CiNii Books - Biomechanics of the hip : as applied to osteoarthritis and related conditions

Dr. MAQUET, the foremost disciple of Professor PAUWELS' and the orthopae- dic heir to the PAUWELS' concepts of osteotomy of the hip for arthritis, has assembled in this one book the strongest and most lucid contemporary statement of the principles and practice of this very important school of hip surgery. Professor PAUWELS' contributions to the understanding of the biomechanics of the hip and to the concepts and execution of osteotomy of the hip for arthritis are outstanding and timeless. With clarity, Dr. MAQUET articulates this position and refines it further in the light of his own investiga- tion. While other investigators, of course, differ on individual concepts or princi- ples in this book or disagree with specific positions, assumptions, or conclu- sions, it is clear to all that this book is a benchmark work. Dr. MAQUET, as Professor PAUWELS always did, illustrates his text lavishly with beautiful examples of individual cases illuminating the principles ad- vanced. But in addition, he has gone further and presents long-term follow-up data, quantifying the results of these surgical precepts as experienced in his own practice. It is a work that has been long sought and is richly received. Boston, Massachusetts, 1984 WILLIAM H. HARRIS, M.D.

Table of Contents

I. Biomechanics of the Hip.- I. Previous Works.- II. Forces Exerted on a Normal Hip.- A. When the Subject Is Standing on Both Legs.- B. When the Subject Is Standing on One Leg.- C. During the Single-Support Period of Gait.- 1. Problem.- a) Co-ordinates of the Centre of the Femoral Head in the System of Axes Originating in S5.- b) Force $$ \mathop K\limits^ \rightharpoonup $$.- c) Plane of the Forces.- d) Force M.- ?) Direction of $$ \mathop M\limits^ \rightharpoonup $$ Using the First Approach.- ?) Direction of $$ \mathop M\limits^ \rightharpoonup $$ Using the Second Approach.- e) Reaction $$ \mathop R\limits^ \rightharpoonup $$.- 2. Discussion.- 3. Conclusion.- III. Mechanical Stressing of the Normal Hip Joint.- IV. Mechanical Stressing of the Normal Femoral Neck.- V. Cartilage Reaction to the Articular Compressive Stresses.- VI. Bone Reaction to the Articular Compressive Stresses.- VII. Mechanical Significance of the Neck-Shaft Angle.- A. Hip Joint.- B. Growth Plate.- C. Femoral Neck.- D. Conclusion.- VIII. Significance of the Subchondral Sclerosis in the Acetabulum.- A. Normal Hip Joint.- B. Primary Osteoarthritis.- C. Osteoarthritis with Subluxation.- D. Osteoarthritis with Protrusio Acetabuli.- E. Different Types of Osteoarthritis.- IX. Conclusion.- II. Principles of a Biomechanical Treatment of Osteoarthritis of the Hip. Critical Analysis of Different Surgical Procedures. Instinctive Attempts to Relieve Stress in the Joint.- I. Modifying the Biology of the Tissues.- II. Reducing Joint Pressure.- A. McMurray Osteotomy.- B. Multiple Tenotomy.- C. Shelf Operation.- D. Pauwels' Approach to Osteoarthritis of the Hip.- E. Remarks on Bombelli's Concepts.- III. Instinctive Attempts to Reduce the Stress on the Affected Hip.- A. Limping.- B. Using a Walking Stick.- IV. Conclusion.- III. Surgical Treatment of Osteoarthritis of the Hip.- I. X-rays.- A. Before the Operation.- 1. Overall Anteroposterior View of the Pelvis.- 2. Anteroposterior Views of the Affected Hip.- 3. Lateral View of the Femoral Neck and Three-quarter View.- 4. Anteroposterior View of the Lower Limbs.- B. During the Operation.- C. After the Operation.- II. Hanging-Hip Procedure.- A. Rationale.- B. Experimental Study.- 1. Material and Method.- 2. Results.- 3. Discussion.- C. Indications.- D. Operative Procedure.- E. Postoperative Care.- F. Postoperative Evolution.- G. Incorrect Indications.- H. Conclusion.- III. Varus Intertrochanteric Osteotomy (Pauwels I).- A. Rationale.- B. Indications.- C. Pre-operative X-rays.- D. Pre-operative Planning.- E. Instruments.- F. Operative Procedure (Adults).- 1. Position.- 2. Approach.