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Trauma + Orthopaedics > 2: Joint Disorders Of The Hip > Flashcards

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

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2
Q

What is an early sign of hip OA

A

Reduced internal rotation

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3
Q

What test is positive in hip OA

A

Reduced external rotation

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4
Q

What is another term for trochanteric bursitis

A

Greater Trochanteric Pain Syndrome

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5
Q

How does trochanteric bursitis present

A

Lateral hip pain

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6
Q

What is a sign for trochanteric bursitis

A

pain on palpating the greater trochanter

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7
Q

What is a sign of sacroiliac join dysfunction

A

positive faber test

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8
Q

What is the most common joint affected in OA

A

knee

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9
Q

What is the second most common joint affected in OA

A

hip

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10
Q

Is OA more common in females or males

A

females

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11
Q

In which age group is OA of the hip most common

A

incidence increases with age

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12
Q

How can aetiology of OA of the hip be divided

A
  1. Primary

2. Secondary

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13
Q

What is primary hip OA

A

OA of the hip with no underlying hip pathology

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14
Q

What is secondary hip OA

A

OA of the hip due to underlying joint disease

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15
Q

Name 3 causes of secondary hip OA

A
  1. Legg Calve Perthes Disease
  2. Developmental dysplasia
  3. Slipped capital femoral epiphysis
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16
Q

What is Legg Calve Perthes Disease

A

Reduced blood supply to the femoral head resulting in avascular necrosis

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17
Q

What are 4 RFs of hip OA

A

Age
Obesity
Female
Developmental dysplasia

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18
Q

How will hip OA present clinically

A

Pain in the groin or over the greater trochanter

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19
Q

What is an early sign of hip OA

A

limited/painful internal rotation

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20
Q

What is a late sign of hip OA

A

limited/painful external rotation

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21
Q

Which is affected first internal or external rotation of the hip in OA

A

internal rotation

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22
Q

What type of gait may be present in hip OA

A

antalgic

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23
Q

What are the two types of hip OA

A

superior pole OA

medial cartilage OA

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24
Q

What is superior pole OA

A

sclerosis of the femoral head and acetabulum, leading to loss of joint space

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25
Q

In which gender is superior pole OA more common

A

male

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26
Q

Is superior pole OA unilateral or bilateral

A

unilateral

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27
Q

In which gender is medial cartiliage loss more common

A

female

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28
Q

What are two signs of hip OA

A
  • Positive Thomas test

- Pain on palpating greater trochanter

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29
Q

What does thomas’s test indicate

A

Fixed Flexion Deformity

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30
Q

how can hip and knee OA be differentiated by symptoms

A

Hip OA = more painful on walking UP the stairs. Knee OA = more painful on walking DOWN the stairs.

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31
Q

What is the criteria for hip OA to be diagnosed solely clinically

A
  1. > 45y
  2. no morning stiffness or morning stiffness <30m
  3. activity-related joint pain
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32
Q

If not clinically, what investigate will be used to diagnose OA

A

X-RAY

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33
Q

What are the features of OA on x-ray

A 
LOSS:
Loss of joint space
Osteophytes
Subchondral sclerosis 
Subchondral cysts
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34
Q

What is first-line Rx of hip OA

A

Conservative measures

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35
Q

What are 4 conservative measures recommended by NICE for managing hip OA

A
  1. Transcutaneous electrical nerve stimulation (TENS)
  2. Exercise and manual therapy
  3. Weight loss
  4. Thermotherapy
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36
Q

What is second-line management of hip OA

A

Analgesia

  • Oral paracetamol
  • Topical NSAIDs

(if poorly controlled consider short-course of oral NSAIDs and PPI)

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37
Q

What is third-line management of hip OA

A

Intra-articular corticosteroids

38
Q

What is 4th line for hip OA

A

Surgical

39
Q

What two surgeries can be offered for hip OA

A
  • Hip hemoarthroplasty

- Total hip replacement

40
Q

What is a hip hemiarthroplasty

A

Femoral head is replaced with a prosthesis. The acetabulum is native.

