Join this informative session led by Adam Brooks, where he delves into the world of hip dysplasia, a condition often unrecognized in routine diagnoses. Brooks provides a comprehensive study of hip dysplasia, touching on important topics from anatomy, pathophysiology, examination, investigation, to management of this condition. In the session, Brooks stresses on the importance of understanding the relevance of the abductor muscles and the labrum in dealing with hip disorders. He will further explain why early identification and management of hip dysplasia is crucial due to its progression to arthritis. This session gives attendees valuable insight into hip stability and provides them with useful information on how hip dysplasia, if undiagnosed or untreated, may overload the hip junction and cause damage over time. This session is ideal for medical professionals looking to deepen their knowledge on hip dysplasia and its proper diagnosis and management.
At the end of this session, participants should be able to correctly describe what hip dysplasia is and identify common risk factors and epidemiology of this condition.
Participants will be able to explain what happens during hip dysplasia in terms of anatomy and pathophysiology, including abnormalities in the femoral head and the joint reaction forces involved.
Participants will be able to specify procedures for accurately diagnosing hip dysplasia, including history-taking, physical examination, and imaging investigation.
Participants should be able to refine investigative techniques, understanding and appreciating the correlation between the structure of the hip joint muscles, femoral diversion, and the development of hip dysplasia.
Upon completion of this session, attendees should be capable of devising appropriate and effective management approaches including prevention, preservation measures, and treatments for hip dysplasia.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
I'm Adam Brooks stage is yours? Thanks, I uh for the mutation. Um So the next hopefully half an hour, I'll um just talk to you briefly about uh hip dysplasia. A So in terms of what do you covered? Iggy it, you've just done fa I and uh assessment of the um uh hips in terms of examination and imaging. Is that correct? Ok. So as you all know, hip dysplasia is, uh it's, it's a condition where there's a shallow stab and uh uh there is an undercover of the femoral head. So this is a big problem and a lot of this is not uh recognized um routinely. So what I'll try to do is, you know, give you an overview of what you should do and how we can make it, make the diagnosis on time so that we can get the best outcome for the patients. Ok. So we'll go through the relevant anatomy, um some pathophysiology, uh history, examination, investigation, and management in these cases. So, in terms of the anatomy, you know, hips uh hip joint, we all know we've done all the, you know, surgeries for arthritis, uh hip fractures, but off note what you need to be. Uh, um, mindful of is the number of muscles around the hip joint. There are quite a lot of muscles uh all around and those in particular are the, uh, the abductor muscles, you know, the gluteus medius minimus, uh, and the ones in the front, the ili sores and um, um Isler capsularis, I'll mention about that. Can you see my pointer at all? No. Ok. So, um, that's a shame. I can't see the pointer anyway. So the other things you need to be aware of is the labrum. So the, the labrum is what we um talk about in the hip preservation world a lot. Whereas uh the arthroplasty surgeons take out the labrum. Um So you want to preserve the labrum. So it's a, it's a harsh shaped fibro cartilage which is attached to the periphery of the stab, it's triger in cross section. And uh uh it's harsher because inferiorly uh it forms a tab that that's what we use when we are. Um um orienting the establish comp in hip replacements, uh it is vascular. So the blood supply comes from the super infla gluteal arteries. Um and also it's got some nerves and that's why patients who have a label, tear will end up having some pain uh in the groin as well. Uh And the other thing of note is the capsule. OK. The hip joint capsule is important in terms of uh maintaining the stability of the hip joint. And um it's a chance just proximal to the um the labrum uh around the ul and distally. You know, it attaches the interotic line anteriorly and posteriorly just uh at the bottom of the neck. The capsule also has these uh ligaments, the iliofemoral poral isem and the zon ocularis. Why is that important? So, the iliofemoral ligament is in the front and it gives a lot of stability to the hip joint. And um uh it it prevents subluxation of the hip joint. Ok. So this is important and some of the people who um uh do uh supine hip arthroscopy will make a capsulotomy anteriorly and that may predispose to some instability in the