OBJECTIVE: To investigate the relationship between the area of psoas major muscle(PMI) and recurrent contralateral hip fracture in the initial intertrochanteric fracture. METHODS: Total of 87 patients with intertrochanteric fracture of femur from January 2008 to January 2011 were selected for CT scanning of lumbar spine and hip at the time of the first fracture, and then divided into two groups according to whether there was fracture in the contralateral hip, 13 patients in the contralateral hip fracture group, 5 males and 8 females, aged(82.30±5.66) years;there were 74 cases in the non contralateral hip fracture group, including 32 males and 42 females, with an age of (79.70±5.84) years. The gender, age, preoperative blood albumin value, operation side, body mass index(BMI), Harris score of hip joint one year after operation, Barthel index before operation and medical diseases before operation were observed and compared between two groups. The PMI was used to compare the area of psosa major on CT before operation in two groups, and the correlation between the area of PMI at the time of initial fracture and the fracture of the contralateral hip was evaluated. RESULTS: The two groups were followed up for more than 2 years after operation. There was a significant difference in PMI between two groups(P<0.05). There was a significant positive correlation between preoperative PMI and the time of re fracture of the contralateral hip(r=0.641, P=0.018). CONCLUSION There are differences in the area of PMI in patients with contralateral hip fracture, so the area of PMI can be regarded as an important risk factor for contralateral hip fracture.
Male ; Female ; Humans ; Psoas Muscles/diagnostic imaging* ; Treatment Outcome ; Hip Fractures/surgery* ; Hip Joint ; Femur

Developmental dysplasia of the hip (DDH) is one of the most common congenital disorders in childhood. Its diverse pathological changes require different treatments and result in different outcomes. Although many studies have been conducted on DDH, some special pathology is still unrecognized. We here presented a rare case of a one-year and eleven-month old girl with DDH; a half-free intra-articular osteocartilaginous tissue was found in her right hip joint. X-ray, computer assisted tomography (CT) and magnetic resonance imaging (MRI) were performed to evaluate the pathological changes. MRI revealed some positive findings. The patient experienced open reduction and histopathological examination of the small tissue. Through gross anatomy it is a half-free intra-articular osteocartilaginous tissue, which can fully match a fossa observed at the femoral head. Histopathological examination found that the tissue was composed of collagenous fiber and cartilage-like tissue. Interestingly, we found the expression of type I collagen according to immunohistochemical analysis, which indicated that the cartilage-like tissue was formed due to laceration of the articular cartilage. This kind of disorder should be included as one of the pathologies of DDH. The most possible origin of this tissue is the femoral head which we speculate may have been fractured before.
Female ; Hip Dislocation, Congenital ; diagnostic imaging ; pathology ; surgery ; Humans ; Infant ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

Acetabulum ; abnormalities ; diagnostic imaging ; Adolescent ; Adult ; Cartilage ; abnormalities ; Female ; Hip Dislocation, Congenital ; diagnosis ; surgery ; Hip Joint ; abnormalities ; surgery ; Humans ; Ligaments ; abnormalities ; Male ; Orthopedic Procedures ; Young Adult

