Prevalence of primary coxarthrosis in siblings of patients with primary coxarthrosis

The prevalence of primary coxarthrosis was investigated in 289 siblings of 184 patients treated by total hip replacement. Age and sex-matched persons from the city files of Malm?, Sweden, were selected as controls. The prevalence of presenting symptoms (initiating a hip roentgen examination) of primary coxarthrosis in the siblings was 8%, compared to 3.8% in the controls (p less than 0.05). The type and localization of primary coxarthrosis was evenly distributed between the two groups. Conversely, the prevalence of gonarthrosis did not differ between the two groups. The prevalence of primary coxarthrosis in the siblings suggests the influence of a hereditary factor in the etiology of primary coxarthrosis.     

The Relationship of Bone Mass and Loosening of the Femoral Component in Total hip Replacement

Parameters of bone mass in the upper end of the femur—the thickness of the calcar femorale and the pattern of the trabeculae—were evaluated in preoperative films of patients who had undergone total hip replacement. Patients with primary coxarthrosis rarely showed signs of osteoporosis; on the contrary, one of the parameters of bone mass was above average in the coxarthrosis cases. However, there was no difference, in the preoperative films, between hips that later went on to show signs of mechanical loosening of the stem prosthesis and hips that remained intact in this respect.     

Coxarthrosis and femoral neck fracture.

A retrospective cross-sectional study of the roentgenograms of 300 hip fracture patients and 300 age- and gender-matched controls was performed to determine the relationship between fracture type, femoral neck trabecular bone integrity (as measured by the Singh index), osteoarthrosis, and age. Coxarthrosis was associated with a low incidence of intracapsular fracture but unchanged rates of extracapsular fracture. Singh grade declined with age in all groups of patients, although the rate of decline was reduced in control female patients with coxarthrosis compared with other diagnostic groups. When the coxarthrosis patients were included, the mean Singh grade for the female fracture patients was significantly reduced in patients compared with controls with or without age adjustment (3.88 versus 4.17). When patients with coxarthrosis were excluded from the analysis, this effect disappeared. It is suggested that the differences in Singh grades observed previously between femoral fracture patients and controls may have resulted from an undetected negative association between coxarthrosis and retention of trabecular integrity with aging.     

Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis

We studied the perioperative blood loss in 100 total hip arthroplasties performed for rapidly destructive coxarthrosis and compared it with the blood loss in 100 total hip arthroplasties for regular coxarthrosis. The treatment protocol was identical in both groups. Total blood loss was calculated as the compensated blood loss (volume transfused during and immediately after surgery) and the non-compensated blood loss using Nadler and Mercuriali formula. The mean blood loss calculated in milliliters of red blood cells (100% haematocrit) was 578 ml in regular coxarthrosis and 945 ml in rapidly destructive coxarthrosis. The blood loss after total hip arthroplasty is greater when surgery is performed for rapidly destructive coxarthrosis than for regular coxarthrosis (P < 0.001).     

A roentogenographical study on the alignment of the lower extremities in secondary coxarthrosis

Alignment of the lower extremities in secondary coxarthrosis (273 lower extremities) and controls (240 normal lower extremities) were studied using roentogenograms of whole lower extremities including the pelvis taken in the standing position with both legs. Secondary coxarthrosis, which is caused by congenital dislocation of the hip joint, was classified into four groups: unreduced dislocation, high dislocation, incomplete dislocation, and dysplasia of the acetabulum. Comparative studies were conducted using statistical data on measured items, obtained from secondary coxarthrosis cases and controls. In controls, the femoro-tibial angle (FTA) was 175.5 +/- 2.08 degrees and the mechanical axis passed through the medial side to the middle of the knee. It has been noted that a tendency for bow-legs was seen after the age of 50. In coxarthrosis with high dislocation, the most marked knock-knees were observed (FTA of 172.5 +/- 3.88 degrees), while in coxarthrosis with incomplete dislocation and dysplasia of the acetabulum, there was a tendency to coxa valga but no tendency toward knock-knees was evident. Cases of total hip replacement revealed that it is possible to improve knock-knees by installing a socket in the primary acetabulum as much as possible, correcting the difference between the length of the legs and elimating adduction contracture. It was also possible to study factors contributing to bow-legs and knock-knees by means of multivariate analysis.     

