Adult Hip Conditions

Question 1

Explain the pathophysiology of femoroacetabular impingement?

Answer 1

Altered shape of femoral neck/acetabulum which causes impingement during movement and can lead to labral tears, damage to cartilage, OA

Question 2

What is the difference between CAM type and pincer type femoroacetabular impingement?

Answer 2

CAM - femoral deformity, usually in sporty males and can be related to previous SUFE
Pincer - acetabular deformity, more common in females

Question 3

How does femoroacetabular impingement typically present?

Answer 3

Pain in the groin on movement - especially on flexion & rotation
Difficulty sitting
C-sign

Question 4

Management of feoroacetabular impingement?

Answer 4

Arthroscopic surgery to debride labral tears

Arthroplasty in older patients with secondary OA

Question 5

What is avascular necrosis?

Answer 5

Failure of the blood supply to the femoral head

Question 6

Explain how idiopathic avascular necrosis develops?

Answer 6

• 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

Question 7

Explain how traumatic avascular necrosis develops?

Answer 7

Injury to medial femoral circumflex artery which leads to necrosis and femoral head collapse

Question 8

Which group of people are most likely to be affected by AVN?

Answer 8

males age 35-50

Question 9

What can increase the risk of AVN?

Answer 9

Alcohol consumption

Question 10

How does AVN typically present?

Answer 10

Gradual onset groin pain which is worse when exercising/going down stairs

Question 11

What is the best form of imaging for diagnosis of AVN?

Answer 11

MRI

Question 12

Explain the management of AVN?

Answer 12

If reversible changes:
- bisphosphonates
- curettage and bone grafting 
If irreversible changes:
- total hip replacement

Question 13

What is idiopathic transient osteonecrosis of the hip?

Answer 13

local hyperaemia and impaired venous return with marrow oedema which leads to temporary increase in intramedullary pressure

Question 14

Who get idiopathic transient osteonecrosis of the hip?

Answer 14

Middle aged men

Pregnant women in the 3rd trimester

Question 15

How does idiopathic transient osteonecrosis of the hip present?

Answer 15

unilateral progressive groin pain over weeks

difficulty weight bearing

Question 16

What is the gold standard investigation for idiopathic transient osteonecrosis of the hip?

Answer 16

MRI

Question 17

Management of idiopathic transient osteonecrosis of the hip?

Answer 17

self limiting condition that will take 6-9 months to improve - analgesia and encourage to keep moving

Question 18

What is trochanteric bursitis?

Answer 18

Inflammation of the trochanteric bursa over the greater trochanter of the femur due to the iliotibial band rubbing over it

Question 19

Who is most likely to be affected by trochanteric bursitis?

Answer 19

Females - typically young runners

Question 20

How does trochanteric bursitis typically present?

Answer 20

pain on the lateral aspect of the hip

pain on palpation of the greater trochanter

Question 21

Management of trochanteric bursitis?

Answer 21

NSAIDS and physio

Question 22

What is the difference between hybrid THA and cemented THA?

Answer 22

hybrid - given to younger patient, uncemented cup with a cemented stem
cemented - given to older patients, cemented cup and stem