scholarly journals Transposition of the great trochanter: A look at the problem

2021 ◽  
Vol 9 (2) ◽  
pp. 195-202
Author(s):  
Ivan Y. Pozdnikin ◽  
Pavel I. Bortulev ◽  
Dmitry B. Barsukov ◽  
Vladimir E. Baskov
Keyword(s):  
Surgical Treatment ◽  
Femoral Neck ◽  
Range Of Motion ◽  
Hip Joint ◽  
Proximal Femur ◽  
Great Trochanter ◽  
Clinical Parameters ◽  
Greater Trochanter ◽  
Hip Joints ◽  
High Position

BACKGROUND: Multiplanar deformity of the proximal femur with a high position of the greater trochanter is one of the most common residual deformities of the hip joint. The VeauLamy transposition of the greater trochanter does not fully treat the mutual trauma of the components of the hip joint, as it only brings down the greater trochanter to provide tension for the gluteal muscles. AIM: This study aimed to share the experience of performing transposition of the greater trochanter according to our proposed technique. MATERIALS AND METHODS: The study included 15 patients (15 hip joints) aged 916 years with a high position of the greater trochanter of the femur, who underwent surgical treatment in the period from 2018 to 2019. In addition to the actual transposition of the greater trochanter, the intervention provided a modeling resection of the base (bed) of the greater trochanter and the formation of an offset of the femoral neck. RESULTS: Patients were followed up for period of up to 30 months. All patients showed positive changes after surgical treatment with improvement of radiological and clinical parameters. CONCLUSIONS: The proposed intervention allows restoration of the function of the gluteal muscles, improves the range of motion in the hip joint, and prevents and treats extra-articular impingement syndrome.

scholarly journals Trochanteric epiphysiodesis in complex treatment of children with hip pathology: analysis of preliminary results

2020 ◽  
Vol 8 (3) ◽  
pp. 249-258
Author(s):  
Ivan Y. Pozdnikin ◽  
Vladimir E. Baskov ◽  
Dmitry B. Barsukov ◽  
Pavel I. Bortulev ◽  
Ekaterina A. Kostomarova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Joint ◽  
Complex Treatment ◽  
Greater Trochanter ◽  
Surgical Interventions ◽  
High Position ◽  
Neck Shaft Angle ◽  
Slowing Down ◽  
Shaft Angle ◽  
Radiological Examinations

Background. The relative overgrowth of the greater trochanter is one of the most common deformities of the proximal femur in association with several disorders of the hip joint. Aim. To analyze the dynamics of proximal femoral growth after trochanteric epiphysiodesis as well as to determine the options for using this method in the complex treatment of children with hip pathology. Materials and methods. We analyzed the data of clinical and radiological examinations and surgical treatment (permanent trochanteric epiphysiodesis with metal fixation) outcomes for 43 (52 joints) patients aged 412 years with a developing high position of the greater trochanter. Results. The surgery enabled slowing down of the growth of the greater trochanter on the side of intervention by (average) 50% (p 0.05), although the values of the neck-shaft angle both on the affected side and the side opposite to it did not change (p 0.05). Conclusion. In moderate disorders of the growth plate of the femoral head epiphysis, trochanteric epiphysiodesis can prevent the progression and, in some cases, correct disturbed ratios of the hip joint, thereby avoiding the need for larger surgical interventions.

scholarly journals Risk factors for venous thrombosis in patients with endoprosthetics of hip joints

2021 ◽  
Vol 11 (9) ◽  
pp. 875-885
Author(s):  
Ihor Venher ◽  
Sviatoslav Kostiv ◽  
Dymytrii Khvalyboha
Keyword(s):  
Connective Tissue ◽  
Femoral Neck ◽  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Hip Joint ◽  
Hip Replacement ◽  
Inferior Vena ◽  
Vena Cava ◽  
Hip Joints ◽  
Connective Tissue Dysplasia

Background. Important part of orthopaedic surgery is endoprosthetics of hip joints, which eliminates pain syndrome, restores the amplitude of movements and the support ability of the lower limb. But there is a number of complications; venous thromboembolism among them occupies a leading place. Material and methods. 219 patients with a mean age of 64.7 ± 3.8 years were operated. In 137 (62.1%) observations, total cement hip replacement was performed for osteoarthritis. 82 (37.4%) patients received total and unipolar cement hip replacement for cervical femoral neck fractures. Results. Clinical manifestations of non-specific connective tissue dysplasia were detected in 83 (37.9%) patients, which were confirmed by the laboratory determination of the level of general, bound and free oxyproline. In the postoperative period, the thrombotic process in the venous system of the inferior vena cava was diagnosed in 23 (10.5%) observations. Operative intervention on the hip joint in patients with nonspecific dysplasia of connective tissue in 11 (13.3%) cases was complicated by the development of venous thrombosis. In patients without non-specific connective tissue dysplasia, postoperative thrombosis in the system of the inferior vena cava was diagnosed in 12 (8.8%) observations. Conclusions. Patients with osteoarthrosis of the hip joint and the femoral neck fracture accompanied by the non-specific dysplasia of the connective tissue are characterized by expressed levels of endothelial dysfunction and increased activity of the blood-coagulation system.