Scintigraphic image patterns in dysplastic coxarthrosis: Evaluation with reference to radiographic findings in 210 hips

Little is known about scintigraphic image patterns in the various stages of coxarthrosis. We assessed bone scintigraphy in 159 patients (210 hips) with dysplastic arthrosis of the hip. Scintigraphic images were divided into 5 types related to the radiographic stages of the disease. The scintigraphic images showed little, if any, uptake in the stage of prearthrosis. In the early stage, we found an increase in uptake in the weight bearing area in 30% of cases. In the advanced stage, more than half of the cases had an increase in uptake in the medial side of the joint and in the weight bearing area. In the terminal stage, a marked increase in uptake in the weight bearing area was commonest. Since the osteoblastic reaction intensified, a marked increase in uptake was seen not only in the weight bearing area, but also throughout the entire joint. These types of scintigraphic patterns, which change with the stage of coxarthrosis, seem to reflect the natural course of the disease. All hips with rapid progression of the disease showed a marked increase in uptake of radionuclide the entire joint at earlier stages.     

Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field: A neurophysiological study

Little is known about scintigraphic image patterns in the various stages of coxarthrosis. We assessed bone scintigraphy in 159 patients (210 hips) with dysplastic arthrosis of the hip. Scintigraphic images were divided into 5 types related to the radiographic stages of the disease. The scintigraphic images showed little, if any, uptake in the stage of prearthrosis. In the early stage, we found an increase in uptake in the weight bearing area in 30% of cases. In the advanced stage, more than half of the cases had an increase in uptake in the medial side of the joint and in the weight bearing area. In the terminal stage, a marked increase in uptake in the weight bearing area was commonest. Since the osteoblastic reaction intensified, a marked increase in uptake was seen not only in the weight bearing area, but also throughout the entire joint. These types of scintigraphic patterns, which change with the stage of coxarthrosis, seem to reflect the natural course of the disease. All hips with rapid progression of the disease showed a marked increase in uptake of radionuclide the entire joint at earlier stages.     

Scintigraphic image patterns in dysplastic coxarthrosis: evaluation with reference to radiographic findings in 210 hips

Little is known about scintigraphic image patterns in the various stages of coxarthrosis. We assessed bone scintigraphy in 159 patients (210 hips) with dysplastic arthrosis of the hip. Scintigraphic images were divided into 5 types related to the radiographic stages of the disease. The scintigraphic images showed little, if any, uptake in the stage of prearthrosis. In the early stage, we found an increase in uptake in the weight bearing area in 30% of cases. In the advanced stage, more than half of the cases had an increase in uptake in the medial side of the joint and in the weight bearing area. In the terminal stage, a marked increase in uptake in the weight bearing area was commonest. Since the osteoblastic reaction intensified, a marked increase in uptake was seen not only in the weight bearing area, but also throughout the entire joint. These types of scintigraphic patterns, which change with the stage of coxarthrosis, seem to reflect the natural course of the disease. All hips with rapid progression of the disease showed a marked increase in uptake of radionuclide the entire joint at earlier stages.     

Pelvic incidence and hip disorders

Background and purpose — The role of pelvic incidence in hip disorders is unclear. Therefore, we undertook a literature review to evaluate the evidence on that role.

Methods — A search was carried out on MEDLINE, SCOPUS, CENTRAL, and CINAHL databases. Quantitative analysis was based on comparison with a reference population of asymptomatic subjects.

