Hip Surgery: A Practical Guide

Preface
Editor’s List
Acknowledgments
About the Book
Contents
About the Editor
1: Surgical Anatomy of the Hip Joint
	1.1	 Overview
		1.1.1	 Acetabulum
		1.1.2	 Proximal Femur
		1.1.3	 Femoral Neck
	1.2	 Anterior Surgical Approach to the Hip and the Anatomical Characteristics
		1.2.1	 Anatomy of the Anterolateral Hip Region and Common Approaches
			1.2.1.1	 Anatomical Landmarks
				1.2.1.1.1	 Anterior Superior Iliac Spine
				1.2.1.1.2	 The Greater Trochanter of the Femur
				1.2.1.1.3	 Median Point of Inguinal Ligament
			1.2.1.2	 Anatomy of Superficial Structures
				1.2.1.2.1	 Sartorius Muscle
				1.2.1.2.2	 Tensor Fascia Latae Muscle
			1.2.1.3	 Deep Anatomy
				1.2.1.3.1	 Rectus Femoris
				1.2.1.3.2	 Iliopsoas
				1.2.1.3.3	 Anterior Capsule, Ligaments, and Blood Supplies
		1.2.2	 Anterior Medial Anatomy of the Hip Region
			1.2.2.1	 Femoral Artery
			1.2.2.2	 Femoral Vein
	1.3	 Lateral Surgical Approach to the Hip and the Anatomical Characteristics
		1.3.1	 Anatomical Landmarks
			1.3.1.1	 Anterior Superior Iliac Spine
			1.3.1.2	 The Greater Trochanter
		1.3.2	 Superficial Anatomy
			1.3.2.1	 Fascia Lata
			1.3.2.2	 Gluteus Medius
			1.3.2.3	 Gluteus Minimus
			1.3.2.4	 Vastus Lateralis
			1.3.2.5	 Vessels and Nerves to Be Protected Through the Lateral Approach
	1.4	 Posterior Surgical Approach to the Hip and the Anatomical Characteristics
		1.4.1	 Anatomical Landmarks
			1.4.1.1	 The Great Trochanter
			1.4.1.2	 Posterior Superior Iliac Spine
			1.4.1.3	 Ischial Tuberosity
			1.4.1.4	 Body Surface Projection
		1.4.2	 Superficial Anatomy
		1.4.3	 Deep Anatomy
			1.4.3.1	 Piriformis
			1.4.3.2	 Obturator Internus
			1.4.3.3	 Quadratus Femoris
		1.4.4	 Vessels and Nerves to Be Protected Through the Posterior Approach
			1.4.4.1	 Sciatic Nerve
			1.4.4.2	 Superior and Inferior Gluteal Artery
	1.5	 Blood Supplies of the Hip Joint
		1.5.1	 Blood Supplies Around the Hip Joint
			1.5.1.1	 Medial Femoral Circumflex Artery
			1.5.1.2	 Lateral Femoral Circumflex Artery
			1.5.1.3	 Obturator Artery
			1.5.1.4	 Superior Gluteal Artery
			1.5.1.5	 Inferior Gluteal Artery
			1.5.1.6	 Femoral Profound Artery
		1.5.2	 Blood Supply to the Head and Neck of the Femur
			1.5.2.1	 Retinacular Arteries
			1.5.2.2	 Artery to the Ligament of the Femoral Head
			1.5.2.3	 Nutrient Artery of the Femur
		1.5.3	 Blood Supplies to the Acetabulum
2: Biomechanics of Hip Joints
	2.1	 Overview
	2.2	 Hip Solid Mechanics
		2.2.1	 Hip Mechanical Properties
		2.2.2	 Bony Stable Structure
		2.2.3	 Static Stability Function of the Joint Capsule, Ligament, and Labrum
		2.2.4	 Hip Dynamic Stability Structure
		2.2.5	 Hip Biotribology
	2.3	 Hip Kinematics and Dynamics
	References
3: Assessment of Hip Pain
	3.1	 Overview
	3.2	 Clinical Features
		3.2.1	 Medical History
		3.2.2	 Physical Examination
			3.2.2.1	 Observation
			3.2.2.2	 Palpation
			3.2.2.3	 Movement
			3.2.2.4	 Measurement
	3.3	 Laboratory Tests and Imaging Examination
		3.3.1	 X-Ray
			3.3.1.1	 Anteroposterior View
			3.3.1.2	 Frog Lateral View
			3.3.1.3	 Abduction Functional View
		3.3.2	 CT
		3.3.3	 MRI
		3.3.4	 MRA
		3.3.5	 EMG
		3.3.6	 Hip Ultrasound
		3.3.7	 PET-CT
	3.4	 Diagnostic Injection Therapy
	3.5	 Hip functional rating scales
		3.5.1	 Harris Hip Score
			3.5.1.2	 History
			3.5.1.3	 Grading Standard
			3.5.1.4	 Advantages
			3.5.1.5	 Disadvantage
			3.5.1.6	 Applicable Population
		3.5.2	 Oxford Hip Score
			3.5.2.1	 History
			3.5.2.2	 Grading Standard
			3.5.2.3	 Advantages
			3.5.2.4	 Disadvantages
			3.5.2.5	 Applicable Population
		3.5.3	 WOMAC Osteoarthritis Index
			3.5.3.1	 History
			3.5.3.2	 Grading Standard
			3.5.3.3	 Advantages
			3.5.3.4	 Disadvantages
			3.5.3.5	 Applicable Population
		3.5.4	 Shanghai Sixth Hospital Hip Function Scoring System
			3.5.4.1	 History
			3.5.4.2	 Grading Standard
			3.5.4.3	 Advantages
			3.5.4.4	 Disadvantages
			3.5.4.5	 Applicable Population
	Bibliography
4: Imaging Examination and Measurement of the Hip Joints
	4.1	 Imaging Examination of the Hip Joint