scholarly journals A Rare Case of Intra-articular Osteochondroma of the Femoral Neck: A Case Report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yazan Hammad ◽  
Ahmad Saleh ◽  
Ibrahim F Aburumman ◽  
Marwan Balasim ◽  
Mohammad Ibrahem Al-Hyari ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Neck ◽  
Range Of Motion ◽  
Hip Joint ◽  
Rare Case ◽  
Long Bone ◽  
Radiographic Evaluation ◽  
Keywords Hip ◽  
Hip Range Of Motion ◽  
Histopathological Evaluation

Abstract Introduction: The osteochondroma (OC) is considered a benign tumor with long bone preference. It presents usually at the metaphyseal part of the bone, with rare cases of intra-articular origins especially in the hip joint. The presentation of such rare cases varies according to its site and mass effect, which may compress the adjacent nerves, tendon, or vascular structures. The femoral neck OC carries a higher risk of femoral head vascular injury and necrosis, as well as sciatic nerve injury, which requires careful preoperative planning and intraoperative cautions. We report a rare case of intra-articular OC in the hip. Case Report: A 28-year-old male, presented to our hospital, with complaints of right-side gluteal pain, decrease hip joint extension, and feeling of a hard mass for 2 years. The radiographic evaluation showed an osseous mass related posterior and inferior to the right femur neck, with cortical and medullary continuation, and cartilaginous cap on the magnetic resonance image. The suspicious was OC, and planned for excision and histopathological evaluation. The excision was done through lateral hip approach, and it was intra-articular with marked stretching of the joint capsule. Complete excision was done, as close as possible to the femoral neck cortex using saw and osteotomes, followed by prophylactic fixation using two cannulated screws. The histopathology reports confirm the diagnoses, and the patient started on hip range of motion and abductor strengthening exercises. Over a 4-month follow-up period the patient showed significant improvement in his hip range of motion. Conclusion: The intra articular OC of the hip is as rare presentation of the OC, which carries the risks of avascular necrosis as well as nerve compression. Clinical suspicion, proper planning, and histopathological evaluation are needed for better results. Keywords: Hip joint, intra-articular tumor, osteochondroma.

scholarly journals Dysplastic Hip Joint Configuration After Bernese Periacetabular Osteotomy

2021 ◽  
Author(s):  
Kamil Kołodziejczyk ◽  
Adam Czwojdziński ◽  
Andrzej Sionek ◽  
Jarosław Czubak
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Normal Distribution ◽  
Hip Joint ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Hip Joints ◽  
Radiological Parameters ◽  
Significant Difference ◽  
Dysplastic Hip

Abstract Background: Residual hip dysplasia is one of the factors contributing to early hip joint osteoarthritis. The main problems caused by residual dysplasia are pain and instability of the hip joint caused by the lack of sufficient bony covering of the femoral head. The aim of this work was to radiologically assess the configuration change of a dysplastic hip joint after surgical treatment using the Bernese periacetabular osteotomy procedure.Methods: We assessed the radiological parameters of patients with hip dysplasia treated by Bernense periacetabular osteotomy by performing a digital antero-posterior pelvis X-ray: central edge angle and femoral head coverage, medialization, distalization and ilio-ischial angle parameters. For normally distributed parameters, we used Student’s t-test; for parameters without a normal distribution, we used the Wilcoxon signed-rank test. Correlations were assessed according to a normal distribution using the Pearson and Spearman method.Results: For all parameters, we observed statistically significant differences in the measurements of dysplastic hip joints before and after the surgery. We also observed a statistically significant difference between the structure of dysplastic hip joints prior to the surgery and healthy hip joints from the control group based on all radiological parameters. The resulting medialization was 2.68 mm, distalization was 3.65 mm, and the ilio-ischial angle was changed by 2.62°. There was also an improvement in the femoral head bony covering: CEA by 17.61° and FHC by 16.46%.Conclusions: Based on all the radiological parameters, we presented the difference between healthy and dysplastic hip joints. Learning the parameter values that are used to describe dysplastic hip joints will allow us to improve the imaging of the condition and will also allow for better planning and proper qualification of patients for surgical treatment of hip joint dysplasia.Trial registration: Consent of the bioethics commission Medical Centre of Postgraduate Education 83/PB/2015 18.11.2015 Warsaw

scholarly journals NONSPECIFIC DYSPLASIA OF THE CONNECTIVE TISSUE – A FACTOR OF VENOUS THROMBOEMBOLIC COMPLICATIONS IN ENDOPROSTHETICS OF HIP JOINTS

