OBJECTIVETo analysis the effects of restoring neck length and femoral calcar of femoral component on the reconstruction of femoral offset and its affection on soft tissue balance in total hip arthroplasty with standard femoral components.

METHODSSixty-eight patients (71 hips, 30 male and 38 female,ranging in age from 17 to 89 years,with an average of 63.5 years)undergone primary total hip arthroplasty were followed up. The postoperative hip scored according to Harris hip score symtem, and femoral offset,femoral calcar restored as well as neck length of femoral component were measured from the postoperative X-ray image, and the adductor muscle force was measured by Cybex-6000 isokinetic muscle strength testing system.

RESULTSFemoral neck length had highly significant and positive correlation with femoral offset (r = 0.64, P < 0.001), and had more effects on femoral offset than restoring femoral calcar (t = 3.07, P < 0.01), but had no significant difference on postoperative Harris score. The postoperative femoral offset of patients operated for the femoral head osteonecrosis was less than those for the hip osteoarthrosis (t = 2.91, P < 0.01) and the femoral neck fracture (t = 3.31, P < 0.01). The adductor muscle force in patients who restored femoral offset were better than those failed to restore femoral offset.

CONCLUSIONThere are several factors affecting femoral offset restoration for soft tissue balance in total hip arthroplasty with standard femoral components, among them, the key factor is the neck length of femoral component which is more significant than femoral calar restoration for reconstruction of femoral offset. The role of femoral offset on soft tissue balance in total hip arthroplasty was strengthening the postoperative adductor muscle.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Cartilage ; physiopathology ; Female ; Femur ; diagnostic imaging ; physiopathology ; surgery ; Follow-Up Studies ; Hip ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography

BACKGROUND: Some dysplastic hips with favorable radiographic parameters fail to develop normally, suggesting that we should consider cartilaginous or soft tissue structures for further information regarding the condition of the hip. The purpose of this study was to provide a clear definition of concentric reduction in developmental dysplasia of the hip (DDH) based on magnetic resonance imaging (MRI), and to determine how radiographic and MR-based parameters could be used together to treat dysplastic hips. METHODS: We studied range of motion (ROM)-MRI of 25 patients with unilateral hip dysplasia (mean age at the time of MR imaging, 44.1 months). Each ROM-MRI consisted of a set of bilateral hip scans in the following positions: neutral; abduction; abduction- internal rotation; abduction-internal rotation-flexion; and adduction. Before MR scanning, the 25 patients received the following primary treatments: closed reduction (n = 15; at a mean age of 14.5 months); and open reduction (n = 10; at a mean age of 10.0 months). The following new parameters appear to be useful in treating DDH: 1) the labral angle, the angle the labrum makes with the acetabulum; 2) the uncorrected labral deformity (ULD), the "residual deformity" (deflection of the labrum) when the affected labrum is freed from pressure in abduction; and 3) the zone of compressive force (ZCF), the region of the acetabulum through which the body weight acts on the femoral head. RESULTS: A concentrically-reduced hip is one in which the labrum points downward in the neutral position, at the same angle as that of the normal side; and in which the ZCF is zone 3, the inner acetabular zone as defined herein. The ULD and the ZCF may be determined precisely as we have done, or the physician may simply observe the changes in the orientation of the labrum and compare the changes qualitatively to the unaffected side, and likewise for the medial joint space. CONCLUSIONS: Detailed analysis of the labrum as permitted by ROM-MRI, together with acetabular index and other parameters measured from radiographs, provides important information for physicians treating childhood hip dysplasia.
Child, Preschool ; Female ; Hip Dislocation, Congenital/*diagnosis/physiopathology/radiography/surgery ; Hip Joint/pathology/physiopathology/radiography ; Humans ; Infant ; *Magnetic Resonance Imaging ; Male ; Range of Motion, Articular

BACKGROUND: The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment. METHODS: Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit. RESULTS: The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed. CONCLUSIONS: Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects/*methods ; Female ; Femur/pathology/radiography/surgery ; Hemiarthroplasty/adverse effects/*methods ; Hip/pathology/radiography/surgery ; Hip Fractures/physiopathology/radiography/*surgery ; Humans ; Male ; Pain Measurement ; Postoperative Complications ; Prospective Studies

BACKGROUND: Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. METHODS: From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. RESULTS: There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. CONCLUSIONS: Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.
Adult ; Arthroscopy/*methods ; Female ; Hip/*physiopathology/radiography/*surgery ; Hip Dislocation/*surgery ; Hip Fractures/*surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis ; Pain/physiopathology/*surgery ; Pain Measurement ; Range of Motion, Articular ; Retrospective Studies ; Young Adult

OBJECTIVETo evaluate the clinical and radiographic effects of total hip arthroplasty (THA) in the treatment of bony ankylosis of hips.

