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MSK lectures > Adult Hip conditions - 26/10/18 > Flashcards

Adult Hip conditions - 26/10/18 Flashcards

1
Q

What is the VITAMIN acronym for what causes things?

A 
Vascular
Infective/Inflammatory
Traumatic
Autoimmune
Metabolic
Iatrogenic/idiopathic
Neoplastic
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2
Q

What are the three layers of the femoral head?

A

Hyaline articular cartilage
Subchondral bone
Cancellous bone

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3
Q

What is femeroacetabular inpingement syndrome?

A

Altered morphology of the femoral neck or acetabular
Causes abutment of the meoral neck on the edge of the acetabulum during movement
Fledxion adduction and intenal rotation

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4
Q

what s CAM type impingement?

A

Femoral deformity

Assymetic femoral head with decreased head:neck ratio

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5
Q

Who gets CAM impingement?

A

Usually young males

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6
Q

What can CAM impingement be related to?

A

SUFE

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7
Q

What is Pincer type impingement?

A

Acetabular deformity

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8
Q

Who gets pincer type impingement?

A

Usually seen in females

Acetabular overhang

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9
Q

What do CAM and Pincer impingement cause?

A

Damage to the labrum and tears
Damage to cartilage
Osteoarthritis in later life

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10
Q

What do patients with FAI present with?

A 
Activity related pain in the groin
Particular in flexion and rotation
Difficulty sitting
C sign positive
FADIR provocation test +ve
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11
Q

How are FAIs diagnosed?

A

Radiographs
CT
MRI

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12
Q

How is FAI managed?

A

Observation in asymptomatic patients
Arthroscopic or open surgery to remove CAM
Peri-acetabular osteotomy remove labral tears
Arthroplasty in older patients with secondary OA

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13
Q

What causes Avascular necrosis (AVN)?

A

Failure of blood supply to the femoral head

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14
Q

What is the pathophysiology of AVN?

A

Idiopathic AVN
-Coagulation of the intraosseous microcirculation
-venous thrombosis causes retrograde arterial occlusion
-Intraosseous hypertension
-Decreased blood flow to femoral head
-Necrosis of femoral head
-chondral fracture and collapse
AVN associated with trauma
-Due to injury of the femoral head blood supply

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15
Q

Who gets AVN?

A

Males>Female
35-50
Bilateral

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16
Q

What are the risk factors for AVN?

A 
Irradiation
Trauma
Haematologic diseases, sickle cell, leukaemia etc
Dysbaric disorders
Alcoholism
Steroid use
Idiopathic!
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17
Q

What do patients present with AVN?

A

Insidious onset of groin pain
Exacerbated by stairs or impact
Examination is usually normal unless disease has advances

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18
Q

How is AVN diagnosed?

A

Radiographs -hanging rope sign

MRI is most specific and sensitive

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19
Q

What is the staging for AVN?

A

Steinberg classification

20
Q

What steinberg stages are reversible?

A

0,1,2
No permanent changes of the femoral head
Pre-subchondral collapse

21
Q

What steinberg stages are irreversible?

A

3,4,5,6

Subchondral collapse

22
Q

How are stages 0,1,2 steinberg treated?

A

Bisphosphonates
core decompression +/- bone grafting
curretage and bone grafting
Vascularised fibular bone graft

23
Q

How are stages 3,4,5 and 6 steinbergs treated?

A

Rostational osteotomy for small bits

Total hip replacement

24
Q

What is idiopathic transient osteonecrosis of the hip (ITOH)?

A

Local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure

25
Q

What do ITOH patients present with?

A

Progressive groin pain over several weeks
Difficulty weight bearing
Unilateral

26
Q

Who gets ITOH?

A

Males>Females
Middle aged men
heavily pregnant women

27
Q

How is ITOH diagnosed?

A 
Elevated ESR
Radiographs
-Osteopaenia of head and neck
Thinning of cortices
Preserved joint space
MRI (golden)
Bone scan
28
Q

How is ITOH treated?

A

Self-limiting
6-9 months to resolve
analgesia
Protected weight bearing to avoid stress fracture

29
Q

What is Trochanteric bursitis?

A

Repetitive trauma caused by iliotibial band tracking over trochanteric bursa
Causes inflammation of the bursa

30
Q

Who gets trochanteric bursitis?

A

Females
Young runners
Older patients

31
Q

How does trochanteric bursitis present?

A

Pain on the lateral aspect of hip

Pain on palpation of greater trochanter

32
Q

How is trochanteric bursitis?

A

Clinical diagnosis
Radiographs usually unremarkable
visible on MRI but not usually needed

33
Q

how is trochanteric bursitis treated?

A 
Analgesia
NSAIDs
Physiotherapy
Steroid injection
No proven benefit from surgery
34
Q

What can cause OA?

A 
DDH
SUFE
Septic arthrits
AVN
FAI
Trauma
35
Q

What is OA of the hip?

A

Degenerative disease of the synovial joints that cause progressive loss of articular cartilage
Inflammatory changes in the capsule leading to thickening and tightness

36
Q

Who gets OA of the hip?

A

Females>Males
Older age
Genetics
Pre-existing hip disease

37
Q

What does OA of the hip present with?

A 
Groin pain
Worse on activity
Pain at night
Start up pain
Stiff on testing ROM
38
Q

How is OA assessed?

A

Level of symptoms and impact on quality of life
Medical comorbidities
Social history
Do they want history

39
Q

How is OA diagnosed?

A 
Radiographs
Loss of joint space
Osteophyte formation
Subchondral Cysts
Subchondral sclerosis
40
Q

How is OA managed?

A 
Analgesia
Weight loss
Walking aids
Physiotherapy if weakness identified
?Steroid injections
Total hip arthroplasty
41
Q

What surgical planning should be done for OA?

A 
Centre of rotation
-High or Low
Leg length
Offset - distance between centre of femoral head and the greater trochanter
Canal width
42
Q

What are the steps in the preparation of a total hip arthropasty?

A 
Discussion of management with patients
Indication - pain
Consent - benefits/risks
Approach - Posterior, Anterolateral, Anterior
Prosthesis choice - Cemented
Uncemented
Hybrid
Bearing choice - Metal on poly, Ceramic on poly, ceramic on ceramic
43
Q

What are the benefits of a total hip arthroplasty?

A

Pain relief and secondary improvement of function

44
Q

What are the risks of a total hip arthroplasty?

A

Scar, bleeding, neurovascular injury, fracture, clotting, infection, dislocation, leg length discrepancy, loosening

45
Q

What is a hybrid THA and who is it used in?

A 
Uncemented cup
Press fit
Biological fixation
Cemented stem
Cone-in-a-cone
Younger patients
46
Q

What is a cemented THA and who is it used in?

A 
Cemented cup 
Mechanical look
Cemented stem
Cone-in-a-cone
Older patients
47
Q

What is bone cement and how does it work?

A

PMMA

Interdigitation into bone surface

MSK lectures (50 decks)

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