Long-standing Hip Research Articles

Combined lumbar and sacral plexus block for the management of long-standing hip pain

Combined lumbar and sacral plexus block for the management of long-standing hip pain

Posterior Acetabular Spike: An Obstacle to Reduction in Long-Standing Hip Dislocations

The posterior insertion of the transverse acetabular ligament can be transformed into a toothlike bony prominence narrowing the acetabulum in its distal part. This deformity can impede the placement of the femoral head deep in the acetabulum, making a complete reduction impossible. The toothlike spike can be detected by computed tomography or by intraoperative palpation, and can be corrected by pushing it back with a punch under palpatory control.

Repeated Psoas Compartment Blocks for the Management of Long-Standing Hip Pain

Repeated Psoas Compartment Blocks for the Management of Long-Standing Hip Pain

Repeated psoas compartment blocks for the management of long-standing hip pain

Background and Objectives: The psoas compartment block is used to produce analgesia of the lumbar plexus mainly for hip and knee surgery. It has also been used for the management of a long-standing pain due to hip joint degeneration. Case Report: A 55-year-old woman with severe left hip pain received repetitive psoas compartment blocks over 18 months. The blocks provided her with effective pain control. The quality and duration of the block was improved by the addition of opioid to the local anesthetic. Conclusion: We successfully performed repeated psoas compartment blocks with a local anesthetic and subsequently with added opioids, which produced substantial pain relief, especially after the addition of opioids. Reg Anesth Pain Med 2001;26:376-378.

Preoperative variables affecting long-term outcome of triple pelvic osteotomy for treatment of naturally developing hip dysplasia in dogs

Objective To determine whether preoperative radiographic evidence of degenerative joint disease (DJD), hip joint laxity, or age at surgery is associated with long-standing DJD or hip function in dogs with hip dysplasia (HD) that had a triple pelvic osteotomy (TRO). Design Prospective study. Animals 34 dogs with HD. Procedure Dogs that had TPO performed during an 8-year period were chosen for long-term follow-up evaluation that included physical examinations, pelvic radiographs, and owner questionnaires. Data on radiographic evidence of DJD, Norberg angle, and percentage of femoral head coverage were retrieved from preoperative records and determined from follow-up radiographs. Results Approximately 40% of dogs had progression of DJD. Eighty-seven percent of dogs received excellent or good physical examination scores, and 76% received excellent or good at-home activity scores. Preoperative and long-standing DJD were not associated. The risk of DJD was increased with increased age at surgery, narrower preoperative Norberg angle, and lower percentage of femoral head coverage, but these variables were not associated with clinical hip function. Clinical Implications TPO for treatment of HD in dogs may slow, rather than stop, radiographic progression of DJD; however, clinical outcome is acceptable for most dogs. Preoperative evidence of DJD may not be a limiting criterion in selecting dogs as suitable TPO candidates. Dogs with extensive hip joint laxity before surgery may be predisposed to developing DJD; thus, the risk-to-benefit ratio for TPO versus salvage procedures should be considered. Younger dogs may develop less severe DJD after TPO; surgery should be considered at the first sign of hip joint laxity and pain. (J Am Vet Med Assoc 1998;213:80-85)

Evaluation of femoral prosthetic loosening using CT imaging.

Arthrography, using either a radiopaque contrast agent or technetium-99m radionuclide, is the established technique for evaluating patients with painful loosening of hip prostheses [1-3]. Although offering the advantage of allowing simultaneous evaluation of painful hip prostheses for both loosening and infection, this technique is invasive and also painful. Although infection can occur at any time after prosthesis placement, the incidence of infection is low, particularly in patients without complicating medical problems [4-8]. Therefore, a noninvasive imaging technique to evaluate for loosening would benefit patients who develop pain in long-standing hip prostheses. Such a technique could be particularly useful for evaluating cementless prostheses, in which the value of arthrography is less established [9]. Fletcher et al. [10], in a recent symposium on the hip, suggested using CT for evaluating femoral component loosening of cementless prostheses. We know of no other published reports that describe the use of CT for this purpose. In our study, we evaluated the ability of CT to detect femoral loosening by applying torsional stress and then measuring angular displacement of the femoral stem within the femoral canal.

Soft tissue release of the hip in juvenile chronic arthritis.

Adductor and/or subspinal tenotomies were performed on 17 patients (25 hips) with longstanding juvenile chronic arthritis and hip disability. The flexion contracture decreased after surgery from 28 to 18 degrees but had increased to the preoperative level by an average follow-up time of 48 months. The adductor contractures followed the same pattern. All but 3 of the patients were dissatisfied with the relatively small gain and the short-lasting effect of the operation. Knee contractures and insufficient release are probably some of the reasons for the poor results. A more extensive release is recommended and in the case of hip pain combined with synovectomy.