YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==HIP REPLACEMENT== 68 AUTHOR Typpo T TITLE Osteoarthritis of the hip. Radiologic findings and etiology. SOURCE Ann Chir Gynaecol Suppl; VOL 201, 1985, P1-38 (REF: 84) ABSTRACT The purpose of the work was to investigate: Whether osteoarthritis of the hip can be divided into radiologic classes by examining the tendency of osteoarthritis of the hips to increase the growth and calcific content of the bone on the one hand and the associated loss of calcium and cartilage and the deformation and destruction of bone on the other. The prevalence of osteoarthritis of the hip in the internal medicinal and surgical outpatients of the University Central Hospital of Oulu, who were radiographed. Whether osteoarthritis of the hip or its different radiologic manifestations correlate with the patient's age, sex, occupation and strenuousity of work, rickets, cancerous diseases, diabetes, rheumatoid arthritis, family history, parity, smoking, obesity, physical activity, corticosteroid and anti-epileptic medication, and previous injuries to the lower extremities causing immobilization. Whether the radiologic findings of osteoarthritis of the hip are associated with typical symptoms. Whether there are correlations between the effects of medication and physiotherapy and the radiologic forms of osteoarthritis of the hip. The study population consisted of two series, of which the first included 401 patients: 167 males and 234 females. The second, or major part comprised 518 patients, of whom 249 were male and 269 female. For all these patients we had radiograms available which permitted reliable assessment of the hip condition. The second series, i.e. the latter group of 518 patients, also filled in a questionnaire which dealt with the etiology and symptoms of the osteoarthritis of the hip as well as the therapies they had received. Whenever possible, the changes of the pelvis and the lumbar spine were also assessed on the basis of the radiograms. On the basis of the radiologic findings, osteoarthritis of the hip was divided into two qualitative classes, hypertrophic and destructive, and a mixed type, and into three grades of severity. Hypertrophic osteoarthritis of the hips accounted for 51% of the cases, destructive for 20% and mixed type for 29%. The percentages for the different severities were 47% for the mild, 16% for the moderately severe and 37% for the severe. A total of 26% of the cases were right-sided, 22% left-sided and 52% bilateral. The mild, bilateral cases of osteoarthritis were mostly hypertrophic, whereas destructive osteoarthritis was clearly more common in the unilateral cases. Hypertrophic osteoarthritis was also more frequent in younger age-groups and destructive in older age-groups. The osteoarthritis of the older patients was more severe.(ABSTRACT TRUNCATED AT 400 WORDS) 2 AUTHOR Aboulafia AJ AUTHOR Littelton K AUTHOR Shmookler B AUTHOR Malawer MM TITLE Malignant fibrous histiocytoma at the site of hip replacement in association with chronic infection. SOURCE Orthop Rev; VOL 23, ISS 5, 1994, P427-32 (REF: 35) ABSTRACT A case of malignant fibrous histiocytoma that developed at the site of an infected metallic implant is presented. The total hip endoprosthesis was composed of a cobalt-chromium alloy. There was a relatively short latency period (less than 2 years) between the initial surgery and the development of malignancy in this patient. The authors urge development of a tumor registry to discover if the association between hip replacement and malignancy is coincidental. 10 AUTHOR Massin P AUTHOR Duparc J TITLE Total hip replacement in irradiated hips. A retrospective study of 71 cases. SOURCE J Bone Joint Surg Br; VOL 77, ISS 6, 1995, P847-52 ABSTRACT We retrospectively reviewed 56 patients (71 hips) treated by total replacement for severe disability after pelvic irradiation. Symptoms were associated with various radiological lesions due to irradiation, including atraumatic femoral-neck fracture, osteonecrosis of the femoral head or of the acetabulum, and radiation osteitis of the whole pelvis. From 1970 to 1982 we used standard cemented components in 49 hips and had a high rate of acetabular loosening (52%) at a mean follow-up of 69 months. This was probably due to the mechanical insufficiency of irradiated periacetabular bone. From 1983 to 1990 we routinely used acetabular reinforcement rings. The rate of aseptic acetabular loosening in 22 hips at a mean follow-up of 40 months was 19%, but there were two septic loosenings emphasising the risk of infection in these patients. When total replacement is required for an irradiated hip, we recommend reinforcement of the acetabulum using a metallic ring, but there is still an increased risk of infection and in difficult cases such as severe acetabular destruction or soft-tissue or vascular injuries, a Girdlestone procedure may be indicated. 