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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Devices and methods have been developed for determining speed and oxygen cost of level walking. Speed was recorded and controlled using a speedometer cart. Oxygen uptake was determined with an argon-dilution method using a mixing box mounted on a backpack. The method was found valid, coefficient of variation (cv) less than 2.1%, and to give excellent reproducibility with regard to self-selected speed, cv less than 1.9%, predetermined speed, cv less than 1.3%, and to oxygen cost, cv less than 3.2%. Artificially arranged immobility of the knee or instability of the ankle decreased comfortable walking speed 23% and 4% respectively. Oxygen cost increased 23% and 10% respectively. Stabilizing splints allowing some flexion could if possible be advocated, particularly with elderly patients. Patients with coxarthrosis were studied before and after THA. One year after surgery the Harris hip score had increased from 35 to 85 points and maximal walking speed from 62 to 80 m min-1 Oxygen cost had decreased from 0.267 to 0.221 ml kg-1m-1. The onset of and the recovery from complications, as well as differences between patients with uni- and bilateral diseases, were reflected in change in oxygen cost but not in clinical scoring. Patients with moderate gonarthrosis were studied before and after unicompartmental knee prosthetic replacement. No major benefit of preoperative physical therapy, mainly aiming to improve thigh muscle strength, was observed three months after surgery. One year after surgery the patients had improved in clinical score rating and recovered an almost normal walking ability. Measurements of pain and self-selected walking speed were found to be sufficient for assessing effects of treatment in these patients. Patients with severe gonarthrosis had improved in clinical score rating one year after TKR. Oxygen cost of walking was unchanged. An acquired uneconomic walking pattern was considered to be the reason for unimproved walking efficiency. Patients with spastic paraparesis were treated with long-term stretch of the hip adductor muscles. Either the oxygen cost or the blood lactate level was decreased during walking, indicating that even during moderate exercise blood lactate must be taken into consideration when energy cost is measured in these patients. Measurements of walking speed and oxygen cost of level walking were found to be useful objective parametres for assessing walking and to be a valuable supplement to clinical assessment of effects of treatment in patients with walking disorders.
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PMID:Energy cost of level walking. 263 29

Twenty-six severely deformed patients with prosthetic arthroplasty of both hips and both knees because of rheumatoid arthritis (16), juvenile rheumatoid arthritis (6), ankylosing spondylitis (2), osteoarthritis (1), and inflammatory arthritis, cause unknown (1), were followed for a mean of 6.8 years. Severe pain was the primary indication for surgery, and consistent and substantial pain relief was achieved. Most patients also had limited ambulatory and functional improvement. Computer analysis showed that this improvement was related only to preoperative walking and function and a combined hip and knee flexion of at least 190 degrees. All other parameters had no correlation with walking and function improvement. Of the 104 arthroplasties (52 hips and 52 knees), six implants (4 hips and 2 knees) in two patients failed and another seven implants (2 hips and 5 knees) in five patients were revised. Of the remaining 91 implants, 89 were clinically stable, and only two hip implants in two patients appeared destined for revision. However, when radiographic review was included, nine acetabular components, three THA femoral components, and five tibial components in 12 patients had some evidence of impending aseptic loosening, despite low patient activity levels.
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PMID:Bilateral hip and knee arthroplasty. 355 5

71 patients (83 hips) with avascular necrosis of the femoral head were followed up. The patients had bilateral necrosis (12), and unilateral (59). Their ages ranged from 19 to 71 years. Ficat classification showed stage I for 1 hip, stage II 19 hips, stage III 35 hips, and stage IV hips. According to the severity, the range of motion, the age, and the X-ray appearances, 6 kinds of procedures were used including decompression with bone grafting (32 hips), surface arthroplasty with cartilage (4), surface arthroplasty with fascia (4), replacement of femoral head (7), THA (20), and obturator neuroetomy (16). The follow-up period ranged from 2 years and 3 months to 10 years and 5 months. Postoperative improvement included pain (39.7%), range of motion (21.7%), and walking (33.7%). Among the procedures, decompression with bone grafting showed best results. Treatment revealed better results in stage I, II than in stage III, IV. We emphysize the early diagnosis and management, and choice of procedure should base on the clinical classification.
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PMID:[Surgical treatment of avascular necrosis of the femoral head]. 758 96

