HIP DISORDERS: RECENT ADVANCEMENT-

1. Recent Advancement
Hip Surgery And
Hip-Replacement
CME ON
Prepared by -
Dr. Md Nazrul islam, MBBS, M.Sc.
Supervised by -
Dr. Sk. Abbas uddin Ahmed
MS (ortho), ao(basic), ao(spine).
Presenting by -
Dr. Golam Mahamud Suhash
From -
Department Of Orthopaedic & Traumatology,
Shaheed Suhrawardy Medical College Hospital.
Dhaka. 1

2. Recent Advancement
Hip Surgery And
Hip-Replacement
Hip-disorders
Recent Advancement
Hip Surgery And
Hip-Replacement
2

3. Recent Advancement
Hip Surgery And
Hip-Replacement
Over view
Hip is the joint where your
thigh bone meets your pelvis
bone.
Hips are very stable. When they
are healthy, it takes great force
to hurt them.
Common Hip-disorders are-
 Strains
 Bursitis
 Dislocations
 Fractures 3

4. Recent Advancement
Hip Surgery And
Hip-Replacement
 Functions of Hip-joint
Contents:  Mechanisms Hip injury
 Most Common Types of Hip Injury-
 Epidemiology
 Anatomy of Hip-joint
 Pathophysiology of Hip-Injury
 Clinical features of Hip-Injury-
 Investigations
 Diagnosis
 Management
 Rehabilitations
 Complications
 Prognosis Of Hip-Replacement-
 Conclusions
 Total Hip Replacement at Shaheed
Suhrawrdy Medical College Hopital-
4

5. Recent Advancement
Hip Surgery And
Hip-Replacement
Functions of Hip-joint
 To provide stability for weight
bearing- standing, walking &
running.
 To allow mobility of the leg in
space.
 To transmit the loads from the
thigh and then to the lower limb.
5

6. Mechanisms Hip injury-
 Direct Stress
o Femoral Neck fracture
o Inter-trochanteric fracture
 Repeated stress
o Degenerative joint disease (DJD) of the
Hip
 Deformities
o Congenital dislocation of the Hip (CDH)
/ Developmental dysplasia of the Hip (DDH).
6

7. Recent Advancement
Hip Surgery And
Hip-Replacement
Most Common
Most Common
Types Of Hip Injury-
Types Of Hip Injury-
 Hip Strain is an overuse or injury that
tears or stretches the muscle fibers.
Strains  Most of the time, muscle strains in the
hip area occur when a stretched
muscle is forced to contract suddenly.
A fall or direct blow to the muscle,
overstretching and overuse can tear
muscle fibers, resulting in a strain.
7

8. Recent Advancement
Hip Surgery And
Hip-Replacement
 Bursa is a fluid filled sac that allows
smooth motion between two uneven
Most Common surfaces.
Types Of Hip Injury- Hip bursitis is a common problem

that causes pain over the outside of
the upper thigh.
Bursitis
 When the bursal sac becomes
inflamed, each time the tendon has to
move over the bone, pain results.
Because patients with hip bursitis
move this tendon with each step, hip
bursitis symptoms can be quite
painful. 8

9. Recent Advancement
Hip Surgery And
Hip-Replacement
Most Common Dislocations- HIP
Types Of Hip Injury-
Types of dislocation:
 Congenitical
 Acquired
 Anterior
 Central
 Posterior (90%)
9

10. Recent Advancement
Hip Surgery And
Hip-Replacement
AO/OTA Classification
Dislocations
 Most thorough.
 Best for reporting data, to allow
comparison of patients from different
studies.
 30-D10 Anterior Hip
Dislocation
 30-D11 Posterior Hip
Dislocation
 30-D30 Obturator (Anterior-
Inferior) Hip
Dislocation
10

11. Recent Advancement
Hip Surgery And
Hip-Replacement
HIP can break at any age, but the
Most Common great majority of hip fractures occur
Types Of Hip Injury-
in people older than 65.
Fractures .
 Fracture of Acetabular Component
 Acetabular fracture
 Central dislocation
 Fracture of Femoral Components.
 1. Femoral Neck fracture (NOF),
 2. Femoral head fracture
 3. Slipped capital femoral epiphysis in
children
 4. Trochanteric fracture
11

