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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report their experience in the surgical management of lesions of the adult hip following radiotherapy. The diagnosis of a hip problem occurring after pelvic radiotherapy for malignant tumors is made by clinical and radiological examination. The problems include femoral head necrosis, necrosis and/or fracture of the acetabulum, or involvement of the entire hip joint (radiation coxopathy). Fractures of the femoral neck have been described in the literature, but are now very rare following the routine use of external shields as protection during irradiation. Post-irradiation lesions are often bilateral 21%. They appear after a variable latency period of two to twenty years and they progress remorselessly. A diagnosis of simple radio necrosis can only be made after using radio isotope bone scanning, MRI or CT to exclude malignant disease as acetabular metastasis, and radio-induced sarcomas. Hemiarthroplasty is often followed by collapse of the acetabulum and should no longer be used. The treatment generally practised nowadays is a Total Hip Replacement (THR). We report a retrospective study of 71 hips in 56 patients treated, between 1970 and 1982, by the use of conventional cemented components. In 49 hips this was followed by a 52% incidence of acetabular loosening resulting from the poor quality of the irradiated bone which had become necrotic and porotic. Between 1983 and 1990, we modified the technique by regularly using reinforcing the acetabulum with a metallic ring fixed by long screws, (as used in revision surgery for THR). Bone grafts were also used in 9 cases. We had a 12% incidence of loosening in 22 hips with a mean follow-up of 40 months. There were also two post-operative infection which need removal of the prostheses. This emphasizes the risk of infection in this type of surgery and is probably increased by the associated lesions of the soft tissues (lymphoedema, radiodermitis). The authors wish to stress the poor prognosis of radiation lesions of the hip which often occur in patients who have otherwise recovered from their pelvic tumour. These radiation lesions have to be recognised and treated in a specific way. Our experience and the reports in the literature suggest that the generally used conventional THR gives uncertain results, and therefore we propose a THR employing metallic reinforcement of the acetabulum with or without any necessary bone grafts. It is vital to warn the patients that the results may not be as excellent as with THR for other types of hip disorders. When there is severe destruction of the acetabulum the choice between a THR combined with massive bone allograft, and a Girdlestone hip resection must be very carefully discussed with the patient. This latter "salvage" procedure may in any case become necessary if there are local and otherwise unmanageable problems.
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PMID:[Surgical treatment of radiation-induced lesions of the hip in adults]. 913 52

Intertrochanteric flexion osteotomy and total hip arthroplasty are the most frequent operative treatments of advanced osteonecrosis of the femoral head in adults. In a retrospective study the postoperative results of intertrochanteric osteotomy and total hip arthroplasty were determined in 68 cases. The evaluation was based on the modified Harris-Hip-Score, the clinical examination and the radiological classification of the ARCO. The patients after osteotomy showed significantly worse subjective results. After osteotomy an increase of the stage of osteonecrosis was found in 73% of the patients. There was no correlation between clinical result and radiological stage of osteonecrosis. In spite of a better preoperative situation the results after osteotomy compared to hip arthroplasty were disappointing in many cases. The postoperative result did not depend on the preoperative stage of the osteonecrosis. The new classification system of the ARCO, which includes the very important MRI, proved to be very suitable and practicable. Based on our results it seems to be reasonable, to restrict the indication for intertrochanteric flexion osteotomy to cases of low stage osteonecrosis and carry out cementless total hip arthroplasty primarily in all others.
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PMID:[Intertrochanteric flexion osteotomy and allo-arthroplasty in femur head necrosis. A comparative retrospective study]. 919 68

The aim of this study was firstly to describe the spectrum of imaging findings seen in iliopsoas bursitis, and secondly to compare cross-sectional imaging techniques in the demonstration of the extent, size and appearance of the iliopsoas bursitis as referenced by surgery. Imaging studies of 18 patients (13 women, 5 men; mean age 53 years) with surgically proven iliopsoas bursitis were reviewed. All patients received conventional radiographs of the pelvis and hip, US and MR imaging of the hip. The CT was performed in 5 of the 18 patients. Ultrasound, CT and MR all demonstrated enlarged iliopsoas bursae. The bursal wall was thin and well defined in 83% and thickened in 17% of all cases. The two cases with septations on US were not seen by CT and MRI. A communication between the bursa and the hip joint was seen, and surgically verified, in all 18 patients by MR imaging, whereas US and CT failed to demonstrate it in 44 and 40% of the cases, respectively. Hip joint effusion was seen and verified by surgery in 16 patients by MRI, whereas CT (4 of 5) and US ( n=12) underestimated the number. The overall size of the bursa corresponded best between MRI and surgery, whereas CT and US tended to underestimate the size. Contrast enhancement of the bursal wall was seen in all cases. The imaging characteristics of iliopsoas bursitis are a well-defined, thin-walled cystic mass with a communication to the hip joint and peripheral contrast enhancement. The most accurate way to assess iliopsoas bursitis is with MR imaging; thus, it should be used for accurate therapy planning and follow-up studies. In order to initially prove an iliopsoas bursitis, US is the most cost-effective, easy-to-perform and fast alternative.
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PMID:Imaging features of iliopsoas bursitis. 1187 Apr 43

We treated 45 hips with idiopathic necrosis of the femoral head stages I-III with core decompression. Average age of patients was 41 (27-68) years and average follow-up 68.9 (31-120) months. In 30 hip joints in stage I, 29 showed no radiographic progression and a complete remission of the changes consistent with necrosis on MRI at the last follow-up. In 27 patients the clinical result based on the Harris Hip Score (HHS) assessment--was excellent (average HHS 91.9 points). Of nine hips in stage II, four had received a total hip arthroplasty, one had deteriorated to stage IV, and four were still classified as stage II (average HHS 95 points). Of six hips in stage III, three had received a total hip arthroplasty and three had deteriorated to stage IV (average HHS 73 points).
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PMID:Core decompression in early stages of femoral head osteonecrosis--an MRI-controlled study. 1195 46

