The Hip Joint

__The Hip Joint__, written in 2016, provides a detailed account of the hip joint's anatomy and biomechanics and covers recent trends in orthopaedic surgery of the hip joint, including the latest advances in revision total hip arthroplasty (THA), computer-assisted navigation for THA, resurfacing of the hip joint and neoplastic conditions around the hip as well as indications, complications and outcomes of hip arthroscopy. Another book, __The Hip Joint in Adults: Advances and Developments__, gives additional important details of how hip joint surgery has evolved around the world. While much of the basic knowledge in this area is constant, it is critically important to stay current on those areas that do change. This updated second edition of __The Hip Joint__ contains a host of original articles from contributory authors all around the world, showing the evolution of the hip joint till the present day, building upon the solid foundation set by the first edition. It covers hot topics such as 3D printing in orthopaedics and traumatology, stem cell therapy in orthopaedics, hip resurfacing, hip-preserving surgery, sports medicine for the hip joint, robotic-assisted surgery in orthopaedics and neoplastic conditions around the hip. Cover Title Page Copyright Page Table of Contents Foreword Preface Chapter 1: Applied Anatomy of the Hip Joint 1.1: The Hip Joint 1.2: Ligaments of the Hip Joint 1.3: Movements of the Hip Joint 1.4: Bursae around the Hip Joint 1.4.1: Iliopsoas Bursa 1.4.2: Trochanteric Bursa 1.4.3: Ischiogluteal Bursa 1.5: Vascular Supply 1.6: Nerve Supply 1.7: Stability of the Hip Joint 1.8: X-Rays of the Pelvis 1.8.1: Hip X-Ray Anatomy 1.9: Hip Ultrasound 1.10: Commonly Seen Sports Injuries of the Hip Joint 1.10.1: Avulsion Injuries of the Hip 1.10.2: Snapping Hip Syndrome 1.10.3: Adductor Muscle Strain 1.10.4: Iliopsoas Strain 1.10.5: Trochanteric Bursitis References Chapter 2: Biomechanics of the Hip Joint 2.1: Introduction 2.2: Biomechanics of the Hip Joint 2.2.1: First-Order Lever 2.2.2: Joint Reaction Force 2.2.3: Forces Acting across the Hip Joint in a Two-Leg Stance 2.2.4: Use of Assistive Devices 2.2.4.1: Canes 2.2.4.2: Walkers 2.2.4.3: Crutches 2.3: Biomechanics of Trendelenberg’s Gait 2.4: Biomechanics of Neck Deformities 2.5: Biomechanics of Weight Gain 2.6: Biomechancis of Total Hip Replacement References Chapter 3: Septic Arthritis of the Hip in Children 3.1: Introduction 3.2: Epidemiology 3.3: Anatomical Considerations and Aetiopathology 3.4: Pathogens 3.5: Clinical Features 3.6: Diagnostic Evaluation 3.6.1: Laboratory Investigations 3.6.2: Imaging Studies 3.7: Diagnostic Aspiration 3.8: Differential Diagnosis 3.9: Management 3.9.1: Choice of Antibiotics 3.9.2: Predictors of Poor Prognosis 3.10: Sequelae of Septic Arthritis of the Hip in Children 3.10.1: Chondrolysis 3.10.2: Dislocation with the Capital Femoral Epiphysis Intact 3.10.3: Sequelae Related to AVN of the CFE and Growth Plate Damage 3.10.3.1: Treatment options for Hunka type I 3.10.3.2: Treatment options for Hunka type II 3.10.3.3: Treatment options for Hunka type III 3.10.3.4: Treatment options for Hunka types IV and V 3.10.3.5: Ilizarov’s reconstruction 3.10.4: Role of Arthroscopy References Chapter 4: Developmental Dysplasia of the Hip 4.1: Graf Classification of DDH Using Ultrasonography 4.1.1: Reliability 4.2: Radiographic