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

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Femur-Based F-A Impingement: “Cam Impingement” • Anatomic causes: Femoral Head: Asphericity (Perthes, etc) Retrotilt (SCFE) No anterior offset (SCFE, idiopathic, etc.) Femoral Neck: Retroversion Coxa vara Femoral neck malunion
Etiologies of Hip OA in North America-UPDATED • Dysplasia 43% Perthes-Impingement 22% SCFE-Impingement 11% * Non-Perthes, non-SCFE FAI >10% “Impingement-related” 43% • Idiopathic + Other 16% (modified from Aronson, 1986)
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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 •
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 24 and 25: Good News About OA in the Hip • R
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: (pincer) M:F = 4:12 pistol grip/ ca
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
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Pre-op, postop offset creation by n
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• Acknowledgement to Professor R.
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Cartilage Delamination due to Impin
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Outcome depends on pre-existing dam
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Hip Joint-Preserving Techniques Ext
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Hip Arthroscopy • What it IS: A s
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Slipped Capital Femoral Epiphysis
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Etiologies of Hip OA in North Ameri
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DDH: Primary Anatomic Characteristi
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Clinical Evaluation of the Patient
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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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