Young Hip Research Articles

Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty

Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from bilateral disease processes that selectively affect the young hip, such as osteonecrosis, or structural hip problems, such as acetabular dysplasia or femoroacetabular impingement. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Twelve-month work–related outcomes following hip fracture in patients under 65 years of age

IntroductionRecent research has highlighted the need for improved outcome reporting in younger hip fracture patients. For this population, return to work (RTW) is a particularly important measure against which to evaluate treatment outcomes. However, to date, only two small studies have reported RTW outcomes in young hip fracture patients and neither investigated factors predictive of RTW. The aims of this study were to report return to work (RTW) status and predictors of RTW 12 months after hip fracture in patients <65 years. MethodsTwo hundred and ninety-one adults aged <65 years, admitted with hip fractures between July 2009 and June 2013 and registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) were included in this prospective cohort study. Twelve-month return to work status was collected through structured telephone interviews conducted by trained interviewers. Multivariate logistic regression was used to identify demographic and injury variables that were important predictors of 12-month work status. ResultsSixty-five per-cent of patients had returned to work 12 months after hip fracture (62% of whom had an isolated hip fracture and 38% of whom had additional injuries). Relative to patients aged 16–24 years, odds of RTW was reduced by 78%–89% for each 10-year increase in age (p=0.02). Relative to patients employed as managers/administrators/professionals, odds of RTW were 68% to 95% lower for all other workers (p<0.001). For those reporting a pre-injury disability, odds of RTW were 79% lower compared to those without disability (p=0.004) and 69% lower for patients with multiple injuries compared to isolated hip fracture patients (p=0.002). Finally, patients compensated by a work or transport insurer had a 67% lower odds of RTW relative to patients who were not compensated (p=0.02). ConclusionsApproximately one third of patients <65years had not returned to work 12 months after hip fracture. Patients who are older, have multiple injuries or pre-existing disabilities or who work in more physical occupations may need more assistance to RTW following hip fracture. The compensation system should be examined to determine why compensated patients may be at risk of poor RTW outcomes.

The effects of caudal mobilisation with movement (MWM) and caudal self-mobilisation with movement (SMWM) in relation to restricted internal rotation in the hip: A randomised control pilot study

BackgroundA loss of internal rotation (IR) of the hip is associated with hip pathology. Improving IR may improve hip range of motion (ROM) or prevent hip pathology. ObjectivesThe purpose of this study was to compare the immediate effects of caudal mobilisation with movement (MWM) and caudal self-mobilisation with movement (SMWM) on young healthy male subjects with reduced IR of the hip. DesignA randomised controlled trial was performed. Twenty-Two subjects were randomised into a MWM group (n = 6), SMWM group (n = 8) or a control group (n = 8). MethodThe primary outcome measures included the functional internal rotation test (FIRT) for the hip and the passive seated internal rotation test (SIRT) for the hip. Outcomes were captured at baseline and immediately after one treatment of MWMs, SMWMs or control. ResultsA two-way analysis of variance (ANOVA), group × time interaction was conducted. The ANOVA revealed the only significant improvement was in the MWM group for the FIRT (p = 0.01), over the control group. Subjects with reduced IR of the hip who receive a single session of MWMs exhibited significantly improved functional IR of their hip than the control group. ConclusionsFrom the data presented, it can be suggested that caudal MWMs of the hip appear to have a positive effect on functional IR of healthy young hips. This may be due to addressing the positional fault theory or the arthrogenic muscular inhibition theory. SMWMs may be effective in augmenting treatments for patients waiting for hip operations.

Rehabilitation in resurfacing hip arthroplasty patients: cost-effectiveness results from a randomised clinical trial

