Clinical Conditions Of The Hip Flashcards
What is the fovea?
A depression in the femoral head where the ligementum teres attaches
What is significant about the artery of Ligamentum Teres in children?
Main blood supply to femoral head
Runs from acetabulum to femoral head
What other blood vessels supply the femoral head with blood?
(Other than ligamentum teres)
Medial and lateral femoral circumflex arteries
What are the branches coming off of the circumflex arteries called?
Ascending cervical branches or Retinacular arteries
What are the risk factors for primary osteoarthritis?
Age
Female
Ethnicity
Nutrition
Genetics
What are the causes of secondary arthritis?
Obesity
Trauma
Infection
Inflammatory arthritis (Rheumatoid)
Metabolic disorders affecting the joints (gout)
Haematological disorders
Describe the pathology of osteoarthritis:
Excessive loading on joint damages the articular cartilage
Chondrocytes try and replace cartilage (proteoglycans)
Cartilage erodes away and the joint space is reduced
What is Osseous metaplasia of connective tissue?
When bony spurs (osteophytes) form on the articular cartilage instead of cartilage usually following osteoarthritis
What does sclerosis mean?
How does it appear on an xray?
Abnormal hardening or thickening of tissue
Whiter region on xray
Why can sclerosis happen in an arthritic hip?
As the bone is remodelled it can be made thicker
What are the symptoms of osteoarthritis of the hip?
Stiffness
Very painful
Crepitus
What is Crepitus?
A sound or feeling (crunching) of bone rubbing against bone (grinding)
What is the Trendelenburg sign/gait?
A examination done to evaluate hip stability
If a patient has a suspected right arthritic hip, describe how you would examine them and what you would see (Trendelenburg sign)?
Get them to lift their left leg off the ground
If they have a right arthritic hip, their right hip will raise up causing an uneven pelvis (right Trendelenburg sign)
What non operative managements are there for Osteoarthritis of the hip?
Activity modification
Weight loss
Walking sticks
Physiotherapy
Medication
Injections
What medications can be give for osteoarthritis of the hip?
Analgesics
NSAIDs
COX-2 inhibitors
What injections are given in patients with osteoarthritis?
Corticosteroids to reduce inflammation
What surgical procedures are done to treat osteoarthritic hips?
Hip replacement
What is the goal of hip replacement surgery?
Reduce pain
Improve patient wellbeing
Implants replace the damaged surfaces
Where do intracapsular hip fractures occur?
The neck of the femur
Where do extracapsular fractures of the hip occur?
In the region of the greater trochanter and just underneath this region before the femoral shaft
Which type of fracture usually leads to Avascular necrosis of the femoral head?
Intracapsular fractures
What is the rule of thirds (1/3s) when it comes to repairing an intracapsular fracture?
If it is repaired
1/3 of cases heal
1/3 get Avascular necrosis of the femoral head
1/3 never heal
Why does Avascular necrosis tend to follow an intracapsular fracture?
Retinacular arteries/ascending cervical branches disrupted by fracture
Blood supply from artery of ligamentum teres not sufficient to supply femoral head
What are the signs of a hip fracture?
Leg shortened
Leg externally rotated
Why does the leg get shortened in a hip fracture?
Rectus femoris and adductor Magnus pull leg up
Why does the leg get externally rotated in a hip fracture?
Gluteus maximus
Piriformis
Superior and inferior gomellus
Obturator internus
Quadratus femoris
All Externally rotate leg
Why do extracapuslar fractures reliably heal but intracapsular fractures do not?
Extracapuslar fractures do not have an interruption to the blood supply of the femoral head whereas intracapsular fractures do
What type of surgery is performed to an undisplaced intracapsular fracture?
Immobilise/fix in place
(Cannulated screws through the femoral head)
How can extracapsular fracture surgeries be done?
With pin and plate or nail
(Irrelevant)
What is hemiarthroplasty?
When only the femoral head sides the joint is replaced
What happens in a total hip replacement?
Both sides of the joint are replaced (femoral head and acetabula’s cup)
What can cause Avascular necrosis?
Broken hip (mechanical disruption)
Alcoholism
Steroid use
Thrombosis
Hypertension
What does idiopathic mean?
Unknown cause
What are the 3 types of hip dislocation?
Posterior
Anterior
Central
Which is the most common type of hip dislocation?
Posterior dislocation
Why is posterior dislocation most common with hip dislocations?
The ischiofemoral ligament is the weakest ligament and its the only ligament supporting the posterior part of the hip
Upon physical examination, how does a posterior dislocation present?
Shortened
Internally rotated
Flexed
Adducted
How can a posterior dislocation cause sciatic nerve palsy?
Dislocated hip can press on sciatic nerve
Where are Posterior hip dislocations commonly seen?
Car crashes
Sport
How does an anterior dislocation of the hip present on physical examination?
Externally rotated
ABducted
Which nerve is rarely damaged in an anterior dislocation of the hip?
Femoral nerve
Why does the leg get shortened in a posterior dislocation?
Gluteus maximus
Hamstrings
Adductor Magnus
ALL PULL SUPERIORLY
Why does the leg get internally rotated in a posterior dislocation?
Gletus medius and minimus have anterior fibres that internally rotate
Why does the leg get externally rotated in an anterior dislocation?
Glut Maximus
Piriformis
Sup + inf gomellus
Obturator internus
Quadratus femoris all pull outwards
What happens in a central dislocation?
Fracture dislocation
Femoral head driven through the socket/acetabulum
What are the life treating complications that can happen as a result of a central dislocation>
Intrapelvic haemorrhage
Complications of hip dislocation:
Avascular necrosis
Post traumatic Osteoarthritis
Sciatic nerve injury
Infection
What abnormalities on a hip x-ray suggests osteoarthritis?
Reduced joint space
Osteophytes
Whitened region around joint from Subchondral Sclerosis
Bone cysts
What is subchondral sclerosis?
Thickening of bone around joints affected by osteoarthritis