Classification of DDH 4.2.1: Tönnis and IHDI Classifications 4.2.1.1: Tönnis classification of DDH 4.2.1.2: IHDI classification of DDH 4.2.2: Reliability 4.3: MRI Classification of DDH 4.3.1: Kashiwagi Classification for Prediction of Reduction 4.3.2: Clinical Application References Chapter 5: Bearing Materials in Total Joint Arthroplasty 5.1: Introduction 5.2: Tribology 5.2.1: Material Strength: Stress versus Strain Curve 5.3: Biomaterials 5.3.1: Polymers 5.3.1.1: Disadvantages of cross-linking 5.3.2: Metals 5.3.2.1: Strengthening mechanisms 5.3.2.2: Orthopaedic implant alloys 5.3.2.2.1: Methods of manufacture 5.3.2.2.2: Benefits and disadvantages of casting and forging 5.3.2.3: Postproduction strengthening mechanisms 5.3.3: Ceramics 5.3.3.1: Manufacture of ceramic biomaterials 5.4: Bearing Surface Couplings and Their Clinical Performance 5.4.1: Ceramic-on-Ceramic 5.4.1.1: Early setbacks and the current situation 5.4.1.2: Tribological characteristics and wear mechanisms 5.4.1.3: Stripe wear 5.4.1.4: Systemic effects of wear particles 5.4.1.5: Advantages 5.4.1.6: Disadvantages 5.5: Polyethylene Liners 5.5.1: Clinical Performance of Polyethylene Liners 5.5.2: Second-Generation HXLPE 5.5.3: Metal-on-Polyethylene 5.5.3.1: Advantages 5.5.3.2: Disadvantages 5.5.4: Ceramic-on-Polyethylene 5.5.4.1: Advantages 5.5.4.2: Disadvantages 5.5.5: Oxinium-on-Polyethylene 5.5.5.1: Advantages 5.5.5.2: Disadvantages 5.5.6: Metal-on-Metal 5.5.6.1: Tribological characteristics and wear mechanisms 5.5.6.2: Advantages 5.5.6.3: Disadvantages 5.6: Discussion 5.7: Summary References Chapter 6: 3D Printing: Clinical Applications in Orthopaedics and Traumatology 6.1: Introduction 6.2: Methods 6.3: Basic Technique of 3D Printing 6.4: Applications in Orthopaedic Traumatology: Examples from Management of Pelvi-Acetabular Trauma an 6.4.1: Acetabular Fractures 6.4.2: Hip Dislocation with Acetabular Fracture 6.4.3: Pelvic Trauma 6.4.4: Sacral Fractures 6.4.5: Proximal Femur 6.5: Recent Advances and Techniques on the Horizon in 3D Printing Applications in Hip Trauma 6.5.1: Atypical Femoral Fracture with Bowed Femur Appropriate Nail Decided Using 3D Printing 6.6: Applications in Hip Preservation Surgery and Arthroscopy 6.6.1: Periacetabular Osteotomies 6.6.2: Osteonecrosis of the Femoral Head 6.6.3: Femoro-Acetabular Impingement 6.6.4: Hip Arthroscopy, FAI and 3D Printing 6.7: Applications in Hip Arthroplasty 6.7.1: Revision Hip Arthroplasty 6.7.2: Custom Prosthesis 6.7.3: Patient-Specific Instrumentation 6.8: Applications in Orthopaedic Oncology 6.8.1: Tumour 6.8.2: Shepherd’s Crook Deformity 6.9: Applications in Paediatric Orthopaedics 6.9.1: Slipped Capital Femoral Epiphysis 6.9.2: Paediatric Hip Fractures 6.9.3: Development Dysplasia of the Hip 6.10: Applications in Plastic Surgery Related to Limbs 6.10.1: Illustrative Case 6.10.2: Evolving Areas in 3D Bioprinting 6.11: Applications in Rehabilitation: Patient-Specific Orthoses and Prostheses 6.12: Reliability of 3D-Printed Models 6.13: Conclusion References Chapter 7: Stem Cell Therapy in Orthopaedics 7.1: Introduction 7.2: Limitations of Conventional Alignment Jigs 7.3: Types of Computer Navigation Systems 7.4: Computer Navigation in Total Hip Arthroplasty 7.5: Computer Navigation in Total Hip Resurfacing 7.6: Limitations of Computer Navigation Systems 7.7: Conclusion References Chapter 8: Principles