HIP International

Forty-seven intertrochanteric osteotomies were performed in 9 years on 40 patients with femoral head necrosis in Arlet and Ficat stages II and III in the Orthopaedic Department of the Medical School, Hannover. With an average follow up of 5.9 years (minimum 2.3 years, maximum 9.3 years), the study shows only 46% of the patients with satisfactory, good and very good results. After the joint saving operation, 26% of treated patients with pre-operative employment went into premature retirement. The average postoperative non-working period was 11 months (7-18 months).

Anthropometric investigation of femoral sizes and femoral pelvic relationships was performed in a group of unilateral total hip arthroplasty patients. Standardized radiographs were used to perform the measurements. The non-operated, contralateral side was used as a standard for endosteal anatomy and the normal femoral pelvic relationship. Analysis of endosteal shape reveals a spectrum ranging from the stovepipe shape of the aged bone that has undergone diaphyseal expansion, to the trumpet shaped proximal femur found in younger patients. There is also a relationship between this shape and the relative varus or valgus position of the head and neck of the femur. Implants can be designed with head and neck geometry corresponding to these relationships. These implants would reconstruct normal anatomy more accurately. Cementless, acetabula placed in a more medial and proximal position should be matched to femoral components with longer neck-length options than cemented acetabular components.

The authors describe an unusual case of extrusive synovitis of the hip that they believe is an anatomo-clinical variant of transient synovitis of the infantile hip. Transient synovitis of the hip (TSH) is a benign pathology of the hip with complete healing within a few days after onset of the disease. The case reported distinguishes itself for the expulsive tendency of the femoral head from the acetabular cavity with potential ischemic disturbances due to an increased pressure inside the articular joint causing stretching of the circumflex vessels supplying the femoral head.

The snapping hip syndrome is a symptom complex characterized by an audible snapping sensation usually, but not necessarily, associated with hip pain during certain movements of the hip joint. A number of different aetiologies, both intraarticular and extraarticular have been described. Intraarticular causes for the snapping hip include loose bodies, osteocartilaginous exostosis, osteochondromatosis and subluxation of the hip. Extraarticular causes for the snapping hip are described in this paper (Tab. I). Due to localization of the causes, three different syndromes are described: the medial (internal), the lateral (external), and the posterior snapping hip syndrome. The authors describe diagnosis, differential diagnosis, and treatment of these syndromes. Successful results in the treatment of lateral snapping hip syndrome with the iliotibial tract fenestration method are also reported.

A total of 102 uncemented Link Rippen System (RS) total hip prostheses were implanted in 100 patients whose mean age was 57 years. The Merle d'Aubigné hip score was 9.3 preoperatively and 15.3 at the latest follow-up. The thigh was painful in 56 per cent; 5 per cent had moderate or severe pain. Forty-five per cent of patients had a slight limp and 9 per cent a severe limp at the most recent follow-up. Fifteen per cent still needed a cane.

A Kaplan-Meier survivorship analysis revealed a 74 per cent probability of survival at 6 years.

Serial radiographic evaluations revealed that 16 per cent of patients (non-revised hips) had acetabular component migration, 10 per cent had continuous femoral radiolucen-cies, 14 per cent had subsidence and 31 per cent progressive varus migration.