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!