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Query: UMLS:C0003864 (arthritis)
 69,039 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hip involvement in ankylosing spondylitis (AS) is a common and disabling problem. The clinical and x-ray records of 87 patients with definite AS (Rome criteria) were examined to define and characterize their hip disease. Clinical hip disease was present in 33 cases (38%), was usually bilateral (91%), and tended to begin early in the disease course; it was the cause of 50% of the Class III and IV disability in the entire study group. Typical findings included regional pain, limitation of motion, muscle atrophy, and flexion contractures. Radiologic hip abnormalities occurred in 42 cases (48%). The radiographic pattern was distinctive when compared to that in two control groups and included axial migration of the femoral head (63%), concentric joint space narrowing (50%), rufflike femoral osteophytosis (36%), and protrusio acetabuli (30%). Eight patients required bilateral hip surgery. Para-articular ossification occurred in 8 of 16 replaced hips; in 5 of 8 hips it caused clinical immobility. This potentially serious complication may limit the usefulness of hip arthroplasty in some AS patients.
Arthritis Rheum
PMID:Hip involvement in ankylosing spondylitis. 94 99

Haemochromatosis (HC) is a group of phenotypically heterogeneous clinical syndromes, which may have a common molecular basis. Classical genetic haemochromatosis (GHC) is one of these syndromes and is a disorder of iron storage due to an increase in intestinal iron absorption, which results in progressive and massive iron deposition leading to fibrosis and organ malfunction. The liver, pancreas, heart and pituitary are commonly involved. There is a specific arthropathy and an association with osteoporosis. Clinically, the arthropathy may resemble rheumatoid arthritis, with acute attacks of inflammation associated with bilateral destruction of the metacarpophalangeal joints. However, bony joint swelling may occur, suggestive of osteoarthritis. Hip arthritis may be unduly severe and disabling. Haemochromatosis arthritis is composed of three radiographic categories: isolated chondrocalcinosis, hypertrophic osteoarthritis which is indistinguishable from pyrophosphate associated arthropathy, and disease specific changes such as subchondral radiolucency of the femoral head, hook-like osteophytes on the metacarpal heads and a degenerative predilection for the metacarpophalangeal joint rather than the scapholunate. The characteristic histological changes are: abnormal amounts of iron deposits, little or no signs of synovial inflammation and CPPD deposition. Subchondral radiolucency of the femoral head and atypical stripping of the cartilage from the subchondral bone are thought to be specific radiographic and histological changes of HC. The pathogenesis of HC arthritis has been associated with the presence of iron in joint tissue, a defect in cartilage metabolism and immunological dysfunction. Treatment has little effect on clinical, radiological or histological progression.
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PMID:Rheumatic manifestations of haemochromatosis. 175 88

Hip surgery is the most common major orthopedic procedure performed in the elderly. The indications are fracture and pain secondary to degenerative arthritis. Patients undergoing hip replacement for arthritis have excellent outcomes with decreased pain, increased mobility, and a low mortality. Age should not be a contraindication to hip replacement, with patient selection being made on the basis of symptomatology and overall health. In hip fracture, the prognosis is more guarded. Poor functional outcome results from complications of the fracture, such as avascular necrosis of the femoral head and fracture nonunion in femoral neck fractures and instability with delayed weight bearing in intertrochanteric fractures. In addition, patients sustaining hip fracture are more likely to have significant comorbidity and subsequent perioperative complications. Pressure ulcers, delirium, deep venous thrombosis, urinary retention and urinary tract infection, and cardiac events are the most frequent complications seen. These complications can be anticipated and prevented with careful preoperative assessment and post-operative prophylactic management. A team approach including the orthopedic surgeon, primary care physician, nursing staff, and physical therapists is essential for optimal outcome.
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PMID:Surgical management of the hip in the elderly patient. 219 20

Hip dysplasia is a major cause of osteoarthrosis in adults. Early aggressive osteotomy has the potential of preventing the development of arthritis, but carries with it significant risks. The problem is further complicated because the surgeon has no means of quantifying the dysplastic deformity or of predicting what a particular combination of osteotomies would do to correct the deformity. This study describes methods of quantifying hip-joint geometry in three dimensions based on computed tomography and magnetic resonance studies, and of simulating pelvic osteotomy to correct the deformities. The study analyzes 49 normal hip joints and 20 dysplastic hip joints. The results show that the normal acetabulum is nearly a full hemisphere, which is anteverted 20 degrees and abducted 53 degrees. The normal lateral center-edge angle is 37 degrees. The dysplastic acetabulum is not anterolaterally maldirected, as has been assumed, but is globally dysplastic. Analysis of the individual dysplastic hip joints showed a wide variability. Some patients were deficient globally, some anterolaterally, and some posterolaterally. Methods of analyzing a patient's hip joint, quantifying abnormalities, simulating surgery, and predicting results are demonstrated in a case example.
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PMID:Acetabular dysplasia in the adolescent and young adult. 842 62

