DYSPLASIA OF THE HIP: A FACTOR IN THE DEVELOPMENT OF STATIC OSTEOARTHROPATHY

Dysplasia of the hip is associated with a shallow acetabulum. It may be present and unrecognized until middle age when arthritic changes develop as a result of repeated microtraumata. By that time the process is irreversible.It can be recognized in infancy by roentgenographic study of the hips, and corrective measures can be taken to develop a normal hip and so prevent the crippling arthritis of later life. Although it is not certain that dysplasia develops in every person having a shallow acetabulum, this structural abnormality is known to be a strongly predisposing factor and therefore should be corrected.     

成人先天性髋关节发育不良的围手术期护理

成人先天性髋关节发育不良是一种髋臼先天性发育缺陷的疾病,长期发展会形成髋关节半脱位、脱位,最终甚至可能出现股骨头坏死等严重合并症。对于早期患者目前主要采用髋臼旋转截骨手术治疗,而晚期出现股骨头脱位及坏死则只能通过全髋关节置换进行治疗。不论哪种手术方式,围手术期的护理对于患者的健康恢复都有着非常重要的意义。     

成人先天性髋关节发育不良的围手术期护理

成人先天性髋关节发育不良是一种髋臼先天性发育缺陷的疾病,长期发展会形成髋关节半脱位、脱位,最终甚至可能出现股骨头坏死等严重合并症。对于早期患者目前主要采用髋臼旋转截骨手术治疗,而晚期出现股骨头脱位及坏死则只能通过全髋关节置换进行治疗。不论哪种手术方式,围手术期的护理对于患者的健康恢复都有着非常重要的意义。     

Morphometric study of the fetal development of the human hip joint: significance for congenital hip disease.

Hip joints (280) from 140 human fetuses, obtained from abortions and deaths in the perinatal period, were studied. The fetuses ranged from 8.7 to 40 cm in crown-rump length and are believed to be between 12 and 42 weeks in age. The joints were dissected, morphology inspected, and measurements taken of the depth and diameter of the acetabulum, the diameter of the femoral head, length and width of the ligament of the head, the neck-shaft, and torsion angles of the proximal femur. Regression models were fitted to determine which would best predict the growth pattern. Multivariate analysis of variance showed no significant differences between males and females or between the right and left sides. Acetabular depth was shown to be the slowest-growing hip variable, increasing less than fourfold in the period studied. Acetabular indices less than 50 percent indicate a shallow socket at term. Femoral head and acetabular diameter demonstrated a strong relationship (r = 0.860) and in many joints the femoral head diameter exceeded that of the acetabulum. Considerable variability was demonstrated in both femoral angles. The femoral angles showed only low correlation with the other hip variables. These observations indicate that soft tissue structures about the joint must play an important role in neonatal joint stability. The explanation of greater female and left side involvement in congenital hip disease must lie in factors other than growth changes of hip dimensions. Neither angle appears to be a useful indicator of normal joint development.     

Brief communication: developmental dysplasia of the hip in medieval London

Developmental dysplasia of the hip (DDH) is a spectrum of disease starting in childhood and in many cases persisting into adulthood. The spectrum ranges from acetabular dysplasia, through hip subluxation to dislocation. The aim of this research was to determine the prevalence and pathoanatomy of acetabular dysplasia and subluxation in excavated human skeletal remains, to complement past research on dislocation in DDH. The material under study was the medieval cemetery of St. Mary Spital in London, in use from c.1100 to 1539 AD. A series of 572 adults with both hips preserved were analyzed. Acetabular dysplasia was indicated by a shallow acetabulum with upward sloping roof. Subluxation was suggested by degenerative change along the margin of the acetabulum suggestive of labral tears, and degenerative change in the outer part of the acetabular roof suggestive of osteoarthritis. The prevalence of DDH (acetabular dysplasia, subluxation, or dislocation) was 1.7%. Because this a congenital musculoskeletal disorder of relatively high frequency, with significant variation in prevalence between populations around the world, it is a topic that warrants targeted research from physical anthropologists studying past populations.     