Femoral osteolysis is and will remain an important cause of THA failures. The presentation is initially radiographic and patients may or may not become symptomatic. If so, pain is the most common symptom. Infection is the most common differential diagnosis and must be excluded. Osteolysis is usually progressive and may eventually lead to loss of implant fixation, implant fracture, or periprosthetic fracture. Multiple factors influence the decision to revise a femoral component, including the degree and type of bone loss, the rate at which it is progressing, the potential for fracture, the degree of symptoms, especially pain, and the activity level and general health of the patient. There are many options for revising failed femoral stems, each with varying degrees of success. The choice of technique and prosthesis used in the revision can be guided by a simple bone defect classification presented in this chapter. Revision of femoral components in these patients can be fraught with complications and poor results; hence, the importance of preoperative planning cannot be overemphasized.
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PMID:Osteolysis of the femur: principles of management. 1137 15

With the predictably good outcome now found with THA, hip arthrodesis has limited indications today. The procedure still has a role in the case of the young, heavy demand male with an isolated arthritic hip condition, and developments such as the Cobra head plate have considerably improved success rates. However, a long-term hip arthrodesis can have profound effects on a patient's daily function and activities of daily living. In addition, gait pattern is considerably affected as well as other joints such as the lower back, ipsilateral knee, and contralateral hip. Many patients with a hip arthrodesis will eventually require a takedown of the fused hip and conversion to a THA. The primary indications include fusion in malposition, pseudarthrosis, or severe pain in other joints. The surgeon undertaking such a task must be familiar with the arthrodesis techniques that have been used in the past as well as the equipment that may be required to extract the fixation hardware. Clinical assessment with particular attention to leg-length discrepancy, position of the arthrodesis, and function of the abductors is of paramount importance. The surgeon must carefully review preoperative radiographs to plan the procedure. The surgeon must also be aware of the presence of pathology in other joints. After takedown of a hip arthrodesis and conversion to a THA, patients cannot expect the result to equal the success rates of primary THA. Patients generally can expect an improvement in function and mobility. Back pain and ipsilateral knee pain are usually improved postoperatively, but the effect on contralateral hip pain is less predictable. Many patients will continue to show a positive Trendelenburg sign, but further improvement in strength of the hip abductors can be expected with time. Leg-length discrepancy is generally improved substantially after THA. However, a substantial number of patients will require a walking aid postoperatively. Overall, the risk of complications and the rates of revision after converting an arthrodesed hip to a THA are quite high. The procedure can be complex. Consideration should be given to referring these patients to a specialized center under the care of an experienced arthroplasty surgeon if preoperative planning suggests that the conversion will not be straightforward.
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PMID:Conversion of hip arthrodesis to total hip arthroplasty. 1137 28

After reviewing recent literature on the treatment of displaced intracapsular fractures of the femoral neck (Garden types III and IV) and from personal experience, a number of conclusions can be made. Orthopedic surgeons and hospitals face the challenge of providing the treatment most beneficial to patients with intracapsular, subcapital hip fractures in the most cost-effective way. The numbers of patients will increase annually and exceed the 125,000 per year at present in the United States. Most authors agree that fractures with the least displacement and younger, more demanding patients will do well with a precise fracture reduction without delay and an accurately placed internal fixation system. However, an overall median risk for reoperation 2 years after internal fixation is 35%. A patient with a displaced intracapsular fracture will need to consider monopolar, bipolar, or THA as the treatment of choice. Monopolar and bipolar arthroplasty have a reduced survivorship compared to THA and are not as suitable for the younger, more active patient. A large femoral head implant leads to decreased motion from increased friction and an undersized head implant leads to reduced contact area with increased erosion and pain. Bipolar arthroplasties, while allowing early mobilization, may develop some of the characteristics of monopolar implants if motion is not mainly at the internal joint. The increased cost may not justify their use over monopolar arthroplasty. Should dislocation occur, monopolar implants are easier to reduce (closed) than bipolar. Ceramic heads on monopolar or bipolar arthroplasties offer reduced wear and less erosion of the acetabulum. Total hip arthroplasty provides early mobilization, long-term pain relief, and little additional morbidity at surgery. The increased rate of early dislocation may be related to surgeon skill rather than an inherent failure of the system. If the early dislocators are removed from consideration, the complication rate drops to equal that of monopolar and bipolar implants. Total hip arthroplasty also is cost effective. Total hip arthroplasty may be the only option if pre-existing arthritis, significant osteoporosis, or Paget's disease of the pelvis is present.
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PMID:Arthroplasty in the treatment of subcapital hip fracture. 1265 Mar 32

