2: Joint Disorders Of The Hip Flashcards
1
Q
What are characteristic symptoms of OA of the hip
A
- Pain radiating to the groin or greater trochanter
- Antalgic gait
2
Q
What is an early sign of hip OA
A
Reduced internal rotation
3
Q
What test is positive in hip OA
A
Reduced external rotation
4
Q
What is another term for trochanteric bursitis
A
Greater Trochanteric Pain Syndrome
5
Q
How does trochanteric bursitis present
A
Lateral hip pain
6
Q
What is a sign for trochanteric bursitis
A
pain on palpating the greater trochanter
7
Q
What is a sign of sacroiliac join dysfunction
A
positive faber test
8
Q
What is the most common joint affected in OA
A
knee
9
Q
What is the second most common joint affected in OA
A
hip
10
Q
Is OA more common in females or males
A
females
11
Q
In which age group is OA of the hip most common
A
incidence increases with age
12
Q
How can aetiology of OA of the hip be divided
A
- Primary
2. Secondary
13
Q
What is primary hip OA
A
OA of the hip with no underlying hip pathology
14
Q
What is secondary hip OA
A
OA of the hip due to underlying joint disease
15
Q
Name 3 causes of secondary hip OA
A
- Legg Calve Perthes Disease
- Developmental dysplasia
- Slipped capital femoral epiphysis
16
Q
What is Legg Calve Perthes Disease
A
Reduced blood supply to the femoral head resulting in avascular necrosis
17
Q
What are 4 RFs of hip OA
A
Age
Obesity
Female
Developmental dysplasia
18
Q
How will hip OA present clinically
A
Pain in the groin or over the greater trochanter
19
Q
What is an early sign of hip OA
A
limited/painful internal rotation
20
Q
What is a late sign of hip OA
A
limited/painful external rotation
21
Q
Which is affected first internal or external rotation of the hip in OA
A
internal rotation
22
Q
What type of gait may be present in hip OA
A
antalgic
23
Q
What are the two types of hip OA
A
superior pole OA
medial cartilage OA
24
Q
What is superior pole OA
A
sclerosis of the femoral head and acetabulum, leading to loss of joint space
25
In which gender is superior pole OA more common
male
26
Is superior pole OA unilateral or bilateral
unilateral
27
In which gender is medial cartiliage loss more common
female
28
What are two signs of hip OA
- Positive Thomas test
| - Pain on palpating greater trochanter
29
What does thomas's test indicate
Fixed Flexion Deformity
30
how can hip and knee OA be differentiated by symptoms
Hip OA = more painful on walking UP the stairs. Knee OA = more painful on walking DOWN the stairs.
31
What is the criteria for hip OA to be diagnosed solely clinically
1. >45y
2. no morning stiffness or morning stiffness <30m
3. activity-related joint pain
32
If not clinically, what investigate will be used to diagnose OA
X-RAY
33
What are the features of OA on x-ray
```
LOSS:
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
```
34
What is first-line Rx of hip OA
Conservative measures
35
What are 4 conservative measures recommended by NICE for managing hip OA
1. Transcutaneous electrical nerve stimulation (TENS)
2. Exercise and manual therapy
3. Weight loss
4. Thermotherapy
36
What is second-line management of hip OA
Analgesia
- Oral paracetamol
- Topical NSAIDs
(if poorly controlled consider short-course of oral NSAIDs and PPI)
37
What is third-line management of hip OA
Intra-articular corticosteroids
38
What is 4th line for hip OA
Surgical
39
What two surgeries can be offered for hip OA
- Hip hemoarthroplasty
| - Total hip replacement
40
What is a hip hemiarthroplasty
Femoral head is replaced with a prosthesis. The acetabulum is native.
