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Book Details
Abstract
Surgery of the Hip is your definitive, comprehensive reference for hip surgery, offering coverage of state-of-the-art procedures for both adults and children. Modelled after Insall & Scott Surgery of the Knee, it presents detailed guidance on the latest approaches and techniques, so you can offer your patients - both young and old - the best possible outcomes.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices.
- Master the latest methods such as the use of fixation devices for proximal femoral fractures, hip preservation surgery, and problems with metal on metal-bearing implants.
- Make optimal use of the latest imaging techniques, surgical procedures, equipment, and implants available.
- Navigate your toughest clinical challenges with vital information on total hip arthroplasty, pediatric hip surgery, trauma, and hip tumor surgery.
- Browse the complete contents online, view videos of select procedures, and download all the images at www.expertconsult.com!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Surgery of the Hip | i | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Section Editors | vi | ||
| Contributors | vii | ||
| Foreword | xvii | ||
| Preface | xix | ||
| Acknowledgments | xxi | ||
| Table of Contents | xxiii | ||
| I Basic Science | 1 | ||
| 1 Biomechanics of the Natural Hip Joint | 2 | ||
| Key Points | 2 | ||
| Introduction | 2 | ||
| Kinematics of the Normal and Diseased Hip | 2 | ||
| Gender/Racial Differences | 3 | ||
| Structures Controlling Hip Motion | 4 | ||
| The Hip Capsule and Ligaments | 4 | ||
| The Acetabular Labrum | 4 | ||
| The Ligamentum Teres | 6 | ||
| Hip Joint Motion During Normal Gait | 6 | ||
| The Role of Muscles in Hip Motion | 7 | ||
| Extension | 7 | ||
| Abduction | 7 | ||
| Flexion and Adduction | 7 | ||
| Pelvic Motion | 7 | ||
| Joint Motion, Gait, and Functional Adaptations | 7 | ||
| Pathologic Impediments to Joint Motion | 8 | ||
| Femoroacetabular Impingement | 8 | ||
| Acetabular Retroversion | 11 | ||
| Kinetics of the Normal Hip | 12 | ||
| Forces Acting Across the Hip Joint | 12 | ||
| Contributions of the Hip Muscles | 14 | ||
| Factors Affecting the Hip Reaction Force | 14 | ||
| The Pathomechanics of Coxarthrosis | 14 | ||
| Effects of Deformities on Forces and Articular Stresses | 15 | ||
| References | 16 | ||
| 2 Biomechanics of the Artificial Hip Joint | 19 | ||
| Key Points | 19 | ||
| Introduction | 19 | ||
| The Basic Science of the Hip Joint | 20 | ||
| Musculoskeletal Loading Conditions at the Hip | 20 | ||
| Background | 20 | ||
| Determination of Internal Loading Conditions | 20 | ||
| Biomechanics of the Proximal Femur | 22 | ||
| Influence of Joint Reconstruction on Biomechanics of the Artificial Joint | 24 | ||
| Reconstruction of the Joint Center | 24 | ||
| Femoral Anteversion | 25 | ||
| Strains and Stresses in the Artificial Hip Joint | 25 | ||
| Influence of Muscle Forces on Femoral Strain Distribution | 25 | ||
| Influence of Altered Anteversion and Offset on Stresses and Strains in the Artificial Joint | 26 | ||
| Anatomically Reconstructed Joint. | 27 | ||
| Joint Reconstruction With Increased Femoral Offset and Anteversion. | 27 | ||
| Short-Stemmed Implants in THA from a Biomechanical Point of View | 30 | ||
| Current Controversies and Future Directions | 31 | ||
| References | 32 | ||
| 3 Tribology of the Artificial Hip Joint | 35 | ||
| Key Points | 35 | ||
| Introduction | 35 | ||
| Basic Science | 35 | ||
| Definition of Terms | 35 | ||
| The Hip Bearing as a Tribological System | 39 | ||
| Wear Mode and Mechanisms | 39 | ||
| System Output | 40 | ||
| Lubrication Regime | 40 | ||
| Wear in Hip Bearings | 41 | ||
| Testing Procedures | 42 | ||
| Screening Wear Tests | 42 | ||
| Pin-on-Flat Wear Test. | 42 | ||
| Pin-on-Disk Configuration. | 43 | ||
| Biaxial Pin-on-Ball Wear Test. | 44 | ||
| Hip Joint Wear Simulators | 45 | ||
| Load Profiles. | 47 | ||
| The Lubricant. | 47 | ||
| Standards. | 50 | ||
| Current Controversies and Future Directions | 50 | ||
| Acknowledgment | 51 | ||
| References | 51 | ||
| Suggested Reading | 52 | ||
| 4 Materials in Hip Surgery: | 54 | ||
| Key Points | 54 | ||
| Introduction | 54 | ||
| Cement Polymerization and Types of Bone Cement | 55 | ||
| Properties of Polymethylmethacrylate Bone Cement | 57 | ||
| Heat Generation | 57 | ||
| Cement Shrinkage | 57 | ||
| Mechanical Properties | 57 | ||
| The Static Properties of Bone Cement | 57 | ||
| Strength and Elasticity. | 57 | ||
| Creep and Stress Relaxation. | 59 | ||
| Dynamic Properties of Bone Cement | 59 | ||
| Effects of Sterilization on Mechanical Properties of Bone Cement | 60 | ||
| Additives in Bone Cement | 60 | ||
| Opacifiers | 60 | ||
| Antibiotics | 60 | ||
| Mechanical Properties of Antibiotic-Loaded Cement. | 62 | ||
| Infection Prevention With Antibiotic-Loaded Cement. | 62 | ||
| Infection Treatment With Antibiotic-Loaded Cement. | 62 | ||
| Cement Defects and Pores | 63 | ||
| Cement Interfaces | 63 | ||
| The Cement-Bone Interface | 63 | ||
| The Cement-Implant Interface | 64 | ||
| Current Controversies and Future Directions | 64 | ||
| Conclusion | 65 | ||
| References | 66 | ||
| 5 Materials in Hip Surgery: | 69 | ||
| Key Points | 69 | ||
| Introduction | 69 | ||
| The History of Bearing Materials | 69 | ||
| UHMWPE | 70 | ||
| Uhmw Resins | 70 | ||
| 1900 Resins | 71 | ||
| Characteristics and Properties of UHMWPE | 71 | ||
| Molecular Weight | 71 | ||
| Physical Properties | 71 | ||
| Fabrication Methods | 72 | ||
| Extrusion and Machining. | 72 | ||
| Sheet Compression Molding. | 72 | ||
| Direct Compression Molding. | 72 | ||
| Sterilization Methods and Oxidation | 72 | ||
| Modifications to Ultra-High-Molecular-Weight Polyethylene | 74 | ||
| Carbon-Reinforced | 74 | ||
| Highly Crystalline | 74 | ||
| Highly Cross-Linked | 74 | ||
| Acetylene Cross-Linked: Grobbelar and Weber | 75 | ||
| Contemporary Materials: Highly Cross-Linked Uhmwpe | 75 | ||
| How Much Wear Resistance Do You Need? | 76 | ||
| Current Controversies of Highly Cross-Linked UHMWPE | 76 | ||
| Controversy 1. Will Highly Cross-Linked UHMWPE Eliminate or Reduce the Incidence of Osteolysis Over the Long Term? | 76 | ||
| Controversy 2. Highly Cross-Linked UHMWPE Is More Prone to Fracture and Fatigue | 77 | ||
| Vitamin E–Doped Highly Cross-Linked Uhmwpe | 78 | ||
| Appendix 5-1 Commercial Formulations of Conventional UHMWPE Used in THR | 80 | ||
| Appendix 5-2 Commercially Available Formulations of Highly Cross-Linked UHMWPE | 81 | ||
| References | 82 | ||
| 6 Materials in Hip Surgery: | 85 | ||
| Key Points | 85 | ||
| Introduction | 85 | ||
| Basic Science | 85 | ||
| Metallic Structures | 85 | ||
| Defects in Crystal Structures and Alloying | 86 | ||
| Strengthening Mechanisms | 87 | ||
| Grain Size Effects | 87 | ||
| Solid Solution Strengthening | 87 | ||
| Work Hardening/Cold Working | 88 | ||
| Precipitation Dispersion Strengthening | 88 | ||
| Orthopedic Implant Alloy Compositions and Microstructures | 88 | ||
| Mechanical Properties | 91 | ||
| Static Mechanical Properties | 91 | ||
| Dynamic Mechanical Properties | 92 | ||
| Corrosion Properties | 95 | ||
| Current Controversies and Future Directions | 98 | ||
| Future Directions | 98 | ||
| Stainless Steels | 98 | ||
| Titanium Alloys | 99 | ||
| Acknowledgments | 99 | ||
| References | 99 | ||
| 7 Materials in Hip Surgery: | 102 | ||
| Key Points | 102 | ||
| Introduction | 102 | ||
| Properties of Ceramic Implants | 102 | ||
| Ceramic Total Hip Replacement Developments in the United States | 104 | ||
| Strength, Toughness, and Safety Issues in Ceramic Implants | 104 | ||
| Ceramic Tribological Properties | 105 | ||
| Mechanics in the Tribology of Ceramic Cups | 105 | ||
| Validating Laboratory Wear Performance With Ceramic Clinical Results | 106 | ||
| The Significance of Stripe Wear in Ceramic Total Hip Replacement | 108 | ||
| Wear Stripes Created In Vivo | 108 | ||
| Wear Stripes Created in the Laboratory | 109 | ||
| Overall Risks and Benefits of Ceramic Total Hip Replacement | 109 | ||
| Fracture Risk of Ceramic Total Hip Replacement | 109 | ||
| Cup Impingement as a Risk to Ceramic Liners | 112 | ||
| Squeaking and Osteolytic Risks With Ceramic Total Hip Replacement | 113 | ||
| Phase Transformation Studies in Retrieved Alumina Matrix Composite Implants | 113 | ||
| Acknowledgments | 115 | ||
| References | 115 | ||
| Suggested Reading | 117 | ||
| 8 Materials in Hip Surgery: | 119 | ||
| Key Points | 119 | ||
| Introduction | 119 | ||
| Basic Science | 119 | ||
| Metallurgy | 119 | ||
| Wear Mechanisms | 120 | ||
| Wear Performance | 120 | ||
| Implant Design Factors | 121 | ||
| Diameter | 121 | ||
| Clearance | 122 | ||
| Inclusion Angle | 122 | ||
| Effects of Patient Activity | 123 | ||
| Effects of Component Positioning | 124 | ||
| Current Controversies and Future Directions | 125 | ||
| Current Controversies | 125 | ||
| Effects of Elevated Wear | 125 | ||
| Future Directions | 126 | ||
| Ceramic-on-Metal Hip Replacements | 126 | ||
| Aspheric Bearings | 126 | ||
| Surface Coatings | 126 | ||
| References | 126 | ||
| 9 Materials in Hip Surgery: | 129 | ||
| Key Points | 129 | ||
| Introduction | 129 | ||
| Implant Surface Design for Cementless Fixation | 130 | ||
| Factors Influencing Bone Ingrowth/ongrowth | 131 | ||
| Surface Design—ingrowth Versus Ongrowth: the Effects of Local Tissue Strain on Osteogenesis | 131 | ||
| Relative Micromovement and Bone Ingrowth/Ongrowth | 132 | ||
| Pore Geometry Effect | 132 | ||
| Pore Size | 132 | ||
| Pore Shape/Surface Morphology | 132 | ||
| Materials for Forming Porous Structures | 133 | ||
| Stress Shielding and Implant Fixation | 133 | ||
| Closeness of Fit: Effect of Interface Gap | 133 | ||
| Fabrication of Cementless Implants | 133 | ||
| CoCrMo Powder–Made Porous Coatings | 134 | ||
| Ti and Ti Alloy Powder-Made Porous Coatings | 135 | ||
| Ti Fiber Metal Composite Coatings | 137 | ||
| Orderly Oriented Wire Mesh (OOWM) Coatings | 137 | ||
| Cast CoCrMo structures | 138 | ||
| Novel Open-Pored Hip Implant Components: Porous Scaffold Designs | 138 | ||
