Adult Hip Conditions Flashcards
How may hip pain present?
Pain in the groin which may radiate to the knee (due to the obturator nerve supplying both joints and referred pain).
Buttock Pain
Knee Pain ONLY e.g. in SUFE
Pain exacerbated by rotational movements
What are other signs of hip pathology?
- Altered Hip Biomechanics/Weakness from Chronic Disuse, Abductor Weakness (Gluteus Medius/Minimus) may manifest as a positive Trendelenburg Sign/Gait.
- Shortening of the lower limb may also be seen in severe OA, Perthes, SUFE or AVN (or fracture).
What is AVN?
Death of bone tissue due to interruption of the blood supply (Bone Infarction) resulting in an area of bone undergoing localized necrosis due to ischaemia from reduction in blood supply.
AVN is an inflammatory disease. True/false?
False, it is a degenerative disease
List causes of AVN
Steroid Injection(s) Infection Trauma Sickle Cell Anaemia Alcohol (not even a vastly excessive intake) Thrombophilia Dysbarism Anti-Phospholipid Syndrome
What is the common trait of all AVN causes?
They all increase coagulability
List common sites of AVN
The femoral head or condyles
The head or capitulum of the Humerus
The proximal pole of the scaphoid
The proximal part of the talus.
What clinical presentations can AVN occur as a secondary complication to?
Fracture
OA (can go both ways)
What are classic characteristics of AVN (on any bone of the body)?
Morphology: wedge-shaped area of discolouration which is often subcortical.
Histology: Creeping Substitution i.e. Holes in the bone which should normally contain bone cells but instead are empty
What imaging is used for AVN?
MRI
X-Ray
Early cases can be seen on MRI before any radiographic changes occur.
How is AVN treated?
If detected Pre‐Collapse, Drill Holes can be made, up the bone and into the abnormal area in the head in an attempt to relieve pressure (decompression), promote healing and prevent collapse.
Once collapse has occurred, the only surgical option is Total Hip Replacement (THR).
What is the classic sign of Hip AVN?
Hanging Rope Sign i.e. Sclerotic line across femoral neck (seen in paediatric cases, not all adult cases)
Also patchy sclerosis of weight-bearing area with a Lytic Zone underneath formed by Granulation Tissue from attempted repair.
What is Trochanteric Bursitis?
Inflammation of the bursa.
Can be accompanied by tendinopathy:
Tendinous insertion of the abductor muscles (predominantly the Gluteus Medius) is under considerable strain and is subject to tendonitis and degeneration leading to tendon tears.
What is the classic sign of Trochanteric Bursitis?
Pain and Tenderness in the region of the greater trochanter
Pain on resisted abduction.
How is Trochanteric Bursitis treated?
Analgesia
Anti‐inflammatories
Physiotherapy (to strengthen other muscles and avoid abductor weakness)
Steroid Injections
No surgical treatment has a proven benefit.
