1. An operation is described for ischio-femoral extra-articular arthrodesis of the hip joint by posterior open approach, based on the techniques of Trumble and Brittain. 2. The operation has the advantages of affording adequate exposure of the sciatic nerve trunk and permitting visual control of the alignment and penetration of the chisel and graft. 3. The operation has been performed successfully without serious shock or subsequent complications in eighteen cases, mostly of tuberculosis of the hip

1. Breech malposition and hormonal joint laxity produce atraumatic posterior dislocations in the hip joints of young rabbits. 2. Experimental studies were shown to cause the development of a limbus and other softtissue changes similar to those found in human congenital dislocations. 3. The development of femoral retroversion and anteversion in the presence of joint laxity is described. 4. The co-existence of breech malposition and hormonal joint laxity in utero, and their importance as prime factors in the etiology of congenital dislocation of the hip, are discussed

We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31° was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months. We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head

1. The long-term results in a consecutive series of 323 healed subcapital fractures of the femur show that, with few exceptions, the capital fragment maintains its integrity when the fragments are aligned within the narrow limits of good reduction, but undergoes superior segmental collapse when reduction is poor. 2. The effect of malreduction on the congruity of the hip joint is examined, and a remodelling response to malalignment of the aspherical femoral head in the imperfectly round acetabulum is proposed as an alternative interpretation of the radiological changes now considered to be the result of capital ischaemia

Aims

Osteolysis, secondary to local and systemic physiological effects, is a major challenge in total hip arthroplasty (THA). While osteolytic defects are commonly observed in long-term follow-up, how such lesions alter the distribution of stress is unclear. The aim of this study was to quantitatively describe the biomechanical implication of such lesions by performing subject-specific finite-element (FE) analysis on patients with osteolysis after THA.

A simple method of measuring the degree of acetabular development in the radiograph of the adult pelvis is described and arguments for its validity are advanced. This measurement is referred to as the acetabular angle. The normal values for this angle are between 33 and 38 degrees. Angles below 32 degrees are uncommon and probably of no clinical significance, whereas angles from 39 to 42 degrees are in the upper limit of normality. An angle of 47 degrees is shown in a hip with congenital subluxation. The prognosis for hip joints with acetabular angles between 42 and 47 degrees is under investigation

Aims

Double-level lengthening, bone transport, and bifocal compression-distraction are commonly undertaken using Ilizarov or other fixators. We performed double-level fixator-assisted nailing, mainly for the correction of deformity and lengthening in the same segment, using a straight intramedullary nail to reduce the time in a fixator.

1. Thirty-eight cases of tuberculosis of the greater trochanter have been reviewed. 2. Classification into bursal and osseous infections is discussed, and reasons have been given for our belief that either lesion may be the primary one. 3. An attempt has been made to assess available methods of treatment. In general, conservative measures are recommended for primary lesions, and surgery for recurrences. We have the impression that chemotherapy is of definite value. 4. The incidence of spread of tuberculosis to the hip joint is discussed. In this connection, reasons have been given for condemning excision of the trochanter

We investigated the wear characteristics and clinical performance of four different total hip joint articulations in 114 patients. Wear and migration was measured by roentgenstereophotogrammetric analysis at five years or at the last follow-up. The mean annual wear was 0.11 mm for a stainless steel/Enduron articulation, 0.34 mm for stainless steel/Hylamer cup, 0.17 mm for zirconium oxide ceramic/Enduron and 0.40 mm for zirconium oxide ceramic/Hylamer. The difference between the groups was significant (p < 0.008) except for stainless steel/Hylamer vs zirconium oxide ceramic/Hylamer (p = 0.26). At present, 12 patients have undergone a revision procedure, four at five years and eight thereafter. No patient who received a stainless steel/Enduron articulation at their primary replacement required revision. Conflicting results have been reported about the performance of the zirconium oxide ceramic femoral head, but our findings suggest that it should not be used with a polymethylmethacrylate acetabular component. Hylamer has already been withdrawn from the market

1. A method has been described whereby the disability of hip disease, bilateral or unilateral, can be graded, and the quality of result following arthroplasty assessed, on a scale of numerical values. 2. The grade expresses the condition of the entire patient, rather than that of the hip joint alone. 3. Certain clinical criteria and physical tests have been adopted as the bases for scoring. The calculation of the patient's total score has been weighted to emphasise mobility, and to provide a more critical measure of the success of arthroplasty. Subjective tests (aside from the patient's estimate of his pain) are avoided, to provide as objective and accurate a method of assessment as possible

Canadian Arthroplasty Society. The Canadian Arthroplasty Society’s experience with hip resurfacing arthroplasty: an analysis of 2773 hips. Bone Joint J 2013;95-B:1045–1051