| Bone Ongrowth Structures | 139 | ||
| Plasma Spray Deposition | 139 | ||
| Future Considerations | 141 | ||
| 1. Increasing Osteoconductivity | 141 | ||
| 2. Increasing Osteoinductivity | 141 | ||
| 3. Scaffold-Like Implants for Joint Replacements | 141 | ||
| 4. Infection Resistance | 142 | ||
| Summary | 142 | ||
| References | 142 | ||
| 10 Materials in Hip Surgery: | 145 | ||
| Key Points | 145 | ||
| Introduction | 145 | ||
| Basic Science of Bioactive Coatings | 146 | ||
| Definitions | 146 | ||
| Biological Response to Implants | 146 | ||
| In Situ Modification of Implant Surfaces | 147 | ||
| Bone Repair and Regeneration | 147 | ||
| Surface Topography | 148 | ||
| Surface Chemistry | 149 | ||
| Calcium Phosphate Surfaces | 149 | ||
| Bioactive Glasses | 151 | ||
| Oxidized Surfaces | 152 | ||
| Functionalized (Biomimetic) Surfaces | 152 | ||
| Antibacterial Surface Treatments | 152 | ||
| Current Controversies and Future Directions | 153 | ||
| References | 154 | ||
| 11 Biological Responses to Particle Debris | 157 | ||
| Key Points | 157 | ||
| Introduction | 157 | ||
| Overview | 157 | ||
| Basic Science | 157 | ||
| The Bone-Implant Interface: Histology, Cell, and Molecular Biology | 157 | ||
| In Vivo Animal Models and In Vitro Studies | 160 | ||
| In Vivo Studies | 160 | ||
| In Vitro Studies | 161 | ||
| Pressure. | 161 | ||
| Particles, Endotoxin, and Bacterial By-products | 162 | ||
| Recent Developments in Particle Disease: New Models and New Concepts | 162 | ||
| Models of Continuous Delivery of Particles In Vivo | 162 | ||
| Cell Migration (Trafficking) in the Presence of Wear Particles | 162 | ||
| Potential Nonsurgical Treatments for Particulate Disease | 163 | ||
| Modulation of Inflammatory Factors | 164 | ||
| Inhibition of Eicosanoids | 164 | ||
| Modulation of Cytokines | 164 | ||
| Modulation of Growth Factor Expression | 165 | ||
| Bisphosponates | 165 | ||
| Drugs That Modulate Other Cellular Functions | 165 | ||
| Summary | 166 | ||
| References | 166 | ||
| 12 Biological Responses to Metal Debris and Metal Ions | 171 | ||
| Key Points | 171 | ||
| Introduction | 171 | ||
| Basic Science of Wear Debris | 171 | ||
| Polyethylene Wear and Osteolysis | 171 | ||
| Historical Background | 171 | ||
| Cellular Mechanisms of Osteolysis | 172 | ||
| Analysis of First-Generation Metal-On-Metal Total Hips | 172 | ||
| How Cobalt-Chromium Products Are Formed | 173 | ||
| The Fate of Particles Entering the Joint | 173 | ||
| Cobalt and Chromium Ions in Patients with Metal-On-Metal Implants | 175 | ||
| Metal Wear Products and Cancer | 175 | ||
| Metal Hypersensitivity (Allergy) | 175 | ||
| ALVAL: A Unique Form of Metal Allergy? | 176 | ||
| Cellular and Immune System Reaction to Metal Wear Debris and Ions | 176 | ||
| Toxicity and Necrosis | 176 | ||
| Pseudotumors: Allergy or Wear? | 177 | ||
| Cobaltism | 178 | ||
| Summary | 179 | ||
| References | 179 | ||
| 13 Bone Grafts in Hip Surgery | 182 | ||
| Key Points | 182 | ||
| Introduction | 182 | ||
| Historical Perspective | 182 | ||
| Bone Autograft | 182 | ||
| Allograft | 183 | ||
| Impaction Bone Grafting | 183 | ||
| Results | 183 | ||
| Acetabular Side | 183 | ||
| Femoral Side | 183 | ||
| Structural Allografts | 184 | ||
| Acetabular Side | 184 | ||
| Femoral Side | 185 | ||
| Basic Science | 189 | ||
| Autograft Bone | 189 | ||
| General Biology | 189 | ||
| Cancellous Autograft | 189 | ||
| Cortical Autograft | 191 | ||
| Allograft | 191 | ||
| General Biology | 191 | ||
| Bone Banks | 191 | ||
| Infection Risks and Sterilization Methods | 191 | ||
| Immune Response and Graft Processing | 192 | ||
| Cancellous Bone Allograft | 192 | ||
| Cortical Bone Allograft | 192 | ||
| Factors Affecting Graft Incorporation | 192 | ||
| Revascularization of the Substance of the Graft | 193 | ||
| New Bone Formation | 193 | ||
| Host-Graft Union | 193 | ||
| Impairment of Bone Graft Healing | 193 | ||
| Current Controversies and Future Directions | 193 | ||
| References | 194 | ||
| II Anatomy and Operative Approaches | 199 | ||
| 14 Normal Hip Embryology and Development | 200 | ||
| Key Points | 200 | ||
| Introduction | 200 | ||
| The Embryonic Phase of Prenatal Development | 200 | ||
| The Fetal Phase of Prenatal Development | 201 | ||
| Femoral Anteversion | 202 | ||
| Neck Shaft Angle | 202 | ||
| Postnatal Development | 203 | ||
| Acetabulum | 203 | ||
| Femur | 203 | ||
| Blood Supply | 204 | ||
| Femoral | 204 | ||
| Acetabular | 204 | ||
| Developmental Dysplasia of the Hip | 205 | ||
| Perthes Disease | 207 | ||
| Slipped Capital Femoral Epiphysis | 208 | ||
| References | 211 | ||
| 15 Anatomy of the Hip | 213 | ||
| Key Points | 213 | ||
| Introduction | 213 | ||
| Surface Anatomy | 213 | ||
| Osseous and Ligamentous Anatomy | 213 | ||
| Musculature | 215 | ||
| Gluteal Musculature | 215 | ||
| Anterior Compartment | 216 | ||
| Medial Compartment | 216 | ||
| Posterior Compartment | 217 | ||
| Vascular Anatomy | 218 | ||
| Neuroanatomy | 221 | ||
| Further Reading | 222 | ||
| 16 Exposures of the Acetabulum | 223 | ||
| Key Points | 223 | ||
| Ilioinguinal Approach | 223 | ||
| Indications | 223 | ||
| Positioning | 223 | ||
| Landmarks | 223 | ||
| Technique | 223 | ||
| Helpful Hints | 227 | ||
| Stoppa Approach | 228 | ||
| Indications | 228 | ||
| Positioning | 228 | ||
| Landmarks | 228 | ||
| Technique | 228 | ||
| Helpful Hints | 229 | ||
| Approach to the Posterior Pelvis (Kocher-Langenbeck Approach) | 229 | ||
| Indications | 229 | ||
| Positioning | 229 | ||
| Landmarks | 229 | ||
| Technique | 229 | ||
| Helpful Hints | 232 | ||
| Extended Iliofemoral Approach | 232 | ||
| Indications | 232 | ||
| Positioning | 232 | ||
| Landmarks | 232 | ||
| Technique | 232 | ||
| Helpful Hints | 234 | ||
| References | 235 | ||
| 17 Direct Anterior Primary Total Hip Arthroplasty | 236 | ||
| Key Points | 236 | ||
| Introduction | 236 | ||
| Indications and Contraindications | 236 | ||
| Preoperative Planning | 237 | ||
| Operative Technique | 237 | ||
| Variations/Unusual Situations | 242 | ||
| Postoperative Care | 242 | ||
| Results | 242 | ||
| Current Controversies and Future Considerations | 243 | ||
| Complications | 243 | ||
| Conclusion | 243 | ||
| References | 243 | ||
| 18 Anterolateral Approach for Primary Total Hip Replacement | 245 | ||
| Key Points | 245 | ||
| Introduction and History | 245 | ||
| Patient Selection | 245 | ||
| Positioning | 245 | ||
| Surgical Anatomy | 245 | ||
| Special Considerations | 247 | ||
| Limitations | 247 | ||
| Summary of Benefits | 247 | ||
| References | 248 | ||
| 19 Posterior Approaches to the Hip | 249 | ||
| Key Points | 249 | ||
| Introduction | 249 | ||
| Historical Background of the Posterior Approach to the Hip | 249 | ||
| Surgical Anatomy of the Posterior Approach to the Hip | 250 | ||
| Muscular Anatomy | 250 | ||
| Neurovascular Anatomy | 250 | ||
| Surgical Technique | 251 | ||
| Patient Positioning | 251 | ||
| Incisions | 251 | ||
| Acetabular Exposure | 253 | ||
| Femoral Exposure | 254 | ||
| Extensile Exposures | 254 | ||
| Current Controversies and Future Directions | 255 | ||
| References | 255 | ||
| 20 Trochanteric Osteotomy | 257 | ||
| Key Points | 257 | ||
| Introduction | 257 | ||
| Indications/Contraindications | 257 | ||
| Preoperative Planning | 258 | ||
| Osteotomy Techniques | 258 | ||
| Standard | 258 | ||
| Modifications of the Standard Osteotomy | 259 | ||
| Chevron. | 259 | ||
| Oblique | 260 | ||
| Posterior | 260 | ||
| Trochanteric Slide | 260 | ||
| Modifications of the Trochanteric Slide | 260 | ||
| Maintaining Posterior Attachments. | 260 | ||
| Triplanar Slide. | 260 | ||
| Step. | 261 | ||
| Anterior Trochanter Only. | 262 | ||
| Split Trochanter (Stracathro). | 262 | ||
| Repeat Osteotomy | 262 | ||
| Horizontal/Vertical | 262 | ||
| Repeat Trochanteric Slide | 262 | ||
| Fixation Techniques | 262 | ||
| Wiring | 262 | ||
| Bolts and First-Generation Plates | 264 | ||
| Cable Fixation | 264 | ||
| Cable Grip System | 265 | ||
| Claw Plate | 265 | ||
| Locking Plate | 266 | ||
| Variations/Unusual Situations | 266 | ||
| Osteoplasty and Trochanteric Excision | 266 | ||
| Myofascial Flap Techniques | 266 | ||
| Abductor Advancement | 267 | ||
| Postoperative Care | 267 | ||
| Complications | 268 | ||
| Current Controversies | 269 | ||
| References | 269 | ||
| 21 Extensile Approaches for Revision Total Hip Arthroplasty | 271 | ||
| Key Points | 271 | ||
| Introduction | 271 | ||
| Indications/Contraindications for Extensile Exposure Of The Hip in Revision Total Hip Arthoplasty | 272 | ||
| Preoperative Planning | 272 | ||
| Old Incisions and Previous Surgical Exposure | 272 | ||
| Radiographs and Templating for Extensile Exposures | 274 | ||
| Decription of Extensile Exposure Techniques: Femoral | 275 | ||
| Extended Trochanteric Osteotomy | 275 | ||
| Extended Trochanteric Osteotomy Performed Via the Posterolateral Exposure | 278 | ||
| Exposure | 278 | ||
| Osteotomy | 278 | ||
| Osteotomy Fixation | 281 | ||
| Postoperative Care | 281 | ||
| Extended Trochanteric Osteotomy Performed Via Direct Lateral Exposure | 281 | ||
| Exposure | 281 | ||
| Osteotomy | 281 | ||
| Fixation | 283 | ||
| Postoperative Care | 283 | ||
| Trochanteric Slide Osteotomy | 283 | ||
| Femoral Cortical Windows | 283 | ||
| Decription of Extensile Exposure Techniques: Acetabular | 285 | ||
| Isolated Revision of the Acetabular Component | 285 | ||
| Exposure for Reconstruction Cages and Posterior Column Fractures | 285 | ||
| Retained Intrapelvic Implants, Cement | 287 | ||
| References | 288 | ||
| Further Reading | 288 | ||
| 22 Minimally Invasive Hip Arthroplasty | 289 | ||
| Key Points | 289 | ||
| Introduction and Background | 289 | ||
| Minimally Invasive Surgical Approaches | 289 | ||
| Posterior Approach | 289 | ||
| Anterolateral (or Direct Lateral) Approach | 290 | ||
| Direct Anterior Approach | 290 | ||
| Two-Incision Approach | 291 | ||
| Gait Studies | 291 | ||
| Conclusion | 292 | ||
| References | 292 | ||
| III Perioperative Management in Hip Surgery | 294 | ||
| 23 Blood Management | 295 | ||
| Key Points | 295 | ||
| Introduction | 295 | ||
| Basic Science | 295 | ||
