ernest f. talarico, jr., ph.d., m.s., b.s., c.l.a. assistant director of medical education assistant...
TRANSCRIPT
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Ernest F. Talarico, Jr., Ph.D., M.S., B.S., C.L.A.Assistant Director of Medical EducationAssistant Professor of Anatomy & Cell BiologyCourse Director, Human Gross Anatomy & EmbryologyIndiana University School of Medicine - NorthwestGary, Indiana
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ObjectivesObjectives
Articulations Pathology of Articulations The Knee Joint The Hip Joint
Radiographs of the joints
Photographs of actual human bones
Photographs of human cadavers
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ArticulationsArticulations
An articulation is a place of union between two or more bones (i.e., a joint)
classified according to the manner or type of material by which the articulating bones are united
fibrous joints (united by fibrous tissue)cartilaginous joints (hyaline cartilage or fibrocartilage)synovial joints (most common; fluid filled capsule)
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united by fibrous tissue amount of movement depends on
fiber length
primary cartilaginous joints are usually temporary unions, such as those present during development of long bones (i.e., they permit growth in length)
secondary cartilaginous joints are strong, slightly moveable joints
Synovial Joint most common type of joint and
the most complex provide free movement between
bones three distinguishing features
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PathologyPathology
Fractures Rheumatoid Arthritis Osteoarthritis
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Rheumatoid Arthritis (RA)Rheumatoid Arthritis (RA)A Chronic Inflammatory DisorderA Chronic Inflammatory Disorder
1% of the world’s population is affected by RA, females 5X more often than males
principally attacks joints, but may affect many tissues and organs
exact cause is unknown, but RA is believed to be triggered by exposure of a susceptible host to an arthritogenic antigen leading to a continuing autoimmune reaction
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OsteoarthritisOsteoarthritisDegenerative Joint DiseaseDegenerative Joint Disease
most common type of joint disease; affects 90% of individuals by age 65
progressive erosion of articular cartilage
intrinsic disease of cartilage in which biochemical and metabolic alterations result in its breakdown
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General InformationGeneral InformationHip JointHip Joint
a multiaxial ball-and-socket type of synovial joint• extension and flexion• abduction and adduction• medial and lateral rotation• circumduction
designed for stability as well as for a wide range of movements• next to the shoulder joint, it is the most stable• weight bearing
reinforced by ligaments and muscles
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Bones of the Hip JointBones of the Hip Joint
femur (thigh bone)
pelvic bone
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iliofemoral ligament (horizontal)iliofemoral ligament (vertical)pubofemoral ligament
iliofemoral ligament (horizontal)ischiofemoral ligamentzona orbicularis
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Ligament of the Head of the Femur Ligament of the Head of the Femur
Ligamentum capitus femorisLigamentum capitus femoris
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NWCME 2003 - 15
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OsteoarthritisOsteoarthritisHistopathologyHistopathology
progressive erosion of cartilage femoral head with fibrocatilaginous
plug and ebrunated bone articular surface with absence of
articular cartilage; bone thickening, and subchondral bone cyst
Rx. (1) exercise; (2) weight loss; (3) joint replacement
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Hip Replacement Surgery Hip Replacement Surgery AML® Total Hip System
• the first porous-coated implant indicated for use without cement
• designed for use with DePuy's patented Porocoat® Porous Coating
The S-ROM® Total Hip System• a primary hip system with
more than 15 years of clinical success
• it is the number one modular stem worldwide.
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General InformationGeneral InformationKnee JointKnee Joint
a hinge type of synovial joint• extension and flexion• hinge movements are combined with gliding and
rolling, and with some rotation about a vertical axis• most complex joint of the human body
consists of 3 articulations• lateral and medial articulation between the femoral and
tibial condyles• intermediate articulation between the patella and femur
reinforced by ligaments• commonly impaired when hyperextended
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Bones of the Knee JointBones of the Knee Joint
femur
patella
tibia
The fibula plays no role in the knee.
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Views of the Knee JointViews of the Knee Joint
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Ligaments of the Knee Ligaments of the Knee Extracapsular LigamentsExtracapsular Ligaments
PatellarPatellar
Fibular CollateralFibular Collateral
Tibial CollateralTibial Collateral
Oblique PoplitealOblique Popliteal
Arcuate PoplitealArcuate Popliteal
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Oblique PoplitealOblique Popliteal
Arcuate PoplitealArcuate Popliteal
*
*
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Ligaments of the Knee Ligaments of the Knee Intra-articular LigamentsIntra-articular Ligaments
Cruciate Ligaments Cruciate Ligaments (ACL and PCL)(ACL and PCL)
Menisci (lateral & Menisci (lateral & medial)medial)
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Bursa of the Knee JointBursa of the Knee Joint
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““Unhappy Triad” of Knee Injuries Unhappy Triad” of Knee Injuries
(1) tibial collateral ligament ruptures, opening the joint on the medial side
(2) tearing of the medial meniscus
(3) snapping of the ACL
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Rheumatoid ArthritisRheumatoid ArthritisHistopathologyHistopathology
females > males principally attacks joints,
but may affect many tissues and organs
swelling of metacarpal phalangeal joints
ulnar deviation of fingers
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Rheumatoid ArthritisRheumatoid ArthritisHistopathologyHistopathology
hyperplastic synovium lymphoid follicles and villous
folds inflammation nodules with central necrosis
and inflammatory infiltrate Rx. (1) anti-inflammatory
agents; (2) remission-inducing drugs; (3) immunosuppressive drugs; (4) surgery
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Knee Replacement Surgery Knee Replacement Surgery LCS® Knee
• developed more than 20 years ago• is a patented, one-of-a-kind knee
system because its mobile-bearings offers a wide range of options to allow the surgeon to match the implant to the patients' anatomy
The P.F.C.® Sigma Total Knee System• is the leading fixed-bearing knee
system in the world• the recent addition of the P.F.C.
Sigma Rotating Platform results in a comprehensive implant system that provides a choice between fixed or mobile-bearings, intraoperatively
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AcknowledgementsAcknowledgements
Thomas J. ScullyOrthopaedic Consultant
Sales Associate & Cadaver Prosector
Daniel Auger, M.D., Ph.D.Director of Knee Research & Development
DePuy® Orthopaedics, Inc.
a Johnson & Johnson Company
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The human cadaver donors, who bequeathed their bodies for medical education and
research and who permitted the anatomical photographs shown in this presentation.