Adult Hip Conditions Flashcards
Explain the pathophysiology of femoroacetabular impingement?
Altered shape of femoral neck/acetabulum which causes impingement during movement and can lead to labral tears, damage to cartilage, OA
What is the difference between CAM type and pincer type femoroacetabular impingement?
CAM - femoral deformity, usually in sporty males and can be related to previous SUFE
Pincer - acetabular deformity, more common in females
How does femoroacetabular impingement typically present?
Pain in the groin on movement - especially on flexion & rotation
Difficulty sitting
C-sign
Management of feoroacetabular impingement?
Arthroscopic surgery to debride labral tears
Arthroplasty in older patients with secondary OA
What is avascular necrosis?
Failure of the blood supply to the femoral head
Explain how idiopathic avascular necrosis develops?
- Coagulation problems of the microcirculation leads to thrombosis of venous system
- causes build up of pressure which compromises the arterial supply to the femoral head
- leads to necrosis and femoral head collapse
Explain how traumatic avascular necrosis develops?
Injury to medial femoral circumflex artery which leads to necrosis and femoral head collapse
Which group of people are most likely to be affected by AVN?
males age 35-50
What can increase the risk of AVN?
Alcohol consumption
How does AVN typically present?
Gradual onset groin pain which is worse when exercising/going down stairs
What is the best form of imaging for diagnosis of AVN?
MRI
Explain the management of AVN?
If reversible changes: - bisphosphonates - curettage and bone grafting If irreversible changes: - total hip replacement
What is idiopathic transient osteonecrosis of the hip?
local hyperaemia and impaired venous return with marrow oedema which leads to temporary increase in intramedullary pressure
Who get idiopathic transient osteonecrosis of the hip?
Middle aged men
Pregnant women in the 3rd trimester
How does idiopathic transient osteonecrosis of the hip present?
unilateral progressive groin pain over weeks
difficulty weight bearing
What is the gold standard investigation for idiopathic transient osteonecrosis of the hip?
MRI
Management of idiopathic transient osteonecrosis of the hip?
self limiting condition that will take 6-9 months to improve - analgesia and encourage to keep moving
What is trochanteric bursitis?
Inflammation of the trochanteric bursa over the greater trochanter of the femur due to the iliotibial band rubbing over it
Who is most likely to be affected by trochanteric bursitis?
Females - typically young runners
How does trochanteric bursitis typically present?
pain on the lateral aspect of the hip
pain on palpation of the greater trochanter
Management of trochanteric bursitis?
NSAIDS and physio
What is the difference between hybrid THA and cemented THA?
hybrid - given to younger patient, uncemented cup with a cemented stem
cemented - given to older patients, cemented cup and stem