| Current Controversies and Future Directions | 295 | ||
| Preoperative Evaluation | 295 | ||
| Preoperative Autologous Donation | 296 | ||
| Preoperative Hematopoiesis | 297 | ||
| Hemodilution | 297 | ||
| Intraoperative Blood Management Strategies | 297 | ||
| Hemostatic Agents | 298 | ||
| Intraoperative Blood Salvage | 298 | ||
| Transfusion Thresholds | 298 | ||
| References | 299 | ||
| Suggested Reading | 300 | ||
| 24 Anesthesia for Hip Surgery: | 301 | ||
| Key Points | 301 | ||
| Introduction | 301 | ||
| Anesthetic Techniques for Hip Surgery: Options | 301 | ||
| General Anesthesia | 302 | ||
| Regional Anesthesia | 303 | ||
| Central Neuraxial Anesthesia | 303 | ||
| Peripheral Nerve Blockade | 304 | ||
| Anesthetic Techniques for Hip Surgery: Risks | 305 | ||
| Cardiovascular Complications | 305 | ||
| Thromboembolic Complications | 306 | ||
| Cognitive Dysfunction | 306 | ||
| Nerve Injury | 306 | ||
| Management Considerations | 307 | ||
| Positioning | 307 | ||
| Pain | 307 | ||
| Blood Transfusion | 308 | ||
| Perioperative Anticoagulation | 308 | ||
| Current Topics and Future Directions | 308 | ||
| References | 309 | ||
| 25 Mortality After Total Hip Arthroplasty | 312 | ||
| Key Points | 312 | ||
| Introduction | 312 | ||
| Mortality Rates | 312 | ||
| Causes of Death Following Total Hip Arthroplasty | 313 | ||
| Intraoperative Mortality | 313 | ||
| Postoperative Mortality | 313 | ||
| Prevention of Death | 314 | ||
| Current Controversies and Future Considerations | 314 | ||
| Conclusion | 314 | ||
| References | 315 | ||
| Suggested Reading | 316 | ||
| 26 Perioperative Medical Management of Hip Surgery Patients | 317 | ||
| Key Points | 317 | ||
| Introduction | 317 | ||
| Basic Science | 317 | ||
| The Surgical Stress Response | 317 | ||
| The Preoperative Evaluation | 318 | ||
| History | 318 | ||
| Past Medical History and Review of Systems. | 318 | ||
| Physical Examination | 318 | ||
| Vital Signs. | 318 | ||
| Airway. | 319 | ||
| Cardiac. | 319 | ||
| Respiratory. | 319 | ||
| Gastrointestinal. | 319 | ||
| Vascular. | 319 | ||
| Neurologic/Psychiatric. | 319 | ||
| Skin. | 319 | ||
| Functional Status | 319 | ||
| Current Medications | 320 | ||
| Preoperative Testing | 320 | ||
| Laboratory Tests. | 321 | ||
| Electrocardiogram. | 322 | ||
| Chest X-rays and Spirometry. | 322 | ||
| Cervical Spine X-rays. | 322 | ||
| Risk Reduction and Medical Optimization | 322 | ||
| Cardiac | 322 | ||
| Risk Factors | 322 | ||
| Recommendations | 322 | ||
| Pulmonary | 323 | ||
| IV Hip Evaluation, Diagnosis, and Pathology | 377 | ||
| 30 History and Physical Examination of the Hip | 378 | ||
| Key Points | 378 | ||
| Introduction | 378 | ||
| History and Physical Examination | 378 | ||
| History | 378 | ||
| Physical Examination of the Hip | 379 | ||
| Standing Examination | 379 | ||
| Seated Examination | 383 | ||
| Supine Examination | 384 | ||
| Dynamic Internal Rotatory Impingement Test. | 385 | ||
| Dynamic External Rotatory Impingement Test. | 385 | ||
| Lateral Examination | 386 | ||
| Prone Examination | 389 | ||
| Specific Tests | 390 | ||
| McCarthy Test. | 390 | ||
| Scour. | 390 | ||
| Foveal Distraction Test. | 390 | ||
| Bicycle Test. | 390 | ||
| Fulcrum Test. | 390 | ||
| Seated Piriformis Stretch Test. | 390 | ||
| Abduction/Extension/External Rotation Test. | 390 | ||
| Resisted Sit-up Test. | 390 | ||
| Pudendal Nerve Block Test. | 390 | ||
| Current Controversies and Future Directions | 390 | ||
| Summary/Conclusions | 392 | ||
| Acknowledgments | 392 | ||
| References | 392 | ||
| 31 Imaging of the Hip | 395 | ||
| Key Points | 395 | ||
| Introduction | 395 | ||
| Imaging Modalities | 395 | ||
| Conventional Radiography | 395 | ||
| Anteroposterior (PA) Pelvis | 395 | ||
| Judet (Oblique) Views | 396 | ||
| Frog-Leg Lateral | 396 | ||
| Cross-Table Lateral | 396 | ||
| Dunn View | 396 | ||
| False Profile View | 396 | ||
| Computed Tomography | 397 | ||
| Magnetic Resonance Imaging | 397 | ||
| Ultrasound | 399 | ||
| Nuclear Medicine | 399 | ||
| Femoroacetabular Impingement | 399 | ||
| Primary Anatomic Abnormalities of Femoroacetabular Impingement | 399 | ||
| Cam Femoroacetabular Impingement | 399 | ||
| Pincer Femoroacetabular Impingement | 400 | ||
| Secondary Abnormalities of Femoroacetabular Impingement | 401 | ||
| Labrum | 401 | ||
| Cartilage | 403 | ||
| Bone | 404 | ||
| Joint | 404 | ||
| Developmental Dysplasia of the Hip | 404 | ||
| Other Common Hip Pathologies | 405 | ||
| Avascular Necrosis | 405 | ||
| Pathophysiology | 405 | ||
| Imaging. | 405 | ||
| Radiography. | 405 | ||
| Radionuclide Imaging. | 406 | ||
| Computed Tomography. | 406 | ||
| Magnetic Resonance Imaging. | 406 | ||
| Differential Diagnosis for AVN | 406 | ||
| Transient Osteoporosis of the Hip. | 406 | ||
| Subchondral Stress Fracture. | 406 | ||
| Fractures | 406 | ||
| Soft Tissue Abnormalities | 407 | ||
| Bursitis | 408 | ||
| Tumor and Tumor-Like Lesions Around the Hip | 408 | ||
| Current Controversies and Future Considerations | 409 | ||
| References | 409 | ||
| Suggested Reading | 411 | ||
| 32 Osteoarthritis | 412 | ||
| Key Points | 412 | ||
| Introduction | 412 | ||
| Epidemiology and Risk Factors | 413 | ||
| Obesity. | 414 | ||
| Heavy manual labor. | 414 | ||
| Gender. | 415 | ||
| Trauma. | 415 | ||
| Anatomic anomalies. | 415 | ||
| Pathophysiology | 415 | ||
| Clinical Features and Diagnosis | 417 | ||
| History. | 417 | ||
| Physical examination. | 417 | ||
| Radiographic studies. | 418 | ||
| Differential Diagnosis | 419 | ||
| Treatment | 419 | ||
| Medical therapies. | 420 | ||
| Medications—glucosamine and chondroitin sulfate. | 420 | ||
| Weight loss and exercise. | 420 | ||
| Viscosupplementation. | 420 | ||
| Alternative treatments. | 421 | ||
| Nonarthroplasty options. | 421 | ||
| Arthrodesis. | 421 | ||
| Arthroplasty. | 421 | ||
| Prognosis | 422 | ||
| Current Controversies and Future Considerations | 422 | ||
| References | 422 | ||
| 33 Femoroacetabular Impingement | 425 | ||
| Key Points | 425 | ||
| Introduction | 425 | ||
| Epidemiology and Risk Factors | 425 | ||
| Pathophysiology | 426 | ||
| Clinical Features and Diagnosis | 427 | ||
| Differential Diagnosis | 432 | ||
| Treatment | 432 | ||
| Conservative | 433 | ||
| Surgical Hip Dislocation | 434 | ||
| Arthroscopic | 434 | ||
| Combined Arthroscopy With Limited Anterior Open Approach | 434 | ||
| Anteversion Periacetabular Osteotomy | 434 | ||
| Prognosis | 434 | ||
| Current Controversies and Future Considerations | 435 | ||
| References | 435 | ||
| 34 Dysplasia in the Skeletally Mature Patient | 437 | ||
| Key Points | 437 | ||
| Introduction | 437 | ||
| Differential Diagnosis | 437 | ||
| Clinical Findings | 437 | ||
| History | 437 | ||
| Physical Examination | 438 | ||
| Radiographic Evaluation | 438 | ||
| Pathology | 440 | ||
| Bony Pathology | 442 | ||
| Soft Tissue Pathology | 442 | ||
| Treatment Options | 442 | ||
| Nonoperative | 442 | ||
| Arthroscopy | 443 | ||
| Joint Preservation | 443 | ||
| Proximal Femoral Osteotomy | 443 | ||
| Arthroplasty | 445 | ||
| Conclusion | 445 | ||
| References | 445 | ||
| 35 Osteonecrosis and Bone Marrow Edema Syndrome | 446 | ||
| Key Points | 446 | ||
| Introduction | 446 | ||
| Epidemiology and Risk Factors | 447 | ||
| Pathogenesis | 448 | ||
| Histopathology | 448 | ||
| Clinical Features and Diagnosis | 450 | ||
| Differential Diagnosis | 453 | ||
| Treatment | 454 | ||
| Prognosis | 456 | ||
| Current Controversies and Future Considerations | 457 | ||
| References | 458 | ||
| 36 Synovial Diseases of the Hip | 461 | ||
| Key Points | 461 | ||
| Introduction | 461 | ||
| Synovial Chondromatosis | 461 | ||
| Overview | 461 | ||
| Clinical Features and Diagnosis | 462 | ||
| Treatment | 462 | ||
| Prognosis | 463 | ||
| Pigmented Villonodular Synovitis | 464 | ||
| Overview | 464 | ||
| Clinical Features and Diagnosis | 464 | ||
| Treatment | 464 | ||
| Conclusion | 467 | ||
| Current Controversies and Future Considerations | 467 | ||
| References | 467 | ||
| 37 Acetabular Rim Damage | 468 | ||
| Key Points | 468 | ||
| Introduction | 468 | ||
| Etiology | 468 | ||
| Acetabular Rim Damage and the Labrum | 470 | ||
| Diagnosis | 471 | ||
| Clinical Evaluation | 471 | ||
| Radiologic Evaluation | 471 | ||
| Treatment Options | 472 | ||
| Current Controversies | 473 | ||
| References | 473 | ||
| Further Reading | 475 | ||
| 38 Hip Joint Infection | 476 | ||
| Key Points | 476 | ||
| Introduction | 476 | ||
| Epidemiology and Risk Factors | 476 | ||
| Epidemiology | 476 | ||
| Risk Factors | 476 | ||
| Microbiology | 476 | ||
| Pathophysiology | 477 | ||
| Pyogenic Infection | 477 | ||
| Granulomatous Infection | 478 | ||
| Clnical Features and Diagnosis | 478 | ||
| Physical Examination | 479 | ||
| Radiographic Assessment | 479 | ||
| Differential Diagnosis | 480 | ||
| Treatment | 480 | ||
| Surgical Drainage | 480 | ||
| Antibiotic Therapy | 480 | ||
| Prognosis | 480 | ||
| Current Controversies and Future Considerations | 481 | ||
| References | 481 | ||
| Suggested Reading | 481 | ||
| 39 Soft Tissue Pathology | 482 | ||
| Key Points | 482 | ||
| Introduction | 482 | ||
| Epidemiology and Risk Factors | 482 | ||
| Pathophysiology | 482 | ||
| Clinical Features and Diagnosis | 483 | ||
| Extra-articular Anterior Hip Pain | 484 | ||
| Iliopsoas Muscle–Tendon Complex Disorders | 484 | ||
| Snapping Hip Syndrome. | 485 | ||
| Diagnostic Imaging. | 486 | ||
| Specific Considerations for the Treatment of Iliopsoas Muscle–Tendon Complex Disorders. | 487 | ||
| Surgical Treatment for Painful Iliopsoas Muscle–Tendon Complex Disorders. | 487 | ||
| Adductor Strains. | 488 | ||
| Sports Hernia. | 489 | ||
| Osteitis Pubis. | 489 | ||
| Extra-Articular Lateral Hip Pain | 490 | ||
| Posterior Pelvic Pain | 492 | ||
| Diagnosis | 492 | ||
| Differential Diagnosis | 493 | ||
| Treatment | 493 | ||
| Therapeutics | 493 | ||
| Acute Phase (1 to 3 Days) | 493 | ||
| Recovery Phase (3 Days to 8 Weeks) | 494 | ||
| Orthosis. | 496 | ||
| Orthotics. | 496 | ||
| Therapeutic Injections. | 496 | ||
| Maintenance Phase | 496 | ||
| Current Controversies and Future Considerations | 497 | ||
