Orthopaedic MD

Site to calculate the Harris Hip Score

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.

Archive Copy - 1999 Annual Meeting Scientific Program. Polyethylene: The Past, Present and Future

Archive Copy: - 1999 Annual Meeting Scientific Program. Low Wear Bearings for Total Hip Replacements
Moderator H. Amstutz

hip joint:
- is affected in upto 50 % of patients with AS, and when it occurs it is often bilateral;
- protrusio and hip flexion contractures are common;
- heterotopic ossification may follow THR;
- total hip replacement:
- hetertopic ossification;
- occurs in 20-40 % of hip replacements and is more common w/ trochanteric osteotomy;
- to avoid heterotopic ossification consider insertion of a cemented acetabular component followed by 750 rads around the component;
Wheeless' Textbook of Orthopaedics

- Smith Petersen improved & revived the anterior iliofemoral approach;
- entire ilium and hip joint can be reached thru iliac part of incision;
- with this approach there is a need for extensive detachment of tendinous insertions & retraction of muscle, with potential damage to femoral artery and nerve and traction on lateral femoral cutaneous nerve;
- among the indications for this approach are ganz osteotomy for DDH and posterior hip frx dislocations;
Wheeless' Textbook of Orthopaedics

Discussion: - major problems with the Watson Jones technique are dealing w/ gluteus medius & minimus, which lie over anteior capsule and must be damaged or cut to obtain adequate exposure; - original Charnely technique used anterolateral approach w/ pt supine, osteotomy of greater troch, & ant dislocation of hip; - this approach is used less commonly now as result of problems related to reattachement of the greater trochanter;
Wheeless' Textbook of Orthopaedics

Perioperative Prophylactic Antibiotics:
- it is essential that antibiotics be given prior to incision;
- in most cases, patients should receive 1-2 gm of IV Ancef 30 min prior to the incision
Wheeless' Textbook of Orthopaedics

Everything a patient with hip arthritis or avascular necrosis needs to know about the nature of the disease, including surgical and non-surgical treatment options, total hip replacement, the pros and cons, complications of treatment, the implant design ma

Discussion: - hip fusions acn occur spontaneously following childhood sepsis or after ORIF of acetabular fractures (secondary to heterotopic bone).
- they also occur spontaneously due to ankylosing spondylitis;
- surgical fusions are performed for young adults with advanced arthritis;
- indications:
- desire to return to near-normal physical activity with manual labor;
- 20 yrs years after surgery, 80% of pts w/ hip arthrodesis performed at relatively young age were working & satisfied w/ their results;
- relief of pain;
- young male;
Wheeless' Textbook of Orthopaedics

Indications:
- evaluation of hip pain- candidates are patients with nonspecific radiographic findings and reproducible, functionally-limiting physical signs and symptoms.
- the false negative rate of plain x-ray, bone scan, CT, arthrogram, and routine MRI has been quoted as high as 80% in some patient populations.
- gadolinium enhanced MRI demonstrated a sensitivity of 55% for all intra-articular pathology and 74% for labral tears in patients where other modalities had failed to reveal a source of pain.
Wheeless' Textbook of Orthopaedics

anterior approach:
- femoral artery may be palpated in femoral triangle, & may be used as a guide in aspirating the hip joint;
- palpate the femoral pulse just as it exits the inguinal ligament;
- entry point is one inch lateral to the artery (at the inguinal ligament) and one inch below the inguinal ligament;
- going lateral 1 inch will also make entry site approx 1 in below ligament;
- needle entry is then straight down into the lateral half of the joint cavity;
Wheeless' Textbook of Orthopaedics

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;