This book is the second one on the Hip Joint,which is written in great details taking all angles of the Hip Joint into consideration.It had been written by Authors from around the world who have sub specialiased in the chapter that they have written.It took me one year to write this book. K.Mohan Iyer,Bangalore,India

1. Front Pages of my book THE HIP JOINT
1st Forword
Professor George Bentley,M.B,Ch.M,D.Sc,FRCS(ENG),FRCS(ED),F.Med.Sci.
Emeritus Professor and Director.Institute of Orthopaedics and Musculo-Skeletal Science.
University College London.
Honorary Consultant Orthopaedic Surgeon,Royal National Orthopaedic Hospital,London.
This thoughtful text on the Hip Joint is the result of the author’s experience over 35 years since his
association with the University of Liverpool and the Royal Infirmary and Children’sHospitals in
Liverpool as Registrar and M.Ch.(Orth) graduate.
He was an outstanding student who,under the tutelage of Mr.G.V.Osborne and our consultant
colleagues in the Liverpool Region,achieved distinction clinically and academically.
Since that time his book entitled “The Hip Joint” is a distillation of his knowledge and experience
together with that of his colleagues from India and U.K.
As a consequence it contains very valuable information and practices from India as well as UK which
are only available to those who have practised in the challenging environment of Indian Orthopaedics
and Traumatology.
The text takes the reader from the childhhood disorders, which are seen less commonly in the West
nowadays,right through adolescence early adulthood and the problems ,ever increasing,of the hip in
the older population.
The text reflects the views of the author but valuable additional chapters have been contributed by
colleagues with special interests.
This book has the great advantage of a consistent theme and philosophical approach to practical
management of hip diseases and injuries.
It will be appreciated by students,post-graduates and experienced Orthopaedic Surgeons alike.

2. George Bentley,M.B,Ch.M,D.Sc.,FRCS(Eng.),FRCS(ED),F.Med.Sci.
2nd
I am honored to have been asked by Dr. Mohan Iyer to provide a forward to this text. I first became
acquainted with Dr. Iyer’s work on the hip joint when I was editing the 9
Forword
th
edition of Campbell’s
Operative Orthopaedics (1992). His descriptions of his innovative posterior approach to the hip and
trochanteric osteotomy are classics in the orthopaedic literature. In addition to his extensive research
and publication on approaches to the hip and total hip arthroplasty, Dr. Iyer has produced an
impressive list of publications on injuries and disorders of the hand, wrist, and shoulder. This current

3. text on the hip joint is a culmination of over 30 years of research by Dr. Iyer, and I am sure it will
become a valuable asset to orthopaedic surgeons worldwide. He has assembled a stellar group of
contributing authors and has, of course, added his own vast experience to the authoring and editing
process. We are proud to have Dr. Iyer included as one of the esteemed surgeons whose work has
added so much to Campbell’s Operative Orthopaedics over the years, and we look forward to adding
this textbook to our collection of essential educational tools for our residents and fellows.
S. Terry Canale, MD
Professor and Chair, University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery &
Biomedical Engineering, Memphis, Tennessee, USA
Editor, Campbell’s Operative Orthopaedics, editions 9, 10, 11, and 12

4. I have mainly written this preface in memory of late Mr.Geoffrey V Osborne,who was like a
fatherly figure to me.After his retirement from the University of Liverpool,he was busy
writing a thesis for his PhD in printing from the University of Liverpool,UK,which he managed
to get in the end.During his later years just before his retirement,he was extremely keen to
propagate his approach and nicknamed it as the `Liverpool Approach’ along with Professor
Robert Owen.
PREFACE
The 1st
foreword for this 2nd
Professor of Orthopaedic and Accident Surgery and
Consultant Orthopaedic and Spinal Surgeon
book THE HIP JOINT has been kindly given by my esteemed
Professor George Bentley Ch. M., FRCS,
, University of Liverpool and Royal Liverpool and
Children's Hospitals, Professor Emeritus and Director,Institute of Orthopaedics & M/S
Science,U.College,London, SICOT,1972 – Present (43 years)Royal National Othopaedic
Hospital,Stanmore,U.K.
Chairman of Scientific Publications-EFORT
Editor-in Chief of
1).European Surgical Orthopaedics and Traumatology-in 7 volumes-Published June 2014-
Springer,Heidelberg.
2).Instructional Course Lecture Series of EFORT -Annually-2009 to present-
Springer,Heidelberg.

