The Soft Tissues in Osteoarthritis and Arthroplasty of the Hip

Research output: ThesisDoctoral Thesis (compilation)

Abstract

Ultrasonography as a tool measuring the anterior capsular distance in THA was so far not described nor validated. Comparing the measurements of the capsular distance set with a caliper/ruler with those performed with ultrasonography on a THA model demonstrated a high correlation between measurements. The effect of experience of ultrasonography in THA was also evaluated comparing the first and last series of examinations. It was shown that intra/ inter observer agreement increased with increasing
number of examinations.
The pain in osteoarthritis (OA) and its relation to the elastic properties of the hip joint capsule was analyzed. In OA patients intracapsular pressure
and capsular elasticity, i.e. compliance, was measured. Pain assessment, radiographic evaluation and ultrasonography measuring the anterior capsular
distance of the hip joint were performed prior to these pressure measurements. No correlation was found between pain and intracapsular pressure in these OA hips. However, there was an inverse correlation
between radiographic severity of OA and elasticity of the hip joint capsule. These findings indicate an increase in intracapsular pressure in early stages of OA and lower or no pressure in late OA. This observed lack of pain/pressure correlation was not in accordance with previous reports. These measurements were performed after the release of the short rotators. To investigate the effect of the short rotators on intracapsular pressure we investigated the pressure, pain and radiographic grade in OA patients. The pressure was measured in various positions of the hip before and after release of the short rotators. Release of the short rotators did
not change the intracapsular pressure in any position
except in 45° flexion, in which the pressure increased, nor did we find any correlation between pain and intracapsular pressure.
Dislocation after THA is one of the most common postoperative complications. Postoperative intraarticular edema and/or fluid might be
contributing factors. Posterior soft tissue repair was suggested to reduce the dislocation rate and decrease the volume of postoperative fluid in the
THA hip. THA patients with or without posterior soft tissue repair were analyzed. To evaluate postoperative capsular distension, indicating synovial
edema/fluid, US was performed 6 and 12 months after surgery. Posterior soft tissue repair resulted in greater sonographically measured capsular distance
6 months postoperatively, but after 12 months there was no difference in hips with or without posterior soft tissue repair. This finding suggests that the previously postulated idea that posterior soft tissue repair reduces postoperative “dead space can be debated.
The role of synovitis and increased intracapsular hydrostatic pressure in the loosening process after THA has gained increased attention. Unrevised,
radiographically stable hips that had THA because of osteoarthritis 10 years earlier with 28 or 32 mm femoral heads were analyzed. The correlation
between PE wear and sonographically measured capsular distances was estimated. It was found that 32 mm femoral heads were associated with greater wear and greater capsular distance as compared to 28 mm heads. A correlation between linear and volumetric wear and sonographically measured
capsular distance was also noted. These findings were observed before radiographic signs of loosening, and indicate that the THA loosening process
starts before its radiographic appearance.

Details

Authors
  • Sarunas Tarasevicius
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Orthopedics

Keywords

  • total hip replacement, intracapsular pressure, Osteoarthritis, sonography
Original languageEnglish
QualificationDoctor
Awarding Institution
Supervisors/Assistant supervisor
Award date2009 May 26
Publisher
  • Department of Clinical Sciences, Lund University
Print ISBNs978-91-86253-41-7
Publication statusPublished - 2009
Publication categoryResearch

Bibliographic note

Defence details Date: 2009-05-26 Time: 13:00 Place: Univ Hosp Lunf Room F1 External reviewer(s) Name: Stark, Andre Title: Prof. Affiliation: Dept Orthop Karolinska Institute Stockholm ---

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Tarasevicius, S., Robertsson, O., Kesteris, U., Kalesinskas, R. J. & Hans Wingstrand, 2008, In : Acta Orthopaedica. 79, 4, p. 489-493

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Tarasevicius, S., Kesteris, U., Gelmanas, A., Smailys, A. & Hans Wingstrand, 2007, In : Journal of Arthroplasty. 22, 4, p. 596-600

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Tarasevicius, S., Skikas, L., Mitraite, D., Torii, Y., Kesteris, U. & Hans Wingstrand, 2007, In : Ultraschall in der Medizin. 28, 5, p. 475-478

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