0:00

I wanna go, uh,

0:02

address one historical aspect in particular

0:05

because, uh, you know, I'm a little older than most of you

0:08

who are listening to this particular lecture,

0:11

and you may not be aware of this particular entity.

0:15

This was an entity that was called the tilt deformity

0:18

of de femoral Head.

0:20

It was popularized by Ronald Murray, a very important

0:24

and well-known skeletal radiologist, uh, from England.

0:28

And what he suggested is if you looked at cases

0:31

of idiopathic osteoporosis of the hip, that some appeared

0:35

to have a tilt deformity with medial angulation

0:40

of the femoral head with respect to the femoral neck.

0:43

There are pictures taken from another article,

0:45

but it was if the femoral head was falling off

0:48

of the femoral neck.

0:50

And because of that appearance, it was his belief

0:53

and the belief of other investigators at the time

0:56

that this type of deformity might relate

0:59

to previously undiagnosed slip capital femoral epiphysis.

1:03

So maybe examples of

1:05

what was called idiopathic osteoarthritis

1:08

or osteoarthrosis of the hip really represented cases of,

1:13

uh, slip capital femoral epiphysis

1:15

that had not been recognized earlier.

1:18

And I would call your attention to the three primary

1:21

features, and particularly feature number two

1:24

was feature number two.

1:26

In this subclinical slip capital femoral epiphysis was a

1:31

loss of normal concavity on the superior region

1:34

of the femoral head.

1:36

Now those of you thinking ahead, you might be thinking,

1:38

well, that's cam type morphology of the proximal femur.

1:43

And indeed you could suggest

1:45

that in some cases in which we diagnose primary cam

1:49

morphology, we're dealing

1:51

with a slipped capital femoral epiphysis.

1:55

What was about that time?

1:56

I was reading these particular articles

1:58

and I said, just wait a minute.

1:59

There's another phenomenon.

2:01

You have to realize that when you have osteoarthrosis

2:05

of the hip and your pictures taken from an article we did

2:07

number a lot of years ago,

2:10

but when you had osteoarthrosis of the femoral head

2:14

and you wore away the cartilage

2:15

and flattened the SubCal bone plate

2:18

with cystic changes in the pressure segment,

2:21

what typically could occur in the non-pressure segment was

2:25

osteophyte formation.

2:27

And you've all seen this,

2:28

it's typically seen on the medial

2:30

aspect of the femoral head.

2:32

So this could look like a slip capal, femoral epiphysis.

2:36

But I call your attention to the fact that typically

2:39

as the osteophyte grows, it buries the original zone.

2:44

Okay? Uh, here of cartilage, okay, of calcified cartilage.

2:49

So when you look at this,

2:50

and you can see a little bit of it here, you know

2:53

that this is an osteophyte.

2:54

It's not related to the slip of anthesis.

2:57

It's rather related

2:59

To a large osteophyte that has developed.

3:02

So be aware of this secondary tilt deformity

3:06

that can involve the femoral head related

3:09

to prominent medial osteophytes on the femoral head

3:13

that looks like the femoral head is falling off

3:16

of the femoral neck.