| Extra-articular Hip Pain: Current Controversies | 497 | ||
| Extra-Articular Hip Pain: Future Considerations | 497 | ||
| References | 497 | ||
| Bibliography | 499 | ||
| V Pediatric Hip Disorders | 501 | ||
| 40 Hip Dysplasia in the Child and Adolescent | 502 | ||
| Key Points | 502 | ||
| Introduction | 502 | ||
| Epidemiology | 502 | ||
| Prevalence | 502 | ||
| Risk Factors | 502 | ||
| Pathophysiology | 502 | ||
| Natural History | 503 | ||
| Clinical Findings/Physical Examination | 503 | ||
| Imaging | 504 | ||
| Ultrasound | 504 | ||
| Radiographs | 505 | ||
| Arthrography | 505 | ||
| Treatment | 506 | ||
| Stable Hip with Ultrasound Evidence of Dysplasia | 506 | ||
| Barlow-Positive Hip | 507 | ||
| Ortolani-Positive Hip | 507 | ||
| Failed Pavlik Treatment | 507 | ||
| Closed Reduction of a Dislocated Hip | 507 | ||
| Open Reduction | 509 | ||
| Residual Acetabular Dysplasia in the Immature Hip | 510 | ||
| Complications | 511 | ||
| References | 512 | ||
| 41 Legg-Calvé-Perthes Disease | 515 | ||
| Key Points | 515 | ||
| Introduction | 515 | ||
| Epidemiology and Risk Factors | 515 | ||
| Pathophysiology | 517 | ||
| Clinical Features and Diagnosis | 520 | ||
| Imaging Studies | 521 | ||
| Differential Diagnosis | 521 | ||
| Natural History | 523 | ||
| Treatment | 524 | ||
| Onset Before Age 6 | 527 | ||
| Onset at Age 6 to 8 | 527 | ||
| Onset After Age 8 | 528 | ||
| Other Nonoperative and Operative Treatments | 529 | ||
| Femoroacetabular Impingement (FAI) in Adolescents and Young Adults With Perthes Disease | 531 | ||
| Developing Medical Treatment for Perthes Disease | 531 | ||
| Prognosis | 531 | ||
| Current Controversies | 531 | ||
| Future Considerations | 532 | ||
| References | 532 | ||
| 42 Slipped Capital Femoral Epiphysis | 535 | ||
| Key Points | 535 | ||
| Introduction | 535 | ||
| Incidence and Epidemiology | 535 | ||
| Classification | 536 | ||
| Causes | 537 | ||
| Clinical Presentation | 538 | ||
| Radiographic Findings | 538 | ||
| Treatment | 539 | ||
| Unstable Slipped Capital Femoral Epiphysis | 543 | ||
| In Situ Fixation | 544 | ||
| Open Reduction | 544 | ||
| Prophylactic Treatment of the Contralateral Hip | 546 | ||
| Valgus Slips | 546 | ||
| Complications | 547 | ||
| Chondrolysis | 547 | ||
| Avascular Necrosis | 548 | ||
| Femoroacetabular Impingement Following Slipped Capital Femoral Epiphysis | 549 | ||
| References | 550 | ||
| 43 Inflammatory Arthritis in the Child and Adolescent | 554 | ||
| Key Points | 554 | ||
| Introduction | 554 | ||
| Epidemiology and Risk Factors | 554 | ||
| Pathophysiology | 555 | ||
| Clinical Features and Diagnosis | 556 | ||
| Differential Diagnosis | 559 | ||
| Treatment | 560 | ||
| Nonsurgical Therapies | 560 | ||
| Surgical Therapies | 561 | ||
| Surgical Indications | 561 | ||
| Preoperative Planning | 561 | ||
| Description of Technique(s) | 561 | ||
| Variations/Unusual Situations | 563 | ||
| Postoperative Care | 563 | ||
| Results | 564 | ||
| Complications | 564 | ||
| Prognosis | 564 | ||
| Current Controversies and Future Considerations | 564 | ||
| References | 565 | ||
| VI Traumatic Disorders of the Hip | 567 | ||
| 44 Femoral Neck Fracture | 568 | ||
| Key Points | 568 | ||
| Introduction | 568 | ||
| Anatomy | 568 | ||
| Indications/Contraindications | 568 | ||
| Preoperative Planning | 568 | ||
| Principles of Management and Treatment Algorithm | 569 | ||
| Description of Technique(s) | 571 | ||
| Surgical Approach | 571 | ||
| Variations/Unusual Situations | 572 | ||
| Postoperative Care | 573 | ||
| Results | 573 | ||
| Complications | 574 | ||
| Current Controversies and Future Considerations | 575 | ||
| Fixation Methods | 575 | ||
| Role of Capsulotomy | 576 | ||
| Timing of Surgery | 577 | ||
| Conclusion | 578 | ||
| References | 578 | ||
| 45 Intertrochanteric Fractures | 582 | ||
| Key Points | 582 | ||
| Introduction | 582 | ||
| Indications/Contraindications | 582 | ||
| Nonoperative Care | 582 | ||
| Operative Management | 582 | ||
| Historical Background | 582 | ||
| Current Surgical Practice | 583 | ||
| Evidence-Based Approach to Choice of Fixation | 585 | ||
| Preoperative Planning | 585 | ||
| Radiographic Evaluation | 585 | ||
| Imaging | 585 | ||
| Assessment of Stability | 586 | ||
| Description of Technique(S) | 587 | ||
| General Issues | 587 | ||
| Surgical Technique | 587 | ||
| Reduction | 587 | ||
| Surgical Fixation | 588 | ||
| Compression Hip Screw | 588 | ||
| Cephalomedullary Nail | 589 | ||
| Tips and Pearls | 592 | ||
| Postoperative Care | 592 | ||
| Results | 592 | ||
| Complications | 592 | ||
| Current Controversies and Future Considerations | 593 | ||
| References | 593 | ||
| 46 Subtrochanteric Fractures | 595 | ||
| Key Points | 595 | ||
| Introduction | 595 | ||
| Indications/Contraindications | 595 | ||
| Preoperative Planning | 595 | ||
| Radiographic Evaluation | 595 | ||
| Description of Technique of Intramedullary Nailing of A Subtrochanteric Fracture | 596 | ||
| Postoperative Care | 598 | ||
| Variations/Unusual Situations | 598 | ||
| Operative Treatment—Plates | 598 | ||
| Pearls and Pitfalls | 599 | ||
| Results | 599 | ||
| Complications | 599 | ||
| Malunion | 599 | ||
| Nonunion | 600 | ||
| Infection | 600 | ||
| Controversies and Future Directions | 600 | ||
| References | 600 | ||
| 47 Acetabular Fracture | 602 | ||
| Key Points | 602 | ||
| Introduction | 602 | ||
| Incidence and Etiology | 602 | ||
| Classification | 602 | ||
| Indications | 603 | ||
| Nonoperative Treatment | 603 | ||
| Operative Treatment | 603 | ||
| Summary of Surgical Indications | 603 | ||
| Preoperative Planning and Assessment | 603 | ||
| Surgical Technique and Approaches | 604 | ||
| Surgical Approach by Fracture Pattern | 607 | ||
| The Special Case of the Posterior Wall | 607 | ||
| Postoperative Care | 610 | ||
| Results/Outcomes | 610 | ||
| Complications | 611 | ||
| Future Considerations | 612 | ||
| References | 612 | ||
| 48 Hip Dislocation and Femoral Head Fractures | 614 | ||
| Key Points | 614 | ||
| Introduction | 614 | ||
| Epidemiology and Risk Factors | 614 | ||
| Anatomy and Pathophysiology | 615 | ||
| Clinical Features and Diagnosis | 615 | ||
| Clinical Examination | 615 | ||
| Radiographic Evaluation | 615 | ||
| Classification | 616 | ||
| Treatment | 617 | ||
| Hip Dislocations | 617 | ||
| Closed Reduction | 618 | ||
| Open Reduction | 621 | ||
| Femoral Head Fractures | 622 | ||
| Rehabilitation | 625 | ||
| Prognosis | 625 | ||
| Complications | 626 | ||
| Current Controversies and Future Considerations | 626 | ||
| References | 626 | ||
| VII Tumors of the Hip | 629 | ||
| 49 Evaluation of Bone Lesions Around the Hip | 630 | ||
| Key Points | 630 | ||
| Introduction | 630 | ||
| Epidemiology of Hip Lesions | 630 | ||
| Clinical Evaluation | 630 | ||
| Clinical Examination | 630 | ||
| Imaging | 632 | ||
| Biopsy | 632 | ||
| Pathophysiology, Clinical Features, Radiographic Appearance, Differential Diagnosis, Treatment, and Prognosis | 633 | ||
| Tumor Simulators | 633 | ||
| Fibrous Dysplasia (FD) | 633 | ||
| “Brown Tumor” | 634 | ||
| Unicameral Bone Cyst (UBC) (Simple Bone Cyst) | 634 | ||
| Aneurysmal Bone Cyst (ABC) | 634 | ||
| Benign Bone Neoplasms | 635 | ||
| Nonossifying Fibroma (NOF) (Fibrous Cortical Defect, Fibrous Xanthoma…) | 635 | ||
| Exostosis (Osteochondroma) | 635 | ||
| Langerhans’ Cell Histiocytosis (eosinophilic granuloma) | 636 | ||
| Giant Cell Tumor (GCT) | 636 | ||
| Chondroblastoma | 636 | ||
| Osteoid Osteoma | 637 | ||
| Enchondroma | 637 | ||
| Malignant Bone Neoplasms | 637 | ||
| Chondrosarcoma | 638 | ||
| Central Chondrosarcoma. | 638 | ||
| Clear Cell Chondrosarcoma. | 638 | ||
| Ewing’s Sarcoma | 639 | ||
| Metastatic Bone Disease | 639 | ||
| Multiple Myeloma | 640 | ||
| Current Controversies and Future Considerations | 641 | ||
| References | 641 | ||
| 50 Benign Bone Tumors | 644 | ||
| Key Points | 644 | ||
| Introduction | 644 | ||
| Evaluation | 644 | ||
| Treatment Options | 644 | ||
| Watchful Waiting | 644 | ||
| Medical Therapy | 645 | ||
| Injection Therapy | 645 | ||
| Radiofrequency Ablation/Cryoablation | 645 | ||
| Curettage | 646 | ||
| Adjuvant Treatments | 647 | ||
| Internal Fixation | 649 | ||
| Marginal Excision | 649 | ||
| Surgical Resection | 649 | ||
| Specific Treatment Recommendations | 649 | ||
| Fibrous Dysplasia | 649 | ||
| Giant Cell Tumor | 650 | ||
| Enchondroma | 650 | ||
| Osteochondroma | 650 | ||
| Osteoid Osteoma | 650 | ||
| Chondroblastoma | 651 | ||
| Conclusions | 651 | ||
| References | 652 | ||
| 51 Primary Malignant Bone Tumors | 653 | ||
| Key Points | 653 | ||
| Introduction | 653 | ||
| Epidemiology | 653 | ||
| General Considerations | 653 | ||
| Staging and Biopsy | 653 | ||
| Adjuvant Therapy | 654 | ||
| Medical Considerations | 655 | ||
| Surgical Approach | 655 | ||
| Reconstructive Options | 656 | ||
| Soft Tissue Tumors | 656 | ||
| Malignant Bone Tumors | 656 | ||
| Pediatric Patients | 660 | ||
| Postoperative Surveillance | 661 | ||
| Comments on Specific Tumor Histologies | 661 | ||
| Osteosarcoma | 661 | ||
| Chondrosarcoma | 662 | ||
| Ewing’s Sarcoma | 664 | ||
| Malignant Soft Tissue Tumors | 664 | ||
| Conclusions | 664 | ||
| References | 664 | ||
| 52 Metastatic Disease Around the Hip | 666 | ||
| Key Points | 666 | ||
| Introduction | 666 | ||
| Epidemiology and Risk Factors | 666 | ||
| Pathophysiology | 666 | ||
| Clinical Features and Diagnosis | 668 | ||
| Differential Diagnosis | 670 | ||
| Treatment | 670 | ||
| Radiation | 670 | ||
| Systemic Therapy | 670 | ||
| Surgical Management | 670 | ||
| General Considerations | 670 | ||
| Percutaneous Treatment of Pelvic Metastasis | 671 | ||
| Femoral Neck and Head Fractures | 671 | ||
| Intertrochanteric Fractures | 671 | ||
| Subtrochanteric Fractures | 672 | ||
| Acetabular Fractures | 673 | ||
| Prognosis | 673 | ||
| Current Controversies and Future Considerations | 673 | ||
| References | 674 | ||
| VIII Nonarthroplasty Treatment of Hip Pathology | 677 | ||
| 53 Hip Arthroscopy for Nonstructural Hip Problems | 678 | ||
| Key Points | 678 | ||
| Introduction | 678 | ||
| Indications/Contraindications | 678 | ||
| Preoperative Planning | 678 | ||
