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

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Analysis for F-A Impingement • Plain Radiography • MRI/MR Arthrography (MRA) •CT Scan • Arthroscopy * Surgical dislocation/arthrotomy (Ganz, 2001) * Excellent DYNAMIC assessment and visualization (but much more invasive than arthroscopy) * (and excellent for direct intraarticular treatment)
Treatment Options for Impingement • Extra-articular procedures – Proximal femoral osteotomies: ITO, esp. valgus – Acetabular procedures: “Reverse” PAO; Chiari * Intra-articular procedures – Trimming of femoral head – Subcapital osteotomy – Rim trim – Combinations
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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
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
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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
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 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
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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
Page 178 and 179:
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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