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MSK > Adult presentation of hip conditions > Flashcards

Adult presentation of hip conditions Flashcards

1
Q

What are common adult hip conditions?

A

Femoroacteabular impingement syndrome (FAI)
Avascular necrosis
Idiopathic transient osteonecrosis of the hip (ITOH)
OA

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2
Q

What is the surgial seive?

A 
VITAMIN
V = vascular 
I = infection/ inflammatory
T = Trauma
M = metabolic
I = Iatrogenic/ idiopathic
N = Neoplastic
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3
Q

Can hyaline cartilage be regenerated?

A

NO

Fibrocatilage takes its place

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4
Q

What is femoroacetabular impingement syndrome (FAI)?

A

Altered morphology of femoral neck and/or acetabulum

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5
Q

What movements will be restricted in FAI?

A

Flexion, adduction and internal rotation

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6
Q

What is a CAM deformity?

A

Femoral deformity where there is an asymmetric femoral head with decreased head/neck ratio that will catch on the acetabulum during flexion

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7
Q

Who is most commonly affected by a CAM deformity?

A

Young atheltic males

People with a previous SUFE

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8
Q

What is a pincer type impingement?

A

Acetabular deformity causing an acetabular overhang

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9
Q

Who is commonly affected by a picer type inpingement?

A

Females

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10
Q

What can FAI cause?

A

Damage to the labrum and tears
Damage to the cartilage
OA in later life

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11
Q

What is the presentation of FAI?

A

Activity related pain in the groin particular in flexion and rotation
Difficulty sitting

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12
Q

What exmination tests can be used to confirm a FAI?

A

C sign positive

FADIR provocation test (Flexion, ADDuction, Internal Rotation)

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13
Q

How can FAI be diagnosed?

A

Radiographs
CT
MRI (better for visualising damage to the labrum)

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14
Q

How can FAI be managed?

A

Observation in asymptomatic patients.. DO NOT OPERATE IF ASYMPTOMATIC
Arthroscopic or open surgery to remove CAM or debride labral tears
Arthroplasty in older patients with secondary OA

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15
Q

What is AVN?

A

Failure of the blood supply to the femoral head

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16
Q

What is the pathophysiology of AVN?

A

Coagulation of the intraosseous microcirculation
Venous thrombosis causes retrograde arterial occlusion
Intraosseous hypertension
Decreased blood flow to femoral head
Necrosis of femoral head
Chondral fracture and collapse

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17
Q

Who will AVN affect?

A

More males than females
Typical age between 35 and 50
Bilateral disease in 80% of cases

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18
Q

What are risk factors for the development of FAI?

A 
Irradiation 
Trauma 
Haematologic diseases (leukaemia, lymphoma, sickle cell) 
Dysbaric disorders 
Alcoholism 
Steroid use 
MOST ARE IDIOPATHIC
19
Q

What is the classical presentation of AVN?

A

Insidious onset of groin pain

Exacerbated by stairs or impact

20
Q

What will be found on examination on AVN?

A

Nothing - usually normal unless disease has advanced to collapse/ OA

21
Q

How can AVN be diagnosed?

A

Radiographs (often normal in early disease)

MRI scans are gold standard

22
Q

What classification is used for AVN?

A

Steinberg classication as a modification of Ficat classification

23
Q

What are the reversible stages of AVN?

A

Type 0-2 - no collapse

24
Q

What are the irreversible stages of AVN?

A

Types 3-6 - sclerotic collapse

25
Q

What is the management for reveresible AVN?

A

Bisphosphonates
Core decompression +/- bone grafting
Curettage and bone grafting
Vasculatised fibular bone graft

26
Q

What is the management for irreversible AVN?

A

THR

27
Q

What is the mode of action of bisphosphonates?

A

Inhibit osteoclast action decreaseing the reabsorption of bone

28
Q

What is idiopathic transient osteonecrosis of the hip?

A

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

29
Q

What is the classic presentation of ITOH?

A

Progressive groin pain over several weeks
Difficulty weight bearing
Usually unilateral

30
Q

Who will ITOH affect?

A

Middle aged men

Pregnant women in 3rd trimester

31
Q

How will ITOH be diagnosed?

A

Elevated ESR
X-ray
MRI
Bone scan

32
Q

What will an x-ray in ITOH show?

A

Osteopenia of the head and neck
Thinning of cortices
Preserved joint space

33
Q

How is ITOH managed?

A

Self-limiting condtion that resolves in 6-9 months
Analgeisa
Protected weight bearing to avoid stress fractures

34
Q

What is trochanteric bursitis?

A

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

35
Q

Who is affected by trochanteric bursitis?

A

Female patients

Young runners and older patients (gluteal cuff syndrome)

36
Q

How will trochanteric bursitis classically present?

A

Pain on the LATERAL aspect of the hip

Pain on palpation of the greater trochanter

37
Q

How is tronchanteric bursitis diagnosed?

A

Clinical diagnosis

38
Q

How is trochanteric bursitis managed?

A

Analgesia
NSAIDs
PT
Steroid injections

39
Q

What is OA?

A

Degenerative disease of the synovial joints that casues progressive loss of articular cartilage
Inflammatory changes int eh capsule lead to thickening and tightness

40
Q

Who is most affected by OA?

A

Affects more femeales
Typically in older age
Genetic element
Pre-existing hip condition

41
Q

How will OA of the hip present?

A 
Groin pain but can radiate to buttock
Worse on activity 
Pain at night 
Start up pain
Stiff testing ROM
42
Q

How is OA assessed?

A

Level of symptoms and impact on QOL
Medical comorbs
Social history
DO THEY WANT SURGERY

43
Q

How is OA diagnosed?

A

X-ray

44
Q

How is OA managed?

A 
Analgeisa
Weight loss 
Walking aids
PT 
Total hip arthroplasty

MSK (34 decks)

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