| Description of Technique | 679 | ||
| Equipment | 679 | ||
| Anesthesia | 679 | ||
| Intra-Articular (Central) Compartment | 679 | ||
| Setup | 679 | ||
| Portals | 679 | ||
| Diagnostic Procedure | 680 | ||
| Peripheral Compartment | 681 | ||
| Positioning | 681 | ||
| Portal Placement | 681 | ||
| Diagnostic Procedure | 682 | ||
| Iliopsoas Bursoscopy | 682 | ||
| Positioning | 682 | ||
| Portals | 683 | ||
| Diagnostic Procedure | 683 | ||
| Trochanteric Bursoscopy (Peritrochanteric Space) | 683 | ||
| Positioning | 683 | ||
| Portals | 684 | ||
| Diagnostic Procedure | 684 | ||
| Specific Situations and Results | 685 | ||
| Labral Débridement | 685 | ||
| Labral Repair | 686 | ||
| Chondroplasty/Microfracture | 687 | ||
| Lesions of the Ligamentum Teres | 688 | ||
| Synovectomy | 689 | ||
| Loose Bodies | 689 | ||
| Iliopsoas Tendon | 691 | ||
| Snapping Iliotibial Band | 692 | ||
| Trochanteric Bursectomy | 692 | ||
| Abductor Tendinopathies | 693 | ||
| Complications | 694 | ||
| Current Controversies and Future Considerations | 694 | ||
| References | 695 | ||
| 54 Hip Arthroscopy for Structural Hip Problems | 697 | ||
| Key Points | 697 | ||
| Introduction | 697 | ||
| Indications/Contraindications | 698 | ||
| Preoperative Planning | 698 | ||
| Description of Techniques | 700 | ||
| Arthroscopic Treatment of Femoroacetabular Impingement | 700 | ||
| Acetabular Rim Trimming With Labral Takedown | 700 | ||
| Acetabular Rim Trimming Without Labral Takedown | 701 | ||
| Femoral Osteoplasty (Cam Resection) | 702 | ||
| Labral Treatment | 703 | ||
| Labral Repair | 704 | ||
| Labral Reconstruction | 705 | ||
| Variations/Unusual Situations | 706 | ||
| Postoperative Care | 706 | ||
| Results | 706 | ||
| Complications | 707 | ||
| Current Controversies and Future Considerations | 708 | ||
| References | 708 | ||
| 55 Open Surgical Débridement for Femoroacetabular Impingement | 710 | ||
| Key Points | 710 | ||
| Introduction | 710 | ||
| Indications | 710 | ||
| Preoperative Planning | 710 | ||
| Description of Technique | 711 | ||
| Variations/Unusual Situations | 713 | ||
| The Deficient Labrum | 713 | ||
| Postoperative Care | 714 | ||
| Results | 714 | ||
| Complications | 714 | ||
| Current Controversies and Future Considerations | 715 | ||
| References | 715 | ||
| 56 Pelvic Osteotomies for Hip Dysplasia | 717 | ||
| Key Points | 717 | ||
| Introduction | 717 | ||
| Indications/Contraindications | 717 | ||
| Surgical Technique | 719 | ||
| Postoperative Management and Rehabilitation | 720 | ||
| Acetabular Retrotorsion | 721 | ||
| Results | 721 | ||
| Complications | 722 | ||
| Conclusion | 722 | ||
| References | 722 | ||
| 57 Femoral Osteotomy | 723 | ||
| Key Points | 723 | ||
| Introduction | 723 | ||
| Current Indications of Femoral Osteotomies | 724 | ||
| Developmental Dysplasia | 724 | ||
| Sequelae of SCFE and Perthes | 725 | ||
| Avascular Necrosis | 725 | ||
| Nonunion of Femoral Neck Fracture | 726 | ||
| Technique and Complications | 727 | ||
| Total Hip Arthroplasty after Intertrochanteric Osteotomy | 727 | ||
| Final Considerations | 728 | ||
| References | 728 | ||
| 58 Femoral Head Sparing Procedures for Osteonecrosis of the Hip | 730 | ||
| Key Points | 730 | ||
| Introduction | 730 | ||
| Core Decompression and Percutaneous Drilling | 732 | ||
| Indications and Contraindications | 732 | ||
| Preoperative Planning | 732 | ||
| Description of Techniques | 732 | ||
| Technique: Modified Hungerford | 732 | ||
| Technique as Described by Mont | 733 | ||
| Variations and Unusual Situations | 733 | ||
| Postoperative Care | 734 | ||
| Results | 734 | ||
| Complications | 735 | ||
| Structural Bone Grafting | 735 | ||
| Nonvascularized Bone Grafting | 735 | ||
| Indications and Contraindications | 735 | ||
| Preoperative Planning | 735 | ||
| Description of Techniques | 735 | ||
| Modified Phemister Technique | 736 | ||
| Trapdoor Procedure | 736 | ||
| Lightbulb Procedure | 737 | ||
| Postoperative Care | 738 | ||
| Results | 738 | ||
| Complications | 739 | ||
| Variations and Unusual Situations | 739 | ||
| Vascularized Bone Grafting | 740 | ||
| Indications and Contraindications | 740 | ||
| Preoperative Planning | 741 | ||
| Description of Techniques | 741 | ||
| Free Fibular Grafting As Described by Urbaniak. | 741 | ||
| Approach to and Preparation of Donor Vessels | 741 | ||
| Preparation of the Femoral Head | 741 | ||
| Fibular Harvest | 741 | ||
| Fibular Preparation | 743 | ||
| Placement of the Fibular Graft Into the Femoral Head | 743 | ||
| Vessel Anastomosis | 744 | ||
| Postoperative Care | 744 | ||
| Results | 744 | ||
| Complications | 745 | ||
| Variations and Unique Situations | 746 | ||
| Osteotomies | 746 | ||
| Indications and Contraindications | 746 | ||
| Preoperative Planning | 746 | ||
| Description of Procedures | 746 | ||
| Results | 746 | ||
| Complications | 747 | ||
| Current Controversies and Future Considerations | 748 | ||
| Discussion | 748 | ||
| References | 748 | ||
| 59 Arthrodesis and Resection Arthroplasty of the Hip | 752 | ||
| Arthrodesis | 752 | ||
| Introduction | 752 | ||
| Historical Perspective | 752 | ||
| Indications/Contraindications | 753 | ||
| Indications | 753 | ||
| Contraindications | 753 | ||
| Preoperative Planning | 754 | ||
| Description of Technique(S) | 754 | ||
| Positioning of the Hip Arthrodesis | 754 | ||
| Techniques | 754 | ||
| Anterior Plating Technique. | 754 | ||
| Screw Technique. | 755 | ||
| Postoperative Care | 755 | ||
| Results | 755 | ||
| Complications | 756 | ||
| Current Controversies and Future Considerations | 756 | ||
| References | 756 | ||
| Resection Arthroplasty | 757 | ||
| Introduction | 757 | ||
| Historical Perspective | 757 | ||
| Indications/Contraindications | 758 | ||
| Indications | 758 | ||
| Primary Indications | 758 | ||
| Secondary Indications | 758 | ||
| Contraindications | 759 | ||
| Preoperative Planning | 759 | ||
| Description of Technique(S) | 759 | ||
| Variations/Unusual Situations | 760 | ||
| Postoperative Care | 761 | ||
| Results | 761 | ||
| Complications | 762 | ||
| Current Controversies and Future Considerations | 762 | ||
| References | 762 | ||
| IX Primary Hip Arthroplasty | 765 | ||
| 60 Long-Term Results of Total Hip Arthroplasty | 766 | ||
| Key Points | 766 | ||
| Introduction | 766 | ||
| Femoral Components in Primary Total Hip Replacement | 766 | ||
| Cemented Fixation | 766 | ||
| Cementless Fixation | 767 | ||
| The Acetabular Component | 768 | ||
| Introduction | 768 | ||
| The Cemented Cup | 769 | ||
| Cementless Fixation | 769 | ||
| The Influence of Bearings | 772 | ||
| Current Controversies/Future Considerations | 772 | ||
| References | 772 | ||
| Suggested Readings | 773 | ||
| 61 Rating Systems and Outcomes of Total Hip Arthroplasty | 774 | ||
| Key Points | 774 | ||
| Introduction | 774 | ||
| Background | 775 | ||
| Objective Outcome Metrics | 775 | ||
| Inclusion of Subjective Metrics | 775 | ||
| Precision Objective Metrics | 775 | ||
| Survivorship | 775 | ||
| Chaotic Innovation | 776 | ||
| Basic Science | 776 | ||
| Outcome Metrics | 776 | ||
| Survival Analysis | 776 | ||
| Arthroplasty Registries | 777 | ||
| Limitation of Survivorship Analysis | 777 | ||
| Subjective Outcomes | 777 | ||
| Subjective Health Outcome Questionnaires | 778 | ||
| Psychometric Considerations: What Makes a Good Questionnaire? | 778 | ||
| Definition of Psychometrics | 778 | ||
| Validity | 778 | ||
| Criterion Validity. | 778 | ||
| Construct Validity. | 778 | ||
| Content Validity. | 778 | ||
| Reliability | 778 | ||
| Responsiveness | 779 | ||
| The Receiver Operating Characteristic Curve (ROC Curve) | 780 | ||
| Sources of Bias When Outcomes Are Assessed | 780 | ||
| Mode of Administration of Questionnaires | 780 | ||
| Types of Outcome Questionnaires | 781 | ||
| General Health Outcomes | 781 | ||
| Disease-Specific Outcomes | 781 | ||
| Joint-Specific Outcomes | 781 | ||
| Patient-Specific Outcomes | 781 | ||
| Single-Item Questionnaires | 781 | ||
| Frequently Used Outcome Questionnaires | 781 | ||
| General Health Questionnaires | 781 | ||
| 36-Item Short-Form Health Survey (SF-36). | 781 | ||
| 12-Item Short-Form Health Survey (SF-12). | 781 | ||
| EuroQual Questionnaire. | 781 | ||
| Disease-Specific Questionnaire | 781 | ||
| Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). | 781 | ||
| Joint-Specific Questionnaire | 782 | ||
| Oxford-12 Item Knee Score (Oxford-12). | 782 | ||
| Precision Objective Metrics | 782 | ||
| Radiosteroemetric Analysis | 782 | ||
| Gait and EMG | 782 | ||
| Limitations of Precision Objective Metrics | 783 | ||
| Future Directions | 783 | ||
| Future Directions: Registries | 783 | ||
| Future Directions: Questionnaires | 783 | ||
| Future Directions: RSA | 783 | ||
| Future Directions: Gait | 783 | ||
| References | 784 | ||
| 62 Preoperative Planning and Templating for Primary Hip Arthroplasty | 786 | ||
| Key Points | 786 | ||
| Introduction | 786 | ||
| Indications/Contraindications | 786 | ||
| Technique: Preoperative Planning | 786 | ||
| Patient Selection | 786 | ||
| Radiographic Evaluation | 787 | ||
| Optimization | 787 | ||
| Templating | 788 | ||
| Step 1: Determine the Magnification | 788 | ||
| Step 2: Identify Radiographic Landmarks | 788 | ||
| Step 3: Assess Leg Length | 788 | ||
| Step 4: Identify Areas of Deformity | 789 | ||
| Step 5: Template the Acetabulum | 789 | ||
| Step 6: Template the Femur | 790 | ||
| Postoperative Needs Assessment | 792 | ||
| Variations/Unusual Situations | 793 | ||
| Current Controversies and Future Considerations | 793 | ||
| Conclusion | 793 | ||
| References | 793 | ||
| Suggested Readings | 794 | ||
| 63 Resurfacing Hip Arthroplasty: | 795 | ||
| Key Points | 795 | ||
| Introduction | 795 | ||
| History and Evolution | 795 | ||
| Design | 797 | ||
| Indications | 798 | ||
| Results | 799 | ||
| Future Directions and Current Controversies | 801 | ||
| References | 801 | ||
| Further Reading | 804 | ||
| 64 Resurfacing Hip Arthroplasty: | 805 | ||
| Key Points | 805 | ||
| Introduction | 805 | ||
| Preoperative Planning | 805 | ||
| Exposure | 805 | ||
| Femoral Preparation | 806 | ||
| Cementing | 807 | ||
