Hefei, 230027 (China)

2017-04-15

Highlights: • The quality of CuCrZr/316L HIP-joint can be enhanced by nickel electroplating on CuCrZr and 316L. • Nickel layer can prevent the occurrence of nickel-poor region in 316L and protect CuCrZr from oxidation. • A Charpy Impact Value as high as 111.5 ± 3.3 J/cm{sup 2} can be obtained by HIP at 980 °C, 140 MPa for 2 h. • At high temperature, CuCrZr is easily oxidized even in the situation of a high vacuum degree of 2 × 10{sup −5} Pa. - Abstract: The quality of CuCrZr/316L joint is crucial for the safety of ITER hypervapotron cooling structure and hot isostatic pressing (HIP) is an important bonding technique for this structure. In this paper, the authors present a finding that the CuCrZr/316L HIP-joint can be enhanced by nickel electroplating on 316L and CuCrZr. A Charpy Impact Value as high as 111.5 ± 3.3 J/cm{sup 2}, which is more than two times the value in a published article, is obtained. The influence of nickel electroplating is twofold: (1) it can prevent the occurrence of nickel-poor region in 316L and the formation of ferrite; (2) it can protect CuCrZr from oxidation during the heating stage of HIP. However, tensile test is not as effective as Charpy Impact Test in characterizing the bonding quality of the CuCrZr/316L HIP-joint. The surface treatment employed in this study is amenable to batch-scale industrial manufacturing at low cost.

MRI as a problem-solving tool in unexplained failed total hip replacement following conventional assessment

International Nuclear Information System (INIS)

Johnston, Ciaran; Kerr, Jennifer; Ford, Stephanie; Eustace, Stephen; O'Byrne, John

2007-01-01

To evaluate MRI as a problem-solving tool for patients with an unexplained failed total hip replacement following conventional radiological assessment. Patients' informed consent was obtained in all cases. Institutional review board approval was obtained. Twenty-eight patients with unexplained failed total hip replacements following conventional radiological assessment underwent additional MR imaging with an optimised turbo-spin echo sequence. Images were reviewed by two musculoskeletal radiologists by consensus and compared with findings at surgery, or following response to image-guided intervention or clinical follow-up. Of the 28 patients, MRI revealed an unsuspected diagnosis explaining the cause of prosthesis failure in 15 patients. In eight of 15 patients in this group, subsequent minimally invasive image-guided intervention obviated the need for revision total hip replacement. No cause for prosthesis failure was identified in 13 patients. MRI may be successfully undertaken in patients following total hip replacement, and, when performed, it frequently leads to an unsuspected diagnosis, allowing informed patient treatment. In this study it allowed the identification of an unsuspected diagnosis in over 50% of cases. (orig.)

A comparative assessment of hip joints some morphometrical criteria for Rottweilers and other breed dogs

International Nuclear Information System (INIS)

Kozinda, O.; Bruveris, Z.

2006-01-01

The aim and objective of the investigation were to make the diagnosis of the hip dysplasia as impartial and precise as possible by using several x-ray morphometrical measurements, to make a comparative analysis of these measurements by using a linear regression analysis, and finally to calculate the value of these parameters and ranks. In total 36 radiogrammes of Rottweiler breed dogs and 24 radiogrammes of other breed dogs of different ages of both sexes, which belonged to owners, were used for the research. In each of the radiogramme 7 morhometrical measurements of the right and left hip joint were made: the Norberg angle, the inclination angle, the tangential angle, the geometrical centre placement of the CFH; the width of the lateral joint fissure gap the width of the medial joint fissure gap and distraction index. From the obtained results the following conclusions can be drawn: to make the diagnosis in dogs of Rottweiler breed, the most essential parameters are distraction index on right hip joint and the tangential angle and width of medial joint fissure on left hip joint

TWO-STAGE REVISION HIP REPLACEMENT PATIENS WITH SEVERE ACETABULUM DEFECT (CASE REPORT

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V. V. Pavlov

2017-01-01

Full Text Available Favorable short-term results of arthroplasty are observed in 80–90% of cases, however, over the longer follow up period the percentage of positive outcomes is gradually reduced. Need for revision of the prosthesis or it’s components increases in proportion to time elapsed from the surgery. In addition, such revision is accompanied with a need to substitute the bone defect of the acetabulum. As a solution the authors propose to replace pelvic defects in two stages. During the first stage the defect was filled with bone allograft with platelet-rich fibrin (allografting with the use of PRF technology. After the allograft remodeling during the second stage the revision surgery is performed by implanting standard prostheses. The authors present a clinical case of a female patient with aseptic loosening of acetabular component of prosthesis in the right hip joint, with failed hip function of stage 2, right limb shortening of 2 cm. Treatment results confirm the efficiency and rationality of the proposed bone grafting option. The authors conclude bone allograft in combination with the PRF technology proves to be an alternative to the implantation of massive metal implants in the acetabulum while it reduces the risk of implant-associated infection, of metallosis in surrounding tissues and expands further revision options.

Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery.

Science.gov (United States)

Fitzgerald, John D; Weng, Haoling H; Soohoo, Nelson F; Ettner, Susan L

2013-01-01

To examine change in regional variations in acute care length of stay (LOS) after orthopedic surgery following expiration of the New York (NY) State exemption to the Prospective Payment System and implementation of the Medicare Short Stay Transfer Policy. Time series analyses were conducted to evaluate change in LOS across regions after policy implementations. Small area analyses were conducted to examine residual variation in LOS. The dataset included A 100% sample of fee-for-service Medicare patients undergoing surgical repair for hip fracture or elective joint replacement surgery between 1996 and 2001. Data files from Centers for Medicare and Medicaid Services 1996-2001 Medicare Provider Analysis and Review file, 1999 Provider of Service file, and data from the 2000 United States Census were used for analysis. In 1996, LOS in NY after orthopedic procedures was much longer than the remainder of the country. After policy changes, LOS fell. However, significant residual variation in LOS persisted. This residual variation was likely partly explained by differences variation in regional managed care market penetration, patient management practices and unmeasured characteristics associated with the hospital location. NY hospitals responded to changes in reimbursement policy, reducing variation in LOS. However, even after 5 years of financial pressure to constrain costs, other factors still have a strong impact on delivery of patient care.

Principles of Human Joint Replacement Design and Clinical Application

CERN Document Server

Buechel, Frederick F

2012-01-01

Drs. Buechel, an orthopaedic surgeon, and Pappas, a professor of Mechanical Engineering, are the designers of several successful joint replacement systems. The most well-known of these is the pioneering LCS knee replacement. They have written this book for the users and designers of joint replacements. It is an attempt to convey to the reader the knowledge accumulated by the authors during their thirty five year effort on the development of replacement devices for the lower limb for the purpose of aiding the reader in their design and evaluation of joint replacement devices. The early chapters describe the engineering, scientific and medical principles needed for replacement joint evaluation. One must understand the nature and performance of the materials involved and their characteristics in vivo, i.e. the response of the body to implant materials. It is also essential to understand the response of the implants to applied loading and motion, particularly in the hostile physiological environment. A chapter de...

Patients' journeys through total joint replacement: patterns of medication use.

Science.gov (United States)

Johnson, Emma C; Horwood, Jeremy; Gooberman-Hill, Rachael

2014-06-01

Medication is used to manage pain that results from both osteoarthritis and total joint replacement (TJR). Research has provided insight into how people living with osteoarthritis use pain relief medication. However, it is not known whether elective TJR affects existing attitudes and behaviours with regard to pain medications. Using qualitative methods, the present study explored patterns of pain relief use around the time of TJR. In-depth face-to-face qualitative interviews were carried out with 24 patients two to four weeks after they had undergone TJR for hip or knee osteoarthritis. Participants were asked to reflect on their use of pain medication pre-surgery, while in hospital and while recovering from their operation at home. Transcripts of the audio-recorded interviews were imported into Atlas.ti® and thematic analysis was used. Attitudes to pain relief medication and their use are not static. Many participants change their use of pain medication around the time of surgery. This shift was influenced by interactions with health professionals and changing views on the acceptability, necessity and value of pain relief in helping to manage an altered pain experience. Understanding reasons for medication-taking behaviour during the journey through joint replacement may be helpful to health professionals. Health professionals have a fundamental role to play in challenging or reinforcing different treatment beliefs, which is the basis for effective use of pain relief over the pre- to postoperative period. © 2013 John Wiley & Sons, Ltd.

Wear debris. An environmental issue in total joint replacement.

Science.gov (United States)

Manley, M T; Serekian, P

1994-01-01

There is a growing concern that osteolytic lesions, often adjacent to otherwise stable implants, are a recent phenomenon caused by some recent change in polyethylene, metal, or other aspect of the total hip construction. This study investigates the possibility that bearings and modular connections used in modern hip replacements are an unappreciated source of particulate debris. Measurements taken from contemporary femoral bearings show a significant mismatch in both surface finish and sphericity of mating metal and polyethylene components, with sphericity of inserts being much worse then sphericity of femoral heads. The tolerances for sphericity of polyethylene inserts were further changed by the placement of an insert into its metal shell. Hip simulator tests of assembled inserts and shells showed greater polyethylene weight loss for metal-backed shells than for inserts alone. Bending and torsional tests of metal/metal modular connections showed that dynamic loads can release large numbers of debris particles from taper junctions. Because osteolytic lesions clearly are associated with overload of tissue by debris particles, the design, manufacture, and tolerances of modular connections in total hip replacement all seem to require reevaluation.

Stereographic processing of CT figures in the hip joints

Energy Technology Data Exchange (ETDEWEB)

Tomihara, Mitsuo (Kinki Univ., Osakasayama, Osaka (Japan). School of Medicine)

1990-12-01

CT scan is widely used in orthopedic examinations. By three-dimentional display of the form of bone and joint, the change of form can be identified and the lesion can be located. CT figures were stereographically processed using a personal computer to display the images of the hip joints. The outlines of the bone seen on the CT film were directly traced with a digitizer, then the A/D converted coordinate data were obtained. The data for each slice were input to the personal computer. After conversion to normal coordinate and magnification, the data were filed on the floppy disc. These data were regained from the disk and made affin transformation to display the stereographic images of the hip joints. In a case of solitary bone cyst of the coxal bone, this method helped us to decide the appropriated surgical approach. For the congenital dysplasia of the hip, acetabular coverage was examined three-dimensionally and postoperative changes were assessed in the cases of shelf operation and intertrochanteric extension osteotomy. In the cases of aseptic necrosis of the femoral head, location and size of the necrotic area were clearly visualized and the appropriate surgical procedure could be decided. Moreover, it was useful to decide the degree of rotation of the femoral head in rotational osteotomy. (author) 61 refs.

OMERACT/OARSI initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis

DEFF Research Database (Denmark)

Gossec, Laure; Hawker, Gillian; Davis, Aileen M

2007-01-01

OBJECTIVE: Time to theoretical indication of joint replacement surgery has been proposed as a primary outcome for potential structure-modifying interventions for osteoarthritis (OA). The objectives of this OMERACT/OARSI Working Group were to identify pain, physical function, and structure states ...

Joint Replacement Surgery: Health Information Basics for You and Your Family

Science.gov (United States)

... Initiative Breadcrumb Home Health Topics English Español Joint Replacement Surgery Basics In-Depth Download Download EPUB Download ... What is it? Points To Remember About Joint Replacement Surgery Joint replacement surgery removes damaged or diseased ...

Joint space width in dysplasia of the hip

DEFF Research Database (Denmark)

Jacobsen, Steffen; Sonne-Holm, Stig; Søballe, K

2005-01-01

. Neither subjects with dysplasia nor controls had radiological signs of ongoing degenerative disease at admission. The primary radiological discriminator of degeneration of the hip was a change in the minimum joint space width over time. There were no significant differences between these with dysplasia...

Analysis of rehabilitation activities within skilled nursing and inpatient rehabilitation facilities after hip replacement for acute hip fracture.

Science.gov (United States)

Munin, Michael C; Putman, Koen; Hsieh, Ching-Hui; Smout, Randall J; Tian, Wenqiang; DeJong, Gerben; Horn, Susan D

2010-07-01

To characterize rehabilitation services in two types of postacute facilities in patients who underwent hip replacement following a hip fracture. Multisite prospective observational cohort from 6 freestanding skilled nursing facilities and 11 inpatient rehabilitation facilities. Patients (n = 218) with hip fracture who had either hemiarthroplasty or total hip arthroplasty followed by rehabilitation at skilled nursing facilities or inpatient rehabilitation facilities were enrolled. Using a point-of-care methodology, we recorded data from actual physical therapy and occupational therapy sessions completed including functional outcomes during the postacute admission. Onset time from surgical repair to rehabilitation admission was not significantly different between sites. Average skilled nursing facilities length of stay was 24.7 +/- 13.6 days, whereas inpatient rehabilitation facilities was 13.0 +/- 5.7 days (P inpatient rehabilitation facilities. For weekdays only, these data changed to 1.6 in skilled nursing facilities and 2.6 hrs per patient in inpatient rehabilitation facilities (P inpatient rehabilitation facilities accrued more time for gait training and exercise in physical therapy, which was found to be 48% and 40% greater, respectively, through day 8. In occupational therapy, patients of inpatient rehabilitation facilities had more time allocated to lower body dressing and transfers. Significant differences in rehabilitation activities were observed, and intensity was notably different within the first 8 therapy days even though baseline demographics and medical complexity were comparable across facility types. Our data suggest that after more complex hip replacement surgery, hip fracture patients can tolerate more intensive therapy earlier within the rehabilitation program.

Articular soft tissue anatomy of the archosaur hip joint: Structural homology and functional implications.

Science.gov (United States)

Tsai, Henry P; Holliday, Casey M

2015-06-01

Archosaurs evolved a wide diversity of locomotor postures, body sizes, and hip joint morphologies. The two extant archosaurs clades (birds and crocodylians) possess highly divergent hip joint morphologies, and the homologies and functions of their articular soft tissues, such as ligaments, cartilage, and tendons, are poorly understood. Reconstructing joint anatomy and function of extinct vertebrates is critical to understanding their posture, locomotor behavior, ecology, and evolution. However, the lack of soft tissues in fossil taxa makes accurate inferences of joint function difficult. Here, we describe the soft tissue anatomies and their osteological correlates in the hip joint of archosaurs and their sauropsid outgroups, and infer structural homology across the extant taxa. A comparative sample of 35 species of birds, crocodylians, lepidosaurs, and turtles ranging from hatchling to skeletally mature adult were studied using dissection, imaging, and histology. Birds and crocodylians possess topologically and histologically consistent articular soft tissues in their hip joints. Epiphyseal cartilages, fibrocartilages, and ligaments leave consistent osteological correlates. The archosaur acetabulum possesses distinct labrum and antitrochanter structures on the supraacetabulum. The ligamentum capitis femoris consists of distinct pubic- and ischial attachments, and is homologous with the ventral capsular ligament of lepidosaurs. The proximal femur has a hyaline cartilage core attached to the metaphysis via a fibrocartilaginous sleeve. This study provides new insight into soft tissue structures and their osteological correlates (e.g., the antitrochanter, the fovea capitis, and the metaphyseal collar) in the archosaur hip joint. The topological arrangement of fibro- and hyaline cartilage may provide mechanical support for the chondroepiphysis. The osteological correlates identified here will inform systematic and functional analyses of archosaur hindlimb evolution and

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

Science.gov (United States)

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 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.

Epilepsia partialis continua present with shoulder joint-trunk-hip joint rhythmic clonic seizure: a case report

Directory of Open Access Journals (Sweden)

Lv YD

2016-09-01

Full Text Available Yudan Lv, Zan Wang, Fengna Chu, Chang Liu, Hongmei Meng Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, ChangChun, People’s Republic of China Abstract: Epilepsia partialis continua (EPC is a particular type of epilepsy which is distinguished from “common epilepsy” by its characteristic semiological features. However, unusual manifestations should be described in order to give awareness at clinical diagnosis. In this case report we describe a rare EPC case not previously reported, in which left shoulder joint-trunk-hip joint jerk was present for 1 week. Abnormal electroencephalogram and cerebrospinal fluid results supported a diagnosis of viral encephalitis. Antiepileptic treatment seemed effective. Our report emphasizes that a detailed functional anatomical analysis and synchronized electroencephalogram discharge should be done to avoid misdiagnosis in patients with synchronic shoulder-trunk-hip jerk symptoms. Keywords: EPC, shoulder-trunk-hip, EEG, clonic seizure, virus encephalitis

Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

Science.gov (United States)

Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

2012-01-01

There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

The Arterial Folding Point During Flexion of the Hip Joint

International Nuclear Information System (INIS)

Park, Sung Il; Won, Je Hwan; Kim, Byung Moon; Kim, Jae Keun; Lee, Do Yun

2005-01-01

Purpose: Endovascular stents placed in periarticular vessels may be at a greater risk of neointimal hyperplasia and eventual occlusion than those placed in non-periarticular vessels. The purpose of this study was to investigate the location of maximal conformational change along the iliac and femoral artery, the folding point, during flexion of the hip joint and its location relative to the hip joint and the inguinal ligament. Methods: Seventy patients undergoing femoral artery catheterization were evaluated. The patients were 47 men and 23 women and ranged in age from 26 to 75 years (mean 54 years). The arteries (right:left = 34:36) were measured using a marked catheter for sizing vessels. Fluoroscopic images were obtained in anteroposterior and lateral projections in neutral position, and in the lateral projection in flexed position of the hip joint. The folding point was determined by comparing the lateral projection images in the neutral and flexed positions. The distance from the acetabular roof to the folding point and the distance from the inguinal ligament to the folding point was evaluated. Results: : The folding point was located 42.8 ± 28.6 mm cranial to the acetabular roof and 35.1 ± 30.1 mm cranial to the inguinal ligament. As the patient’s age increased, the folding point was located more cranially (p < 0.001). Conclusions: The folding point during flexion of the hip joint was located 42.8 ± 28.6 mm cranial to the acetabular roof and 35.1 ± 30.1 mm cranial to the inguinal ligament. As the patient's age increased, the folding point was located more cranially. When a stent is inserted over this region, more attention may be needed during follow-up to monitor possible occlusion and stent failure.

Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

Science.gov (United States)

2015-11-24

This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

Dysfunction in the hip joints in children with Charcot-Marie-Tooth syndrome (literature review

Directory of Open Access Journals (Sweden)

Ivan Yurievich Pozdnikin

2015-09-01

Full Text Available A review of the literature on the treatment of children with dysfunction in the hip joints in motor-sensory neuropathy Charcot-Marie-Tooth is presented. Peculiarities of disease diagnosis and the approach used in the treatment of patients are described. The Charcot-Marie-Tooth syndrome is a hereditary neuromuscular disease characterized by progressive atrophy of the distal muscle group of the lower limbs. According to international authors, the incidence of hip joint dysfunction in this condition is at least 10%, ranking second only to foot deformities. In the Russian literature, the problem has not been adequately interpreted. Early diagnosis of dysfunction in the hip joints during Charcot-Marie-Tooth syndrome is complicated by the child's age and is characterized by progression. Conflicting clinical signs and trivial symptoms of the disease also confuse diagnosis, until it becomes clearer in adolescence or the second or third decade of life. Surgical reconstructive operations on the hip joint often occur too late, and they are accompanied by a greater frequency of neurological complications. Practitioner awareness coupled with an early diagnosis of hip subluxation and decentration and complex orthopedic and neurological examinations of children with the disease of Charcot-Marie-Tooth should result in more favorable outcomes.