5. Professor George Bentley knew me and late Geoffrey V Osborne very well and hence this is a
fitting tribute to him.
The 2nd
foreword has been kindly given by Dr.S Terry Canale MD.Harold B Boyd Professor and
Chair,Department of Orthopaedic Surgery,Campbell Clinic, Campbell Foundation,1211 Union
Avenue, Suite 510,University of Tennessee,Memphis, TN 38104, a book which is likened as
the Bible in Orthopedics,because my original research on the Hip Joint,first came out in that
book in its 9th
Edition in 1992 till the 12th
Edition today.
He inspired me with his approach and knowledge of Orthopaedics,that is unforgetable,and I
would not have followed his footsteps,had it been for him.I just have hallucianations that he
is very much present there and I am sharing with him the joy of being in India.He was a
patron of the Indian Orthopedic Association and he patiently listened when I presented my
original research on the Hip Joint ,done in Liverpool,with my respected teacher and late
Dr.Rasik M.Bhansali who was the chairman at the Conference of the Association of Surgeons
of India in December 1982.Despite my original research work on the Hip joint,he inspired me
for a followup of his cases to be presented as a thesis to the University of Liverpool,UK for the
MCh.Orth Degree, of Excision of theTrapezium,and for Arthrography of the pseudojoint along
with the newly appointed Professor Graham Whitehouse,Professor of Radiodiagnosis at the
University of Liverpool,UK.

6. DEDICATIONS
To the memory of my respected teacher,(Late)Mr.Geoffrey V Osborne
and
My wife,Mrs.Nalini K.Mohan
My Daughter Deepa Iyer,MBBS,MRCP(UK)
My Son,Rohit Iyer,BE(IT)

7. THE HIP JOINT
Table of Contents:
1.Anatomy of the Hip Joint by K.Mohan Iyer,Bangalore,India
2.Biomechanics of the Hip Joint by Ram Ravishankar,Rochdale,UK
3.Clinical Examination of the Hip Joint by K.Mohan Iyer,Bangalore,India
4.Imaging of the Hip Joint, by Ram Vaidyanath and Rajesh Botchu,Leicester,UK
5. Disorders of the hip in the child.
(1) Disorders in the child
a Acute septic arthritis in infants and children by K.Vinodh,Coimbatore,India
b.Complications and Treatment of Complications in Children by
K.Vinodh,Coimbatore,India
c.DDH or Congenital Dislocation of the Hip Joint by Sughran Banerjee,Kolkatta,India
d.The Irritable Hip by K.Mohan Iyer,Bangalore,India
e.Coxa vara, by K.Mohan Iyer,Bangalore,India
f.Femoral Anteversion by K.Mohan Iyer,Bangalore,India
(2) Disorders in the adolescent

8. a.Slipped femoral Epiphysis by Vijay Kumar,Robert Jennings,Southampton, and Sharad
Goyal,Chichester,UK
b.Perthes’disease by Vijay kumar ,Sharad Goyal and Robert Jennings,Chichester,UK
6. Injuries around the hip joint including peri-prosthetic fractures.
a.Fractures of the neck of the femur in children by K.Mohan Iyer,Bangalore,India
b.Fractures in the neck of the femur in adults by Vijay Kumar and Sharad
Goyal,Chichester,UK
c.Dislocations and Fracture-dislocations of the Hip Joint by K.Mohan Iyer,Bangalore,India
d.Periprosthetic Fractures by Shibu P Krishnan and Gudeep Singh Biring,London,UK
7. The Adult Hip and it's disorders.
a.Osteoarthritis by K.Mohan Iyer,Bangalore,India
b.Rheumatoid Arthritis by K.Mohan Iyer,Bangalore,India
c.Tuberculosis of the Hip Joint by K.Mohan Iyer,Bangalore,India
d.Metabolic and Nutritional Disorders by K.Mohan Iyer,Bangalore,India
e.Haemophilic Arthritis by K.Mohan Iyer,Bangalore,India
f.Paget’s disease of the Hip Joint by K.Mohan Iyer,Bangalore,India
g.Meralgia paresthetica by K.Mohan Iyer,Bangalore,India