Results — The search resulted in 326 records: 15 studies were analyzed qualitatively and 13 quantitatively. The estimates of pelvic incidence varied more than 10 degrees from 47 (SD 3.7) to 59 (SD 14). 2 studies concluded that higher pelvic incidence might contribute to the development of coxarthrosis while 1 study reported the opposite findings. In 2 studies, lower pelvic incidence was associated with a mixed type of femoroacetabular impingement. We formed a reference population from asymptomatic groups used or cited in the selected studies. The reference comprised 777 persons with pooled average pelvic incidence of 53 (SD 10) degrees. The estimate showed a relatively narrow 95% CI of 52 to 54 degrees. The 95% CIs of only 4 studies did not overlap the CIs of reference: 2 studies on coxarthrosis, 1 on mixed femoroacetabular impingement, and 1 on ankylosing spondylitis

Interpretation — We found no strong evidence that pelvic incidence plays any substantial role in hip disorders. Lower pelvic incidence may be associated with the mixed type of femoroacetabular impingement and hip problems amongst patients with ankylosing spondylitis. The evidence on association between pelvic incidence and coxarthrosis remained inconclusive.     

Blood levels of vitamin D metabolites in gonarthrosis

Summary The blood levels of the active metabolites of vitamin D₃ 25-hydroxycholecalciferol [25(OH)D₃], 1,25-dihydroxycholecalciferol [1,25(OH)₂D₃], and 24,25-dihydroxycholecalciferol [24,25(OH)₂D₃] were determined in 27 patients suffering from arthrosis of the knee, including 4 patients with non-insulin-dependent diabetes mellitus. The blood level of 24,25-dihydroxycholecalciferol was found to be significantly lower in patients with gonarthrosis than in patients with coxarthrosis. With the exclusion of the diabetic patients, the mean value for this metabolite was lower than in the coxarthrosis group, but the difference was not significant statistically.     

Coinciding morbidity in patients with coxarthrosis. An epidemiological study of roentgen examinations

In 279 patients who had undergone total hip replacement because of primary coxarthrosis, the occurrence of fractures, other diseases, and roentgen examinations was compared with that in the same number of age- and sexmatched controls from the same population. Coxarthrosis patients had had significantly more fractures than the controls before their hip operation but did not have significantly more after the operation except for fracture distal to the femur implant, which was rare but occurred only in the patients who had undergone surgery. Fragility fractures, including hip fractures, were equally frequent in coxarthrosis patients and controls. There was a higher tendency to morbidity in conditions related to ageing and degeneration; diabetes, however, was less frequent in coxarthrosis patients. Coxarthrosis patients had also had more frequent examinations of their gastro intestinal tract and their kidneys.     

The coexistence and characteristics of osteoarthritis and osteoporosis

We defined the clinical features and radiographic coexistence of osteoarthritis and osteoporosis in fifty women with primary coxarthrosis and fifty age-matched women (average age, 69 +/- 5 years) with idiopathic osteoporosis. The patients with osteoarthritis had undergone total hip replacement. The diagnosis of primary osteoarthritis was established by clinical, radiographic, and histological criteria, and the diagnosis of osteoporosis was confirmed by histomorphometric analysis of specimens taken at iliac-bone biopsy. In the arthritic patients, spinal osteoporosis was identified by radiographic evidence of compression fractures, kyphosis, and scoliosis. Femoral osteoporosis was demonstrated by the index of Singh et al. and the femoral canal-shaft ratio. In the osteoporotic patients coxarthrosis was measured radiographically by the scale of Kellgren and Lawrence. On the average, the osteoporotic patients were twelve kilograms lighter than the osteoarthritic patients. Fifty-eight per cent of the osteoporotic and 18 per cent of the osteoarthritic patients had a scoliotic curve of at least 10 degrees. The prevalence of osteoarthritis of the hip in the osteoporotic women was 4 per cent, and the prevalence of compression fractures in the arthritic women was 6 per cent, which was approximately one-quarter of the expected incidence. These results show that: (1) osteoporosis does not protect against the development of coxarthrosis, (2) coxarthrosis is a negative risk factor for osteoporotic compression fractures, and (3) scoliosis and an ectomorphic habitus are clinical markers that identify a risk for osteoporosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Indications and results of intertrochanteric reconstructive osteotomy in coxa profunda and protrusio coxae

