Table Of ContentThe Hip Joint
Second Edition
edited by
K. Mohan Iyer
Published by
Jenny Stanford Publishing Pte. Ltd.
Level 34, Centennial Tower
3 Temasek Avenue
Singapore 039190
Email: [email protected]
Web: www.jennystanford.com
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
The Hip Joint
Copyright © 2022 by Jenny Stanford Publishing Pte. Ltd.
All rights reserved. This book, or parts thereof, may not be reproduced in any form
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For photocopying of material in this volume, please pay a copying fee through
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ISBNԘ978-981-4877-51-0 (Hardcover)
ISBNԘ978-1-003-16546-0 (eBook)
DOI: 10.1201/97810031 65460
I have written this dedication with a very heavy mind, full of fond
memories for my respected teacher, late Mr. Geoffrey V. Osborne,
without whose constant encouragement
and freedom I could not have written this
book. Such teachers are extremely rare to
spot these days where the turmoil of
daily life overtakes one’s ambitions,
duties, and career aspirations. I have a
remarkable store of personal and
academic memories of him, with whom I
spent four long years at the University of
Liverpool, UK, during which I rarely
looked upon him as my teacher as he was
more of a close friend and father to me.
I also dedicate this book, with loving thanks, to
My wife, Mrs. Nalini K. Mohan
My daughter, Deepa Iyer, MBBS, MRCP (UK), FAFRM (RACP) [Honorary
adjunct assistant professor, Bond University, Queensland, and senior
lecturer,
rifϔith University and University of Queensland, AustraliaȐ
My son-in-law, Kanishka B.
My son, Rohit Iyer, BE (IT)
My daughter-in-law, Deepti B.U.
My grandsons, Vihaan and Kiaan
My grandchild, Nisha Iyer
Contents
Foreword xxxiii
Preface xxxv
1. Applied Anatomy of the Hip Joint 1
K. Mohan Iyer
1.1 The Hip Joint 1
1.2 Ligaments of the Hip Joint 3
1.3 Movements of the Hip Joint 5
1.4 Bursae around the Hip Joint 6
1.4.1 Iliopsoas Bursa 6
1.4.2 Trochanteric Bursa 6
1.4.3 Ischiogluteal Bursa 7
1.5 Vascular Supply 7
1.6 Nerve Supply 7
1.7 Stability of the Hip Joint 8
1.8 X-Rays of the Pelvis 8
1.8.1 Hip X-Ray Anatomy 9
1.9 Hip Ultrasound 9
1.10 Commonly Seen Sports Injuries of the Hip Joint 11
1.10.1 Avulsion Injuries of the Hip 11
1.10.2 Snapping Hip Syndrome 11
1.10.3 Adductor Muscle Strain 11
1.10.4 Iliopsoas Strain 11
1.10.5 Trochanteric Bursitis 12
2. Biomechanics of the Hip Joint 13
K. Mohan Iyer
2.1 Introduction 13
2.2 Biomechanics of the Hip Joint 18
2.2.1 First-Order Lever 18
2.2.2 Joint Reaction Force 19
2.2.3 Forces Acting across the Hip Joint
in a Two-Leg Stance 22
2.2.4 Use of Assistive Devices 23
viii Contents
2.2.4.1 Canes 23
2.2.4.2 Walkers 23
2.2.4.3 Crutches 24
2.3 Biomechanics of Trendelenberg’s Gait 24
2.4 Biomechanics of Neck Deformities 25
2.5 Biomechanics of Weight Gain 25
2.6 Biomechancis of Total Hip Replacement 26
3. Septic Arthritis of the Hip in Children 29
K. Vinodh
3.1 Introduction 29
3.2 Epidemiology 30