		4.1.1	 X-Ray Examination of the Hip Joint
			4.1.1.1	 Anteroposterior Films of the Hip Joint
			4.1.1.2	 Lateral Films of the Hip Joint
			4.1.1.3	 Frog Films of the Hip Joint
			4.1.1.4	 Posteroanterior Oblique Films of the Hip Joint
			4.1.1.5	 Obturator Oblique Films of the Hip Joint
			4.1.1.6	 Ilium Oblique Films of the Hip Joint
		4.1.2	 CT Examination of the Hip Joint
		4.1.3	 MRI Examination of the Hip Joint
	4.2	 II. X-Ray Measurement and Parameters of the Hip Joint
		4.2.1	 Hip Parameters
			4.2.1.1	 Shenton Line (Menard Line)
			4.2.1.2	 Calve Line (Iliac Neckline)
			4.2.1.3	 Skinner Line
		4.2.2	 Proximal Femur Parameters
			4.2.2.1	 Neck-Shaft Angle
			4.2.2.2	 Femoral Neck Anteversion
			4.2.2.3	 Femoral Offset
		4.2.3	 Acetabular Parameters
			4.2.3.1	 Center Edge Angle (CEA)
			4.2.3.2	 Acetabular Index
			4.2.3.3	 Sharp Angle
			4.2.3.4	 Kohler Line (Nelaton)
			4.2.3.5	 HE Angle
			4.2.3.6	 Perkin Grid
	References
5: Application of Ultrasound in the Diagnosis of Hip Diseases
	5.1	 Normal Adult Hip Ultrasound Detection
		5.1.1	 Anterior Part
		5.1.2	 Medial Part
		5.1.3	 Lateral Part
		5.1.4	 Posterior Part
	5.2	 Ultrasound Diagnosis of Adult Hip Disease
		5.2.1	 Joint Effusion
		5.2.2	 Hip Synovitis
		5.2.3	 Peri-Hip-Joint Mass
			5.2.3.1	 Cystic Mass
			5.2.3.2	 Solid Tumors
		5.2.4	 Muscle Tear
			5.2.4.1	 Grade 0 Damage
			5.2.4.2	 Grade 1 Damage
			5.2.4.3	 Grade 2 Damage
			5.2.4.4	 Grade 3 Damage
		5.2.5	 Tendinopathy
		5.2.6	 Snapping Hip Syndrome
			5.2.6.1	 Iliotibial Band Snapping Syndrome
			5.2.6.2	 Iliopsoas Tendon Snapping Syndrome
	5.3	 Ultrasound Diagnosis of Developmental Dislocation of the Hip
		5.3.1	 Ultrasonic Examination Method
		5.3.2	 The Normal Sonogram
		5.3.3	 Ultrasound Measurement
		5.3.4	 Ultrasound Classification
	References
6: Pediatric Hip Disorders
	6.1	 Developmental Dysplasia of the Hip
		6.1.1	 Pathology
			6.1.1.1	 Soft Tissue Abnormalities
				6.1.1.1.1	 Acetabulum
				6.1.1.1.2	 Ligamentum Teres
				6.1.1.1.3	 Hip Joint Capsule
				6.1.1.1.4	 Iliopsoas
				6.1.1.1.5	 Muscles Around the Hip Joint
			6.1.1.2	 Bony Structure Abnormalities
				6.1.1.2.1	 Femoral Head
				6.1.1.2.2	 Acetabulum
				6.1.1.2.3	 Proximal Femur
		6.1.2	 Classification
		6.1.3	 Clinical Manifestations
			6.1.3.1	 Symptoms
			6.1.3.2	 Signs
		6.1.4	 Imaging Examinations
			6.1.4.1	 X-Ray
				6.1.4.1.1	 Pelvic Radiograph and Measurements
				6.1.4.1.2	 Perkin Quadrants
				6.1.4.1.3	 Acetabular Index
				6.1.4.1.4	 Shenton Line
			6.1.4.2	 Computed Tomography
			6.1.4.3	 Magnetic Resonance Imaging
		6.1.5	 Treatment
			6.1.5.1	 Tenotomy of the Adductors
				6.1.5.1.1	 Clinical Applications
				6.1.5.1.2	 Indications
				6.1.5.1.3	 Surgical Techniques
			6.1.5.2	 Open Reduction
				6.1.5.2.1	 Indications
				6.1.5.2.2	 Position
				6.1.5.2.3	 Surgical Techniques
			6.1.5.3	 Salter’s Osteotomy
				6.1.5.3.1	 Clinical Application
				6.1.5.3.2	 Indications
				6.1.5.3.3	 Position
				6.1.5.3.4	 Incision
				6.1.5.3.5	 Surgical Techniques
				6.1.5.3.6	 Postoperative Management
			6.1.5.4	 Pemberton Acetabuloplasty
				6.1.5.4.1	 Indications
				6.1.5.4.2	 Surgical Techniques
				6.1.5.4.3	 Acetabular Osteotomy
				6.1.5.4.4	 Fixation of the Bone Graft
				6.1.5.4.5	 Checking the Stability of the Joint
				6.1.5.4.6	 Postoperative Management
			6.1.5.5	 Proximal Femoral Osteotomy
				6.1.5.5.1	 Indications
				6.1.5.5.2	 Implants Options
				6.1.5.5.3	 Position
				6.1.5.5.4	 Incision and Exposure
				6.1.5.5.5	 Osteotomy and PHP Insertion
			6.1.5.6	 Bernese Osteotomy
				6.1.5.6.1	 Indications
				6.1.5.6.2	 Techniques of Osteotomy
				6.1.5.6.3	 Postoperative Managements
	6.2	 Legg-Calvé-Perthes Disease
		6.2.1	 Classification
			6.2.1.1	 Waldenström’s Chronological Stages
				6.2.1.1.1	 Initial Stage
				6.2.1.1.2	 Fragmentation Stage
				6.2.1.1.3	 Reossification Stage
				6.2.1.1.4	 Healed Stage
			6.2.1.2	 Catterall Classification
				6.2.1.2.1	 Group 1
				6.2.1.2.2	 Group 2
				6.2.1.2.3	 Group 3
