Disease and Injury of the Hip

By Ly Nguyen & Hayley Lough

Learning Objectives

● Review of the Hip ● Disease: Perthes Disease and Hip

Dysplasia● Injury: Hip dislocation, labral tear, and

avascular necrosis● Hip Replacement

Anatomy of the Hip

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

Diseases

Perthes Disease

● Definition● Causes● Symptoms● Treatment

(Legg Calve Perthes Disease)

Hip Joint with Perthes Disease

Definition

A condition where disrupted blood supply causes bone to die.

The ball (femoral head) collapses and becomes flat.

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

Anatomical changes

The friction between the socket joint and the ball increases

Damage of cartilage

Altered shape of the acetabulum and femoral head

X-Rays of Perthes Disease

Causes Rare condition

Gender & Age

Ratio of 4 boys to 1 girl (4-10 years old)

with Perthes Disease

Symptoms

Legs of unequal length

Pain & Stiffness in joints, groin and knees

Limited Range of movement

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

Hip Dysplasia

●Definition●Causes ●Symptoms●Treatment

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

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

Wrong Swaddling Methods

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

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

X Ray of Hip Dysplasia - Infant

Unilateral Hip Dysplasia in an infant

X-Ray of Hip Dysplasia - Adult

Bilateral Hip Dysplasia in a Young 29-year-old woman.

Treatment

Braces

Soft braces

Hip abduction braces

Surgery

Cutting & rotating the hip

Hip replacement

Injuries

Common Injuries to the Hip

Hip Dislocation

Labral Tear

Avascular Necrosis

Hip Dislocation

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

Causes

Large Forces - Car accidents and long distance falls

High Impact Sports - Football, gymnastics, and skiing

Diseases - Hip Dysplasia

Treatment

Reduction Procedure

Surgery to reset the hip back into the proper position

Physical Therapy

2-3 Month Recovery Period

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

Osteonecrosis (Avascular Necrosis)

Reduction in blood supply to the hip causes damage to the femoral head

Causes

Injury (Hip dislocation and hip fracture)

Alcoholism

Corticosteroid Medicine

Progression of Avascular Necrosis

Preventative Treatment

Preventative

- Anti-inflammatory drugs

- Physical Therapy

- Electrical Stimulation

Surgical Treatment

Core DecompressionOsteotomy - Reshapes bone to reduce stress

Total Hip Replacement

Labral Tear

Causes

Sports that involve pivoting of the hip - golf, soccer, hockey, and football

Trauma

Disease - Osteoarthritis, Hip Dysplasia

Treatment and Diagnosis

Diagnosed: MRI

Treatment - Arthroscopic Surgery

- Physical Therapy

Hip Replacement

Most Common Causes:

Osteoarthritis

Avascular Necrosis

Injury

Tumor

Partial Hip Replacement

Only the ball of the femur is removed

Hip Replacement

Ball of the femur and femoral neck are replaced

Hip Replacement Video

http://www.ypo.education/orthopaedics/hips/total-hip-replacement-t95/video/

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?

What does each image represent?

A B C

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