Gonzalez Della Valle A, Serota A, Go G, Sorriaux G, Sculco TP, Sharrock NE, et al. Venous thromboembolism .... Yu HT, Dylan ML, Lin J, Dubois RW. Hospitals' ...
stable (greater than the control) when walking over barriers as was roll for the sit-to-stand task, indicative of ... after total hip replacement regarding the risk of a fall, especially in the elderly. Most patients ... metre cable to a computer whi
D. W. MURRAY, A. R. BRITTON, C. J. K. BULSTRODE. From the Nuffield Orthopaedic Centre, Oxford, England. The recommendation that patients having a total hip replacement should receive pharmacological thromboprophylaxis is based on the belief that fata
Marc E. Umlas. From the Centre for Total Joint Replacement, New York, USA. We report 16 cases of erythematous eruption on the skin within the flaps of the ...
Apr 29, 2013 - ing total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was ...
impingement after THR, to assess the results of surgical ... dysplasia in five patients (five hips). .... dislocation of the hip, a superficial wound infection and five .... Meyer JD, PlÃ¶tz W, Tillmann K, Russlies M. Iliopsoas impingement after ceme
arthroplasty. After total hip replacement recurrent dislocation is a serious and ..... to incorrect positioning of prosthetic components, loosening of the trochanter.
hip replacement performed after fixation failed for femoral neck fracture. (A) (n = .... of femoral loosening discovered at review. No acetabular cups were loose.
We compared the radiographic results of secondary total hip replacements,. 99 following failed uncemented hemiarthroplasties and 21 following failed.
Anne McMurray, PhD, RN, FRCNA, Professor of Nursing,. Research Centre .... significance. This level was achieved using a Bonferroni. Correction to reduce the probability of making a Type I error when performing multiple tests. For single tests, the .
Girdlestone type of pseudarthrosis. The infection may not present for a considerable period after operation, though relatively few cases occur after one year ( ...
1 -Radiograph before operation. Figure. 2-Twelve months after operation. Figure. 3-Sinogram two years after operation. Figure. 4-After a Girdlestone operation.
Bilateral protrusio acetabuli following pelvic irradiation. J Rheumatol 1977;4:189-96. Hasselbacher P, Schumacher HR. Synovial fluid eosinophilia following.
In 1985 Galante pleaded that âorthopaedic surgeons should agree to a uniform method of evaluating and reporting the results of hip replacement surgeryâ. 1.
October 2006. Intra-articular injections of steroid into the hip are used for a variety of reasons in current .... A diagnosis of trochanteric bursitis was made and the ...
Consultant Plastic Surgeon. â« G. C. Bannister, MD,. FRCS(Orth), Professor of. Orthopaedic Surgery. North Bristol Trust. Avon Orthopaedic Centre,. Southmead Hospital, Bristol ... appearance of the scar at three months using a surgeon-rated visual an
biocompatible is the titanium alloy extra low interstitial (ELI)2 Tiâ6Alâ4V; its composi- tion is 90 wt% Ti, 6 wt% Al, and 4 wt% V. The optimal properties for this material are produced by hot forging; any subsequent deformation and/or heat treat
able position for males was prone (patient on top), ... gated the impact of hip osteoarthritis on sex- ... was obtained regarding which sexual positions pa-.
subjects completed a 30-second bout of isometric hip abduc- tion, from .... The preferred leg was defined as the landing leg that ... the largest mean time to peak joint angle of the hip, knee, and ..... Multi-segment coordination: fatigue effects.
and the types of arthroplasty performed are shown in Tables. II and ... arthroplasties performed. Number of ..... in all 12 a Girdlestone arthroplasty was performed.
Abstract: Instability after total hip arthroplasty (THA) is not a rare occurrence. Numerous factors have been associated with dislocation including surgical approach, implant design, failure to restore proper hip mechanics and soft tissue restraints,
V early osteointegration. On-growth of bone to porous coated prostheses is ... rich femoral component or with the ce- ... total hip arthroplasty in dogs (1, 2). Loo-.
Radiological analysis assessing heterotopic ossification, femoral osteolysis and femoral stem ... following total joint replacement.12 A retrospec- tive study by ...
Total hip replacement (THR) is a very common procedure undertaken in up to 285 000 .... diagnosis can include activity-related pain, aseptic loosening,.
A. S. BAKER,
Assessments were made The Trendelenburg weakness
of union with
anterior fibres of gluteus greater trochanter, and procedure is postoperative This
attachment Hardinge cautioned
(Robinson, is a possible
In a prospective study we sought to investigate the incidence and cause of abductor weakness in patients undergoing total hip replacement by the lateral approach. Three groups of patients were compared : after Dali’s
Hardinge a posterior
of the gluteal
of the flap
flap. in the to the
he does of his
as a control
the superior gluteal nerve, its relationship to the proximal pole ofthe greater trochanter, and its proximity to the
to the Dali’s
modified direct lateral (MDL) approach was used in 29 hips. In these cases the gluteal flap was raised with a sliver of greater trochanter (Fig. 1) and fixation was
performed by a double wire technique. Two 20 gauge stainless steel wires were passed around the trochanteric sliver and through drill holes in the proximal femur. Hardinge’s direct lateral (DL) approach, with a soft tissue flap, was used in 29 hips, and the posterior (P) approach in 21 hips. Altogether a total of 79 hips in 69 patients
A. S. Baker. and
(1982) approach, approach.