				6.2.1.2.4	 Group 4
			6.2.1.3	 Herring Classification
				6.2.1.3.1	 Type A
				6.2.1.3.2	 Type B
				6.2.1.3.3	 Type B/C
				6.2.1.3.4	 Type C
			6.2.1.4	 Stulberg Classification
				6.2.1.4.1	 Class I
				6.2.1.4.2	 Class II
				6.2.1.4.3	 Class III
				6.2.1.4.4	 Class IV
				6.2.1.4.5	 Class V
		6.2.2	 Treatment
			6.2.2.1	 Proximal Femoral Varus Osteotomy (PFO)
			6.2.2.2	 Salter Innominate Osteotomy
			6.2.2.3	 Combined Surgery
	6.3	 Slipped Capital Femoral Epiphysis
		6.3.1	 Etiology
		6.3.2	 Clinical Manifestations
		6.3.3	 Clinical Classification
		6.3.4	 Imaging Examinations
		6.3.5	 Measuring the Slip
		6.3.6	 Treatment
			6.3.6.1	 In Situ Fixation
			6.3.6.2	 Bone-Peg Epiphysiodesis
			6.3.6.3	 Cast Immobilization
			6.3.6.4	 Contralateral Prophylactic Fixation
			6.3.6.5	 Corrective Femoral Osteotomy
		6.3.7	 Complications
			6.3.7.1	 Chondrolysis
				6.3.7.1.1	 Clinical Manifestations
				6.3.7.1.2	 Physical Examinations
				6.3.7.1.3	 Radiographic Features
				6.3.7.1.4	 Pathogenesis
				6.3.7.1.5	 Treatment
			6.3.7.2	 Avascular Necrosis of Femoral Head
	References
7: Osteonecrosis of the Femoral Head
	7.1	 Overview
	7.2	 Imaging Diagnosis of Osteonecrosis of the Femoral Head in Adult
		7.2.1	 Imaging Diagnosis
			7.2.1.1	 Radiographic Diagnosis
				7.2.1.1.1	 Radiography
				7.2.1.1.2	 Radiographic Performances of ONFH
			7.2.1.2	 CT Findings
				7.2.1.2.1	 CT Scanning
				7.2.1.2.2	 CT Performances of ONFH in Adults
			7.2.1.3	 Nuclear Medicine Scans
				7.2.1.3.1	 Radionuclide Scans of the Normal Femoral Head
				7.2.1.3.2	 Radionuclide Scan Findings of Adult Avascular Necrosis of the Femoral Head
			7.2.1.4	 DSA Examination of ONFH in Adults
				7.2.1.4.1	 Normal Hip Angiography
				7.2.1.4.2	 DSA Findings of Adult Osteonecrosis of the Femoral Head
			7.2.1.5	 PET-CT Examination of Adult Osteonecrosis of the Femoral Head
				7.2.1.5.1	 PET-CT Scan of the Normal Femoral Head
				7.2.1.5.2	 PET-CT Findings of Osteonecrosis of the Femoral Head Necrosis in Adults
			7.2.1.6	 MRI Examination of Adult ONFH
		7.2.2	 MRI Diagnosis and Classification
			7.2.2.1	 Normal MRI Performances of Adult Femoral Head
			7.2.2.2	 MRI Performances of Adult ONFH
				7.2.2.2.1	 Early Stage
				7.2.2.2.2	 Mid-Term (III)
				7.2.2.2.3	 Later Stage (IV)
	7.3	 The Classification System of Osteonecrosis of the Femoral Head
		7.3.1	 Marcus Classification
		7.3.2	 Ficat Classification System
		7.3.3	 Classification System of Shanghai Sixth People’s Hospital Modified Version
		7.3.4	 Steinberg Classification System
		7.3.5	 ARCO Classification System
		7.3.6	 Other Classification Systems
	7.4	 The Pathology of Osteonecrosis of the Femoral Head
		7.4.1	 The Basic Concepts of Bone Histology and Pathology
			7.4.1.1	 Bone Cells and Matrix
				7.4.1.1.1	 Bone Cells
				7.4.1.1.2	 Bone Matrix
				7.4.1.1.3	 Articular Cartilage
				7.4.1.1.4	 Osteoid Tissue
			7.4.1.2	 Basic Pathological Changes of Bone
				7.4.1.2.1	 Bone Formation
				7.4.1.2.2	 Bone Resorption
				7.4.1.2.3	 Osteonecrosis
		7.4.2	 Pathology and Biochemical Changes in ONFH
			7.4.2.1	 Pathological Changes
				7.4.2.1.1	 Osteonecrosis
				7.4.2.1.2	 Repair of Necrotic Bone
			7.4.2.2	 The Pathological Characters of Femoral Head Osteonecrosis Due to Various Etiologies
				7.4.2.2.1	 Avascular Necrosis of the Femoral Head in Children
				7.4.2.2.2	 Traumatic Femoral Head Osteonecrosis
				7.4.2.2.3	 Steroid-Induced Osteonecrosis of the Femoral Head
				7.4.2.2.4	 Osteonecrosis of the Femoral Head Due to Hematological Diseases
				7.4.2.2.5	 Avascular Necrosis of the Femoral Head Caused by Radiation
				7.4.2.2.6	 Alcohol (Ethanol)
				7.4.2.2.7	 Decompression-Induced Avascular Necrosis of the Femoral Head
				7.4.2.2.8	 Idiopathic Avascular Necrosis of the Femoral Head
	7.5	 Symptoms and Signs of Osteonecrosis of the Femoral Head
		7.5.1	 Symptoms
			7.5.1.1	 Pain
			7.5.1.2	 Restricted Joint Motion and Activity
			7.5.1.3	 Claudication
		7.5.2	 Physical Examination
			7.5.2.1	 Localized Deep Tenderness
