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Musculoskeletal > Adult Hip Conditions & Surgery > Flashcards

Adult Hip Conditions & Surgery Flashcards

1
Q

What is the surgical sieve?

A 
V: vascular
I: infective/inflammatory
T: traumatic
A: autoimmune
M: metabolic
I: iatrogenic/idiopathic
N: neoplastic
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2
Q

Name the layers of cartilage and bone usually found in the head of the femur

A

Hyaline cartilage
Subchondral Bone
Cancellous Bone

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3
Q

What condition is characterised by altered morphology of the femoral neck and/or acetabulum causing them to rub together on movement?

A

Femoroacetabular Impingement Syndrome

FAI

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4
Q

What movements does FAI specifically affect?

A

F - Flexion of hip
A - Adduction of hip
I - Internal Rotation of hip

remember this as its also FAI

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5
Q

What is the difference between a CAM femoroacetabular impingement and a Pincer impingement?

A

CAM = neck of femur has extra bone growing on outside causing deformity

Pincer = acetabulum has extra bone growing down towards femur causing the deformity

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6
Q

What type of FAI is most common?

A

Mixed CAM and Pincer Impingement

=> deformity in both femoral neck and the acetabulum

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7
Q

What type of FAI is more common in males?

A

CAM

Usually young athletic males

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8
Q

What can a CAM deformity in the femoral neck be related to in a patients history?

A

Previous Slipped Upper Femoral Epiphysis (SUFE)

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9
Q

What type of FAI is more common in females and why could this be?

A

Pincer Impingement
this is due to acetabular overhang/ an excessively deep acetabulum

=> females have wider hips and suffer from this deformity more

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10
Q

What do both types of FAI cause?

A

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

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11
Q

How do patients with femoroacetabular impingement usually present?

A 
Activity related pain in the groin 
(especially on flexion and rotation)
Difficulty sitting
C sign positive
FADIR provocation test positive
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12
Q

What methods of imaging are used in the diagnosis of FAI?

A

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

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13
Q

How is FAI managed?

A

Observation if asymptomatic

CAM and Pincer:
Remove excess bone deformity and debride labral tears

Joint replacement in Secondary OA

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14
Q

What is Avascular Necrosis (AVN) in the head of the femur?

A

Failure of the blood supply to the femoral head

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15
Q

What are the two types of AVN?

A

Idiopathic

Trauma-related

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16
Q

Describe the pathophysiology of idiopathic AVN

A
  • coagulation of intraosseous microcirculation
  • venous thrombosis causes retrograde arterial occlusion
    => intraosseous hypertension
  • decreased blood flow to femoral head
    => necrosis
  • chondral fracture and collapse
17
Q

In traumatic AVN, what artery is usually compromised?

A

Medial Femoral Circumflex artery

18
Q

How do patients with AVN often present?

A
  • Insidious onset groin pain
  • Exacerbated by stairs or impact
  • Examination = usually normal
  • *unless disease has advanced to collapse/OA**
19
Q

What imaging methods are used in AVN, and what do they show?

A

Radiographs
(ALTHOUGH these = often normal in early disease)

MRI scan is most sensitive/specific

20
Q

What sign of AVN in children (Perthe’s disease) can be seen on X-Ray ?

A

Hanging rope sign

Thin sclerotic line across femoral neck

21
Q

How many stages of AVN have been identified? What range of these stages are reversible and irreversible?

A

Stages 0-VI

Stages 0-II = Reversible
Stages III-VI = Irreversible

22
Q

How is AVN commonly treated?

A

Drilling into the femoral head to relieve pressure and restore blood flow

Bone grafting

Rotational osteotomy

Total Hip Replacement (THR)

23
Q

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

A
  • Local hyperaemia (excess blood in vessels)
  • impaired venous return
  • marrow oedema
  • increased intramedullary pressure
24
Q

How do patients with ITOH usually present?

A
  • Progressive groin pain over several weeks
  • Difficulty weight bearing
  • Usually unilateral
25
Q

Who is most likely to get ITOH?

A

Males > Females

2 groups:

  • Middle aged men
  • Pregnant women in third trimester
26
Q

What investigations are used to diagnose ITOH?

A

Elevated ESR

Radiographs:
Lucent bone on X-Ray
Joint space = preserved

MRI (gold standard)

Bone scan

27
Q

How is ITOH managed?

A
  • Self-limiting condition that resolves in 6-9 months
  • Analgesia
  • Protected weight bearing to avoid stress fracture
28
Q

What is trochanteric bursitis?

A

Repetitive trauma caused by IT band tracking over trochanteric bursa
=> causes inflammation

29
Q

What type of patients usually present with trochanteric bursitis?

A

Female patients

Young runners and older patients
may be linked to gluteal cuff syndrome

30
Q

How do patients with Trochanteric bursitis present?

A

Pain on the LATERAL ASPECT of the hip

Pain on palpation of greater trochanter

31
Q

What imaging modalities are used in trochanteric bursitis?

A

Clinical diagnosis!!!
=> Radiographs usually unremarkable
Visible on MRI but not usually needed (expensive)

32
Q

How is trochanteric bursitis usually treated?

A

Analgesia
NSAIDs
Physiotherapy
Steroid injection

No proven benefit from surgery!

33
Q

What conditions can lead to potential secondary OA?

A 
DDH
SUFE
Septic arthritis
AVN
FAI
Trauma
34
Q

What is osteoarthritis (OA)?

A

Degenerative disease of synovial joints
=> progressive loss of articular cartilage

Inflammatory changes in capsule lead to:

  • thickening
  • tightness
35
Q

What type of people usually get osteoarthritis?

A

Female > Males

  • older age
  • Genetic element
  • Pre-existing hip disease
36
Q

How do patients with OA tend to present?

A 
Groin pain
Worse on activity
Pain at night
Start up pain
Stiff on testing ROM
37
Q

What should you asses

A

Level of symptoms and impact on quality of life
Medical comorbidities
Social history
WOULD THE PATIENT LIKE SURGERY?!

38
Q

What is the management of osteoarthritis?

A 
Analgesia
Weight loss (decrease joint reaction force)
Walking aids
Physiotherapy if weakness identified
Steroid injections
THR

Musculoskeletal (27 decks)

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