DDH, septic coxarthritis and slipped capital epiphysis should be diagnosed as soon as possible. Hip sonography is the goal of DDH examination technique, anatomical identification and 3 landmarks check up are there most important points of the method. With the progress of ossification and loss of the 3 landmarks consecutively, x-rays become increasingly important. Septic coxarthritis is an orthopaedic emergency case, sonography is the most important tool in primary diagnosis. Slipped capital epiphysis requires an x-ray in 2 planes, MRI oder CT scans respectively makes sense in special cases to localize the area of necrosis and to plan further reconstructive procedures.
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PMID:[Profile of radiologic-orthopedic requirements in pediatric hip dysplasia, coxitis and epiphyseolysis capitis femoris]. 1214 7

Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis. Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement. Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty.
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PMID:[Diagnostic imaging in hip prostheses]. 1214 8

Hip dysplasia is an important cause of osteoarthrosis of the hip, especially in Japanese. Recently, the role of the acetabular labrum in hip diseases has attracted the attention of researchers, but the condition of the labrum in the dysplastic hips has not been described. We used radial MRI to measure the degree of coverage of the femoral head by the acetabulum and the labrum, corresponding to 7 positions on the acetabular rim at every 15 degrees from anterosuperior 45 degrees via midsuperior to posterosuperior 45 degrees. 38 Japanese patients (51 hips) with dysplasia, and 11 healthy controls 122 hips) were studied. In the dysplastic hips, the labrum was larger than in the controls. We found no correlation between the coverage of the acetabulum in the anterosuperior positions and the size of the labrum among the dysplastic hips.
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PMID:Coverage of the femoral head by the acetabular labrum in dysplastic hips: quantitative analysis with radial MR imaging. 1289 48

Hip arthroscopy is an excellent way to evaluate, diagnose, and treat acetabular labral and chondral lesions. It is minimally invasive and can be done on an outpatient basis. Candidates for hip arthroscopy will have functionally limiting symptoms and reproducible physical findings. Patients will often have mechanical symptoms such as clicking, catching, locking, or giving way. Symptoms may be preceded by a traumatic event such as a fall or twisting injury or may have an insidious onset. Radiographic studies are not sensitive enough to diagnose intra-articular hip pathology; however, contrast agents used in conjunction with CT and MRI may aid in the diagnosis. Therefore, a high level of clinical suspicion and prudent clinical judgment are warranted. A thorough knowledge of positioning and anatomic relationships to portal placement is necessary to prevent potential neurovascular complications from occurring during hip arthroscopy. Labral tears are the most common cause of mechanical hip symptoms. Tears occur anteriorly, and associated chondral lesions are common. The severity of the chondral lesion is highly correlated with the surgical outcome. The most frequently observed chondral lesion is the watershed lesion, which consists of a labral tear with separation of the labrum from the articular surface at the labral-cartilage junction. The difficulty in identifying these lesions as well as their effect on outcome provides a convincing rationale for arthroscopic hip surgery. Arthroscopic treatment of these tears involves judicious debridement back to a stable base while carefully preserving the capsular labral tissue. Eliminating the source of mechanical symptoms secondary to labral pathology should alleviate the patient's discomfort. Chondral defects are drilled or treated with a microfracture technique to enhance fibrocartilage formation. Patient outcomes are directly dependent on the stage or extent of the labral and chondral lesion.
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PMID:The diagnosis and treatment of labral and chondral injuries. 1511 46

The incidence and long-term outcome of undisplaced fatigue fractures of the femoral neck treated conservatively were examined in Finnish military conscripts between 1970 and 1990. From 106 cases identified, 66 patients with 70 fractures were followed for a mean of 18.3 years (11 to 32). The original medical records and radiographs were studied and physical and radiological follow-up data analysed for evidence of risk factors for this injury. The development of avascular necrosis and osteoarthritis was determined from the follow-up radiographs and MR scans. The impact of new military instructions on the management of hip-related pain was assessed following their introduction in 1986. The preventive regimen (1986) improved awareness and increased the detected incidence from 13.2 per 100,000 service-years (1970 to 1986) to 53.2 per 100,000 (1987 to 1990). No patient developed displacement of the fracture or avascular necrosis of the femoral head, or suffered from adverse complications. No differences were found in MRI-measured hip joint spaces at final follow-up. The mean Harris Hip Score was 97 (70 to 100) and the Visual Analogue Scale 5.85 mm (0 to 44). Non-operative treatment, including avoidance of or reduced weight-bearing, gave favourable short- and long-term outcomes. Undisplaced fatigue fractures of the femoral neck neither predispose to avascular necrosis nor the subsequent development of osteoarthritis of the hip.
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PMID:Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults. 1715 66

We report the observations of two women with a recurrent periarthritis of the hip complicated by a spontaneous rupture of the tendons of the gluteus medius and minimus. These patients usually complain from an acute lateral hip pain and show a Trendelenburg gait. When the rupture is complete, clinical evaluation reveals a drop of the pelvis on the non-stance side and resisted rotation starting from the extreme external rotation position is weak. MRI plays a key role in the diagnosis and the evaluation of a possible surgical repair. Hip rotator-cuff rupture is probably insufficiently diagnosed by ignorance. Nonetheless, optimized handling could relieve the pain of most these patients and improve the disability of some of them.
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PMID:[Rotator cuff tear of the hip]. 1856 29


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