12. Recent Advancement
Hip Surgery And
Hip-Replacement
Epidemiology
 Worldwide gender distribution of Hip Fracture
 Men: 4-5 per 1,000
 Women: 8-10 per 1,000
 Men: 30%
 Women: 70%
 Morbidity and Mortality
Mortality 20% within 1 year Hip Fracture
o Men: 31% mortality in 1 year
o Women: 17% mortality in 1 year
o ADL assistance needed in 50% of Hip Fractures
o Long term care needed in 25% of Hip Fractures.
Cooper (1992) Osteoporos Int 2:285-9
Forsen (1999) Osteoporos Int 10:73-8
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13. Recent Advancement
Anatomy of Hip-joint
Hip Surgery And
Hip-Replacement
Introduction to hip joint anatomy
The hip joint is a ball and socket
joint, formed by the head of the
Femur (thigh bone) and the
acetabulum of the pelvis.
The dome-shaped head of the femur
forms the ball, which fits snuggly into
the concave socket of the acetabulum.
The hip joint is a very sturdy joint,
due to the tight fitting of the bones
and the strong surrounding ligaments
and muscles.
13

14. Recent Advancement
Hip Surgery And
Hip-Replacement
Anatomy of Hip-joint
Vital
Components of Hip-joint -
 Bones of the hip joint
 The hip joint capsule
 Ligaments of the hip joint
 Labrum of the hip joint
 Muscle Groups surrounding
the hip joint.
 Neuro-vascular Components. 14

15. Recent Advancement
Hip Surgery And
Hip-Replacement
Anatomy of Hip-joint Bones
 The ilium: This is the
largest area of the hip bones.
 The ischium: The ischium
consists of 2 broad curves of
Hip bones - bone, one on each side, which
lie below the ilium,
 The pubis: The pubis is the
front-most area of the hip
bones. It attaches to the ilium
on the sides and the ischium
on the bottom. 15

16. Recent Advancement
Hip Surgery And
Muscles And Ligaments-
Hip-Replacement
Muscles
 Muscles which attach to or
cover the hip joint:
• Gluteals.
• Quadriceps-
• Iliopsoas.
• Hamstrings.
• Groin muscles.
 Ligaments.
• Iliofemoral ligament:
• Pubofemoral ligament:
• Ischiofemoral ligament:
16

17. Recent Advancement
Hip Surgery And
Hip-Replacement
Blood supply Neurovascular Components
 Mainly by –
Medial and lateral circumflex
femoral arteries.
 And
Deep division of the superior
gluteal artery
Inferior gluteal artery
Posterior division of the obturator
artery(Head of the femur ).
17

18. Recent Advancement
Neurovascular Components
Hip Surgery And
Hip-Replacement
Nerve supply
 Femoral nerve - Via nerve to
the rectus femoris muscle
 Obturator nerve - Via it’s
anterior division.
 Sciatic nerve - Via the nerve to
the quadratus femoris muscle.
 Superior gluteal nerve - Here
the femoral, sciatic and oburator
nerves also supply the knee joint,
so hip disease may cause a
refered pain to the hipjoint. 18

19. Pathophysiology of Hip-Injury
Recent Advancement
Hip Surgery And
Hip-Replacement
 Age. The rate increases for people 65 and older.
 Gender. Women have two to three times as
Who is
vulnerable to many hip fractures as men.
hip fracture?  Heredity. A family history of fractures in later
life, particularly in Caucasians and Asians. A
small-boned, slender body.
 Nutrition. A low calcium dietary intake or
reduced ability to absorb calcium.
 Personal habits. Smoking or excessive alcohol
use.
 Physical impairments. Physical frailty,
arthritis, unsteady balance, and poor eyesight.
 Mental impairments. Senility, dementia, e.g.,
Alzheimer's disease.
Weakness or dizziness from side effects of 19
medication

20. Recent Advancement
Hip Surgery And
Clinical features of Hip-
Hip-Replacement
fracture(prox. Femur)
 Shortened limb on Fracture side
 Hip externally rotated and
Signs - abducted
(But internally rotated and
adducted in post. dislocation of
hip).
 Tenderness to palpation over
injured hip
 Limited range of motion
oDo not test ROM unless XRay 20

21. Recent Advancement
Hip Surgery And
Hip-Replacement
Hip fractures usually are caused by a
fall. If you fracture your hip, you may
experience the following symptoms:
Clinical features Severe pain in your hip or pelvic
of Hip-Injury-
area
symptoms Bruising and/or swelling in your
hip area
Inability to put weight on your hip
Difficulty walking
The injured leg may look shorter
than the other leg and may be
turned outward. 21

