Hip Hip Hurrah! Hip size inversely related to heart disease and total mortality

During the past decade a series of published reports have examined the value of studying the relation between hip circumferences and cardiovascular end points. Specifically, in a series of recent studies the independent effects of hip circumference have been studied after adjustment for general obesity and/or waist circumference. These studies have been remarkable in terms of their consistency, and in the unexpected finding of an adverse effect of small hip size, after statistically correcting for differences in general and abdominal size. The hazard related to a small hip size may be stronger for women than men, but is evident in both genders. In this ‘viewpoint’, we wish to draw attention to the emerging body of evidence and to encourage researchers to continue collecting measures of lower body size in their surveys.     

Hip fracture

A prospective study of 79 patients with recent hip fracture revealed prior functional impairments with community mobility (49%), using a bathtub (40%), walking outdoors (26%), and stair-climbing (18%). Eighty-six per cent of patients (mean age 77.9 years) were admitted from home, with 95% surviving to discharge but only 28% returning directly home following surgical repair. In-hospital complications included confusion (49%), urinary tract infection (33%), and heart rhythm disturbance (26%). Mean length of stay was 21.7 days and mean hospital charges were $11,052. The outliers (15%) averaged 60.6 days in length of stay and $28,190 in charges. Stepwise multivariate regression revealed that lengths of stay varied significantly with prefracture functional status, presence of intertrochanteric fractures, and in-hospital complications, but not with patient age. Examination of these findings in relation to prospective reimbursement led to the conclusion that hip fracture patients are particularly vulnerable in the era of new hospital strategies to avoid high-cost patients and curtail hospital costs. Presented at the meeting of the Gerontological Society of America, November 1984. Supported by a grant from The Robert Wood Johnson Foundation.     

动力加压髋螺钉内固定治疗老年转子间骨折的临床研究

目的探讨股骨转子间骨折采用动力加压髋螺钉(DHS)内固定治疗后的临床疗效。方法选取2002年1月—2009年1月40例年龄49～79岁股骨转子间骨折患者,采用切开复位DHS手术治疗,并进行围手术期治疗和功能锻炼。结果随访4～12个月,平均6个月,关节活动优良者85%,骨折愈合率100%,髋内翻1例,DHS内固定牢固,功能恢复好。结论股骨转子间骨折采用DHS内固定,对无手术禁忌证的患者行积极的内固定治疗,结合术后功能锻炼,疗效良好,有利于骨折愈合,减少并发症。     

Vitamin D and Hip Fracture

Hip fractures are recognized as a major public health problem worldwide. Demographic changes will lead to enormous increases in the number of hip fractures and projections indicate that the number of hip fractures occurring worldwide each year will rise from 1.26 million in 1990 to 4.5 million by 2050. However, preventive strategies are available. Supplementation with Ca²⁺ and vitamin D restores bone quality through suppression of secondary hyperparathyroidism and decreases the risk of falling through improvement of neuromuscular coordination and body sway. This leads to a reduction of hip fracture risk of 43% in the vitamin D-insufficient elderly. Treatment with the bisphosphonate alendronate increases bone strength and results in a 51% reduction of hip fracture risk. Hip protectors absorb energy during a fall and reduce hip fracture risk by 56%. Combining these three procedures could prevent a large proportion of hip fractures in the future.     

Hip protectors improve falls self-efficacy

OBJECTIVES: To investigate the effect of use of external hip protectors on subjects' fear of falling and falls self-efficacy (belief in their own ability to avoid falling). DESIGN: Randomized controlled trial. SETTING: Aged-care health services in Sydney, Australia. PARTICIPANTS: 131 women aged 75 years or older, who had two or more falls or one fall requiring hospital admission in the previous year and who live at home. Sixty-one subjects were in the intervention group and 70 in the control group. INTERVENTION: Use of external hip protectors and encouragement to use the protectors by an adherence nurse. MEASUREMENTS: At the time of enrolment into a wider study examining the effect of hip protectors on hip fractures, participants recruited at home completed an assessment of fear of falling and falls efficacy as measured by the Falls Efficacy Scale and the Modified Falls Efficacy Scale. At 4-month follow-up, these scales were readministered by an observer who was not aware of the allocation of the participant to intervention or control groups. RESULTS: Fear of falling and falls self-efficacy, as measured by the Falls Efficacy and Modified Falls Efficacy Scales, were similar at baseline in both groups. Fear of falling was present at follow-up in 43% of subjects using hip protectors and 57% of the control group (chi2 = 2.58, P = 0.11). Hip protector users had greater improvement in falls self-efficacy at follow-up as measured by the Falls Efficacy Scale (t = 2.44, P = 0.016) and the Modified Falls Efficacy Scale (t = 2.08, P = 0.039). CONCLUSION: Hip protectors improve falls self-efficacy. As users of hip protectors feel more confident that they can complete tasks safely, they may become more physically active and require less assistance with activities of daily living.     

Hip involvement in ankylosing spondylitis

Hip involvement in ankylosing spondylitis (AS) is a common and disabling problem. The clinical and x-ray records of 87 patients with definite AS (Rome criteria) were examined to define and characterize their hip disease. Clinical hip disease was present in 33 cases (38%), was usually bilateral (91%), and tended to begin early in the disease course; it was the cause of 50% of the Class III and IV disability in the entire study group. Typical findings included regional pain, limitation of motion, muscle atrophy, and flexion contractures. Radiologic hip abnormalities occurred in 42 cases (48%). The radiographic pattern was distinctive when compared to that in two control groups and included axial migration of the femoral head (63%), concentric joint space narrowing (50%), rufflike femoral osteophytosis (36%), and protrusio acetabuli (30%). Eight patients required bilateral hip surgery. Paraarticular ossification occurred in 8 of 16 replaced hips; in 5 of 8 hips it caused clinical immobility. This potentially serious complication may limit the usefulness of hip arthroplasty in some AS patients.     

Hip fracture as the tracer condition

Hip fractures represent the most severe complication of osteoporosis from the perspectives of the patient, carer, health care system and society. Given the strong association with age, numbers are set to rise significantly in the next few decades despite evidence that the age adjusted rates in some countries are either plateauing or falling. Given the almost invariable need for inpatient admission, hospital administrative data for hip fractures remain a robust measure of number of hip fractures in the community and can be extrapolated to determine the total expected number of clinical fragility fractures from the same population. Both process and outcome standards have now been developed to benchmark clinical quality in the care of patients with hip fractures and fragility fractures at other sites.