Between 4/5/99 and 5/20/2002, our university performed 31 total hip arthroplasties in 27 young patients utilizing a conservative hip prosthesis developed at the Mayo Clinic. Eleven patients underwent Bipolar replacement, while the remaining twenty required an acetabular component. The patients ranged in age from 25 to 50 (mean of 39.9). The mean follow up was 12.4 months (range 4.5-27). Twenty-eight hips were treated for AVN secondary to RA, HIV, ETOH abuse, and SLE; while two underwent THA for OA secondary to trauma, and one for JRA. Three patients were lost to follow up at less than 6 months and were excluded from the study. The patients were followed for a minimum of 6 months utilizing the Harris hip score, the Charnley hip score, and radiographic evaluation including subsidence, radiolucency, and calcar resorption. Four patients (13%) had subsidence ranging from 1 to 3 mm at the most recent visit. One patients (3.2%) had radiographic evidence of radiolucency measuring 2 mm. Nine patients (29%) developed 1-3 mm of calcar resorption. No hips required revision. Thirty patients had improvement in their Harris hip score and Charnley hip score. The one patient who decreased his score had developed AVN secondary to ETOH abuse. Three hips had an intra-operative complication of lateral cortex penetration and required circlage wiring. Comparisons were made utilizing Multiple Logistic Regression to determine if preoperative BMI, Dorr score, and gender had an impact on the postoperative hip scores or degree of osteolysis, subsidence, and calcar resorption. Although the Harris hip score and Charnley hip scores significantly improved postoperatively, the preoperative BMI, Dorr score, and gender did not correlate with patient outcome. Our patients improved clinically in pain level, function and ROM. Further follow up will reveal if this component truly preserves bone stock for ease of future revision.
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PMID:Bone sparing surgical options for total hip replacement. 1272 8

The mini-incision exposure can be used in most primary THA patients. As the surgeon begins to perform mini-incision THA, he or she can gradually shorten the skin incision with improved confidence and skill. A true mini-incision THA (2.5"-3.5") requires specialized retractors and instrumentation such as the mini-incision set. Following the outlined procedure not only results in a smaller incision, but also transects less muscle and tendon. This less invasive approach can result in a shorter length of stay, less pain, fewer rehabilitation transfers, quicker recovery, and better cosmesis. All of these combine to produce a more satisfied THA patient.
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PMID:Mini-incision total hip replacement using an anterolateral approach: technique and results. 1506

Minimally invasive surgery has the potential for minimizing surgical trauma, pain, and recovery time in patients having THA. This minimally invasive two-incision total hip technique was found to be safe and facilitated a rapid patient recovery. Further-more, unique instruments and fluoroscopic assistance ensure accurate component position and alignment. This technique is technically challenging, however; as such, proper training, including cadaveric training, is essential to minimize complications and ensure success.
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PMID:The two-incision minimally invasive total hip arthroplasty: technique and results. 1506 2

It is not known if a previous periacetabular osteotomy poses technical difficulties and may increase the incidence of complications after total hip arthroplasty. The records of 41 patients who had THA after periacetabular osteotomy were evaluated. Followup averaged 6.9 years (range, 2-14 years). The average interval from osteotomy to total hip arthroplasty was 6.3 years (range, 4 months-14 years). Total hip arthroplasty provided significant relief of pain and improvement in function for all the patients. The acetabulum was judged to be retroverted in 23 patients and special attention to component positioning was needed. An abnormal proximal femoral anatomy secondary to previous intertrochanteric osteotomy or underlying dysplasia, or trochanteric overgrowth necessitated the use of trochanteric osteotomy for exposure in 24 patients. There were an acceptable number of complications and two revisions in the series. Aseptic loosening of the femoral component in one patient (one hip) and acetabular component in another patient (one hip) were the reasons for the two revisions. Total hip arthroplasty with technical consideration and careful evaluation of the acetabular version and relocated teardrop can be done safely in patients with a previous periacetabular osteotomy and should provide excellent results.
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PMID:Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty. 1523 36


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