| Acetabular Preparation and Component Positioning | 807 | ||
| Current Controversies and Future Directions | 808 | ||
| References | 808 | ||
| Further Readings | 808 | ||
| 65 Cemented Acetabular Components | 810 | ||
| Key Points | 810 | ||
| Introduction | 810 | ||
| Indications/Contraindications | 810 | ||
| Preoperative Planning | 811 | ||
| Description of Technique | 812 | ||
| Exposure | 812 | ||
| Reaming | 812 | ||
| Drill Holes | 813 | ||
| Cementing Technique | 813 | ||
| Insertion of Component | 813 | ||
| Unusual Situations/Variations | 814 | ||
| Postoperative Care | 814 | ||
| Outcomes | 814 | ||
| Complications | 816 | ||
| High-Risk Patient | 816 | ||
| Current Controversies | 816 | ||
| References | 817 | ||
| Further Reading | 818 | ||
| 66 Uncemented Acetabular Components | 819 | ||
| Key Points | 819 | ||
| Introduction | 819 | ||
| General Considerations | 819 | ||
| Implant Materials | 819 | ||
| Titanium and Cobalt-Chromium Alloys | 819 | ||
| Implant Shape | 820 | ||
| Surface Coatings | 821 | ||
| Calcicoat | 821 | ||
| Porous Metals | 822 | ||
| Methods of Uncemented Acetabular Cup Fixation | 822 | ||
| Supplemental Fixation | 822 | ||
| Press-Fit Technique | 823 | ||
| Polyethylene Liners and Modularity | 823 | ||
| Radiographic Evaluation of Cementless Acetabular Component Fixation | 824 | ||
| Cementless Acetabular Component Retrieval Data | 825 | ||
| Clinical Results of Current Cementless Acetabular Components | 826 | ||
| Indications/Contraindications | 828 | ||
| Technique of Cementless Acetabular Component Insertion | 828 | ||
| Preoperative Planning | 828 | ||
| Description of Surgical Technique | 829 | ||
| Summary of Complications | 831 | ||
| Current Controversies and Future Directions | 833 | ||
| Acknowledgment | 833 | ||
| References | 833 | ||
| Further Reading | 836 | ||
| 67 Cemented Femoral Components | 837 | ||
| Key Points | 837 | ||
| Introduction | 837 | ||
| General Considerations | 837 | ||
| Indications/Contraindications of Cemented Femoral Components | 839 | ||
| Preoperative Planning | 840 | ||
| Radiologic Assessment | 840 | ||
| Results | 840 | ||
| Techniques | 841 | ||
| Overview of Technique | 841 | ||
| Exposure and Bone Preparation | 842 | ||
| Rasping and First Trial Reduction | 842 | ||
| Final Preparation of the Femur and Cementing | 843 | ||
| Stem Introduction and Final Trial Reduction | 844 | ||
| Practical Tips | 844 | ||
| Complications | 845 | ||
| Reducing Risk During Hip Arthroplasty | 845 | ||
| Pressurized Lavage | 845 | ||
| Cement Restrictor/Plug | 845 | ||
| Suction Catheter | 845 | ||
| Summary and Future Considerations | 845 | ||
| References | 846 | ||
| 68 Uncemented Extensively Porous-Coated Femoral Components | 848 | ||
| Key Points | 848 | ||
| Introduction | 848 | ||
| Indications and Contraindications | 848 | ||
| Preoperative Planning | 849 | ||
| Surgical Technique | 850 | ||
| Variations and Unusual Situations | 851 | ||
| Postoperative Care | 851 | ||
| Results | 852 | ||
| Complications | 854 | ||
| Current Controversies and Future Considerations | 855 | ||
| References | 856 | ||
| 69 Uncemented Tapered Femoral Components | 857 | ||
| Key Points | 857 | ||
| Introduction | 857 | ||
| Design Rationale for Tapered Femoral Components | 859 | ||
| Surgical Technique | 861 | ||
| Preoperative Planning | 861 | ||
| Surgical Technique | 862 | ||
| Avoiding and Dealing with Complications | 864 | ||
| Intraoperative Femoral Fracture | 864 | ||
| Thigh Pain | 864 | ||
| Stress Shielding | 865 | ||
| Stem Subsidence | 865 | ||
| Dislocation | 865 | ||
| Clinical Results | 866 | ||
| Thigh Pain | 866 | ||
| Stress Shielding | 867 | ||
| Long-Term Results | 868 | ||
| Conclusions | 869 | ||
| References | 869 | ||
| Further Reading | 871 | ||
| 70 Uncemented Short Metaphyseal Femoral Components | 872 | ||
| Key Points | 872 | ||
| Introduction | 872 | ||
| Functions of the Diaphyseal and Metaphyseal Portions of Uncemented Femoral Stems | 872 | ||
| Design Rationale and Requirements for Uncemented, Short, Metaphyseal Engaging Stems | 875 | ||
| Evolution of and Experience with Metaphyseal-Engaging Short Stems | 878 | ||
| Summary | 882 | ||
| References | 883 | ||
| 71 Highly Cross-Linked Polyethylene Bearings | 887 | ||
| Key Points | 887 | ||
| Background | 887 | ||
| Polyethylene Manufacturing | 887 | ||
| Sterilization | 887 | ||
| Cross-Linking | 888 | ||
| Clinical Results | 888 | ||
| Radiographic Analysis of Polyethylene Wear Rates | 888 | ||
| Radiographic Osteolysis Evaluation | 890 | ||
| HCLPE Liner Failures and Retrieval Data | 890 | ||
| Summary | 891 | ||
| References | 892 | ||
| 72 Metal-on-Metal Bearings | 893 | ||
| Key Points | 893 | ||
| Introduction | 893 | ||
| Development of Metal-on-Metal Bearings | 893 | ||
| Wear | 894 | ||
| Metallurgy | 895 | ||
| Metal Particles | 895 | ||
| Metal Ion Analysis | 895 | ||
| Component Position | 897 | ||
| Clinical Outcome (Table 72-1) | 897 | ||
| Immune Response (Table 72-2) | 901 | ||
| Histologic Examination | 902 | ||
| Chromosomal Anomalies | 902 | ||
| Carcinogenicity | 903 | ||
| Future Directions | 903 | ||
| References | 903 | ||
| 73 Ceramic-on-Ceramic Bearings | 907 | ||
| Key Points | 907 | ||
| Introduction | 907 | ||
| Basic Science | 907 | ||
| History | 907 | ||
| General Statements About Ceramics | 908 | ||
| Manufacturing Process | 908 | ||
| Alumina Ceramics Mechanical Properties | 908 | ||
| Tribological Properties | 909 | ||
| Wear Debris and Tissue Response | 909 | ||
| Ceramic Advantages | 910 | ||
| Current Controversies and Future Directions | 910 | ||
| Major Ceramic Concerns | 910 | ||
| Fracture | 910 | ||
| Stripe Wear | 911 | ||
| The Squeaking Hip | 912 | ||
| Other Ceramic Concerns | 913 | ||
| Clinical Studies | 913 | ||
| Future Directions | 914 | ||
| Alumina Matrix Composite (AMC) | 914 | ||
| Summary | 914 | ||
| References | 914 | ||
| Further Reading | 916 | ||
| 74 Computer Navigation in Hip Arthroplasty and Hip Resurfacing | 917 | ||
| Key Points | 917 | ||
| Rationale and Indications | 917 | ||
| Technical Considerations | 918 | ||
| Pelvic Registration | 918 | ||
| Femoral Preparation | 918 | ||
| Acetabular Preparation | 918 | ||
| Cup Placement | 921 | ||
| Leg Length and Offset | 922 | ||
| Results | 923 | ||
| References | 924 | ||
| Further Reading | 924 | ||
| X Primary Total Hip Arthroplasty in Specific Conditions | 927 | ||
| 75 Hip Dysplasia | 928 | ||
| Key Points | 928 | ||
| Introduction | 928 | ||
| Classification | 928 | ||
| Anatomy | 929 | ||
| Preoperative Evaluation | 932 | ||
| Indications | 933 | ||
| Surgical Exposure/Approach | 933 | ||
| Acetabular Reconstruction | 935 | ||
| Methods for Improving Coverage | 935 | ||
| Autogenous Bone Grafting. | 935 | ||
| Medial Protrusio Technique. | 936 | ||
| Using an Elevated or Lateral Hip Center of Rotation. | 936 | ||
| Cemented Acetabular Reconstruction | 936 | ||
| Cementless Acetabular Reconstruction | 937 | ||
| Femoral Component | 937 | ||
| Complications | 937 | ||
| Previous Operations | 938 | ||
| Conclusion | 938 | ||
| Current Controversies/ Future Directions | 939 | ||
| References | 939 | ||
| 76 Previous Acetabular Fracture | 941 | ||
| Key Points | 941 | ||
| Introduction | 941 | ||
| Indications/Contraindications | 941 | ||
| Preoperative Planning | 942 | ||
| Radiographic Evaluation | 942 | ||
| Description of Technique | 943 | ||
| Variations/Unusual Situations | 944 | ||
| Postoperative Care | 945 | ||
| Results | 945 | ||
| Complications | 946 | ||
| Current Controversies and Future Considerations | 947 | ||
| References | 947 | ||
| 77 Previous Proximal Femoral Fracture and Proximal Femoral Deformity | 948 | ||
| Key Points | 948 | ||
| Introduction | 948 | ||
| Indications | 948 | ||
| Contraindications | 949 | ||
| Preoperative Planning | 949 | ||
| Description of Techniques | 951 | ||
| Retained Hardware | 951 | ||
| Exposure | 951 | ||
| Prosthetic Choice | 951 | ||
| Osteotomy | 952 | ||
| Unusual Situations | 952 | ||
| Case 1 | 952 | ||
| Case 2 | 952 | ||
| Case 3 | 952 | ||
| Case 4 | 952 | ||
| Case 5 | 953 | ||
| Case 6 | 953 | ||
| Postoperative Care | 955 | ||
| Results | 955 | ||
| THA With Proximal Femoral Deformity | 955 | ||
| THA After Conversion from Failed Fracture Fixation | 956 | ||
| Complications | 957 | ||
| Current Controversies and Future Considerations | 958 | ||
| References | 958 | ||
| 78 Metabolic Bone Disease | 959 | ||
| Key Points | 959 | ||
| Paget’s Disease | 959 | ||
| Introduction | 959 | ||
| Pathoanatomy | 959 | ||
| Alternative Treatment | 960 | ||
| Surgical Treatment | 960 | ||
| Technique | 960 | ||
| Preoperative Planning. | 960 | ||
| Exposure. | 961 | ||
| Bony Preparation. | 962 | ||
| Prosthesis Implantation. | 962 | ||
| Wound Closure. | 962 | ||
| Postoperative Regimen. | 962 | ||
| Total Hip Arthroplasty: Renal Osteodystrophy, Renal Transplant, and Dialysis | 963 | ||
| Results | 963 | ||
| References | 963 | ||
| 79 Osteonecrosis of the Hip | 965 | ||
| Key Points | 965 | ||
| Introduction | 965 | ||
| Indications and Contraindications | 966 | ||
| Preoperative Planning | 966 | ||
| Description of Technique | 966 | ||
| Technical Variations/ Unusual Situations | 966 | ||
| Postoperative Care | 967 | ||
| Results | 967 | ||
| Complications | 967 | ||
| Current Controversies and Future Considerations | 967 | ||
| References | 970 | ||
| 80 The Neuromuscular Hip | 972 | ||
| Key Point | 972 | ||
| Introduction | 972 | ||
| Intrinsic Disorders | 973 | ||
| Spasticity | 973 | ||
| Head-Neck Resection and Interposition Arthroplasty | 973 | ||
| Hip Arthrodesis | 974 | ||
| Total Hip Arthroplasty | 976 | ||
| Flaccid Paralysis | 976 | ||
| Poliomyelitis | 977 | ||
| Myelomeningocele | 978 | ||
| Charcot-Marie-Tooth Disease | 980 | ||
| Extrinsic Disorders | 980 | ||
| Charcot Neuropathic Hip Joint | 980 | ||
| Parkinson’s Disease | 982 | ||
| Multiple Sclerosis | 983 | ||
| Adult-Onset Cerebrovascular Accident (Stroke), Upper Motor Neuron Spinal Cord Injury, and Head Injury | 984 | ||
| Spinal Cord Injury | 984 | ||
| Conclusion | 984 | ||
| References | 984 | ||
| 81 Previous Hip Arthrodesis | 986 | ||
| Key Points | 986 | ||