			7.5.2.2	 Localized Percussive Tenderness
			7.5.2.3	 Hip Joint Dysfunction
			7.5.2.4	 Functional Test of Hip
	7.6	 The Joint-Preservation Treatment of Osteonecrosis of the Femoral Head
		7.6.1	 Nonsurgical Joint-Preservation Strategy
			7.6.1.1	 Lifestyle Change
			7.6.1.2	 Medications
			7.6.1.3	 Biological and Physical Therapy
		7.6.2	 Surgical Joint-Preservation Strategy
			7.6.2.1	 Core Decompression
			7.6.2.2	 Transplantation of Osteogenic Precursor Cells
			7.6.2.3	 Nonstructural Bone Grafting
			7.6.2.4	 Non-vascularized Bone Grafting
			7.6.2.5	 Local Transposition of Vascularized Pedicled Bone Graft
			7.6.2.6	 Free Vascularized Bone Grafting
			7.6.2.7	 Hip Osteotomy
			7.6.2.8	 Implantation of Porous Metal
		7.6.3	 Summary and Outlook
	7.7	 Free Vascularized Fibular Graft for the Treatment of Osteonecrosis of the Femoral Head
		7.7.1	 Overview
		7.7.2	 Clinical Anatomy of the Fibula
			7.7.2.1	 Adjacent Structures
			7.7.2.2	 Blood Supply
			7.7.2.3	 Anatomical Variations of the Fibular Artery
		7.7.3	 Indications and Contraindications
		7.7.4	 Surgical Approach
			7.7.4.1	 Preoperative Preparation
			7.7.4.2	 Position
			7.7.4.3	 Harvest of the Free Vascularized Fibula
			7.7.4.4	 Pretreatment of the Fibula
			7.7.4.5	 Hip Surgery (Anterior Approach, Shanghai No.6 Hospital)
			7.7.4.6	 Hip Surgery (Lateral Approach, Urbaniak Method)
			7.7.4.7	 Postoperative Management
		7.7.5	 Complications
	7.8	 Conclusion
	7.9	 Corrective Proximal Femoral Osteotomy for the Treatment of Osteonecrosis of the Femoral Head
		7.9.1	 Indication of Operation
		7.9.2	 Surgical Methods
			7.9.2.1	 Transtrochanteric Rotational Osteotomy (Sugioka)
				7.9.2.1.1	 Preoperative Preparation
				7.9.2.1.2	 Position
				7.9.2.1.3	 Incision
				7.9.2.1.4	 Surgical Approach
				7.9.2.1.5	 Cautions
			7.9.2.2	 Proximal Femoral Valgus Osteotomy
				7.9.2.2.1	 Preoperative Preparation
				7.9.2.2.2	 Position
				7.9.2.2.3	 Incision
				7.9.2.2.4	 Surgical Approach
				7.9.2.2.5	 Cautions
			7.9.2.3	 Proximal Femoral Varus Osteotomy
				7.9.2.3.1	 Preoperative Preparation, Surgical Position, and Incision
				7.9.2.3.2	 Surgical Approach
				7.9.2.3.3	 Cautions
				7.9.2.3.4	 Complications
			7.9.2.4	 Curved Intertrochanteric Varus Osteotomy
				7.9.2.4.1	 Preoperative Preparation
				7.9.2.4.2	 Position
				7.9.2.4.3	 Incision
				7.9.2.4.4	 Surgical Approach
				7.9.2.4.5	 Cautions
			7.9.2.5	 Lateral Approach T Shaped Rotational Osteotomy
				7.9.2.5.1	 Preoperative Preparation
				7.9.2.5.2	 Position
				7.9.2.5.3	 Incision
				7.9.2.5.4	 Surgical Approach
				7.9.2.5.5	 Cautions
		7.9.3	 Recovery
		7.9.4	 Prognosis
		7.9.5	 Case
			7.9.5.1	 Case History
			7.9.5.2	 3D Print the Hip Model
			7.9.5.3	 Operation Plan
			7.9.5.4	 Surgical Approach
	7.10	 Typical Cases
		7.10.1	 Case 1
			7.10.1.1	 Medical History
			7.10.1.2	 Diagnosis
			7.10.1.3	 Treatment and Prognosis
		7.10.2	 Case 2
			7.10.2.1	 Medical History
			7.10.2.2	 Diagnosis
			7.10.2.3	 Treatment and Prognosis
		7.10.3	 Case 3
			7.10.3.1	 Medical History
			7.10.3.2	 Diagnosis
			7.10.3.3	 Treatment and Prognosis
		7.10.4	 Case 4
			7.10.4.1	 Medical History
			7.10.4.2	 Diagnosis
			7.10.4.3	 Treatment and Prognosis
		7.10.5	 Case 5
			7.10.5.1	 Medical History
			7.10.5.2	 Diagnosis
			7.10.5.3	 Treatment and Prognosis
		7.10.6	 Case 6
			7.10.6.1	 Medical History
			7.10.6.2	 Diagnosis
			7.10.6.3	 Treatment and Prognosis
		7.10.7	 Case 7
			7.10.7.1	 Medical History
			7.10.7.2	 Diagnosis
			7.10.7.3	 Treatment and Prognosis
		7.10.8	 Case 8
			7.10.8.1	 Medical History
			7.10.8.2	 Diagnosis
			7.10.8.3	 Treatment and Prognosis
		7.10.9	 Case 9
			7.10.9.1	 Medical History
			7.10.9.2	 Diagnosis
			7.10.9.3	 Treatment and Prognosis
		7.10.10 Case 10
			7.10.10.1	 Medical History
			7.10.10.2	 Diagnosis
			7.10.10.3	 Treatment and Prognosis
		7.10.11 Case 11
			7.10.11.1	 Medical History
			7.10.11.2	 Diagnosis
			7.10.11.3	 Treatment and Prognosis
8: Inflammatory Diseases of the Hip Joint
	8.1	 Osteoarthritis