"In vivo" determination of hip joint separation and the forces generated due to impact loading conditions

Numerous supporting structures assist in the retention of the femoral head within the acetabulum of the normal hip joint including the capsule, labrum, and ligament of the femoral head (LHF). During total hip arthroplasty (THA), the LHF is often disrupted or degenerative and is surgically removed. In addition, a portion of the remaining supporting structures is transected or resected to facilitate surgical exposure. The present study analyzes the effects of LHF absence and surgical dissection in THA patients. Twenty subjects (5 normal hip joints, 10 nonconstrained THA, and 5 constrained THA) were evaluated using fluoroscopy while performing active hip abduction. All THA subjects were considered clinically successful. Fluoroscopic videos of the normal hips were analyzed using digitization, while those with THA were assessed using a computerized interactive model-fitting technique. The distance between the femoral head and acetabulum was measured to determine if femoral head separation occurred. Error analysis revealed measurements to be accurate within 0.75mm. No separation was observed in normal hips or those subjects implanted with constrained THA, while all 10 (100%) with unconstrained THA demonstrated femoral head separation, averaging 3.3mm (range 1.9-5.2mm). This study has shown that separation of the prosthetic femoral head from the acetabular component can occur. The normal hip joint has surrounding capsuloligamentous structures and a ligament attaching the femoral head to the acetabulum. We hypothesize that these soft tissue supports create a passive, resistant force at the hip, preventing femoral head separation. The absence of these supporting structures after THA may allow increased hip joint forces, which may play a role in premature polyethylene wear or prosthetic loosening.     

髋关节撞击征的诊断和治疗*

摘要：髋关节撞击综合征(femoroacetabular impingement,FAI)是以髋关节解剖结构异常而引发的股骨近端和髋臼间发生异常碰 撞,从而导致髋关节盂唇和关节软骨的退行性变化,引起髋关节慢性疼痛的疾病。髋关节活动范围特别是屈曲和内旋受限,最终 发展为髋关节骨关节炎。FAI在我国国内为一个较新的概念,临床能得到诊断的病例不多,但实际病例很多,相当一部分的髋关节 疼痛是由撞击征造成,平常的药物止痛不能解除持续的撞击,最终会发生骨关节炎。由此早期的诊断及手术干预,可以消除疼痛, 防止骨关节炎的发生,进而推迟或消除关节置换手术是有巨大的经济和社会价值。     

髋关节撞击征的诊断和治疗

髋关节撞击综合征（femoroacetabularimpingement,FAI）是以髋关节解剖结构异常而引发的股骨近端和髋臼间发生异常碰撞,从而导致髋关节孟唇和关节软骨的退行性变化,引起髋关节慢性疼痛的疾病。髋关节活动范围特别是屈曲和内旋受限,最终发展为髋关节骨关节炎。FAI在我国国内为一个较新的概念,临床能得到诊断的病例不多,但实际病例很多,相当一部分的髋关节疼痛是由撞击征造成,平常的药物止痛不能解除持续的撞击,最终会发生骨关节炎。由此早期的诊断及手术干预,可以消除疼痛,防止骨关节炎的发生。进而推迟或消除关节置换手术是有巨大的经济和社会价值。     

Regional load bearing of the canine acetabulum

OBJECTIVE: To determine the load bearing areas of the canine acetabulum. MATERIALS AND METHODS: A kinematic study of four healthy dogs was used to determine the orientation of the femur to the pelvis at mid-stance. Femora and pelves from 10 canine cadavers were loaded with the physiological canine hip reaction force and angle being replicated. Impression material placed within the acetabulum was extruded from areas of load bearing. Digital images before and after loading were used to assess if six different regions of the acetabulum were fully, partially or non-load bearing. RESULTS: All areas of the acetabulum were partially or fully load bearing. The cranial and caudal thirds of the acetabulum were 7.9 and 13.1 times more likely to be fully load bearing than the central third, respectively. There was a significant difference in load bearing between the axial, middle and abaxial thirds of the acetabulum in all tests, with the middle and abaxial thirds 72.4 and 351 times more likely to be fully load bearing than the axial third, respectively. CONCLUSION: The cranial and caudal thirds and the middle and abaxial thirds of the canine acetabulum are fully load bearing. CLINICAL RELEVANCE: The caudal third of the canine acetabulum is loaded and therefore recommendations that fractures in this area be managed conservatively need to be reconsidered.     

Congenital Dislocation of the Hip

Congenital dislocation or subluxation of the hip (congenital acetabular dysplasia) is a complete or partial displacement of the femoral head out of the acetabulum. The physical signs essential for diagnosis are age related. In newborns the tests for instability are the most sensitive. After the neonatal period, and until the age of walking, tightness of the adductor muscles is the most reliable sign. Early diagnosis is vital for successful treatment of this partially genetically determined condition. Various therapeutic measures, ranging from abduction splinting to open reduction and osteotomy, may be required. Following diagnosis in the first month of life, the average treatment time in one recent series was only 2.3 months from initiation of therapy to attainment of a normal hip. When the diagnosis was not made until 3 to 6 months of age, ten months of treatment was required to achieve the same outcome. When the diagnosis is not made, or the treatment is not begun until after the age of 6, a normal hip will probably not develop in any patient.     

Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

ABSTRACT: INTRODUCTION: Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. CASE PRESENTATION: We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day) for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. CONCLUSIONS: Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.     

Hip contact stress during normal and staircase walking: the influence of acetabular anteversion angle and lateral coverage of the acetabulum

Hip contact stress is considered to be an important biomechanical factor related to development of coxarthrosis. The effect of the lateral coverage of the acetabulum on the hip contact stress has been demonstrated in several studies of hip dysplasia, whereas the effect of the anterior anteversion remains unclear. Therefore, the joint hip contact stress during normal level walking and staircase walking, in normal and dysplastic hips, for small and large acetabular anteversion angle was computed. For small acetabular anteversion angle, the hip contact stress is slightly increased (less than 15%) in staircase walking when compared with normal walking. In hips with large angle of acetabular anteversion, walking downstairs significantly increases the maximal peak contact stress (70% in normal hips and 115% in dysplastic hips) whereas walking upstairs decreases the peak contact stress (4% in normal hips and 34% in dysplastic hips) in comparison to normal walking. Based on the presented results, we suggest that the acetabular anteversion should be considered in biomechanical evaluation of the hips, especially when the lateral coverage of the acetabulum is small.     

Ossification of the human fetal ilium.

Ossification of the ilium is similar to that of a long bone. It possesses three cartilaginous epiphyses and one cartilaginous process. Moreover, it undergoes peculiar osteoclastic resorption, comparable with that of the cranium bones. Asymmetrical ossification of the ilium, haversian bone remodelling and apposition of chondroid tissue posterosuperiorly to the acetabulum most probably emphasize the importance of mechanical factors in the morphogenesis of the hip bone during fetal life.     

Mapping of surface area 'containment' of the femoral head during walking

This note describes a mathematical method for the calculation of surface area of the femoral head covered ('contained') by the acetabulum as a time-dependent function. It uses displacement vectors from the center of rotation of the hip joint to the femoral joint surface, and rotates these vectors in small increments to simulate the desired motion. At each interval, the vectors are tested to determine whether they lie within the coverage area of the acetabulum. The result is a containment density plot which displays coverage area as a function of time. The general method is used in a variety of clinically important situations, and an example of its use in the study of abduction bracing is described.     

The transmission of load through the human hip joint

This paper describes the results of loading experiments carried out on human hip joints. The unloaded surfaces of the femoral head and the acetabulum are slightly incongruous. The location and magnitude of the contact areas between the surfaces therefore depend on the magnitude and direction of the applied load. The contact areas were determined experimentally for a variety of loads typical of normal walking. Two distinct contact areas were found on the anterior and posterior aspects of the acetabulum at light loads, gradually merging with increasing load until, at a certain transition load, the dome of the acetabulum comes into contact and contact is then complete. The value of the transition load depends on the rate of loading, due to creep of the cartilage, and was found to vary from 50 per cent of body weight in young specimens to 25 per cent of body weight for elderly specimens for rates of loading typical of normal walking. Thus, the dome of the acetabulum is out of contact for a substantial portion of the swing phase of normal walking.

The analysis of a much simplified model of the hip joint is presented. The dependence of contact area on load is demonstrated, but also a method of determining the transition load for complete contact from the load/deflection relation for the hip is suggested. The values of the transition load quoted above were obtained by this method. The analysis further indicates that the distribution of pressure between the articular surfaces depends critically on the distribution of cartilage thickness throughout the joint. It is suggested that the distribution of cartilage thickness is such as to lead to a state of uniform pressure at the upper end of the physiological load range. Some experimental evidence is presented in support of this suggestion.

It is concluded that the function of joint incongruity is to allow the articular surfaces to come out of contact at light loads so that the cartilage may be exposed to synovial fluid for the purposes of nutrition and lubrication. At large loads, the distribution of cartilage thickness ensures that a state of hydrostatic pressure is achieved in order that cartilage, with a large fluid content, may transmit large pressures without flow and consequent loss of its integrity.     

Shape of the pelvis and posture of the hindlimbs inPlateosaurus

The pelvis ofPlateosaurus is examined from a biomechanical point of view. The shape of the acetabulum in particular is analysed in order to determine the range of possible directions of the forces exchanged between femur and pelvis. These forces must have been more or less confined to a sagittal plane. From a quasi-static analysis under consideration of the major hip muscles ofPlateosaurus, a nearly but not fully extended posture of the hindlimbs can be deduced. The hip joints ofPlateosaurus and probably of some other dinosaurs with a narrow biacetabular width were balanced rather by adducting than by abducting muscles.     

