hip

Timing

Early < 3 - 6 months

- most common

- excessive hip position by patient

- before adequate muscle control & soft tissue healing

Secondary 6 months - 5 years

- represents majority of recurrent dislocations

Aims

Prevent contractures

Prevent dislocations

Improve walking 

Provide stable and painless sitting

Allow perineal care

Issues

Hip Dislocation

Adductor contractures

Flexion contractures

In-toeing

Windswept hips

Hip Dislocation

Natural History

Accepted that a dislocated hip in CP is painful

Definition

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

Epidemiology

Age: 20 - 50

Sex: M > F

Types

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

Definition

Chondroid Metaplasia of synovium affecting large joints

Nodules of hyaline cartilage

- formed in the subsynovial layer of joint capsules

Epidemiology

Rare lesion

Most common in 20's and 30's

Sex: M > F (2:1)

Monoarticular

Site

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex

Management Summary

Stage 0

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

Stage 1 / Normal X-ray, abnormal MRI

Forage: 80% G/E

Bisphosphonates

Stage 2 / Abnormal X-ray with cysts and sclerosis

A:  As for Stage I

Definition

Non-traumatic or traumatic condition of femoral head with bone death

Epidemiology

20 - 50 yo (average 38)

- M: F 4:1

NHx  

70-80% with AVN will progress within 1 year

Concept

THR in dysplastic hips has a higher failure rate

- due to anatomic abnormalities

- due to generally younger age

Aim

Restore normal biomechanics and preserve bone stock

Issues

Soft tissues

Indications

Young adult 

- 16 - 30 years old

- monoarticular disease

- heavy demand 

Exhausted options of osteotomy

- risk of THA failure  / multiple revision surgeries considered too high

Aims of arthrodesis

Maximise bony contact

Minimise shortening