| Introduction | 986 | ||
| Indications/Contraindications | 986 | ||
| Preoperative Planning | 987 | ||
| Description of Technique | 988 | ||
| Technique | 988 | ||
| Exposure | 988 | ||
| Bone Preparation | 988 | ||
| Prosthesis Implantation | 989 | ||
| Wound Closure | 991 | ||
| Tips and Pearls | 991 | ||
| Variations/Unusual Situations | 991 | ||
| Postoperative Care | 991 | ||
| Results | 991 | ||
| Pain Relief | 992 | ||
| Function and Pain of the Converted Hip | 992 | ||
| Survival of the Converted Total Hip Replacement | 992 | ||
| Overall Patient Satisfaction | 992 | ||
| Complications | 994 | ||
| Current Controversies and Future Considerations | 994 | ||
| References | 994 | ||
| 82 Protrusio Acetabuli | 996 | ||
| Key Points | 996 | ||
| Introduction | 996 | ||
| Indications/Contraindications | 996 | ||
| Preoperative Planning | 998 | ||
| Surgical Technique | 999 | ||
| Variations and Caveats | 1002 | ||
| Postoperative Care | 1002 | ||
| Results | 1003 | ||
| Complications of Protrusio Acetabuli | 1003 | ||
| Future Considerations | 1004 | ||
| References | 1004 | ||
| 83 Sickle Cell Disease | 1005 | ||
| Key Points | 1005 | ||
| Introduction | 1005 | ||
| Indications/Contraindications | 1006 | ||
| Preoperative Planning | 1007 | ||
| Description of Technique | 1009 | ||
| Tips and Pearls | 1009 | ||
| Postoperative Care | 1010 | ||
| Results | 1010 | ||
| Complications | 1010 | ||
| Current Controversies and Future Considerations | 1011 | ||
| References | 1012 | ||
| Further Reading | 1013 | ||
| 84 High Body Mass Index | 1014 | ||
| Key Points | 1014 | ||
| Introduction | 1014 | ||
| Indications/Contraindications | 1014 | ||
| Preoperative Planning | 1014 | ||
| Description of Surgical Technique: Variations in Obese Patients | 1015 | ||
| Postoperative Care | 1015 | ||
| Effects of Obesity on THA: Results/Complications | 1015 | ||
| Super-Obese Patients | 1021 | ||
| Infection | 1021 | ||
| Thromboembolic Complications | 1022 | ||
| Current Controversies and Future Considerations | 1022 | ||
| Conclusions | 1022 | ||
| References | 1022 | ||
| XI Revision Total Hip Arthroplasty | 1025 | ||
| 85 Evaluation of the Failed Total Hip Arthroplasty | 1026 | ||
| Key Points | 1026 | ||
| Introduction | 1026 | ||
| Clinical Evaluation | 1026 | ||
| Physical Examination | 1027 | ||
| Imaging of the Failed Total Hip Replacement | 1028 | ||
| Osteolysis and Wear | 1029 | ||
| Causes | 1029 | ||
| Risk Factors | 1029 | ||
| Diagnosis | 1029 | ||
| Radiology and Classification | 1029 | ||
| Femoral Component | 1029 | ||
| Acetabular Component | 1030 | ||
| Periprosthetic Infection | 1031 | ||
| Incidence and Epidemiology | 1031 | ||
| Risk Factors | 1031 | ||
| Pathophysiology | 1032 | ||
| Clinical Features and Diagnosis | 1032 | ||
| Future Directions | 1033 | ||
| Dislocation | 1033 | ||
| Epidemiology | 1033 | ||
| Patient Factors | 1033 | ||
| Surgical Factors | 1034 | ||
| Implant Factors | 1034 | ||
| Clinical Features and Diagnosis | 1034 | ||
| Periprosthetic Fractures | 1035 | ||
| Epidemiology | 1035 | ||
| Risk Factors | 1035 | ||
| Classification | 1035 | ||
| Diagnosis | 1035 | ||
| References | 1036 | ||
| Further Reading | 1038 | ||
| 86 Preoperative Planning and Templating for Revision Hip Arthroplasty | 1039 | ||
| Key Points | 1039 | ||
| Introduction | 1039 | ||
| Preoperative Diagnosis | 1039 | ||
| Physical Examination | 1041 | ||
| Radiographic Evaluation | 1042 | ||
| Infection Evaluation | 1045 | ||
| Templating | 1046 | ||
| Conclusions | 1050 | ||
| Current Controversies and Future Considerations | 1050 | ||
| References | 1050 | ||
| 87 Implant Removal in Revision Hip Arthroplasty | 1053 | ||
| Key Points | 1053 | ||
| Introduction | 1053 | ||
| Indications/Contraindications | 1053 | ||
| Preoperative Planning | 1054 | ||
| Description of Techniques | 1055 | ||
| Surgical Approach | 1055 | ||
| The Acetabulum | 1056 | ||
| Removal of the Cemented Acetabular Component | 1056 | ||
| Removal of the Solidly Fixed Uncemented Acetabular Component | 1056 | ||
| Removal of the Metal-on-Metal Uncemented Acetabular Component | 1057 | ||
| The Femur | 1058 | ||
| Removal of the Solidly Fixed Cemented Femoral Component | 1058 | ||
| Removal of the Proximally Coated Cementless Femoral Component | 1059 | ||
| Removal of the Fully Coated Cementless Femoral Component | 1060 | ||
| Removal of a Broken Femoral Stem | 1061 | ||
| Postoperative Care | 1061 | ||
| Future Considerations | 1061 | ||
| References | 1061 | ||
| 88 Osteolysis Around Well-Fixed Hip Replacement Parts | 1064 | ||
| Key Points | 1064 | ||
| Introduction | 1064 | ||
| Indications | 1064 | ||
| Acetabular Treatment Algorithm | 1065 | ||
| Femoral Treatment Algorithm | 1065 | ||
| Surgical Technique | 1066 | ||
| Results | 1067 | ||
| Future Directions | 1068 | ||
| References | 1068 | ||
| Key Readings | 1069 | ||
| 89 Acetabular Reconstruction: | 1070 | ||
| Key Points | 1070 | ||
| Introduction | 1070 | ||
| Indications/Contraindications | 1070 | ||
| Classification Systems | 1071 | ||
| AAOS Classification | 1071 | ||
| Paprosky Classification | 1071 | ||
| Reliability and Validity of the Classification Systems | 1075 | ||
| Preoperative Planning | 1075 | ||
| Algorithmic Approach | 1076 | ||
| Treatment Options for Acetabular Defects | 1076 | ||
| Hemispherical Porous-Coated Cementless Acetabular Component | 1077 | ||
| Jumbo Cups | 1078 | ||
| High Hip Center | 1079 | ||
| Bilobed or Oblong Cups | 1079 | ||
| Impaction Grafting and Cement | 1079 | ||
| Structural Bulk Allografts | 1080 | ||
| Antiprotrusio Cages | 1080 | ||
| Highly Porous Acetabular Cups and Augment Systems | 1081 | ||
| Current Controversies/ Future Considerations | 1082 | ||
| Summary | 1082 | ||
| References | 1082 | ||
| Further Reading | 1083 | ||
| 90 Acetabular Revision: | 1085 | ||
| Key Points | 1085 | ||
| Introduction | 1085 | ||
| Indications | 1085 | ||
| Preoperative Planning | 1087 | ||
| Description of Technique | 1088 | ||
| Is Bone Stock Adequate to Secure a Cementless Hemispherical Acetabular Component? | 1090 | ||
| Variations/Unusual Situations | 1092 | ||
| Postoperative Care | 1093 | ||
| Results | 1094 | ||
| Complications | 1094 | ||
| References | 1094 | ||
| 91 Acetabular Revision: | 1098 | ||
| Key Points | 1098 | ||
| Introduction | 1098 | ||
| Indications/Contraindications | 1099 | ||
| Indications | 1099 | ||
| Contraindications | 1099 | ||
| Equipment | 1099 | ||
| Description of Technique | 1099 | ||
| Preoperative Procedure | 1099 | ||
| Surgical Exposure | 1100 | ||
| Acetabular Assessment | 1100 | ||
| Acetabular Reconstruction | 1100 | ||
| Cavitary Defects | 1100 | ||
| Medial Segmental Defects | 1101 | ||
| Peripheral Segmental Defects | 1101 | ||
| Graft Preparation | 1101 | ||
| Acetabular Impaction | 1101 | ||
| Reverse Reaming Versus Impaction Grafting (Figs 91-9 and 91-10) | 1103 | ||
| Postoperative Care | 1103 | ||
| Complications | 1104 | ||
| Results | 1104 | ||
| Use of Support Rings and Cages with Impaction Grafting | 1105 | ||
| Histology of Impacted Bone Graft | 1106 | ||
| Alternatives to the Use of Fresh-Frozen Allograft | 1106 | ||
| Conclusions | 1107 | ||
| Current Controversies and Future Considerations | 1107 | ||
| References | 1107 | ||
| Further Reading | 1109 | ||
| 92 Acetabular Revision: | 1111 | ||
| Key Points | 1111 | ||
| Introduction | 1111 | ||
| Bone Loss Classification | 1111 | ||
| Indications | 1111 | ||
| Contraindications | 1111 | ||
| Preoperative Planning | 1112 | ||
| History and Physical Examination | 1112 | ||
| Radiographic Evaluation | 1112 | ||
| Component Design | 1113 | ||
| Description of Techniques | 1115 | ||
| Surgical Approach | 1115 | ||
| Acetabular Cage Implantation | 1116 | ||
| CTAC Implantation | 1117 | ||
| Wound Closure | 1118 | ||
| Variations/Unusual Situations | 1118 | ||
| Use of A Cage in Pelvic Discontinuity | 1118 | ||
| Use of A CTAC With Pelvic Discontinuity | 1118 | ||
| The Cup-Cage Construct | 1118 | ||
| Postoperative Care | 1120 | ||
| Results | 1120 | ||
| Acetabular Cages | 1120 | ||
| CTAC | 1120 | ||
| Complications | 1120 | ||
| References | 1121 | ||
| 93 Femoral Revision: | 1123 | ||
| Key Points | 1123 | ||
| Introduction | 1123 | ||
| Classifications and Treatment Options | 1123 | ||
| Paprosky Classification | 1123 | ||
| Mallory Classification | 1126 | ||
| American Academy of Orthopaedic Surgeons Committee on the Hip Classification | 1127 | ||
| Endo-Klink Classification | 1128 | ||
| Classification of Saleh and Associates | 1129 | ||
| Engh and Glassman Classification | 1129 | ||
| Gustilo and Pasternak Classification | 1130 | ||
| Chandler and Penenberg Classification | 1130 | ||
| Classification Reliability and Validity | 1130 | ||
| Conclusions | 1131 | ||
| Current Controversies and Future Directions | 1131 | ||
| References | 1131 | ||
| 94 Cemented Femoral Revision in Total Hip Arthroplasty: | 1133 | ||
| Key Points | 1133 | ||
| Introduction | 1133 | ||
| Early Experience | 1133 | ||
| Lessons Learned | 1133 | ||
| Lesson 1: Longer stems can improve cemented femoral fixation | 1134 | ||
| Lesson 2: Cemented re-revision does poorly | 1134 | ||
| Lesson 3: Bone loss and time to failure are risk factors for failure | 1134 | ||
| Lesson 4: Cement technique matters | 1135 | ||
| Lesson 5: Young age increases risk of failure | 1135 | ||
| Lessons Learned: Long-term follow-up | 1135 | ||
| Indications | 1135 | ||
| Technique | 1135 | ||
| Conclusion | 1136 | ||
| References | 1136 | ||
| 95 Femoral Revision: | 1138 | ||
| Key Points | 1138 | ||
| Introduction | 1138 | ||
| Indications/Contraindications | 1138 | ||
| Indications | 1138 | ||
| Contraindications | 1138 | ||
| Preoperative Planning | 1138 | ||
| Description of the Technique | 1139 | ||
| Insertion of Intramedullary Plug | 1139 | ||
| Sizing of the Femoral Canal | 1139 | ||
| Distal Impaction | 1140 | ||
| Proximal Impaction | 1141 | ||
| Cementing and Stem Insertion | 1142 | ||
| Technical Tips | 1144 | ||
| Unusual Situations/Caveats | 1144 | ||
| Templated Plug Position Distal to Isthmus | 1144 | ||
| Awareness of Risk of Intraoperative Fracture | 1144 | ||
| Risk of Graft Extrusion Through Femoral Cortical Defects | 1144 | ||