of Anterior Approach for Total Hip Arthroplasty 8.1: Introduction 8.2: Surgical Technique 8.2.1: Choice of Patients 8.2.2: Patient Positioning 8.2.3: Skin Incision 8.2.4: Superficial Dissection: The Intramuscular Approach 8.2.5: Deep Dissection: The Intramuscular Approach 8.2.6: Femoral Preparation: The Use of the Traction Table 8.2.7: Femoral Preparation: The Use of the Traditional Table 8.2.8: Dedicated Surgical Instruments 8.3: Intra-operative Digital Imaging 8.4: Advantages of Anterior Hip Replacement 8.5: Disadvantages of Anterior Hip Replacement 8.6: Conclusions References Chapter 9: Periprosthetic Fractures of the Hip Joint 9.1: Introduction 9.2: Epidemiology 9.2.1: Risk factors 9.3: Classification of Periprosthetic Fractures 9.3.1: The Vancouver Classification System 9.3.2: The Unified Classification System 9.4: Clinical Diagnosis of Periprosthetic Fractures 9.4.1: Investigations 9.5: Treatment 9.5.1: Surgical Approach 9.5.1.1: Pre-operative workup and planning 9.5.2: Non-operative Treatment 9.6: Surgical Management of Periprosthetic Acetabular Fractures 9.6.1: Surgical Considerations in the Management of Periprosthetic Femoral Fractures 9.6.1.1: Treatment of intra-operative femur fractures 9.6.1.2: Treatment of post-operative femur fractures 9.6.2: Post-operative Management 9.6.3: Complications 9.6.4: Prevention 9.7: Current Controversies and Future Considerations References Chapter 10: Periprosthetic Osteolysis after Total Hip Replacement 10.1: Introduction 10.2: Periprosthetic Osteolysis: Current Concepts 10.2.1: Initiation of Osteolysis 10.2.2: Processes Involved in Osteolysis 10.2.3: Cell Types Involved 10.2.4: Alternate Pathways 10.3: Investigation and Monitoring 10.4: Nonsurgical Treatment of Periprosthetic Osteolysis 10.5: Surgical Treatment of Periprosthetic Osteolysis References Chapter 11: Surgical Approaches to the Hip Joint 11.1: Introduction 11.2: The Posterior Approach 11.3: The Direct Lateral Approach 11.4: The Direct Anterior Approach 11.5: Conclusion References Chapter 12: Classifications Used in Total Hip Arthroplasty 12.1: Paprosky Classification of Acetabular Deficiencies for Revision Hip Arthroplasty 12.1.1: Introduction 12.1.2: Classification 12.1.3: Clinical Applications 12.1.4: Reliability 12.2: Saleh Classification of Acetabular Deficiencies for Revision Hip Arthroplasty 12.2.1: Introduction 12.2.2: Classification 12.2.3: Reliability 12.3: Hodgkinson Classification of Radiographic Demarcation of the Socket, Following Total Hip Arthro 12.3.1: Introduction 12.3.2: Classification 12.3.3: Clinical Significance 12.4: Paprosky Classification of Femoral Bone Deficiencies 12.4.1: Introduction 12.4.2: Classification 12.4.3: Clinical Applications 12.5: AAOS Classification of Femoral Bone Deficiencies for Revision Hip Arthroplasty 12.5.1: Introduction 12.5.2: Classification 12.5.3: Clinical Applications 12.5.4: Reliability 12.6: Saleh Classification of Femoral Bone Deficiencies 12.7: Dossick and Dorr Classification of Proximal Femoral Geometry 12.7.1: Introduction 12.7.2: Classification 12.7.3: Clinical Significance 12.8: Vancouver Classification of Intra-operative Periprosthetic Femur Fractures around Total Hip Art 12.8.1: Classification 12.8.2: Clinical Applications 12.9: Vancouver Classification of Post-operative Periprosthetic Femur Fractures around Total Hip Arth 12.9.1: Classification 