hip joints. And that's why uh if you do a big capsulotomy, uh it needs to be repaired. Ok. And the other muscle uh which is of important is the eye look capsule. Very little has been mentioned about this. Uh you know, generally, but this is a very tiny muscle um which is just overlying the capsule. And it has been described that there is a role of this muscle as a dynamic stabilizer in giving some anti stability to the hips, mainly in uh dysplastic hips. Ok. So, in terms of the risk factors and epidemiology, you know, we all know the risk factors for hip dis DD DH. It's the same, it's a breech, first born low birth weight there, oligohydramnios and once the child is born if, uh, they are used to being swd. So that seems to, uh, increase the risk of, uh, hip dysplasia even if they didn't have D DH, um, and in certain cultures where the Children are carried over the, um, around the hips. So, which gives a kind of an abduction position in, uh, in the hip joints, they have a decreased, um, uh, incidence of, uh, hip dysplasia. There are various reports for 3 to 5% incidence of hip dysplasia and some reports it's up to 10%. And again, 10% of all hip replacement may have somewhat of hip dysplasia. Hip dysplasia is common in females, um, but can occur in males as well. So this study from, um, Scandinavia, uh, again, it shows, uh, in their population of over 3600 people that hip dysplasia was about, you know, between 3.6 to 4.3% and they have slightly higher pre uh, prevalence in, uh, in men. That's very interesting to know. And again, from the same group they evaluated, um, all, uh, you know, um, what 3.5 1000 people, majority of women who had hip dysplasia, about 5.4 to 12.8% had hip dysplasia. Uh, and when they looked at, uh, what is the rate of, what is the conversion of, um, uh, hip dysplasia into oa? And they felt in women the higher the age and the presence of dysplasia that led to oa whereas in men, it was only hip dysplasia. So hip dysplasia does have a role in uh progression to arthritis. So that's why early identification and management is important. So what actually happens uh in hip dispace? Yeah. So before we go there, so in terms of the the stability of the hip joint, there are several factors. Uh we talked about the, the static uh factors. The most important is the bone anatomy. Uh The estab is, is quite a deep structure. So that gives an inherent stability to the hip joint. Uh When you compare it to uh the shoulder joint, both the ball and socket, whereas the hip is much more stable than the shoulder joint. Uh In addition, the capsule provides a static stability. Then the muscles we looked at the ili or is capsularis, even the rectus gluteus medias and TFL um give some stability to the hip joint. Then again, if there is any presence of collagen disorders that can give rise to instability in the hip joint, the uh the establish coverage of the femoral head, that's what we'll be looking at mainly um in the stock. So that is important in terms of stability, the femoral uh morphology. Uh what is the femoral anti version? And they give us telling you about how to measure the femoral uh anti version. And there are several methods and I'll show you one which uh we use commonly. Um and that is also important in uh maintaining stability to the hip joint. Often we see patients with hip dysplasia having increased femoral diversion. So that's a bad sign hip dysplasia and the fem increased femoral diversion. So that will be unstable. Um, again, if they've had previous surgery when we've taken off bone, then that can affect the stability in the hip joint. Again, what happens here is, there's an abnormal movement of the femoral head within the stab and there is overload of the rim and over a period of time because of the overload, they develop on factors. So if you look at it, the model, so this yellow is the cartilage and green is the labrum. And the blue is where there is contact in the femoral um head with the stab um in hip dysplasia rather than uh an upward force. There is an upward and a lateral force where in that, every time they are weight bearing it, the weight bearing, you know, the the forces go through the um establish labrum. And if you look at this uh study um where they did the measurements, you see there is this darker mm these uh forces going through the uh labrum and the contra la junction. So that's where the tears happen in the um uh labrum. Similarly. Yeah, this is again. So they've done quite a lot of studies in this uh where they've seen the forces through the um established lab and the con la junction and what happens in uh in various faces of walking again. So, dysplastic hips, there is a significantly increased load uh at the labrum and that's, that's what happens. OK. So in terms of you would have heard about joint reaction forces. Uh So this is also very important. So in the dysplastic hip, there is an increased.
