Adult Hip & DJD

Question 1

Developmental causes of hip DJD (4)

Answer 1

DDH, Perthes disease, slipped capital femoral epiphysis, femoral-acetabular impingement (FAI)

Question 2

Non-developmental causes of hip DJD (4)

Answer 2

Traumatic (dislocations / fractures), infection, inflammatory (RA), idiopathic

Question 3

PE findings for hip DJD (3)

Answer 3

Restricted / painful hip ROM (esp IR and flexion contracture), weak hip abductors (Trendelenburg test), length discrepancy.

Question 4

Imaging findings for hip DJD (4)

Answer 4

Loss of joint space, cysts in femoral head, sclerosis, and osteophytes

Question 5

Where does hip pain radiate to?

Where does back pain radiate to?

Answer 5

Hip: knee
Back: butt and below the knee

Question 6

Non-operative treatments for hip OA

Answer 6

NSAIDs, activity modification, PT, weight reduction, assist devices

Question 7

Joint sparing surgeries for hip OA

Answer 7

Osteotomy and hip arthroscopy

Question 8

Reconstructive surgeries for hip OA

Answer 8

• THA is the treatment of choice for hip DJD. Bone loss or joint wear may cause loosening of the joint and fracture. 80% of THA’s use polyethylene bearings.
• Surface Replacement Arthroplasty (SRA) = resurfacing. Joint is replaced w/ a metal-on-metal articulation w/ less bone removal than w/ THA. SRA is generally reserved for younger, high demand pxs.

Question 9

Treating a femoral neck fracture in elderly vs younger pxs

Answer 9

• Elderly pxs – Treatment of choice is partial or total joint replacement
• Younger pxs – anatomic reduction and fracture fixation to avoid prosthetic replacement.

Question 10

Treating intertrochanteric hip fracture

Answer 10

Save femoral head w/ pins due to better blood supply.

Question 11

Goals prior to elective THA / TKA in obese pxs

Answer 11

Reduce BMI under 40, optimize nutrition, control blood sugar / HTN / cholesterol / sleep apnea / venous stasis.