3 - hip conditions & surgery Flashcards
what is FAI? (femoroacetabular impingement syndrome)
altered morphology of femoral neck and/or acetabulum
what are some deformity types of femoroacetabular impingement syndrome (FAI)?
- CAM deformity →bony lump that smoothes over normally curvature and impinges off acetabulum as flexes & internally rotates. femoral deformity. usually young athletic males. asymmetrical femoral head. can be related to previous SUFE
- pincer lesion →extra spur on acetabular wall causing same thing. acetabular deformity. usually in females. acetabular overhang
- mixed (Of both)
what is typical presentation of FAI (femoroacetabular impingement syndrome)?
pain on groin, particularly flexion & rotation, difficult sitting, C sign positive, FADIR provocation test positive (pain on abduction & adduction clin skills)
what is management for FAI (femoroacetabular impingement syndrome)?
observation if asymptomatic, can do arthroscopic surgery to burr down deformity (if young & normal hip joint otherwise like OA), arthroplasty in older patients secondary to OA
what is avascular necrosis?
= failure of blood supply to femoral head (mostly idiopathic but can suspected maybe from coagulation of intraosseous microcirculation, venous thrombosis, hypertension, decreased blood flow to femoral head etc)
what are some risk factors for avascular necrosis?
radiation (prostate cancer), trauma, haematological diseases, sickle cell, alcohol, steroid use (if have autoimmune disorder or crohn’s etc)
*BUT MOST CASES IDIOPATHIC
what is presentation of avascular necrosis?
gradual onset of groin pain, exacerbated by stairs, often normal exam apart from pain
what is management of avascular necrosis?
early stages reversible (bisphosphonates, decompress femoral head with drill as a theory is hypertension, bone graft), irreversible do total hip replacement
what is idiopathic transient osteonecrosis of hip (ITOH)?
= temporary loss of blood supply to hip
- localised decrease in blood flow or local bone oedema, impaired venous return
→like bone bruising, lots of pain & takes a while to settle
*self limiting. solves itself on it’s own
how does ITOH present?
progressive groin pain over several weeks, difficult weight bearing, unilateral
what is trochanteric bursitis?
= also called greater trochanteric pain syndrome
= repetitive trauma caused by iliotibial band tracking over trochanteric bursa, causes inflammation of bursa
what is presentation of trochanteric bursitis?
more in females, runners, pain over greater trochanter
what is management of trochanter bursitis?
with painkillers and physio (can have steroid injections if severe). usually settles itself. mostly managed in GP
what are 4 radiographic signs of OA?
- loss of joint space (narrowing)
- osteophytes
- subchondral sclerosis
- subchondral cyst formation
*LOSS
what is typical presentation of osteoarthritis?
groin pain, worse on activity, pain at night, start up pain, stiff on test, doesn’t get better with movement
