hip arthrodesis if very young patient in a labor intensive occupationįemoral head within acetabulum despite some subluxation.contraindicated in underlying disease process or chronic steroid use causing AVN (poor bone quality) and renal disease (metal ions from metal-on-metal implant).requires adequate bone to support resurfacing component.in advanced DJD with small, isolated focus of AVN.rotational osteotomy if small lesions (40 with large lesions.early AVN, before subchondral collapse occurs.core decompression with or without bone grafting if.

nonoperative treatment acceptable if precollapse AVN (Ficat stages 0-II).Steinberg Classification (modification of Ficat classification) grade 3 = large cysts in femoral head/acetabulum, joint space obliteration/severe narrowing, severe femoral head deformity vs.grade 2 = small cysts in femoral head/acetabulum, moderate joint space narrowing, moderate loss of head sphericity.grade 1 = sclerosis of femoral head + acetabulum, slight joint space narrowing, slight lipping at joint margins.OA posterior increased = anterior convexityĭistance between line parallel to femoral neck through anterior femoral neck + anterior femoral head divided by diameter of femoral headĭisplacement of femoral head from reference circleĪnterior center-edge angle/angle of lequesneĪngle between vertical line through femoral head + line along femoral head/anterior acetabulumĪssesses anterior coverage can have crossover sign but no posterior wall deficiency Minimum distance between femoral head + acetabulum Hip instability > 10° pincer-type FAI 10 mm femoral headĬoxa profunda = acetabular floor touches/medial to ilioischial line protrusion acetabuli = femoral head touches/medial to ilioischial lineĪcetabular inclination/acetabular roof angle of tonnisĪngle between line through inferior sourcil parallel to inter-teardrop line + line from inferior to lateral sourcil Relationship of ilioischial line with acetabular floor vs. % of femoral head not covered by acetabulum Lateral center-edge angle/angle of wibergĪngle between vertical line through femoral head + line along lateral acetabulumĪssesses superolateral coverage: dysplasia 40 ° Line along inferior ischial tuberosity + line along superior aspect of lesser trochanterĪngle between femoral neck + femoral shaft demonstration of bullet sign = superimposition of ischial tuberosity.too much ER leads to nonvisualization of lesser trochanter.visualization of greater trochanters in profile.symmetrical obturator foramen + iliac wing concavity.no overhang of greater trochanter over posterior margin.no obstructing soft tissue artifact via adequate elevation of contralateral leg.increased cephalad angle leads to increased visualization of greater trochanter off femoral neck but will distort/elongate femoral neck.useful for determining anterior center-edge angle.demonstrates anterior acetabular coverage of femoral head.provides true lateral projection of femoral head/neck and oblique view of acetabulum.useful as alternative to frog leg view, as it is technically easier to obtain.useful for confirming epiphysiolysis, SCFE, Perthes disease.better demonstrates shape of femoral head + head/neck transition.useful for confirming femoroacetabular impingement (alpha angle).better demonstrates relationship of femoral head with acetabulum.useful in trauma patients where positioning is limited by pain.Hip extended + pelvis ER 65° toward ipsilateral side TKA Postoperative Rehabilitation & Outpatient ManagementĬontralateral hip flexed 90° + ipsilateral hip IR 15-20 ° THA Pseudotumor (Metal on Metal Reactions) Idiopathic Transient Osteoporosis of the Hip (ITOH) Arthroplasty Preoperative Medical Optimization

Normal hip xray