Coxa profunda often connected with coxa vara lead to an increasing stress on the medial part of the acetabulum. Secondary degenerative alterations with painful limited motion are the result. In 20 hip joints with coxa profunda a valgus intertrochanteric osteotomy was carried out in order to modify the direction of the resulting force from the depth to the roof of the acetabulum. A relief of pain was achieved in 18 of 20 cases. Therefore the valgus intertrochanteric osteotomy has to be considered an effective method in the treatment of coxarthrosis in coxa profunda.     

Insulin-like growth factor 1 (IGF-1) and growth hormone (hGH) as the markers of osteoarthritis

AIM OF STUDY: The aim of study was evaluation of diagnostic usefulness of IGF-1 and hGH serum level in osteoarthritis. MATERIAL AND METHODS: IGF-1 and hGH concentration were measured in serum collected from 25 patients with coxarthrosis and 16 healthy persons. IGF-1 and hGH serum level were assayed by ELISA. RESULTS: There was no statistics difference in growth hormone serum level between osteoarthritis patients and healthy persons. The ROC curve for hGH concentration confirmed low discriminatory value of this test. There was no significant correlation between hGH and IGF-1 in serum. IGF-1 concentration in patients serum was significant lower then in control grupe. The ROC curve for serum level of IGF-1 confirmed significant usefulness this test in laboratory diagnostic of osteoarthritis. CONCLUSIONS: Serum concentration of IGF-1 seems to be usefull laboratory marker of osteoarthritis.     

Analyse von Versorgungsumfang und -qualität bei Arthrosepatienten anhand von GKV-Routinedaten

Background

In an epidemiological context arthrosis is becoming more important due to demographic changes. This study describes the routine medical treatment of patients with arthrosis.

Methods

Claims data of a German statutory health insurance fund for the period from 2005 to 2008 were analyzed. All insured patients aged 60 years and older residing in Kinzigtal were included. In detail all 1,551 insured persons with a validated ambulatory diagnosis of gonarthrosis or coxarthrosis (ICD-10: M16/M17) were analyzed.

Results

The treatment prevalence of arthrosis documented by practice-based physicians rose from 14?% (60–69 years old) to 25?% (80 years and older). At least one hospital admission between 2006 and 2008 was documented for two thirds of the patients whereby 86 and 95 patients were admitted because of coxarthrosis or gonarthrosis, respectively. A total of 112 and 96 insured patients received an implantation or revision of an endoprosthesis of the hip or knee, respectively. The need for nursing care did not decrease in cases of surgical compared to conservative treatment.

Conclusion

Claims data allow a differentiated analysis of medical treatment and quality of care as well as a comparison of alternatives of medical care for patients with arthrosis. Results of such analyses can be used to identify patients with increased vulnerability.     

Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis

Heterotopic bone formation was investigated in 392 Charnley low-friction total hip arthroplasties. A multivariate linear regression analysis was used to account for the influence of co-variables: sex, age at surgery, postoperative treatment with antiinflammatory drugs during at least the first 2 weeks, and previous ipsilateral hip surgery. A total of 232 hips had been treated for primary coxarthrosis, and 114 and 46 hips for secondary coxarthrosis due to congenital dislocation and fracture-dislocation of the hip, respectively. None of the hips with primary coxarthrosis previously had ipsilateral hip surgery, whereas 41 hips (36%) in patients with congenital dislocation of the hip and 28 hips (61%) in patients with fracture-dislocation of the hip had one or more ipsilateral surgical procedures prior to the arthroplasty. The sex ratio varied between the groups, with a male:female hip ratio of 1:1, 1:10, and 3:1 for the three groups, respectively. The risk of developing grades 2 or 3 heterotopic ossification after total hip arthroplasty were significantly higher in men, patients without postoperative treatment with antiinflammatory drugs, and patients above age 60. In contrast, the analysis documented that previous ipsilateral hip surgery and type of coxarthrosis did not influence lesion development, supporting the theory that a systemic, rather than local factor, is responsible for the development of heterotopic bone formation after total hip arthroplasty.     