Background: In young active adults hip resurfacing arthroplasty (RHA) has been shown to provide good outcomes. A randomised controlled trial recently showed a programme of accelerated physiotherapy (AP) to be effective in terms of improving functional outcomes and range of motion when compared with standard physiotherapy (Barker et al., 2013). Purpose: This study reports trial-based cost-effectiveness estimates of AP compared with standard physiotherapy following RHA. Methods: 80 male patients undergoing RHA were randomised either to standard physiotherapy (n= 40) or to AP (n= 40). The AP program was without hip precautions and patients were fully weight bearing. AP exercises included on-going gait re-education, direction, activities to increase the range of hip movement and lower limb strength, and balance training and weight bearing exercises. AP patients also received an additional rehabilitation session two weeks after surgery. Patients in the standard arm received conventional physiotherapy with hip precautions and standard post operative hip exercises. Costs: An NHS and patients’ perspective was used when costing. Patients recorded NHS and private health care contacts at 6, 16, and 52 weeks post randomisation. Patients in the AP arm were assigned the cost of an additional rehabilitation visit. Resource use data were costed used using 2012/13 unit costs in UK £ Sterling. Outcome: The 3-level EuroQoL EQ-5D questionnaire was used to measure Health Related Quality of Life (HRQoL) with responses converted into utilities using the UK social tariff. Utilities were combined with survival data to calculate Quality Adjusted Life Years (QALYs) for each patient. Statistics: Multiple imputation (MI) was used to handle missing data. Results within arms are reported using means and standard errors (SE). Differences between arms are described using mean differences and 95% confidence intervals. Uncertainty around cost-effectiveness results was examined using 2000 non-parametric bootstraps. Results: The mean (SE) overall QALY in the accelerated group was 0.84 (0.02) and in the standard group was 0.71 (0.03) (mean QALY difference 0.13 in favour of AP (95% CI 0.05 to 0.21, p< 0.01). Mean HRQoL over time was lower on average in the standard physiotherapy arm. The overall mean cost difference (including the extra physiotherapy visit for Accelerated patients at £34)was−£170.43 (95% CI −£550.69 to £209.84. The mean (SE) cost per patient of NHS health care contacts reported by patients to 52 weeks was £410.99 (£91.14) in the AP arm and £615.41 (£150.70) in the standard arm (mean cost difference −£204.43, 95% CI −£584.69 to £175.84). AP patients had more physiotherapy home visits but fewer (albeit not significantly) visits to surgeons, hospital doctors, physiotherapists, and hospital inpatients days. Conclusion(s): The preliminary results of the study showed an encouraging economic profile for the AP programme for RHA patients when compared with standard physiotherapy. Adopting a £20,000 per QALY threshold, the AP programme is highly cost-effective; even lowering the threshold to £0 per QALY the AP still has a high probability of being cost-effective (0.88). Implications: The findings demonstrate that a new protocol that may increase delivery costs can still be cost-effective when other healthcare costs and cost effectiveness is evaluated.

Surgical dislocation of the hip for excision of benign tumours

AimSurgical dislocation of hip is used to treat a variety of hip conditions. We report our experience of the approach in excision of benign tumours of the hip. MethodsThis is a review of the cases presenting with benign tumours to a tertiary care complex hip clinic. Data was collected prospectively. All patients were radiologically investigated before surgery for anatomical detail. Surgical dislocation was carried out by the senior surgeon in all cases. Non-Arthritic Young Hip Scores were done preoperatively and at 12 months. All patients are under annual follow-up. ResultsThere were 9 cases of benign tumours in this series including Pigmented Villonodular Synovitis (2), synovial chondromatosis (2), fibrous dysplasia (2), osteochondroma (2) and chondroblastoma (1). No recurrences, trochanteric nonunion or avascular necrosis have been seen up to a minimum of 18 months follow-up. Non-arthritic Young Hip scores improved from a mean of 45 to 89 at 12 months. ConclusionSurgical dislocation of the hip is a useful approach for removal of benign tumours of the hip joint.

Foreword: European Hip Society Symposium on Management of the Young arthritic hip.

Foreword: European Hip Society Symposium on Management of the Young arthritic hip.

Approach to the Patient Evaluation Using Static and Dynamic Hip Pathomechanics

The etiology of mechanical hip pain in the absence of osteoarthritic changes requires a careful consideration of static and dynamic factors. Dynamic factors result from abnormal stress and contact between the femoral head and acetabular rim with hip motion, whereas static factors result from asymmetric and supraphysiologic loads between the femoral head and acetabular socket when in the standing or axially loaded position. Compensatory motion resulting from restricted terminal hip motion may adversely affect dynamic muscle forces across the hip joint, leading to several other related extra-articular symptoms and pain. An appreciation of abnormal hip morphology and hip joint mechanics is required to understand the important role of both static and dynamic stresses in the development of hip pain and early onset osteoarthritis in the young hip. This review describes the static and dynamic factors associated with mechanical hip pain to allow for the development of a thoughtful and effective treatment plan.

Functional outcomes in the young total hip arthroplasty patient

Functional outcomes in the young total hip arthroplasty patient

Coxofemoral congruency in a case of severe post-SCFE deformity

Slipped capital femoral epiphysis (SCFE) is a common disease affecting the young hip, that may lead to an extremely wide spectrum of deformities observable in standard roentgenograms, from a subtle pistol grip appearance of the proximal femur to an apparent loss of coxofemoral congruency. This last finding might induce surgeons to treat young patients’ painful hips with early replacement. The Authors present a case of severe post-SFCE deformity in which standard x-rays demonstrate complete loss of congruency, while MRI and subsequent hip arthroscopy contradict it. Femoroacetabular impingement decompression through arthroscopic osteochondroplasty made the patient pain-free and increased significantly the range of motion. In conclusion the reported case suggests that the evaluation of young-adult painful hips after SCFE should always include MRI, as conventional x-rays may underestimate true joint congruency. This approach might lead to extend indications to joint-preserving surgery and to reduce indications to total hip arthroplasty, whose results are still debated in young and active people as for durability and patients’ satisfaction.

