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Musculoskeletal > Adult Hip Conditions & Surgery > Flashcards

Adult Hip Conditions & Surgery Flashcards

Miss S Gill

1
Q

what is the pneumonic for surgical sieve?

A

vitamin

Vascular
Infective/inflammatory
Traumatic
Autoimmune
Metabolic
Iatrogenic/idiopathic
Neoplastic
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2
Q

what is Femoroacetabular impingement syndrome (FAI)?

A

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

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3
Q

what is a CAM type impingement a deformity of?

A

femur

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

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4
Q

who are CAM inpingements seen in?

A

young athletic men

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5
Q

Pincer type impingements are deformity of what structure?

A

acetabulum

seen in females
acetabular overhang

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6
Q

what do CAMs and pincer types FAIs cause?

A

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

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7
Q

what is the patient presentation in FAI?

A

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

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8
Q

how would you diagnose FAI?

A

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

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9
Q

what is the management in FAI?

A

Observation in asymptomatic patients

surgery

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10
Q

what is avascular necrosis?

A

Failure of the blood supply to the femoral head

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11
Q

what is the main cause of AVN?

A

idiopathic

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12
Q

what age and sex is AVN common in?

A

males

35-50

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13
Q

what are the risk factors for AVN?

A 
trauma
irradiation
hematologic disease
dysbaric disorders
alcohol
steroid
most are idiopathic
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14
Q

what is the patient presentation of AVN?

A

Insidious onset of groin pain

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

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15
Q

what is AVN pain exacerbated by?

A

stairs or impact

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16
Q

how do you diagnose AVN?

A

radiographs

MRI is best

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17
Q

how many stages of AVN are there?

18
Q

which stages of AVN disease are reversible?

19
Q

which stages of AVN disease are irreversible?

A

III, IV, V, VI

20
Q

what is the management in AVN?

A 
Bisphosphonates
Core decompression +/- bone grafting
Curettage and bone grafting
Vascularised fibular bone graft
Rotational osteotomy
Total hip replacement
21
Q

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

A

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

22
Q

what do patients with ITOH present with?

A

Progressive groin pain over several weeks
Difficulty weight bearing
Usually unilateral

23
Q

what is the epidemiology in ITOH?

A

M>F

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

24
Q

how do you diagnose ITOH?

A

elevated ESR
radiographs
MRI - gold standard
bone scan

25
Q

what is the management in ITOH?

A

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

26
Q

what is Trochanteric bursitis?

A

Repetitive trauma caused by iliotibial band tracking over trochanteric bursa

Causes inflammation of the bursa

27
Q

who is Trochanteric bursitis seen in?

A

female patients and/or young/old runners

28
Q

what is the patient presentation in Trochanteric bursitis?

A

pain on lateral aspect of hip

pain on palpation of greater trochanter

29
Q

how do you diagnose Trochanteric bursitis?

A

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

30
Q

what is the management in Trochanteric bursitis?

A

Analgesia
NSAIDs
Physiotherapy
Steroid injection

No proven benefit from surgery

31
Q

why is OA so common?

A

endpoint for multiple pathologies (secondary)

32
Q

what is OA?

A

Degenerative disease of synovial joints that causes progressive loss of articular cartilage

Inflammatory changes in the capsule lead to thickening and tightness

33
Q

what are the demographics of OA?

A

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

34
Q

what is the patient presentation in OA?

A 
Groin pain
Worse on activity
Pain at night
Start up pain
Stiff on testing ROM
35
Q

what are the radiographic signs of OA?

A

Joint space narrowing
Subchondral sclerosis
Osteophtyes
Cyst formation

36
Q

what is the management in OA?

A 
analgesia
weight loss
walking aids
physiotherapy
steroid injections
total hip arthroplasty
37
Q

what are the 3 different types of prosthesis choice?

A

Cemented
Uncemented
Hybrid

38
Q

what are the 3 types of bearing choice?

A

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

39
Q

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

A

uncemented cup
cemented stem

younger patients

40
Q

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

A

cemented cup
cemented stem

bone cement - PMMA

older patients

Musculoskeletal (37 decks)

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