		8.1.1	 Clinical Manifestation
			8.1.1.1	 Symptoms
			8.1.1.2	 Signs
			8.1.1.3	 Laboratory Test
		8.1.2	 Diagnosis
		8.1.3	 Treatment
			8.1.3.1	 Patient Education and Self-Management
			8.1.3.2	 Non-medical Therapy
				8.1.3.2.1	 Sports and Massage
				8.1.3.2.2	 Weight Loss
				8.1.3.2.3	 Electrotherapy
				8.1.3.2.4	 Orthosis
			8.1.3.3	 Pharmacological Therapy
				8.1.3.3.1	 Oral Medicine
				8.1.3.3.2	 Topical Medicine
				8.1.3.3.3	 Intraventricular Injection Medicine
			8.1.3.4	 Surgical Treatment
	8.2	 Rheumatoid Arthritis
		8.2.1	 Pathogenesis
		8.2.2	 Clinical Manifestations and Diagnosis
			8.2.2.1	 Symptoms and Signs
			8.2.2.2	 Laboratory Test
			8.2.2.3	 Diagnosis and Differential Diagnosis
		8.2.3	 Treatment
			8.2.3.1	 General Treatment
			8.2.3.2	 Pharmacological Therapy
				8.2.3.2.1	 Non-steroidal Anti-inflammatory Drug
				8.2.3.2.2	 Disease-Modifying Antirheumatic Drug
					Methotrexate
					Leflunomide
					Chloroquine and Hydroxychloroquine
					Salazosulfapyridine (SASP)
					Tripterygium wilfordii
					Tofacitinib
					Biological Agents
				8.2.3.2.3	 Glucocorticoid
					Oral Glucocorticoid
					Intra-articular Injection of Glucocorticoid
					High Dose Methylprednisolone Intravenous Pulse Therapy
			8.2.3.3	 Surgical Treatment
				8.2.3.3.1	 Synovectomy
				8.2.3.3.2	 Surgical Debridement
				8.2.3.3.3	 Arthrolysis
				8.2.3.3.4	 Osteotomy
				8.2.3.3.5	 Arthrodesis
				8.2.3.3.6	 Arthroplasty
	8.3	 Ankylosing Spondylitis
		8.3.1	 Clinical Manifestations
		8.3.2	 Diagnosis and Diagnostic Criteria
		8.3.3	 Treatment
			8.3.3.1	 Non-medical Treatment
			8.3.3.2	 Pharmacological Treatment
				8.3.3.2.1	 NSAID
				8.3.3.2.2	 TNF-α Inhibitor (TNFi)
				8.3.3.2.3	 Thalidomide
				8.3.3.2.4	 Sulfasalazine
				8.3.3.2.5	 Methotrexate
				8.3.3.2.6	 Glucocorticoid
			8.3.3.3	 Surgical Treatment
	8.4	 Pigmented Villonodular Synovitis
		8.4.1	 Clinical Manifestations
		8.4.2	 Diagnosis and Diagnostic Criteria
		8.4.3	 Treatment
			8.4.3.1	 Nonsurgical Treatment
			8.4.3.2	 Synovectomy
			8.4.3.3	 Foci Resection Combined with Postoperative Radiotherapy
			8.4.3.4	 Joint Replacement
	Bibliography
9: Infectious Diseases in Hip Joint
	9.1	 Suppurative Arthritis of the Hip Joint
		9.1.1	 Etiology
		9.1.2	 Clinical Manifestation and Laboratory Examination
		9.1.3	 Imaging Examinations
			9.1.3.1	 X-Ray
			9.1.3.2	 CT
			9.1.3.3	 MRI
		9.1.4	 Diagnosis
		9.1.5	 Differential Diagnosis
			9.1.5.1	 Acute Rheumatic Fever
			9.1.5.2	 Rheumatoid Arthritis
			9.1.5.3	 Osteomyelitis of the Upper Femur
			9.1.5.4	 Transient Synovitis of the Hip
			9.1.5.5	 Osteochondritis of Femoral Head
			9.1.5.6	 Tuberculous Hip Osteoarthritis
		9.1.6	 Treatment
			9.1.6.1	 Arthrocentesis and Incision and Drainage
			9.1.6.2	 The Hip Joint Debridement Surgery
			9.1.6.3	 Femoral Head and Neck Ostectomy
			9.1.6.4	 Systemic Therapy
			9.1.6.5	 Rest and Immobilization
		9.1.7	 Complications
	9.2	 Tuberculosis of Hip Joint
		9.2.1	 Introduction
		9.2.2	 Clinical Manifestation
		9.2.3	 Diagnostic Criteria
		9.2.4	 Treatment
	Bibliography
10: Hip Bone Tumor
	10.1	 Primary Acetabular Tumor
		10.1.1	 Indications and Contraindications
			10.1.1.1	 Indications
			10.1.1.2	 Contraindications
		10.1.2	 Surgical Methods
			10.1.2.1	 Preoperative Preparation
			10.1.2.2	 Tumor Resection
			10.1.2.3	 Functional Reconstruction
			10.1.2.4	 Precautions After Operation
		10.1.3	 Complication
			10.1.3.1	 Skin Edge Necrosis
			10.1.3.2	 Wound Infection
			10.1.3.3	 Hip Dislocation
		10.1.4	 Summary
	10.2	 Primary Bone Tumor of the Proximal Femur
		10.2.1	 Indications and Contraindications
			10.2.1.1	 Indications
			10.2.1.2	 Contraindications
		10.2.2	 Surgical Methods
			10.2.2.1	 Preoperative Preparation
			10.2.2.2	 Tumor Resection
			10.2.2.3	 Postoperative Attention
		10.2.3	 Complication
		10.2.4	 Summary
	10.3	 Bone Metastases Around the Acetabulum
		10.3.1	 Indications and Contraindications
			10.3.1.1	 Indications
			10.3.1.2	 Contraindications
		10.3.2	 Surgical Methods