3.3 Anatomical Considerations and Aetiopathology 30
3.4 Pathogens 32
3.5 Clinical Features 33
3.6 Diagnostic Evaluation 34
3.6.1 Laboratory Investigations 34
3.6.2 Imaging Studies 35
3.7 Diagnostic Aspiration 38
3.8 Differential Diagnosis 39
3.9 Management 40
3.9.1 Choice of Antibiotics 41
3.9.2 Predictors of Poor Prognosis 43
3.10 Sequelae of Septic Arthritis of the Hip in
Children 43
3.10.1 Chondrolysis 44
3.10.2 Dislocation with the Capital Femoral
Epiphysis Intact 45
3.10.3 Sequelae Related to AVN of the CFE
and Growth Plate Damage 46
3.10.3.1 Treatment options for
Hunka type I 47
3.10.3.2 Treatment options for
Hunka type II 48
3.10.3.3 Treatment options for
Hunka type III 48
3.10.3.4 Treatment options for
Hunka types IV and V 50
3.10.3.5 Ilizarov’s reconstruction 52
3.10.4 Role of Arthroscopy 53
Contents ix
4. Developmental Dysplasia of the Hip 63
Munis Ashraf and Senthilnathan Sambandam
4.1 Graf Classification of DDH Using
Ultrasonography 63
4.1.1 Reliability 65
4.2 Radiographic Classification of DDH 65
4.2.1 Tönnis and IHDI Classifications 65
4.2.1.1 Tönnis classification of DDH 65
4.2.1.2 IHDI classification of DDH 66
4.2.2 Reliability 68
4.3 MRI Classification of DDH 68
4.3.1 Kashiwagi Classification for
Prediction of Reduction 68
4.3.2 Clinical Application 68
5. Bearing Materials in Total Joint Arthroplasty 71
Hemant Kumar Singh, Arya Mishra,
Sharad Goyal and Conal Quah
5.1 Introduction 71
5.2 Tribology 72
5.2.1 Material Strength: Stress versus
Strain Curve 73
5.3 Biomaterials 76
5.3.1 Polymers 77
5.3.1.1 Disadvantages of
cross-linking 78
5.3.2 Metals 79
5.3.2.1 Strengthening mechanisms 81
5.3.2.2 Orthopaedic implant alloys 82
5.3.2.3 Postproduction
strengthening mechanisms 83
5.3.3 Ceramics 85
5.3.3.1 Manufacture of ceramic
biomaterials 86
5.4 Bearing Surface Couplings and Their Clinical
Performance 92
5.4.1 Ceramic-on-Ceramic 95
5.4.1.1 Early setbacks and the
current situation 95
x Contents
5.4.1.2 Tribological characteristics
and wear mechanisms 97
5.4.1.3 Stripe wear 97
5.4.1.4 Systemic effects of wear
particles 98
5.4.1.5 Advantages 98
5.4.1.6 Disadvantages 98
5.5 Polyethylene Liners 100
5.5.1 Clinical Performance of Polyethylene
Liners 100
5.5.2 Second-Generation HXLPE 101
5.5.3 Metal-on-Polyethylene 102
5.5.3.1 Advantages 103
5.5.3.2 Disadvantages 103
5.5.4 Ceramic-on-Polyethylene 103
5.5.4.1 Advantages 103
5.5.4.2 Disadvantages 104
5.5.5 Oxinium-on-Polyethylene 104
5.5.5.1 Advantages 105
5.5.5.2 Disadvantages 105
5.5.6 Metal-on-Metal 106
5.5.6.1 Tribological characteristics
and wear mechanisms 106
5.5.6.2 Advantages 107
5.5.6.3 Disadvantages 107
5.6 Discussion 109
5.7 Summary 109
6. 3D Printing: Clinical Applications in Orthopaedics
and Traumatology 121
Mohit Kumar Patralekh and Hitesh Lal
6.1 Introduction 121
6.2 Methods 123
6.3 Basic Technique of 3D Printing 125
6.4 Applications in Orthopaedic Traumatology:
Examples from Management of
Pelvi-Acetabular Trauma and Proximal
Femoral Fractures 127
6.4.1 Acetabular Fractures 127