12.9.2: Clinical Applications 12.9.3: Reliability 12.10: Tsukayama Classification of Infected Hip Joint Prostheses 12.10.1: Introduction 12.10.2: Classification 12.10.3: Clinical Applications 12.11: Brooker’s Classification of Heterotopic Ossification 12.11.1: Introduction 12.11.2: Classification 12.11.3: Clinical Applications 12.11.4: Reliability 12.12: Barrack Grading of Cementing 12.12.1: Introduction 12.12.2: Classification 12.12.3: Clinical Applications 12.13: Crowe Classification of Proximal Migration of the Femoral Head in DDH 12.13.1: Introduction 12.13.2: Classification 12.13.3: Clinical Applications 12.13.4: Reliability 12.14: Hartofilakidis Classification of Hip Dysplasia 12.14.1: Introduction 12.14.2: Classification 12.14.3: Clinical Applications 12.14.4: Reliability References Chapter 13: Total Hip Arhroplasty 13.1: Introduction 13.2: Primary Total Hip Arthroplasty 13.2.1: History 13.2.1.1: Chronology 13.2.2: Indications 13.2.3: Symptoms of Hip Pathology 13.2.4: Signs of Hip Pathology 13.2.5: Radiographic Features of Degenerative Hip Joint Disease 13.2.6: Investigations 13.2.7: Treatment 13.2.7.1: Initial management 13.2.7.2: Medical management 13.2.7.3: Surgical management 13.2.8: Components of Hip Replacement 13.2.9: Types of Hip Replacements 13.2.9.1: Cemented joint replacement 13.2.9.2: Uncemented joint replacement 13.2.9.3: Hybrid replacement 13.2.10: Types of Materials Used in Joint Replacement Surgery 13.2.11: Surgical Approaches 13.2.11.1: Direct lateral transgluteal (Hardinge) approach 13.2.11.2: Posterior approach 13.2.11.3: The Charnley approach 13.2.11.4: Minimally invasive surgery 13.2.11.5: Direct anterior approach 13.2.12: Complications References Chapter 14: Hip Resurfacing 14.1: Introduction 14.2: Rationale 14.3: Patient Selection 14.4: Complications 14.5: Long-Term Prognosis 14.6: Future Developments References Chapter 15: Proximal Femoral Replacement 15.1: Introduction 15.2: History of Proximal Femur Replacements 15.3: Indications 15.4: Contraindications 15.5: Pre-operative Planning 15.5.1: Primary Bone Tumours 15.5.2: Metastatic Bone Tumours 15.5.3: Miscellaneous Conditions 15.6: Surgical Approach 15.6.1: Position 15.6.2: Landmarks and Incision 15.6.2.1: Superficial dissection 15.6.2.2: Deep surgical dissection 15.7: Post-operative Rehabilitation 15.8: Advantages and Disadvantages 15.9: Current Evidence on Proximal Femur Replacements 15.10: Conclusion References Chapter 16: Pelvic and Acetabular Reconstruction Following Oncological Resection 16.1: Introduction 16.2: Allografts and APC 16.3: Autografts 16.4: The Harrington Procedure 16.5: Pedestal Cups 16.6: Saddle Prosthesis 16.7: Salvage 16.8: Conclusion References Chapter 17: Complications of Hip Arthroscopy 17.1: Introduction 17.2: Traction and Perineal Post-Related Complications 17.3: Portal-Related Neurovascular Complications 17.4: Iatrogenic Labral and Chondral Injury 17.5: Fluid Extravasation 17.6: Iatrogenic Hip Instability 17.7: Complications of the Femoral Head and Neck: Osteonecrosis, Chondrolysis and Fracture 17.8: Deep Venous Thrombosis 17.9: Infection 17.10: Heterotopic Ossification 17.11: Re-admission 17.12: Other Complications 17.13: Closing Remarks and Future Directions References Chapter 18: Femoral Neck-Lengthening Osteotomies around the Hip Joint 18.1: Introduction 18.2: Evaluation of Femoral Deformities 18.3: Indication