			10.3.2.1	 Resection and Reconstruction of Proximal Femoral Metastases
			10.3.2.2	 Resection and Reconstruction of Acetabular Metastases
		10.3.3	 Complication
			10.3.3.1	 Joint Dislocation
			10.3.3.2	 Lateral Femoral Nerve Injury Cutaneous Nerve Injury
			10.3.3.3	 Other Traditional Complications
		10.3.4	 Summary
	10.4	 Benign Proximal Femoral Tumor
		10.4.1	 Bone Fibrous Dysplasia
			10.4.1.1	 Overview
			10.4.1.2	 Clinical Manifestation
			10.4.1.3	 Imaging Findings
			10.4.1.4	 Pathology
			10.4.1.5	 Treatment
		10.4.2	 Bone Cyst
			10.4.2.1	 Overview
			10.4.2.2	 Clinical Manifestation
			10.4.2.3	 Imaging Findings
			10.4.2.4	 Pathology
			10.4.2.5	 Treatment
		10.4.3	 Giant Cell Tumor of Bone
			10.4.3.1	 Overview
			10.4.3.2	 Clinical Manifestation
			10.4.3.3	 Imaging Performance
			10.4.3.4	 Pathology
			10.4.3.5	 Treatment
		10.4.4	 Chondroblastoma
			10.4.4.1	 Overview
			10.4.4.2	 Clinical Manifestation
			10.4.4.3	 Imaging Performance
			10.4.4.4	 Pathology
			10.4.4.5	 Treatment
	Bibliography
11: Acetabular Fractures
	11.1	 Etiology and Classification
		11.1.1	 Etiology
		11.1.2	 Classification
			11.1.2.1	 Elementary Fracture
				11.1.2.1.1 Posterior Wall Fracture (A1)
				11.1.2.1.2 Posterior Column Fracture (A2)
				11.1.2.1.3 Anterior Column and/or Wall Fracture (A3)
				11.1.2.1.4 Transverse Fracture (B1)
			11.1.2.2	 Associated Fracture
				11.1.2.2.1 Posterior Column and Posterior Wall Fracture (A2.3)
				11.1.2.2.2 Transverse Fracture (B1) and Posterior Wall Fracture
				11.1.2.2.3 T-Type Fracture (B2)
				11.1.2.2.4 Anterior Column and Posterior Hemitransverse Fracture (B3)
				11.1.2.2.5 Both Columns Fracture (C)
				11.1.2.2.6 Other Specific Types
	11.2	 Diagnosis and Treatment
		11.2.1	 Diagnosis
			11.2.1.1	 Medical History
			11.2.1.2	 Physical Examination
			11.2.1.3	 Imaging
		11.2.2	 Treatment Indication
			11.2.2.1	 Indications for Nonsurgical Treatment
				11.2.2.1.1 Stable Posterior Wall Fracture
				11.2.2.1.2 Non-Both-Column Fracture and Non-Posterior-Wall Fracture
				11.2.2.1.3 Secondary Congruence of Both Column Fracture
			11.2.2.2	 Indications for Surgical Treatment
		11.2.3	 Surgical Approach
		11.2.4	 Surgical Technique
			11.2.4.1	 Posterior Wall Fracture
			11.2.4.2	 Posterior Column Fracture
			11.2.4.3	 Anterior Column or Anterior Wall Fracture
			11.2.4.4	 Transverse Fracture
			11.2.4.5	 Transverse and Posterior Wall Fracture
			11.2.4.6	 T-Type Fracture
			11.2.4.7	 Anterior Column and Posterior Hemitransverse Fracture
			11.2.4.8	 Associated Both Columns Fracture
		11.2.5	 Prognosis
	Bibliography
12: Fracture of Femoral Head and Femoral Neck
	12.1	 Femoral Neck Fracture
		12.1.1	 Etiology
		12.1.2	 Clinical Anatomy
		12.1.3	 Pathology
		12.1.4	 Classification
			12.1.4.1	 Classification on the Location
			12.1.4.2	 Garden Classification
			12.1.4.3	 Pauwels Classification
			12.1.4.4	 AO/OTA Classification
			12.1.4.5	 VN Angle and a New Classification
		12.1.5	 Diagnosis
		12.1.6	 Indication of Surgery
			12.1.6.1	 Indications for Internal Fixation
			12.1.6.2	 Indications for Arthroplasty
		12.1.7	 Surgical Methods
			12.1.7.1	 For Non-displaced Femoral Neck Fractures (Garden Type I and Type II)
			12.1.7.2	 For Displaced Femoral Neck Fractures (Garden III and IV)
			12.1.7.3	 For More Vertical Femoral Neck Fractures
			12.1.7.4	 For Basicervical Fractures
			12.1.7.5	 For Displaced Femoral Neck Fractures (Garden III and IV) in the Elderly
			12.1.7.6	 Experience of the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
		12.1.8	 Surgical Technique
			12.1.8.1	 Closed Reduction and Lag Screw Fixation
				12.1.8.1.1 Position
				12.1.8.1.2 Incision
				12.1.8.1.3 Internal Fixation
			12.1.8.2	 Open Reduction
			12.1.8.3	 DHS with Derotational Screw Fixation
			12.1.8.4	 Intramedullary Nail Fixation
			12.1.8.5	 Arthroplasty
		12.1.9	 Prognosis and Complications
			12.1.9.1	 General Prognosis and Complications
			12.1.9.2	 Non-displaced Femoral Neck Fracture
			12.1.9.3	 Young Patients with Displaced Femoral Neck Fractures