22. Recent Advancement
Hip Surgery And
Hip-Replacement
Investigations
 Complete medical history
 Physical examination to assess hip
The mobility, strength, and alignment.
orthopaedic  Blood tests
evaluation  X-rays (radiographs) to determine the
will extent of damage or deformity in your
typically
include -
hip.
 MRI / CT scan.
 Ultrasound scans
 Bone scans
 Biopsy
22

23. Recent Advancement
Hip Surgery And
Hip-Replacement
Investigations
Routine Pre-operative
Investigations-
1. Blood tests.
2. Kidney, Liver tests.
3. Lungs, Heart and Neurological
assessments.
Bone pathology specific
Investigations-
1. Assessment of bone strength
2. Assessment of bone infection
3. Assessment of bone TB/ Carcinoma.
4. Assessment of metabolic/systemic
bone diseases. 23

24. MR Arthrogram
Recent Advancement
Hip Surgery And
Hip-Replacement
 Hip Xray
Imaging
 Usually identifies Fracture and
Dislocation
 Hip MRI (T1-weighted)
 Indicated for high suspicion
despite normal XRay
 Test Sensitivity: 100%
An MRI may identify a
 Does not require delay after
injury
hip fracture otherwise
missed on plain X-ray.
 Hip Bone Scan with Technetium
Tc99m Polyphosphate
 Test Sensitivity: 98%
 Delay scan at least 72 hours
MR Arthrogram after time of injury 24

25. Recent Advancement
Diagnosis
Hip Surgery And
Hip-Replacement
Subjective Assessment
 Pain localized in hip region
 Exaggerated gait pattern (limp)
 Increase in pain when weight
barring
 Reduction in the degree of ROM
 As the degeneration of the joint
worsen, individual may be awakened
at night with pain
 Bone spurs may occur 25

26. Recent Advancement
Hip Surgery And
Hip-Replacement
Objective Assessment
 Gait pattern – Adaptive walking
pattern that reduces pressure on the
affected side.
Diagnosis  Muscle atrophy – Muscles in affected
area are not used as much due to pain,
therefore, use-it-or-lose-it applies.
 Active Range Of Motion – Limited
ROM, stiffness
Passive ROM – End feels causes severe
pain
 X-ray – clear degeneration of the bone
 MRI – determines underlying
complications (e.g.avascular necrosis) 26

27. Recent Advancement
Hip Surgery And
Hip-Replacement Management
Treatment for hip disorders may
include-
Medical-
 Rest,
 Medicines,
 Physical therapy
 Immobilization and/ or
 Reduction(dislocation) 27

28. Management
 Surgical-
 Osteotomy
 ORIF
 HIP Resurfacing
 Hip replacement. 28

29. Recent Advancement
Hip Surgery And
Hip-Replacement
Common HIP Condition
Fixation Which Requires Internal
Fixation-
Acetabular Component-
 Dysplasia, Impingement.
Femoral Components.
1. Femoral Neck
fracture (NOF),
2. Femoral head fracture
3. Slipped capital femoral
epiphysis in children
4. Trochanteric fracture
29

30. Recent Advancement
Hip Surgery And
Hip-Replacement
HIP Resurfacing-
Surface hip replacements
Developed in late nineties in UK by
Dr.Derek Mcminn
 Longevity of any primary THA cannot
be predicted
 Revision remains an issue
 Young/active patient may outlive
primary THA.
 Hip resurfacing extends continuum of
care in young patients with hip disease
30

31. Recent Advancement
Hip Surgery And
Candidates for hip
Hip-Replacement
HIP Resurfacing
resurfacing
 Young & active patients with hip
arthritis or secondary osteo-
arthritis
 Primary OA in young patients
 Avascular necrosis
 Ankylosing spondylitis
 Post traumatic arthritis
 DDH
 Slipped capital femoral epiphysis
www.hipsurgery.in 31

32. Recent Advancement
Hip Surgery And
Hip-Replacement
HIP Resurfacing Hip resurfacing-
considerations and steps-
 Head of femur is sculpted and not
chopped off to receive a cap or
resurfaced.
 Socket is deepened and a new
socket banged in
 Could survive for long term as
bearings are made of metal on
metal – Unknown at present
 Recovery is faster.
 Function is better.
32

33. Recent Advancement
Hip Surgery And
Hip-Replacement
HIP
Alternative Names
REPLACEMENT
• Hip arthroplasty;
• Total hip replacement;
• Hip hemiarthroplasty.
Definition of Hip joint
replacement:
Hip joint replacement is
surgery to replace all or part
of the hip joint with an
artificial joint. The artificial
joint is called a prosthesis.
33