for Surgery 18.4: Mechanical Effects of Proximal Femoral Osteotomy 18.5: Types of Proximal Femoral Deformities 18.6: Classification of Proximal Femoral Osteotomies 18.7: Relative Femoral Neck-Lengthening and Greater Trochanter Distalisation Osteotomies 18.7.1: Wagner Osteotomy 18.7.2: Morscher Osteotomy 18.7.3: Ganz Relative Neck-Lengthening Osteotomy 18.8: Contractures around the Hip 18.9: Conclusion References Chapter 19: Hip-Preserving Surgery 19.1: Introduction 19.2: Anatomical Considerations and Surgical Approaches in Hip Preservation Surgery 19.3: The Scope of Hip Preservation Surgery 19.3.1: Hip Arthroscopy and Arthroscopic Procedures 19.3.1.1: Arthroscopic FAI management and arthroscopic osteochondroplasty 19.3.1.2: Arthroscopic cartilage implantation and microfracture for cartilage growth stimulation 19.4: Open Hip Preservation Procedures 19.4.1: Osteotomies to Manage Hip Acetabular Alignment and Cup Head Inclinations 19.4.1.1: Femoral osteotomies 19.4.1.2: Peri-acetabular osteotomies and DDH management 19.4.2: Preservation Surgery to Manage and Prevent Osteoarthritis 19.5: Rehabilitation Following Hip Preservation Surgery 19.6: Complications and Managing Complications of Hip Preservation Surgery 19.7: Concluding Notes References Chapter 20: Extracorporeal Shockwave Treatment of the Hip 20.1: History 20.2: Physics of Shockwaves 20.3: Mechanism of Action 20.3.1: Shockwave Treatment for Tendinopathy 20.3.2: Shockwave Treatment for Bone Healing 20.4: Clinical Indications 20.5: Greater Trochanteric Pain Syndrome 20.5.1: Introduction 20.5.2: Aetiology 20.5.3: Differential Diagnosis 20.5.4: Investigation 20.5.5: Treatment 20.5.6: Technique 20.5.7: Results 20.5.8: Conclusion 20.6: Avascular Bone Necrosis 20.6.1: Introduction 20.6.2: Aetiology 20.6.3: Classification 20.6.4: Differential Diagnosis 20.6.5: Investigations 20.6.6: Treatment 20.6.6.1: Conservative treatment 20.6.6.2: ESWT 20.6.6.3: Surgery 20.6.7: Technique 20.6.8: Results 20.6.9: Conclusion 20.7: Common Empirically Tested Clinical Uses 20.7.1: Tendon Pathologies 20.7.1.1: Adductor insertional tendinopathy syndrome 20.7.1.2: Hamstring tendinopathy 20.7.2: Bone Pathologies 20.7.2.1: Bone marrow oedema syndrome 20.8: Complications 20.9: Conclusions References Chapter 21: Sports Medicine of the Hip Joint 21.1: Introduction 21.2: Epidemiology 21.3: Functional Anatomy 21.3.1: Morphology 21.3.2: Acetabular Labrum 21.3.3: Ligaments of the Hip 21.3.4: Chondral Surface 21.3.5: Muscle Function 21.3.6: Short Hip-Stabilising Muscles 21.3.7: Clinical Biomechanics 21.4: Clinical Approach 21.4.1: History 21.4.2: Physical Examination 21.4.3: Key Outcome Measures 21.4.4: Investigations 21.5: Predisposing Factors for Hip Pain 21.5.1: Local Factors 21.5.2: Remote Factors 21.5.3: Proximal Factors 21.5.4: Distal Factors 21.5.5: Systemic Factors 21.6: Hip Pathologies 21.6.1: Femoro-Acetabular Impingement 21.6.1.1: Types of FAI-cam and pincer impingement 21.6.1.2: Prevalence of FAI 21.6.1.3: Aetiology 21.6.1.4: Association with pain and pathology 21.6.2: Osteoarthritis 21.6.3: Acetabular Labral Tears 21.6.3.1: Pathology 21.6.4: Ligamentum Teres Tears 21.6.5: Synovitis 21.6.6: Chondropathy 21.6.7: Hip Instability 21.7: Treatment 21.7.1: Principles of Rehabilitation of the Injured Hip 21.7.2: Nine Principles of Rehabilitation for Hip Pain Patients 21.7.2.1: Restore the hip