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Wheeless' Textbook of Orthopaedics

The Atlas of Hip Surgery Images is a collection of medical illustrations depicting the anatomy, disease, and surgery of the hip and associated anatomical structures produced by a professional medical illustrator.

Wheeless' Textbook of Orthopaedics
pathogenesis and risk factors: - Intravascular coagulation and osteonecrosis. - natural history - blood supply to femoral head: - diff dx: - synovitis; - transient osteoporosis - femoral neck stress frx: - metastatic disease; - trochanteric bursitis:

Anatomy: - extracapsular arterieal ring at the base of the femoral neck; - formed posteriorly by large branch of MFCA - formed anteriorly by smaller branches of LFCA; - superior & inferior gluteal artery have minor contributions; - ascending cervical branches - these give rise to retinacular arteries; - gives rise to subsynovial intra articular ring - artery of ligamentum teres; - derived from obturator or MFCA; - inadequate to supply femoral head with displaced fractures; - forms the medial epiphyseal vessels; - only small & variable amount of the femoral head is nourished by artery of ligamentum teres; - epiphyseal blood supply: - arises primarily from lateral epiphyseal vessels that enter head posterosuperiorly; - vessels from medial epiphyseal artery entering thru ligamentum teres; - epiphyseal arterial branches: - arise as arteries of subsynovial intraarticular ring; - two groups of epiphyseal arteries: lateral & inferior vessels; - metaphyseal blood supply: - arises from extracapsular arterial ring; - arise from branches of ascending cervical arteries, & subsynovial intra articular ring;

Background Avascular necrosis (AVN) of the femoral head is a pathologic process resulting from interruption of blood supply to bone. AVN of the hip is poorly understood but is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment. Osteonecrosis of the femoral head was first described in 1738 by Munro. In approximately 1835, Cuwilhier depicted femoral head morphologic changes secondary to interruption of blood flow. Since Mankin described 27 cases of AVN in 1962, the number of reported cases has increased steadily. (full text)

Wheeless' Textbook of Orthopaedics
- typically develops on x-ray 3-8 wks postop in pericapsular area of the affected hip joint; - over all incidence is 50% (1/3 of these are clinically significant); - risk factors: - male gender (uncommon in females); - active AS; - DISH - post traumatic arthritis; - heterotrophic osteoarthritis - previous HO; - previous hip fusion; - Paget's disease - Parkinson's disease - excessive osteophytosis or enthesiopathic radiographic changes on AP of pelvis; - head injury and/or spinal cord injury;

Avascular necrosis has been documented following Disseminated Intravascular Coagulation 2 . We are presenting such a case of bilateral avascular necrosis of femoral heads, which interestingly was followed by the spontaneous presentation of the patient's sister with a unilateral avascular necrosis of the femoral head. Both sisters presented with symptoms at the same age. N. Jane Madeley, Mohammed Maqsood, Arshad Bhatti: Hidden Predisposition To Osteonecrosis Of The Femoral Head. The Internet Journal of Orthopedic Surgery. 2006. Volume 3 Number 1.

HIP ARTHROPLASTY: NORMAL AND ABNORMAL IMAGING APPEARANCES Lakeside Center - Education Exhibits - Space 0101CE-e Thomas Learch MD, Amilcare Gentili MD, Deborah Forrester MD, Edward McPherson MD USC and UCSD Newer joint replacement systems and surgical techniques combined with the aging US population have lead to an increase in patients undergoing hip arthroplasty surgery. Baseline and follow-up imaging studies help in determining success or failure of joint replacement surgery, and aid in identifying common complications. Radiologists following these patients need to be aware of the normal radiographic appearance of post operative and follow up studies, as well as complications that occur over the course of implant use. This computer exhibit will describe the normal and abnormal radiographic appearances postoperatively and on follow up studies, including alignment and positioning abnormalities of the acetabular cup and femoral prostheses, bone, cement, and hardware fracture, polyethylene cup wear and dislocation, particle disease, loosening, and infection. Conventional radiography, arthrography, nuclear medicine, and multislice computed tomography imaging studies will be demonstrated. Imaging of antibiotic impregnated cement spacers used to treat infection as well as revision hip arthroplasty will also be presented.

Hip-Op© is a surgical planning system for total hip replacement originally conceived at the Istituti Ortopedici Rizzoli (Bologna, Italy) and currently developed by the Bio-Computing Competence Centre.

Wheeless' Textbook of Orthopaedics Extensive menu on this topic includes -
Classification, Radiography, Woek-up, Treatment

Goldmine of orthopaedic scores and scoring systems. 10 surgeon based and 20 patient based scoring systems for all regions of the musculoskeletal system. Includes: Harris Hip Score, Knee Society Score, Oxford Knee Score, WOMAC, Cincinatti Knee Score, Tegner Lysholm, American Foot & Ankle Score AFAS, UCLA Shoulder Rating Scale, Mayo Elbow Score, DASH (Disabilities of Arm Shoulder & Hand) and several more.

Synonyms and related keywords: aseptic necrosis, avascular necrosis, osteonecrosis of the femoral head, ischemic necrosis
Contents - Introduction Indications Relevant Anatomy And Contraindications Workup Treatment Complications Outcome And Prognosis Future And Controversies Pictures Bibliography
Osteonecrosis of the femoral head involves the hip joint. Osteocytes of the femoral head die along with the bone marrow; resorption of the dead tissue by new but weaker osseous tissue can lead to subchondral fracture and collapse. Two forms of osteonecrosis exist, traumatic (the most common form) and atraumatic. Other terms to describe this disorder include avascular necrosis and ischemic necrosis to denote vascular etiology. The term aseptic necrosis also has been used to indicate that infection does not play a causative role.

Hip padding systems

Wheeless' Textbook of Orthopaedics
- slip of the captial femoral epiphysis occurs with in a narrow window of physiologic maturity of the growing child; - arises from mechanical and constitutional factors; - pts may have underlying endocrine dz (such as hypothyroidism) delayed puberty & bone age; - position of growth plate of proximal femur normally changes from horizontal to to obliqueduring preadolescence and adolescence; - wt increase that occurs during adolescent growth spurt puts extra strain on the growth plate; - remember that bilateral involvement is occurs in over 25% of patients - often within 6 months of the other side;