| Use of Long Stems | 1144 | ||
| Combined Use With Extended Trochanteric Osteotomy (ETO) | 1144 | ||
| Postoperative Care | 1144 | ||
| Results | 1144 | ||
| Complications | 1145 | ||
| Current Controversies and Future Considerations | 1145 | ||
| References | 1145 | ||
| Further Reading | 1146 | ||
| 96 Femoral Revision: | 1147 | ||
| Key Points | 1147 | ||
| Introduction | 1147 | ||
| Indications for Extensively Porous-Coated Stems | 1148 | ||
| Contraindications | 1150 | ||
| Preoperative Planning | 1151 | ||
| Description of Techniques | 1151 | ||
| Variations/Unusual Situations | 1153 | ||
| Postoperative Care | 1153 | ||
| Results | 1153 | ||
| Complications | 1154 | ||
| Current Controversies and Future Considerations | 1155 | ||
| References | 1155 | ||
| 97 Femoral Revision: | 1157 | ||
| Key Points | 1157 | ||
| Introduction | 1157 | ||
| Indications and Choice of Implants | 1157 | ||
| Preoperative Planning | 1159 | ||
| Technique | 1159 | ||
| Removal of the Failed Femoral Stem | 1159 | ||
| Femoral Preparation | 1159 | ||
| Insertion of the Trial Stem | 1160 | ||
| Mobility and Stability Tests | 1160 | ||
| HA-Coated Implants and Bone Grafting | 1160 | ||
| Implantation of the Definitive Stem | 1161 | ||
| Results | 1162 | ||
| The Study | 1162 | ||
| Clinical Results | 1163 | ||
| Radiologic Results | 1164 | ||
| Complications | 1165 | ||
| Current Controversies and Future Considerations | 1166 | ||
| References | 1167 | ||
| 98 Femoral Revision: | 1170 | ||
| Key Points | 1170 | ||
| Introduction | 1170 | ||
| Design Rationale | 1170 | ||
| Preoperative Planning | 1171 | ||
| Preoperative Templating | 1171 | ||
| Surgical Technique | 1171 | ||
| Assembly In Situ With Extended Trochanteric Osteotomy | 1171 | ||
| Assembly on the Back Table for the Endofemoral Route | 1174 | ||
| Postoperative Care | 1175 | ||
| Results | 1175 | ||
| Complications | 1176 | ||
| Summary and Conclusion | 1176 | ||
| Current Controversies and Future Considerations | 1176 | ||
| References | 1177 | ||
| Further Reading | 1177 | ||
| 99 Femoral Revision: | 1179 | ||
| Key Points | 1179 | ||
| Introduction | 1179 | ||
| Indications and Contraindications | 1180 | ||
| Indications | 1180 | ||
| Contraindications | 1180 | ||
| Preoperative Planning | 1180 | ||
| Allograft Prosthetic Composites | 1180 | ||
| Allograft Availability | 1180 | ||
| Ruling Out Infection | 1180 | ||
| Equipment and Implants | 1180 | ||
| Leg Length Discrepancy | 1181 | ||
| Description of Technique | 1181 | ||
| General Setup | 1181 | ||
| Initial Graft Preparation | 1181 | ||
| Surgical Approach | 1182 | ||
| Leg Length Reference and Monitoring | 1182 | ||
| Preparation of the Host Distal Femur | 1183 | ||
| Final Graft Preparation | 1183 | ||
| Final Step | 1184 | ||
| Variations/Unusual Situations | 1185 | ||
| Postoperative Care | 1186 | ||
| Results | 1187 | ||
| Survivorship | 1187 | ||
| Functional Outcomes | 1188 | ||
| Complications | 1189 | ||
| Dislocation | 1189 | ||
| Infection | 1189 | ||
| Nonunion | 1190 | ||
| Loosening | 1190 | ||
| Resorption | 1190 | ||
| Current Controversies and Future Considerations | 1190 | ||
| References | 1192 | ||
| Further Reading | 1192 | ||
| XII Complications of Hip Arthroplasty | 1195 | ||
| 100 Infection | 1196 | ||
| Key Points | 1196 | ||
| Introduction | 1196 | ||
| Risk Factors and Prevention | 1196 | ||
| Microbiology | 1197 | ||
| Diagnosis | 1198 | ||
| Treatment | 1200 | ||
| Retention of the Prosthesis | 1201 | ||
| Antibiotic Suppression | 1201 | ||
| Irrigation and Débridement | 1201 | ||
| Removal of the Prosthesis | 1201 | ||
| Direct or “One-Stage” Exchange | 1201 | ||
| Delayed or “Two-Stage” Exchange | 1202 | ||
| Articulating Spacers | 1203 | ||
| Resection Arthroplasty | 1204 | ||
| References | 1204 | ||
| 101 Hip Instability | 1207 | ||
| Key Points | 1207 | ||
| Introduction | 1207 | ||
| Risk Factors for Instability | 1207 | ||
| Treatment of the Unstable THA | 1209 | ||
| Indications/Contraindications | 1210 | ||
| Preoperative Planning for Revision THA for Instability | 1210 | ||
| Techniques and Results of Revision THA for Instability | 1210 | ||
| Component Revision | 1211 | ||
| Modular Component Exchange | 1212 | ||
| Large Femoral Heads | 1212 | ||
| Soft Tissue Augmentation | 1212 | ||
| Trochanteric Advancement | 1212 | ||
| Conversion to a Bipolar Arthroplasty | 1212 | ||
| Unconstrained Tripolar Arthroplasty | 1213 | ||
| Constrained Liners | 1214 | ||
| Conclusion | 1215 | ||
| References | 1215 | ||
| 102 Periprosthetic Fracture: | 1218 | ||
| Key Points | 1218 | ||
| Introduction | 1218 | ||
| Epidemiology and Risk Factors | 1218 | ||
| Prevention | 1220 | ||
| Diagnosis | 1222 | ||
| Classification | 1222 | ||
| Acetabular Fractures | 1223 | ||
| Femoral Fractures | 1223 | ||
| Treatment and Results | 1224 | ||
| Acetabular Fractures | 1224 | ||
| Femoral Fractures | 1225 | ||
| Type A Intraoperative Fractures of the Greater or Lesser Trochanter | 1227 | ||
| Type B Intraoperative Fractures | 1227 | ||
| Type C Intraoperative Fractures | 1227 | ||
| Postoperative Fractures | 1228 | ||
| Type A Postoperative Fractures. | 1228 | ||
| Type B Postoperative Fractures. | 1228 | ||
| Vancouver B1 Periprosthetic Fractures. | 1228 | ||
| Vancouver B2 Periprosthetic Fractures. | 1229 | ||
| Vancouver B3 Periprosthetic Fractures. | 1229 | ||
| Vancouver Type C Periprosthetic Fractures. | 1230 | ||
| Prognosis | 1231 | ||
| Current Controversies and Future Considerations | 1231 | ||
| References | 1231 | ||
| 103 Abductor Muscle and Greater Trochanteric Complications | 1235 | ||
| Key Points | 1235 | ||
| Introduction | 1235 | ||
| Bony Complications | 1235 | ||
| Nonunion | 1235 | ||
| Heterotopic Ossification | 1237 | ||
| Fracture | 1237 | ||
| Soft Tissue Complications | 1238 | ||
| Bursitis | 1238 | ||
| Nerve Injury | 1238 | ||
| Tendinous Avulsion | 1238 | ||
| Surgical Techniques | 1238 | ||
| Intraoperative Fractures of the Greater Trochanter | 1238 | ||
| Technique of Abductor Muscle Reconstruction With Achilles Tendon Allograft | 1240 | ||
| References | 1242 | ||
| Further Reading | 1244 | ||
| 104 Leg Length Inequality: | 1245 | ||
| Key Points | 1245 | ||
| Introduction | 1245 | ||
| Incidence and Prevalence | 1245 | ||
| Steps to Prevent and Minimize Leg Length Inequality | 1245 | ||
| Preoperative Assessment | 1245 | ||
| History and Physical Examination | 1245 | ||
| Measuring True Leg Length Inequality | 1246 | ||
| The “Direct Method”: Using a Tape Measure. | 1246 | ||
| The Indirect Method: The “Block Test.” | 1246 | ||
| Measuring Apparent Leg Length Inequality | 1247 | ||
| Radiographic Assessment. | 1247 | ||
| AP pelvis radiograph. | 1247 | ||
| Full Limb Standing Radiographs. | 1248 | ||
| Preoperative Templating | 1248 | ||
| Intraoperative Assessment | 1248 | ||
| Leg Length Inequality Following Total Hip Arthroplasty | 1250 | ||
| Apparent Leg Length Inequality | 1250 | ||
| Treatment of Apparent Leg Length Inequality | 1250 | ||
| True Leg Length Inequality | 1250 | ||
| Risk Factors for True Leg Length Inequality | 1250 | ||
| Developmental Conditions. | 1250 | ||
| Revision Surgery With Soft Tissue Laxity. | 1250 | ||
| Post-traumatic Conditions. | 1250 | ||
| Treatment of True Leg Length Inequality After Total Hip Arthroplasty | 1251 | ||
| Stability and Leg Length Inequality | 1251 | ||
| Conclusion | 1251 | ||
| References | 1251 | ||
| Further Reading | 1252 | ||
| 105 Neurovascular Injuries | 1253 | ||
| Neurologic Injuries | 1253 | ||
| Introduction | 1253 | ||
| Epidemiology and Risk Factors | 1253 | ||
| Peripheral Nerve Injury | 1253 | ||
| Central Nervous System Injury | 1254 | ||
| Pathophysiology | 1254 | ||
| Peripheral Nerve Injury | 1254 | ||
| Central Nervous System Injury | 1255 | ||
| Diagnosis | 1256 | ||
| Peripheral Nerve Injury | 1256 | ||
| Central Nervous System Injury | 1258 | ||
| Treatment | 1258 | ||
| Peripheral Nerve Injuries | 1258 | ||
| Central Nervous System Injury | 1259 | ||
| Prognosis | 1259 | ||
| Current Controversies and Future Considerations | 1259 | ||
| Vascular Injuries | 1262 | ||
| Introduction | 1262 | ||
| Epidemiology and Risk Factors | 1262 | ||
| Pathophysiology/Anatomy | 1263 | ||
| Clinical Features and Diagnosis | 1266 | ||
| Treatment | 1266 | ||
| Prognosis | 1266 | ||
| References | 1268 | ||
| 106 Wound Complications | 1270 | ||
| Key Points | 1270 | ||
| Introduction | 1270 | ||
| Wound Drainage in Total Hip Arthroplasty | 1270 | ||
| Use of a Closed Suction Drain | 1271 | ||
| Early Plastic Surgery Consultation | 1271 | ||
| Serum Markers of Malnutrition | 1271 | ||
| The Diagnosis of Acute Postsurgical Infection | 1273 | ||
| Reducing the Probability of Infection | 1273 | ||
| Wound Closure and Cosmesis | 1274 | ||
| References | 1274 | ||
| 107 Heterotopic Ossification | 1277 | ||
| Key Points | 1277 | ||
| Introduction | 1277 | ||
| Epidemiology and Risk Factors | 1277 | ||
| Pathophysiology | 1278 | ||
| Genetics of Fibrodysplasia Ossificans Progressiva | 1280 | ||
| Clinical Features and Diagnosis | 1280 | ||
| Radiographic Staging | 1280 | ||
| Clinical Presentation | 1281 | ||
| Differential Diagnosis | 1281 | ||
| Treatment | 1281 | ||
| Prophylaxis of Heterotopic Ossification | 1281 | ||
| Indications | 1282 | ||
| Contraindications | 1282 | ||
| Treatment Alternatives and Results | 1282 | ||
| Prophylaxis. | 1282 | ||
| Complications | 1283 | ||
| Excision of Heterotopic Bone | 1283 | ||
| Indications | 1283 | ||
| Contraindications | 1284 | ||
| Treatment Alternatives and Results | 1284 | ||
| Complications | 1286 | ||
| Prognosis | 1286 | ||
| Current Controversies and Future Considerations | 1286 | ||
| References | 1286 | ||
| Further Readings | 1288 | ||
| Index | 1289 | ||
| A | 1289 | ||
| B | 1292 | ||
| C | 1294 | ||
| D | 1297 | ||
| E | 1299 | ||
| F | 1300 | ||
| G | 1302 | ||
| H | 1303 | ||
| I | 1304 | ||
| J | 1306 | ||
| K | 1306 | ||
| L | 1306 | ||
| M | 1307 | ||
| N | 1309 | ||
| O | 1309 | ||
| P | 1311 | ||
| Q | 1314 | ||
| R | 1314 | ||
| S | 1316 | ||
| T | 1318 | ||
| U | 1319 | ||
| V | 1319 | ||
| W | 1320 | ||
| X | 1321 | ||
| Y | 1321 | ||
| Z | 1321 |