Table Of ContentThe Hip Joint
The Hip Joint
edited by
K. Mohan Iyer
July12,2016 13:51 PSPBook-9inx6in 00-K-Mohan-Iyer-Prelims
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TheHipJoint
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PrintedintheUSA
July12,2016 13:51 PSPBook-9inx6in 00-K-Mohan-Iyer-Prelims
Tothememoryofmyrespectedteacher
(Late)Mr.GeoffreyV.Osborne
and
Mywife,Mrs.NaliniK.Mohan
Mydaughter,DeepaIyer,MBBS,MRCP(UK)
Myson,RohitIyer,BE(IT)
Mygrandson,Vihaan
July12,2016 13:51 PSPBook-9inx6in 00-K-Mohan-Iyer-Prelims
Contents
Foreword xxiii
Preface xxvii
Acknowledgements xxix
1 EmbryologyandAnatomyoftheHipJoint 1
K.MohanIyer
1.1 EmbryologyoftheHipJoint 1
1.1.1 TheFibrousCapsule 3
1.1.2 TheAcetabularLabrum 3
1.1.3 LigamentoftheHeadoftheFemur 3
1.1.4 TheIliofemoralLigament 3
1.2 AnatomicalRelationsoftheHipJoint 4
1.3 MovementsoftheHip 4
1.4 AppliedAnatomy 5
1.5 BloodSupplyoftheHipJoint 6
1.5.1 AnatomyoftheBloodSupply 6
1.5.2 ChangeswithAge 7
2 BiomechanicsoftheHipJoint 9
RamRavishankar
2.1 FunctionalAnatomy 10
2.1.1 BonyStructure 11
2.1.2 ArticularCartilage 12
2.1.3 AcetabularLabrum 13
2.1.4 Capsule,Ligaments,andMusculature 13
2.2 KinematicsandKinetics 15
2.2.1 ForcesActingontheHipJoint 16
2.2.2 BiomechanicsAppliedtoTotalHip
Arthroplasty 23
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viii Contents
2.2.3 PathologicalBiomechanicsoftheHip 26
2.2.3.1 Dysplastichips,coxavara,andcoxa
valga 26
2.2.3.2 Femoroacetabularimpingement 28
2.2.3.3 Labraltears,capsularlaxity,and
chronicinstability 29
3 ClinicalExaminationoftheHipJoint 33
K.MohanIyer
3.1 Inspection 33
3.2 Palpation 34
3.3 RangeofMotion 35
3.3.1 ActiveRangeofMovements 36
3.3.2 PassiveRangeofMovements 36
3.4 NeurologicalExamination 37
3.4.1 Muscles 37
3.4.2 SensoryTesting 38
3.5 SpecialTests 39
3.5.1 Trendelenburg’sTest 39
3.5.2 LimbLengthDiscrepancy 39
3.5.2.1 Truelimblengthdiscrepancy 40
3.5.2.2 Apparentlimblengthdiscrepancy 40
3.5.3 Ober’sTest 40
3.5.4 ImportantTestsforCongenitalDislocationof
theHip 40
3.5.4.1 Ortolaniclick 40
3.5.4.2 Telescoping 41
3.5.4.3 Adductioncontracture 41
3.5.5 ProximalFocalFemoralDeficiency 41
3.5.5.1 Treatment 41
4 ImagingoftheHipJoint 43
RajeshBotchuandRamVaidhyanath
4.1 Introduction 43
4.1.1 AnteroposteriorPelvicRadiograph 45
4.1.2 LateralView 46
4.1.3 FrogLegLateralView 47
4.1.4 JudetView 47
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Contents ix
4.1.5 Acetabulum 47
4.2 MRIAnatomyoftheHip 49
4.2.1 MusclesandTendons 51
4.3 Labrum 57
5 DisordersoftheHipinChildrenandAdolescents 59
K.Vinodh,SughranBanerjee,K.MohanIyer,
VijayaKumarKempanna,RobertJennings,andSharadGoyal
5.1 SepticArthritisoftheHipinInfantsandChildren 59
5.1.1 Epidemiology 60
5.1.2 Aetiopathology 61
5.1.3 CausativeOrganisms 62
5.1.4 ClinicalFeatures 63
5.1.5 Investigations 64
5.1.6 ImagingStudies 64
5.1.7 JointAspiration 68
5.1.8 DifferentialDiagnosis 69
5.1.9 Treatment 70
5.1.9.1 Antibiotics 71
5.1.10Prognosis 72
5.2 ComplicationsandTreatmentofComplicationsin
Children 72
5.2.1 Chondrolysis 74
5.2.2 DislocationwithCapitalFemoralEpiphysis
Intact 75
5.2.2.1 SequelaerelatedtoAVNoftheCFE
andgrowthplatedamage 76
5.2.2.2 TreatmentoptionsforHunkatypes 78
5.2.3 Ilizarov’sReconstruction 83
5.3 DDHorCongenitalDislocationoftheHipJoint 86
5.3.1 Incidence 86
5.3.2 Pathology 87
5.3.3 Diagnosis 87
5.3.4 GrafAngles 88
5.3.4.1 Measurements 88
5.3.5 Management 89
5.3.5.1 Birthto6months 89
5.3.5.2 6–18months 90
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x Contents
5.3.5.3 18–30months 90
5.3.5.4 >4yearsold 91
5.4 TheIrritableHip 93
5.4.1 SymptomsoftheIrritableHip 93
5.4.2 Management 94
5.4.3 KeyPointstoRemember 95
5.5 CoxaVara 95
5.5.1 Treatment 96
5.5.2 EpiphysealCoxaVara 96
5.5.3 Diagnosis 97
5.5.4 DifferentialDiagnosis 97
5.5.5 Prognosis 97
5.5.6 Treatment 98
5.5.6.1 Earlycaseswithaminimalslip 98
5.5.6.2 Caseswithdisplacement 98
5.5.6.3 Treatmentofthehealedcaseina
youngadult 99
5.5.6.4 Treatmentofoldercaseswith
arthritis 99
5.6 FemoralAnteversion 99
5.6.1 Diagnosis 100
5.6.2 Treatment 101
5.7 SlippedCapitalFemoralEpiphysis 101
5.7.1 WhatIsIt? 101
5.7.2 Introduction 102
5.7.3 WhoAreatMostRisk? 102
5.7.4 RiskFactors 103
5.7.5 Aetiology 103
5.7.6 Pathology 105
5.7.7 Classification 105
5.7.8 ClinicalFeatures 107
5.7.9 PhysicalExamination 107
5.7.10Investigations 107
5.7.10.1CTscan 110
5.7.10.2Ultrasoundscan 110
5.7.10.3Bonescan 110
5.7.10.4MRIscan 110
5.7.11Treatment 110
Description:For centuries, orthopaedic surgeons have been managing the pain, limp, and gait disturbance that develop in association with various traumas and diseases of the hip joint. The hip is a ball-and-socket joint that has a good range of movement, but it is stable and rarely dislocates, even after high-im
