Thesis (doctoral)--Freie Universität Berlin, 1980.

No description available.

Thesis (doctoral)--University of Uppsala, 1983. / Includes bibliographical references (p. 17-19).

L'arthroplastie totale de hanche est une des interventions le plus pratiquées en chirurgie orthopédique. Malgré un taux de réussite élevé, cette chirurgie présente des limites, liées aux complications possibles, dont la luxation reste la principale cause de reprise chirurgicale. Les causes de l'instabilité prothétique ne sont pas entièrement connus. La relation entre la position de la cupule acétabulaire et l'instabilité n'est pas consensuelle, dans la littérature. Le développement de la navigation chirurgicale a le mérite de mettre en évidence ces limites. L'objectif de cette thèse est de proposer un positionnement optimal de la cupule acétabulaire, pour diminuer le risque de luxation. Deux études différentes ont été réalisé, la première étant une analyse de l'orientation anatomique de 150 sujets sains et la deuxième, une étude comparative cas-temoin analysant le risque de luxation en fonction de l'orientation acétabulaire. La première étude à retrouvé une très grande variabilité d'orientation acétabulaire anatomique. La deuxième étude à permis d'identifier un algorithme de calcul du risque de luxation en fonction du débord prothétique par rapport à l'orientation de l'acetabulum (la difference entre l'orientation de l'acetabulum et celle de la cupule prothétique). Cette recherche montre que le positionnement prothétique acétabulaire le plus proche de l'orientation de l'acetabulum diminue le risque de luxation. Ce résultat original pourra être utilisé par les systèmes de navigation pour améliorer la précision de la chirurgie conventionnelle. / The hip arthroplasty is one of the most successful interventions in orthopedics. Despite its good results, there are still some important issues to clarify. One of the most disturbing complication is dislocation. It represents the number one cause of failure. Its causes are not fully understood, especially the relationship between the orientation of the acetabular cup and dislocation. There is no generally accepted optimal cup orientation, in the literature. Computer navigation technologies contributed to recognize these limitations in the field of hip arthroplasty. The thesis purpose is to identify the optimal position of the ace tabular cup, in relation withe the risk of dislocation. Two studies were conducted in parallel: firstly, the analysis of the normal anatomical acetabular orientation on 150 healthy subjects and secondly, a comparative case control study, analyzing the relationship between the risk of dislocation and the cup orientation. The first study found a very important variability in the anatomical orientation of the acetabulum. The second one allowed to describe and quantify the relationship between the risk of dislocation and the ace tabular cup overhang (the difference between the orientation of the acetabulum and the cup orientation). This research shows that cup positioning closest to the acetabulum orientation, diminishes the dislocation risk. This original data could be used by the navigation systems to increase the cup placement accuracy.

In 220 rabbits (65 mature and 155 immature) the effects of dislocation, persistant dislocation and reduction at varying intervals (immediately, 12, 24 and 48 hours after dislocation) of the left hip were studied by microangiographic, histological and radiographic examination. Dislocation of the left hip was induced manually under anaesthesia by a doraally applied force with the hip held adducted and internally rotated. Reduction was effected by ventral traction with the hip in the same position. The right hip was untouched and used as a control in all cases. In 135 animals, a tracer dye was infused into the abdominal aorta proximal to its bifurcation under standard conditions of temperature and pressure. This infusion was done at 10 minutes, and at 1, 3, 5, and 7 days after dislocation or reduction. The femoral heads were then processed and studied under stereomicroscopy. Histological and radiographic studies were made in the remaining 85 animals at intervals between 3 and 10 weeks after dislocation or reduction. In immature animals, severe dye perfusion defecit was observed in all cases within 10 minutes of dislocation. This was maximal in the antero-medial half of the femoral head. The defecit was increased at 24 hours and persisted until 5 days after dislocation. At the seventh day recovery had commenced. A profound perfusion defecit was also noted within 10 minutes of immediate reduction, however, recovery was observed at 24 hours and was almost complete at 5 - 7 days. The rate of recovery in those animals in which the dislocation was reduced at 12, 24 and 48 hours did not differ from that observed in unreduced animals. In adult animals, significant circulatory disturbance was infrequently observed after dislocation and persistant dislocation. Consequently, the beneficial effects of reduction, if any, were obscured. The epiphyseo-metaphyseal vascular anastomoses across the epiphyseo scar were filled with dye in all mature rabbits and seemed to act as a route of blood supply and drainage in adult animals.. Extensive histological avascular necrosis of the femoral head was observed in the majority of animals, but was significantly more common in immature rabbits. Less extensive and less common avascular necrosis was observed in immature animals after immediate reduction. However, reduction delayed to 12 hours or later was not associated with a lower incidence of bone death. Abnormal radiological findings were common and varied. Specific alteration in density and outline of the femoral head was however infrequently observed, but corelated well with the histological findings. Decreased biodensity was associated with inbalanced bone resorption and hyperaemia, and increased radiodensity with bone death and new bone apposition. It is concluded that traumatic dislocation causes embarassment and sequential changes in the circulation within the femoral head in rabbits. The perfusion defecit is more severe in immature animals as the intra-osseous epiphyseo-metaphyseal vessels minimize this circulatory disturbance in adult animals. Early reduction enhances early and complete recovery of blood supply in immature animals. Varying degrees of avascular necrosis of the femoral head occur in both adult and immature animals with and without reduction, but is more common and extensive in immature animals. Abnormal radiological features within the femoral head are infrequently observed up to ten weeks after dislocation but correlate well with the histological findings when present. / Surgery, Department of / Medicine, Faculty of / Graduate