Long-term results of rotational acetabular osteotomy in young patients with advanced osteoarthrosis of the hip

Between 1974 and 1987, we performed 38 rotational acetabular osteotomies to treat advanced coxarthrosis caused by acetabular dysplasia in 38 patients who were aged 40 years old or less at the time of surgery. Of these patients, 28 were followed-up for more than 10 years after surgery. The preoperative severity of coxarthrosis was graded as stage III in 21 hips and as stage IV in 7 hips, according to our modification of the classification of coxarthrosis advocated by the Japanese Orthopaedic Association. At the time of follow-up, 27 patients retained their own hip joints on the operated side 10 to 18 years (average, 13 years) after surgery, and the remaining patient had had a secondary total hip replacement 7 years after the surgery. Of the 27 patients who retained their own hip joints on the operated side, 20 had little or no pain and none suffered from severe pain in the operated hip; the severity of coxarthrosis was graded as stage II in 4 hips, as stage III in 9 hips, and as stage IV in 14 hips. We conclude that rotational acetabular osteotomy can be a useful procedure in young patients who have advanced coxarthrosis secondary to acetabular dysplasia. Received: September 22, 1999 / Accepted: February 7, 2000     

Autologous blood transfusion in hip replacement: No effect on blood loss but less increase of plasminogen activator inhibitor in a randomized series of 80 patients

80 patients underwent total hip replacement (THR) for primary coxarthrosis. in a randomized study, half of them donated 2 units of blood before operation. One unit was collected 4 weeks and one 2 weeks before the scheduled THR. All except 1 patient tolerated the predonations well. Total blood losses were similar in both groups. Additional bank blood was given in 7/38 in the predonation group, compared to 29/40 in the control group.

Hemostatic parameters were studied in 10 consecutive patients in each group. Plasminogen activator inhibitor 1 (PAI-1), a possible risk parameter for thromboembolism, was significantly more increased postoperatively in the control group, which received only homologous blood. Platelet count, prothrombin complex, antithrombin III and von Willebrand factor antigen were significantly reduced and C reactive protein increased after surgery in both groups.

We recommend predonation of 2 autologous units before a primary THR. in most cases, such predonation makes homologous blood transfusion unnecessary. the use of predonated blood causes no reduction of blood loss in THRs, but the increase in PAI-1 seen after homologous transfusions is avoided.     

Surgical methods in the treatment of patients with sequelae of hip joint injuries]

The article analyzes results of treatment of 64 patients with sequelae of traumas of the hip joint. They showed that arthrodesis of the hip joint was indicated in treatment of young patients with severe posttraumatic coxarthrosis, destruction of the cotyloid cavity or the femur head including those after fighting injuries of the joint, purulent complications after traumas or preceding operations. Intertrochanteric osteotomy of the femur is reasonable in treatment of young patients with the initial stages of coxarthrosis and preserved amplitude of movement of the joint. Endoprosthesis of the hip joint is the operation of choice in patients older than 40-45 years with posttraumatic coxarthrosis and aseptic necrosis of the femur head, as well as in patients with the recurrent pain syndrome after intertrochanteric osteotomy.     

Triphasic bone scanning following porous-coated hip arthroplasty

In a long-term follow-up evaluation of a homogenous group of patients with a standardized total hip arthroplasty for coxarthrosis, the imaging levels follow a predictable pattern over a prolonged period of time. Because of the prolonged nature of increased uptake in the static phases, the utilization of bone scanning in the early diagnosis and evaluation of the patient with a painful noncemented hip may have little value. Increased blood pool and blood flow studies may indicate localized pathology, but, at the present time, static images of noncemented hip arthroplasty within 12 months of surgery probably are of little diagnostic value.