9. h.Bursitis in the Hip Region by K.Mohan Iyer,Bangalore,India
i.Avascular necrosis of the Hip Joint by K.Mohan Iyer,Bangalore,India
8. Total Hip Arthroplasty.
Primary by Sharad Goyal and Edward Lindisfarne,Chichester,UK
Revision by David Ball and Ardeshir Bonshahi,Rochdale,UK
9.Girdlestones Arthroplasty by K.Mohan Iyer,Bangalore,India
10.Osteotomies around the Hip Joint by K.Mohan Iyer,Bangalore,India
11.Surface Replacement of the Hip Joint by Michael Moss,Sharad Goyal and Gynanendra
Kumar
Singh,Chichester,UK
12.Minimally invasive Surgery of the Hip Joint by Dayanand Manjunath and Deepak
Shivanna,Bangalore,India.
13.Computer Assisted navigation of the Hip Joint by Wasim S Khan,London,UK
14. Neoplastic conditions around the hip by Ram Vaidyanath and Rajesh
Botchu,Birmingham,UK
[15. Arthroscopy of the Hip Joint by Gurdeep Singh Biring,London,UK

10. Contributors:
1. K.Mohan Iyer,Author and Main Editor,Bangalore,India
M.Ch.Orth(Liverpool,UK),M.S.Orth.(Bom),F.C.P.S.Orth.(Bom),D’Orth.(Bom)MBBS(Bom)
Senior Consultant Orthopedic Surgeon,Bangalore,India.Email Address for
correspondence:kmiyer28@hotmail.com
2. Ram Ravishankar,Rochdale,UK
D.Orth., M.S.(Orth), M.Ch.Orth (L'Pool), Associate Specialist in Orthopaedics,Rochdale,UK
Email Address for correspondence :rrshankar227@gmail.com
3.Ram Vaidyanath: MBBS, DMRD, DNB, FRCR, EBHNR,Consultant Radiologist ,University
Hospitals of
Leicester,Leicester, UK.Email Address:rvaidhyanath@gmail.com
4.Rajesh Botchu, MBBS, MS(Orthopaedics) MRCSI, MRCS Ed, FRCR,Consultant
Musculoskeletal
Radiologist,The Royal Orthopaedic Hospital,Birmingham, UK.Email
Address:drbrajesh@icloud.com
5. K.Vinodh,MB, D Ortho, M Ch ortho (Liverpool),Senior Consultant and Clinical director,
Ortho One,
Orthopedic speciality centre, Coimbatore,India.Email Address:vinodhortho@gmail.com

11. 6. Sughran Banerjee,MD(Lon),Dip SICOT,AFRCS,Director and Consultant Orthopedic
Surgeon,Chiron
Day Care Clinic,Kolkata,INDIA.Email Address:sughran@yahoo.com
7.Vijaya Kumar Kempanna,MS(Orth), DNB(Orth), MRCS(Ed), FRCS (Tr&Orth),Southampton
General
Hospital, Southampton, UK.Email Address:vijaysuma3@yahoo.co.uk
8.Robert Jennings ,FRCS (Tr&Orth) ,Consultant Orthopaedic Surgeon,Southampton University
Hospital,UK.Email Address: robert.jennings@uhs.nhs.uk
9. Sharad Goyal ,Assosciate Specialist,MS(Orth), DNB(Orth),D’Orth, M.Ch.’Orth (Liv),St
Richards
Hospital, Chichester, UK.Email Address:goyal108@gmail.com
10. Shibu P Krishnan,MBBS, MS, MRCS, Dip. SEM, FRCS (Tr. & Orth.),Pg Cert. Innovation &
Performance,Consultant in Trauma & Orthopaedics,Buckinghamshire NHS Trust.
Email Address:shibupkrishnan@hotmail.com
11. Gurdeep Singh Biring,Consultant Trauma & Orthopaedic Surgeon,BSc, MBBS, MRCS, MSc,
FRCS
(T&O), Buckinghamshire NHS Trust.Email Address:biring7@aol.com
12. Edward A.O. Lindisfarne ,MBBS, BA (Oxon), MA, MRCS,Specialist Registrar in Trauma &