METHODSFrom January 2003 to August 2009, 20 patients (30 hips) with bony ankylosis of hips were treated with THA. There were 12 males and 8 females, with an average age of 36 years old. After operation, the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated with Harris score, satisfaction of pain relief, limb length discrepancy, ROM of hip and the strength of hip abductor. The X-ray imaging follow-up results were evaluated with acetabula and periprosthetic osteolysis, prosthesis loosening, radiolucent and heterotopic ossification.

RESULTSThe average following-up was 4 years. The mean preoperative Harris score was (40.75 +/- 6.52) as opposed to postoperative Harris score of (86.40 +/- 5.42). Total pain relief was 65% and partial pain relief was 35% around the affected hips. The recovery of abductors strength was satisfactory in 13 cases, with limp symptoms was relieved obviously, and limb shortening decreased to less than 0.5 cm. The postoperative ROM of hip was significantly improved compared with the preoperative ROM. Radiographic analysis showed that heterotopic ossification in 2 cases, and radiolucent around prosthesis in one case. There were no dislocation and revision cases.

CONCLUSIONThe THA can provide satisfactory clinical results in bony ankylosis of hips, which not only correct the deformity and recover the functions of hip, but also relieve the pain of hip to improve quality of life.

Adult ; Ankylosis ; diagnostic imaging ; physiopathology ; surgery ; Arthroplasty, Replacement, Hip ; methods ; Female ; Hip Joint ; physiopathology ; Humans ; Male ; Middle Aged ; Radiography ; Range of Motion, Articular

OBJECTIVETo evaluate indications and clinical results of total hip arthroplasties for degenerative hips with history of infection.

METHODSSeven cases of degenerative hip with history of infection underwent primary total hip arthroplasties, which involved 5 males and 2 females, with an average age of 45.8 years (range, 30 to 65 years). The quiescent period of infection were more than 10 years in all hips. According to Kim classification, 3 cases were of type I, and 4 of type II. The method to exclude active infection at the site of degenerative hips preoperatively was combination of physical examination, erythrocyte sedimentation rate and C-reactive protein level. The lateral incision was adopted in all cases, and all prosthesis were cementless. The clinical results of affected hips were assessed according to Harris hip score.

RESULTSThe follow-up was performed with the mean duration of 33.5 months (range, 21 to 44 months). No recurrence of infection, damage of nerve function or deep vein thrombosis of lower extremities occurred in all cases. The mean Harris hip scores improved from 44.5 points preoperatively to 84 points at the latest follow-up. No aseptic loosening of prosthesis or periprosthetic osteolysis were found at the latest follow-up.

CONCLUSIONTotal hip arthroplasties has good short term results for degenerative hips with history of infection. It is important to select indicated cases and rule out the possibility of active infection.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Bone Diseases, Infectious ; complications ; Female ; Follow-Up Studies ; Hip ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography

OBJECTIVETo study advantages of Pemberton acetabuloplasty for the treatment of developmental dislocation of hip joint.

METHODSAmong 106 children (116 hips) with development dislocation of hip joint treated by Pemberton acetabuloplasty, 19 patients (29 hips) were boy, and 87 patients (87 hips) were girl, 46 hips were left side, 50 hips were right side and 20 hips were double side, ranging in age from 18 months to 13 years, with an average of 7 years and 3 months. All the 116 hips were treated with Pemberton acetabuloplasty, or "complete operation", which included the cutting of adductor and iliopsoas, Pemberton acetabuloplasty combined with subtrochanteric femoral shortening and rotation osteotomy. Among the hips, 95 hips were treated with simple Pemberton acetabuloplasty, and the other 21 hips were treated with complete operation. All the patients with bilateral developmental dislocation of hip joint were performed the operation at one side firstly, and one year later the other side were performed and the plate fixation in the first operation were removed.

RESULTSAll the patients were followed-up ranging from 2 to 10 years, with an average of 6 years. According to Muller and Seddon's evaluation criteria, 67 hips got an excellent result, 34 good, 10 fair and 5 bad, the excellent and good rate was 87%.

CONCLUSIONPemberton acetabuloplasty is suitable for the treatment of developmental dislocation of hip joint in children at different ages, and the therapeutic effects are good.

Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hip Dislocation ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Hip Joint ; diagnostic imaging ; growth & development ; physiopathology ; surgery ; Humans ; Infant ; Male ; Radiography ; Recovery of Function ; Treatment Outcome