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    X-Ray Interpretation of The Hip

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    almer hutapea
    Hold the femur steady in the guide. Cut perpendicular to the axis of the femur. Femoral Canal Preparation - Ream sequentially in 0.5mm increments - Use a flexible reamer to contour the canal - Take care not to perforate the cortex - Irrigate frequently to remove debris - Trial stems to check for fit and stability

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    X-Ray Interpretation of The Hip

    Uploaded by

    almer hutapea
    83 views32 pages
    Hold the femur steady in the guide. Cut perpendicular to the axis of the femur. Femoral Canal Preparation - Ream sequentially in 0.5mm increments - Use a flexible reamer to contour the canal - Take care not to perforate the cortex - Irrigate frequently to remove debris - Trial stems to check for fit and stability

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    X-Ray Interpretation of the Hip

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    Hold the femur steady in the guide. Cut perpendicular to the axis of the femur. Femoral Canal Preparation - Ream sequentially in 0.5mm increments - Use a flexible reamer to contour the canal - Take care not to perforate the cortex - Irrigate frequently to remove debris - Trial stems to check for fit and stability

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    83 views32 pages

    X-Ray Interpretation of The Hip

    Uploaded by

    almer hutapea
    Hold the femur steady in the guide. Cut perpendicular to the axis of the femur. Femoral Canal Preparation - Ream sequentially in 0.5mm increments - Use a flexible reamer to contour the canal - Take care not to perforate the cortex - Irrigate frequently to remove debris - Trial stems to check for fit and stability

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    © All Rights Reserved
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    You are on page 1of 32

    X-Ray Interpretation of

    the Hip (Templating)


    Overview
    • X-Ray: Basic Principles

    • Hip X-ray features

    • Spotting Pathological Findings

    • Prosthesis x-ray findings

    • Case-Studies
    Rontgen Rays
    1895
    X-Ray: Basic Principles

    • X-rays darken
    film

    • More rays =
    darker film
    Gas
    • Dense objects Fat
    5 Densities = Fluid
    result in white Bone
    areas Metal
    X-Ray: Basic Principles
    • When Looking at an X-ray check the following:

    • Label - Patient details

    • Orientation

    • Overall picture – exposure,

    • Bone shape, outline, key features, trabeculae

    • Soft Tissues

    • Focus on specific features


    X-Ray: Basic Principles
    PA Chest Film: What tissues can you spot?
    Hip – Key Features

    Must recognise normal to know what abnormal looks like


    X-Ray
    A-P Pelvic X-ray

    • Full contact of joint surfaces not acheived – consequence of erect posture


    X-Ray

    What has happened to the hip joints in these x-rays?


    Hip – Key Features
    What key features do you notice?

    Joint Space – Cartilage thinning


    Hip – Key Features
    Femoral Neck Femoral Head

    Epi
    Ilio-Pubic Ramus

    GT OF

    Ischial Tuberosity

    Femoral Shaft
    Dia
    Hip – Key Features
    Shenton’s Line
    (Inferior border of femoral neck – inferior border of iliopubic ramus)

    Indicator of neck fracture or dislocation


    Hip – Key Features
    Calcar Femorale

    • Thick plate of bone deep to lesser trochanter

    • Reinforces femoral neck

    • Joins to medial cortex

    Provides proximal support for new implants


    Hip – Key Features
    4 5
    1
    2
    3 6

    1 Iliopectineal line
    2 Ilioischial line
    3 Teardrop
    4 Acetabular dome line
    5 Anterior rim of acetabulum line

    6 Posterior rim of acetabulum line


    Hip – Key Features
    Acetabular Teardrop

    • Represents acetabular floor on x-ray

    • Lies above obturator foramen


    Hip – Key Features
    Femoral Trabeculae

    • Osteoarthritis - Singh index assesses patterns of loss

    • Fracture – alignment within head & between head + acetabulum


    Hip – Key Features
    Osteophytes

    • Bone outgrowths – occur with age & disease (osteoarthritis)

    • Cause confusion in templating – false margins

    • Inhibit simple intraoperative dislocation


    Hip – Key Features
    Templating on A-P X-ray

    • X-ray used to template position and size of new components

    • Medial position of acetabular template on teardrop

    • Inferior margin = obturator foramen


    X-Ray: Pathological
    Findings
    X-Ray: Pathological Findings
    What do you notice?

    Anterior Hip Dislocation Posterior Hip Dislocation


    X-Ray: Pathological Findings
    What do you notice?

    Intertrochanteric fracture Neck fracture


    X-Ray: Pathological Findings

    Collapse Sclerosis

    ? Bilateral avascular necrosis of femoral heads


    X-Ray: Pathological Findings

    Osteophytes Joint Space Obliteration

    Osteoarthritis
    X-Ray: Pathological Findings

    Acetabular osteolysis
    What view is shown?

    What problem is indicated by the arrow?


    Preoperative Templating
    and
    Surgical Technique
    Pre-Operative Planning Goals
    • Determine leg length
    discrepancy
    • Assess Acetabular size
    and placement
    • Determine femoral
    component size,
    position and fit
    • Assess femoral offset
    Determine leg length discrepancy

    • Draw a reference line through


    the bottom of the obturator
    foramina
    • Measure the difference from
    the lesser or greater
    trochanter landmark on each
    . .
    side . . . .
    • The difference between the 15mm 9mm
    two is the radiographic leg
    LLD 6mm on Rt
    length discrepancy
    Acetabular cup size and position
    • The goal in cementless acetabular
    reconstruction is to maximise bone
    contact while restoring center of
    rotation.
    • Mark out the ilioischial line, the base
    of the teardrop, and the superolateral Duraloc Cup 56mm
    acetabular margin
    • The acetabular teardrop can be .
    referenced as the inferior margin of
    the acetabular reconstruction
    • Determine the optimal position for the
    component and predict correct size
    using x-ray templates with known
    .
    magnification
    • Mark center of rotation & cup size and Mark the intended centre of rotation of the
    validate with the other side bearing surface on the x-ray
    Femoral component selection
    • Select femoral template with known
    magnification and align to long axis of
    femur while filling the proximal femur vertical gain 6mm
    • Not required to fill distal canal
    • Mark out the head option that will
    make up for the vertical LLD distance
    & double check with the altitude of the 1 cm from lesser troch
    tip of greater troch
    • Mark the level of planned neck
    resection
    • Mark area of proximal femoral 28mm + 5.0 head
    entrance
    • Indicate planned stem size and head Summit hi offset sz 5 stem
    option
    Meeting offset requirements
    • Hi offset option increases
    offset without increasing
    height
    • Through templating and
    intraoperative trialling the
    option which best restores
    proper offset by matching
    the cup’s centre of rotation
    with the desired centre of
    rotation of the head is
    chosen
    Femoral Head Resection
    • Elevate femur.
    • Align neck resection guide down
    the long axis of the femur
    • Determine the resection level by
    aligning the top of the guide with
    the tip of the greater trochanter
    or a measured distance above the
    lesser trochanter.
    • If required make a conservative
    neck cut initially which can be
    adjusted later with a calcar
    planer.

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