range of motion 21.7.2.2: Restore hip muscle strength 21.7.3: Improve Balance and Proprioception 21.7.4: Improve Hip Control in Functional Task Performance 21.7.5: Improve Trunk Muscle Strength 21.7.6: Optimise Gait Biomechanics 21.7.7: Optimise Functional Task Performance 21.7.8: Address Adverse Loading 21.7.9: Address Other Remote Factors That May Be Altering the Function of the Kinetic Chain 21.7.10: Criteria for Returning to Sport as the Final Stage of Hip Rehabilitation 21.7.11: Surgical Management of the Injured Hip 21.7.11.1: Rehabilitation following hip arthroscopy 21.8: Some Other Major Pathologies 21.8.1: Proximal Hamstring Tendinopathy 21.8.1.1: Examination 21.8.1.2: Treatment 21.8.2: Sacroiliac Joint Dysfunction 21.8.2.1: Functional anatomy 21.8.2.2: Clinical features 21.8.2.3: Treatment 21.8.3: Myofascial Pain 21.8.3.1: Examination 21.8.3.2: Treatment of myofascial buttock pain 21.8.4: Lateral Hip Pain 21.8.4.1: Greater trochanteric pain 21.8.4.2: Iliac crest pain 21.8.4.3: Examination of the patient with lateral hip pain 21.8.4.4: Treatment of the patient with lateral hip pain 21.8.4.5: Managing pain 21.8.4.6: Managing load: First-line treatment 21.9: Less Common Causes of Hip Region Pain 21.9.1: Piriformis Syndrome 21.9.2: Ischiofemoral Impingment 21.9.2.1: Treatment 21.9.3: Proximal Hamstring Tendon Rupture 21.9.3.1: Treatment 21.9.4: Avulsion Fracture of the Ischial Tuberosity 21.9.5: Stress Fracture of the Sacrum 21.9.5.1: Diagnosis confirmed by MRI and CT scans 21.10: Groin Pain in Athletes 21.10.1: Terminology 21.10.2: Classification 21.10.3: Clinical Overview 21.10.3.1: Pain pattern 21.10.3.2: Where is the pain located? 21.10.3.3: Assessment of severity 21.10.3.4: Strength 21.10.3.5: Range of motion 21.10.3.6: Patient-reported outcome measures 21.10.3.7: Imaging 21.10.3.8: Radiography 21.10.3.9: Magnetic resonance imaging 21.10.3.10: Ultrasonography 21.10.3.11: Computed tomography scan 21.10.4: Acute Groin Injuries 21.10.4.1: Diagnosis 21.10.5: Long-Standing Groin Pain 21.10.5.1: Adductor-related groin pain 21.10.5.2: lliopsoas-related groin pain 21.10.5.3: Inguinal-related groin pain 21.10.5.4: Pubic-related groin pain 21.11: Less Common Injuries 21.11.1: Complete Adductor Avulsion 21.11.2: Obturator Neuropathy 21.11.3: Other Nerve Entrapments 21.11.4: Stress Fracture of the Neck of the Femur 21.11.5: Stress Fracture of the Inferior Pubic Ramus 21.11.6: Referred Pain to the Groin 21.12: Prevention of Groin Injuries 21.12.1: Possible Prevention Strategies References Chapter 22: Evaluation of a Painful Total Hip Replacement 22.1: Introduction 22.2: Differential Diagnosis 22.3: Intrinsic Causes 22.3.1: Aseptic Loosening 22.3.2: Infection 22.3.3: Instability 22.3.4: Peri-prosthetic Fractures 22.3.5: Inflammatory Conditions 22.3.6: Stem Tip Pain: Thigh Pain 22.3.7: Metal-on-Metal 22.4: Extrinsic Causes 22.5: Initial Assessment 22.5.1: History 22.5.2: Examination 22.6: Investigations 22.6.1: Blood Tests 22.6.2: Plain Radiography 22.6.3: Nuclear Medicine 22.6.4: Hip Aspiration/Anaesthetic Injection 22.6.5: Computed Tomography 22.6.6: Magnetic Resonance Imaging 22.7: Summary References Chapter 23: Robotic-Assisted Surgery in Orthopaedics 23.1: Introduction 23.2: Total Hip Arthroplasty 23.2.1: Types of Robotic Systems 23.2.2: Conventional THA vs. Robotic THA 23.2.3: Surgical Technique: MAKO THR 23.2.3.1: Pre-operative requirements 23.2.3.2: Acetabular planning 23.2.3.3: Femoral planning 23.2.3.4: Surgical approach 23.2.3.5: Femoral workflow 23.2.3.6: Operating room layout 23.2.3.7: Acetabular reaming 23.2.3.8: Femoral preparation 23.2.4: Implant Positioning and Hip Biomechanics 23.2.5: Functional and Radiological Outcomes 23.2.5.1: Earlier studies 23.2.5.2: Recent studies 23.3: Limitations 23.4: Hip Arthroscopy 23.5: Summary References Chapter 24: Computer Navigation in Hip Arthroplasty 24.1: Introduction 24.2: Limitations of Conventional Alignment Jigs 24.3: Types of Computer Navigation Systems 24.3.1: Computer Navigation in Total Hip Arthroplasty 24.3.2: Computer Navigation in Total Hip Resurfacing 24.3.3: Limitations of Computer Navigation Systems 24.4: Conclusion References Chapter 25: Surgical Advancements in Hip Arthroscopy and FAI Syndrome: Indications and Technique for Labral Rec 25.1: Introduction 25.2: Anatomical Overview of the Labrum 25.3: Biomechanical Evidence and Rationale for Labral Reconstruction 25.4: Indications 25.5: Surgical Technique 25.5.1: Patient Positioning and Anaesthesia 25.5.2: Diagnostic Arthroscopy 25.5.3: Acetabuloplasty 25.5.4: Femoroplasty 25.5.5: Labral Reconstruction 25.5.6: Suture Management 25.5.7: Measurement Technique 25.5.8: Graft Preparation 25.5.9: Graft Insertion 25.6: Outcomes 25.7: Conclusion References Chapter 26: Fracture Neck of the Femur 26.1: Introduction 26.2: Epidemiology 26.3: Risk Factors for Fragility Fractured Neck of the Femur 26.3.1: Osteoporosis as a Risk Factor for Fracture Neck of the Femur 26.3.1.1: Bony trabeculae of the proximal femur: The Singh index 26.3.1.2: DEXA scan in diagnosing osteoporosis 26.4: Mechanism of Injury 26.4.1: Associated Injuries 26.5: Fracture Classification 26.5.1: Intracapsular Fracture Classification 26.5.1.1: Garden’s classification 26.5.1.2: Pauwel’s classification 26.5.2: Extracapsular Fracture Classification 26.5.2.1: Intertrochanteric fractures 26.5.2.2: Evan’s classification 26.5.2.3: Subtrochanteric fractures 26.5.2.4: All-encompassing classification: AO classification 26.6: Clinical Presentation 26.7: Diagnosis 26.8: Management of Fracture Neck of Femur 26.8.1: Assessment and Management in the Emergency Department and the Orthopaedic Ward 26.8.2: Timing of Surgery 26.8.3: Definitive Management of Intracapsular NOF in the Elderly 26.8.3.1: Nondisplaced intracapsular fracture NOF 26.8.4: Definitive Management of Displaced Intracapsular NOF in the Elderly 26.8.5: Surgical Approaches for NOF Arthroplasty 26.8.6: Definitive Management of Intertrochanteric Fracture NOF 26.8.6.1: Extramedullary devices 26.8.6.2: Intramedullary devices 26.8.6.3: Arthroplasty 26.8.6.4: Reverse oblique type of trochanteric fracture 26.8.7: Definitive Management of Subtrochanteric Fracture NOF 26.9: Complications of Femoral Neck Fractures and Treatment 26.10: Intracapsular Fractures in Young Adults 26.10.1: Who Are Young Patients? 