Osteoarthritis of the Hip

1 Introduction.- 1.1 Histology of the Osteophytes.- 2 Biomechanics of the Normal Static and Dynamic Hip.- 2.1 Static.- 2.1.1 Centre of Gravity S4: Bipedal Support.- 2.1.2 Centre of Gravity S5: Monopodal Support.- 2.1.3 Force of Abductors (M): Magnitude and Direction of Resultant Force R.- 2.1.4 “Sourcil”.- 2.1.5 “Gothic Arch”.- 2.1.6 “Hourglass”.- 2.1.7 Spherical Sector.- 2.1.8 Centre of Stress.- 2.2 Dynamic.- 2.2.1 Division of Gait into 26 and 31 Phases: Path of Centre of Gravity S6 (Fischer).- 2.2.2 Path of Centre of Gravity S5(Pauwels).- 3 Biomechanics of the Osteoarthritic Hip.- 3.1 Effect of Inclination of the Weight-Bearing Surface on the Magnitude and Direction of the Component Forces of Forces R and R1.- 3.1.1 Craniolateral Inclination.- 3.1.2 Craniomedial Inchnation.- 4 Classification of Osteoarthritis of the Hip.- 4.1 Etiology.- 4.1.1 Mechanical.- 4.1.2 Metabolic.- 4.1.3 Combined.- 4.2 Morphology.- 4.2.1 Superolateral.- 4.2.2 Concentric.- 4.2.3 Medial.- 4.2.4 Inferomedial.- 4.3 Biological Reaction.- 4.3.1 Atrophic.- 4.3.2 Normotrophic.- 4.3.3 Hypertrophic.- 4.4 Range of Motion.- 5 Pathogenesis of Superolateral Types a), b) and c) Osteoarthritis.- 5.1 Anterocraniolateral Inclination of the Weight-Bearing Surface.- 5.1.1 Locating CR, CR1 and CS from X-ray of a Deformed Elliptical Femoral Head.- 5.2 Osteophytes.- 5.2.1 Positive Tension Osteophytes.- 5.2.2 Negative Tension Osteophyte.- 5.2.3 Fatigue Fractures of Osteophytes.- 6 Therapy of Superolateral Types b) and c) and Medial Osteoarthritis.- 6.1 Valgus-Extension Osteotomy.- 6.1.1 Effect of Valgus-Extension Osteotomy.- 6.1.2 Indications for Valgus-Extension Osteotomy.- 6.1.3 Evolution of the Technique of Valgus Osteotomy.- 6.1.4 Aims of Present Operation.- 6.1.5 How to Plan a Valgus-Extension Osteotomy.- 6.1.6 Present Operation Technique.- 6.1.7 Postoperative Treatment.- 6.2 Effect of Valgus Osteotomy on the Knee.- 6.3 Results of Osteotomy for Superolateral Osteoarthritis.- 6.3.1 Cases of Superolateral Type b).- 6.3.2 Cases of Superolateral Type c).- 6.3.3 Statistics on Superolateral Type b).- 6.3.4 Statistics on Mechanical, Superolateral Type c).- 6.4 Results of Osteotomy for Medial Types a) and b) Osteoarthritis.- 7 Acetabuloplasty and Pelvic Osteotomy.- 7.1 Surgical Technique.- 7.2 Results.- 7.3 Statistics.- 7.3.1 Simple Pelvic Osteotomy.- 7.3.2 Pelvic Osteotomy Combined with Intertrochanteric Osteotomy.- 8 Therapy of Superolateral Type a) and Concentric Osteoarthritis.- 8.1 Varus and Varus-Extension Osteotomy.- 8.1.1 How to Calculate the Angle of Varus.- 8.1.2 Technique of Varus Osteotomy.- 8.1.3 Postoperative Treatment.- 8.2 Effect of Varus Osteotomy on the Knee.- 8.3 Results.- 8.4 Statistics.- 9 Pathogenesis of Superolateral Types d1) and d2) Osteoarthritis.- 10 Therapy of Superolateral Types d1 and d2) Osteoarthritis.- 10.1 Varus-Extension Osteotomy for Type d1.- 10.1.1 Reduction of Compressive Force.- 10.1.2 Increase in Width of Weight-Bearing Surface.- 10.1.3 Statistics.- 10.2 Valgus-Extension Osteotomy for Type d2).- 10.2.1 Reduction of Compressive Force.- 10.2.2 Increase in Width of Weight-Bearing Surface.- 10.2.3 Results.- 10.2.4 Statistics.- 11 What to Consider When Faced with a Patient Suffering from Osteoarthritis of the Hip.- 11.1 Errors to Be Avoided.- 11.2 Indications for Osteotomy and Total Hip Replacement.- 12 How to Reduce Stress in the Hip Joint.- 12.1 Shifting the Centre of Gravity (S5) Towards the Supporting Limb.- 12.2 Using One Stick.- 12.2.1 One Stick on Healthy Side.- 12.2.2 One Stick on Diseased Side.- 12.3 Using Two Sticks.- 12.4 Carrying a Weight.- 12.5 Conclusion.- 13 Summary.- 14 Appendix: Notes on Principles of Mechanics and Dynamics.- 14.1 Principles of Mechanics.- 14.2 Principles of Dynamics.- 14.3 Culmann’s Theorem.- References.