by the direct
1989 British Editorial Society of Bone 0301 -620X/89/1026 $2.00 J Bone Joint Surg [Br] 1989;71-B:47-50.
A. S. Baker, BSc, FRCS, Senior Orthopaedic V. C. Bitounis, MD, Research Fellow University Department of Orthopaedic Infirmary, Bristol BS2 8BJ, England.
from the of this abduction.
so as to allow the
nerve, or by failure to establish rethe flap to the greater trochanter. was aware of these problems and
Dall (1986) described a modification ofthe technique, which a sliver of trochanteric bone is taken with gluteal
occurred in only five of the 28 hips with abductor In the modified direct lateral group, radiological
medius and minimus one of the complications weakness of hip
gluteal of (1982)
and by Hardinge (1982) they avoid the complication
likely than with the posterior approach Robinson and Salvati 1980). However, there The
three months after operation. test was positive (Grade H) in eight
to the hip described
of the trochanteric
one of each of the other two groups. without statistical difference between
but in only
on a visual pain
analogue to 10 (the
by a 47
A. S. BAKER,
support only. The patient leg, flexing the other leg
The patient was asked which he or she could
one leg, positive
at least In Grade
remained horizontal or II the unsupported pelvis line.
pain was not or the DL groups
different with the P
Abductor power was assessed in the 72 patients with normal EMG patterns (Table II). In this group, abductor weakness, with a Grade II positive Trendelenburg test, was found in seven DL cases, in one of the MDL group (p
of the operation.
Peritrochanteric in either the MDL
held there for were recorded.
by needle puncture 14 and 21 days after
the unsupported pelvis either could not be elevated. In Grade dropped below the horizontal
a Zimmer by finger
was then asked to stand on one at the knee, while keeping the
to stand behind use for balance
V. C. BITOUNIS
of fibrillation and lata
apart. The unoperated side was examined first in order to establish the normal EMG pattern and then on three sample sites in the tensor fascia lata of the operated side. Needles
examinations, at the
of 28 patients
the femoral osteotomy.
Posteriorly of the
operation. in three
period. in one
compared with the MDL (p < 0.05). At three months
(p < 0.001), follow-up,
in 28 patients
of trochanteric malunion or non(Table III). In four hips the broken, in two there was proximal sliver
ununited. Hip abductor better in the 1 7 hips with
of trochanteric union than in the 11 malunion or non-union (p < 0.05).
weeks, 10 DL
Denervation ofthe gluteal flap was presumed from EMG analysis of the tensor fascia lata. This muscle is the end
to the tip
above piriformis in a of gluteus medius.
radiological hips with
6 and 8 cm proximal
caudally from the substance
it lies between
group showed evidence union in 1 1 cases trochanteric wires had
sliver was undisplaced function was significantly
MDL group three months postoperatively to assess state of union of the trochanteric osteotomy.
and the P
group however, the incidence of denervation was lower and there was no significant difference between the three groups.
or P groups,
significantly MDL group.
group OF BONE
in the MDL
this difference the
was in the
on by SURGERY
the same surgeon and particular care was taken to protect the nerve. For the lateral approach, therefore, proximal gluteal splitting should be kept to a minimum and any extension of the exposure should be obtained by distal splitting of the vastus lateralis. Three hips showed evidence
the posterior branch during Fig.
gluteal nerve presumably
be injured injudicious
of the superior this approach,
Electromyogram showing denervation. pattern is produced by adjacent muscles against gravity. Then at rest, spontaneous as fibrillation potentials.
Initially, an interference as the patient flexes the hip electrical activity is detected
of the Trendelenburg test evidence of denervation
MOdified direct lateral
We tried mounted
to quantify tensiometer
denervation weakness usually
of the hip showing the course of the superior gluteal nerve.
Dd lateral Total
muscle power and Checketts and
EMG. a direct
of these This lateral
using a 1984),
In all, 17 patients had a II positive Trendelenpatients
that abductor to the hip
MOdified direct lateral
of denervation at two weeks at three months
of hips with pain
( 9 dlssections
the modified Trendelenburg test. Grade I positive and 1 1 a Grade
to the be
trochanteric bone with the gluteal patients in the MDL group, abductor only in inadequate. the bone osteotomy,
weakness occurred those in whom trochanteric fixation was Sliver osteotomy may create problems when is of poor quality or when, after a low neck the posterior trochanteric remnant is frac-
A. S. BAKER,
the 28 patients these, 15 patients
hip can cause ofthe superior
with positive tests still had positive
for 27 of
anterior giuteal flap from the Even at 1 2 months, 56% of hips with at three months still showed positive
use of the direct
at three months. Of Trendelenburg tests;
of which DL
V. C. BITOUNIS
The authors would like to thank Dr Alan Hedges, BSc, PhD, of the Department of Microbiology, University of Bristol for his help with the statistical analysis. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
abductor weakness. If the inferior branch gluteal nerve is protected, the incidence of
E & S Livingstone, Charnley J. Total hip Orthop l970;72:7-2l. iippInger FW, evaluating Surg [Am] Dali
: a modified
1986;68-B P, Nade Joint Surg
Goidner JL, Roberts JM. upper-extremity peripheral l962;44-A :1047-60.