2 AUTHOR Visuri T AUTHOR Pukkala E AUTHOR Paavolainen P AUTHOR Pulkkinen P AUTHOR Riska EB TITLE Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. SOURCE Clin Orthop, ISS 329 Suppl, 1996, PS280-9 (REF: 51) ABSTRACT The incidence of cancer after metal on metal total hip arthroplasty (McKee-Farrar) and polyethylene on metal total hip arthroplasty (Brunswik, Lubinus) was compared with that of the general population in Finland. The mean followup time for the patients who had metal on metal total hip arthroplasty was 15.7 (9092 person years) and for the patients who had polyethylene on metal total hip arthroplasty it was 12.5 years (19,846 person years). One hundred thirteen malignant cancers were observed in patients who had metal on metal total hip arthroplasty and 212 were observed in patients who had polyethylene on metal total hip arthroplasty. The standardized incidence ratio for all cancers of the metal on metal arthroplasty group was 0.95 (95% confidence limits 0.79-1.13) and that of the polyethylene on metal arthroplasty group was 0.76 (95% confidence limits 0.68-0.86). The risk of total cancer in the patients who had metal on metal total hip arthroplasty was 1.23-fold compared with that of the patients who had polyethylene on metal total hip arthroplasty. Both groups had significantly less lung cancer than the general population: the leukemia incidence in the patients who had metal on metal total hip arthroplasty was slightly increased (observed to experienced 7/3.03, standardized incidence ratio 0.61; 95% confidence limits 0.17-1.56). The leukemia rate of the patients who had metal on metal total hip arthroplasty was 3.77-fold compared with that of the patients who had polyethylene on metal total hip arthroplasty, but this difference was not statistically significant. No sarcomas were observed at the site of the prosthesis. The incidence of the other forms of cancers did not differ significantly from those in the general population. The observed variation in the incidence of different cancers among patients who had total hip arthroplasty compared with the general population suggests that factors other than total hip arthroplasty play a major role in the origin of cancer. 7 AUTHOR Holtgrewe JL AUTHOR Hungerford DS TITLE Primary and revision total hip replacement without cement and with associated femoral osteotomy. SOURCE J Bone Joint Surg [Am]; VOL 71, ISS 10, 1989, P1487-95 ABSTRACT Nine porous-coated total hip prostheses were implanted without cement in nine patients who had a major proximal femoral deformity. Six patients had revision and three, primary total hip replacement. In all nine patients, as well placed corrective osteotomy was needed to successfully perform the arthroplasty. The average time until union of the proximal femoral osteotomy was fifteen weeks for the patients who had a primary arthroplasty and twenty-seven weeks for the patients who had a revision arthroplasty. The average Harris hip-rating score was 94 points for the patients who had a primary arthroplasty and 84 points (range, 60 to 93 points) for those who had a revision arthroplasty. The length of follow-up averaged forty-seven months. 9 AUTHOR Tooke SM AUTHOR Amstutz HC AUTHOR Hedley AK TITLE Results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. SOURCE Clin Orthop, ISS 224, 1987, P150-7 ABSTRACT Eighteen transtrochanteric rotational osteotomies have been performed in 17 patients for femoral head osteonecrosis (15 patients, Ficat Stage III disease; three patients, Ficat Stage IV disease) during a 51-month period and have 18 to 63 months of follow-up study. The best results were in the posttraumatic and nonsteroid-associated idiopathic cases in patients with small necrotic segments in the weight-bearing region, with no degenerative changes. Failures occurred in patients with large necrotic fragments, preexisting degenerative changes, and steroid- and alcohol-associated etiologies. Although joint arthroplasty was eventually required in ten hips, a period of temporization was achieved sufficient to bring them into the era of cementless hip arthroplasties. Indications for this operation should be restricted to those patients under 40 years of age with late Ficat Stage II or Stage III disease, in which the articular involvement in the lateral roentgenogram is 50% or less. 13 AUTHOR Sugioka Y TITLE Transtrochanteric rotational osteotomy in the treatment of idiopathic and steroid-induced femoral head necrosis, Perthes' disease, slipped capital femoral epiphysis, and osteoarthritis of the hip. Indications and results. SOURCE Clin Orthop, ISS 184, 1984, P12-23 ABSTRACT Transtrochanteric rotational osteotomies were successful in 342 hips (274 patients) for the treatment of idiopathic and steroid-induced osteonecrosis of the femoral head, Perthes' disease, slipped capital femoral epiphysis, osteoarthritis, and other disorders. One hundred fifty-eight hips (113 patients) with idiopathic and steroid-induced necrosis were followed up for two to 11 years. In 121 of 158 hips, excellent results were obtained clinically and roentgenographically. In 42 Grade I or II hips, excellent results were obtained in every respect (success rate, 86%). Eighty-eight of 93 hips in which the intact surface was greater than one-third of the total on lateral roentgenograms obtained prior to surgery showed no collapse of the newly created weight-bearing area (success rate, 95%). Ninety-eight of the 102 hips in which the ratio of the intact area of the femoral head to the acetabular weight-bearing area on postoperative anteroposterior roentgenograms was greater than 36% showed no further collapse. These results suggest that adequate rotation is essential. Intentional varus positioning should be designed for patients with advanced collapse and extensive lesions. In the case of Perthes' disease all seven hips showed excellent results, and repair processes were completed within one year. In the treatment of slipped epiphysis anterior rotational osteotomies were performed in ten hips (10 patients); nine of the ten hips showed excellent results, with perfect correction of the deformity. Twenty-two patients with osteoarthritis were treated by rotational osteotomy. Ten of these patients were followed up for two to nine years; nine of ten showed excellent results. In only one hip with a severely dysplastic acetabulum was there a recurrence of pain and narrowing of joint space. These results suggest that this procedure may be used not only for femoral head necrosis but for patients with Perthes' disease, slipped capital epiphysis, and osteoarthritis of the hip as well.