2020 ◽  
Vol 6 (1) ◽  
pp. 35-42
Author(s):  
I. K. Venher ◽  
N. I. Herasymiuk ◽  
S. Ya. Kostiv ◽  
I. I. Loyko ◽  
D. V. Khvalyboha
Keyword(s):  
Endothelial Dysfunction ◽  
Connective Tissue ◽  
Femoral Neck ◽  
Hip Joint ◽  
Hip Replacement ◽  
Inferior Vena ◽  
Vena Cava ◽  
Hip Joints ◽  
Neck Fracture ◽  
Connective Tissue Dysplasia

Background. Important part of orthopedic surgery is endoprosthetics of hip joints, which eliminates pain syndrome, restores the amplitude of movement and the support ability of lower limbs. But some complications usually take place; venous thromboembolism is leading among them. Objective. The aim of the study was to investigate endothelial dysfunction and activity of the hemocoagulation system at different levels of VTEC risks and thus to work out the strategy of thromboprophylaxis in patients with osteoarthrosis of the hip joint and femoral neck fracture combined with non-specific dysplasia of the connective tissue. Methods. 219 patients of a mean age of 64.7±3.8 years old underwent surgery. In 137 (62.1%) cases, a total cement hip replacement was performed for osteoarthritis. 82 (37.4%) patients underwent total and unipolar cement hip replacement for cervical femoral neck fractures. Results. Clinical manifestations of non-specific connective tissue dysplasia were detected in 83 (37.9%) patients that was confirmed by the laboratory determination of the level of general, bound and free oxyproline. In the postoperative period, the thrombotic process in the venous system of the inferior vena cava was diagnosed in 23 (10.5%) cases. The level of indicators of endothelium status dysfunction was much more significant in the patients in cases of nonspecific dysplasia of connective tissue. Operative intervention on the hip joint in the patients with nonspecific dysplasia of connective tissue in 11 (13.3%) cases was complicated by development of venous thrombosis. In the patients without non-specific connective tissue dysplasia, postoperative thrombosis in the system of the inferior vena cava was diagnosed in 12 (8.8%) cases. Conclusions. Patients with osteoarthrosis of the hip joint and the femoral neck fracture accompanied by the non-specific dysplasia of the connective tissue are characterized by high levels of endothelial dysfunction and increased activity of the blood-coagulation system.

scholarly journals Juvenile pubic symphysiodesis associated with pectineus myectomy for treatment of hip dysplasia in dog

2021 ◽  
Vol 49 ◽  
Author(s):  
Daniel Munhoz Garcia Perez Neto ◽  
Leonardo Augusto Lopes Muzzi ◽  
Fernando Yoiti Kitamura Kawamoto ◽  
Caio Afonso dos Santos Malta ◽  
Laura Lourenço Freitas ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Hip Joint ◽  
Hip Dysplasia ◽  
Weight Bearing ◽  
Clinical Signs ◽  
Radiographic Examination ◽  
Acetabular Coverage ◽  
Hip Joints ◽  
Limb Muscles

Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery.Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development.Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life.Keywords: hip dysplasia, juvenile pubic symphysiodesis, hip joint, osteoarthritis, dog.Título: Sinfisiodese púbica juvenil associada à miectomia do pectíneopara tratamento de displasia coxofemoral em cãoDescritores: displasia coxofemoral, sinfisiodese púbica juvenil, coxofemoral, osteoartrite.

Dimensions of Proximal Femur - An Anatomical Study

2021 ◽  
pp. 2540-2542
Author(s):  
Gyanaranjan Nayak
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Head And Neck ◽  
Hip Joint ◽  
Proximal Femur ◽  
Hip Replacement ◽  
Anatomical Study ◽  
Morphometric Parameters ◽  
Prosthesis And Implants ◽  
Axis Length

The morphometry of proximal femur is necessary in planning surgeries of hip joint and preparation of prosthesis for hip replacement. The aim of the study was to measure various morphometric parameters of femoral head and neck. The study consisted of sixty adult dry human femora of both sexes (thirty left sided and thirty right sided). Various dimensions of femoral head and neck were measured by slide caliper. Diameter of femoral head was estimated to be 39.28±3.87mm along cranio-caudal axis and 41.18±4.14mm along sagittal axis. Diameter of femoral neck was established as 29.03±3.8mm along cranio-caudal axis and 24.36±3.13mm along sagittal axis. Length of femoral neck was measured to be 50.57±6.77mm. The findings of the study will be useful in manufacturing prosthesis and implants for hip replacement as well as other surgeries involving proximal femur.