			12.1.9.4	 Femoral Neck Fractures in Elderly People Over 60 Years Old
			12.1.9.5	 Arthroplasty for Displaced Femoral Neck Fractures in the Elderly
	12.2	 Femoral Head Fracture
		12.2.1	 Etiology
		12.2.2	 Classification
		12.2.3	 Diagnosis
		12.2.4	 Treatment
			12.2.4.1	 Principles
			12.2.4.2	 Surgical Techniques
				12.2.4.2.1 Anterior Approach
				12.2.4.2.2 Posterior Approach
				12.2.4.2.3 Ganz Osteotomy Approach
		12.2.5	 Postoperative Treatment and Prognosis
	12.3	 Femoral Neck Nonunion
		12.3.1	 Diagnosis
			12.3.1.1	 Clinical Signs and Symptoms
				12.3.1.1.1 Abnormal Activity
				12.3.1.1.2 Pain
				12.3.1.1.3 Malformation
				12.3.1.1.4 Compromise or Even Loss of Function
			12.3.1.2	 X-Ray Examination
			12.3.1.3	 CT Scan
			12.3.1.4	 Diagnosis of Internal Fixation Failure
		12.3.2	 The Treatment of FNN
			12.3.2.1	 Valgus Intertrochanteric Osteotomy
			12.3.2.2	 Direct Cannulated Compression Screw Fixation
			12.3.2.3	 Cannulated Compression Screw Fixation Combined with Local Vascularized Bone Grafts
			12.3.2.4	 Modified Free Vascularized Fibular Grafting Combined with Cannulated Compression Screw Fixation
				12.3.2.4.1 Surgical Technique
				12.3.2.4.2 Postoperative Treatment
				12.3.2.4.3 Complications
			12.3.2.5	 Modified FVFG Combined with Locking Plate Fixation
		12.3.3	 Summary
		12.3.4	 Pearls Cases
	Bibliography
13: Developmental Dysplasia of the Hip
	13.1	 Pathology and Classification
		13.1.1	 Pathology
			13.1.1.1	 Acetabulum
			13.1.1.2	 Proximal Femur
		13.1.2	 Classification
			13.1.2.1	 Crowe Classification
			13.1.2.2	 Hartofilakidis Classification
	13.2	 Clinical Features
		13.2.1	 Symptoms
		13.2.2	 Signs
	13.3	 Imaging Examinations
		13.3.1	 X-ray Imaging
			13.3.1.1	 Anteroposterior View
			13.3.1.2	 Frog Lateral View
			13.3.1.3	 False-Profile View
			13.3.1.4	 Abduction Functional View
		13.3.2	 Computed Tomography
		13.3.3	 Magnetic Resonance Imaging
	13.4	 Treatment of DDH in Adults
		13.4.1	 Treatment of DDH in Adults
		13.4.2	 Periacetabular Osteotomy
			13.4.2.1	 Indications
			13.4.2.2	 Contraindications
			13.4.2.3	 Preoperative Planning
			13.4.2.4	 Surgical Techniques
				13.4.2.4.1 Position
				13.4.2.4.2 Approach
				13.4.2.4.3 Exposure and Osteotomy of the Anterior Portion of the Ischium
				13.4.2.4.4 Superficial Dissection of the Ilioinguinal Approach
				13.4.2.4.5 Deep Dissection of the Ilioinguinal Approach
				13.4.2.4.6 Osteotomy
				13.4.2.4.7 Acetabular Fragment Displacement
				13.4.2.4.8 Acetabular Fragment Fixation
				13.4.2.4.9 Closure of the Incision
			13.4.2.5	 Postoperative Management
			13.4.2.6	 Complications
			13.4.2.7	 Outcomes
			13.4.2.8	 Treatment of Intra-Articular Abnormalities
		13.4.3	 Spherical Acetabular Osteotomy
			13.4.3.1	 Indications and Contraindications
			13.4.3.2	 Surgical Techniques
			13.4.3.3	 Postoperative Management and Complications
		13.4.4	 Proximal Femoral Osteotomy
			13.4.4.1	 Indications
			13.4.4.2	 Contraindications
			13.4.4.3	 Preoperative Planning
			13.4.4.4	 Surgical Techniques
				13.4.4.4.1 Approach and Exposure
				13.4.4.4.2 Osteotomy and Fixation
			13.4.4.5	 Complications
	13.5	 Prognosis
		13.5.1	 Case1
			13.5.1.1	 Medical History
			13.5.1.2	 Physical Examinations
			13.5.1.3	 X-ray Examination
			13.5.1.4	 Diagnosis
			13.5.1.5	 Treatment
			13.5.1.6	 Follow-Ups
	Bibliography
14: Femoroacetabular Impingement (FAI)
	14.1	 Classification and Pathogenesis of FAI
		14.1.1	 Classification of FAI
			14.1.1.1	 Cam Lesions
			14.1.1.2	 Pincer Lesions
		14.1.2	 Role of Acetabular Labrum
	14.2	 Clinical Manifestations, Diagnosis, and Treatment Principle of FAI
		14.2.1	 Patient History
		14.2.2	 Physical Findings
		14.2.3	 Intra-Articular Local Anesthetic
		14.2.4	 Imaging Study
		14.2.5	 Principles of FAI Treatment
			14.2.5.1	 Nonoperative Treatment
			14.2.5.2	 Operative Treatment
	14.3	 Surgical Dislocation of Hip Joint
		14.3.1	 Surgical Indication
		14.3.2	 Blood Supply of Femoral Head
		14.3.3	 Surgical Techniques
