PLL #2- The Hip:Anatomy, Disease, Injury, and Repair

By: Phil Kemp, Andrew Thistle, Tim

Hersey, Brian Wilson, John BocchinoBNG 345

Professor Currey

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

Learning Objectives

Anatomy of the Hip

Ball and Socket joint composed of:

Ilium Ishcium Pubis Femur

Bones That Make up the Hip

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.

Acetabulum

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.

Femur

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.

Trochanters

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.

Biomechanics

Quadriceps Hamstrings Gluteal Group Adductor Group Illiopsoas Group Lateral Rotator Group

Muscles of the Hip

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.

Quadriceps

Has a large moment aiding in hip extension.

Hamstrings

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

Gluteal 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.”

Adductor Group

Comprised of the iliacus and psoas major.

The strongest of the hip flexors. Important in standing, walking,

and running.

Iliopsoas 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.

Lateral Rotator Group

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 teres-

connects 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

http://www.superteachertools.com/jeopardy/usergames/Feb201306/game1360011345.php

Jeopardy

Common Hip Injuries

Common Hip Injuries

Hip Dislocation Hip Fracture Athletic Hip Injuries

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-for-30-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=A00392

Athletic Injuries

Trochanteric Bursitis Hip Pointer Labral Tear Stress Fracture Muscle/Ligament Strain

Trochanteric Bursitis

Hip Pointer

Labral Tear

Stress Fracture

Hip Strain/Sprain

Common Hip Diseases

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

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

Rheumatoid Arthritis

X-Ray: RA

Arthritis-Methods of Repair

Basic Treatments

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

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 10-20 thousand people develop AN at the head of the femur each year

Avascular Necrosis

Avascular Necrosis

Avascular Necrosis-Methods of Repair

Most cases eventually require surgery Bone grafts Osteotomy Total Joint

replacement Core Decompression Vascularized bone

graft

Total Hip Replacement

Components:

http://www.exac.com/patients-caregivers/images/img_patients_hip_components.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.

http://www.youtube.com/watch?v=YrSmlwNWAmQ

THR Animation

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

http://www.edheads.org/activities/hip/index.shtml

Who Wants to try it!