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

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Middle-Term Results of PAO: Bern and Boston • Hip still preserved in 84% at 10+ yrs • Pain relief excellent in most • Mild loss of flexion in most • CE angles improved from ~5 to~30 degrees * Best results if OA 0 or grade 1 preop and no labral tear • ~50% reoperation rate at 5 y if OA gr. 2-3 • Conversion to THR straightforward
5-15 yr Boston PAO Followup: Matheney, Kim, and Millis (JBJS, 9/09) • 161/189 of 1991-1998 PAO’s (MBM) located. • All had pain preop. Preop CE angle in most 83% * Important prognostic factors for outcome after PAO
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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
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Etiologies of Hip OA in North Ameri
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Acetabulum-Based Femoro- Acetabular
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“We see what we know.” Frank Ph
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Pincer Impingement-Mechanism PINCER
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Impingement of Acetabular Rim Contr
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Protusio Ortho Uni Berne
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Campincer Impingement • Commonest
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Clinical Evaluation for Femoro- Ace
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Contour of the Head-Neck Junction a
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Imaging for F-A Impingement • Pla
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Analysis for F-A Impingement • Pl
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Treatment of pincer impingement (pr
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Treatment of combined femoral and a
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Prerequisite for “Safe” Surgica
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Surgical Dislocation Technique •
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Lateral Position
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Greater Trochanter Piriformis Tendo
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Femoral Head Acetabulum
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Improved Access
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Early Harvard Experience with Surgi
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Pre-op, postop offset creation by n
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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
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Page 145 and 146: Clinical Evaluation of the Patient
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Page 150 and 151: Acetabular depth and version • An
Page 152 and 153: Indications for Joint-Preserving Th
Page 154 and 155: Site(s) of Correction • Willy Sut
Page 156 and 157: Acetabular Redirectional Osteotomy
Page 158 and 159: Bernese Periacetabular • Single i
Page 160: Arthrotomy • Useful if labral sx,
Page 164 and 165: Positioning of the osteotomized fra
Page 166 and 167: 14 yo F 1 yr hx limp
Page 169 and 170: Now 49 yo; 11.5 y after PAO; no sym
Page 171: CH PAO Numbers • >1100 hips (1991
Page 175 and 176: “Salvage” Joint-Preserving Proc
Page 178 and 179: Diarthrodial Joint Function Activit
Page 180: Summary Thoughts on Osteotomy and R
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Mike Millis, M.D., Boston Children's Hospital

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