Effect of head contact on the rim of the cup on the offset loading and torque in hip joint replacement.

Science.gov (United States)

Liu, Feng; Williams, Sophie; Jin, Zhongmin; Fisher, John

2013-11-01

Head contact on the rim of the cup causes stress concentration and consequently increased wear. The head contact on the rim of the cup may in addition cause an offset load and torque on the cup. The head-rim contact resulting from microseparation or subluxation has been investigated. An analytical model has been developed to calculate the offset loading and resultant torque on the cup as a function of the translational displacement of the head under simplified loading condition of the hip joint at heel strike during a walking cycle. The magnitude of the torque on the cup was found to increase with the increasing translational displacement, larger diameter heads, eccentric cups, and the coefficient of friction of the contact. The effects of cup inclination, cup rim radius, and cup coverage angle on the magnitude of the torque were found to be relatively small with a maximum variation in the torque magnitude being lower than 20%. This study has shown an increased torque due to the head loading on the rim of the cup, and this may contribute to the incidence of cup loosening. Particularly, metal-on-metal hip joints with larger head diameters may produce the highest offset loading torque.

COXA-VERTEBRAL SYNDROME AND ITS SIGNIFICANCE IN HIP ARTHROPLASTY (REVIEW

Directory of Open Access Journals (Sweden)

A. O. Denisov

2012-01-01

Full Text Available Lumbosacral spine and hip joints is a complex physiological functions of the co-operation of a large number of anatomical structures. Lesions of the links in the system can mutually afflict each other. Combined pathology of the hip and lumbosacral spine is called hip-spine syndrome, or coxa-vertebral syndrome. Symptoms of the joint and spine are very similar and only a careful examination and clinical examination may find the differences. As the disease progresses the hip increases the restriction of movement, there is a contracture of the limbs in a vicious position, which leads to an increase in tilt of the pelvis, increased lumbar lordosis and to functional shortening of limbs on the affected side. This gives rise to functional impairment, and then strain the joints of his spine and disease - osteochondrosis and scoliosis. After the successful operation of total hip replacement is often progressive clinical lesions of vertebral segment, which is manifested pain and is often offset by the results of arthroplasty as the restoration of movement in the hip joint, and the change in length limb after arthroplasty leads to rupture formed a functional stereotype change in the mobility of the lumbar spine, pelvis regression bias that causes the dynamic compression spinal nerve root. Depending on the duration of the existence, severity and nature of changes in the pelvic girdle is suitable correction of equipment replacement surgery, including, for example, in some cases, deliberate shortening or lengthening the preservation of the lower extremity, offset change, etc.

Selection of contact bearing couple materials for hip prosthesis using finite element analysis under static conditions

Science.gov (United States)

Arirajan, K. A.; Chockalingam, K.; Vignesh, C.

2018-04-01

Implants are the artificial parts to replace the missing bones or joints in human anatomy to give mechanical support. Hip joint replacement is an important issue in orthopaedic surgery. The main concern limiting the long-run success of the total hip replacement is the limited service life. Hip replacement technique is widely used in replacing the femur head and acetabular cup by materials that are highly biocompatible. The success of the artificial hip replacement depends upon proper material selection, structure, and shape of the hip prosthesis. Many orthopaedic analyses have been tried with different materials, but ended with partial success on the application side. It is a critical task for selecting the best material pair in the hip prosthesis design. This work develops the finite element analysis of an artificial hip implant to study highest von Mises stress, contact pressure and elastic strain occurs for the dissimilar material combination. The different bearing couple considered for the analysis are Metal on Metal, Metal on Plastic, Metal on Ceramic, Ceramic on Plastic, Ceramic on Ceramic combinations. The analysis is carried out at different static positions of a human (i.e) standing, sitting. The results reveals that the combination with metal in contact with plastic (i.e) Titanium femoral head paired with Ultra High Molecular Weight Poly Ethylene acetabular cup reduces maximum von Mises stress and also it gives lowest contact pressure than other combination of bearing couples.

No evidence hip joint angle modulates intrinsically produced stretch reflex in human hopping.

Science.gov (United States)

Gibson, W; Campbell, A; Allison, G

2013-09-01

Motor output in activities such as walking and hopping is suggested to be mediated neurally by purported stretch reflex augmentation of muscle output. Reflex EMG activity during these tasks has been frequently investigated in the soleus muscle; with alterations in reflex amplitude being associated with changes in hip joint angle/phase of the gait cycle. Previous work has focussed on reflex activity induced by an artificial perturbation or by induction of H-reflexes. As such, it is currently unknown if stretch reflex activity induced intrinsically (as part of the task) is modulated by changes in hip joint angle. This study investigated whether hip joint angle modulated reflex EMG 'burst' activity during a hopping task performed on a custom-built partially reclined sleigh. Ten subjects participated; EMG and kinematic data (VICON motor capture system) was collected for each hop cycle. Participants completed 5 sets of 30s of self-paced hopping in (1) hip neutral and (2) hip 60° flexion conditions. There was no difference in EMG 'burst' activity or in sagittal plane kinematics (knee/ankle) in the hopping task between the two conditions. The results indicate that during a functional task such as hopping, changes in hip angle do not alter the stretch reflex-like activity associated with landing. Copyright © 2013 Elsevier B.V. All rights reserved.

Explanations pertaining to the Hip Joint Flexor Moment During the Stance Phase of Human Walking

DEFF Research Database (Denmark)

Simonsen, Erik B; Cappelen, Katrine L; Skorini, Ragnhild

2012-01-01

A hip joint flexor moment in the last half of the stance phase during walking has repeatedly been reported. However, the purpose of this moment remains uncertain and it is unknown how it is generated. Nine male subjects were instructed to walk at 4.5 km/h with their upper body in three different...... positions: normal, inclined and reclined. Net joint moments were calculated about the hip, knee and ankle joint. The peak hip joint flexor moment during late stance was significantly lower during inclined walking than in the two other conditions. During normal walking the iliacus muscle showed no or very...... weak activity and first at the transition from stance to swing. When walking reclined, a clear but rather low activity level of the iliacus muscle was seen in the first half of the stance phase, which could contribute to the hip moment. In the inclined condition the iliacus showed much increased...

Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis.

Science.gov (United States)

2005-01-01

The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patientsTo determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patientsTo determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person's functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. THE THERAPY: The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient

Synovial cyst of the hip joint as a rare cause of unlateral leg edema; A case report

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Kang, Ji Hun; Chang, Il Soo; Park, Sang Woo; Yun, Ik Jin; Park, Hyung Kyu; Kim, Wan Seop; Lee, Hui Jin; Kim, Na Ra; Moon, Sung Gyu [Konkuk University School of Medicine, Seoul (Korea, Republic of)

2015-06-15

A synovial cyst of the hip joint is a rare cause of unilateral leg edema, and it is usually associated with arthropathies such as rheumatoid arthritis and osteoarthritis. An asymptomatic synovial cyst of the hip joint that is not associated with an arthritic condition occurs infrequently. In this paper, we described the case of a 52-year-old woman who presented with unilateral right leg edema caused by a synovial cyst of the hip joint.

Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury.

Science.gov (United States)

Wellsandt, E; Zeni, J A; Axe, M J; Snyder-Mackler, L

2017-12-01

Anterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. Nineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. Five of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. The current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

Directory of Open Access Journals (Sweden)

Xiao-Dong Cao

2017-04-01

Full Text Available Objective: To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty. Methods: A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group, total hip group received anterolateral-approach minimally invasive total hip replacement, half hip group received anterolateral-approach minimally invasive hemiarthroplasty, and 1 month after operation, serum was collected to detect the levels of bone metabolism markers, osteocyte cytokines, SP and CGRP. Results: 1 month after operation, serum PINP, PICP, BMP, TGF-β, FGF, IGF-I and IGF-II levels of total hip group were significantly higher than those of half hip group while TRAP5b and CatK levels were significantly lower than those of half hip group; the day after operation, serum pain media SP and CGRP levels were not significantly different between the two groups of patients; 36 h after operation, serum SP and CGRP levels of total hip group were significantly lower than those of half hip group. Conclusion: The bone metabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty, and the degree of pain is less than that after hemiarthroplasty.

Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care.

Science.gov (United States)

Finnegan, Micaela A; Shaffer, Robyn; Remington, Austin; Kwong, Jereen; Curtin, Catherine; Hernandez-Boussard, Tina

2017-06-21

Major joint replacement surgical procedures are common, elective procedures with a care episode that includes both inpatient readmissions and postoperative emergency department (ED) visits. Inpatient readmissions are well studied; however, to our knowledge, little is known about ED visits following these procedures. We sought to characterize 30-day ED visits following a major joint replacement surgical procedure. We used administrative records from California, Florida, and New York, from 2010 through 2012, to identify adults undergoing total knee and hip arthroplasty. Factors associated with increased risk of an ED visit were estimated using hierarchical regression models controlling for patient variables with a fixed hospital effect. The main outcome was an ED visit within 30 days of discharge. Among the 152,783 patients who underwent major joint replacement, 5,229 (3.42%) returned to the inpatient setting and 8,883 (5.81%) presented to the ED for care within 30 days. Among ED visits, 17.94% had a primary diagnosis of pain and 25.75% had both a primary and/or a secondary diagnosis of pain. Patients presenting to the ED for subsequent care had more comorbidities and were more frequently non-white with public insurance relative to those not returning to the ED (p care insurance coverage expansions are uncertain; however, there are ongoing attempts to improve quality across the continuum of care. It is therefore essential to ensure that all patients, particularly vulnerable populations, receive appropriate postoperative care, including pain management. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Corrosion and Tribology of Materials Used in a Novel Reverse Hip Replacement.

Science.gov (United States)

Braddon, Linda; Termanini, Zafer; MacDonald, Steven; Parvizi, Jay; Lieberman, Jay; Frankel, Victor; Zuckerman, Joseph

2017-07-05

Total hip arthroplasty has been utilized for the past 50 years as an effective treatment for degenerative, inflammatory and traumatic disorders of the hip. The design of these implants has generally followed the anatomy of the hip as a ball and socket joint with the femoral head representing the ball and the acetabulum representing the socket. We describe a novel hip arthroplasty design in which the "ball" is located on the acetabular side and the "socket" is located on the femoral side. The results of extensive biomechanical testing are described and document wear and corrosion characteristics that are at least equivalent to standard designs. These results support clinical assessment as the next step of the evaluation.

Repair of gluteus medius muscle avulsion following transgluteal hip replacement

NARCIS (Netherlands)

Groot, Diederik; van Ooij, Andre; Haverkamp, Daniel; Morrenhof, Wim

2011-01-01

During a transgluteal approach to the hip joint the anterior part of the gluteus medius and minimus muscles are detached and subsequently reattached to the greater trochanter. Avulsion or rupture of these muscles may result in weak abduction, pain and/or instability. 15 patients with these symptoms

Clinical application of the modified medially-mounted motor-driven hip gear joint for paraplegics.

Science.gov (United States)

Sonoda, S; Imahori, R; Saitoh, E; Tomita, Y; Domen, K; Chino, N

2000-04-15

This paper describes a motor-driven orthosis for paraplegics which has been developed. This orthosis is composed of a medially-mounted motor-driven hip joint and bilateral knee-ankle-foot orthosis. With the gear mechanism, the virtual axis of the hip joint of this orthosis is almost as high as the anatomical hip joint. A paraplegic patient with an injury level of T10/11 walked using bilateral lofstrand crutches and this new orthosis with or without the motor system. The motor is initiated by pushing a button attached at the edge of the grab of the crutches. Faster cadence and speed and smaller rotation angle of the trunk was obtained in motor walking compared with non-motor walking. The patient did not feel fearful of falling. The benefit of motor orthosis is that it can be used even in patients with lower motor lesions and that it provides stable regulation of hip flexion movement in spastic patients. In conclusion, this motor orthosis will enhance paraplegic walking.

Self-aligning exoskeleton hip joint: Kinematic design with five revolute, three prismatic and one ball joint.

Science.gov (United States)

Beil, Jonas; Marquardt, Charlotte; Asfour, Tamim

2017-07-01

Kinematic compatibility is of paramount importance in wearable robotic and exoskeleton design. Misalignments between exoskeletons and anatomical joints of the human body result in interaction forces which make wearing the exoskeleton uncomfortable and even dangerous for the human. In this paper we present a kinematically compatible design of an exoskeleton hip to reduce kinematic incompatibilities, so called macro- and micro-misalignments, between the human's and exoskeleton's joint axes, which are caused by inter-subject variability and articulation. The resulting design consists of five revolute, three prismatic and one ball joint. Design parameters such as range of motion and joint velocities are calculated based on the analysis of human motion data acquired by motion capture systems. We show that the resulting design is capable of self-aligning to the human hip joint in all three anatomical planes during operation and can be adapted along the dorsoventral and mediolateral axis prior to operation. Calculation of the forward kinematics and FEM-simulation considering kinematic and musculoskeletal constraints proved sufficient mobility and stiffness of the system regarding the range of motion, angular velocity and torque admissibility needed to provide 50 % assistance for an 80 kg person.

Hip joint torques during the golf swing of young and senior healthy males.

Science.gov (United States)

Foxworth, Judy L; Millar, Audrey L; Long, Benjamin L; Way, Michael; Vellucci, Matthew W; Vogler, Joshua D

2013-09-01

Descriptive, laboratory study. To compare the 3-D hip torques during a golf swing between young and senior healthy male amateur golfers. The secondary purpose was to compare the 3-D hip joint torques between the trail leg and lead leg. The generation of hip torques from the hip musculature is an important aspect of the golf swing. Golf is a very popular activity, and estimates of hip torques during the golf swing have not been reported. Twenty healthy male golfers were divided into a young group (mean ± SD age, 25.1 ± 3.1 years) and a senior group (age, 56.9 ± 4.7 years). All subjects completed 10 golf swings using their personal driver. A motion capture system and force plates were used to obtain kinematic and kinetic data. Inverse dynamic analyses were used to calculate 3-D hip joint torques of the trail and lead limbs. Two-way analyses of covariance (group by leg), with club-head velocity as a covariate, were used to compare peak hip torques between groups and limbs. Trail-limb hip external rotator torque was significantly greater in the younger group compared to the senior group, and greater in the trail leg versus the lead leg. When adjusting for club-head velocity, young and senior healthy male amateur golfers generated comparable hip torques during a golf swing, with the exception of the trail-limb hip external rotator torque. The largest hip torque found was the trail-limb hip extensor torque.

A Rare Case of Morel-Lavallee Syndrome Complicating an Anterior Dislocation of Hip Joint.

Science.gov (United States)

Nekkanti, Supreeth; Vijay, C; Theja, Sujana; Shankar, R Ravi; Verma, Anubhav

2016-01-01

Hip dislocations are serious injuries as hip joint is an extremely stable joint. It requires a significant amount of force to produce such an injury. Anterior dislocations are uncommon. Potential complications of anterior hip dislocations are a neurovascular injury to femoral vessels or acetabular fractures. We report a rare late complication of Morel-Lavallee syndrome occurring 3 weeks after an anterior dislocation of the hip in a 43-year-old male. The patient presented to us with history. Morel-Lavallee syndrome is a rare complication. However if diagnosed early can be successfully treated with minimal burden to the patient. The authors recommend surgeons to have a high index of suspicion for this syndrome and a stringent follow-up examination of the patient.

Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: A randomized pilot trial

NARCIS (Netherlands)

Hoogeboom, T.J.; Dronkers, J.J.; Ende, C.H.M. van den; Oosting, E.; Meeteren, N.L.U. van

2010-01-01

Objective: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly. Design: A single-blind, randomized clinical pilot trial. Setting: Outpatient physiotherapy department. Subjects: Frail elderly with hip osteoarthritis awaiting

Conversion coefficients for determining organ doses in paediatric pelvis and hip joint radiography

International Nuclear Information System (INIS)

Seidenbusch, Michael C.; Schneider, Karl

2014-01-01

Knowledge of organ and effective doses achieved during paediatric X-ray examinations is an important prerequisite for assessment of radiation burden to the patient. Conversion coefficients for reconstruction of organ and effective doses from entrance doses for pelvis and hip joint radiographs of 0-, 1-, 5-, 10-, 15- and 30-year-old patients are provided regarding the Guidelines of Good Radiographic Technique of the European Commission. Using the personal computer program PCXMC developed by the Finnish Centre for Radiation and Nuclear Safety (Saeteilyturvakeskus STUK), conversion coefficients for conventional pelvis and hip joint radiographs were calculated by performing Monte Carlo simulations in mathematical hermaphrodite phantom models representing patients of different ages. The clinical variation of radiation field settings was taken into consideration by defining optimal and suboptimal standard field settings. Conversion coefficients for the reconstruction of organ doses in about 40 organs and tissues from measured entrance doses during pelvis and hip joint radiographs of 0-, 1-, 5-, 10-, 15- and 30-year-old patients were calculated for the standard sagittal beam projection and the standard focus detector distance of 115 cm. The conversion coefficients presented can be used for organ dose assessments from entrance doses measured during pelvis and hip joint radiographs of children and young adults with all field settings within the optimal and suboptimal standard field settings. (orig.)

Increased pain sensitivity but normal function of exercise induced analgesia in hip and knee osteoarthritis--treatment effects of neuromuscular exercise and total joint replacement.

Science.gov (United States)

Kosek, E; Roos, E M; Ageberg, E; Nilsdotter, A

2013-09-01

To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters. The dataset consisted of knee (n = 66) and hip (n = 47) OA patients assigned for total joint replacement at Lund University Hospital undergoing pre-operative neuromuscular exercise and 43 matched controls. Sensitivity to pressure pain was assessed by pressure algometry at 10 sites. Subjects were then instructed to perform a standardized static knee extension. Pressure pain thresholds (PPTs) were assessed at the contracting quadriceps muscle (Q) and at the resting deltoid muscle (D) before and during contraction. The relative increase in PPTs during contraction was taken as a measure of localized (Q) or generalized (D) EIA. Patients were assessed at baseline, following on average 12 weeks of neuromuscular exercise and 3 months following surgery. We found a normal function of EIA in OA patients at baseline. Previous studies have reported beneficial effects of physical exercise on pain modulation in healthy subjects. However, no treatment effects on EIA were seen in OA patients despite the increase in muscle strength following neuromuscular exercise and reduced pain following surgery. Compared to controls, OA patients had increased pain sensitivity and no beneficial effects on pain sensitivity were seen following treatment. To our knowledge, this is the first study of EIA in OA patients. Despite increased pain sensitivity, OA patients had a normal function of EIA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Total ankle joint replacement.

Science.gov (United States)

2016-02-01

Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. 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/

The influence of optimism on functionality after total hip replacement surgery.

Science.gov (United States)

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.

Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3 T: A prospective controlled study

Energy Technology Data Exchange (ETDEWEB)

Zilkens, Christoph, E-mail: christoph.zilkens@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Miese, Falk, E-mail: falk.miese@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Kim, Young-Jo, E-mail: young-jo.kim@childrens.harvard.edu [Department of Orthopaedic Surgery, The Children' s Hospital Boston, 300 Longwood Ave., Boston, MA 02115 (United States); Hosalkar, Harish, E-mail: hhosalkar@rchsd.org [Department of Orthopaedic Surgery, Rady Children' s Hospital San Diego, 3030 Childrens Way Ste 410, San Diego, CA 92123 (United States); Antoch, Gerald, E-mail: antoch@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Krauspe, Ruediger, E-mail: krauspe@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Bittersohl, Bernd, E-mail: bbittersohl@partners.org [Univ. Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstrasse 5, D-40225 Dusseldorf (Germany)

2012-11-15

Purpose: To assess acetabular and femoral hip joint cartilage with three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) in patients with degeneration of hip joint cartilage and asymptomatic controls with morphologically normal appearing cartilage. Methods and materials: A total of 40 symptomatic patients (18 males, 22 females; mean age: 32.8 {+-} 10.2 years, range: 18-57 years) with different hip joint deformities including femoroacetabular impingement (n = 35), residual hip dysplasia (n = 3) and coxa magna due to Legg-Calve-Perthes disease in childhood (n = 2) underwent high-resolution 3D dGEMRIC for the evaluation of acetabular and femoral hip joint cartilage. Thirty-one asymptomatic healthy volunteers (12 males, 19 females; mean age: 24.5 {+-} 1.8 years, range: 21-29 years) without underlying hip deformities were included as control. MRI was performed at 3 T using a body matrix phased array coil. Region of interest (ROI) analyses for T1{sub Gd} assessment was performed in seven regions in the hip joint, including anterior to superior and posterior regions. Results: T1{sub Gd} mapping demonstrated the typical pattern of acetabular cartilage consistent with a higher glycosaminoglycan (GAG) content in the main weight-bearing area. T1{sub Gd} values were significantly higher in the control group than in the patient group whereas significant differences in T1{sub Gd} values corresponding to the amount of cartilage damage were noted both in the patient group and in the control group. Conclusions: Our study demonstrates the potential of high-resolution 3D dGEMRIC at 3 T for separate acetabular and femoral hip joint cartilage assessment in various forms of hip joint deformities.

Hip2Norm: an object-oriented cross-platform program for 3D analysis of hip joint morphology using 2D pelvic radiographs.

Science.gov (United States)

Zheng, G; Tannast, M; Anderegg, C; Siebenrock, K A; Langlotz, F

2007-07-01

We developed an object-oriented cross-platform program to perform three-dimensional (3D) analysis of hip joint morphology using two-dimensional (2D) anteroposterior (AP) pelvic radiographs. Landmarks extracted from 2D AP pelvic radiographs and optionally an additional lateral pelvic X-ray were combined with a cone beam projection model to reconstruct 3D hip joints. Since individual pelvic orientation can vary considerably, a method for standardizing pelvic orientation was implemented to determine the absolute tilt/rotation. The evaluation of anatomically morphologic differences was achieved by reconstructing the projected acetabular rim and the measured hip parameters as if obtained in a standardized neutral orientation. The program had been successfully used to interactively objectify acetabular version in hips with femoro-acetabular impingement or developmental dysplasia. Hip(2)Norm is written in object-oriented programming language C++ using cross-platform software Qt (TrollTech, Oslo, Norway) for graphical user interface (GUI) and is transportable to any platform.

Who should have knee joint replacement surgery for osteoarthritis?

DEFF Research Database (Denmark)

Dieppe, Paul; Lim, Keith; Lohmander, Stefan

2011-01-01

Knee joint replacement is an effective and cost-effective intervention for severe symptomatic osteoarthritis of the knee joint. However, utilisation rates vary hugely, there are no indications, it is difficult to know when (in the course of arthritis) it is best to operate, and some 10-20% of peo......Knee joint replacement is an effective and cost-effective intervention for severe symptomatic osteoarthritis of the knee joint. However, utilisation rates vary hugely, there are no indications, it is difficult to know when (in the course of arthritis) it is best to operate, and some 10...

The Fate of DDH Hips Showing Cartilaginous or Fibrous Tissue-filled Joint Spaces Following Primary Reduction.

Science.gov (United States)

Kim, Hui Taek; Lee, Tae Hoon; Ahn, Tae Young; Jang, Jae Hoon

Because the use of magnetic resonance imaging is still not universal for the patients with developmental dysplasia of the hip patients, orthopaedists do not generally distinguish widened joint spaces which are "empty" after primary treatment (and therefore still reducible), from those which are filled and much more difficult to treat. To date no studies have focused on the latter hips. We treated and observed the outcomes for 19 hips which showed filled joint spaces after primary treatment. We retrospectively reviewed 19 cases of developmental dysplasia of the hip: (1) who showed a widened joint space on radiographs after primary treatment; and (2) whose magnetic resonance imaging showed that the widened joint space was accompanied by acetabular cartilage hypertrophy and/or was filled with fibrous tissues. All patients were over 1 year old at the time of primary reduction (reduction was closed in 4 patients, open in 6, and open with pelvic osteotomy in 9). Thirteen patients received at least 1 secondary treatment. Final results were classified using a modified Severin classification. Final outcomes were satisfactory in 10 (52.6%) and unsatisfactory in 9 (47.4%). The widened joint spaces gradually filled with bone, resulting in a shallow acetabulum in the patients with unsatisfactory results. Of 9 patients who underwent combined pelvic osteotomy at the time of primary reduction, results were satisfactory in 6 (66.7%), whereas all patients who had only closed or open primary reduction had unsatisfactory results. Combined pelvic osteotomy at the time of primary reduction is advisable in hips with widened joint spaces. However, hips with filled joint spaces after primary treatment often have unsatisfactory results even after additional pelvic and/or femoral osteotomy. Level IV-prognostic study.

Treatment of tuberculosis of the hip | Gakuu | East and Central ...

African Journals Online (AJOL)

Adductor tenotomy was performed in 17 patients, while five had arthrodesis, three had excisional arthroplasties and two had total hip replacements after chemotherapy. The 43 patients who presented with preserved joint spaces did well but the 14 who presented with reduced joint space, subchondral erosions and protrusio ...

Relationship between degenerative joint disease and hip joint laxity by use of distraction index and Norberg angle measurement in a group of cats

International Nuclear Information System (INIS)

Langenbach, A.; Giger, U.; Green, P.; Rhodes, H.; Gregor, T.P.; Lafond, E.; Smith, G.

1998-01-01

Objective: To determine the relationship between degenerative joint disease (DJD) and passive laxity of the hip joint in a group of cats. Design: Prospective study. Animals: A select (nonrandomized) group of 78 cats. Procedure: Standard hip-extended radiographic views and compression and distraction views of the pelvis were obtained from cats during sedation. Radiographs were evaluated, using an Orthopedic Foundation for Animals (OFA)-like scoring system for dogs. Passive joint laxity was measured, using Norberg angle (NA) and distraction index (DI). Hip laxity in cats with DJD was compared with hip laxity in cats without DJD. Results: Hip dysplasia (HD) was subjectively diagnosed radiographically in 25 of 78 (32%) cats using the OFA-like scoring system. Nineteen cats had mild HD 4 had moderate HD, and 2 had severe HD. Fifteen of the 25 cats with HD had DJD. The NA ranged from 56 to 105. The mean NA in cats with DJD was (84 degrees) significantly lower than in cats without DJD (95 degrees). The DI ranged from 0.2 to 0.84. The mean DI for cats with DJD was (0.6) significantly higher than that for cats without DJD (0.49). Cats with a DI < 0.4 did not have DJD. Cats had an increased likelihood of having DJD with increased laxity in the coxofemoral joint, as measured by NA or DI. Clinical Implications: The mean NA for radiographically normal cats (92.4 degrees) was lower than that in radiographically normal dogs (103 degrees). The overall mean DI for cats in this group (0.51) is similar to dogs of breeds with high joint laxity, such as the Labrador Retriever (0.5). As in dogs, there is a relationship between DJD and laxity in the hip joint of cats

The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty

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Pohl, F.; Seufert, J.; Flentje, M.; Koelbl, O. [Wuerzburg Univ. (Germany). Dept. of Radiotherapy; Tauscher, A.; Springorum, H.W. [Caritas Krankenhaus Bad Mergentheim (Germany). Orthopedic Clinic; Lehmann, H. [Caritas Krankenhaus Bad Mergentheim (Germany). Inst. of Radiology

2005-08-01

Purpose: The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure. Patients and methods: From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the evening before surgery with a 7-Gy single fraction. The patients' median age was 66.3 years. Radiologic failure was assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). Analysis of radiographs was performed according to the Brooker Score. Clinical failure was appraised by measurement of passive range of motion (ROM) of the hip joint with a standard goniometer. The t-test was used for statistical analysis. Results: 281 patients (81.5%) did not develop HO. HO of Brooker grade I or II was found in 58 patients (16.8%). Six patients (1.7%) developed HO Brooker grade III or IV. There was a significant negative correlation between the degree of radiologic and clinical failure. ROM differed significantly between patients with HO Brooker grade 0, I, II and patients with HO Brooker grade III, IV. Comparing the pre- and postoperative ROM, all patients with Brooker grade 0, I and II showed a significant improvement of flexion, internal and external rotation, abduction and adduction movement. Patients with HO Brooker grade III and IV showed no improvement of ROM in the postoperative follow-up. Conclusion: The development of HO following THA influences the physical function of the hip joint dependent on the degree of ossification. HO of lower degree (Brooker I, II) does not influence the clinical outcome, whereas HO of higher degree (Brooker III, IV) reduces the function of hip arthroplasty. Therefore, the purpose of a prophylactic therapy must be to reduce HO of higher degree. (orig.)

CT evaluation of chronic hip joint diseases: avascular necrosis vs. osteoarthritis

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Kim, Myeong Jin; Suh, Jin Seok; Lee, Jong Doo; Park, Chang Yoon [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1988-12-15

Computed tomography (CT) of the hip was done on 37 patients those who have been suffered from chronic hip joint pain. There were 18 patients of avascular necrosis of hip (AVN), 67% of whom were affected bilaterally, 15 patients of degenerative arthritis (DA), 33% bilaterally; one patient of tuberculous arthritis, rheumatoid arthritis and traumatic arthritis respectively. Comparison of the staging by means of the CT and plain film showed good correlation between the two methods. The CT findings of the AVN and OA were also compared; crescent sign or fissure, loss of congruity, and loss or change of normal asterisk sign were more commonly seen in AVN. Acetabular change especially associated cystic appearance, osteophytes formation and joint narrowing were more frequent in OA. CT showed primary and secondary change of AVN and OA more clearly without confusion than plain film. We think that CT can be helpful in evaluation and understanding of each disease process and differentiation of the two lesions in difficult case000.

CT evaluation of chronic hip joint diseases: avascular necrosis vs. osteoarthritis

International Nuclear Information System (INIS)

Kim, Myeong Jin; Suh, Jin Seok; Lee, Jong Doo; Park, Chang Yoon

1988-01-01

Computed tomography (CT) of the hip was done on 37 patients those who have been suffered from chronic hip joint pain. There were 18 patients of avascular necrosis of hip (AVN), 67% of whom were affected bilaterally, 15 patients of degenerative arthritis (DA), 33% bilaterally; one patient of tuberculous arthritis, rheumatoid arthritis and traumatic arthritis respectively. Comparison of the staging by means of the CT and plain film showed good correlation between the two methods. The CT findings of the AVN and OA were also compared; crescent sign or fissure, loss of congruity, and loss or change of normal asterisk sign were more commonly seen in AVN. Acetabular change especially associated cystic appearance, osteophytes formation and joint narrowing were more frequent in OA. CT showed primary and secondary change of AVN and OA more clearly without confusion than plain film. We think that CT can be helpful in evaluation and understanding of each disease process and differentiation of the two lesions in difficult cases.

Percutaneous radio frequency ablation for relief of pain in a patient of hip joint avascular necrosis

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Prasad Kasliwal

2014-01-01

Full Text Available Avascular osteonecrosis (AVN of the femoral head is one of the most common skeletal complications of kidney transplantation. Patients with hip joint avascular necrosis usually undergo joint arthroplasty. However, if a patient is unfit for surgery due to some comorbidities, hip joint articular branches denervation can be done to control pain and improve functional life. There is a large variation in the contribution as well in the position of the articular branches to hip joint by obturator, femoral, and sciatic nerves. Several authors have proposed percutaneous radio frequency denervation of the hip joint to eliminate pain.In our case, the patient was having an intractable hip joint pain which was not responding to conservative drug therapy as well physiotherapy. In our patient, hip arthroplasty was contraindicated because of the high risk of infection and anticoagulants. After diagnostic block, the pain in his groin and hip disappeared immediately. The patient noted a decrease in pain (Visual Analog Scale, VAS 9-10 to 1-2 and an improvement in the ability to walk. Then we performed percutaneous radio frequency ablation of the articular branches of the obturator nerve and the femoral nerve. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Because optimal coagulation requires electrodes to lie parallel to the nerves, a perpendicular approach probably produced only a minimal lesion. A perpendicular approach is likely to puncture femoral vessels. Vessel puncture can be avoided if an oblique pass is used. The patient had improved ability to ambulate and the patient can carry out his daily routine activites at home without much pain and can sleep comfortably. There were no complications like motor deficit, neuritis, bleeding, or infection. Our case report gives few impressions. First, it shows that if radio contrast agent (omnipaque dye use is restricted or contraindicated, a

Volume of the ligamentum capitis femoris in osteoartritic hip joints of adult dogs

International Nuclear Information System (INIS)

Mande, J.D.; Mbithi, P.M.F.; Mbugua, S.W.; Buoro, I.B.J.; Gathumbi, P.K.

2003-01-01

Ventrodorsal pelvic radiographs were made of 32 adult dogs under general anaesthesia. The hip joints were evaluated according to the severity of osteoarthritic changes graded as 0, 1, 2 or 3. The dogs were euthanased, the hip joints opened and the ligamentum capitis femoris dissected out in toto. The volume of each ligament was determined using a water displacement technique and the mean volume compared to the four radiographic grades of osteoarthritis. There was an inverse correlation (r = -0.75) between the mean volume of the ligamentum capitis femoris and the increasing severity of osteoarthritis as assessed by radiography. The results confirmed the crucial role of radiography in the clinical evaluation of hip dysplasia and osteoarthritis in the adult dog. Assessment of the volume of the ligamentum capitis femoris revealed that it is an important tool for research in canine hip dysplasia and osteoarthritis

Volume of the ligamentum capitis femoris in osteoarthritic hip joints of adult dogs

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J.D. Mande

2003-06-01

Full Text Available Ventrodorsal pelvic radiographs were made of 32 adult dogs under general anaesthesia. The hip joints were evaluated according to the severity of osteoarthritic changes graded as 0, 1, 2 or 3. The dogs were euthanased, the hip joints opened and the ligamentum capitis femoris dissected out in toto. The volume of each ligament was determined using a water displacement technique and the mean volume compared to the four radiographic grades of osteoarthritis. There was an inverse correlation (r = -0.75 between the mean volume of the ligamentum capitis femoris and the increasing severity of osteoarthritis as assessed by radiography. The results confirmed the crucial role of radiography in the clinical evaluation of hip dysplasia and osteoarthritis in the adult dog. Assessment of the volume of the ligamentum capitis femoris revealed that it is an important tool for research in canine hip dysplasia and osteoarthritis.

Development and validation of the small punch test for UHMWPE used in total joint replacements

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Edidin, A.A. [Drexel Univ., Philadelphia, PA (United States). School of Biomedical Engineering, Science and Health Systems; Howmedica Osteonics Corp., Allendale, NJ (United States); Kurtz, S.M. [Drexel Univ., Philadelphia, PA (United States). School of Biomedical Engineering, Science and Health Systems; Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Orthopaedic Surgery; Exponent, Inc., Philadelphia, PA (United States)

2001-07-01

In order to better understand the mechanical effects of oxidative degradation, improved oxidative stability and crosslinking on ultra-high molecular weight polyethylene (UHMWPE), a unique miniature specimen mechanical testing technique, known as the small punch test, was developed for evaluating total joint replacement components. The small punch test involves deforming a disk-shaped specimen having a thickness of 0.5 mm and a diameter of 6.4 mm. In addition to its small specimen size, the small punch test differs from conventional testing in that deformation of the UHMWPE specimen occurs under multiaxial loading conditions. Using the small punch test, we have traced the evolution of mechanical behavior in UHMWPE after natural (shelf-storage) and accelerated aging conditions. In addition, we have determined relationships between the mechanical behavior of UHMWPE and the biologically relevant wear debris volume generated in total hip replacements. The small punch test has also been used to investigate the effects of radiation crosslinking which has been shown to improve the wear performance in an in vitro hip simulator. However, the crosslinking and subsequent thermal processes used to improve the wear behavior may compromise the native mechanical behavior by changing the ductility and toughness of the UHMWPE bearing. The primary objective of this study was to investigate which tradeoffs exist related to the mechanical behavior associated with various clinically available types of highly crosslinked and thermally treated UHMWPE. We also review the development and validation of the small punch disk bend test and highlight its application to problems of clinical relevance in both hip and knee arthroplasty. (orig.)

Granulomatous pseudotumors in total joint replacement

International Nuclear Information System (INIS)

Griffiths, H.J.; Burke, J.; Bonfiglio, T.A.

1987-01-01

Fourteen patients (15 joints) developed a foreign body reaction to methylmethacrylate, polyethylene, or metal adjacent to a total joint implant, a condition we would like to term granulomatous pseudotumors. There were eight male and six female patients. Their average age was 61 years. The hip was involved in 14 joints (femoral component 11 times, acetabulum 7, and greater trochanter once). One patient presented with granulomatous pseudotumors of the knee. The principal findings included increasing pain and radiographic evidence of loosening occurring on average 2.7 years following the implant. This was followed by a characteristic and gradually developing radiographic pattern of discrete rounded lucencies. These developed into large ovoid lytic areas, destroying both methylmethacrylate and bone. Histologically, the appearances were characterized by histiocytic infiltration and the presence of multiple foreign body giant cells. Foreign material was identified in 9 of 11 cases. The pathogenesis is unknown but appears related to micromovement or loosening of the implant. (orig.)

Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study.

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Charbonnier, Caecilia; Kolo, Frank C; Duthon, Victoria B; Magnenat-Thalmann, Nadia; Becker, Christoph D; Hoffmeyer, Pierre; Menetrey, Jacques

2011-03-01

Early hip osteoarthritis in dancers could be explained by femoroacetabular impingements. However, there is a lack of validated noninvasive methods and dynamic studies to ascertain impingement during motion. Moreover, it is unknown whether the femoral head and acetabulum are congruent in typical dancing positions. The practice of some dancing movements could cause a loss of hip joint congruence and recurrent impingements, which could lead to early osteoarthritis. Descriptive laboratory study. Eleven pairs of female dancer's hips were motion captured with an optical tracking system while performing 6 different dancing movements. The resulting computed motions were applied to patient-specific hip joint 3-dimensional models based on magnetic resonance images. While visualizing the dancer's hip in motion, the authors detected impingements using computer-assisted techniques. The range of motion and congruence of the hip joint were also quantified in those 6 recorded dancing movements. The frequency of impingement and subluxation varied with the type of movement. Four dancing movements (développé à la seconde, grand écart facial, grand écart latéral, and grand plié) seem to induce significant stress in the hip joint, according to the observed high frequency of impingement and amount of subluxation. The femoroacetabular translations were high (range, 0.93 to 6.35 mm). For almost all movements, the computed zones of impingement were mainly located in the superior or posterosuperior quadrant of the acetabulum, which was relevant with respect to radiologically diagnosed damaged zones in the labrum. All dancers' hips were morphologically normal. Impingements and subluxations are frequently observed in typical ballet movements, causing cartilage hypercompression. These movements should be limited in frequency. The present study indicates that some dancing movements could damage the hip joint, which could lead to early osteoarthritis.