12. Orthopaedics,Western Sussex Hospitals NHS Trust.Email Address: findeddy@gmail.com
13. David Ball,MBBS,MRCSEd,Registrar Trauma & Orthopaedic Surgery, Royal Oldham
Hospital,UK.
Email Address:davidball@doctors.org.uk
14. Ardeshir Bonshahi,FRCS(Tr&Orth), FRCSEd, MSOrth,Consultant Orthopaedic
Surgeon, Royal
Oldham Hospital,UK.Email Address:abonshahi@yahoo.co.uk
15.Michael C Moss FRCS,Consultant Orthopaedic Surgeon,Western Sussex Hospitals NHS
Foundation
Trust,Chichester, United Kingdom.Email Address:michael.c.moss@btinternet.com
16.Gyanendra Kumar Singh,Assosciate
Specialist,MBBS(Hons).,D'Ortho,MS.(Ortho),FRCS(Edin)M.Ch.,
Western Sussex Hospitals NHS Foundation Trust,Chichester, United Kingdom
Email Address:drgksingh2003@yahoo.co.uk
17.Dayanand Manjunath, MBBS,MS ortho,Assistant Professor Bangalore Medical College and
Research Institute.Bangalore,India.Email Address:drdayanand.m@gmail.com
18.Deepak Shivanna, MS (Orth), MSc (Tr.Orth)(MCh) Ortho – UK,Associate
Professor,Bangalore

13. Medical College and Research Institute.Bangalore,India.Email
Address:deepsdoc@gmail.com
19.Wasim Khan MBChB, MRCS, MSc, PhD, FRCS (Tr&Orth),University College London Institute
of
Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital,
Stanmore,
Middlesex, HA7 4LP, United Kingdom.Email Address:wasimkhan@doctors.org.uk

14. ACKNOWLEDGEMENTS
I am extremely grateful to Professor George Bentley for his appreciation of my book `THE HIP
JOINT ‘ being dedicated to my respectful teacher late,Mr.Geoffrey V Osborne,Senior
Consultant orthopedic Surgeon,University of Liverpool,UK, and for given me the 1st
I am also extremely grateful to Dr.S Terry Canale of Campbell’s Operative Orthopedics for
having given me the 2
Foreword
for this book,despite leading a busy tumultuous life in Orthopedics till today.
nd
foreword to this book,because my original research on the Hip Joint
came out first in its 9th
Edition in 1992 till today in its 12th
My sincere thanks to Prim.Univ.Prof. Dr. Gerald Pflüger,Professor of Orthopaedic
Surgery,University of Vienna,Emeritus Medical Director and Chief of Orthopaedic
Department,EKH,Vienna,Head of the Medical Education Academy,has been kind enough
to use his services to go through this chapter on `Minnimally Invasive Surgery of the Hip
Joint’,as having gone through this chapter for the benefit of the target audience and deemed
it ideal for publication in my book.
Edition.
I would like to express my thanks to Professor Fares S Haddad, UCLA,London,UK for his
encouraging guidance and Mr Dinesh Nathwani,Consultant & Hon Senior Lecturer,Trauma &
Orthopaedic Surgery
Imperial College Healthcare for all their timely help,without which it would have been
extremely difficult to complete this book.

15. Finally I would like to thank all the Orthopedic Surgeons for their valuable contribution in
their sub-specialities.
I am extremely grateful to Magdi E.Greiss,M.D.,M.Ch.Orth,FRCS,Senior Consultant Orthopedic
Surgeon,North Cumbria university Hospitals,UK,Former President,BOFAS,UK for his
invaluable in snaps which he had preserved in his life during his training and early years after
becoming a Consultant in Orthopedics.
I am extremely grateful to Ardeshir Bonshahi,FRCS(Tr&Orth), FRCSEd, MSOrth,Consultant
Orthopaedic Surgeon, Royal Oldham Hospital,UK,for his unique chapter written along with
David Ball
MBBS,MRCSEd,Registrar Trauma & Orthopaedic Surgery on Revision Total Hip Arthroplasty.
I am particularly thankful to Wasim S Khan, MBChB, MSc, PhD, FRCS (Tr&Orth), Clinical
Lecturer, UCL,Division of Surgery, London,acknowledging Professor Justin Cobb of Charing
Cross Hospital and Imperial College,London,UK in his chapter as pioneer in `Computer
Assisted Navigation for Total Hip Arthroplasty’.
I am extremely thankful to Shibu Krishnan ,MBBS, MS, MRCS, Dip. SEM, FRCS (Tr. & Orth.),Pg
Cert. Innovation & Performance,Consultant in Trauma & Orthopaedics
Buckinghamshire NHS Trust for his novel chapter on Periprosthetic Fractures
I am thankful to K.Vinodh,MB, D Ortho, M Ch ortho (Liverpool),Senior Consultant and Clinical
director, Ortho One, Orthopedic speciality centre, Coimbatore.,for his chapter on