		14.3.4	 Postoperative Treatment
		14.3.5	 Typical Cases
			14.3.5.1	 Case 1
				14.3.5.1.1 Medical History
				14.3.5.1.2 Physical Examination
				14.3.5.1.3 Diagnosis
				14.3.5.1.4 Treatment
				14.3.5.1.5 Prognosis
			14.3.5.2	 Case 2
				14.3.5.2.1 Medical History
				14.3.5.2.2 Physical Examination
				14.3.5.2.3 Diagnosis
				14.3.5.2.4 Treatment
				14.3.5.2.5 Prognosis
	14.4	 Arthroscopic Surgery
		14.4.1	 Surgical Indication
		14.4.2	 Surgical Contraindications
		14.4.3	 Equipment and Instrument
		14.4.4	 Surgical Steps and Techniques
			14.4.4.1	 Anesthesia and Positioning
			14.4.4.2	 Preoperative Body Surface Positioning
			14.4.4.3	 Traction
			14.4.4.4	 Build the Surgical Accesses
			14.4.4.5	 Surgical Techniques
		14.4.5	 Postoperative Treatment
		14.4.6	 Typical Cases
			14.4.6.1	 Case 1
				14.4.6.1.1 Medical History
				14.4.6.1.2 Physical Examination
				14.4.6.1.3 Diagnosis
				14.4.6.1.4 Treatment
				14.4.6.1.5 Prognosis
			14.4.6.2	 Case 2
				14.4.6.2.1 Medical History
				14.4.6.2.2 Physical Examination
				14.4.6.2.3 Diagnosis
				14.4.6.2.4 Treatment
				14.4.6.2.5 Prognosis
	Bibliography
15: Hip Arthroplasty
	15.1	 Design of Total Hip Joint Prosthesis
		15.1.1	 Wearing Surfaces
			15.1.1.1	 Cross-Linked Polyethylene
			15.1.1.2	 Metal-on-Metal Bearings
			15.1.1.3	 Ceramic-on-Ceramic Bearings
			15.1.1.4	 Ceramic-on-Metal Interface
		15.1.2	 Prosthesis Design
			15.1.2.1	 Bone Cement Femoral Prosthesis
			15.1.2.2	 Uncemented Acetabular Prosthesis
			15.1.2.3	 Uncemented Femoral Prosthesis
	15.2	 Surgical Indication of Total Hip Arthroplasty
	15.3	 Preoperative Evaluation of Total Hip Arthroplasty
		15.3.1	 Preoperative X-ray Assessment
		15.3.2	 Preoperative Measurement
	15.4	 Direct Lateral Approach for Total Hip Arthroplasty
		15.4.1	 Surgical Techniques
			15.4.1.1	 Patient Position
			15.4.1.2	 Surgical Approach
			15.4.1.3	 Uncemented Acetabular Prosthesis
				15.4.1.3.1 Acetabular Exposure
				15.4.1.3.2 Preparation of Acetabular Bed
				15.4.1.3.3 Placement of Acetabular Cup
			15.4.1.4	 Cemented Acetabular Prosthesis Arthroplasty
				15.4.1.4.1 Preparation of Acetabular Bed
				15.4.1.4.2 Placement of Acetabular Cup
				15.4.1.4.3 Placement of Uncemented Femoral Prosthesis
				15.4.1.4.4 Installation of Cemented Femoral Prosthesis
				15.4.1.4.5 Determination of Soft Tissue Tension and Lower Limb Length
				15.4.1.4.6 Closure of the Wound
		15.4.2	 Postoperative Treatment
		15.4.3	 Typical Cases
			15.4.3.1	 History
			15.4.3.2	 Physical Examination
			15.4.3.3	 Diagnosis
			15.4.3.4	 Treatment
			15.4.3.5	 Prognosis
	15.5	 Total Hip Arthroplasty Through Posterior-Lateral Approach
		15.5.1	 Surgical Techniques
			15.5.1.1	 Patient Position
			15.5.1.2	 Surgical Approach
			15.5.1.3	 Femoral Osteotomy
			15.5.1.4	 Exposure of Acetabulum
			15.5.1.5	 Prosthesis Placement
			15.5.1.6	 Joint Capsule Repair
		15.5.2	 Postoperative Treatment
		15.5.3	 Tips
	15.6	 Minimally Invasive Total Hip Arthroplasty in the Direct Anterior Side
		15.6.1	 Indications and Contraindications
		15.6.2	 Surgical Techniques
			15.6.2.1	 Hip Joint Exposure
			15.6.2.2	 Acetabular Prosthesis Installation
			15.6.2.3	 Femoral Prosthesis Installation
			15.6.2.4	 Closure of the Wound
		15.6.3	 Complications
			15.6.3.1	 Proximal Femoral Fractures
			15.6.3.2	 Anterior Lateral Cutaneous Nerve Injury
			15.6.3.3	 Other Complications
		15.6.4	 Typical Cases
			15.6.4.1	 Medical History
			15.6.4.2	 Physical Check
			15.6.4.3	 Diagnosis
			15.6.4.4	 Treatment
			15.6.4.5	 Prognosis
	Bibliography
16: Management of Chondral Injuries of the Hip
	16.1	 Introduction
	16.2	 Current Techniques of Reconstructing Articular Surface of Femoral Head
		16.2.1	 Cartilage Trapdoor Technology
		16.2.2	 Allogeneic Osteochondral Tissue Transplantation
		16.2.3	 Autologous Articular Osteochondral Tissue Transplantation
		16.2.4	 Autologous Cartilage Cell Transplanting Technology
	16.3	 Costal Cartilage Grafting for Femoral Head Cartilage Repair and Reconstruction
	Bibliography