Adult Hip Conditions & Surgery

Question 1

what is the pneumonic for surgical sieve?

Answer 1

vitamin

Vascular
Infective/inflammatory
Traumatic
Autoimmune
Metabolic
Iatrogenic/idiopathic
Neoplastic

Question 2

what is Femoroacetabular impingement syndrome (FAI)?

Answer 2

Altered morphology of femoral neck and/or acetabular

Causes abutment of the femoral neck on the edge of the acetabulum during movement

Usually flexion, adduction and internal rotation

Question 3

what is a CAM type impingement a deformity of?

Answer 3

femur

Asymmetric femoral head with decreased head:neck ratio
Can be related to previous SUFE

Question 4

who are CAM inpingements seen in?

Answer 4

young athletic men

Question 5

Pincer type impingements are deformity of what structure?

Answer 5

acetabulum

seen in females
acetabular overhang

Question 6

what do CAMs and pincer types FAIs cause?

Answer 6

damage to the labrum and tears
damage to cartilage
osteoarthritis in later life

Question 7

what is the patient presentation in FAI?

Answer 7

Activity related pain in the groin, particularly in flexion and rotation
Difficulty sitting
C sign positive
FADIR provocation test positive

Question 8

how would you diagnose FAI?

Answer 8

Radiographs
CT
MRI (better for visualising damage to labrum and bony oedema)

Question 9

what is the management in FAI?

Answer 9

Observation in asymptomatic patients

surgery

Question 10

what is avascular necrosis?

Answer 10

Failure of the blood supply to the femoral head

Question 11

what is the main cause of AVN?

Answer 11

idiopathic

Question 12

what age and sex is AVN common in?

Answer 12

males

35-50

Question 13

what are the risk factors for AVN?

Answer 13

trauma
irradiation
hematologic disease
dysbaric disorders
alcohol
steroid
most are idiopathic

Question 14

what is the patient presentation of AVN?

Answer 14

Insidious onset of groin pain

Examination is usually normal unless disease has advanced to collapse/OA

Question 15

what is AVN pain exacerbated by?

Answer 15

stairs or impact

Question 16

how do you diagnose AVN?

Answer 16

radiographs

MRI is best

Question 17

how many stages of AVN are there?

Answer 17

0-6

Question 18

which stages of AVN disease are reversible?

Answer 18

0, I, II

Question 19

which stages of AVN disease are irreversible?

Answer 19

III, IV, V, VI

Question 20

what is the management in AVN?

Answer 20

Bisphosphonates
Core decompression +/- bone grafting
Curettage and bone grafting
Vascularised fibular bone graft
Rotational osteotomy
Total hip replacement

Question 21

what is Idiopathic Transient Osteonecrosis of the Hip (ITOH)?

Answer 21

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

Question 22

what do patients with ITOH present with?

Answer 22

Progressive groin pain over several weeks
Difficulty weight bearing
Usually unilateral

Question 23

what is the epidemiology in ITOH?

Answer 23

M>F

2 groups - middle ages men and pregnant women in 3rd trimester

Question 24

how do you diagnose ITOH?

Answer 24

elevated ESR
radiographs
MRI - gold standard
bone scan

Question 25

what is the management in ITOH?

Answer 25

Self-limiting condition that resolves in 6-9 months Analgesia Protected weight bearing to avoid stress fracture

Question 26

what is Trochanteric bursitis?

Answer 26

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

Question 27

who is Trochanteric bursitis seen in?

Answer 27

female patients and/or young/old runners

Question 28

what is the patient presentation in Trochanteric bursitis?

Answer 28

pain on lateral aspect of hip | pain on palpation of greater trochanter

Question 29

how do you diagnose Trochanteric bursitis?

Answer 29

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

Question 30

what is the management in Trochanteric bursitis?

Answer 30

Analgesia NSAIDs Physiotherapy Steroid injection No proven benefit from surgery

Question 31

why is OA so common?

Answer 31

endpoint for multiple pathologies (secondary)

Question 32

what is OA?

Answer 32

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

Question 33

what are the demographics of OA?

Answer 33

Female > Males Typically in older age Genetic element Pre-existing hip disease

Question 34

what is the patient presentation in OA?

Answer 34

``` Groin pain Worse on activity Pain at night Start up pain Stiff on testing ROM ```

Question 35

what are the radiographic signs of OA?

Answer 35

Joint space narrowing Subchondral sclerosis Osteophtyes Cyst formation

Question 36

what is the management in OA?

Answer 36

``` analgesia weight loss walking aids physiotherapy steroid injections total hip arthroplasty ```

Question 37

what are the 3 different types of prosthesis choice?

Answer 37

Cemented Uncemented Hybrid

Question 38

what are the 3 types of bearing choice?

Answer 38

Metal-on-poly Ceramic-on-poly Ceramic-on-ceramic

Question 39

what is a hybrid THA and who are they used in?

Answer 39

uncemented cup cemented stem younger patients

Question 40

what is a cemented THA and who are they used in?

Answer 40

cemented cup cemented stem bone cement - PMMA older patients