BACKGROUND: To augment cement-bone fixation, Dr. Hironobu Oonishi attempted additional physicochemical bonding through interposition of osteoconductive crystal hydroxyapatite (HA) granules at the cement-bone interface in 1982. He first used the interface bioactive bone cement (IBBC) technique in 12 selected patients (12 hips) in 1982 (first stage) and followed them for 2 years. In 1985, the technique was applied in 25 total hip arthroplasty (THA) patients (second stage) and the effects were investigated by comparing the side with the IBBC technique and the other side without the IBBC technique. He has employed this technique in all THA patients since 1987 (third stage). METHODS: In the IBBC technique, HA granules (2 to 3 g) were smeared on the bone surface just before the acetabular and femoral components were cemented. In the first stage, 12 hips were operated using the IBBC technique in 1982. In the second stage, THA was performed without the IBBC technique on one side and with the IBBC technique on the other side within 1 year in 25 patients. In the third stage, THA was performed with the IBBC technique in 285 hips in 1987. RESULTS: In the first stage patients, implant loosening was not detected at 30 years after operation. In the second stage patients, revision was required in 7 hips without the IBBC technique due to cup loosening (5 hips) and stem loosening (2 hips), whereas no hip was revised after THA with the IBBC technique at 26 years after operation. In the third stage patients, the incidence of radiolucent lines and osteolysis was very few at 25 years after operation. CONCLUSIONS: The long-term follow-up of THA performed around the inception of the IBBC technique has revealed low incidences of radiolucent lines, osteolysis, and revision surgery.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Hip/adverse effects/instrumentation/methods ; *Bone Cements/adverse effects/therapeutic use ; Bone-Implant Interface/physiology ; Follow-Up Studies ; Hip/diagnostic imaging/surgery ; Humans ; Hydroxyapatites/therapeutic use ; Middle Aged ; Young Adult

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.
Acetabulum/diagnostic imaging/*surgery ; Adult ; Female ; Hip Dislocation/diagnostic imaging/*surgery ; Humans ; Imaging, Three-Dimensional ; Male ; Osteotomy/*methods ; Surgery, Computer-Assisted/*methods ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND: Early stage osteonecrosis of the femoral head (ONFH) has many treatment options including core decompression with implantation of a tantalum rod. The purpose of this study was to evaluate clinical and radiological outcomes and potential complications during conversion total hip arthroplasty (THA) in such patients. METHODS: Six male patients (8 hips) underwent THA subsequent to removing a tantalum rod (group I) from April 2010 to November 2011. We retrospectively reviewed the medical records of these patients. We enrolled 12 age- and sex-matched patients (16 hips) during the same period, who had undergone primary THA without a previous operation as the control group (group II). All patients were followed for at least 3 years. We checked the Harris hip score (HHS), operative time, and volume of blood loss. Radiological results, including inclination, anteversion of the acetabular cup, presence of periprosthetic osteolysis, and subsidence of femoral stem were checked at the last follow-up. RESULTS: The mean preoperative HHS values were 56.5 (range, 50 to 62) and 59.1 (range, 42 to 70) in groups I and II, respectively. The HHS improved to 96.0 (range, 93 to 100) and 97.6 (range, 93 to 100), respectively, at the 3-year follow-up (p = 0.172). Mean operation time was 98.8 minutes (range, 70 to 120 minutes) in group I and 77.5 minutes (range, 60 to 115 minutes) in group II (p = 0.006). Total blood loss volumes were 1,193.8 mL (range, 960 to 1,360 mL) and 944.1 mL (range, 640 to 1,280 mL) in groups I and II, respectively (p = 0.004). No significant differences in inclination or anteversion of acetabular cup and no evidence of osteolysis or subsidence of the femoral stem were reported in either group in radiological follow-up results. However, one case of squeaking occurred in group I during the follow-up. CONCLUSIONS: The two groups showed no clinical or radiological differences except extended operative time and increased blood loss. However, the incidence of squeaking (1 of 8 hips) was higher, as compared to the control group or previously reported values.
Adult ; *Arthroplasty, Replacement, Hip/adverse effects/methods/statistics & numerical data ; Case-Control Studies ; *Decompression, Surgical/adverse effects/methods/statistics & numerical data ; Femur Head/diagnostic imaging/surgery ; Femur Head Necrosis/diagnostic imaging/*surgery ; Humans ; Male ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Tantalum/*therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUNDPorous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures.

METHODSA total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed.

RESULTSThe mean Harris hip score increased from 34 (range, 8-52) before surgery to 91 (range, 22-100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted.

CONCLUSIONSDespite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures.

Acetabulum ; diagnostic imaging ; injuries ; surgery ; Adult ; Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Follow-Up Studies ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Treatment Failure

BACKGROUNDA quantitative and accurate measurement of the range of hip joint flexion (RHF) is necessarily required in the evaluation of disordered or artificial hip joint function. This study aimed to assess a novel method to measure RHF more accurately and objectively.