Fourteen hip arthroscopies between January 1985 and May 1988 were reviewed. Included were ten women and four men with an age ranging from 12 to 76 years. Indications were avascular necrosis; loose bodies; osteoarthrosis, arthritis, or pain; and snapping hip. The diagnosis was verified in five cases, including arthroscopic removal of a loose body in one and resection of a plica bridging the space between the femoral head and acetabular roof in two patients. The diagnosis was rejected in three cases. In five cases, no pathologic changes were found. One arthroscopy was inconclusive because of a narrow field of vision in a dysplastic hip. No serious complications occurred. Hip arthroscopy is useful in diagnostics and surgical treatment of selected hip disorders. The rehabilitation time is short. Hip arthroscopy is, however, a technically demanding procedure.
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PMID:Arthroscopy in diagnosis and treatment of hip disorders. 271 Jul

Hip problems form about 10% (7.0 to 14.2%) of most published series of ballet injuries. The abnormally large range of external rotation needed for a perfect turnout is primarily due to soft tissue adaptation, more readily achieved in the young dancer. Insufficient range of motion at the hip throws considerable stress on the other lower limb segments. The snapping hip syndrome is common (43.8% of hip problems), with about one-third associated with pain. A tight iliotibial band may contribute to this, and balanced flexibility requires special attention to abductor stretching. The external clicking hip must be distinguished from the internal clicking hip, which is associated with the joint and psoas tendon. Stress fractures of the hip are easily overlooked and, if undetected, they may progress to a complete fracture. Knee problems account for 14.0 to 20% of complaints, and over 50% of these are peri- or retropatellar problems. This includes synovial plica, medial chondromalacia, lateral patella facet syndrome, subluxing patella and the fat pad syndrome. Specific diagnosis leads to specific treatment and the best chance of cure. Mild hyperextension of the knee may be aesthetically desirable, but excessive range leads to symptoms in the posterior capsule and poor control. Young dancers with a tendency to very lax joint structures should be identified early and protected from overstretching. In the author's series, meniscal lesions did not appear to be as big a problem as reported elsewhere in the literature. Ballerinas appear to have less leg strength than other groups of athletes, having only 77% of the weight-predicted norms. The introduction of strength training for male and female dancers may reduce injuries and improve balance, but it requires an intensive educational programme to dispense with the many myths. There are several references to the development of early arthritis but, while relatively common in the foot, symptomatic arthrosis in ballet dancers' hips and knees is not more prevalent than in the general population. The young age at which serious dance training begins, the long and rigorous hours of practice, the thin ballet slipper, dancing en pointe and unusual dietary regimens may all contribute to injury patterns in varying degrees.
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PMID:Prevention of hip and knee injuries in ballet dancers. 306 38

The clinical features of acute Brucella arthritis were reported in a prospective study of 58 patients (29 male, 29 female). Polyarthritis occurred in 33, was migratory in ten, additive in 23 and symmetrical in ten. Monoarthritis of knee or hip joints occurred in ten patients, whilst the spine alone was involved in 15. Hip and spinal involvement was more destructive than peripheral joint involvement. Hotness, redness and joint effusions were not prominent features. Tissue-typing did not show any association with Brucella arthritis. Treatment with various antimicrobials was followed by recovery, but the relapse rate was lowest with combined tetracycline and streptomycin. Brucella arthritis is frequently seen in Iraq, and dairy products prepared locally from unpasteurized milk should be controlled by local health authorities.
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PMID:Brucella arthritis among Iraqi patients. 381 63