34. Description:
The artificial hip joint has 4 parts:
HIP A. A socket that replaces your old hip
REPLACEMENT socket. The socket is usually made of
metal.
B. The liner fits inside the socket. It is
usually plastic, but some surgeons are
now trying other materials, like
ceramic and metal. The liner allows
the hip to move smoothly.
C. A metal or ceramic ball that will
replace the round head (top) of your
thigh bone.
D. A metal stem that is attached to the
shaft of the bone to add stability to
the joint. 34

35. Recent Advancement
Hip Surgery And
Hip-Replacement
Types of Hip Replacement
HIP
REPLACEMENT
 Traditional (Conventional) Hip
Replacement
Traditional hip replacement surgery
involves making a 10- to 12-inch incision
on the side of the hip. The muscles are
split or detached from the hip, allowing
the hip to be dislocated.
 Minimally Invasive Hip Replacement
Minimally invasive hip replacement
surgery allows the surgeon to perform the
hip replacement through one or two
smaller incisions (2 to 4 inch).
35

36. Recent Advancement
Hip Surgery And
Hip-Replacement
Hip conditions that frequently
HIP lead to total hip replacement
REPLACEMENT are the following-
 Rheumatoid Arthritis
 Secondary Osteoarthritis
 Ankylosing Spondylitis
 Old Perthes' disease
 Broken hip
 Bone tumor
 Avascular necrosis of the
femoral head
 Fused Hip Joint. 36

37. Recent Advancement
Hip Surgery And
Hip-Replacement Benefit from hip replacement
surgery if:
 Hip pain limits your everyday activities such
as walking or bending.
 Hip pain continues while resting, either day
or night.
 Stiffness in a hip limits your ability to move
or lift your leg.
 You have little pain relief from anti-
inflammatory drugs or glucosamine sulfate.
 You have harmful or unpleasant side effects
from your hip medications.
 Other treatments such as physical therapy or
the use of a gait aid such as a cane do not
relieve hip pain.
37

38. Recent Advancement
Hip Surgery And
Hip-Replacement
38

39. Recent Advancement
Hip Surgery And
Hip-Replacement
Intelligent Hip surgery
39

40. Recent Advancement
Hip Surgery And
Hip-Replacement
40

41. Recent Advancement
Hip Surgery And
Hip-Replacement
Conventional Total Hip
replacements
 Introduced in 1960’s by Dr.John
Charnley, an English Orthopedic
surgeon.
 Upper end of the femur is resected
consisting of the head and neck
portion .
 Socket of the pelvic bone is deepened
 Prosthesis is implanted with bone
cement.
 Metal articulates with High density
polyetheylene.
 Risk of dislocation results in poor
function
 Recovery takes upto three months 41

42. Recent Advancement
Hip Surgery And
Hip-Replacement
Minimally invasive Hip
surgery - What is it?
 Skin incisions are smaller
than conventional surgery
 It is not Key hole or
arthroscopic surgery
 Inside soft tissue dissection is
less.
 More Bone, tendons, soft
tissues are preserved 42

43. Recent Advancement
Hip Surgery And Difference Between Traditional and
Minimally Invasive Hip Replacement
Hip-Replacement
Surgery-
Traditional Hip Minimally Invasive Hip
Replacement Surgery- Replacement Surgery-
 Proven in clinical studies and
successfully performed for  Long-term effects and success
decades are being studied
 Allows surgeon full  Smaller incisions/ Scars (2-4
visualization of operative area inches)
 Larger incision/ scar (12-18  Potentially less disruption of
inches) muscles and tissues
 More disruption of muscles and  May lead to less blood loss
tissues  Potential for less postoperative
 May lead to more blood loss . pain
 May lead to a extendeded  May lead to a shortened
hospital stay/ recovery time hospital stay/ recovery time
43

44. Recent Advancement
Hip Surgery And
Hip-Replacement
PROSTHESIS TYPE
1. Conventional
1. Conventional total hip
2. Metal-on-metal
1. Metal-on-metal total hip
3. Ceramic
1. Ceramic total hip
4. Cemented / Cementless
1. Cemented and cementless
total hip
5. Other prostheses
1. Prostheses for other
operations 44

