Adult Hip

Question 1

Name different conditions that can lead to hip arthritis.

Answer 1

developmental (dysplasia, Perthes, SCFE, etc.)
traumatic (dislocations, fractures)
infectious
inflammatory (RA)
idiopathic

Question 2

List symptoms that have a high specificity for pain specific to the hip

Answer 2

**pain in the groin (true hip)
**difficulty on activity (stairs, tying shoes)
use of assist devices (cane, walker)
use of analgesics
affects quality of life/ level of activity

on PE: restricted and painful hip ROM, especially IR; weak hip abductors (check gait) and assess limb length discrepancy

Question 3

List classic signs of osteoarthritis on hip x-ray.

Answer 3

loss of joint space, osteophytes, sub-chondral sclerosis

Question 4

How can back pain and vascular insufficiency be differentiated from hip pain?

Answer 4

back pain located in the buttuck or just above and back pain can frequently radiate below the knee, improves with back flexion (grocery cart)

vascular problems such as claudication will often present as pain in the calf, worsens with activity, relived with rest

Question 5

How can back pain and vascular insufficiency be differentiated from hip pain?

Answer 5

back pain located in the buttuck or just above and back pain can frequently radiate below the knee, improves with back flexion (grocery cart)

vascular problems such as claudication will often present as pain in the calf, worsens with activity, relived with rest

Question 6

Discuss different treatment of OA given the patients’ age.

Answer 6

young: non-operative approaches, joint sparring surgery including osteomy or hip arthroscopy

older 65+: reconstruction including THA or partial replacement

Question 7

Discuss different treatment of OA given the patients’ age.

Answer 7

young: non-operative approaches, joint sparring surgery including osteomy or hip arthroscopy

older 65+: reconstruction including THA (optimal) or partial replacement

not there is an increasing demand for replacements in younger patients/more active patients that will put more stress on joints

Question 8

What are the limitation of THA? What are the risks of THA?

Answer 8

they do wear out and are at greater risk for dislocation; they often require revisions in young patients due to osteolysis (bone loss), loosening or fracture

surgery includes the risk of dislocation, limb length inequality, DVT, PE, pneumonia, bleeding, infection and fracture

Question 9

Name risk factors for hip fracture.

Answer 9

women
smokers
ETOH use
thin
caucasian
post-menopausal
family history
sedentary lifestyle

Question 10

Contrast the two types of femur-hip fractures.

Answer 10

intertrochanteric- good supply are able to save femoral head, often surgically femur joint to stabilize

femoral neck fractures: surgical, because of possibility of interrupting blood flow and likelihood of necrosis, usually requires replacement of femoral head

Question 11

Contrast the two types of femur-hip fractures.

Answer 11

intertrochanteric- good supply are able to save femoral head, often surgically femur joint to stabilize

femoral neck fractures: surgical, because of possibility of interrupting blood flow and likelihood of necrosis, usually requires replacement of femoral head

Question 12

What is the associated mortality and morbidity of a hip fracture?

Answer 12

often considered a sentinel event in the decline of an elderly person

20-25% patients die within a year, 20% require long-term nursing-home care after fracture

Question 13

Describe current practices on preventing hip fracture, particularly in the elderly patient.

Answer 13

address obesity as both a reason for faster wear on hip joint and also complications in THA

treat osteoporosis: calcium and vitamin D, bisphosphonates; often very important to address even after a fracture

address fall prevention with muscle strengthening activities and home safety