41
What are indications of hip hemoarthroplasty
- NOF fracture in elderly patient with no concomitant hip OA
- Hip OA with joint destruction in older patients (due to inactivity - reduced use)
42
What is a total hip replacement (THR)
The femoral head and acetabulum are replaced with a prosthesis
43
What are the indications for THR
- NOF fracture with hip OA
| - Hip OA with complete joint destruction
44
What is greater trochanteric bursitis
inflammation of the bursa over the greater trochanter
45
what causes greater trochanteric bursitis
repeated use of the fibroelastic illiotibial (IT) band
46
which type of patients is greater trochanteric bursitis most common in
female runners
47
what is the peak incidence of greater trochanteric bursitis
50-70y
48
What are 6 risk factors for greater trochanter bursitis
- Repetitive use
- Rheumatoid arthritis
- Leg length discrepancy
- Running on banked surfaces
- Hip injury
- Previous surgery
49
Why is rheumatoid arthritis a risk factor for greater trochanteric bursitis
Results in inflammation of the bursa
50
How does greater trochanteric bursitis present clinically
Pain in the lateral hip
51
What is a sign of greater trochanter bursitis
Pain on palpation over the greater trochanter
52
how is greater trochanteric bursitis diagnosed
Clinically
53
what is first-stage in the management of greater trochanteric bursitis
Conservative:
- Avoid exacerbating movement
- Sleep on unaffected side
- Ice pack 10-20m several times a day
- Weight loss
54
what is second stage in greater trochanteric bursitis
Analgesia:
| Paracetamol or short-course oral NSAIDs
55
what is 3rd stage management of greater trochanteric bursitis
Physiotherapy
56
what is 4th stage in management of greater trochanteric bursitis
Peri-trochanteric corticosteroid injection
57
What is sacroiliac joint dysfunction also referred to as
sacroillitis
58
In which gender is SI joint dysfunction more common
males
59
What 2 disorders commonly cause SI joint dysfunction
- Reiter's syndrome
| - Ankylosing spondylitis
60
What is renter's syndrome
Triad of: arthritis, conjunctivitis, urethritis secondary to urogenital or GI infection.
61
How does SI joint dysfunction present clinically
- Generalised pain
- Worse on prolonged standing
- Difficultly climbing stairs
- Morning stiffness
- Weakness on muscles of that side
62
What test may be positive in SI joint dysfunction
FABER test
63
What is FABER's test
Pain on flexion, abduction and external rotation of the hip
64
How may ankylosing spondylitis present
Reduced spinal flexion
65
what are two possible investigations for SI joint dysfunction
X-ray
| MRI
66
what may x-ray of the SI joint show
Calcification
67
what may MRI of the SI joint show
Inflammation
68
What is transient synovitis of the hip also referred to as
Irritable hip
69
What is transient synovitis of the hip
Inflammation of the synovial membrane (synovitis) with associated hypertrophy of the synovium
70
What is the most common cause of hip pain in paediatric patients
transient synovitis of the hip
71
What age range does transient synovitis of the hip commonly occur
3-10y
72
In which gender is transient synovitis of the hip more common
Females (2:1)
73
What does transient synovitis of the hip occur after
URTI
74
If occurring after a bacterial infection, what is the likely causative organism
Post-streptococcal toxic synovitis
75
Explain clinical presentation transient synovitis of the hip
- Recent URTI
- Complains of pain in the groin or thigh
- Child does not walk on the affected side. This improves throughout the day, with the child typically limping by the evening.
76
How may the leg/hip present in transient synovitis of the hip and why
flexed, abducted and externally rotated as this is the position it is often most comfortable
77
What movement may be impaired in transient synovitis of the hip
internal rotation of the hip
78
What criteria is used to determine differential diagnosis of hip pain in children
Kocher
79
What is the Kocher criteria looking for
Septic arthritis of the hip
80
What is the Kocher Criteria (FNEW)
Fever
Non-weight bearing
ESR >40
WCC >12
81
If a child scores 4 on Kocher criteria what is the probability of it being septic arthritis
99%
82
If a child scores 3 on Kocher criteria what is the probability of it being septic arthritis
93%
83
If a child scores 2 on Kocher criteria what is the probability of it being septic arthritis
40%
84
If a child scores 1 on Kocher criteria what is the probability of it being septic arthritis
3%
85
How is transient synovitis of the hip in children diagnosed
Clinically
86
How is transient synovitis managed
Observation
| NSAIDs: if improves with NSAIDs likely transient synovitis
87
How often does it take for symptoms to improve in transient synovitis of the hip
24-48h
88
How long does it take for symptoms to fully resolve in transient synovitis of the hip
1-2W
89
how will a posterior hip dislocation present
leg is shorted, adducted and internally rotated
90
what structure is most likely damaged in posterior hip dislocation
sciatic nerve
