The Hip Joint - K. Mohan Iyer

This monumental volume, of which K. Mohan lyer is the editor, was written by several authors. It contains more than 500 pages and provides comprehensive cover of the hip joint in 15 broad chapters. After a rather brief embryological and anatomical description, the author studies the biomechanics defining the forces applied to the femoral head in particular. Each chapter ends with a rich reference list.


The clinical examination is written by K. Mohan Iyer himself. While medical imaging is gaining increasing importance both among surgeons and patients, it is essential as the author does to recall the clinical features which begin from the exterior aspect and gait examination. The neurological examination as well as specific testing are then detailed.

Imaging begins with standard X-ray studies with its classical landmarks, then MRI with beautiful images in order to identify in detail anatomical elements and muscles. Anatomical structures may even be observed with ultrasonography.

The following chapters will allow for the study of different hip pathologies, beginning with child and adolescent conditions, from septic arthritis in the infant, to dysplasia and congenital dislocation, irritable hip (i.e. transient synovitis) and coxa vara, as well as excessive anteversion, epiphysiolysis, and osteochondritis (i.e. Legg-Calvé-Perthes disease). Each condition is studied thoroughly with its clinical diagnosis, epidemiology, pathogenesis, diagnosis and classifications, including the recommended treatments and complications. An inclusive and extensive reference list can be found at the end of this broad chapter.

Chapter 6 is about hip traumas. Fractures of the femoral head in children and adults as well as hip dislocations and periprosthetic fractures are dealt with in succession. Each sub-chapter is comprehensively covered with its classifications and surgical treatments. Illustrations and drawings are of high quality.

Chapter 7 deals with non-traumatic hip conditions in adults. The study begins with a thorough coverage of osteoarthritis of the hip (including diagnostic and radiological examinations, treatments, surgical approaches, arthroplasties as well as complications), the next sections are on rheumatoid artritis, hip tuberculosis, metabolic and nutritional disorders of the hip; haemophilia, Paget’s disease, meralgia, types of bursitis (great trochanter, psoas, snapping hip) and aseptic necrosis of the femoral head are also described.

Chapter 8 is devoted to hip arthroplasty providing at the very beginning a wide historical background (from Charnley and the cobalt-chrome alloy, to the brothers Judget and acrylic cement, as well as Moore and Thompson). Then indications are detailed based on clinical and imaging findings. The different types of total hip prostheses are described, including anterior and posterior approaches, minimally invasive surgery, complications, advantages and drawbacks of the various approaches. Hip prostheses reoperations are presented in detail, in particular complications in ceramic-on-ceramic

implants, loss of bone stock, as well as the different surgical approaches, including removal of cemented and uncemented femoral implants, of acetabular components, femoral reconstruction in case of cemented prosthesis, bone grafting, results and complications. The option of a one-step or two-step surgical procedure is also presented. A clinical case is described thoroughly in order to demonstrate the procedure, numerous colour pre- and post-operative pictures are present. Chapter 8 ends with a gigantic list of bibliographical references over the last thirty years.

Girdlestone resection arthroplasty of the hip, sometimes the only option in reoperations, is the focus of chapter 9, while chapter 10 deals with osteotomies around the hip. They are classified according to their indications, location, the main area of pain, and the neurological conditions. The authors provide full description of osteotomies, among which Salter osteotomy, Pemberton osteotomy, innominate Steel osteotomy, periacetabular (Ganz) osteotomy, Staheli osteotomy, Chiari osteotomy, Schanz osteotomy, Lorenz osteotomy, varus- and valgus-production osteotomy, osteotomy for Blount’s disease, Sarmiento valgus osteotomy, McMurray’s osteotomy, Sugioka’s osteotomy are also described.

Chapter 11 describes surface replacement techniques.

Chapter 12 covers minimally invasive hip arthroplasty with an overview of patient-specific instrumentation, potential advantages for the patient and selection of patients eligible for these treatments; surgical approaches are superbly illustrated with preoperative colour photographs. Extensive reference sections spanning between the years 2001 and 2004 are included at the end of the chapter.

Navigation is the focus of the short chapter 13. Methods for navigation are described with their indications in total arthroplasty or in surface replacement, as well as their limitations.

Chapter 14 deals with tumours around the hip, presented as follows: osteogenic tumours (such as bone islands, osteid osteoma, conventional osteosarcoma, periosteal osteosarcoma and secondary or telangiectatic), comprising Ewing sarcoma, cartilaginous tumours (osteochondroma and chondrosarcoma), giant-cell tumours, fibrogenic tumours, aneurysmal cyst, also focusing on Jaffe-Lichtenstein fibrous dysplasia, angiosarcoma, hemangioma, myeloma, lymphoma, metastases and brown tumeurs. Paget’s disease, alveolar soft part sarcomas and cordoma are also reviewed. All these paragraphs are enriched with demonstrative radiographs.

The book ends with chapter 15 illustrating hip arthroscopy, its description and indications, a number of examples are also given.

In conclusion, this book is truly a bible of the current medical and surgical state of knowledge regarding hip joint. It should be on the shelves of every specialist in the field: orthopaedic surgeons, trauma surgeons, rheumatologists, may they be senior or in training, or at least it should be accessible electronically.

In the electronic version examined, we regret the absence of an index which would enable prompt access according to keywords.

Professor Pierre Kehr

Strasbourg (France)
Conflict of Interest Disclosure : Nil to disclose

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