The acetabulum-head index (AHI), which is used to assess femoral head coverage on plain radiographs, was measured in 77 children (154 hips) with normal hips aged 2 to 14 years. The mean AHI value was 94 (range, 79-114). Both the intraobserver and the interobserver reproducibility of the measurements was high. The AHI values tended to decrease with increasing age. The mean AHI minus 2 standard deviations, which was used to define the border value for subluxation of the femoral head, was 80. The authors propose that an AHI
There is no consensus on the association between global femoral offset (FO) and outcome after total hip arthroplasty (THA). We assessed the association between FO and patients' reported hip function, quality of life, and abductor muscle strength.
We included 250 patients with unilateral hip osteoarthritis who underwent a THA. Before the operation, the patient's reported hip function was evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life was evaluated with EQ-5D. At 1-year follow-up, the same scores and also hip abductor muscle strength were measured. 222 patients were available for follow-up. These patients were divided into 3 groups according to the postoperative global FO of the operated hip compared to the contralateral hip, as measured on plain radiographs: the decreased FO group (more than 5 mm reduction), the restored FO group (within 5 mm restoration), and the increased FO group (more than 5 mm increment).
Multiple epiphyseal dysplasia tarda (MEDT) and spondylo-epiphyseal dysplasia tarda (SEDT) are genetically transmitted conditions affecting the hips, which may resemble bilateral Legg-Perthes disease (LPD). Misdiagnoses are not uncommon, with serious implications for treatment, prognosis and genetic counseling. An epidemiologic study of MEDT and SEDT in a well-defined population of 453,921 persons in Denmark was performed. A population prevalence of 0.7 per 100,000 inhabitants with SEDT and 4.0 per 100,000 inhabitants with MEDT was found. Distinguishing features between MEDT, SEDT and bilateral LPD based on radiologic findings in the hips, other joints, and spine were ascertained. Bilateral LPD is always asymmetric, exhibits patches of increased density in the epiphyses and often metaphyseal cyst-like changes. No spinal lesion or affection of other joints is present, and the acetabula are normal. In MEDT and SEDT the capital femoral epiphyses are symmetrically flattened, fragmented and uniformly slightly sclerotic. Generalised platyspondyly is a constant finding in SEDT.
One hundred patients treated for slipped capital femoral epiphysis (SCFE) were reviewed to evaluate the incidence of bilateral slipping of the epiphysis at an average follow-up time of 32 years. When the patients were examined during adolescence, repeat lateral radiographs of the hips had been obtained by the frog lateral view in 33 patients and by the standardized lateral view according to the method of Billing in 67 patients. At re-examination, 59 patients (59%) were judged to have had a previous bilateral SCFE; in 42 of these 59 patients (71%), slipping of the contralateral hip was asymptomatic. In 23 patients (23%), the diagnosis of bilateral slipping was established at primary admission, in 18 (18%) later during adolescence, and in 18 (18%) not until the patients were reexamined as adults and the primary radiographs were reviewed. The incidence of bilateral slipping was higher in patients in whom the Billing standardized lateral view was used (63%) than in patients in whom the frog lateral view was used (52%). We conclude that the incidence of bilateral slipping of the epiphysis in patients with SCFE is approximately 60% in Sweden. If repeat radiographs of the contralateral hip are obtained with the Billing standardized lateral view until physeal closure occurs, even minor slipping of the epiphysis, which is often advisable to treat, will be apparent.
Treatment of displaced femoral neck fractures in Sweden has shifted towards more arthroplasties, especially hemiarthroplasties. We describe the hemiarthroplasty population in Sweden 2005 through 2009.
Since 2005, the Swedish Hip Arthroplasty Register has registered hemiarthroplasties on a national basis. We assessed hemiarthroplasty procedures in the Register 2005-2009 regarding patient details, implants, and surgical techniques. Completeness of recordings was calculated compared to the Swedish National Patient Register.
Completeness increased from 89% to 96% during the study period. 21,346 hemiarthroplasty procedures were assessed. The relative number of patients with femoral neck fracture as diagnosis increased from 91% to 94%; the proportion of men increased from 27% to 30%. The median age increased from 83 to 84 years in men and from 84 to 85 years in women. Patients classified as having evident cognitive impairment increased from 19% to 22%. More men than women were ASA 4. The proportion of monoblock-type implants (Austin-Moore and Thompson) decreased from 18% to 0.9%. Modular implants increased generally, but in 2009 bipolar implants decreased in favor of unipolar implants. Lubinus and Exeter stems, and Mega Caput and Vario Cup implant heads were most common. The use of uncemented implants decreased from 10% to 3%. Use of the anterolateral approach increased from 47% to 56%.
Important changes in surgical technique and implant choice occurred during the observation period. We interpret these changes as being reflections of the continuing effort by Swedish orthopedic surgeons to improve the quality of treatment, because the changes are consistent with recent findings in the Swedish Hip Arthroplasty Register and in other scientific studies.
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Cites: J Bone Miner Metab. 2011 May;29(3):309-1420814705
Cites: J Bone Joint Surg Br. 1975 Nov;57(4):437-431194309
The purpose of this investigation was to assess the midterm clinical outcomes after implantation of Oxinium (OX) vs cobalt-chrome (CC) femoral heads. Primary total hip arthroplasty (THA) procedures were performed in 100 patients. After randomization, half of the patients received OX femoral heads and half received CC femoral heads. At a minimum follow-up of 2-years, stem survival was 98% for both groups. The mean Harris Hip score was 92 for OX and 92.5 for CC, with mean WOMAC scores of 84.9 and 87, respectively. For SF-12, the OX group had mean physical and mental component scores of 45.2 and 53.8 and the CC group 49.2 and 52.6, respectively. At a minimum follow-up of 2 years, clinical outcomes for THA procedures using OX and CC femoral heads appear equivalent.
Ceramic-on-ceramic (CoC) bearings were introduced in total hip arthroplasty (THA) to reduce problems related to polyethylene wear. We compared the 9-year revision risk for cementless CoC THA and for cementless metal-on-polyethylene (MoP) THA.
In this prospective, population-based study from the Danish Hip Arthroplasty Registry, we identified all the primary cementless THAs that had been performed from 2002 through 2009 (n = 25,656). Of these, 1,773 THAs with CoC bearings and 9,323 THAs with MoP bearings were included in the study. To estimate the relative risk (RR) of revision, we used regression with the pseudo-value approach and treated death as a competing risk.
444 revisions were identified: 4.0% for CoC THA (71 of 1,773) and 4.0% for MoP THA (373 of 9,323). No statistically significant difference in the risk of revision for any reason was found for CoC and MoP bearings after 9 years of follow-up (adjusted RR = 1.3, 95% CI: 0.72-2.4). Revision rates due to component failure were 0.5% (n = 8) for CoC bearings and 0.1% (n = 6) for MoP bearings (p
Cites: J Bone Joint Surg Br. 2007 Sep;89(9):1158-6417905951
This study was designed to estimate direct and indirect costs incurred by hip disease in patients eligible for total hip arthroplasty (THA). Before THA, 2635 patients completed a questionnaire regarding the use of resources because of their hip disease. Costs were assigned using official statistical sources or market prices. Annual costs amounted to US$ 7666 per patient. In a regression analysis, higher annual costs were associated with working age, female gender, comorbidity, and operation waiting time more than 90 days (P