Interfacial properties of HIP joint between beryllium and reduced activation ferritic/martensitic steel

International Nuclear Information System (INIS)

Hirose, T.; Ogiwara, H.; Enoeda, M.; Akiba, M.

2007-01-01

Full text of publication follows: ITER test blanket module is the most important components to validate energy production and fuel breeding process for future demonstration reactor. Reduced activation ferritic / martensitic steel is recognized as a promising structural material for breeding blanket systems. And Beryllium must be used as plasma facing materials for ITER in vessel components. In this work, interfacial properties of beryllium/reduced activation ferritic/martensitic steel (RAF/Ms) joint were investigated for a first wall of ITER test blanket module (TBM). The starting materials were ITER grade Beryllium, S65C and a Japanese RAF/M, F82H. The joint was produced by solid state hot isostatic pressing (HIP) method. Chromium layer with the thickness of 1 μm and 10 μm were formed by plasma vapor deposition on the beryllium surface as a diffusion barrier. The HIP was carried out at 1023 K and 1233 K which are determined by standard normalizing and tempering temperature of F82H. The joint made at 1233 K was followed by tempering at 1033 K. The bonding interface was characterized by electron probe microanalysis (EPMA). The bonding strength was also investigated by isometric four point bending tests at ambient temperature. EPMA showed chromium layer effectively worked as a diffusion barrier at 1023 K. However, the beryllium rich layer was formed in F82H after HIP at 1233 K followed by tempering. Bending tests revealed that thin chromium layer and low temperature HIP is preferable. The high temperature HIP introduce brittle BeFe inter metallic compounds along bonding interface. On the other hand, joint with thick chromium layer suffer from brittleness of chromium itself. (authors)

Interfacial properties of HIP joint between beryllium and reduced activation ferritic/martensitic steel

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Hirose, T. [Blanket Engineering Group, Japan Atomic Energy Agency, Naka, Ibaraki (Japan); Ogiwara, H. [Japan Atomic Energy Agency, Tokai-mura, Naga-gun, Ibaraki-ken (Japan); Enoeda, M. [Naka Fusion Research Establishment, J.A.E.R.I., Japan Atomic Energy Research Institute, Naka-gun, Ibaraki-ken (Japan); Akiba, M. [Naka Fusion Institute, Japan Atomic Energy Agency, Naka, Ibaraki (Japan)

2007-07-01

Full text of publication follows: ITER test blanket module is the most important components to validate energy production and fuel breeding process for future demonstration reactor. Reduced activation ferritic / martensitic steel is recognized as a promising structural material for breeding blanket systems. And Beryllium must be used as plasma facing materials for ITER in vessel components. In this work, interfacial properties of beryllium/reduced activation ferritic/martensitic steel (RAF/Ms) joint were investigated for a first wall of ITER test blanket module (TBM). The starting materials were ITER grade Beryllium, S65C and a Japanese RAF/M, F82H. The joint was produced by solid state hot isostatic pressing (HIP) method. Chromium layer with the thickness of 1 {mu}m and 10 {mu}m were formed by plasma vapor deposition on the beryllium surface as a diffusion barrier. The HIP was carried out at 1023 K and 1233 K which are determined by standard normalizing and tempering temperature of F82H. The joint made at 1233 K was followed by tempering at 1033 K. The bonding interface was characterized by electron probe microanalysis (EPMA). The bonding strength was also investigated by isometric four point bending tests at ambient temperature. EPMA showed chromium layer effectively worked as a diffusion barrier at 1023 K. However, the beryllium rich layer was formed in F82H after HIP at 1233 K followed by tempering. Bending tests revealed that thin chromium layer and low temperature HIP is preferable. The high temperature HIP introduce brittle BeFe inter metallic compounds along bonding interface. On the other hand, joint with thick chromium layer suffer from brittleness of chromium itself. (authors)

Perioperative plasmatic presepsin levels in patients undergoing total hip or knee replacement: a preliminary study.

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Vicenti, G; Pesce, V; Bizzoca, D; Nappi, V; Palmiotto, F; Carrozzo, M; Moretti, B

2017-01-01

Presepsin (sCD14-ST) is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in the diagnosis and management of periprosthetic joint infections (PJI). The aim of this study is to define the normal perioperative plasmatic levels of presepsin in patients undergoing primary cementless total hip replacement (THR) or primary cemented total knee replacement (TKR). For this purpose, 50 patients (19 male, 31 female, mean age= 64.04±8.88) were recruited. The patients were divided into two groups: Group A patients underwent cementless THR, whereas Group B patients underwent cemented TKR. On recruitment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score (HHS) for Group A patients and Knee Society Score (KSS) for Group B patients, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS), C-reactive protein (CRP) and procalcitonin (PCT) 24 hours before arthroplasty (T0) and at 24 (T1), 48 (T2), 72 (T3) and 96 (T4) hours postoperatively. Body temperature (θ) was recorded every six hours in the time lapse T0-T4. Presepsin plasmatic concentration was comparable at baseline in both groups. After surgery, however, a significant increase of presepsin was observed in Group A, whereas in Group B no significant changes of presepsin were recorded. A comparable trend of this biomarker was found in the two groups, i.e. presepsin increased from T0 to T3, when it reached its maximum value, and its decrease started at T4. Finally, presepsin resulted more accurate than CRP in the evaluation of perioperative inflammatory response in patients undergoing THR or TKR. These data will be helpful in defining a reference interval for presepsin in patients with prosthetic joint implants, and a cut-off of this biomarker for the diagnosis of PJI.

Immediate mobilisation with complete weight bearing after uncemented total hip replacement in elderly

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Sankarlingam P, Shivraj V, V R Subramaniyam

2014-11-01

Full Text Available This prospective study was analyzed in 23 patients who were allowed to do immediate weight bearing after uncemented total hip arthroplasty. Immediate mobilization shortened the hospital stay and facilitated early rehabilitation of hip. Immediate mobilization was started on postoperative Day 3 rather than Day 7 without any adverse consequences to the patients. A series of 23 elderly patients of age more than 60 years, who were diagnosed with conditions such as avascular necrosis of hip, non union of fracture neck of femur, trochanteric non union and rheumatoid arthritis, underwent uncemented total hip replacement and immediate mobilization was started in our hospital. Patients were evaluated by Harris Hip Scoring Scale. All ambulated patients had painless hip and the mean Harris Hip Score was 85. There were no incidence of stem subsidence, acetabular component loosening, and heterotrophic ossification. This data concluded that early intensive rehabilitation yielded faster attainment of short-term functional milestones in fewer days.

Finite element analysis for friction noise of simplified hip joint and its experimental validation

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Nam, Jae Hyun; Choi, Hoil; Kang, Jae Young [Div. of Mechanical and Automotive Engineering, College of Engineering, Kongju National University, Cheonan (Korea, Republic of)

2016-08-15

In a hip joint system, squeak noise often occurs due to friction between the ball and hemispherical cup. To analyze the dynamic instability induced by friction in the hip joint system, the dynamic ball joint model was constructed by using the finite element method. The results from stability analysis revealed that the mode-coupling type instability occurred for one bending mode and its adjacent composite mode with the axial and transverse displacements with the increase of friction coefficient. The vitro squeak test and vibration modal tests confirmed that squeak arose near the frequency of the mode pair.

3D printing technology used in severe hip deformity.

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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 (P3D 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.

Revision hip replacement for recurrent Hydatid disease of the pelvis: a case report and review of the literature

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Chandrasekar Coonoor R

2010-03-01

Full Text Available Abstract A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis.

Patellofemoral Joint Replacement and Nickel Allergy: An Unusual Presentation

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Farhan Syed

2015-01-01

Full Text Available Metal allergy is an unusual complication of joint replacement that may cause aseptic loosening and necessitate joint revision surgery. We present the case of nickel allergy causing aseptic loosening following patellofemoral joint replacement (PFJR in a 54-year-old male. Joint revision surgery to a nickel-free total knee replacement was performed with good results. Our literature review shows that there is no evidence to guide the management of metal allergy in PFJR. The evidence from studies of total knee replacement is limited to retrospective case series and case reports and gives contradictory recommendations. The optimal management strategy for metal allergy in PFJR is not clear. We recommend allergy testing in patients with history of metal allergy and use of an allergen-free implant in those with positive tests. As there is no gold standard test to establish metal allergy, the choice of test should be guided by availability and recommendation from the local unit of dermatology and allergy testing. We recommend investigation for metal allergy in patients with implant loosening where other causes have been excluded.

Variation in age and physical status prior to total knee and hip replacement surgery

DEFF Research Database (Denmark)

Ackerman, Ilana N; Dieppe, Paul A; March, Lyn M

2009-01-01

OBJECTIVE: To investigate whether variation exists in the preoperative age, pain, stiffness, and physical function of people undergoing total knee replacement (TKR) and total hip replacement (THR) at several centers in Australia and Europe. METHODS: Individual Western Ontario and McMaster Univers...

Assessment of the Patient-Centered and Family-Centered Care Experience of Total Joint Replacement Patients Using a Shadowing Technique.

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Marcus-Aiyeku, Ulanda; DeBari, Margaret; Salmond, Susan

2015-01-01

In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed.

Evaluation of formal methods in hip joint center assessment: an in vitro analysis.

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Lopomo, Nicola; Sun, Lei; Zaffagnini, Stefano; Giordano, Giovanni; Safran, Marc R

2010-03-01

The hip joint center is a fundamental landmark in the identification of lower limb mechanical axis; errors in its location lead to substantial inaccuracies both in joint reconstruction and in gait analysis. Actually in Computer Aided Surgery functional non-invasive procedures have been tested in identifying this landmark, but an anatomical validation is scarcely discussed. A navigation system was used to acquire data on eight cadaveric hips. Pivoting functional maneuver and hip joint anatomy were analyzed. Two functional methods - both with and without using the pelvic tracker - were evaluated: specifically a sphere fit method and a transformation techniques. The positions of the estimated centers with respect to the anatomical center of the femoral head, the influence of this deviation on the kinematic assessment and on the identification of femoral mechanical axis were analyzed. We found that the implemented transformation technique was the most reliable estimation of hip joint center, introducing a - Mean (SD) - difference of 1.6 (2.7) mm from the anatomical center with the pelvic tracker, whereas sphere fit method without it demonstrated the lowest accuracy with 25.2 (18.9) mm of deviation. Otherwise both the methods reported similar accuracy (<3mm of deviation). The functional estimations resulted in the best case to be in an average of less than 2mm from the anatomical center, which corresponds to angular deviations of the femoral mechanical axis smaller than 1.7 (1.3) degrees and negligible errors in kinematic assessment of angular displacements.

Routine one-stage exchange for chronic infection after total hip replacement.

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Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François

2014-12-01

We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange. Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence. The five-year rate for infection recurrence was 16%. The five-year survival rate for recurrence of the index infection was 8%. Forty-two percent of the hips had a good or excellent PMA score, and 46% a good or excellent OH score. Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.

Knee joint motion and muscle activation patterns are altered during gait in individuals with moderate hip osteoarthritis compared to asymptomatic cohort.

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Rutherford, Derek; Moreside, Janice; Wong, Ivan

2015-07-01

Knee replacements are common after hip replacement for end stage osteoarthritis. Whether abnormal knee mechanics exist in moderate hip osteoarthritis remains undetermined and has implications for understanding early osteoarthritis joint mechanics. The purpose of this study was to determine whether three-dimensional (3D) knee motion and muscle activation patterns in individuals with moderate hip osteoarthritis differ from an asymptomatic cohort and whether these features differ between contra- and ipsilateral knees. 3D motions and medial and lateral quadriceps and hamstring surface electromyography were recorded on 20 asymptomatic individuals and 20 individuals with moderate hip osteoarthritis during treadmill walking, using standardized collection and processing procedures. Principal component analysis was used to derive electromyographic amplitude and temporal waveform features. 3D stance-phase range of motion was calculated. A 2-factor repeated analysis of variance determined significant within-group leg and muscle differences. Student's t-tests identified between group differences, with Bonferroni corrections where applicable (α=0.05). Lower sagittal plane motion between early and mid/late stance (5°, P=0.004, effect size: 0.96) and greater mid-stance quadriceps activity was found in the osteoarthritis group (P=0.01). Compared to the ipsilateral knee, a borderline significant increase in mid-stance hamstring activity was found in the contra-lateral knee of the hip osteoarthritis group (P=0.018). Bilateral knee mechanics were altered, suggesting potentially increased loads and knee muscle fatigue. There was no indication that one knee is more susceptible to osteoarthritis than the other, thus clinicians should include bilateral knee analysis when treating patients with hip osteoarthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Development of a hip joint model for finite volume simulations.

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Cardiff, P; Karač, A; FitzPatrick, D; Ivanković, A

2014-01-01

This paper establishes a procedure for numerical analysis of a hip joint using the finite volume method. Patient-specific hip joint geometry is segmented directly from computed tomography and magnetic resonance imaging datasets and the resulting bone surfaces are processed into a form suitable for volume meshing. A high resolution continuum tetrahedral mesh has been generated, where a sandwich model approach is adopted; the bones are represented as a stiffer cortical shells surrounding more flexible cancellous cores. Cartilage is included as a uniform thickness extruded layer and the effect of layer thickness is investigated. To realistically position the bones, gait analysis has been performed giving the 3D positions of the bones for the full gait cycle. Three phases of the gait cycle are examined using a finite volume based custom structural contact solver implemented in open-source software OpenFOAM.

Functional exercise after total hip replacement (FEATHER): a randomised control trial.

LENUS (Irish Health Repository)

Monaghan, Brenda

2012-11-01

Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR). It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life.

Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf's method of hip ultrasonography.

Science.gov (United States)

Tschauner, Christian; Fürntrath, Frank; Saba, Yasaman; Berghold, Andrea; Radl, Roman

2011-12-01

PURPOSE/BACKGROUND/INTRODUCTION: The aim of this study was to retrospectively evaluate the impact of neonatal sonographic hip screening using Graf's method for the management and outcome of orthopaedic treatment of decentered hip joints with developmental dysplasia of the hip (DDH), using three decades (1978-2007) of clinical information compiled in a medical database. Three representative cohorts of consecutive cases of decentered hip joints were selected according to different search criteria and inclusion and exclusion parameters: (1) cohort 1 (1978-1982; n = 80), without sonographic screening; (2) cohort 2.1 (1994-1996; n = 91), with nationwide established general sonographic screening according to the Graf-method; (3) cohort 2.2 (2003-2005; n = 91), with sonographic screening including referred cases for open reduction from non-screened populations. These three cohorts were compared for the following parameters: age at initial treatment, successful closed reduction, necessary overhead traction, necessary adductor-tenotomy, rate of open reduction, rate of avascular necrosis (AVN) and rate of secondary acetabuloplasty. The age at initial treatment was reduced from 5.5 months in the first cohort to 2 months in the two subsequent two cohorts and the rate of successful closed reduction increased from 88.7 to 98.9 and 95.6%, respectively. There was a statistically significant improvement in six out of seven parameters with sonographic hip screening; only the rate of secondary acetabuloplasty did not improve significantly. Compared to the era before the institution of a sonographic hip screening programme according to the Graf-method in Austria in 1992, ultrasound screening based-treatment of decentered hip joints has become safer, shorter and simpler: "safer" means lower rate of AVN, "shorter" means less treatment time due to earlier onset and "simpler" means that the devices are now less invasive and highly standardized.

Cross-cultural adaptation and validation of the French version of the Hip disability and Osteoarthritis Outcome Score (HOOS) in hip osteoarthritis patients

DEFF Research Database (Denmark)

Ornetti, P; Parratte, S; Gossec, L

2010-01-01

osteoarthritis (OA). METHODS: The French version of the HOOS was developed according to published international guidelines to ensure content validity. The new version was then evaluated in two symptomatic hip OA populations, one with no indication for joint replacement (medical group), and the other waiting......OBJECTIVE: To translate and adapt the Hip disability and Osteoarthritis Outcome Score (HOOS) into French and to evaluate the psychometric properties of this new version, by testing feasibility, internal consistency, construct validity, reliability and responsiveness, in patients with hip...

Bone mineral density in patients with destructive arthrosis of the hip joint.

Science.gov (United States)

Okano, Kunihiko; Aoyagi, Kiyoshi; Enomoto, Hiroshi; Osaki, Makoto; Chiba, Ko; Yamaguchi, Kazumasa

2014-05-01

Recent reports have shown the existence of subchondral insufficiency fracture in rapidly destructive arthrosis of the hip joint (RDA), and the findings suggest that osteopenia is related to the pathogenesis of the rapid progression of this disease. Therefore, we measured bone mineral density (BMD) in RDA patients. We measured BMD of the lumbar spine, radius, and calcaneus using dual-energy X-ray absorptiometry in 19 patients with RDA and 75 with osteoarthritis of the hip (OA) and compared BMD at different skeletal sites between RDA and OA patients. No significant differences were observed in BMD of the lumbar spine, ultradistal radius, mid-radius, and calcaneous between the RDA and OA groups. Our data suggest that RDA is not accompanied by generalized osteoporosis. Factors other than generalized bone status, for example, BMD around the affected hip joint before destruction, need to be analyzed to elucidate the pathophysiological mechanism of RDA.

Postoperative radiation therapy after hip replacement in high-risk patients for development of heterotopic bone formation

International Nuclear Information System (INIS)

Hashem, R.; Rene, N.; Souhami, L.; Tanzer, M.; Evans, M.

2011-01-01

Purpose. - To report the results of postoperative radiation therapy in preventing the development of heterotopic bone formation after hip replacement surgery in high-risk patients. Patients and methods. - Between 1991 and 2007, 44 patients were preventively treated with postoperative RT after total hip replacement. In total, 47 hips were treated. All patients were considered at high risk for developing heterotopic bone formation. Most patients (63.5%) were treated because of a history of severe osteoarthritis or ankylosing spondylitis. All patients were treated with shaped parallel-opposed fields with a single fraction of 7 Gy using 6 or 18 MV photons. Most patients (94%) received radiation therapy within 72 hours postoperative and in only three patients radiation therapy was delivered after 72 hours post-surgery (5-8 days). Results. - Minimum follow-up was 1 year. There were 18 females and 26 males. Median age was 63 years (range: 18-80). Treatments were well tolerated and no acute toxicity was seen post-radiation therapy. Only one of the 47 hips (2%) developed heterotopic bone formation. This patient received postoperative radiation therapy to both hips but only developed heterotopic bone formation in one of them. None of the three patients treated beyond 72 hours failed. To date no late toxicity has been observed. Conclusion. - The use of postoperative radiation therapy was an effective and safe treatment in the prevention of heterotopic bone formation in a high-risk group of patients undergoing total hip replacement. (authors)

Characterization and tribology of PEG-like coatings on UHMWPE for total hip replacements.

