Hip 1 ortho spring 2012

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Hip 1:

Hip 1 PHT 5132C Musculoskeletal 1 Orthopaedics


Osteochondrosis Disorder of the epiphyses Growing children age 3-10, male > female Lower limb >upper limb Idiopathic: genetic? trauma? effusion? Self-limiting

Osteochondroses Phases:

Osteochondroses Phases Example: Legg-Calvé-Perthes’ Disease Phase 1: Early phase of necrosis Blood vessel damage Bone deposition ceases in the epiphyses, osteocyte loss. “silent phase” unremarkable on plain film radiograph

Phase 2 Revascularization:

Phase 2 Revascularization Dead epiphysis becomes revascularized “biological plasticity” “pathological fracture” Symptoms

Phase 3 Bone Healing:

Phase 3 Bone Healing Bone resorption stops and deposition continues Granulation fibrous tissue replaced by bone Still “plasticity”

Phase 4 Residual Deformity:

Phase 4 Residual Deformity Healing complete Deformity present Cartilage initially normal Degeneration over time

Degenerative Joint Disease:

Degenerative Joint Disease Primary and secondary Biomechanical factors

Degenerative Joint Disease:

Degenerative Joint Disease Exam Gradual onset Weight bearing pain Compression pain Treatment Conservative Surgical

Total Hip Replacement:

Total Hip Replacement Performed since 1960’s More than 200,000 THA per year in U.S. Average patient age= 66 Female greater than male Relieve pain, improve function = Modest Activity participation


Components Acetabulum shell with liner Femoral head with stem


Components Uncemented (press-fit) vs Cemented Healing considerations


Approaches Posterolateral Anterior Minimal incision Outcome considerations


Complications Femoral stem loosening Femoral fracture DVT / PE Infection

Femoroacetabular Impingement:

Femoroacetabular Impingement FAI: 2 types Cam lesion: abnormal femur head/neck junction Pincer lesion: acetabular overcoverage

FAI Physical Exam:

FAI Physical Exam Anterior hip/groin pain PROM Classical: flexion and internal rotation Special Tests: FABER, Scouring Interventions: Conservative and surgical

Hip Labrum Tear:

Hip Labrum Tear Cause: trauma/athletic injury, instability, developmental dysplasia, impingement, degeneration

Labrum Tear Physical Exam:

Labrum Tear Physical Exam Anterior hip/groin pain Clicking, popping, locking PROM classical rotation limited Special Tests: Anterior hip labral tear Posterior hip labral tear Treatment: conservative and surgical

Osteochondral Lesion (OCD):

Osteochondral Lesion (OCD) Onset Exam: compression, weight bearing, limited PROM classical, impingement signs

Hip Tendinopathy:

Hip Tendinopathy Etiology Exam Managment


References Chambers B, St. Clair SF, Froimson MI. Hydroxyapatite-coated tapered cementless femoral components in total hip arthroplasty. J Arthroplasty 2007;22(suppl 1):71–4. Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A, Krismer M, Leardini A. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech. 2009;24:812–818. Lewis CL, Sahrmann SA. Acetabular labral tears. Phys Ther. 2006;86:110–121. Morshed S, Bozic KJ, Ries MD, Malchau H, Colford JM Jr. Comparison of cemented and uncemented fixation in total hip replacement: a meta-analysis. Acta Orthop 2007;78:315–326. O'Brien DA, Rorabeck CH. The mini-incision direct lateral approach in primary total hip arthroplasty. Clin Orthop Relat Res. 2005;441:99–103. Roth A, Winzer T, Sander K, Anders JO, Venbrocks RA. Press fit fixation of cementless cups: how much stability do we need indeed? Arch Orthop Trauma Surg 2006;126:77–81.

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