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Learning Objectives
● Review of the Hip ● Disease: Perthes Disease and Hip
Dysplasia● Injury: Hip dislocation, labral tear, and
avascular necrosis● Hip Replacement
Why is the hip prone to disease?
Ball and Socket Joint
Location of many nerves and main artery
Stabilized by several muscles and joints
Bursae
Perthes Disease
● Definition● Causes● Symptoms● Treatment
(Legg Calve Perthes Disease)
Hip Joint with Perthes Disease
Definition
A condition where disrupted blood supply causes bone to die.
The ball (femoral head) collapses and becomes flat.
Anatomical changes
The friction between the socket joint and the ball increases
Damage of cartilage
Altered shape of the acetabulum and femoral head
Symptoms
Legs of unequal length
Pain & Stiffness in joints, groin and knees
Limited Range of movement
Treatment
Goal: Keep the Ball part of the joint round
Orthopedic Bracing (until the age of 6)
Surgery
http://www.semiologiaortopedica.com.br/2012/07/exame-fisico-patologias-do-quadril_08.html
Definition
A condition where the hip socket does not fully cover the femoral head leading to loose and unstable joints
The hip socket is too shallow
Causes
Family History
Common in young women
ligament laxity
Infants
Not fully developed hip joints
Wrong swaggling method
Teenagers and Adults
Undiagnosed Hip Dysplasia since childhood
Anatomical Changes
Higher contact pressure over a smaller surface area of the socket leads to Cartilage damage
Cartilage damage leads to labral tear and eventually arthritis
Symptoms
Mild to severe Pain in hip joints
Decreased mobility
Hard to diagnose
-onset of the disease later in childhood
-esp. the bilateral hip dysplasia
Treatment
Braces
Soft braces
Hip abduction braces
Surgery
Cutting & rotating the hip
Hip replacement
Types of Hip Dislocation
Posterior Dislocation
- Femur is pushed out of the socket in a backwards direction
Anterior Dislocation
- Femur is pushed out of the socket in a forward direction
Causes
Large Forces - Car accidents and long distance falls
High Impact Sports - Football, gymnastics, and skiing
Diseases - Hip Dysplasia
Treatment
Reduction Procedure
Surgery to reset the hip back into the proper position
Physical Therapy
2-3 Month Recovery Period
Major Complications
Nerve Injury - dislocated femur crushes and stretches surrounding nerves
- Sciatic nerve injury
Osteonecrosis - dislocated femur damages blood vessels
- Results in a loss of blood supply to the bone
Osteonecrosis (Avascular Necrosis)
Reduction in blood supply to the hip causes damage to the femoral head
Preventative Treatment
Preventative
- Anti-inflammatory drugs
- Physical Therapy
- Electrical Stimulation
Surgical Treatment
Core DecompressionOsteotomy - Reshapes bone to reduce stress
Total Hip Replacement
Causes
Sports that involve pivoting of the hip - golf, soccer, hockey, and football
Trauma
Disease - Osteoarthritis, Hip Dysplasia
Partial Hip Replacement
Only the ball of the femur is removed
Hip Replacement
Ball of the femur and femoral neck are replaced
Hip Replacement Video
http://www.ypo.education/orthopaedics/hips/total-hip-replacement-t95/video/
Review Questions
Is avascular necrosis a disease? If so, what is it caused by?
Are hip dislocations a common injury?
Why can hip dislocations be life-threatening?
What is damaged during a labral tear?
What are the main causes that lead to hip replacement surgery?
Sources
http://emedicine.medscape.com/article/86930-overview#a5 http://orthoinfo.aaos.org/topic.cfm?topic=A00352 http://orthoinfo.aaos.org/topic.cfm?topic=a00216 http://www.niams.nih.gov/Health_Info/Osteonecrosis/#b https://www.hss.edu/conditions_summer-sports-and-hip-injuries.asp http://www.mayoclinic.org/diseases-conditions/hip-labral-tear/basics/treatment/con-20031062 http://health.ucsd.edu/specialties/surgery/ortho/areas-expertise/sports-medicine/conditions/hip/Pages/labral-tears.aspx http://www.niams.nih.gov/Health_Info/Hip_Replacement/ http://orthoinfo.aaos.org/topic.cfm?topic=a00377