Science.gov (United States)

Kane, Sheryl R; Ashby, Paul D; Pruitt, Lisa A

2010-03-15

A crosslinked hydrogel coating similar to poly(ethylene glycol) (PEG) was covalently bonded to the surface of ultrahigh molecular weight polyethylene (UHMWPE) to improve the lubricity and wear resistance of the UHWMPE for use in total joint replacements. The chemistry, hydrophilicity, and protein adsorption resistance of the coatings were determined, and the wear behavior of the PEG-like coating was examined by two methods: pin-on-disk tribometry to evaluate macroscale behavior, and atomic force microscopy (AFM) to simulate asperity wear. As expected, the coating was found to be highly PEG-like, with approximately 83% ether content by x-ray photoelectron spectroscopy and more hydrophilic and resistant to protein adsorption than uncoated UHMWPE. Pin-on-disk testing showed that the PEG-like coating could survive 3 MPa of contact pressure, comparable to that experienced by total hip replacements. AFM nanoscratching experiments uncovered three damage mechanisms for the coatings: adhesion/microfracture, pure adhesion, and delamination. The latter two mechanisms appear to correlate well with wear patterns induced by pin-on-disk testing and evaluated by attenuated total reflection Fourier transform infrared spectroscopy mapping. Understanding the mechanisms by which the PEG-like coatings wear is critical for improving the behavior of subsequent generations of wear-resistant hydrogel coatings. (c) 2009 Wiley Periodicals, Inc.

Joint angles of the ankle, knee, and hip and loading conditions during split squats.

Science.gov (United States)

Schütz, Pascal; List, Renate; Zemp, Roland; Schellenberg, Florian; Taylor, William R; Lorenzetti, Silvio

2014-06-01

The aim of this study was to quantify how step length and the front tibia angle influence joint angles and loading conditions during the split squat exercise. Eleven subjects performed split squats with an additional load of 25% body weight applied using a barbell. Each subject's movements were recorded using a motion capture system, and the ground reaction force was measured under each foot. The joint angles and loading conditions were calculated using a cluster-based kinematic approach and inverse dynamics modeling respectively. Increases in the tibia angle resulted in a smaller range of motion (ROM) of the front knee and a larger ROM of the rear knee and hip. The external flexion moment in the front knee/hip and the external extension moment in the rear hip decreased as the tibia angle increased. The flexion moment in the rear knee increased as the tibia angle increased. The load distribution between the legs changed squat execution was varied. Our results describing the changes in joint angles and the resulting differences in the moments of the knee and hip will allow coaches and therapists to adapt the split squat exercise to the individual motion and load demands of athletes.

Modern radiological postoperative diagnostics of the hip joint in children and adults; Moderne radiologische postoperative Diagnostik des Hueftgelenks im Kindes- und Erwachsenenalter

Energy Technology Data Exchange (ETDEWEB)

Weber, M.A.; Thierjung, H.; Kloth, J.K. [Heidelberg University Hospital (Germany). Diagnostic and Interventional Radiology; Egermann, M. [Heidelberg University Hospital (Germany). Center for Orthopedics

2015-07-15

The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the hip joint following trauma and endoprosthesis implantation. With the increasing number of joint-preserving surgery, e. g. of surgical hip luxation and hip arthroscopy for the treatment of femoroacetabular impingement (FAI), high-resolution imaging of intra-articular pathologies before and after surgery has become increasingly important. In this review article, diagnostic imaging of the hip joint is presented following common trauma surgery and orthopedic surgery interventions. The imaging modalities of projection radiography, CT and MRI including direct MR-arthrography are discussed with regard to their diagnostic capability in the postoperative assessment of the hip joint. Among others topics, imaging is discussed following hip arthroplasty, following surgical hip luxation and arthroscopic interventions for the treatment of FAI, as well as following core decompression for avascular necrosis of the femoral head. Moreover, orthopedic interventions of the hip joint in children and adolescents are presented and the dedicated reporting of postoperative imaging is outlined.

Hospital Discharge Information After Elective Total hip or knee Joint Replacement Surgery: A clinical Audit of preferences among general practitioners

Directory of Open Access Journals (Sweden)

Andrew M Briggs

2012-05-01

Full Text Available AbstractThe demand for elective joint replacement (EJR surgery for degenerative joint disease continues to rise in Australia, and relative to earlier practices, patients are discharged back to the care of their general practitioner (GP and other community-based providers after a shorter hospital stay and potentially greater post-operative acuity. In order to coordinate safe and effective post-operative care, GPs rely on accurate, timely and clinically-informative information from hospitals when their patients are discharged. The aim of this project was to undertake an audit with GPs regarding their preferences about the components of information provided in discharge summaries for patients undergoing EJR surgery for the hip or knee. GPs in a defined catchment area were invited to respond to an online audit instrument, developed by an interdisciplinary group of clinicians with knowledge of orthopaedic surgery practices. The 15-item instrument required respondents to rank the importance of components of discharge information developed by the clinician working group, using a three-point rating scale. Fifty-three GPs and nine GP registrars responded to the audit invitation (11.0% response rate. All discharge information options were ranked as ‘essential’ by a proportion of respondents, ranging from 14.8–88.5%. Essential information requested by the respondents included early post-operative actions required by the GP, medications prescribed, post-operative complications encountered and noting of any allergies. Non-essential information related to the prosthesis used. The provision of clinical guidelines was largely rated as ‘useful’ information (47.5–56.7%. GPs require a range of clinical information to safely and effectively care for their patients after discharge from hospital for EJR surgery. Implementation of changes to processes used to create discharge summaries will require engagement and collaboration between clinical staff

The tribological behaviour of different clearance MOM hip joints with lubricants of physiological viscosities.

Science.gov (United States)

Hu, X Q; Wood, R J K; Taylor, A; Tuke, M A

2011-11-01

Clearance is one of the most influential parameters on the tribological performance of metal-on-metal (MOM) hip joints and its selection is a subject of considerable debate. The objective of this paper is to study the lubrication behaviour of different clearances for MOM hip joints within the range of human physiological and pathological fluid viscosities. The frictional torques developed by MOM hip joints with a 50 mm diameter were measured for both virgin surfaces and during a wear simulator test. Joints were manufactured with three different diametral clearances: 20, 100, and 200 microm. The fluid used for the friction measurements which contained different ratios of 25 percent newborn calf serum and carboxymethyl cellulose (CMC) with the obtained viscosities values ranging from 0.001 to 0.71 Pa s. The obtained results indicate that the frictional torque for the 20 microm clearance joint remains high over the whole range of the viscosity values. The frictional torque of the 100 microm clearance joint was low for the very low viscosity (0.001 Pa s) lubricant, but increased with increasing viscosity value. The frictional torque of the 200 microm clearance joint was high at very low viscosity levels, however, it reduced with increasing viscosity. It is concluded that a smaller clearance level can enhance the formation of an elastohydrodynamic lubrication (EHL) film, but this is at the cost of preventing fluid recovery between the bearing surfaces during the unloaded phase of walking. Larger clearance bearings allow a better recovery of lubricant during the unloaded phase, which is necessary for higher viscosity lubricants. The selection of the clearance value should therefore consider both the formation of the EHL film and the fluid recovery as a function of the physiological viscosity in order to get an optimal tribological performance for MOM hip joints. The application of either 25 per cent bovine serum or water in existing in vitro tribological study should

Can shared care deliver better outcomes for patients undergoing total hip replacement?

NARCIS (Netherlands)

Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

2000-01-01

Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

The relationship of hip joint space to self reported hip pain. A survey of 4.151 subjects of the Copenhagen City Heart Study: the Osteoarthritis Substudy

DEFF Research Database (Denmark)

Jacobsen, Steffen; Sonne-Holm, Stig; Søballe, Kjeld

2004-01-01

OBJECTIVES: (1) To evaluate the effect of pelvic orientation on measurements of hip joint space widths (JSW) in cadaver pelvic radiographs, thereby validating the pelvic radiographs of the Copenhagen City Heart Study: The Osteoarthritis Substudy (CCHS III) cohort of 4.152 subjects, and (2...... was significantly associated to self reported pain in or around the hip joint in both sexes. CONCLUSION: Measurements of minimum hip JSW did not seem to be significantly influenced by varying spatial orientation of the pelvis during X-ray recordings. An inclusion criteria of minimum JSW

A model-based approach to stabilizing crutch supported paraplegic standing by artifical hip joint stiffness

OpenAIRE

van der Spek, J.H.; Veltink, Petrus H.; Hermens, Hermanus J.; Koopman, Hubertus F.J.M.; Boom, H.B.K.

2003-01-01

The prerequisites for stable crutch supported standing were analyzed in this paper. For this purpose, a biomechanical model of crutch supported paraplegic stance was developed assuming the patient was standing with extended knees. When using crutches during stance, the crutches will put a position constraint on the shoulder, thus reducing the number of degrees of freedom. Additional hip-joint stiffness was applied to stabilize the hip joint and, therefore, to stabilize stance. The required hi...

Feasibility of Early-Initiated Progressive Resistance Training after Total Hip Replacement

DEFF Research Database (Denmark)

Mikkelsen, Lone Ramer; Mechlenburg, Inger; Petersen, Annemette Krintel

during the exercises were measured at each training session. Isometric muscle strength was measured before and 4 weeks after the THR. Findings / Results: Pain during exercises and resting pain before and after each training session was unchanged or decreased during the 4 weeks of training. Averaged...... across exercises pain during training decreased from 3.6 (sd: 2.8) at the first session to 1.52 (sd: 1.8) VAS-mm at the last session, ptraining load increased progressively for all 4 exercises during the 4 weeks of training. For example: 2nd, 5th and 8th training session. Hip......Background: Muscle atrophy, reduced hip muscle strength and function are documented within the first weeks after Total Hip Replacement (THR). Purpose / Aim of Study: The purpose of this study was to evaluate the feasibility of early-initiated progressive resistance training (PRT) after THR...

The Biologic Response to Polyetheretherketone (PEEK) Wear Particles in Total Joint Replacement: A Systematic Review.

Science.gov (United States)

Stratton-Powell, Ashley A; Pasko, Kinga M; Brockett, Claire L; Tipper, Joanne L

2016-11-01

Polyetheretherketone (PEEK) and its composites are polymers resistant to fatigue strain, radiologically transparent, and have mechanical properties suitable for a range of orthopaedic applications. In bulk form, PEEK composites are generally accepted as biocompatible. In particulate form, however, the biologic response relevant to joint replacement devices remains unclear. The biologic response to wear particles affects the longevity of total joint arthroplasties. Particles in the phagocytozable size range of 0.1 µm to 10 µm are considered the most biologically reactive, particularly particles with a mean size of PEEK-based wear debris from total joint arthroplasties. (1) What are the quantitative characteristics of PEEK-based wear particles produced by total joint arthroplasties? (2) Do PEEK wear particles cause an adverse biologic response when compared with UHMWPE or a similar negative control biomaterial? (3) Is the biologic response affected by particle characteristics? Embase and Ovid Medline databases were searched for studies that quantified PEEK-based particle characteristics and/or investigated the biologic response to PEEK-based particles relevant to total joint arthroplasties. The keyword search included brands of PEEK (eg, MITCH, MOTIS) or variations of PEEK types and nomenclature (eg, PAEK, CFR-PEEK) in combination with types of joint (eg, hip, knee) and synonyms for wear debris or immunologic response (eg, particles, cytotoxicity). Peer-reviewed studies, published in English, investigating total joint arthroplasty devices and cytotoxic effects of PEEK particulates were included. Studies investigating devices without articulating bearings (eg, spinal instrumentation devices) and bulk material or contact cytotoxicity were excluded. Of 129 studies, 15 were selected for analysis and interpretation. No studies were found that isolated and characterized PEEK wear particles from retrieved periprosthetic human tissue samples. In the four studies that

Comparative responsiveness of measures of pain and function after total hip replacement

DEFF Research Database (Denmark)

Nilsdotter, A K; Roos, Ewa M.; Westerlund, J P

2001-01-01

To compare the responsiveness of the Functional Assessment System (FAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Medical Outcomes Study 36-item Short Form (SF-36) in patients with osteoarthritis (OA) scheduled for total hip replacement....

Lower limb joint replacement in rheumatoid arthritis

Directory of Open Access Journals (Sweden)

Clement Nicholas D

2012-06-01

Full Text Available Abstract Introduction There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis. Methods We performed a search of the medical literature, using the PubMed search engine (http://www.pubmed.gov. We used the following terms: ‘rheumatoid’ ‘replacement’ ‘arthroplasty’ and ‘outcome’. Findings The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR and total knee replacement (TKR have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome.

Strain-stress analysis of surface prosthesis of hip joint

Czech Academy of Sciences Publication Activity Database

Návrat, Tomáš; Fuis, Vladimír; Florian, Z.; Hlavoň, Pavel

2007-01-01

Roč. 40, č. 2 (2007), S559-S559 ISSN 0021-9290. [ISB 2007. Taipei, 01.07.2007-05.07.2007] R&D Projects: GA ČR GA101/05/0136 Institutional research plan: CEZ:AV0Z20760514 Keywords : surface prosthesis * hip joint * FEM Subject RIV: BO - Biophysics Impact factor: 2.897, year: 2007

Steroid-associated hip joint collapse in bipedal emus.

Directory of Open Access Journals (Sweden)

Li-Zhen Zheng

Full Text Available In this study we established a bipedal animal model of steroid-associated hip joint collapse in emus for testing potential treatment protocols to be developed for prevention of steroid-associated joint collapse in preclinical settings. Five adult male emus were treated with a steroid-associated osteonecrosis (SAON induction protocol using combination of pulsed lipopolysaccharide (LPS and methylprednisolone (MPS. Additional three emus were used as normal control. Post-induction, emu gait was observed, magnetic resonance imaging (MRI was performed, and blood was collected for routine examination, including testing blood coagulation and lipid metabolism. Emus were sacrificed at week 24 post-induction, bilateral femora were collected for micro-computed tomography (micro-CT and histological analysis. Asymmetric limping gait and abnormal MRI signals were found in steroid-treated emus. SAON was found in all emus with a joint collapse incidence of 70%. The percentage of neutrophils (Neut % and parameters on lipid metabolism significantly increased after induction. Micro-CT revealed structure deterioration of subchondral trabecular bone. Histomorphometry showed larger fat cell fraction and size, thinning of subchondral plate and cartilage layer, smaller osteoblast perimeter percentage and less blood vessels distributed at collapsed region in SAON group as compared with the normal controls. Scanning electron microscope (SEM showed poor mineral matrix and more osteo-lacunae outline in the collapsed region in SAON group. The combination of pulsed LPS and MPS developed in the current study was safe and effective to induce SAON and deterioration of subchondral bone in bipedal emus with subsequent femoral head collapse, a typical clinical feature observed in patients under pulsed steroid treatment. In conclusion, bipedal emus could be used as an effective preclinical experimental model to evaluate potential treatment protocols to be developed for prevention of

Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres

Directory of Open Access Journals (Sweden)

Puhl Wofhart

2009-02-01

Full Text Available Abstract Background Total hip joint replacement (THR is a high volume, effective intervention for hip osteoarthritis (OA. However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation. Methods A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC – Likert version 3.1. Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L grading and Osteoarthritis Research Society International (OARSI atlas features. Regression analyses were carried out. Results Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4% than men. Most (79% were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common. Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score; the mean total WOMAC score was 59.2 (SD 16.1. The radiographic severity showed no correlation with WOMAC scores. Significantly higher WOMAC scores (worse disease were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment. Conclusion 1. Clinical disease severity

[Short-term effectiveness of Swanson artificial joint replacement in treating posttraumatic metacarpophalangeal joint stiffness].

Science.gov (United States)

Lu, Hui; Shen, Xiangqian; Xu, Jihua; Huang, Xin; Ye, Po; Wu, Shoucheng

2011-11-01

To investigate the short-term effectiveness of Swanson artificial joint replacement in treating post-traumatic metacarpophalangeal joint stiffness. Between August 2007 and May 2010, 11 cases (13 fingers) of metacarpophalangeal joint stiffness with soft tissue defects underwent Swanson artificial joint replacement. There were 7 males (9 fingers) and 4 females (4 fingers), aged 43 to 65 years with an average of 49 years. The involved fingers included 4 thumbs, 4 index fingers, 3 middle fingers, and 2 ring fingers. The types of injury included open and crush injury in 8 fingers, fracture of the metacarpophalangeal joint in 3 fingers, metacarpophalangeal joint severing in 2 fingers. The time from joint stiffness to hospitalization was 12 to 48 weeks (mean, 24 weeks). The joint activity was (136.82 +/- 28.96) degrees. According to total active motion (TAM) assessment, included good in 1 finger, fair in 6 fingers, and poor in 6 fingers before operation. The activities of daily living were assessed by Sollerman score, which was 45.64 +/- 11.04. The X-ray films and CT scan showed traumatic arthritis of the metacarpophalangeal joint. The incision healed by first intention. All patients were followed up 12 to 34 months (mean, 24.1 months). At last follow-up, the joint activity was (194.64 +/- 28.86) degrees, showing significant difference when compared with preoperative value (t = 25.214, P = 0.000). According to TAM assessment, including excellent in 1 finger, good in 4 fingers, fair in 7 fingers, and poor in 1 finger. The Sollerman score was 67.45 +/- 8.20 postoperatively, showing significant difference when compared with the preoperative score (t = -10.470, P = 0.000). X-ray examination showed no prosthesis fracture, periprosthetic fracture, or joint dislocation occurred at last follow-up. Swanson artificial joint replacement can be applied to treat post-traumatic metacarpophalangeal joint stiffness, which can improve the joint activity and has satisfactory short

Nurses' responsibilities in postoperative pain management following total hip arthroplasty

OpenAIRE

Dumolard, Pierre; Gök, Mustafa; Le, Ngoc

2017-01-01

Total hip arthroplasty is the replacement of a hip joint that has been severely damaged. The operation is recommended if other treatments have not responded adequately. As the nurses are the professionals who spend the most time with patients after the surgery, they play an important role in the patient’s pain management. The aim of the thesis is to define the nurse’s responsibilities in the care of total hip arthroplasty. The purpose of the thesis is to analyze existing research, which may s...

Preoperative radiotherapy (RT) for prevention of heterotopic ossification (HO) after total hip replacement

International Nuclear Information System (INIS)

Heyd, R.; Schopohl, B.; Boettcher, H.D.; Kirchner, J.

1997-01-01

Preliminary results of a prospective study which investigates the efficacy of preoperative radiotherapy (RT) for prevention of heterotopic ossification (HO) after total hip arthroplasty are summarized. A total number of 20 hip joints (18 patients) were irradiated with a single dose of 6.0 Gy Brooker grade II). The functional outcome quantified with the Harris score was improved by an average of 37.9 points. The authors conclude that preoperative RT is an effective alternative for postoperative irradiation. (orig.) [de

Hip and knee joint loading during vertical jumping and push jerking.