Studies in Osteoarthritis of the Hip: Part IV, * Biomechanics and clinical considerations

Present knowledge of hip biomechanics supports the contention that the stresses imposed on the hip on the side of the longer leg are greater than normal; those on the short side are comparably reduced. Indirect measurements by various authors have demonstrated greater stress on the hip if the pelvis is adducted, a persistent and chronic condition of the hip joint on the side of a long leg. Furthermore the pressure on the acetabulum will be displaced laterally in these circumstances. The consistent pattern of degeneration in unilateral superolateral O A hip is what would be expected if the consequences of leg-length disparity were as described. Leg-length inequality may be a major contributing factor in the development of unilateral degenerative disease of the hip of this type.A clinical method of estimating leg-length disparity is described. Clinical findings in patients support the hypothesis that hip stress is increased on the side of a longer leg.     

Association of a single nucleotide polymorphism in growth differentiate factor 5 with congenital dysplasia of the hip: a case-control study

Introduction

Congenital dysplasia of the hip is an abnormal seating of the femoral head in the acetabulum, mainly caused by shallow acetabulum and lax joint capsule. Genetic factors play a considerable role in the pathogenesis of congenital dysplasia of the hip. The gene growth differentiate factor 5 (GDF5) has been implicated in skeletal development and joint morphogenesis in humans and mice. A functional single nucleotide polymorphism (SNP) in the 5'-untranslated region of GDF5 (rs143383) was reported to be associated with osteoarthritis susceptibility. As a key regulator in morphogenesis of skeletal components and soft tissues in and around the joints, GDF5 may be involved in the aetiology and pathogenesis of congenital dysplasia of the hip. Our objective is to evaluate if the GDF5 SNP is associated with congenital dysplasia of the hip in people of Han Chinese origin.

Methods

The GDF5 SNP was genotyped in 338 children with congenital dysplasia of the hip and 622 control subjects.

Results

The SNP was significantly associated with congenital dysplasia of the hip (p = 0.0037; odds ration (OR) = 1.40; 95% confidence interval (CI) = 1.11 to 1.75). A significant difference was detected in female samples when stratified by gender (p = 0.0053; OR = 1.46; 95% CI = 1.21 to 1.91), and in hip dislocation when stratified by severity (p = 0.0078; OR = 1.43; 95% CI = 1.11 to 1.85).

Conclusions

Our results indicate that GDF5 is important in the aetiology of congenital dysplasia of the hip. To the authors' knowledge this is the first time that a definite association with the congenital dysplasia of the hip susceptibility has been detected.

     

太行山猕猴髋臼性别二态性研究

本文使用几何形态测量法探讨42例成年太行山猕猴Macaca mulatta tcheliensis髋臼的性别二态性。结果显示,太行山猕猴雌雄个体的髋臼形态具有明显的性别二态性,利用髋臼可以正确判别92.3%的雌性和87.5%的雄性个体。髋臼的形态差异主要分布于月状面的后上部,即与髋臼切迹相对的月状面区域的宽度表现为雄性大于雌性,另外雄性髋臼大小的波动范围也比雌性更广。造成髋臼性别二态性的生物学原因可能与其功能有关,髋臼作为髋关节的组成部分,起着支撑身体和协同运动的功能,能够优化关节接触面的压力分布。推测雄性髋臼受到的体质量压力更大可能是雄性进化出比雌性更宽大的月状面的主要原因。     

Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living

Estimation of the hip joint contact area and pressure distribution during activities of daily living is important in predicting joint degeneration mechanism, prosthetic implant wear, providing biomechanical rationales for preoperative planning and postoperative rehabilitation. These biomechanical data were estimated utilizing a generic hip model, the Discrete Element Analysis technique, and the in vivo hip joint contact force data. The three-dimensional joint potential contact area was obtained from the anteroposterior radiograph of a subject and the actual joint contact area and pressure distribution in eight activities of daily living were calculated. During fast, normal, and slow walking, the peak pressure of moderate magnitude was located at the lateral roof of the acetabulum during mid-stance. In standing up and sitting down, and during knee bending, the peak pressures were located at the edge of the posterior horn and the magnitude of the peak pressure during sitting down was 2.8 times that of normal walking. The peak pressure was found at the lateral roof in climbing up stairs which was higher than that in going down stairs. These results can be used to rationalize rehabilitation protocols, functional restrictions after complex acetabular reconstructions, and prosthetic component wear and fatigue test set up. The same model and analysis can provide further insight to soft tissue loading and pathology such as labral injury. When the pressure distribution on the acetabulum is inverted onto the femoral head, prediction of subchondral bone collapse associated with avascular necrosis can be achieved with improved accuracy.