- 3. Delineation of the Wedge to Be Resected.- 4. Resection of the Wedge.- 5. Derotation.- 6. Positioning the Compression-hook.- 7. Suture.- 8. Using the Resected Wedge.- G. Postoperative Care.- H. Postoperative Evolution.- I. Incorrect Indications.- J. Procedure in Children.- K. Conclusion.- IV. Valgus Intertrochanteric Osteotomy and Tenotomy (Pauwels II).- A. Rationale.- B. Indications.- C. Pre-operative Planning.- D. Operative Procedure.- 1. Standard Procedure.- a) Delineating the Wedge to Be Resected.- b) Tenotomy of the Abductor Muscles.- c) Resection of the Wedge.- d) Derotation.- e) Fixing the Fragments.- f) Suture.- 2. Valgus Osteotomy Combined with a Shortening of the Leg.- 3. Correction of a Flexion Contracture.- 4. Correction of an Adduction Contracture or Deformity.- 5. Too Much Valgum.- E. Postoperative Care.- F. Postoperative Evolution.- G. Reducing the Compressive Stresses in the Joint Rather than Restoring Normal Anatomical Shape.- H. Conclusion.- V. Lateral Displacement of the Greater Trochanter.- A. Rationale.- B. Indications.- C. Pre-operative Planning.- D. Operative Procedure.- E. Postoperative Care.- F. Postoperative Evolution.- G. Lateral Displacement of the Greater Trochanter Complementing a Varus Intertrochanteric Osteotomy.- H. Lateral Displacement of the Greater Trochanter Complementing a Valgus Intertrochanteric Osteotomy.- I. Conclusion.- VI. Shortening of the Opposite Leg.- A. Rationale.- B. Pre-operative Planning.- C. Surgical Procedure.- D. Results.- E. Conclusion.- VII. Changing Indication.- VIII. No Indication for Any of the Operations Previously Described.- IX. Reoperations.- A. After a Hanging-Hip Operation.- B. After a Varus Osteotomy.- C. After a Valgus Osteotomy.- D. Conclusion.- X. Age of the Patients and Duration of the Postoperative Results.- XI. Long-term Results.- A. Lasting Positive Results.- B. Secondary Deterioration.- XII. Osteotomies Distal to the Lesser Trochanter (Lorenz, Schanz, Milch).- A. Rationale.- B. Indications.- C. Pre-operative Planning.- D. Operative Procedure.- E. Postoperative Care.- F. Postoperative Evolution.- G. Additional Procedures.- H. Conclusion.- IV. Osteoarthritis with Protrusio acetabuli.- I. Rationale.- II. Indications.- III. Abduction Contracture.- IV. Conclusion.- V. Avascular Necrosis of the Femoral Head.- I. Legg-Calve-Perthes' Disease.- II. Avascular Necrosis of the Femoral Head in Adults.- A. Rationale.- B. Hanging-Hip Procedure.- C. Varus Intertrochanteric Osteotomy.- D. Lateral Displacement of the Greater Trochanter.- E. Valgus Intertrochanteric Osteotomy.- F. Conclusion.- VI. Dysplastic Hips.- I. Introduction.- II. In Infants.- A. Innominate Osteotomy.- B. Lowering the Lateral Aspect of the Acetabulum.- C. Varus Intertrochanteric Osteotomy.- D. Combining Different Surgical Procedures.- E. Spontaneous Recurrence of the Valgus Deformity of the Femoral Neck.- III. In Children and Adolescents.- A. Colonna Procedure.- B. Varus Intertrochanteric Osteotomy.- C. Varus Intertrochanteric Osteotomy Supplemented by Lateral Displacement of the Greater Trochanter.- IV. In Adults.- A. Dysplastic Hips with Osteoarthritis.- B. Unreduced Congenital High Dislocation.- V. Conclusion.- VII. Results.- I. Hanging-Hip Procedure.- A. As Procedure of Choice.- B. As Temporary Palliative Measure.- C. Complications.- II. Varus and Valgus Intertrochanteric Osteotomy.- A. Three-Year Follow-up.- B. Ten-Year Follow-up.- 1. Varus Intertrochanteric Osteotomy (Pauwels I).- 2. Valgus Intertrochanteric Osteotomy (Pauwels II).- 3. Comment.- III. Lateral Displacement of the Greater Trochanter.- A. Single Procedure.- B. As a Complement to an Intertrochanteric Osteotomy.- IV. Schanz Osteotomy.- V. Conclusion.- VIII. General Conclusions.- Appendix: Fixation of the Fragments After Intertrochanteric Osteotomy.- References.

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Biomechanics of the hip : as applied to osteoarthritis and related conditions

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