scholarly journals Relative overgrowth of the greater trochanter and trochanteric-pelvic impingement syndrome in children: causes and X-ray anatomical characteristics

2019 ◽  
Vol 7 (3) ◽  
pp. 15-24
Author(s):  
Ivan Y. Pozdnikin ◽  
Vladimir E. Baskov ◽  
Dmitry B. Barsukov ◽  
Pavel I. Bortulev ◽  
Andrey I. Krasnov
Keyword(s):  
Hip Joint ◽  
Hip Dislocation ◽  
Preschool Age ◽  
Greater Trochanter ◽  
X Ray ◽  
High Position ◽  
Anatomical Changes ◽  
Joint Pathology ◽  
Developmental Hip Dislocation ◽  
Survey Results

Background. The formation of multiplanar deformities of the proximal femur, in most cases combined with hypertrophy of the greater trochanter (relative overgrowth of the greater trochanter (ROGT)) and its high position relative to the femoral head, up to the development of pelvic and pelvic spine syndrome (trochanteric-pelvic impingement), has been considered one of the most common problems in the treatment of children with hip joint pathology of various etiologies. Aim. The aim of this study was to determine the causes of and characterize the X-ray anatomical changes in children with ROGT. Materials and methods. This study is based on an analysis of the survey results of 350 children 3 to 17 years old with an emerging high position of the greater trochanter due to various diseases of the hip joint. Details of the radiological indicators characterizing the change in the growth of the greater trochanter relative to the head and neck of the thigh were examined in 68 of these children (112 joints). Results. Most often, hypertrophy of the greater trochanter was observed in children with the sequele of ischemic disorders that occurred during the conservative treatment of hip dysplasia and developmental hip dislocation, as well as due to previous hematogenous osteomyelitis. It was revealed that in the affected hip joints, there was a regular decrease in the articulo-trochanteric distance index; simultaneously, TTD values, which characterize the isolated growth of the greater trochanter, were almost the same in normal and pathological conditions (p 0.05). Conclusion. Damage to the growth plates of the pineal gland and neck of the femur of various etiologies was the reason for ROGT formation. The X-ray anatomical changes include progressive shortening of the femoral neck. Moderately pronounced in preschool-age children, they progress with the childs growth and become the cause of chronic trauma injuries of the components of the hip joint.

scholarly journals Hip Arthroplasty of the Destructive-Dystrophic Lesions

2018 ◽  
Vol 8 (1) ◽  
pp. 21-27
Author(s):  
B. S. Minasov ◽  
R. R. Yakupov ◽  
T. B. Minasov ◽  
M. M. Valeev ◽  
T. R. Mavlyutov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Connective Tissue ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
System Approach ◽  
Phase State ◽  
Long Term Results ◽  
Control Group ◽  
Hip Joints ◽  
Tissue Phase

Introduction. Hip arthroplasty is considered to be the most effective method providing social and household reintegration for destructive-dystrophic lesions. Goal of the study is to improve the results of surgical treatment using the technology of arthroplasty in patients with decompensated forms of destructive-dystrophic hip joint lesions. Material and methods. It was an open prospective, randomized study carried out on the base of traumatology and ortopaedics department of the Bashkir State Medical University including 710 patients with decompensated destructivedystrophic hip joint lesions. All patients (n=710, of which 6.1% were female) depending on the diacritic approach were divided into groups: the control group included (n=406) patients with hip joint trauma who were provided a conventional range of diagnostic and treatment procedures; the experimental group (n=304) included patients who had a range of diagnostics and treatment of destructive-dystrophic lesions of hip joints based on assessment of the connective tissue phase state. Results. Biometric indicators of stance and walking phase firmly improved in all groups 3 years after arthroplasty (p<0.05). Comparative analysis of arthroplasty results in the research groups showed effectiveness of the developed concept to surgically treat destructive and dystrophic lesions of hip joint on the basis of the system approach in the form of improved parameters of the components of the local and systemic level by 2.38% and 2.3% for osteoarthrosis (p<0.05), by 1.61% and 1.84% for aseptic necrosis of femoral head (p>0.05), by 5.62% and 4.37% for post-traumatic damage of hip joint (p<0.05). Conclusion. Analysis of short-term and long-term results of arthroplasty showed high efficiency of the developed concept of surgical treatment and monitoring of connective tissue phase state at destructive-dystrophic lesions of hip joints based on the system approach in the form of reduced pain syndrome, improvement of functional possibilities and patients life quality.

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