This document summarizes a presentation on bioengineering research of the hip. It discusses how quantitative anatomical research has improved understanding of hip structures like the acetabulum, proximal femur, capsular thickness, labrum, ligamentum teres, and proximal hamstrings. Biomechanical studies investigate injury patterns and validate surgical reconstruction/repair techniques. Future research directions include robotic studies of the hip. The conclusion is that anatomical and biomechanical hip research is growing and will lead to improved surgical techniques and patient outcomes.

1. Bioengineering Hip Research:
Why it's important to your Practice and
What's Next
Vail Hip Symposium
January 15th, 2015
Vail, CO
Robert F. LaPrade, MD, PhD
Chief Medical Officer
Steadman Philippon Research Institute
Deputy Director, Sports Medicine Fellowship
Complex Knee and Sports Medicine Surgeon
The Steadman Clinic Vail, CO
Adjunct Professor, University of Minnesota
Affiliate Faculty, Colorado State University

2. Disclosures
I, Robert F. LaPrade, have relevant financial
relationships to be discussed, directly or
indirectly, referred to or illustrated with or
without recognition within the presentation
as follows:
• Editorial Boards for AJSM & KSSTA
• AOSSM Board
• Chair, AOSSM Research Committee
• Consultant : Arthrex, Smith & Nephew
• AOSSM Research Grant
• OREF Career Development Grant; OREF Clinical
Research Award 2013
• Health East Norway Research Grant
• Minnesota Medical Foundation Grants
• AOSSM: Chair, Research Committee, AOSSM
Board
The Steadman Philippon Research
Institute is a 501(c)(3) non-profit
institution supported financially by
private donations and corporate support
from the following entities:
• Smith & Nephew
• Arthrex, Inc.
• Siemens Medical Solutions USA, Inc.
• ConMed Linvatec
• Össur Americas
• Synthes
• Ceterix Orthopaedics, Inc.
• AANA
• University of Oslo
• The Steadman Clinic
• Vail Valley Medical Center

3. Translational Biomechanics
Research Model
• Components
Quantitative
Anatomy
Biomechanics
Clinical Outcomes

4. How do we improve our
understanding of the
complex anatomy of the
hip?
-Quantitative descriptions of
clinically pertinent hip
anatomy
Hip Research Pyramid:
Anatomy

5. Hip Research Pyramid:
Acetabular Anatomy
• Philippon MJ, Michalski MP, Campbell
KJ, Goldsmith MT, Devitt BM, Wijdicks
CA, LaPrade RF. An anatomical study of
the acetabulum with clinical applications to
hip arthroscopy. J Bone Joint Surg Am. 2014
Oct 15;96(20):1673-82.

6. Acetabular Anatomy
• Direct Head of Rectus
Femoris; Superior Facet
ASIS- 137.6 mm2
• AIIS Ridge- 8.9 mm2
• Indirect head RF,
closest at 12:30; 5.1 mm

7. Acetabular Anatomy
“A new clock-face @ 3:00”
The center of the anterior labral sulcus (psoas-u)- a reliable
landmark, previously 3:30, TAL = 6:00 (Philippon 2007, Blankenbacker 2007)

8. Hip Research Pyramid: Anatomy of
the Proximal Femur

9. Anatomy of the Proximal Femur
Reliable Osseous
Landmarks:
1. Superomedial Border of
the Greater Trochanter
2. Femoral Head-Neck
Junction
3. Vastus Tubercle

10. Anatomy of the Proximal Femur-
Quantitative Anatomy
Gluteus medius: Superomedial footprint Post. Tip of GT- 17.0 mm
Lateral footprint anteriorinferior VT- 17.1 mm
Gluteus minimus: Center of footprint anteroinferior VT- 22.9 mm

11. Capsular Thickness
Capsule:
• Thickest at 2 o’clock position
• Maximal thickness: 8.3 mm
• Thinnest at 10 o’clock position
• Minimal thickness: 4.1 mm

12. Acetabular Labrum
• Acetabular labrum
• Secondary stabilizer to
external rotation and
anterior translation
• Iliofemoral ligament
• Significant role in limiting
external rotation and
anterior translation
Bi-plane fluroscopy: Test hip motion in
intact and sectioned states

13. The Ligamentum Teres
Ligamentum teres:
• Yield Load: 75 N
• Ulitmate failure load: 204 N
• Mechanism of failure: Tearing at fovea capitis

14. The Proximal Hamstring-
Anatomy, structural properties
and repair techniques
Conjoined tendon- Semi T, long head of biceps
Semimebranosus
Proximal hamstring tendon avulsion
5 small anchors (1164 N) > 2 large anchors (474 N)
or 2 small anchors (543 N)
Conclusion: Aggressive post-op early ROM and
WB with 5 small anchor repair

15. Bioengineering Hip Research:
What’s Next
• Biomechanical robotic studies investigating:
• Injury patterns
• Reconstruction and repair techniques

16. Conclusions
• Quantitative anatomy- improved understanding of the complex
anatomy of the hip and surrounding structures
• Biomechanical research- emerging research understanding injury
patterns and validating/improving surgical techniques
• Clinical implications- hip anatomical and biomechanical research is
increasing rapidly and will lead to anatomic repairs/reconstructions
and ultimately improved patient outcomes

17. Steadman Philippon
Research Institute
Thank
You