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

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“The best hip replacement has an unknown but certainly finite life, whereas a hip healed after osteotomy will often last a lifetime.” Prof. Maurice Mueller
Page 1 and 2: Hipology 2010 COA Meeting April 17,
Page 3 and 4: Disclosures • None relevant to th
Page 5 and 6: Major Points * In North America, mo
Page 7 and 8: “It seems clear that either osteo
Page 9: Joint Function Activity level Insta
Page 13 and 14: “We see what we know.” 18 yo so
Page 15 and 16: The Contemporary Mechanical Theory
Page 17 and 18: MAJOR POINTS * Hip OA is rarely idi
Page 19 and 20: MAJOR POINTS * Hip OA is rarely idi
Page 21 and 22: Principles of Joint Preservation
Page 23 and 24: Hard Truths (Bad News) • No good
Page 25 and 26: Goals for Every Orthopaedist * Lear
Page 27 and 28: The Normal Hip: Anatomic Characteri
Page 29 and 30: • Anatomy: “Normal” Hip • S
Page 31 and 32: Important Definitions • Femoro-ac
Page 33 and 34: How can joints go wrong mechanicall
Page 35 and 36: How can joints go wrong mechanicall
Page 37 and 38: Etiologies of Hip OA in North Ameri
Page 39 and 40: Femoro-Acetabular Impingement as a
Page 41 and 42: Femur-based FAI: Cam Impingement
Page 43 and 44: Femoro-Acetabular Impingement (Ganz
Page 45 and 46: Ortho Uni Berne
Page 47 and 48: Schematic FAI • Thanks to Dr. Ira
Page 56: Impingement of Acetabular labrum
Page 62 and 63:
Pathology Seen w. Cam Impingement
Page 64 and 65:
Ortho Uni Berne
Page 66 and 67:
Cam Impingement: Location of acetab
Page 68 and 69:
Femur-Based F-A Impingement: “Cam
Page 70 and 71:
Acetabulum-based (Pincer) FAI as a
Page 72 and 73:
Ortho Uni Berne
Page 74 and 75:
Pincer Impingement • Extensive di
Page 79 and 80:
Mechanical Damage Contrecoup Injury
Page 81:
Tearing of Labrum Contrecoup injury
Page 85 and 86:
Pincer Impingement • Pathoanatomy
Page 87 and 88:
Contemporary Concept of Impingement
Page 89 and 90:
The contour of the femoral headneck
Page 91 and 92:
Imaging for F-A Impingement • Pla
Page 93 and 94:
Imaging for F-A Impingement • Pla
Page 95 and 96:
Treatment Options for Impingement
Page 97 and 98:
Treatment of cam deformities • Fe
Page 99 and 100:
“Safe” Surgical Hip Dislocation
Page 101 and 102:
Surgical Technique • Exactly as p
Page 103 and 104:
Step I Step II Ortho Uni Berne Orth
Page 105 and 106:
ANTERIOR Trochanteric Branch of the
Page 107 and 108:
Greater Trochanter Anterior Hip Cap
Page 109 and 110:
Potential Uses for the Surgical Dis
Page 112:
Improved Safety
Page 115:
Insufficient Head-Neck Offset • 1
Page 120:
• 20 yo hockey goalie; 5 yr hx gr
Page 124:
SCFE - osteoplasty
Page 127 and 128:
Points on Femoro-Acetabular Impinge
Page 129 and 130:
Clinical Evaluation for Femoro- Ace
Page 131:
Points on Surgical Dislocation Appr
Page 134 and 135:
Extra-articular Impingement Relief
Page 139:
Anterior femoro-acetabular impingem
Page 142 and 143:
Major Points about Hip Dysplasia
Page 144 and 145:
MechanicalCharacteristics of DDH *
Page 146 and 147:
Imaging Possibilities • Plain rad
Page 149 and 150:
Imaging for Hip Dysplasia • The f
Page 151 and 152:
Imaging for Hip Dysplasia • Plain
Page 153 and 154:
Treatment Goals in DDH: Create join
Page 155 and 156:
Surgical Rules for DDH • Congruen
Page 157 and 158:
Joint-PreservingTreatment of Congru
Page 159 and 160:
PAO • Patient selection • Preop
Page 163 and 164:
Correction/Acetabular Reorientation
Page 165 and 166:
Positioning of the osteotomized fra
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• 38 yo nurse 13 y post left Stee
Page 170 and 171:
Our post-PAO Program • Epidural f
Page 172 and 173:
Middle-Term Results of PAO: Bern an
Page 174 and 175:
Important prognostic factors after
Page 176:
Chiari Osteotomy • Salvage proced
Page 179 and 180:
The Bottom Line/The END!! • Most
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Mike Millis, M.D., Boston Children's Hospital

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