26.10.2: Timing of Surgery 26.10.3: Role of Capsulotomy 26.10.4: Implant Choice 26.11: Stress Fractures of the Femoral Neck 26.11.1: Definition, Presentation and Risk Factors 26.11.2: Diagnosis 26.11.3: Treatment and Prognosis 26.12: Pathological Fracture NOF 26.12.1: Neoplastic Fracture 26.12.2: Atypical Femoral Fracture 26.13: Ipsilateral Fracture of the Femoral Shaft and Neck 26.13.1: Diagnosis 26.13.2: Complications 26.13.3: Management References Chapter 27: Conversion of Hip Arthrodesis to Total Hip Arthroplasty 27.1: Introduction 27.2: Indications and Contra-indications 27.3: Pre-operative Assessments and Planning 27.3.1: Physical Examination 27.3.2: Imaging 27.4: Surgical Technique 27.4.1: Surgical Exposure 27.4.2: Acetabular and Femoral Preparation and Implantation 27.5: Clinical Results 27.5.1: Pain Relief in Adjacent Joints 27.5.2: Functional Recovery and Patient Satisfaction 27.5.3: Prognosis and Survival of the Converted Hip 27.6: Complications 27.7: Conclusions References Chapter 28: The Direct Anterior Approach to the Hip 28.1: Introduction 28.1.1: Background 28.1.2: History 28.1.3: Resurgence of the Approach 28.1.4: Key Advantages and Disadvantages 28.2: The Approach 28.2.1: Indications and Contraindications 28.2.2: Anatomy 28.2.3: The Traditional Approach 28.2.3.1: Position 28.2.3.2: Incision 28.2.3.3: Approach 28.2.3.4: The internervous plane 28.2.3.5: Capsule arthrotomy 28.2.3.6: Dislocation 28.2.3.7: Surgical procedures 28.2.3.8: Closure 28.2.4: Modifications, New Instrumentation and Minimally Access Approach [17] 28.2.4.1: Incision 28.2.4.2: Approach 28.2.4.3: The internervous plane 28.2.4.4: Capsule arthrotomy 28.2.4.5: Closure 28.2.4.6: Rehabilitation protocol 28.3: Complications 28.4: Pearls and Pitfalls 28.5: Conclusions References Chapter 29: Modified PLOP Osteotomy Approach to the Hip 29.1: Introduction 29.2: The Posterior Hip Anatomy 29.3: Proximal Femur Anatomy 29.4: Development of the Osteotomy of the Posterolateral Overhanging Part of Greater Trochanter 29.5: Modified PLOP Osteotomy Approach Procedures 29.6: Indications for the Modified PLOP Osteotomy Approach References Chapter 30: Single-Incision Piriformis-Sparing Posterior THA 30.1: Introduction 30.2: Surgical Technique 30.3: Supporting Evidence 30.3.1: Efficacy of the Piriformis-Sparing Surgical Approach 30.3.2: Integrity of SER Repair 30.3.3: The Impact of Preserving the Piriformis 30.3.4: Relative Benefit Compared to the Standard Posterior Approach 30.3.5: Long-Term Results 30.4: Discussion 30.5: Summary References Chapter 31: Imaging of the Hip Joint 31.1: Introduction 31.2: Anatomy of the Pelvis 31.3: MRI Anatomy of the Hip 31.3.1: Muscles and Tendons 31.3.2: The Labrum References Chapter 32: Neoplastic Conditions around the Hip 32.1: Introduction 32.2: Osteogenic Tumours 32.2.1: Bone Islands 32.2.2: Osteoid Osteoma and Osteoblastoma 32.2.3: Conventional Osteosarcoma 32.2.4: Surface Osteosarcoma 32.2.5: Periosteal Osteosarcoma 32.2.6: Telangiectatic Osteosarcoma 32.2.7: Low-Grade Osteosarcoma 32.2.8: Secondary Osteosarcoma 32.2.9: Small-Cell Osteosarcoma 32.3: Ewing’s Sarcoma 32.4: Cartilage Tumours 32.4.1: Osteochondroma 32.4.2: Enchondroma 32.4.3: Chondroblastoma 32.4.4: Chondrosarcoma 32.5: Giant-Cell Tumour 32.6: Fibrogenic and Fibrocystic Tumours 32.6.1: Fibrous Cortical Defect 32.6.2: Desmoblastic Fibroma/Benign Fibrohistiocytoma 32.6.3: Malignant Fibrohistiocytoma 32.6.4: Aneurysmal Bone Cyst 32.6.5: Unicameral Bone Cyst 32.6.6: Fibrous Dysplasia 32.6.7: Angiosarcoma 32.6.8: Haemangioma 32.7: Myeloma 32.8: Lymphoma 32.9: Metastasis 32.10: Brown Tumour 32.11: Osteomyelitis 32.12: Fractures 32.13: Stress Fractures 32.14: Myositis Ossificans 32.15: ALVAL 32.16: Paget’s Disease 32.17: Soft-Tissue Sarcoma 32.18: Synovial Chondromatosis References Index