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

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Good News About OA in the Hip • Rarely idiopathic or “primary” • Mechanical nature, familiar to the orthopaedist • Treatable/preventable by mechanical means * Several joint-preserving alternatives exist • Arthroscopy • Arthrotomy * Surgical hip dislocation/osteoplasty/debridement • Realignment osteotomy(Femoral or pelvic) • (Biologic resurfacing of articular surfaces) • Combinations
Goals for Every Orthopaedist * Learn to recognize the mechanicallycompromised joint before arthrosis occurs * Learn how to save/preserve those joints rather than replacing them (if possible and reasonable)
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 12 and 13: “We see what we know.” Frank Ph
Page 14 and 15: The Contemporary Mechanical Theory
Page 16 and 17: Etiology of OA of the Hip-1986 •
Page 18 and 19: MAJOR POINTS * A labral tear is usu
Page 20 and 21: Acetabular Rim Syndrome(s) • Groi
Page 22 and 23: Step-Wise Analysis of the Symptomat
Page 26 and 27: The Normal Hip: Anatomic Characteri
Page 28 and 29: The Normal Hip: Mechanical Characte
Page 30 and 31: Important Definitions • Instabili
Page 32 and 33: Hip Mechanics (INSTABILITY) (IMPIN
Page 34 and 35: How can joints go wrong mechanicall
Page 36 and 37: Hip Mechanics • IMPINGEMENTINSTAB
Page 38 and 39: Femoro-Acetabular Impingement as a
Page 40 and 41: Femoro-Acetabular Impingement • F
Page 42 and 43: Femoro-Acetabular Impingement as a
Page 44 and 45: Herniation pit; usually means cam-
Page 46 and 47: Femur-based FAI: Cam Impingement
Page 48: 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 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 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
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 and 172:
CH PAO Numbers • >1100 hips (1991
Page 173 and 174:
5-15 yr Boston PAO Followup: Mathen
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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