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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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.