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

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• 20 yo hockey goalie; 5 yr hx groin pain sitting; increasing groin pain with sports • Flexion 90 degrees; IR 0 degrees • XR: crossover sign and neck “bump”
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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
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Delamination of Cartilage
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Ortho Uni Berne
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Ortho Uni Berne
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(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 100 and 101: Prerequisite for “Safe” Surgica
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: Pre-op, postop offset creation by n
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
Page 167: • 38 yo nurse 13 y post left Stee
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Our post-PAO Program • Epidural f
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Middle-Term Results of PAO: Bern an
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Important prognostic factors after
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Chiari Osteotomy • Salvage proced
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The Bottom Line/The END!! • Most
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Mike Millis, M.D., Boston Children's Hospital

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