A thesis submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy. Johannesburg, 1994. / Dislocation of the hip is a common deformity in cerebral palsied (CP) patients who are not walking. Surgery of the hip is performed to prevent or correct the deformity. This surgery is based on the assumption that a dislocated hip contributes towards patient management problems, in that it compromises nursing care, interferes with sitting, snd may be painful. Reports on the outcome of surgery vary, and there is a controversy as to whether an established hip dislocation should be reduced. This study was undertaken to investigate the above assumptions, and to assess the long term outcome of hip surgery, both in terms of stability, and patient management, In the background to the study, abnormal development of the CP hip, causation theory, rationale of treatment (both conservative and surgical) and the evolution of hip surgery are described. This comparative study involves two groups of patients. Surgically treated patients are compared to a random sample of untreated patients matched for age and nonambulatory status. The treated patients (Group A) had undergone surgery at the Johannesburg Hospital between 1980 and 1987, and the minimum follow-up period

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

Submitted by ALEXANDRE ZUCCON null (alexandre.zuccon@gmail.com) on 2018-03-13T18:43:03Z No. of bitstreams: 1 ZucconA_tese.pdf: 2380193 bytes, checksum: edc82ec834fe6990d8e85db3314e4696 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-13T20:34:25Z (GMT) No. of bitstreams: 1 zuccon_a_dr_bot.pdf: 2380193 bytes, checksum: edc82ec834fe6990d8e85db3314e4696 (MD5) / Made available in DSpace on 2018-03-13T20:34:25Z (GMT). No. of bitstreams: 1 zuccon_a_dr_bot.pdf: 2380193 bytes, checksum: edc82ec834fe6990d8e85db3314e4696 (MD5) Previous issue date: 2018-02-22 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: A luxação do quadril em uma criança pode interferir com a função dessa articulação, causando dor, limitação de movimento, entre outras consequências. Na redução aberta da articulação, diversas estruturas anatômicas são abordadas como o ligamento redondo (LR) que, tradicionalmente, é ressecado. Porém, existe controvérsia a respeito de sua importância funcional. Objetivo: Comparar através de análise biomecânica, bioquímica e histológica o LR de quadris instáveis (luxados e subluxados) com o ligamento de quadris normais. Métodos: Estudo experimental com coelhos esqueleticamente imaturos, utilizando um modelo para luxação do quadril. Oitenta e oito coelhos foram submetidos à fixação do joelho de uma das patas traseiras em extensão, o que leva à instabilidade do quadril ipsilateral, devido ao desequilíbrio muscular e à alteração em posicionamento no membro. Dezenove coelhos morreram, 28 foram excluídos por não evoluírem com a luxação e 5 foram excluídos pela impossibilidade de identificação do LR. Dos 36 coelhos que compuseram a amostra, estratificamos as análises em quantitativas: biomecânica (12 coelhos), zimografia (8 coelhos), histologia (14 coelhos) e qualitativa: imuno-histoquímica (2 coelhos). Realizamos análise estatística para comparação entre o lado luxado e o controle de cada coelho quanto às análises quantitativas. Resultados: No ensaio biomecânico, a média da força máxima do ligamento redondo no lado luxado foi de 43,25 ± 16,25N e 46,62 ± 15,56N para o lado normal (p=0,594) e a média da deformação máxima foi de 3,94 ± 1,88mm para o lado luxado e 4,55 ± 1,19mm para o normal (p = 0,328). Histologicamente foi quantificada a celularidade, mostrando em média, para o ligamento do lado luxado, 6,83 ± 3,47 células por campo e 3,87 ± 2,13 para o lado normal (p<0,001), além de 74,3 ± 10,5% de ocupação por colágeno no lado luxado e 84,5 ± 9,5% no lado normal (p<0,001). Na zimografia, a quantidade de metaloproteinase 2 (MMP2) em forma ativa foi 481,8 ± 228UA, em média, para o lado luxado e de 294,4 ± 78UA para o lado normal (p=0,068). Conclusão: Embora tenham ocorrido alterações significativas no LR dos quadris instáveis do ponto de vista histológico e com diferença importante na zimografia, esta sem significância estatística, isso não foi observado no ensaio biomecânico, no qual não houve diferença estatística entre os lados. / In the open reduction, used in the treatment of the hip dislocation in children, several structures are approached, such as the round ligament (RL) that has traditionally been resected. However, there is controversy regarding its possible maintenance as well as its functional importance. The aim of this study was to compare the RL properties of stable and unstable hips. Methods: Experimental study with young rabbits using a model for congenital hip dislocation. Eighty-eight rabbits underwent fixation of the knee of one hind leg in extension, which leads to ipsilateral hip instability. Nineteen rabbits died and 28 were excluded because they did not develop dislocation. Five additional rabbits also excluded because they did not present the RL. Thirty-six rabbits composed the sample that was stratified for quantitative analysis: biomechanical (12 rabbits), zymography (8 rabbits), histology (14 rabbits) and qualitative: immunohistochemistry (2 rabbits). We performed statistical analysis for comparison between the unstable side and the control of each rabbit. Results: Biomechanical assay showed the mean maximal strength of the RL on the unstable side was 43.25 ± 16,25N and 46.62 ± 15,56N for the control side (p = 0.594) and the mean maximum deformation was 3.94 ± 1,88mm for the unstable side and 4.55 ± 1,19mm for the control (p = 0.328). Histologically, there was an increase in cellularity on the unstable side showing, on average, 6.83 ± 3,47 cells per field and 3.87 ± 2,13 for the control side (p <0.001), in addition to 74.3 ± 10,5% of collagen occupancy on the unstable side and 84, 5 ± 9,5% on the control side (p <0.001). In zymography, the amount of metalloproteinase 2 (MMP-2) was 481.8 ± 228UA, on average, for the unstable side and 294.4 ± 78UA for the control side (p = 0.068). Conclusions: Although there were significant changes in the RL of the unstable hips from the histological analysis and there were an important diference in zymography without statistical significance, that was not observed in the biomechanical test.

