Ernest F. Talarico, Jr., Ph.D., M.S., B.S., C.L.A.
Assistant Director of Medical Education
Assistant Professor of Anatomy & Cell Biology
Course Director, Human Gross Anatomy & Embryology
Indiana University School of Medicine - Northwest
Gary, Indiana
Objectives
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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Articulations

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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Synovial Joint



most common type of joint and
the most complex
provide free movement between
bones
three distinguishing features




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
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Pathology
Fractures
 Rheumatoid Arthritis
 Osteoarthritis

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Rheumatoid Arthritis (RA)
A 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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Osteoarthritis
Degenerative 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 Information
Hip 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 Joint
pelvic bone
femur (thighNWCME
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iliofemoral ligament (horizontal)
iliofemoral ligament (vertical)
pubofemoral ligament
iliofemoral ligament (horizontal)
ischiofemoral ligament
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zona orbicularis
Ligament of the Head of the Femur
Ligamentum capitus femoris
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Osteoarthritis
Histopathology




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

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 Information
Knee 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 Joint
patella
femur
tibia
The fibula plays no role
in the knee.
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Views of the Knee Joint
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Patellar
Ligaments of the Knee
Extracapsular Ligaments
Fibular Collateral
Tibial Collateral
Oblique Popliteal
Arcuate Popliteal
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Oblique Popliteal
Arcuate Popliteal
*
*
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Ligaments of the Knee
Intra-articular Ligaments
Cruciate Ligaments
(ACL and PCL)
Menisci (lateral &
medial)
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Bursa of the Knee Joint
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“Unhappy Triad” of Knee Injuries
(1)
(2)
(3)
tibial collateral
ligament
ruptures,
opening the joint
on the medial
side
tearing of the
medial meniscus
snapping of the
ACL
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Rheumatoid Arthritis
Histopathology




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 Arthritis
Histopathology





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
 LCS® Knee
• developed more than 20 years ago
• is a patented, one-of-a-kind knee
system because its mobilebearings 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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Acknowledgements
Thomas J. Scully
Orthopaedic 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.
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