Adult presentation of hip conditions Flashcards
What are common adult hip conditions?
Femoroacteabular impingement syndrome (FAI)
Avascular necrosis
Idiopathic transient osteonecrosis of the hip (ITOH)
OA
What is the surgial seive?
VITAMIN V = vascular I = infection/ inflammatory T = Trauma M = metabolic I = Iatrogenic/ idiopathic N = Neoplastic
Can hyaline cartilage be regenerated?
NO
Fibrocatilage takes its place
What is femoroacetabular impingement syndrome (FAI)?
Altered morphology of femoral neck and/or acetabulum
What movements will be restricted in FAI?
Flexion, adduction and internal rotation
What is a CAM deformity?
Femoral deformity where there is an asymmetric femoral head with decreased head/neck ratio that will catch on the acetabulum during flexion
Who is most commonly affected by a CAM deformity?
Young atheltic males
People with a previous SUFE
What is a pincer type impingement?
Acetabular deformity causing an acetabular overhang
Who is commonly affected by a picer type inpingement?
Females
What can FAI cause?
Damage to the labrum and tears
Damage to the cartilage
OA in later life
What is the presentation of FAI?
Activity related pain in the groin particular in flexion and rotation
Difficulty sitting
What exmination tests can be used to confirm a FAI?
C sign positive
FADIR provocation test (Flexion, ADDuction, Internal Rotation)
How can FAI be diagnosed?
Radiographs
CT
MRI (better for visualising damage to the labrum)
How can FAI be managed?
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
What is AVN?
Failure of the blood supply to the femoral head
What is the pathophysiology of AVN?
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
Who will AVN affect?
More males than females
Typical age between 35 and 50
Bilateral disease in 80% of cases
What are risk factors for the development of FAI?
Irradiation Trauma Haematologic diseases (leukaemia, lymphoma, sickle cell) Dysbaric disorders Alcoholism Steroid use MOST ARE IDIOPATHIC
What is the classical presentation of AVN?
Insidious onset of groin pain
Exacerbated by stairs or impact
What will be found on examination on AVN?
Nothing - usually normal unless disease has advanced to collapse/ OA
How can AVN be diagnosed?
Radiographs (often normal in early disease)
MRI scans are gold standard
What classification is used for AVN?
Steinberg classication as a modification of Ficat classification
What are the reversible stages of AVN?
Type 0-2 - no collapse
What are the irreversible stages of AVN?
Types 3-6 - sclerotic collapse
What is the management for reveresible AVN?
Bisphosphonates
Core decompression +/- bone grafting
Curettage and bone grafting
Vasculatised fibular bone graft
What is the management for irreversible AVN?
THR
What is the mode of action of bisphosphonates?
Inhibit osteoclast action decreaseing the reabsorption of bone
What is idiopathic transient osteonecrosis of the hip?
Local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure
What is the classic presentation of ITOH?
Progressive groin pain over several weeks
Difficulty weight bearing
Usually unilateral
Who will ITOH affect?
Middle aged men
Pregnant women in 3rd trimester
How will ITOH be diagnosed?
Elevated ESR
X-ray
MRI
Bone scan
What will an x-ray in ITOH show?
Osteopenia of the head and neck
Thinning of cortices
Preserved joint space
How is ITOH managed?
Self-limiting condtion that resolves in 6-9 months
Analgeisa
Protected weight bearing to avoid stress fractures
What is trochanteric bursitis?
Repetitive trauma caused by iliotibial band tracking over the trochanteric bursa causing inflammation
Who is affected by trochanteric bursitis?
Female patients
Young runners and older patients (gluteal cuff syndrome)
How will trochanteric bursitis classically present?
Pain on the LATERAL aspect of the hip
Pain on palpation of the greater trochanter
How is tronchanteric bursitis diagnosed?
Clinical diagnosis
How is trochanteric bursitis managed?
Analgesia
NSAIDs
PT
Steroid injections
What is OA?
Degenerative disease of the synovial joints that casues progressive loss of articular cartilage
Inflammatory changes int eh capsule lead to thickening and tightness
Who is most affected by OA?
Affects more femeales
Typically in older age
Genetic element
Pre-existing hip condition
How will OA of the hip present?
Groin pain but can radiate to buttock Worse on activity Pain at night Start up pain Stiff testing ROM
How is OA assessed?
Level of symptoms and impact on QOL
Medical comorbs
Social history
DO THEY WANT SURGERY
How is OA diagnosed?
X-ray
How is OA managed?
Analgeisa Weight loss Walking aids PT Total hip arthroplasty