During an ongoing survey of 161 patients with ankylosing spondylitis (AS), 25 females were identified and retrospectively studied in detail. For each, a case-control male subject with similar age of onset of illness (mean, 23.0 years for women, 22.2 years for men) and duration of followup (mean, 20.7 years for women, 17.0 years for men) was selected. The diagnosis of AS was delayed an average of 12.8 years for females and 10.3 years for males. Extraspinal arthropathy occurred in 18 women (72%) and 8 men (32%) (p less than 0.05). Cervical spine disease and shoulder arthritis each occurred in 10 women (40%) and 4 men (16%) (NS). Hip disease affected 10 females and 6 males (NS). Peripheral joint disease occurred in 12 women (48%) and 9 men (36%); the knees were most commonly involved. Recurrent uveitis affected 10 females and 1 male (p less than 0.01). Anemia was detected in 8 women and 2 men (p less than 0.05). Sixty percent of the women had relatives with spondylarthritis, compared to 35% of the men (p less than 0.05). This last finding suggests that, in addition to possible hormonal and anatomic influences on the expression of disease, there may be some sex-linked, genetic factors.
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PMID:Ankylosing spondylitis in women and men: a case-control study. 662 Feb 64

New cross-sectional studies have been designed to evaluate therapeutic effectiveness of medical and surgical treatments. The extent to which error in recollection may threaten the validity of conclusions reached in these studies has not been determined. The purpose of this research was to evaluate the impact of recollection error by comparing patients' prospectively acquired reports about their condition before total hip replacement with their recollections of their preoperative condition obtained several years after surgery. A total of 104 patients prospectively completed the Hip Rating Questionnaire (HRQ), a valid, reproducible, responsive, disease-specific scale composed of four domains (pain, walking, function, and impact of hip arthritis on overall health). These same patients then completed the HRQ several years after surgery by recalling their preoperative condition. Current postoperative condition was also obtained several years after surgery with the HRQ. Patient characteristics include: 55% were women, mean age was 67 years, 90% had osteoarthritis, 78% had no prognostically significant comorbid disease, and the mean time interval between surgery and recall was 2.5 years. Comparison of prospective and recalled responses with the weighted kappa and intraclass correlation coefficients showed poor to fair agreement in three domains, and moderate agreement in the fourth domain. Overall, the directions of the recollection errors were toward patients' recalling more pain, better walking, better function, and worse impact of hip arthritis on health than they reported before surgery. When the data were stratified to determine if there were systematic biases among major patient subgroups, there were discrepancies in the percentage of patients within each subgroup who had recollection error for the different domains, as well as differences in the magnitudes and directions of the recollection errors. These results indicate that relying on patients' recollections does not provide an accurate measure of preoperative state, and that attempting to adjust data is not feasible because the directions and magnitudes of recollection error vary for major subgroups of patients. In addition, when outcome was assessed using postoperative HRQ responses, the cross-sectional data overestimated the effectiveness of total hip replacement in 68% of patients. It is concluded that cross-sectional data do not accurately portray baseline preintervention condition and therefore can lead to overestimating, as in this instance, or to underestimating effectiveness.
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PMID:Does recollection error threaten the validity of cross-sectional studies of effectiveness? 772 63

The objective of this work was to evaluate the course of hip disease in patients with systemic-onset juvenile chronic arthritis. 59 patients with systemic-onset juvenile chronic arthritis followed-up for a mean of 15 years (+/- 6 years) were studied retrospectively. 28 patients (47.5%) had involvement of the hip. Mean age at onset of symptoms of hip disease was 9.5 years (+/- 5 years). Hip arthritis was always preceded by other manifestations of the disease, including arthritis of other lower limb joints. Mean time interval between onset of the disease and onset of hip symptoms was 6.3 years (+/- 3 years). In 66% of cases, symptoms occurred simultaneously in both hips. Eight of nine patients with initially unilateral hip arthritis subsequently developed arthritis of the other hip; in four patients, less than one year elapsed between involvement of the two hips. Roentgenographic changes were variable and included acetabular protrusion (25%), complex cervico-cephalic and acetabular growth disorders (21%), subdislocation (18%), a short femoral neck with varus deformity (14%), and a long femoral neck with valgus deformity (14%). Avascular necrosis of the femoral head occurred in three patients. Roentgenographic evidence of repair was seen in one patient. Among the ten patients who required surgery, two had corrective osteotomy with adductor tenotomy and eight had total hip arthroplasty (of both hips in six patients) with good short- and medium-term outcomes. After arthroplasty, a single patient required reoperation in the short term, for persistent flexion contracture. Loosening of the acetabular arthroplasty required revision in two patients 5 and 10 years, respectively, after the initial procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Involvement of the hip in systemic-onset forms of juvenile chronic arthritis. Retrospective study of 28 cases]. 785 91


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