Adult Hip Problems

Question 1

where can hip pain originate from in the adult?

Answer 1

groin

can radiate to the knee (obturator nerve supplies both)

Question 2

how long does a THR last?

Answer 2

10-15 years

Question 3

what is the most common hip replacement materials?

Answer 3

metal-on-polyethene

Question 4

what is the most common direction of a hip dislocation?

Answer 4

posterior

Question 5

what can occur with a hip dislocation?

Answer 5

acetabular wall fracture

femur fracture

Question 6

presentation of hip dislocation

Answer 6

flexed
internally rotated
adducted knee

Question 7

risks in hip dislocation

Answer 7

sciatic nerve palsy
AVN of femoral head
OA

Question 8

management of hip dislocation

Answer 8

reduction

stabilisation

Question 9

risk factors for proximal femur fractures

Answer 9

OP
smoking
malnutrition

Question 10

two types of proximal femur fractures

Answer 10

1. intra-capsular

2. extra-capsular

Question 11

what does intra-capsular proximal femur fracture risk?

Answer 11

AVN

non-union

Question 12

three types of extra-capsular proximal femur fractures

Answer 12

1. basicervical
2. intertrochanteric
3. subtrochanteric

Question 13

risks in extra-capsular proximal femur fractures

Answer 13

non-union

mal-union

Question 14

diagnosis of proximal femur fracture

Answer 14

XR (Shenton’s line)

MRI

Question 15

management of extracapsular proximal femur fracture

Answer 15

intertrochnateric DHS

IM nail

Question 16

management of intracapsular proximal femur fracture

Answer 16

good function= hemiarthroplasty or THR

poor function= hemiarthroplasty

Question 17

two types of femoroacetabular impingement syndromes (FAI)

Answer 17

1. cam type impingement

2. pincer type impingement

Question 18

what is cam type impingement?

Answer 18

there is a femoral head deformity (head not round)

Question 19

who is cam type impingement more common in?

Answer 19

men

Question 20

what is pincer-type impingement

Answer 20

acetabular overhang

Question 21

who is pincer-type impingement more common in?

Answer 21

females

Question 22

what are complications of FAI?

Answer 22

damage to labrum
damage to cartilage
leads to OA

Question 23

presentation of FAI

Answer 23

activity related pain in groin (particularly flexion and rotation)
difficulty sitting
C positive sign (grasping hip)
FADIR test positive

Question 24

diagnosis of FAI

Answer 24

MRI for visualising labrum

Question 25

management of FAI

Answer 25

observe in asymptomatic patients | surgery

Question 26

surgical options in FAI

Answer 26

debride labral tears peri-acetabular osteotomy THR in OA

Question 27

what is avascular necrosis of the hip?

Answer 27

failure of blood supply to the femoral head

Question 28

what is the blood supply to the femoral head?

Answer 28

medial femoral circumflex

Question 29

causes of AVN of the hip

Answer 29

``` idiopathic alcohol steroids hyperlipidaemia thrombophilia ```

Question 30

presentation of AVN of the hip

Answer 30

insidious onset | pain exacerbated by stairs or impact

Question 31

diagnosis of AVN of the hip

Answer 31

XR normal | MRI shows sclerosis/ lytic zones with hanging rope sign

Question 32

management of reversible AVN of the hip

Answer 32

``` bisphosphonates core decompression +/- graft curettage and bone grafting vascularised fibular bone graft rotational osteotomy ```

Question 33

management of irreversible AVN of the hip (collapse)

Answer 33

rotational osteotomy | THR

Question 34

what is idiopathic transient osteonecrosis of the hip?

Answer 34

blood supply to the hip has been interrupted

Question 35

who gets ITOH?

Answer 35

middle-aged men | women in the 3rd trimester

Question 36

presentation of ITOH

Answer 36

progressive unilateral groin pain | difficulty bearing weight

Question 37

diagnosis of ITOH

Answer 37

radiographs | MRI

Question 38

what does the XR of ITOH show?

Answer 38

osteopenia of head and neck thin cortices but preserved joint space

Question 39

management of ITOH

Answer 39

self-limiting (6-9 months) analgesia protected weight bearing

Question 40

what is another name for trochanteric bursitis?

Answer 40

gluteal cuff syndrome

Question 41

what is trochanteric bursitis?

Answer 41

repetitive trauma of IT band over bursa causes inflammation

Question 42

presentation of trochanteric bursitis

Answer 42

pain on lateral hip | pain on palpation of greater trochanter

Question 43

management of trochanteric bursitis

Answer 43

analgesia NSAIDs physiotherapy steroid injections