1. Disease and Injury of the Hip By Ly Nguyen & Hayley Lough

2. Learning Objectives ●Review of the Hip ●Disease: Perthes Disease and Hip Dysplasia ●Injury: Hip dislocation, labral tear, and avascular necrosis ●Hip Replacement

3. Anatomy of the Hip

4. Why is the hip prone to disease? Ball and Socket Joint Location of many nerves and main artery Stabilized by several muscles and joints Bursae

5. Diseases

6. Perthes Disease ●Definition ●Causes ●Symptoms ●Treatment (Legg Calve Perthes Disease) Hip Joint with Perthes Disease

7. Definition A condition where disrupted blood supply causes bone to die. The ball (femoral head) collapses and becomes flat.

8. Network of blood supply in normal and abnormal bone with the Perthes Disease.

9. Anatomical changes The friction between the socket joint and the ball increases Damage of cartilage Altered shape of the acetabulum and femoral head

10. X-Rays of Perthes Disease

11. Causes Rare condition Gender & Age

12. Ratio of 4 boys to 1 girl (4-10 years old) with Perthes Disease

13. Symptoms Legs of unequal length Pain & Stiffness in joints, groin and knees Limited Range of movement

14. Treatment Goal: Keep the Ball part of the joint round Orthopedic Bracing (until the age of 6) Surgery http://www.semiologiaortopedica.com.br/2012/07/exame-fisico- patologias-do-quadril_08.html

15. Hip Dysplasia ●Definition ●Causes ●Symptoms ●Treatment

16. Definition A condition where the hip socket does not fully cover the femoral head leading to loose and unstable joints The hip socket is too shallow

17. Causes Family History Common in young women ligament laxity Infants Not fully developed hip joints Wrong swaggling method Teenagers and Adults Undiagnosed Hip Dysplasia since childhood

19. Wrong Swaddling Methods

20. Anatomical Changes Higher contact pressure over a smaller surface area of the socket leads to Cartilage damage Cartilage damage leads to labral tear and eventually arthritis

21. Symptoms Mild to severe Pain in hip joints Decreased mobility Hard to diagnose -onset of the disease later in childhood -esp. the bilateral hip dysplasia

22. X Ray of Hip Dysplasia - Infant Unilateral Hip Dysplasia in an infant

23. X-Ray of Hip Dysplasia - Adult Bilateral Hip Dysplasia in a Young 29-year-old woman.

24. Treatment Braces Soft braces Hip abduction braces Surgery Cutting & rotating the hip Hip replacement

25. Injuries

26. Common Injuries to the Hip Hip Dislocation Labral Tear Avascular Necrosis

27. Hip Dislocation

28. Types of Hip Dislocation Posterior Dislocation  Femur is pushed out of the socket in a backwards direction Anterior Dislocation  Femur is pushed out of the socket in a forward direction

29. Causes Large Forces - Car accidents and long distance falls High Impact Sports - Football, gymnastics, and skiing Diseases - Hip Dysplasia

30. Treatment Reduction Procedure Surgery to reset the hip back into the proper position Physical Therapy 2-3 Month Recovery Period

31. Major Complications Nerve Injury - dislocated femur crushes and stretches surrounding nerves - Sciatic nerve injury Osteonecrosis - dislocated femur damages blood vessels - Results in a loss of blood supply to the bone

32. Osteonecrosis (Avascular Necrosis) Reduction in blood supply to the hip causes damage to the femoral head

33. Causes Injury (Hip dislocation and hip fracture) Alcoholism Corticosteroid Medicine

34. Progression of Avascular Necrosis

35. Preventative Treatment Preventative  Anti-inflammatory drugs - Physical Therapy - Electrical Stimulation

36. Surgical Treatment Core Decompression Osteotomy - Reshapes bone to reduce stress Total Hip Replacement

37. Labral Tear

38. Causes Sports that involve pivoting of the hip - golf, soccer, hockey, and football Trauma Disease - Osteoarthritis, Hip Dysplasia

39. Treatment and Diagnosis Diagnosed: MRI Treatment - Arthroscopic Surgery - Physical Therapy

40. Hip Replacement Most Common Causes: Osteoarthritis Avascular Necrosis Injury Tumor

41. Partial Hip Replacement Only the ball of the femur is removed Hip Replacement Ball of the femur and femoral neck are replaced

42. Hip Replacement Video http://www.ypo.education/orthopaedics/hips/total-hip-replacement-t95/video/

43. Review Questions Is avascular necrosis a disease? If so, what is it caused by? Are hip dislocations a common injury? Why can hip dislocations be life-threatening? What is damaged during a labral tear? What are the main causes that lead to hip replacement surgery?

44. What does each image represent? ABC

45. Sources http://emedicine.medscape.com/article/86930-overview#a5 http://orthoinfo.aaos.org/topic.cfm?topic=A00352 http://orthoinfo.aaos.org/topic.cfm?topic=a00216 http://www.niams.nih.gov/Health_Info/Osteonecrosis/#b https://www.hss.edu/conditions_summer-sports-and-hip-injuries.asp http://www.mayoclinic.org/diseases-conditions/hip-labral-tear/basics/treatment/con-20031062 http://health.ucsd.edu/specialties/surgery/ortho/areas-expertise/sports- medicine/conditions/hip/Pages/labral-tears.aspx http://www.niams.nih.gov/Health_Info/Hip_Replacement/ http://orthoinfo.aaos.org/topic.cfm?topic=a00377