Die Zielsetzung dieser Arbeit besteht darin zu prüfen, ob die Luxationsrate bei Hochrisikopatienten durch den Einsatz von 40-mm- und 44-mm-Köpfen im Vergleich zu Patienten mit maximal 36-mm-Köpfen reduziert werden kann. Hierzu wurden die im Zeitraum von September 2009 bis Mai 2014 hüftendoprothetisch versorgten Patienten mit einem erhöhten Luxationsrisiko erfasst und die Verläufe auf Luxationen überprüft. Zur Risikobewertung diente eine eigens entwickelte Klassifikation. Des Weiteren erfolgte die Analyse der postoperativen Verläufe, der Röntgenbilder und eines Telefoninterviews in den Fällen, in denen Köpfe ≥ 40 mm zum Einsatz kamen. Im Untersuchungszeitraum wurden 288 Hüftendoprotheseneingriffe mit erhöhtem Luxationsrisiko durchgeführt. Bei 278 HTEP-Implantationen erfolgte der Einsatz von Gelenkköpfen ≤ 36 mm. In dieser Gruppe betrug die Luxationsrate 15,1% (n=42). Bei 10 Patienten wurden 40-mm- oder 44-mm-Gelenkköpfe eingesetzt. In diesen Fällen wurde das Luxationsrisiko entsprechend der vorgeschlagenen Klassifikation mit 3A (hoch) bis 4B (sehr hoch) bewertet. Bei einem mittleren Follow up von 22,8 Monaten wurde bei diesen Patienten keine Luxation festgestellt. Die mit 40-mm- sowie 44-mm-Köpfen erzielten Ergebnisse und die aktuelle Literatur sprechen für eine wesentlich höhere Gelenkstabilität und eine deutlich verminderte Luxationsneigung größerer Köpfe. Deren Einsatz ist daher gegenwärtig bei Risiko-patienten gerechtfertigt, sofern dieser in Abhängigkeit vom Pfannenaußendurch-messer konstruktiv möglich ist. In der weiteren Entwicklung der Hüftendoprothetik sollte die Verwendung größerer Köpfe angestrebt werden.

Orientador: Daniele Cristina Cataneo / Resumo: Introdução: A luxação do quadril em uma criança pode interferir com a função dessa articulação, causando dor, limitação de movimento, entre outras consequências. Na redução aberta da articulação, diversas estruturas anatômicas são abordadas como o ligamento redondo (LR) que, tradicionalmente, é ressecado. Porém, existe controvérsia a respeito de sua importância funcional. Objetivo: Comparar através de análise biomecânica, bioquímica e histológica o LR de quadris instáveis (luxados e subluxados) com o ligamento de quadris normais. Métodos: Estudo experimental com coelhos esqueleticamente imaturos, utilizando um modelo para luxação do quadril. Oitenta e oito coelhos foram submetidos à fixação do joelho de uma das patas traseiras em extensão, o que leva à instabilidade do quadril ipsilateral, devido ao desequilíbrio muscular e à alteração em posicionamento no membro. Dezenove coelhos morreram, 28 foram excluídos por não evoluírem com a luxação e 5 foram excluídos pela impossibilidade de identificação do LR. Dos 36 coelhos que compuseram a amostra, estratificamos as análises em quantitativas: biomecânica (12 coelhos), zimografia (8 coelhos), histologia (14 coelhos) e qualitativa: imuno-histoquímica (2 coelhos). Realizamos análise estatística para comparação entre o lado luxado e o controle de cada coelho quanto às análises quantitativas. Resultados: No ensaio biomecânico, a média da força máxima do ligamento redondo no lado luxado foi de 43,25 ± 16,25N e 46,62 ± 15,56N para o lad... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor