PURPOSE: This study was performed to evaluate long-term clinical and radiologic outcomes of cemented total hip arthroplasty in patients with ankylosing spondylitis. MATERIALS AND METHODS: A retrospective study of 12 patients (16 cases) diagnosed with ankylosing spondylitis undergoing total hip arthroplasty with cemented femoral stem from November 2002 to January 2006 with a minimum follow up of 10 years. Clinical outcomes were assessed using Harris Hip Scores and measures of pain and range of motion. Radiologic outcomes were assessed with serial plain X-ray. Fixation and stability of implant, enthesopathy of ischium and development of heterotopic ossification were also evaluated. RESULTS: Mean Harris Hip Scores significantly improved from pre-operative levels (58 points; range, 39–81 points) to post-operative (92 points; range, 68–100 points). Mean flexion contracture levels decreased from preoperative (13°) to post-operative (5°), and mean post-operative range of motion improved 106° compared to preoperative levels. No newly developed osteolysis lesions or implant loosening were observed in last follow up X-rays. One heterotopic ossification and one greater trochanter fracture were observed. Greater trochanter fracture was treated conservatively, and was resulted in bony union. No patients underwent revisions. CONCLUSION: This study revealed positive long-term clinical and radiologic outcomes following total hip arthroplasty with cemented femoral stems in patients with ankylosing spondylitis patients.
Arthroplasty, Replacement, Hip ; Contracture ; Femur ; Follow-Up Studies ; Hip ; Humans ; Ischium ; Ossification, Heterotopic ; Osteolysis ; Range of Motion, Articular ; Retrospective Studies ; Rheumatic Diseases ; Spondylitis, Ankylosing

OBJECTIVETo investigate clinical curative effects of gluteal muscle contracture release combined with insertion of gluteus maximus tendo-chilles lengthening with Z-shaped in treating severe gluteal muscles contracture.

METHODSFrom 2006 May to 2011 May, 20 patients (35 sides) with severe gluteal muscle contracture were collected, including 12 males and 8 females, aged from 8 to 34 years old with an average of 13 years old; the courses of disease ranged from 3 to 21 years. All patients manifested abnormal gait at different degree, knees close together cannot squat,positive syndrome of Ober, positive test of alice leg. Gluteus contracture fascia release were performed firstly in operation, then insertion of tendo-chilles lengthening with Z-shaped were carried out. Preoperative and postoperative gait, and knee flexion hip extensor squat test, cross leg test, adduction and internal rotary activity of hip joint, stretch strength and motor ability after hip abduction were observed and compared.

RESULTSTwenty patients were followed up for 1 to 5 years. Gluteus maximus were released thoroughly, and snapping hip was disappeared, Ober syndrome were negative. There was significant differences in knee flexion hip extensor squat test, adduction and internal rotary activity of hip joint,stretch before and after operation (P<0.01). Gluteus muscle strength was protected,stretch strength and motor ability of hip joint were recovered well. Among them,31 cases got excellent results and 4 good.

CONCLUSIONFor severe gluteal muscles contracture,insertion of gluteus maximus tendo-chilles lengthening with Z-shaped performed after gluteus contracture fascia release could release gluteal muscle contracture to the greatest extent and obtain postoperative curative effect without resection of normal hip muscle fibers and destroy joint capsule.

Adolescent ; Adult ; Buttocks ; surgery ; Child ; Contracture ; surgery ; Female ; Hip ; surgery ; Humans ; Male ; Muscle, Skeletal ; surgery ; Thigh ; surgery ; Young Adult

Ullrich congenital muscular dystrophy (UCMD) is characterized by congenital weakness, proximal joint contractures, and hyperlaxity of distal joints. UCMD is basically due to a defect in extra cellular matrix protein, collagen type VI. A 37-year-old woman who cannot walk independently visited our outpatient clinic. She had orthopedic deformities (scoliosis, joint contractures, and distal joint hyperlaxity), difficulty of respiration, and many skin keloids. Her hip computed tomography showed diffuse fatty infiltration and the 'central shadow' sign in thigh muscles. From the clinical information suggesting collagen type VI related muscle disorder, UCMD was highly considered. COL6A1 gene sequencing confirmed this patient as UCMD with novel c.904G>A (p.Gly302Arg) variant. If musculoskeletal and dermatologic manifestations and radiologic findings imply abnormalities in collagen type VI network, COL6A related congenital muscular dystrophy was to be suspected.
Adult ; Ambulatory Care Facilities ; Collagen Type VI ; Congenital Abnormalities ; Contracture ; Female ; Hip ; Humans ; Joints ; Keloid ; Muscles ; Muscular Diseases ; Muscular Dystrophies* ; Orthopedics ; Respiration ; Skin ; Thigh

OBJECTIVETo explore clinical effects of gluteal muscle contracture and minimum invasive surgery under the arthroscopy.

METHODSTotally 358 patients with gluteus contracture were treated,which included 175 males and 183 females with an average age of (19.7 +/- 6.8) years old (ranged, 14 to 41). All patients have a history of repetitive intramuscular injection of penicillin with benzyl alcohol solvent. According to clinical characteristics and intraoperative situation, patients were classified into four groups:cable strip (118 cases), fanshaped (107 cases), mixed (87 cases), tensor fasciae latae contracture(46 cases). The curative effects were evaluated according to postoperative function evaluation standard of gluteus contracture.

RESULTSAll patients were followed up and 37 cases withdrew. The following up time ranged from 1.5 to 8 years with an average of 3.5 years. According to evaluation standard of gluteus contracture, 303 cases got excellent results, 13 cases good,and 5 cases fair at the final follow-up. No recurrence, infection and neurovascular injury occurred.

CONCLUSIONThe classification of gluteal muscle contracture is beneficial for choose surgical strategy and improve curative effect. The advantage of plasma knife minimally invasive solution in treating gluteal muscle contracture with radiofrequency under arthroscopy is minimally invasive, safe, and benefit for early functional exercises.

Adolescent ; Adult ; Arthroscopy ; Female ; Hip Contracture ; surgery ; Humans ; Male ; Muscle, Skeletal ; surgery ; Treatment Outcome ; Young Adult

PURPOSE: CryoDerm (CGbio) is derived donated human skin. After removing epidermis and fibroblast of dermal layer, it preserved with cryo-preservation technique using control rate freezer system. To prevent post burn joint contracture in massive burns, we have used CryoDerm in acute stage. METHODS: From January of 2010 to July of 2012, 50 patients who undergone CryoDerm graft with split thickness skin graft were reviewed. The operative method was as follows: 1) Early wound excision and or cadaveric allograft skin coverage was performed within 5 days after burn injury 2) 2~3 weeks after wound excision, split thickness skin graft was performed with CryoDerm graft. Then graft take rate was investigated by inspection. Follow up duration was 3~32 months. RESULTS: Mean age of patients was 42.2 (2~70) years. Mean percentage of total body surface area burned was 27.22% (1~61%). Among 50 patients, 98 joints was operated including 14 hands, 4 wrists, 10 shoulders, 23 elbows, 4 necks, 3 hip joints, 31 knee joints and 9 ankles and feet. Total used graft size of Cryoderm was 10,945 cm2. Average take rate was near 100%. CONCLUSION: Cryoderm graft with split thickness skin graft can be used as a safe and effective operative method for one stage operation in acutely burned patients.
Animals ; Ankle ; Body Surface Area ; Burns ; Cadaver ; Contracture ; Elbow ; Epidermis ; Fibroblasts ; Follow-Up Studies ; Foot ; Hand ; Hip Joint ; Humans ; Joints ; Knee Joint ; Neck ; Shoulder ; Skin ; Transplantation, Homologous ; Transplants ; Wrist

OBJECTIVE: This study analyzed the midterm results of hip resurfacing arthroplasty in patients with rheumatoid arthritis. METHODS: Between October of 2003 and September of 2008, 13 consecutive hips that were treated with hip resurfacing arthroplasty due to rheumatoid arthritis were analyzed. The average follow up period was 48.6 months and the mean age at the time of operation was 35.9 years old. The mean BMI at the operation was 23.2 kg/m2. The implanted prostheses were the Conserve Plus system in five hips, the Birmingham hip resurfacing system in four hips and the Durom system in four hips. The results were clinically evaluated with the Harris hip score, the UCLA activity score, hip or thigh pain, the limb length discrepancy and the range of motion. As radiological evaluation, we observed the patterns of bone remodeling and complications such as femoral neck fracture, loosening and osteolysis. RESULTS: The average Harris hip score improved from 62.2 to 98.9 at the final visit. The range of motion improved to 0degrees in flexion contracture, 118.1degrees in further flexion, 22.7degrees in internal rotation, 40.4degrees in external rotation, 28.8degrees in adduction and 38.1degrees in abduction, respectively. No patient complained of a limb length discrepancy and hip or thigh pain. Radiographically, impingement between the acetabular component and the femoral neck was observed in one case. However, radiographic findings such as osteolysis, radiolucency, wear and loosening were not observed. CONCLUSION: The midterm results of hip resurfacing arthroplasty in patients with rheumatoid arthritis were excellent. But long-term studies are needed to determine the survivorship and to evaluate the osteoporotic change, the metal ion level and their influence after hip resurfacing arthroplasty.
Arthritis, Rheumatoid ; Arthroplasty ; Bone Remodeling ; Contracture ; Extremities ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Prostheses and Implants ; Range of Motion, Articular ; Survival Rate ; Thigh

Sagittal spinal balance is an essential factor for not only the external appearance, but also for the spine's function. Fixed sagittal imbalance is the result of different causes, and this generally requires surgical treatment. Sagittal imbalance is mainly caused by decreased lumbar lordosis and increased thoracic kyphosis, and it can also be influenced by the pelvic incidence and flexion contracture of the hip and knee joints. So, a careful understanding and clinically considering the many factors and compensatory mechanisms that are associated with sagittal imbalance are needed. Proper surgical treatments provide a satisfactory outcome for these patients and good radiographic results. Correction of sagittal imbalance generally requires spinal osteotomy and long segment fusion. For the surgical treatment, we should consider the perioperative and postoperative complications of osteotomy and long segment fusion and then make proper decisions for the range of fusion of the proximal and distal sides and the selection of the correct method of osteotomy, the ideal correction angle and the best method of internal fixation. Problems such as loss of correction may occur postoperatively due to kyphotic change and pseudarthrosis of the proximal and distal sides. Therefore, we need to conduct a thorough analysis and make a detailed plan for the surgical approach. We should also study and understand the radiological factors when treating sagittal spinal balance because not only the spine, but also the pelvis, hip and knee joints are involved in forming the sagittal balance
Animals ; Contracture ; Hip ; Humans ; Incidence ; Knee Joint ; Kyphosis ; Lordosis ; Osteotomy ; Pelvis ; Postoperative Complications ; Pseudarthrosis ; Spine

A psoas abscess (PA) is a rare clinical entity but is potentially serious condition which presents diagnostic and therapeutic challenges. The diagnosis is frequently delayed due to its variable and nonspecific features and occult clinical course. The delay in diagnosis and treatment of PA is the major poor prognostic factor. We describe herein a case of the sterile psoas abscess complicating Cronh's disease which presented as hip flexion contracture. A 29-year-old man, at remission stage of CD involving ileocolic segment, was admitted due to pain from hip contracture. He had no bloody diarrhea and no abdominal pain. PA was confirmed by abdominal ultrasound. PA with hip contracture was completely treated with surgical excision, irrigation, drainage, and antibiotics. PA was sterile and there was no evidence of a fistulous communication from the bowel. Once suspected, aggressive diagnostic work up and definitive operative intervention is needed.
Adult ; Crohn Disease/*complications/drug therapy ; Diagnosis, Differential ; Drainage ; Hip Contracture/complications/*diagnosis/surgery ; Humans ; Male ; Psoas Abscess/*diagnosis/etiology/ultrasonography ; Tomography, X-Ray Computed

Bilateral psoas abscesses extending to the gluteal muscle and intrapelvic area are uncommon. We present our experience with computed tomography (CT)-guided percutaneous catheter drainage for the treatment of multiple aggressive abscesses in a diabetic patient. The abscesses completely resolved after the procedures. Psoas abscess should be considered in the differential diagnosis of older diabetic patients with fever, flank or back pain, and flexion contracture of the hip joint. CT scanning is a useful method in diagnosing abscesses, and CT-guided percutaneous catheter drainage is an effective treatment method in selected patients.
Abscess ; Back Pain ; Catheters ; Contracture ; Diagnosis, Differential ; Discitis ; Drainage ; Fever ; Hip Joint ; Humans ; Muscles ; Psoas Abscess

Sacral agenesis is an uncommon condition characterized by absence of different segments of lumbar spine along with total or partial absence of sacrum. It does not have an established etiology but may be associated with insulin dependent diabetes mellitus in the mother. Motor deficits are present and correspond to the level of vertebral agenesis. Sensation is better preserved than motor function. Orthopedic deformities such as hip dislocation, flexion contractures, genu recurvatum, posterior compartment atrophy, scoliosis and so on are observed. Urinary and bladder dysfunction are constant and it can lead to fatal kidney damage, finally. We report one case of type IV sacral agenesis with review of literature.
Atrophy ; Congenital Abnormalities ; Contracture ; Diabetes Mellitus ; Hip Dislocation ; Humans ; Insulin ; Kidney ; Mothers ; Orthopedics ; Sacrococcygeal Region ; Sacrum ; Scoliosis ; Sensation ; Spine ; Urinary Bladder ; Urinary Bladder, Neurogenic