Transcript Hip Diseases

PLL #2- The Hip:
Anatomy, Disease, Injury, and Repair
By:
Phil Kemp, Andrew Thistle, Tim Hersey,
Brian Wilson, John Bocchino
BNG 345
Professor Currey
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
Anatomy of the Hip
Bones That Make up the Hip
Ball and Socket joint
composed of:
 Ilium
 Ishcium
 Pubis
 Femur
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.
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.
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.
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.
Muscles of the Hip
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Quadriceps
Hamstrings
Gluteal Group
Adductor Group
Illiopsoas Group
Lateral Rotator Group
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.
Hamstrings
Has a large
moment aiding in
hip extension.
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
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.”
Iliopsoas Group
 Comprised of the iliacus and psoas
major.
 The strongest of the hip flexors.
 Important in standing, walking, and
running.
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.
Hip Tendons and Ligaments
IT Band (Tendon)
 IT Band (Iliotibial Band)
 Runs along femur from
hip to knee
Ligaments
 Connect bones to bones
 Joint Capsule
 Pubo-femoral
 Iliofemoral
 Ischiofemoral
 Provides Stability
 ligamentum teresconnects femoral head to
acetabulum & supplies
femoral head with blood
Ligaments 2
 Labrum
 Facilitate keeping femoral
head in the acetabulum
Nerves
 Sciatic nerve
 large, travels under the gluteus maximus down the back of the
leg and further onto the foot.
Bursae
 Sacs of liquid that allow for
lubrication between bones,
muscles and tendons
Jeopardy
 http://www.superteachertools.com/jeopardy/userga
mes/Feb201306/game1360011345.php
Common Hip Injuries
Common Hip Injuries
 Hip Dislocation
 Hip Fracture
 Athletic Hip Injuries
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Trochanteric Bursitis
Hip Pointer
Labral Tear
Stress Fracture
Muscle/Ligament Strain
Hip Dislocation
 Difficult to do
 Ball and Socket joint very
stable
 Can be acquired or
congenital (hip dysplasia)
 Easy to diagnose
Famous example of hip dislocation…
Bo Jackson
http://www.ddotomen.com/2012/12/10/30-for30-you-dont-know-bo-full-episode/
Hip Fracture
 Serious problem in elderly
population
 Requires surgical repair or
replacement
 Can lead to further
complications
Fracture-Surgical Methods of Repair
 Method of Repair depends
on:
 Placement of fracture
 Surgeons Discretion
http://orthoinfo.aaos.org/topic.cfm?topic=A0
0392
Athletic Injuries
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Trochanteric Bursitis
Hip Pointer
Labral Tear
Stress Fracture
Muscle/Ligament Strain
Trochanteric Bursitis
Hip Pointer
Labral Tear
Stress Fracture
Hip Strain/Sprain
 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
http://www.joint-pain-expert.net/images/hip-osteoarthritis.JPG
 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
X-Ray: RA
Arthritis-Methods of Repair
Basic Treatments
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Rest
Exercise
Cane/walker
Anti-inflammatory Drugs
Cortisone shots
Rest and exercise?
Surgical Treatments
 Joint Resurfacing
 Joint replacement
 AKA Developmental Dysplasia of the Hip (DDH)
 Lifelong condition 1:1000 people
 Ranges from barely detectable to severely malformed
or dislocated
Hip Dysplasia X-Ray
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
 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 1020 thousand people develop AN at the head of the
femur each year
Avascular Necrosis
Avascular Necrosis-Methods of
Repair
 Most cases eventually
require surgery
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Bone grafts
Osteotomy
Total Joint replacement
Core Decompression
Vascularized bone graft
Total Hip Replacement
Components:
http://www.exac.com/patientscaregivers/images/img_patients_hip_comp
onents.jpg/image_product
Variation in Femoral Stem
Procedure-Pre Operative planning
 2D images and stencils
are used to determine
stem size and neck length
 Can this method be
improved?
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
Procedure-Broaching of Femoral
Cavity
Procedure-Implant Placement
 Implant is hammered into
place
 Proper neck and head
components are placed on
femoral stem
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.
THR Animation
 http://www.youtube.com/watch?v=YrSmlwNWAmQ
Result:
Revisionary Surgery
 Hip replacements loosen
after 10-20 years
 Aseptic loosening
 Mechanical loading
 Stress Shielding
 Revisionary implants:
longer, wider, more
invasive stems
Hip Resurfacing
 Used on younger patients
in order to preserve bone
Who Wants to try it!
 http://www.edheads.org/activities/hip/index.shtml