9: Adult and orthopaedic hip surgery

Question 1

slide 10 - dysplastic hip on left, poorly centred, biomechanics different, weight bearing overloads part of femur not designed to handle force, early onset OA

Question 2

child with perthes (transient avn) - fragmentation of right femoral head, “extruded” piece of hip jams and causes movement issues

Question 3

tennis players encouraged to have open stance to maximise power of shots - increased internal rotation

may go on to develop hip issues due to catching, pincing etc

Question 4

slide 15 - labrum (extension of cartilage capsule) tears in patient with pincer hip issue

Question 5

learn hip joint anatomy

Question 6

slide 17 - mri scan of patient with sore hip, difference in signal due to AVN

bone infarction leading to early onset severe OA

common in alcoholics, sickle cell anaemia

LOSS + irregularity of femoral head

Question 7

slide 19 - hip fracture in rtc, bone surface totally wrecked

Question 8

hyaline cartilage layers:

superficial —–

transitional -|/)(Z

deep ||||||

Question 9

LOSS of OA

loss of joint space

osteophytes

sclerosis

subarticular cysts

Question 10

don’t forget that OA can also affect the hip

bizarre presentation such as femoral head penetrating roof of acetabulum

Question 11

DDH can be managed by osteotomy - controlled break and stabilisation to improve weight distribution

Question 12

osteotomies:

perthes

impingement

Question 13

if hip pain seems out of proportion to issue, consider AVN - management:

MRI scan - difference in signal i.e black vs white

early AVN (no evidence of bone death) - drill hole to decompress and encourage revascularisation

late AVN with collapse - hip replacement

Question 14

management of OA initially:

weight loss

optimum analgesia

physio

local anaesthetic injection to differentiate hip pain from referred back pain

Question 15

lots of factors to think before going for thr

Question 16

major factor influencing decision to operate or not is NIGHT PAIN

Question 17

main indication for thr is pain, not stiffness

Question 18

metal on metal replacements cause pseudotumours

basically alternatives to thr (e.g resurfacing) have poor outcomes

Question 19

thrs don’t last forever - 15-20 years

complications:

loosening due to inflammation - bone resorption around replacement, presents as thigh pain or dislocation depending on where the loosening has occurred

dislocation

femoral fracture

Question 20

trochanteric bursitis is a common self-limiting condition mistaken for OA

not GROIN PAIN, instead located at greater trochanter