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PLL #2- The Hip: Anatomy, Disease, Injury, and Repair By:

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1 PLL #2- The Hip: Anatomy, Disease, Injury, and Repair By:
Phil Kemp, Andrew Thistle, Tim Hersey, Brian Wilson, John Bocchino BNG 345 Professor Currey

2 Learning Objectives To be able to label the parts associated with the hip joint on both the femoral and pelvic sides To be able to explain how the muscles and ligaments in the hip allow for movement To deduce and identify common diseases and injuries of the hip To compare the methods of repairing common hip diseases and injuries, both biologically and surgically

3 Anatomy of the Hip

4 Bones That Make up the Hip
Ball and Socket joint composed of: Ilium Ishcium Pubis Femur

5 Acetabulum Formed by the Ilium, ischium, and pubis.
Deep Socket on the outer edge of the pelvis The depth of the acetabulum is further increased by a fibrocartilagenous labrum attached to the acetabulum.

6 Femur The large round head of the femur rotates and glides within the acetabulum. The neck of the femur connects the femoral head with the shaft of the femur. The neck ends at the greater and lesser trochanter prominences.

7 Trochanters Greater Trochanter
Bump on the femur and easy to feel on outside of your thigh Site for tendons of several muscles to attach. The lesser trochanter is also a the site for tendon attachment.

8 Biomechanics As the joint bears more weight, the contact of the surface areas increases as does joint stability. When standing, the body’s center of gravity passes through the center of the acetabulum.

9 Muscles of the Hip Quadriceps Hamstrings Gluteal Group Adductor Group
Illiopsoas Group Lateral Rotator Group

10 Quadriceps The quads make up about 70% of the thigh’s muscle mass. The purpose of the quads is flexion (bending) of the hip and extension (straightening) of the knee.

11 Hamstrings Has a large moment aiding in hip extension.

12 Gluteal Group Gluteus maximus – main hip extensor and keeps the head of the femur from sliding forward in the hip socket Gluteus medius – helps keep the pelvis level when walking and helps to abduct the thigh Gluteus minimus – Works with medius to help abduct the thigh

13 Adductor Group Made up of: adductor brevis, adductor longus, adductor magnus, pectineus, and the gracilis muscles. Originate on the pubis and insert on the medial, posterior surface of the femur. Muscles aid in adduction, hence “adductor group.”

14 Iliopsoas Group Comprised of the iliacus and psoas major.
The strongest of the hip flexors. Important in standing, walking, and running.

15 Lateral Rotator Group Made up of the externus and internus obturators, the piriformis, the superior and inferior gemelli, and the quadratus femoris. Originate at or below the acetabulum of the ilium and insert on or near the greater trochantor. Aid lateral rotation of the hip.

16 Hip Tendons and Ligaments

17 IT Band (Tendon) IT Band (Iliotibial Band)
Runs along femur from hip to knee Hip Anatomy,Iliotibial Band

18 Ligaments Connect bones to bones Joint Capsule Provides Stability
Pubo-femoral Iliofemoral Ischiofemoral Provides Stability ligamentum teres- connects femoral head to acetabulum & supplies femoral head with blood

19 Ligaments 2 Labrum Facilitate keeping femoral head in the acetabulum

20 Nerves Sciatic nerve large, travels under the gluteus maximus down the back of the leg and further onto the foot.

21 Bursae Sacs of liquid that allow for lubrication between bones, muscles and tendons

22 Jeopardy

23 Common Hip Injuries

24 Common Hip Injuries Hip Dislocation Hip Fracture Athletic Hip Injuries
Trochanteric Bursitis Hip Pointer Labral Tear Stress Fracture Muscle/Ligament Strain

25 Hip Dislocation Difficult to do
Ball and Socket joint very stable Can be acquired or congenital (hip dysplasia) Easy to diagnose


27 Famous example of hip dislocation…
Bo Jackson

28 Hip Fracture Serious problem in elderly population
Requires surgical repair or replacement Can lead to further complications


30 Fracture-Surgical Methods of Repair
Method of Repair depends on: Placement of fracture Surgeons Discretion Compression screw Intermedulary rod

31 Athletic Injuries Trochanteric Bursitis Hip Pointer Labral Tear
Stress Fracture Muscle/Ligament Strain

32 Trochanteric Bursitis

33 Hip Pointer

34 Labral Tear

35 Stress Fracture

36 Hip Strain/Sprain

37 Common Hip Diseases

38 Osteoarthritis (OA) Most common form of hip arthritis
Chronic condition characterized by the breakdown of cartilage that cushions the ends of the bones where they meet to form joints “Wear and Tear” Arthritis Results in pain, stiffness, loss of movement, and potential formation of bone spurs

39 Rheumatoid Arthritis Chronic Inflammatory Disease affecting 1.3 million Americans Causes: Unknown, but genetics, environmental factors, and hormones have been speculated as potential causes Results in pain, redness, inflammation, and potentially loss of function and disability

40 X-Ray: RA

41 Arthritis-Methods of Repair
Basic Treatments Surgical Treatments Rest Exercise Cane/walker Anti-inflammatory Drugs Cortisone shots Rest and exercise? Joint Resurfacing Joint replacement

42 Hip Dysplasia AKA Developmental Dysplasia of the Hip (DDH)
Lifelong condition 1:1000 people Ranges from barely detectable to severely malformed or dislocated

43 Hip Dysplasia X-Ray

44 Hip Dysplasia-Methods of Repair
Treatment depends on age of diagnosis Infants: brace 6 months to 10 years: full body brace Older children & adults: Surgical bone remodeling and/or total joint replacement

45 Avascular Necrosis Proposed causes: chemotherapy, alcoholism, excessive steroid use, and many others Most commonly affects the ends of long bones, thus the hip joint is commonly affected by AN Usually affects people between 30 and 50; about thousand people develop AN at the head of the femur each year

46 Avascular Necrosis

47 Avascular Necrosis-Methods of Repair
Most cases eventually require surgery Bone grafts Osteotomy Total Joint replacement Core Decompression Vascularized bone graft

48 Total Hip Replacement

49 Components:

50 Variation in Femoral Stem

51 Procedure-Pre Operative planning
2D images and stencils are used to determine stem size and neck length Can this method be improved?

52 Procedure-Femoral Neck Recision
A 6-8 inch incision is made anteriorly or posteriorly Hip is dislocated Femoral head and neck are removed using a bone saw

53 Procedure-Broaching of Femoral Cavity

54 Procedure-Implant Placement
Implant is hammered into place Proper neck and head components are placed on femoral stem

55 Procedure: Acetabular cup
Acetabular cup region is reamed out of pelvis Using bone screws, the metal cup is secured in place Polyethylene cup is compacted into metal cup.

56 THR Animation

57 Result:

58 Revisionary Surgery Hip replacements loosen after 10-20 years
Aseptic loosening Mechanical loading Stress Shielding Revisionary implants: longer, wider, more invasive stems

59 Hip Resurfacing Used on younger patients in order to preserve bone

60 Who Wants to try it!

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