Science.gov (United States)

Cleather, Daniel J; Goodwin, Jon E; Bull, Anthony M J

2013-01-01

The internal joint contact forces experienced at the lower limb have been frequently studied in activities of daily living and rehabilitation activities. In contrast, the forces experienced during more dynamic activities are not well understood, and those studies that do exist suggest very high degrees of joint loading. In this study a biomechanical model of the right lower limb was used to calculate the internal joint forces experienced by the lower limb during vertical jumping, landing and push jerking (an explosive exercise derived from the sport of Olympic weightlifting), with a particular emphasis on the forces experienced by the knee. The knee experienced mean peak loadings of 2.4-4.6×body weight at the patellofemoral joint, 6.9-9.0×body weight at the tibiofemoral joint, 0.3-1.4×body weight anterior tibial shear and 1.0-3.1×body weight posterior tibial shear. The hip experienced a mean peak loading of 5.5-8.4×body weight and the ankle 8.9-10.0×body weight. The magnitudes of the total (resultant) joint contact forces at the patellofemoral joint, tibiofemoral joint and hip are greater than those reported in activities of daily living and less dynamic rehabilitation exercises. The information in this study is of importance for medical professionals, coaches and biomedical researchers in improving the understanding of acute and chronic injuries, understanding the performance of prosthetic implants and materials, evaluating the appropriateness of jumping and weightlifting for patient populations and informing the training programmes of healthy populations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Expressiveness and frequency differences of hip joint tissues pathomorphological changes in diseases complicated by femoroacetabular impingement syndrome

Directory of Open Access Journals (Sweden)

V. V. Grigorovsky

2013-12-01

Full Text Available Preface. Last years the increasing value in pathogenesis of hip joint osteoarthrosis (ОА both in adult patients and in children and teenagers is attached to articular surfaces congruence violation of the femoral head and acetabulum that is formed by articular cartilage and labrum, the last one by head movements in the maximum hip flexion and adduction enters in femoroacetabular impingement (FAI with edge of the head and allied site of the neck and is mechanically damaged. Purpose of the work. To establish hip joint tissues pathomorphological changes, to which FAI syndrome leads, and on the basis of graded expressiveness quantification of pathological changes to define differences of their occurrence frequency in groups of patients in some diseases with affected hip joint. Materials and research methods. 65 biopsies of hip joint tissues: proximal femoral epimetaphysis, acetabulum, acetabular lip and joint capsule –from patients with aseptic femoral head necrosis (АNFH and juvenile slipped femoral capital epiphysis (JSFCE. After study of qualitative features of hip joint tissues injury, some graded morphological indices characterizing conditions of affected joints, as occurrence frequencies of pathological changes of certain gradation, and also their comparison in groups of monitoring with calculation of their distinctions significance, were estimated. Results and their discussion. Clinical-pathomorphological research has revealed the various pathological changes shown by signs of discirculatory, chronic dystrophic-destructive and inflammatory processes in tissues of the femoral head, neck, acetabulum and joint capsule. FAI, causing secondary dystrophic-destructive changes in hip joint tissues, has different rates of development in various primary pathology: in JSCFE anatomic conditions of FAI develop faster, in АNFH – more slowly in the dynamics of secondary changes, the last ones do not differ statistically in various nosologies on rates

Prosthesis infections after orthopedic joint replacement

DEFF Research Database (Denmark)

Song, Zhijun; Borgwardt, Lotte; Høiby, Niels

2013-01-01

Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore...

The impact of surface and geometry on coefficient of friction of artificial hip joints.

Science.gov (United States)

Choudhury, Dipankar; Vrbka, Martin; Mamat, Azuddin Bin; Stavness, Ian; Roy, Chanchal K; Mootanah, Rajshree; Krupka, Ivan

2017-08-01

Coefficient of friction (COF) tests were conducted on 28-mm and 36-mm-diameter hip joint prostheses for four different material combinations, with or without the presence of Ultra High Molecular Weight Polyethylene (UHMWPE) particles using a novel pendulum hip simulator. The effects of three micro dimpled arrays on femoral head against a polyethylene and a metallic cup were also investigated. Clearance played a vital role in the COF of ceramic on polyethylene and ceramic on ceramic artificial hip joints. Micro dimpled metallic femoral heads yielded higher COF against a polyethylene cup; however, with metal on metal prostheses the dimpled arrays significantly reduced the COF. In situ images revealed evidence that the dimple arrays enhanced film formation, which was the main mechanism that contributed to reduced friction. Copyright © 2017 Elsevier Ltd. All rights reserved.

The role of imaging in early hip OA.

Science.gov (United States)

Siebelt, M; Agricola, R; Weinans, H; Kim, Y J

2014-10-01

Hip osteoarthritis (OA) is characterized by cartilage degradation, subchondral bone sclerosis and osteophyte formation. Nowadays, OA is thought to develop via different etiologies that all lead to a similar form of end stage joint degradation. One of these subtypes is related to an abnormal shaped hip joint, like acetabular dysplasia and a cam deformity. These bony abnormalities are highly predictive for development of hip OA, but they are likely to already be present from childhood. This suggests that these deformations induce OA changes in the hip, well before extensive hip degradation becomes present three to four decades later. Accurate detection and successful characterization of these early OA events might lead to better treatment options for hip OA besides nowadays available invasive joint replacement surgery. However, current diagnostic imaging techniques like radiographs or plain magnetic resonance imaging (MRI), are not sensitive enough to detect these subtle early OA changes. Nor are they able to disentangle intertwined and overlapping cascades from different OA subtypes, and neither can they predict OA progression. New and more sensitive imaging techniques might enable us to detect first OA changes on a cellular level, providing us with new opportunities for early intervention. In this respect, shape analysis using radiography, MRI, computed tomography (CT), single photon emission computed tomography (SPECT)/CT, and positron emission tomography (PET) might prove promising techniques and be more suited to detect early pathological changes in the hip joint. A broad application of these techniques might give us more understanding what can be considered physiological adaptation of the hip, or when early OA really starts. With a more clear definition of early OA, more homogenous patient populations can be selected and help with the development of new disease modifying OA interventions. Copyright © 2014 Osteoarthritis Research Society International

An in vitro simulation model to assess the severity of edge loading and wear, due to variations in component positioning in hip joint replacements.

Science.gov (United States)

O'Dwyer Lancaster-Jones, O; Williams, S; Jennings, L M; Thompson, J; Isaac, G H; Fisher, J; Al-Hajjar, M

2017-09-23

The aim of this study was to develop a preclinical in vitro method to predict the occurrence and severity of edge loading condition associated with the dynamic separation of the centres of the head and cup (in the absence of impingement) for variations in surgical positioning of the cup. Specifically, this study investigated the effect of both the variations in the medial-lateral translational mismatch between the centres of the femoral head and acetabular cup and the variations in the cup inclination angles on the occurrence and magnitude of the dynamic separation, the severity of edge loading, and the wear rate of ceramic-on-ceramic hip replacement bearings in a multi-station hip joint simulator during a walking gait cycle. An increased mismatch between the centres of rotation of the femoral head and acetabular cup resulted in an increased level of dynamic separation and an increase in the severity of edge loading condition which led to increased wear rate in ceramic-on-ceramic bearings. Additionally for a given translational mismatch, an increase in the cup inclination angle gave rise to increased dynamic separation, worst edge loading conditions, and increased wear. To reduce the occurrence and severity of edge loading, the relative positions (the mismatch) of the centres of rotation of the head and the cup should be considered alongside the rotational position of the acetabular cup. This study has considered the combination of mechanical and tribological factors for the first time in the medial-lateral axis only, involving one rotational angle (inclination) and one translational mismatch. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc.

The Relationship between Isokinetic Relative Torque of Hip, Knee and Ankle Joints and the Height of Guide Leg Jump in Young Men

Directory of Open Access Journals (Sweden)

Saeed Nikoukheslat

2016-06-01

Full Text Available Objective: The aim of this study was to investigate the relationship between isokinetic relative torques of hip, knee and ankle joints and the height of guide leg jump in young men. Methods: 27 college male athletes with mean age of 25±3.5 years, height 178.5±7.8 cm and weight of 75.7±10.7 kg voluntarily participated in this study. Isokinetic torque of hip, knee and ankle joints and the height of vertical jump were measured using BIODEX SYSTEM PRO 4 and digital vertical jumping tester systems respectively. Pearson correlation test at p<0.05 was used for statistical analysis. Results: Results showed that there were significant correlations between height of jump and hip joint flexion (p= 0.047 & r= 0.39 and extension (p= 0.003 & r= 0.55 torques of guide leg, hip joint extension torque of support leg (p= 0.020 & r=0.45 and knee joint flexion (p= 0.019 & r=0.45 and extension torques of support leg (p=0.006 & r=0.52. Conclusion: The results of this study show that flexion and extension torques of hip joint in guide leg and knee joint in support leg and also extension torque of hip joint in support leg have main effect on height of guide leg jump. Thus, in designing a specific training program for athletes in whom the nature of jump in their sports is guide leg jump, particular attention should be given to hip and knee joints strength.

Cemented total hip replacement cable debris and acetabular construct durability.

Science.gov (United States)

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

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.

Resumption of car driving after total hip replacement.

Science.gov (United States)

Abbas, Ghulam; Waheed, Abdul

2011-04-01

To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR). 80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so. 105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability. The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.

Surgical treatment of isolated aseptic acetabular loosening of the hip joint

Directory of Open Access Journals (Sweden)

Zvereva К.Р.

2017-09-01

Full Text Available Aseptic acetabular loosening is one of the most common complications of primary hip arthroplasty Its treatment is possible in the volume of replacement of only the endoprosthesis cup with the preservation of a stable correctly oriented femoral component. The sequence of actions consists of provision of access to the acetabulum component and its replacement, after which the necessary offset is selected by changing the size of the head and installing a new pair of friction. Currently, the vast majority of the installed heads during the primary and revision hip replacement have a standard size forthe cone of the femoral component 12/14mm. According to the observations, in 3% of cases, there are femoral components with non-standard cone sizes 11/13 mm, usually established 7-8 years ago. The absence of heads forthe necessary cone leads to the need to replace the stable correctly oriented femoral component, which is accompanied by an increase in the time of intervention, the volume of intraoperative blood loss and the risk of intraopera-tive peri-prosthetic fracture. We represent the clinical case of a 75-year-old patient with a dislocation of the acetabular component and a stable correctly oriented femoral component, which during the audit intervention due to the lack of heads for an irregular cone size, total replacement of the components was made.

The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities.

Science.gov (United States)

Hua, Xijin; Li, Junyan; Jin, Zhongmin; Fisher, John

2016-06-01

The occurrence of edge loading in hip joint replacement has been associated with many factors such as prosthetic design, component malposition and activities of daily living. The present study aimed to quantify the occurrence of edge loading/contact at the articulating surface and to evaluate the effect of cup angles and edge loading on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR) during different daily activities. A three-dimensional finite element model was developed based on a modular MoP bearing system. Different cup inclination and anteversion angles were modelled and six daily activities were considered. The results showed that edge loading was predicted during normal walking, ascending and descending stairs activities under steep cup inclination conditions (≥55°) while no edge loading was observed during standing up, sitting down and knee bending activities. The duration of edge loading increased with increased cup inclination angles and was affected by the cup anteversion angles. Edge loading caused elevated contact pressure at the articulating surface and substantially increased equivalent plastic strain of the polyethylene liner. The present study suggested that correct positioning the component to avoid edge loading that may occur during daily activities is important for MoP THR in clinical practice. Copyright © 2016. Published by Elsevier Ltd.

Finite Element Simulations of Hard-On-Soft Hip Joint Prosthesis Accounting for Dynamic Loads Calculated from a Musculoskeletal Model during Walking.

Science.gov (United States)

Ruggiero, Alessandro; Merola, Massimiliano; Affatato, Saverio

2018-04-09

The hip joint replacement is one of the most successful orthopedic surgical procedures although it involves challenges to overcome. The patient group undergoing total hip arthroplasty now includes younger and more active patients who require a broad range of motion and a longer service lifetime for the replacement joint. It is well known that wear tests have a long duration and they are very expensive, thus studying the effects of geometry, loading, or alignment perturbations may be performed by Finite Element Analysis. The aim of the study was to evaluate total deformation and stress intensity on ultra-high molecular weight polyethylene liner coupled with hard material head during one step. Moving toward in-silico wear assessment of implants, in the presented simulations we used a musculoskeletal multibody model of a human body giving the loading and relative kinematic of the investigated tribo-system during the gait. The analysis compared two frictional conditions -dry and wet and two geometrical cases- with and without radial clearance. The loads and rotations followed the variability of the gait cycle as well as stress/strain acting in the UHWMPE cup. The obtained results allowed collection of the complete stress/strain description of the polyethylene cup during the gait and calculation of the maximum contact pressure on the lateral edge of the insert. The tensional state resulted in being more influenced by the geometrical conditions in terms of radial clearance than by the variation of the friction coefficients due to lubrication phenomena.

Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

Energy Technology Data Exchange (ETDEWEB)

Yamamoto, Takuaki; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Fukuoka (Japan); Schneider, Robert [Hospital for Special Surgery, Department of Radiology, New York (United States); Bullough, Peter G. [Hospital for Special Surgery, Department of Laboratory Medicine, New York, NY (United States)

2010-02-15

A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

International Nuclear Information System (INIS)

Yamamoto, Takuaki; Iwamoto, Yukihide; Schneider, Robert; Bullough, Peter G.

2010-01-01

A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

The migration of femoral components after total hip replacement surgery: accuracy and precision of software-aided measurements

International Nuclear Information System (INIS)

Decking, J.; Schuetz, U.; Decking, R.; Puhl, W.

2003-01-01

Objective: To assess the accuracy and precision of a software-aided system to measure migration of femoral components after total hip replacement (THR) on digitised radiographs. Design and patients: Subsidence and varus-valgus tilt of THR stems within the femur were measured on digitised anteroposterior pelvic radiographs. The measuring software (UMA, GEMED, Germany) relies on bony landmarks and comparability parameters of two consecutive radiographs. Its accuracy and precision were calculated by comparing it with the gold standard in migration measurements, radiostereometric analysis (RSA). Radiographs and corresponding RSA measurements were performed in 60 patients (38-69 years) following cementless THR surgery. Results and conclusions: The UMA software measured the subsidence of the stems with an accuracy of ±2.5 mm and varus-valgus tilt with an accuracy of ±1.8 (95% confidence interval). A good interobserver and intraobserver reliability was calculated with Cronbach's alpha ranging from 0.86 to 0.97. Measuring the subsidence of THR stems within the femur is an important parameter in the diagnosis of implant loosening. Software systems such as UMA improve the accuracy of migration measurements and are easy to use on routinely performed radiographs of operated hip joints. (orig.)

The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the Copenhagen Osteoarthritis Study

DEFF Research Database (Denmark)

Gosvig, K.K.; Jacobsen, S.; Sonne-Holm, S.

2008-01-01

. The relationships between cam malformation and self-reported hip pain were evaluated, and the relative importance of known risk factors for cam malformation estimated. RESULTS: We found a pronounced sex-related difference in cam-deformity distribution. The overall prevalence of cam deformity was approximately 17......BACKGROUND: Cam deformity is a preosteoarthritic malformation causing premature hip-joint degeneration. While the pathogenetic pathway from deformity to osteoarthrosis (OA) has been well established, almost nothing is known of the malformation's epidemiology. PURPOSE: To determine the distribution......% in men and 4% in women. The distribution of cam deformity was unaltered in subjects with normal joint-space width or other features of hip-joint degeneration. We found no significant association with self-reported hip pain, nor did we find any relative importance of possible risk factors for hip...

CT-based quantification of bone stock in large head metal-on-metal unilateral total hip replacements

NARCIS (Netherlands)

Boomsma, Martijn F.; Slouwerhof, Inge; van Lingen, Christiaan; Pakvis, Dean F. M.; van Dalen, Jorn A.; Edens, Mireille A.; Ettema, Harmen B.; Verheyen, Cees C. P. M.; Maas, Mario

2016-01-01

To explore ipsilateral and contralateral acetabular roof bone stock density in unilateral large head MoM THA whether there is a significant lower acetabular bone stock in the hip with a metal-on-metal (MoM) total hip replacement compared to the contralateral side. Second part of this study is to

Metal artefact suppression at 3 T MRI: comparison of MAVRIC-SL with conventional fast spin echo sequences in patients with Hip joint arthroplasty

International Nuclear Information System (INIS)

Kretzschmar, Martin; Nardo, Lorenzo; Han, Misung M.; Heilmeier, Ursula; Sam, Craig; Joseph, Gabby B.; Krug, Roland; Link, Thomas M.; Koch, Kevin M.

2015-01-01

The aim of our study was to evaluate the clinical feasibility and diagnostic value of a new MRI metal artefact reduction pulse sequence called MAVRIC-SL in a 3 T MRI environment. Two MAVRIC-SL sequences obtained in 61 patients with symptomatic total hip replacement were compared with standard FSE-STIR sequences optimized for imaging around metal. Artefact size was measured on the slice of greatest extent. Image quality, fat saturation, image distortion, visibility of anatomical structures, and detectability of joint abnormalities were visually assessed and graded on qualitative scales. Differences between MAVRIC-SL and FSE sequences were tested with the Wilcoxon signed-rank test. MAVRIC-SL sequences at 3 T showed significantly smaller metal artefacts compared to FSE-STIR sequences (p < 0.0001). The general image quality of MAVRIC-SL sequences was reduced with regard to spatial resolution, noise and contrast (p = 0.001), and fat saturation (p < 0.0001). The reduction of artefact size and image distortion significantly improved visualization of joint anatomy (p < 0.0001) and diagnostic confidence regarding implant-associated abnormalities (p = 0.0075 to <0.0001). Although the image quality of MAVRIC-SL sequences is limited at 3 T, its clinical application is feasible and provides important additional diagnostic information for the workup of patients with symptomatic hip replacement through substantially reduced metal artefacts. (orig.)

Metal artefact suppression at 3 T MRI: comparison of MAVRIC-SL with conventional fast spin echo sequences in patients with Hip joint arthroplasty

Energy Technology Data Exchange (ETDEWEB)

Kretzschmar, Martin; Nardo, Lorenzo; Han, Misung M.; Heilmeier, Ursula; Sam, Craig; Joseph, Gabby B.; Krug, Roland; Link, Thomas M. [University of California San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Koch, Kevin M. [Medical Collage of Wisconsin, Departments of Biophysics and Radiology, Milwaukee, WI (United States)

2015-08-15

The aim of our study was to evaluate the clinical feasibility and diagnostic value of a new MRI metal artefact reduction pulse sequence called MAVRIC-SL in a 3 T MRI environment. Two MAVRIC-SL sequences obtained in 61 patients with symptomatic total hip replacement were compared with standard FSE-STIR sequences optimized for imaging around metal. Artefact size was measured on the slice of greatest extent. Image quality, fat saturation, image distortion, visibility of anatomical structures, and detectability of joint abnormalities were visually assessed and graded on qualitative scales. Differences between MAVRIC-SL and FSE sequences were tested with the Wilcoxon signed-rank test. MAVRIC-SL sequences at 3 T showed significantly smaller metal artefacts compared to FSE-STIR sequences (p < 0.0001). The general image quality of MAVRIC-SL sequences was reduced with regard to spatial resolution, noise and contrast (p = 0.001), and fat saturation (p < 0.0001). The reduction of artefact size and image distortion significantly improved visualization of joint anatomy (p < 0.0001) and diagnostic confidence regarding implant-associated abnormalities (p = 0.0075 to <0.0001). Although the image quality of MAVRIC-SL sequences is limited at 3 T, its clinical application is feasible and provides important additional diagnostic information for the workup of patients with symptomatic hip replacement through substantially reduced metal artefacts. (orig.)

Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

Directory of Open Access Journals (Sweden)

Simon S Jameson

Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

Primary total hip replacement versus hip resurfacing - hospital considerations.

Science.gov (United States)

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.

