Mike Millis, M.D., Boston Children's Hospital

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Prerequisite for “Safe” Surgical Hip Dislocation: * Knowledge of blood supply to femoral head * Technique to dislocate and do intra-articular work without disturbing blood supply to the femoral head
Surgical Technique • Exactly as per Ganz et al • Lateral position/Gibson approach/troch flip • peripheral capsulotomy * Spare obturator externus • Anterior dislocation • Intraarticular surgery as needed • Occasional simultaneous ITO
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Hipology 2010 COA Meeting April 17,
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Disclosures • None relevant to th
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Major Points * In North America, mo
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“It seems clear that either osteo
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Joint Function Activity level Insta
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“We see what we know.” Frank Ph
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The Contemporary Mechanical Theory
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Etiology of OA of the Hip-1986 •
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MAJOR POINTS * A labral tear is usu
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Acetabular Rim Syndrome(s) • Groi
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Step-Wise Analysis of the Symptomat
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Good News About OA in the Hip • R
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The Normal Hip: Anatomic Characteri
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The Normal Hip: Mechanical Characte
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Important Definitions • Instabili
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Hip Mechanics (INSTABILITY) (IMPIN
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How can joints go wrong mechanicall
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Hip Mechanics • IMPINGEMENTINSTAB
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Femoro-Acetabular Impingement as a
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Femoro-Acetabular Impingement • F
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Femoro-Acetabular Impingement as a
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Herniation pit; usually means cam-
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Femur-based FAI: Cam Impingement
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CAM Impingement-Mechanism CAM Type
Page 61 and 62: Delamination of Cartilage
Page 63 and 64: Ortho Uni Berne
Page 65 and 66: Ortho Uni Berne
Page 67 and 68: (pincer) M:F = 4:12 pistol grip/ ca
Page 69 and 70: Etiologies of Hip OA in North Ameri
Page 71 and 72: Acetabulum-Based Femoro- Acetabular
Page 73 and 74: “We see what we know.” Frank Ph
Page 75: Pincer Impingement-Mechanism PINCER
Page 80 and 81: Impingement of Acetabular Rim Contr
Page 84 and 85: Protusio Ortho Uni Berne
Page 86 and 87: Campincer Impingement • Commonest
Page 88 and 89: Clinical Evaluation for Femoro- Ace
Page 90 and 91: Contour of the Head-Neck Junction a
Page 92 and 93: Imaging for F-A Impingement • Pla
Page 94 and 95: Analysis for F-A Impingement • Pl
Page 96 and 97: Treatment of pincer impingement (pr
Page 98 and 99: Treatment of combined femoral and a
Page 102 and 103: Surgical Dislocation Technique •
Page 104 and 105: Lateral Position
Page 106 and 107: Greater Trochanter Piriformis Tendo
Page 108 and 109: Femoral Head Acetabulum
Page 110: Improved Access
Page 114 and 115: Early Harvard Experience with Surgi
Page 119 and 120: Pre-op, postop offset creation by n
Page 122: • Acknowledgement to Professor R.
Page 126 and 127: Cartilage Delamination due to Impin
Page 128 and 129: Outcome depends on pre-existing dam
Page 130 and 131: Hip Joint-Preserving Techniques Ext
Page 133 and 134: Hip Arthroscopy • What it IS: A s
Page 135: Slipped Capital Femoral Epiphysis
Page 141 and 142: Etiologies of Hip OA in North Ameri
Page 143 and 144: DDH: Primary Anatomic Characteristi
Page 145 and 146: Clinical Evaluation of the Patient
Page 147: Plain Radiography: The Gold Standar
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Acetabular depth and version • An
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Indications for Joint-Preserving Th
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Site(s) of Correction • Willy Sut
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Acetabular Redirectional Osteotomy
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Bernese Periacetabular • Single i
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Arthrotomy • Useful if labral sx,
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Positioning of the osteotomized fra
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14 yo F 1 yr hx limp
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Now 49 yo; 11.5 y after PAO; no sym
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CH PAO Numbers • >1100 hips (1991
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5-15 yr Boston PAO Followup: Mathen
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“Salvage” Joint-Preserving Proc
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Diarthrodial Joint Function Activit
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Summary Thoughts on Osteotomy and R
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Mike Millis, M.D., Boston Children's Hospital

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