METHODSLateral radiographs were taken of 31 supine men with hip joints extended or flexed. Relevant angles were measured directly from the radiographs. The change in the sacrofemoral angle (SFA) (the angle formed between the axis of the femur and the line tangent to the upper endplate of S1) from hip joint extension to hip joint flexion, was proposed as the RHF. The validity of this method was assessed via concomitant measurements of changes in the femur-horizontal angle (between the axis of the femur and the horizontal line) and the sacrum-horizontal angle (SHA) (between the line tangent to the upper endplate of S1 and the horizontal line), the difference of which should equal the change in the SFA.

RESULTSThe mean change in the SFA was 112.5 ± 7.4°, and was independent of participant age, height, weight, or body mass index. The mean changes in the femur-horizontal and SHAs were 123.0 ± 6.4° and 11.4 ± 3.0°, respectively. This confirmed that the change of SFA between hip joint extension and hip joint flexion was equal to the difference between the changes in the femur-horizontal and SHAs.

CONCLUSIONSUsing the SFA, to evaluate RHF could prevent compromised measurements due to the movements of pelvis and lumbar spine during hip flexion, and is, therefore, a more accurate and objective method with reasonable reliability and validity.

Adult ; Hip Joint ; diagnostic imaging ; surgery ; Humans ; Male ; Radiography ; Range of Motion, Articular ; physiology ; Sacrum ; diagnostic imaging ; surgery ; Young Adult

OBJECTIVETo analyze the gender, age, fracture classification and variation trend of adult intertrochanteric fractures treated in a single-center hospital in ten years.

METHODSThe data of adult (age ≥ 16 years) intertrochanteric fractures admitted to the Third Hospital of Hebei Medical University from January 2003 to December 2012 were collected retrospectively. All the fractures were acute and the pathological or periprosthetic fractures were excluded. The radiography of fracture were classified by same experienced orthopedic resident and verified by two orthopedic deans and one radiologist. The gender, age and fracture classification were analyzed and compared between January 2003 to December 2007 and January 2008 to December 2012.

RESULTSA total of 3 201 cases were collected. The adult intertrochanteric fractures accounted for 2.97% of all adult fractures and 43.76% of adult proximal femoral fractures. Of all fractures 64.98% were elderly ( ≥ 60 years) and 35.02% were middle-aged (16-59 years). In elderly, female were common (57.78%) while in middle-aged were male commonly (79.13%). According to Evans classification, instable fractures were more common (68.92%). According to AO classification, the most common type was A2 (49.67%) and the least was A3 (15.93%). Comparing between January 2003 to December 2012 and January 2008 to December 2012, the proportion of intertrochanteric fracture of adult fracture was decreased by 0.31% (χ² = 9.29, P = 0.002)and the proportion of intertrochanteric fracture of adult proximal femoral fractures was decreased by 3.15% (χ² = 7.35, P = 0.007). The proportion of elderly patients, female and stable fractures was increased by 14.35% (χ² = 71.98, P < 0.01), 4.04% (χ² = 8.16, P = 0.004) and 5.62% (χ² = 11.7, P = 0.001), respectively. The proportion of AO classification was not significantly verified (χ² = 3.24, P = 0.198).

CONCLUSIONSThe intertrochanteric fractures are most common in elderly patients, A2-type of AO Classification and stable (Evans III, IV, V) in Evans classification. Compared with the previous five years, the proportions of female, elderly and stable (Evans I, II) fracture increase in last 5 years.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Female ; Femoral Fractures ; diagnostic imaging ; epidemiology ; surgery ; Hip Fractures ; diagnostic imaging ; epidemiology ; surgery ; Humans ; Male ; Middle Aged ; Periprosthetic Fractures ; Radiography ; Retrospective Studies ; Young Adult

Adult ; Asymptomatic Diseases ; China ; Chondromatosis, Synovial ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Hip Joint ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Hospitals ; Humans ; Male ; Tomography, X-Ray Computed