Pain in the hip joint

Directory of Open Access Journals (Sweden)

Yuri Aleksandrovich Olyunin

2013-01-01

Full Text Available Pathological changes that develop in the hip joints (HJ have different origins and mechanisms of development, but their main manifestation is pain. The nature of this pain cannot be well established on frequent occasions. The English-language medical literature currently classifies such disorders as greater trochanter pain syndrome (GTPS. Its major signs are chronic pain and local palpatory tenderness in the outer part of HJ. The development of GTPS may be associated with inflammation of the synovial bursae situated in the greater tronchanter, as well as with tendinitis, myorrhexis, iliotibial band syndrome, and other local changes in the adjacent tissues or with systemic diseases. So GTPS may be characterized as regional pain syndrome that frequently mimics pain induced by different diseases, including myofascial pain syndrome, osteoarthrosis, spinal diseases, etc.

Magnetic resonance imaging features of complications following hip replacement: A pictorial review

Directory of Open Access Journals (Sweden)

Khushboo Pilania

2016-01-01

Full Text Available Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients.

Magnetic resonance imaging features of complications following hip replacement: A pictorial review

International Nuclear Information System (INIS)

Pilania, Khushboo; Jankharia, Bhavin

2016-01-01

Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients

Older Person's Guide to Joint Replacement

Science.gov (United States)

... who prep for surgery and follow through with physical therapy afterward can further boost their odds of a good outcome. If you’re considering joint replacement surgery, here’s what the experts with the American Geriatrics Society’s Foundation for Health in Aging (FHA) suggest: Ask ...

On Patellofemoral joint replacement - Clinical, radiological, and numerical studies.

NARCIS (Netherlands)

Jonbergen, J.P.W. van

2011-01-01

Patellofemoral, osteoarthritis, joint replacement, arthroplasty, anterior knee pain Isolated patellofemoral joint osteoarthritis is a degenerative disorder of the knee estimated to occur in approximately 4% to 24% of patients with osteoarthritis of the knee. Mild isolated patellofemoral

Aquatic exercises versus land based exercises for elderly patients after a total hip replacement

OpenAIRE

Miroljub Jakovljevič; Renata Vauhnik

2011-01-01

Background: Aquatic therapy allows secure, active exercise with pain reduction using a combination of the water’s buoyancy, hydrostatic pressure, resistance and warmth. By aquatic therapy, elderly patients after total hip replacement can achieve more positive effects than by land-based exercise. The aim of the study was to investigate the use of aquatic-based exercises in the rehabilitation programme after a hip fracture surgery in elderly adults. Results: Both groups, regardless of the ty...

Cost feasibility of a pre-checking medical tourism system for U.S. patients undertaking joint replacement surgery in Taiwan.

Science.gov (United States)

Haung, Ching-Ying; Wang, Sheng-Pen; Chiang, Chih-Wei

2010-01-01

Medical tourism is a relatively recent global economic and political phenomenon that has assumed increasing importance for developing countries, particularly in Asia. In fact, Taiwan possesses a niche for developing medical tourism because many hospitals provide state-of-the-art medicine in all disciplines and many doctors are trained in the United States (US). Among the most common medical procedures outsourced, joint replacements such as total knee replacement (TKR) and total hip replacement (THR) are two surgeries offered to US patients at a lower cost and shorter waiting time than in the US. This paper proposed a pre-checking medical tourism system (PCMTS) and evaluated the cost feasibility of recruiting American clients traveling to Taiwan for joint replacement surgery. Cost analysis was used to estimate the prime costs for each stage in the proposed PCMTS. Sensitivity analysis was implemented to examine how different pricings for medical checking and a surgical operation (MC&SO) and recovery, can influence the surplus per patient considering the PCMTS. Finally, the break-even method was adopted to test the tradeoff between the sunk costs of investment in the PCMTS and the annual surplus for participating hospitals. A novel business plan was built showing that pre-checking stations in medical tourism can provide post-operative care and recovery follow-up. Adjustable pricing for hospital administrators engaged in the PCMTS consisted of two main costs: US$3,700 for MC&SO and US$120 for the hospital stay. Guidelines for pricing were provided to maximize the annual surplus from this plan with different number of patients participating in PCMTS. The maximal profit margin from each American patient undertaking joint surgery is about US$24,315. Using cost analysis, this article might be the first to evaluate the feasibility of PCMTS for joint replacement surgeries. The research framework in this article is applicable when hospital administrators evaluate the

Validation of the diagnosis 'prosthetic joint infection' in the Danish Hip Arthroplasty Register

DEFF Research Database (Denmark)

Gundtoft, P H; Pedersen, Alma Becic; Schønheyder, H C

2016-01-01

and followed them until first-time revision, death, emigration or until 31 December 2012. Revision for PJI, as registered in the DHR, was validated against a benchmark which included information from microbiology databases, prescription registers, clinical biochemistry registers and clinical records. We......AIMS: The purpose of this study was to validate the diagnosis of periprosthetic joint infection (PJI) in the Danish Hip Arthroplasty Register (DHR). PATIENTS AND METHODS: We identified a cohort of patients from the DHR who had undergone primary total hip arthroplasty (THA) since 1 January 2005...... the validity of the diagnosis of PJI and should enable future register-based studies. Cite this article: Bone Joint J 2016;98-B:320-5....

Personality, function and satisfaction in patients undergoing total hip or knee replacement.

Science.gov (United States)

Ramaesh, Rishikesan; Jenkins, Paul; Lane, Judith V; Knight, Sara; Macdonald, Deborah; Howie, Colin

2014-03-01

The aim of this study was to investigate the relationships between personality and joint-specific function, general physical and general mental health in patients undergoing total hip (THA) and knee arthroplasty (TKA). One hundred and eighty-four patients undergoing THA and 205 undergoing TKA were assessed using the Eysneck Personality Questionnaire, brief version (EPQ-BV). General physical and mental health was measured using the Short-Form 12 (SF-12) questionnaire and the EuroQol (EQ-5D). Joint-specific function was measured using the Oxford hip or knee score. The "unstable introvert" personality type was associated with poorer pre-operative function and health in patients with hip arthrosis. In patients with knee arthrosis, there was poorer general health in those with "stable extrovert" and "unstable introvert" types. Personality was not an independent predictor of outcome following TKA or THA. The main predictor was pre-operative function and health. Comorbidity was an important covariate of both pre-operative and postoperative function. Personality may play a role in the interaction of these disease processes with function and health perception. It may also affect the response and interpretation of psychometric and patient-reported outcome measures. It may be important to characterise and identify these traits in potential arthroplasty patients as it may help deliver targeted education and management to improve outcomes in certain groups.

Understanding Total Hip Replacement Recovery towards the Design of a Context-Aware Systems

NARCIS (Netherlands)

Jimenez Garcia, Juan

2011-01-01

Total Hip Replacement (THR) is a common procedure to improve the mobility of elderly with osteoarthritis. Presently information about the recovery process after discharge is unclear. As consequence patients and physiotherapists face uncertainties to follow an adequate trajectory for recovery.

The Joint Clinic: Managing Excess Demand for Hip and Knee Osteoarthritis Referrals Using a New Physiotherapy-Led Outpatient Service.

Science.gov (United States)

Gwynne-Jones, David P; Hutton, Liam R; Stout, Kirsten M; Abbott, J Haxby

2018-04-01

There are increasing problems with access to both outpatient assessment and joint replacement surgery for patients with hip or knee osteoarthritis. Data were collected on all patients seen at the Joint Clinic over a 2-year period with minimum 12-month follow-up. Patients were assessed by a nurse and a physiotherapist, baseline scores and demographic details collected, and an individualized personal care plan developed. Patients could be referred for a first specialist assessment (FSA) if their severity justified surgical assessment. Three hundred fifty-eight patients were seen at Joint Clinic, of whom 150 (44%) had hip and 189 (56%) had knee OA. The mean age was 67.4 years and there were 152 men (45%) and 187 women (55%). The mean baseline Oxford score was 19.8 (standard deviation 8.2). Fifty-four patients were referred directly to FSA (mean Oxford score 13.0, standard deviation 6.7) and 89 after a subsequent review. The scores of patients referred for FSA were significantly worse than those managed in the Joint Clinic (P < .001). Of the 143 referred for FSA, 115 underwent or were awaiting surgery, 18 were recommended surgery but scored below prioritization threshold, and 10 were not recommended surgery. The Oxford scores of the 194 patients managed non-operatively improved from 22.0 to 25.0 (P = .0013). This study shows that the Joint Clinic was effective as a triage tool with 93% of those referred for FSA being recommended surgery. This has freed up surgeon time to see only those patients most in need of surgical assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

Flowtron foot-pumps for prevention of venous thromboembolism in total hip and knee replacement.

Science.gov (United States)

Pitto, Rocco P; Koh, Chuan K

2015-03-01

Mechanical prophylaxis with foot-pumps provides an interesting alternative to chemical agents in the prevention of venous thomboembolism following major orthopaedic surgery procedures. The aim of this prospective study was to assess efficacy and safety of the Flowtron(®) foot-pumps system following total hip and knee replacement. The foot pumps were used as main tool for prevention of thromboembolic events, in most cases in association with a variety of chemicals. The primary endpoint of the study was to assess the incidence of deep vein thrombosis and pulmonary embolism after total hip and knee replacement. The secondary endpoints included postoperative bleeding, swelling, bruising and wound ooze. 424 consecutive patients were included in the study. Symptomatic deep vein thrombosis was detected in 7 patients (1.6%). All symptomatic deep vein thromboses were detected after discharge before the six week follow-up clinic. Five non-fatal pulmonary embolisms occurred (1.2%). Only one patient presented a major wound bleeding (0.2%). The mean difference of swelling of thigh pre-versus postoperatively was only 22.8 mm. In conclusion, thromboembolism prophylaxis after total hip and knee replacement using Flowtron(®) foot-pumps as main prevention tool of an individualised protocol appears effective and safe. This is the first clinical report related to this popular brand of foot pumps.

Wear mechanisms in ceramic hip implants.

Science.gov (United States)

Slonaker, Matthew; Goswami, Tarun

2004-01-01

The wear in hip implants is one of the main causes for premature hip replacements. The wear affects the potential life of the prosthesis and subsequent removals of in vivo implants. Therefore, the objective of this article is to review various joints that show lower wear rates and consequently higher life. Ceramics are used in hip implants and have been found to produce lower wear rates. This article discusses the advantages and disadvantages of ceramics compared to other implant materials. Different types of ceramics that are being used are reviewed in terms of the wear characteristics, debris released, and their size together with other biological factors. In general, the wear rates in ceramics were lower than that of metal-on-metal and metal-on-polyethylene combinations.

Hip joint centre position estimation using a dual unscented Kalman filter for computer-assisted orthopaedic surgery.

Science.gov (United States)

Beretta, Elisa; De Momi, Elena; Camomilla, Valentina; Cereatti, Andrea; Cappozzo, Aurelio; Ferrigno, Giancarlo

2014-09-01

In computer-assisted knee surgery, the accuracy of the localization of the femur centre of rotation relative to the hip-bone (hip joint centre) is affected by the unavoidable and untracked pelvic movements because only the femoral pose is acquired during passive pivoting manoeuvres. We present a dual unscented Kalman filter algorithm that allows the estimation of the hip joint centre also using as input the position of a pelvic reference point that can be acquired with a skin marker placed on the hip, without increasing the invasiveness of the surgical procedure. A comparative assessment of the algorithm was carried out using data provided by in vitro experiments mimicking in vivo surgical conditions. Soft tissue artefacts were simulated and superimposed onto the position of a pelvic landmark. Femoral pivoting made of a sequence of star-like quasi-planar movements followed by a circumduction was performed. The dual unscented Kalman filter method proved to be less sensitive to pelvic displacements, which were shown to be larger during the manoeuvres in which the femur was more adducted. Comparable accuracy between all the analysed methods resulted for hip joint centre displacements smaller than 1 mm (error: 2.2 ± [0.2; 0.3] mm, median ± [inter-quartile range 25%; inter-quartile range 75%]) and between 1 and 6 mm (error: 4.8 ± [0.5; 0.8] mm) during planar movements. When the hip joint centre displacement exceeded 6 mm, the dual unscented Kalman filter proved to be more accurate than the other methods by 30% during multi-planar movements (error: 5.2 ± [1.2; 1] mm). © IMechE 2014.

Estimation of Human Hip and Knee Multi-Joint Dynamics Using the LOPES Gait Trainer

NARCIS (Netherlands)

Koopman, Hubertus F.J.M.; van Asseldonk, Edwin H.F.; van der Kooij, Herman

2016-01-01

In this study, we present and evaluate a novel method to estimate multi-joint leg impedance, using a robotic gait training device. The method is based on multi-input–multi-output system identification techniques and is designed for continuous torque perturbations at the hip and knee joint

Human bones obtained from routine joint replacement surgery as a tool for studies of plutonium, americium and {sup 90}Sr body-burden in general public

Energy Technology Data Exchange (ETDEWEB)

Mietelski, Jerzy W., E-mail: jerzy.mietelski@ifj.edu.pl [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland); Golec, Edward B. [Traumatology and Orthopaedic Clinic, 5th Military Clinical Hospital and Polyclinic, Independent Public Healthcare Facility, Wroclawska 1-3, 30-901 Cracow (Poland); Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Department of Physical Therapy Basics, Faculty of Physical Therapy, Administration College, Bielsko-Biala (Poland); Tomankiewicz, Ewa [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland); Golec, Joanna [Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Physical Therapy Department, Institute of Physical Therapy, Faculty of Heath Science, Jagiellonian University, Medical College, Cracow (Poland); Nowak, Sebastian [Traumatology and Orthopaedic Clinic, 5th Military Clinical Hospital and Polyclinic, Independent Public Healthcare Facility, Wroclawska 1-3, 30-901 Cracow (Poland); Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Szczygiel, Elzbieta [Physical Therapy Department, Institute of Physical Therapy, Faculty of Heath Science, Jagiellonian University, Medical College, Cracow (Poland); Brudecki, Kamil [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland)

2011-06-15

The paper presents a new sampling method for studying in-body radioactive contamination by bone-seeking radionuclides such as {sup 90}Sr, {sup 239+240}Pu, {sup 238}Pu, {sup 241}Am and selected gamma-emitters, in human bones. The presented results were obtained for samples retrieved from routine surgeries, namely knee or hip joints replacements with implants, performed on individuals from Southern Poland. This allowed to collect representative sets of general public samples. The applied analytical radiochemical procedure for bone matrix is described in details. Due to low concentrations of {sup 238}Pu the ratio of Pu isotopes which might be used for Pu source identification is obtained only as upper limits other then global fallout (for example Chernobyl) origin of Pu. Calculated concentrations of radioisotopes are comparable to the existing data from post-mortem studies on human bones retrieved from autopsy or exhumations. Human bones removed during knee or hip joint surgery provide a simple and ethical way for obtaining samples for plutonium, americium and {sup 90}Sr in-body contamination studies in general public. - Highlights: > Surgery for joint replacement as novel sampling method for studying in-body radioactive contamination. > Proposed way of sampling is not causing ethic doubts. > It is a convenient way of collecting human bone samples from global population. > The applied analytical radiochemical procedure for bone matrix is described in details. > The opposite patient age correlations trends were found for 90Sr (negative) and Pu, Am (positive).

Understanding why people do or do not engage in activities following total joint replacement: a longitudinal qualitative study.

Science.gov (United States)

Webster, F; Perruccio, A V; Jenkinson, R; Jaglal, S; Schemitsch, E; Waddell, J P; Venkataramanan, V; Bytautas, J; Davis, A M

2015-06-01

Numerous studies report large and significant improvements in basic mobility and activities of daily living following total hip or knee replacement (TJR). Nevertheless, quantitative research has shown minimal increase in participation in activities that benefit overall health. This study explored why people do or do not engage in activities following hip or knee TJR. This was a longitudinal qualitative study. Sampling was guided by constructivist grounded theory and data collected using open-ended, semi-structured interviews. Participants were recruited using maximum variation sampling based on age, sex and joint replaced (hip or knee). Data were analysed using a constant comparative approach and coded for thematic patterns and relationships from which overarching themes were constructed. Twenty-nine patients participated in interviews prior to, and 8 and 18 months post following TJR. A high degree of variability with regard to participants' return to activities was found and five emergent themes were identified that accounted for this variability. These themes highlight the importance of issues beyond medical factors alone, such as socio-cultural factors that partially determine participants' participation in activity following TJR. Findings suggest that multi-faceted experiences impact participation in activity following TJR. These experiences include changes in identity and lifestyle that preclude a 'return to normal'. There is an urgent need for supports to increase people's activity post-TJR in order to facilitate enhancement of post-surgery levels of engagement. Approaches that take into consideration more personalized interventions may be critical to promoting healthy aging in people with TJR. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Granulicatella adiacens prosthetic hip joint infection after dental treatment.

Science.gov (United States)

Aweid, Osama; Sundararajan, Sabapathy; Teferi, Abraham

2016-06-01

Granulicatella adiacens is a Gram-positive bacteria and a normal component of oral flora. It is also found in dental plaques, endodontic abscesses and can rarely cause more serious infections. We describe a prosthetic hip joint infection in an 81-year-old fit and healthy man due to Granulicatella adiacens who underwent a prolonged dental intervention two days earlier without antibiotic prophylaxis. The infection was successfully treated with surgical intervention and a combination of antibiotics. The patient eventually succumbed to severe community-acquired pneumonia two months later. Current guidelines recommend avoidance of antibiotic prophylaxis prior to dental treatment in patients who have no co-morbidities and no prior operation on the index prosthetic joint. This case report indicates that infections of prosthetic joints may be associated with dental procedures even in fit and healthy patients without the recognized risk factors.

Using a calliper to restore the centre of the femoral head during total hip replacement.

Science.gov (United States)

Hill, J C; Archbold, H A P; Diamond, O J; Orr, J F; Jaramaz, B; Beverland, D E

2012-11-01

Restoration of leg length and offset is an important goal in total hip replacement. This paper reports a calliper-based technique to help achieve these goals by restoring the location of the centre of the femoral head. This was validated first by using a co-ordinate measuring machine to see how closely the calliper technique could record and restore the centre of the femoral head when simulating hip replacement on Sawbone femur, and secondly by using CT in patients undergoing hip replacement. Results from the co-ordinate measuring machine showed that the centre of the femoral head was predicted by the calliper to within 4.3 mm for offset (mean 1.6 (95% confidence interval (CI) 0.4 to 2.8)) and 2.4 mm for vertical height (mean -0.6 (95% CI -1.4 to 0.2)). The CT scans showed that offset and vertical height were restored to within 8 mm (mean -1 (95% CI -2.1 to 0.6)) and -14 mm (mean 4 (95% CI 1.8 to 4.3)), respectively. Accurate assessment and restoration of the centre of the femoral head is feasible with a calliper. It is quick, inexpensive, simple to use and can be applied to any design of femoral component.

Hip Abductor Muscle Volume and Strength Differences Between Women With Chronic Hip Joint Pain and Asymptomatic Controls.