45. Recent Advancement
Hip Surgery And
Hip-Replacement
The major problems with standard hip
replacements are:
 Wearing out of plastic sockets.
 Loosening of the bond between the
implant and bone. In time the cement can
crack, directly resulting in loosening.
 Secondly, the body reacts to minute
fragments of cement, plastic or metal, and
attempts to remove them, and also removes
bone adjacent to the particles, leaving the
bone structurally weakened.
 If the implant loosens, a second
surgery may become necessary to reattach it.
45

46. Recent Advancement
Hip Surgery And
Hip-Replacement
There has been much research into the
loosening problem. This led to the
development of the:
 Cementless Hip Replacement in which
the surface of the metal parts is porous, and
looks like coral. Bone can grow into the
metal pores and bond the implant to the
bone without the use of cement.
 The AML Total Hip Replacement (DePuy
/ Johnson & Johnson) is the most widely
used cementless implant in the world, and
has the longest track record (since 1978).
 Cement is still used with very soft bones,
regardless of age.
46

47. Recent Advancement
Hip Surgery And
Hip-Replacement
Technique:
Total Hip Replacement
 Insertion of acetabular
component
47
Acetabular reaming

48. Recent Advancement
Hip Surgery And
Hip-Replacement
Technique:
Total Hip Replacement
Insertion of femoral
component
Reaming/broaching of 48
femoral component

49. Recent Advancement
Hip Surgery And
Hip-Replacement
Technique:
Total Hip Replacement
Final implant
Femoral head impaction 49

50. Recent Advancement
Hip Surgery And
Hip-Replacement
What are the alternative
operations?
 Arthroscopy
 Osteotomy
 Surface replacement
 Fusion (arthrodesis) of the hip
 Some alternative operations for
avascular hip necrosis
• Core decompression
• Vascularized graft
• Hemiarthroplasty
• Resection arthroplasty -
Girdlestone 50

51. Recent Advancement
Hip Surgery And
Hip-Replacement
Rehabilitations
REHAB GOALS
Get the patient up out of bed
and moving (the fracture is
painful, but the pt must get
moving)
opain is usually a symptom
of stress on fx
Begin functional activities
Prevent DVTs
Prevent inactivity. 51

52. Recent Advancement
Hip Surgery And
Hip-Replacement
Rehabilitations The Don'ts
 Don't cross your legs at the knees for at least 8 weeks.
 Don't bring your knee up higher than your hip.
 Don't lean forward while sitting or as you sit down.
 Don't try to pick up something on the floor while you are
sitting.
 Don't turn your feet excessively inward or outward when you
bend down.
 Don't reach down to pull up blankets when lying in bed.
 Don't bend at the waist beyond 90°.
 Don't stand pigeon-toed.
 Don't kneel on the knee on the unoperated leg (the good side).
 Don't use pain as a guide for what you may or may not do.
The Dos
 Do keep the leg facing forward.
 Do keep the affected leg in front as you sit or stand.
 Do use a high kitchen or barstool in the kitchen.
 Do kneel on the knee on the operated leg (the bad side).
 Do use ice to reduce pain and swelling, but remember that ice
will diminish sensation. Don't apply ice directly to the skin; use
an ice pack or wrap it in a damp towel.
 Do apply heat before exercising to assist with range of motion.
Use a heating pad or hot, damp towel for 15 to 20 minutes.
 Do cut back on your exercises if your muscles begin to ache,
but don't stop doing them!
52

53. Recent Advancement
Hip Surgery And
Hip-Replacement
Rehabilitations An appropriate and progressive rehab
program should be started early in the
treatment of patients with hip injuries.
Several rehab techniques are available,
none of which require expensive
equipment or great time commitments.
Selecting the best exercise approach for
each patient’s hip problem is not
difficult.
A closely monitored home exercise
program allows the doctor of
Chiropractic to provide cost-efficient,
yet very effective rehabilitation care.
53

54. Recent Advancement
Complications
Hip Surgery And
Hip-Replacement
 The most common hip problem that may
arise soon after hip replacement surgery is
hip dislocation.
 The most common later complication of
hip replacement surgery is an inflammatory
reaction
 Heterotopic bone formation (bone growth
beyond the normal edges of bone).
Leg length discrepancy which may be
caused by the prosthesis or by weakness in
the muscles of the hip
 Breakage of the prosthesis which may
require an additional surgery for
replacement
 Wound infection. 54