41
Q

What are indications of hip hemoarthroplasty

A
  • NOF fracture in elderly patient with no concomitant hip OA
  • Hip OA with joint destruction in older patients (due to inactivity - reduced use)
42
Q

What is a total hip replacement (THR)

A

The femoral head and acetabulum are replaced with a prosthesis

43
Q

What are the indications for THR

A
  • NOF fracture with hip OA

- Hip OA with complete joint destruction

44
Q

What is greater trochanteric bursitis

A

inflammation of the bursa over the greater trochanter

45
Q

what causes greater trochanteric bursitis

A

repeated use of the fibroelastic illiotibial (IT) band

46
Q

which type of patients is greater trochanteric bursitis most common in

A

female runners

47
Q

what is the peak incidence of greater trochanteric bursitis

A

50-70y

48
Q

What are 6 risk factors for greater trochanter bursitis

A
  • Repetitive use
  • Rheumatoid arthritis
  • Leg length discrepancy
  • Running on banked surfaces
  • Hip injury
  • Previous surgery
49
Q

Why is rheumatoid arthritis a risk factor for greater trochanteric bursitis

A

Results in inflammation of the bursa

50
Q

How does greater trochanteric bursitis present clinically

A

Pain in the lateral hip

51
Q

What is a sign of greater trochanter bursitis

A

Pain on palpation over the greater trochanter

52
Q

how is greater trochanteric bursitis diagnosed

A

Clinically

53
Q

what is first-stage in the management of greater trochanteric bursitis

A

Conservative:

  • Avoid exacerbating movement
  • Sleep on unaffected side
  • Ice pack 10-20m several times a day
  • Weight loss
54
Q

what is second stage in greater trochanteric bursitis

A

Analgesia:

Paracetamol or short-course oral NSAIDs

55
Q

what is 3rd stage management of greater trochanteric bursitis

A

Physiotherapy

56
Q

what is 4th stage in management of greater trochanteric bursitis

A

Peri-trochanteric corticosteroid injection

57
Q

What is sacroiliac joint dysfunction also referred to as

A

sacroillitis

58
Q

In which gender is SI joint dysfunction more common

A

males

59
Q

What 2 disorders commonly cause SI joint dysfunction

A
  • Reiter’s syndrome

- Ankylosing spondylitis

60
Q

What is renter’s syndrome

A

Triad of: arthritis, conjunctivitis, urethritis secondary to urogenital or GI infection.

61
Q

How does SI joint dysfunction present clinically

A
  • Generalised pain
  • Worse on prolonged standing
  • Difficultly climbing stairs
  • Morning stiffness
  • Weakness on muscles of that side
62
Q

What test may be positive in SI joint dysfunction

A

FABER test

63
Q

What is FABER’s test

A

Pain on flexion, abduction and external rotation of the hip

64
Q

How may ankylosing spondylitis present

A

Reduced spinal flexion

65
Q

what are two possible investigations for SI joint dysfunction

A

X-ray

MRI

66
Q

what may x-ray of the SI joint show

A

Calcification

67
Q

what may MRI of the SI joint show

A

Inflammation

68
Q

What is transient synovitis of the hip also referred to as

A

Irritable hip

69
Q

What is transient synovitis of the hip

A

Inflammation of the synovial membrane (synovitis) with associated hypertrophy of the synovium

70
Q

What is the most common cause of hip pain in paediatric patients

A

transient synovitis of the hip

71
Q

What age range does transient synovitis of the hip commonly occur

A

3-10y

72
Q

In which gender is transient synovitis of the hip more common

A

Females (2:1)

73
Q

What does transient synovitis of the hip occur after

A

URTI

74
Q

If occurring after a bacterial infection, what is the likely causative organism

A

Post-streptococcal toxic synovitis

75
Q

Explain clinical presentation transient synovitis of the hip

A
  • 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
Q

How may the leg/hip present in transient synovitis of the hip and why

A

flexed, abducted and externally rotated as this is the position it is often most comfortable

77
Q

What movement may be impaired in transient synovitis of the hip

A

internal rotation of the hip

78
Q

What criteria is used to determine differential diagnosis of hip pain in children

A

Kocher

79
Q

What is the Kocher criteria looking for

A

Septic arthritis of the hip

80
Q

What is the Kocher Criteria (FNEW)

A

Fever
Non-weight bearing
ESR >40
WCC >12

81
Q

If a child scores 4 on Kocher criteria what is the probability of it being septic arthritis

A

99%

82
Q

If a child scores 3 on Kocher criteria what is the probability of it being septic arthritis

A

93%

83
Q

If a child scores 2 on Kocher criteria what is the probability of it being septic arthritis

A

40%

84
Q

If a child scores 1 on Kocher criteria what is the probability of it being septic arthritis

A

3%

85
Q

How is transient synovitis of the hip in children diagnosed

A

Clinically

86
Q

How is transient synovitis managed

A

Observation

NSAIDs: if improves with NSAIDs likely transient synovitis

87
Q

How often does it take for symptoms to improve in transient synovitis of the hip

A

24-48h

88
Q

How long does it take for symptoms to fully resolve in transient synovitis of the hip

A

1-2W

89
Q

how will a posterior hip dislocation present

A

leg is shorted, adducted and internally rotated

90
Q

what structure is most likely damaged in posterior hip dislocation

A

sciatic nerve

Trauma + Orthopaedics (11 decks)

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