Science.gov (United States)

Mastenbrook, Matthew J; Commean, Paul K; Hillen, Travis J; Salsich, Gretchen B; Meyer, Gretchen A; Mueller, Michael J; Clohisy, John C; Harris-Hayes, Marcie

2017-12-01

Study Design Secondary analysis, cross-sectional study. Background Chronic hip joint pain (CHJP) can lead to limitations in activity participation, but the musculoskeletal factors associated with the condition are relatively unknown. Understanding the factors associated with CHJP may help develop rehabilitation strategies to improve quality of life of individuals with long-term hip pain. Objectives To compare measures of hip abductor muscle volume and hip abductor muscle strength between women with CHJP and asymptomatic controls. Methods Thirty women, 15 with CHJP and 15 matched asymptomatic controls (age range, 18-40 years), participated in this study. Magnetic resonance imaging was used to determine the volume of the primary hip abductor muscles, consisting of the gluteus medius, gluteus minimus, a small portion of the gluteus maximus, and the tensor fascia latae, within a defined region of interest. Break tests were performed using a handheld dynamometer to assess hip abductor strength. During the strength test, the participant was positioned in sidelying with the involved hip in 15° of abduction. Independent-samples t tests were used to compare muscle volume and strength values between those with CHJP and asymptomatic controls. Results Compared to asymptomatic controls, women with CHJP demonstrated significantly increased gluteal muscle volume (228 ± 40 cm 3 versus 199 ± 29 cm 3 , P = .032), but decreased hip abductor strength (74.6 ± 16.8 Nm versus 93.6 ± 20.2 Nm, P = .009). There were no significant differences in tensor fascia lata muscle volume between the 2 groups (P = .640). Conclusion Women with CHJP appear to have larger gluteal muscle volume, but decreased hip abductor strength, compared to asymptomatic controls. J Orthop Sports Phys Ther 2017;47(12):923-930. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7380.

Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

DEFF Research Database (Denmark)

Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

2008-01-01

BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. INTERPRETATION: We identified several patient...... characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation....

[Experiences with the condition of resection of the hip joint following removal of the alloarthroplastic implantate (author's transl)].

Science.gov (United States)

Reflor, H J; Wirth, C J; Schreiner, B

1979-10-01

30 patients whose total endoprosthesis of the hip joint had been removed without any replacement, thus creating a so-called state of secondary resection, were followed up 6 months to 6 years after the operation. It was found that in almost two-thirds of the cases a subjective feeling of improved mobility was reported. The objective findings consisted in restrictions of the total rotation, abduction and adduction of 1/3 rd of the normal extent of mobility. An average value of 74.7 degrees was recorded for flexion. 28 patients stated that their walking performance was satisfactory to very good when using a walking-stick as support. More than three-quarters of the patients questioned stated their pain had been positively influenced by the creation of the state of secondary resection. Another objective finding was a difference between the length of the legs amounting to 4.2 cm on the average. We could prove the existence of a relationship between the difference in leg length and the roentgenologically visualised supporting of the resection area of the coxal end of the femur at the lateral pelvis. Since all the patients with the exception of two could resume their customary daily routine activities, the state of secondary resection after unsuccessful total endoprosthesis of the hip joint must be considered a reasonably acceptable alternative.

Novel chitosan/diclofenac coatings on medical grade stainless steel for hip replacement applications

Science.gov (United States)

Finšgar, Matjaž; Uzunalić, Amra Perva; Stergar, Janja; Gradišnik, Lidija; Maver, Uroš

2016-05-01

Corrosion resistance, biocompatibility, improved osteointegration, as well the prevention of inflammation and pain are the most desired characteristics of hip replacement implants. In this study we introduce a novel multi-layered coating on AISI 316LVM stainless steel that shows promise with regard to all mentioned characteristics. The coating is prepared from alternating layers of the biocompatible polysaccharide chitosan and the non-steroid anti-inflammatory drug (NSAID), diclofenac. Electrochemical methods were employed to characterize the corrosion behavior of coated and uncoated samples in physiological solution. It is shown that these coatings improve corrosion resistance. It was also found that these coatings release the incorporated drug in controlled, multi-mechanism manner. Adding additional layers on top of the as-prepared samples, has potential for further tailoring of the release profile and increasing the drug dose. Biocompatibility was proven on human-derived osteoblasts in several experiments. Only viable cells were found on the sample surface after incubation of the samples with the same cell line. This novel coating could prove important for prolongation of the application potential of steel-based hip replacements, which are these days often replaced by more expensive ceramic or other metal alloys.

Clinical examination and physical assessment of hip joint-related pain in athletes

DEFF Research Database (Denmark)

Reiman, Michael P; Thorborg, Kristian

2014-01-01

UNLABELLED: Evidence-based clinical examination and assessment of the athlete with hip joint related pain is complex. It requires a systematic approach to properly differentially diagnose competing potential causes of athletic pain generation. An approach with an initial broad focus (and hence use...... of highly sensitive tests/measures) that then is followed by utilizing more specific tests/measures to pare down this imprecise differential diagnosis list is suggested. Physical assessment measures are then suggested to discern impairments, activity and participation restrictions for athletes with hip...

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

Science.gov (United States)

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.

Finite Element Simulations of Hard-On-Soft Hip Joint Prosthesis Accounting for Dynamic Loads Calculated from a Musculoskeletal Model during Walking

Directory of Open Access Journals (Sweden)

Alessandro Ruggiero

2018-04-01

Full Text Available The hip joint replacement is one of the most successful orthopedic surgical procedures although it involves challenges to overcome. The patient group undergoing total hip arthroplasty now includes younger and more active patients who require a broad range of motion and a longer service lifetime for the replacement joint. It is well known that wear tests have a long duration and they are very expensive, thus studying the effects of geometry, loading, or alignment perturbations may be performed by Finite Element Analysis. The aim of the study was to evaluate total deformation and stress intensity on ultra-high molecular weight polyethylene liner coupled with hard material head during one step. Moving toward in-silico wear assessment of implants, in the presented simulations we used a musculoskeletal multibody model of a human body giving the loading and relative kinematic of the investigated tribo-system during the gait. The analysis compared two frictional conditions -dry and wet and two geometrical cases- with and without radial clearance. The loads and rotations followed the variability of the gait cycle as well as stress/strain acting in the UHWMPE cup. The obtained results allowed collection of the complete stress/strain description of the polyethylene cup during the gait and calculation of the maximum contact pressure on the lateral edge of the insert. The tensional state resulted in being more influenced by the geometrical conditions in terms of radial clearance than by the variation of the friction coefficients due to lubrication phenomena.

Anatomic variation of the deep venous system and its relationship with deep vein thrombosis found on the lower extremity venograms that were obtained after artificial joint replacements

International Nuclear Information System (INIS)

Lee, Min Sun; Lee, Jee Eun; Hwang, Ji Young; Shim, Sung Shine; Yoo, Jeong Hyun; Suh, Jeong Soo; Park, Jae Young

2006-01-01

We wanted to evaluate the anatomic variations, the number of valves and the presence of deep vein thrombosis (DVT) on the lower extremity venograms obtained after artificial joint replacements, and we also wanted to determine the correlation of the incidence of DVT with the above-mentioned factors and the operation sites. From January to June 2004, conventional ascending contrast venographies of the lower extremities were performed in 119 patients at 7-10 days after artificial joint replacement, and all the patients were asymptomatic. Total knee replacement was done for 152 cases and total hip replacement was done for 34 cases. On all the venographic images of 186 limbs, the anatomic variations were classified and the presence of DVT was evaluated; the number of valves in the superficial femoral vein (SFV) and calf veins was counted. The sites of DVT were classified as calf, thigh and pelvis. Statistically, chi square tests and Fischer's exact tests were performed to determine the correlation of the incidence of DVT with the anatomic variations, the numbers of valves and the operation sites. Theoretically, there are 9 types of anatomical variation in the deep vein system of the lower extremity that can be classified, but only 7 types were observed in this study. The most frequent type was the normal single SFV type and this was noted in 117 cases (63%), and the others were all variations (69 cases, 37%). There was a 22.2% incidence of DVT (69 cases) in the normal single SFV type and 26.4% (17 cases) in the other variations. No significant difference was noted in the incidences of DVT between the two groups. In addition, no significant statistical differences were noted for the incidences of DVT between the single or variant multiple veins in the SFV and the popliteal vein (PV) respectively, between the different groups with small or large numbers of valves in the thigh and calf, respectively, and also between the different operation sites of the hip or knee

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

Science.gov (United States)

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 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

The Immediate Effect of Neuromuscular Joint Facilitation (NJF) Treatment on Hip Muscle Strength.

Science.gov (United States)

Wang, Hongdan; Huo, Ming; Huang, Qiuchen; Li, Desheng; Maruyama, Hitoshi

2013-11-01

[Purpose] This study investigated the change in hip muscle strength of younger persons after neuromuscular joint facilitation (NJF) treatment. [Subjects] The subjects were 45 healthy young people, who were divided into two groups: a NJF group and a proprioceptive neuromuscular facilitation (PNF) group. The NJF group consisted of 21 subjects (11 males, 10 females), and the PNF group consisted of 24 subjects (11 males, 13 females). [Methods] Participants in the NJF group received NJF treatment. We measured the maximal flexor strength and the maximal extensor strength during isokinetic movement of the hip joint before and after intervention in both groups. The angular velocities used were 60°/sec and 180°/sec. [Results] The NJF group showed significant increases in the maximal flexor strength and the maximal extensor strength after the intervention at each angular velocity. In the PNF group, the maximal flexor strength of 60°/sec and the maximal extensor strength of 180°/sec were significant increases. [Conclusion] These results suggest that there is an immediate effect of NJF intervention on hip muscle strength.

the Hip Joint Affected by Osteoarthritis

Directory of Open Access Journals (Sweden)

Anetta Zioła-Frankowska

2015-01-01

Full Text Available The aim of the study was to determine the content of particular elements Ca, Mg, P, Na, K, Zn, Cu, Fe, Mo, Cr, Ni, Ba, Sr, and Pb in the proximal femur bone tissue (cancellous and cortical bone of 96 patients undergoing total hip replacement for osteoarthritis using ICP-AES and FAAS analytical techniques. The interdependencies among these elements and their correlations depended on factors including age, gender, place of residence, tobacco consumption, alcohol consumption, exposure to environmental pollution, physical activity, and type of degenerative change which were examined by statistical and chemometric methods. The factors that exerted the greatest influence on the elements in the femoral head and neck were tobacco smoking (higher Cr and Ni content in smokers, alcohol consumption (higher concentrations of Ni, Cu in people who consume alcohol, and gender (higher Cu, Zn, and Ni concentrations in men. The factors influencing Pb accumulation in bone tissue were tobacco, alcohol, gender, and age. In primary and secondary osteoarthritis of the hip, the content and interactions of elements are different (mainly those of Fe and Pb. There were no significant differences in the concentrations of elements in the femoral head and neck that could be attributed to residence or physical activity.

Iranian Joint Registry(Iranian National Hip and Knee Arthroplasty Registry

Directory of Open Access Journals (Sweden)

Hamidreza Aslani

2016-04-01

Full Text Available Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR with a joint collaboration of the Social Security Organization (SSO and academic research departments considering the requirements of the Iran’s Ministry of Health and Education.

Long-Acting Morphine Following Hip or Knee Replacement: A Randomized, Double-Blind, Placebo-Controlled Trial

Directory of Open Access Journals (Sweden)

Shirley L Musclow

2012-01-01

Full Text Available BACKGROUND: Patients undergoing total hip or knee replacement surgery experience unmanaged pain during postoperative physiotherapy sessions. It was theorized that a baseline opioid would improve pain management.

Segmental blood pressure after total hip replacement

DEFF Research Database (Denmark)

Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik Sahl

1992-01-01

Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...... drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found...... on the operated side. None of the patients had symptoms from the lowered pressure. We conclude that in patients without signs of ischemia, the postoperative segmental pressure decrease is reversible and therefore not dangerous....

Comparative study of radiography and scintigraphy for loosening and infection of prosthetic hip replacement

International Nuclear Information System (INIS)

Park, Mi Sook; Lee, Sun Wha; Choi, Woo Suk; Lim, Joo Won; Song, Han Joon; Ahn, Chi Yul

1987-01-01

Prosthetic hip replacement is associated with certain complications which result in a painful hip. Many of these, e. g. prosthetic dislocation, fracture, trochanteric avulsion, and heterotopic calcification are easily diagnosed by conventional radiography. However, radiographic evaluation for infection and/pr loosening of prosthesis as major complications requiring reoperation often contributes little to the resolution of the diagnostic problem. The authors made a comparative study of plain radiography and scintigraphy of 39 cases performed revision at Kyung Hee University Hospital from Sep. '81-to Aug. '86. The results were as follows: 1. In 39 revised prosthetic hip replacement, 26 cases (67%) of loosening without infection and 11 cases (28%) of infection were proven. 2. In loosening of prosthesis, plain radiography showed true positive rate of 76% and true negative rate of 60%, and scintigraphy showed true positive rate of 75% and true negative rate of 95%. 3. In infection of prosthesis, plain radiography revealed true positive rate of 55% and true negative rate of 96%, and scintigraphy revealed true positive rate of 100% and true negative rate of 83%. 4. Scintigraphy and plain radiography were useful as complementary procedure in evaluating and differentiating loosening and/or infection of prosthetic component

Stress analysis of the hip joint endoprosthesis with shape deflections

Czech Academy of Sciences Publication Activity Database

Fuis, Vladimír; Návrat, Tomáš

2005-01-01

Roč. 12, č. 5 (2005), s. 323-330 ISSN 1802-1484. [Mechatronics, Robotics and Biomechanics 2005. Třešť, 26.09.2005-29.09.2005] R&D Projects: GA ČR(CZ) GA101/05/0136 Institutional research plan: CEZ:AV0Z20760514 Keywords : hip joint endoprosthesis * weibul weakest link Subject RIV: JH - Ceramics, Fire-Resistant Materials and Glass

Grading and quantification of hip osteoarthritis severity by analyzing the spectral energy distribution of radiographic hip joint space

International Nuclear Information System (INIS)

Boniatis, I; Costaridou, L; Panayiotakis, G; Panagiotopoulos, E

2009-01-01

An image analysis system is proposed for the assessment of hip osteoarthritis (OA) severity. Sixty four hips (18 normal, 46 osteoarthritic), corresponding to 32 patients of unilateral or bilateral hip OA were studied. Employing custom developed software, 64 Region Of Interest (ROI) images of Hip Joint Spaces (HJSs) were delineated on patients' digitized radiographs. The Fourier spectrum of each HJS-ROI was computed and expressed in polar coordinates. Spectral signatures, quantifying the radial and angular distribution of HJS spectral energy were formed. Signature descriptors were generated and utilized in the design of a two-level hierarchical decision tree, used for the grading of the severity of the disease. Accordingly, at Level 1, implemented by a multiple classifier system, the discrimination between normal and osteoarthritic hips was performed. At Level 2, the hips that had been successfully characterized as osteoarthritic at Level 1, were further characterized as of 'Mild / Moderate' or 'Severe' OA, by the Bayes classifier. A signature descriptors based regression model was designed, so as to quantify OA-severity. The system graded OA reliably, given that the accomplished classification accuracies for Level 1 and Level 2 were 98.4% and 100%, respectively. OA-severity values, expressed by HJS-narrowing, correlated highly (r = 0.9, p < 0.001) with values predicted by the model. The system may contribute to OA-patient management.

Interventions for Hip Pain in the Maturing Athlete

Science.gov (United States)

Gomberawalla, M. Mustafa; Kelly, Bryan T.; Bedi, Asheesh

2014-01-01

Context: Femoroacetabular impingement (FAI) alters hip mechanics, results in hip pain, and may lead to secondary osteoarthritis (OA) in the maturing athlete. Hip impingement can be caused by osseous abnormalities in the proximal femur or acetabulum. These impingement lesions may cause altered loads within the hip joint, which result in repetitive collision damage or sheer forces to the chondral surfaces and acetabular labrum. These anatomic lesions and resultant abnormal mechanics may lead to early osteoarthritic changes. Evidence Acquisition: Relevant articles from the years 1995 to 2013 were identified using MEDLINE, EMBASE, and the bibliographies of reviewed publications. Level of Evidence: Level 4. Results: Improvements in hip arthroscopy have allowed FAI to be addressed utilizing the arthroscope. Adequately resecting the underlying osseous abnormalities is essential to improving hip symptomatology and preventing further chondral damage. Additionally, preserving the labrum by repairing the damaged tissue and restoring the suction seal may theoretically help normalize hip mechanics and prevent further arthritic changes. The outcomes of joint-preserving treatment options may be varied in the maturing athlete due to the degree of underlying OA. Irreversible damage to the hip joint may have already occurred in patients with moderate to advanced OA. In the presence of preexisting arthritis, these patients may only experience fair or even poor results after hip arthroscopy, with early conversion to hip replacement. For patients with advanced hip arthritis, total hip arthroplasty remains a treatment option to reliably improve symptoms with good to excellent outcomes and return to low-impact activities. Conclusion: Advances in the knowledge base and treatment techniques of intra-articular hip pain have allowed surgeons to address this complex clinical problem with promising outcomes. Traditionally, open surgical dislocations for hip preservation surgery have shown good

BILATERAL PATHOLOGICAL HIP DISLOCATION IN CHILDREN

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Yuriy E. Garkavenko

2017-03-01

Full Text Available Introduction. Pathological dislocation of the hip is one of the most severe complications of acute hematogenous osteomyelitis. The program of treatment for children with pathological hip dislocation is complex, but it has been sufficiently developed and implemented very successfully. At the same time, the available literature provides no cases of treating children with bilateral pathological hip dislocations after hematogenous osteomyelitis. There is no information on the incidence of such cases or in regards to remote functional results. Materials and methods. The results of the treatment of 18 children with bilateral pathological dislocation of the hip after hematogenous osteomyelitis are presented, which constituted 23.1% of the total number of patients (78 who underwent surgery in 2000–2016 for the diagnosis of pathological hip dislocation. Both hip joints were surgically operated on in 12 patients, while one hip joint was operated on in 6 patients. To assess the anatomical and functional state of hip joints, the clinical and roentgenological diagnostic techniques were used. Results and discussion. To stabilize and restore the function of the hip joints, 18 children underwent 30 surgical interventions: simple open hip reduction (19 and open hip reduction with hip arthroplasty with one (6 or two (5 demineralized osteochondral allogeneic grafts. The decision regarding the possibility of performing surgical intervention on the second hip joint was made only after a child's check-up examination was complete and after positive information about the anatomical and functional state of the operated hip joint was obtained. According to these criteria, 14 (77.8% children underwent surgical treatment of the second hip joint 1–1.5 years after the course of conservative measures to restore the range of motion in the previously operated hip joint. Over a period of 1–12 years, 17 patients were examined, 10 of which underwent an operation on both

The morphology and functions of the muscles around the hip joint after a unilateral transfemoral amputation

NARCIS (Netherlands)

Jaegers, Sonja Maria Héléne José

1993-01-01

This dissertation is concerned with the consequences of a transfemoral amputation for the morphology and functions of the muscles around the hip joint. Knowledge about and insight into the changes appearing in the morphology and functions of the hip muscles of transfemoral amputees are important to

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study

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Eitzen Ingrid

2012-12-01

Full Text Available Abstract Background 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. Methods 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. Results 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 (pp=0.011, and a reduced hip flexion moment at midstance and peak hip extension (p2 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. Conclusions Reduced gait velocity, reduced sagittal plane joint excursion, and

Characterization of HIP bonded DS-Cu/SS316L joints for fusion experimental reactors

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