55. Other (systemic) complications
include:
Complications
 Blood clots in the deep veins of the
leg (deep vein thrombosis or DVT)
that can move to the lung and
cause pulmonary embolism (PE)
 Urinary infection or difficulty with
urination
 Pneumonia that may result from
difficulty taking deep breaths and
coughing after anesthesia.
55

56. Recent Advancement
Hip Surgery And
Hip-Replacement
Complications-
56

57. Recent Advancement
Failure rates for individual hip
Hip Surgery And
Hip-Replacement
diseases
FAILURE RATES FOR INDIVIDUAL HIP DISEASES
FAILURE RATE
HIP DISEASE (during ten years after
operation)
 A-vascular necrosis 0%
 Slipped epiphysis 3%
 Congenital hip dysplasia 5%
 Rheumatoid arthritis 15 %
 Previous hip fracture 18% 57

58. Recent Advancement
Hip Surgery And
Hip-Replacement
Prognosis Of Hip-
Replacement-
Hip replacement surgery results are
usually excellent. Most or all of your pain
Outlook and stiffness should go away.
(Prognosis):
 Some people may have problems with
infection or loosening, or even
dislocation, of the new hip joint.
 Over time -- sometimes as long as 20
years -- the artificial hip joint will loosen.
A second replacement may be needed.
 Younger, more active, people may wear
out parts of their new hip. It may need to
be replaced before the artificial hip
loosens. 58

59. Recent Advancement
Hip Surgery And
Hip-Replacement
Conclusions-
 Next to Spine injury, Hip-joint is the most
important issue in orthopedic surgery.
 Hip disorder/ injury needs throughout
assessment before starting treatment.
 Treatment strategy/ plan is changing rapidly
with the advent of new research/ investigation
procedures/ biomaterial.
 Hip Replacement surgery in orthopedics'
changing our life with rapidly increasing
success.
 Successful Hip replacement surgery in
orthopedics’ can play a pivotal role in medical
science. 59

60. Recent Advancement
Hip Surgery And
Hip-Replacement
Name Of Operation: Total Hip Replacement.
“Total Hip Replacement”
Patient Name: Md Sayoeb Ahmed,Age:27 ys.
At- Shaheed Suhrawrdy
Indication: Rheumatoid Arthritis ( Lt. Hip ).
Medical College Hopital-
Team Leader:
Associate Professor Dr. Sheikh Abbasuddin
Team Members:
Associate Professor Dr.Paritosh Ch.Debenath
Assistant Professor Kazi Shamimuzzaman
Dr. Md Nazrul Islam, Resident Surgeon.
Assistant Professor Md. Hasan Masud (NITOR),
Dr Golam Mahamud Susash ( Suhash ) .
Anesthesiologist : Dr. Julfiqar Bhai(Consultant).
Dr. Nizam Bhai (Consultant).
& Dr. Shamim-Ara (Apa), Dr. Nizam Bhai
And Dr. Anwar Hossain
Venue: Shaheed Suhrawardy Medical college
Hospital, Department Of Orthopaedics &
Traumatology. 60

61. Recent Advancement
Hip Surgery And
Hip-Replacement
“Total Hip Replacement”
done at Shaheed Suhrawardy
Medical College Hospital,
December-2010”.
Department of
Orthopadic & Traumatology.
61

62. Recent Advancement
Hip Surgery And
Hip-Replacement
“Total Hip Replacement” At-
Shaheed Suhrawrdy Medical College Hopital-2010
62

63. Recent Advancement
Hip Surgery And
Hip-Replacement
63

64. Recent Advancement
Hip Surgery And
Hip-Replacement
Mobile Hip, Mobile Man.
Have a Healthy Hip with
Fruitful Life.
From-
Department Of Orthopedics’ & Traumatology
Shaheed Suhrawardy Medical College Hospital. 64

65. Recent Advancement
Hip Surgery And
Hip-Replacement
Associate Prof. Dr. P. C. Debenath
Associate Prof. Dr. Sheikh Abbas Uddin.
Associate Prof. Dr. Ziaul Haq
Associate Prof. Dr. Shamimul Haq
Associate Prof. Dr. Monowarul Islam
Associate Surgeon Dr. Md. Aminur Rahman
Assistant Prof. Dr. Kazi Shamimuzzaman
Assistant Prof. Dr. A T M Bahar Uddin
Dr. Abdul Hannan
Mr. Anisul Haque Khandaker (Incepta).
&
Dr. Md Nazrul Islam
Resident Surgeon,
Department of Orthopedic & Traumatology.
Shaheed Suhrawardy Medical College Hospital.
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