1. Degenerative arthritis has been produced consistently in adult rabbits by the injection of the proteolytic plant enzyme papain into the hip joint. Arthritic changes were recognisable radiographically after six weeks. 2. A progression of changes occurred, from loss of acid mucopolysaccharide staining in the matrix, fibrillation, fissuring and erosion of articular cartilage with death of chondrocytes in the weight-bearing areas, to secondary bony changes of subchondral sclerosis, occasional cysts and osteophyte formation. 3. Synovial inflammation occurred with accumulation of cartilage and bone debris in the inferior capsule and later capsular thickening. 4. It is suggested that this arthritis is sufficiently similar to human osteoarthritis to be useful as a model for further studies of the pathogenesis of the disease and the effects of different methods of treatment

1. Twenty-two dislocations of the hip occurring in patients paralysed from an early age have been studied. All showed abnormal coxa valga. The coxa valga, which may gradually reach 180 degrees, precedes dislocation and makes it inevitable. The presence of unbalanced adductor power may hasten dislocation, but the latter can occur in complete flaccid paralysis. 2. The combination of structural instability of the hip joint and muscular weakness may make independent walking impossible, but restoration of stability gives considerable improvement in any remaining muscular power and may alter the patient's whole future. 3. A method of correcting the basic deformity of coxa valga by osteotomy is described and the results of nine operations are reviewed

Objectives

Metabolic syndrome and low-grade systemic inflammation are associated with knee osteoarthritis (OA), but the relationships between these factors and OA in other synovial joints are unclear. The aim of this study was to determine if a high-fat/high-sucrose (HFS) diet results in OA-like joint damage in the shoulders, knees, and hips of rats after induction of obesity, and to identify potential joint-specific risks for OA-like changes.

Computed tomography was performed on 40 patients with recent hip trauma. Radiographs of 25 showed a fracture of the femoral neck with slight displacement; 24 of these had intra-articular fluid and 20 had a lipohaemarthrosis on the CT scan. In 15 patients, radiographs at the time of admission were normal but suspicion of fracture remained. A fracture was later verified in five patients, four of whom had lipohaemarthrosis on admission. In the remaining 10 patients no fracture could be detected; only one patient had a hip joint effusion but no free fat. Thus all 24 patients with lipohaemarthrosis had an intracapsular fracture of the hip. We suggest CT for patients with hip trauma and negative radiographs. The presence of a lipohaemarthrosis of the hip strongly suggests an intra-articular fracture of either the femoral neck or the acetabulum

Trendelenburg's test of function of the hip joint was first reported before radiology was available. At least four methods of performing it have since been described in the literature. We examined 50 normal subjects and 103 people with disorders affecting either the spine or the hip, in order to determine the different responses that occurred when they were asked to stand on one leg. This has enabled us to define a standard method of performing the Trendelenburg test, and to interpret the test as a method of assessing hip abductor function. The major pitfalls that result in misinterpretation, or false-positive responses, are pain, lack of cooperation from the patient, and impingement between the rib cage and the iliac crest. False-negative responses result from the patient using muscles above and below the pelvis, and from leaning beyond the hip on the standing side

Sixty-nine patients with congenital abnormality of the femur were reviewed. Their manifestation of femoral dysplasia ranged from an intact femur approximately 60 per cent of the length of the normal leg to a subtotal absence of the femur in which only the femoral condyles remained, often with a congenital fusion of the knee joint. Two groups were defined: Group I consisted of those with congenital hypoplastic femur in which the hip and knee could be made functional and where, in some patients at least, leg equalisation was possible; Group II consisted of those with true proximal focal femoral deficiency where the hip joint was never normal and the knee joint was always useless. The patients in each group were examined and evaluated with respect to clinical signs, surgical procedures performed, and prosthetic requirements and function. A protocol of treatment for both groups is suggested

1. Avascular necrosis of the bony epiphysis or necrosis of the articular cartilage of the hip joint–without bony necrosis–can occur after a slipped upper femoral epiphysis. 2. In avascular necrosis of the bony epiphysis the prognosis depends upon the degree of revascularisation that occurs and upon survival of the articular cartilage. The articular cartilage can survive and a good functioning hip result especially if aided by mobilisation without weight bearing. 3. The prognosis after necrosis of the articular cartilage is poor. This complication occurs more often when conservative treatment is used. 4. A certain number of hips will show poor results no matter what treatment is used. 5. Nutrition of the articular cartilage is probably by the synovial fluid. 6. Strong traction may damage the soft-tissue structure of the hip joint. 7. It is not advisable to perform an osteotomy soon after a slip of the epiphysis. It is better to wait until good function is assured in the joint