16. Acute Septic Arthritis of Infants,along with Acute Septic Arthritis in Children.I am also grateful
to him for other X-rays in other chapters of this book.
I am extremely grateful to . Ram Vaidhyanath,MBBS, DMRD, DNB, FRCR, EBHNR
Consultant Radiologist ,University Hospitals of Leicester,Leicester, UK and
RajeshBotchu,MBBS, MS(Orthopaedics) MRCSI, MRCS Ed, FRCR,Consultant Musculoskeletal
Radiologist,The Royal Orthopaedic Hospital,Birmingham, UK, for their chapters written
together on Imaging of the hip joint, and Neoplastic conditions around the hip,which has
been so elaborately covered in detail.I am particularly very grateful to them in helping me out
with additional X-rays required for the complete coverage of this book,in other chapters as
well.
I am extremely thankful to Vijaya Kumar H.K.,MS(Orth), DNB(Orth), MRCS(Edin),
FRCS(Tr&Orth),
Senior Registrar in Dept of Orthopaedics,Royal West sussex hospitals NHS trust(St Richards
Hospital)
Chichester, PO19 6UN, United Kingdom for his contribution in chapters on Slipped femoral
Epiphysis,
Perthes’disease,and Fractures in the neck of the femur in adults,despite leading a busy life in
the Department of Orthopedics and Traumatolgy in the busy Southampton General
Hospital,UK.

17. I am grateful to Sughran Banerjee,MD(Lon),Dip SICOT,AFRCS,Director and Consultant
Orthopedic Surgeon,Chiron Day Care Clinic,Kolkata,INDIA for his chapter on Congenital
Dislocation of the Hip Joint.
I am extremely indebted to Robert Jennings FRCS (Tr&Orth) Consultant Orthopaedic
Surgeon,Southampton University Hospital,UK,for his timely help in the chapter of Slipped
Femoral Epiphyses.
I am also thankful to Sharad Goyal MS(Orth), DNB(Orth),D’Orth, M.Ch.’Orth (Liv),St Richards
Hospital, Chichester, UK for taking active interest and faith in me in publishing this book and
for his contribution in chapters on Slipped Femoral Epiphysis, Perthes’disease and Fractures
ofthe neck of the femur in adults and for writing the chapter on Total Hip Arthroplasty. I am
grateful to Edward A.O. LindisfarneMBBS, BA (Oxon), MA, MRCS Specialist Registrar in
Trauma & Orthopaedics Western Sussex Hospitals NHS Trust for his contribution to the
chapter on Total Hip Arthroplasty.
I am extremely thankful to Gyanendra Kumar Singh,
MBBS(Hons).,D'Ortho,MS.(Ortho),FRCS(Edin)M.Ch. and Michael Moss, BSc, MB BS, FRCS,
Consultant Orthopaedic Surgeon, Western Sussex Hospitals NHS Trust, Chichester, UK, in
writing the chapter with Sharad Goyal on Surface Replacement of the Hip Joint.

18. I am extremely thankful to Gurdeep Singh Biring, Consultant Trauma & Orthopaedic Surgeon
BSc, MBBS, MRCS, MSc, FRCS (T&O)for his extraordinary chapter on Arthroscopy of the Hip
Joint and Periprosthetic Fractures of the Hip Joint along with Shibu P.Krishnan.
I am very thankful to Ram Ravishankar, D.Orth., M.S.(Orth), M.Ch.Orth (L'Pool), Associate
Specialist in Orthopaedics,Rochdale,UK,Associate Specialist ot Rochdale,for his contribution
on Biomechanics of the Hip Joint and for guiding me through the contents of this book.
I am also indebted to the AAOS for permissions given to insert the illustrations in the above
chapter of `Biomechanics of the Hip Joint’
Finally I am thankful to Dayanand Manjunath, MBBS,MS ortho
Assistant Professor and Deepak Shivanna, MS (Orth), MSc (Tr.Orth)(MCh) Ortho –
UK,Associate Professor,Bangalore Medical College and Research Institute.Bangalore,India for their
unique chapter on Minimally Invasive Surgery of the Hip Joint.
Above all I highly appreciate the help of my son,Mr.Rohit Iyer in the presentation and
publication of this book.

19. K.Mohan Iyer
Karnataka,India
M.Ch.Orth(Liverpool,UK),M.S.Orth.(Bom),
F.C.P.S.Orth.(Bom),D’Orth.(Bom)MBBS(Bom)