Aboriginal youth, hip hop and the politics of identification

This paper explores the identity work taking place around contemporary subcultural hip hop amongst Australian indigenous youth in two disadvantaged urban locations. Previous work on Aboriginal hip hop has been attentive to the interface between tradition and modernity. However, existing scholarship has lacked a deeper ethnographic understanding of the dynamics between youth and parent cultures, and the tensions between the two generations. This article is based on research with young hip hop enthusiasts, community activists and educators. It deals with the cultural politics of identification and sees hip hop practice as associated with a process in which Aboriginality is crystallized as a principal affiliation and as offering an account for experiences of social marginalization. Far from being an outlet for expressing a prior or essential Aboriginality, hip hop as cultural practice is associated with the production of particular identifications.

Resurfacing and Uncemented Arthroplasty for Young Hip Arthritis: Functional Outcomes at 5 Years

The management of osteoarthritis of the hip in young active patients is challenging. We compared the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. Mean follow-up period was five years (4-7 years). Within each group there was a statistically significant improvement in the mean University of California at Los Angeles (UCLA) and Oxford Hip Score (OHS) scores following surgery. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA which in itself has longer follow-up compared to resurfacing.

Total hip resurfacing: a viable alternative to total hip arthroplasty for the young active hip patient in the United States?

Total hip resurfacing: a viable alternative to total hip arthroplasty for the young active hip patient in the United States?

The Nearby Young Visual Binary HIP 115147 and Its Common Proper Motion Companion LSPM J2322+7847

We report a late M-type, common proper motion companion to a nearby young visual binary HIP 115147 (V368 Cep), separated by 963'' from the primary K0 dwarf. This optically dim star was identified as a candidate high proper motion, nearby dwarf LSPM J2322+7847 by Lepine in 2005. The wide companion is one of the latest post-T Tauri low-mass stars found within 20 pc. We obtain a trigonometric parallax of 51.6 ± 0.8 mas, in good agreement with the Hipparcos parallax of the primary star (50.7 ± 0.6 mas). Our BVRI photometric data and near-infrared data from 2MASS are consistent with LSPM J2322+7847 being brighter by 1 mag in Ks than field M dwarfs at V - Ks = 6.66, which indicates its pre-main-sequence status. We conclude that the most likely age of the primary HIP 115147 and its 11'' companion HIP 115147B is 20-50 Myr. The primary appears to be older than its close analog PZ Tel (age 12-20 Myr) and members of the TWA association (7 Myr).

Treatment of Femoroacetabular Impingement: A Modified Resection Osteoplasty Technique Through an Anterior Approach

Femoroacetabular impingement has emerged as a cause of osteoarthritis of the young hip. This article presents a modified open procedure for cases that cannot be completely managed arthroscopically.

Helical Single and Multidetector Row CT with Three-Dimensional Volume Rendering of the Young Hip

Helical Single and Multidetector Row CT with Three-Dimensional Volume Rendering of the Young Hip

Helical single and multidetector row CT with three-dimensional volume rendering of the young hip.

The complex ball and socket hip joint requires multiple projections for complete assessment. Though these have traditionally been acquired using multiple plain films, appropriately post-processed helical CT data can provide a comprehensive evaluation of congenital and acquired hip conditions from a single study.

Legg-Perthes disease in the young hip--does it necessarily do well?

Thirty-one patients (with forty involved hips) in whom Legg-Perthes disease developed when they were less than five years old were reviewed. Previously defined roentgenographic features of prognostic significance were measured. Long-term follow-up (average, 129 months) allowed statistical testing of factors previously thought to be of significance in predicting outcome. Many of these patients were found to have poor results as measured roentgenographically. In addition, many prognostic indications were found not to be independent measures and of those demonstrating independence, none correlated with the functional outcome.

Inherited degenerative arthropathy of the hip in young beef bulls.

Australian Veterinary JournalVolume 48, Issue 10 p. 562-563 INHERITED DEGENERATIVE ARTHROPATHY OF THE HIP IN YOUNG BEEF BULLS C. R. Howlett B.V.Sc., M.R.C.V.S., M.A.C.V.Sc., C. R. Howlett B.V.Sc., M.R.C.V.S., M.A.C.V.Sc. Department of Veterinary Pathology, University of Sydney, New South Wales, 2006.Search for more papers by this author C. R. Howlett B.V.Sc., M.R.C.V.S., M.A.C.V.Sc., C. R. Howlett B.V.Sc., M.R.C.V.S., M.A.C.V.Sc. Department of Veterinary Pathology, University of Sydney, New South Wales, 2006.Search for more papers by this author First published: October 1972 https://doi.org/10.1111/j.1751-0813.1972.tb08013.xCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume48, Issue10October 1972Pages 562-563 RelatedInformation

The YOUNG child's hip.

The YOUNG child's hip.