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MSK > Common Conditions of the Hip > Flashcards

Common Conditions of the Hip Flashcards

1
Q

Describe the pelvis

A

Each hemipelvis has 3 bones - ilium, ischium and pubis
Joined by sacrum posteriorly and pubic symphysis anteriorly
Acetabulum is socket

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2
Q

What is key anatomy of the femur?

A

Head - articulates with acetabulum
Neck - blood supply
Greater trochanter -attachment for abductor and rotators
Lesser trochanter - attachment for psoas

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3
Q

What is the acetubulum?

A

Part of pelvis
Cup shape socket

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4
Q

What is the labrum?

A

Fibrocartilaginous lining of acetabulum
Deepens socket and adds stability

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5
Q

Describe the profunda femoris

A

Branches of medial and lateral circumflex arteries
MFCA - major contributor of femoral head - ascends to head and transverse to form cruciate anastomose
LFCA - 3 branches - ascending branch to joint capsule, transverse branch to cruciate anastomosis and descending branch

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6
Q

What are the minor contributors to the blood supply of hip?

A

Artery ligamentum teres
Nutrient arteries of bone

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7
Q

Where does primary blood supply enter neck of femur?

A

Via capsule
Has clinical significance as fracture to neck of femur

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8
Q

Why does neck of femur fracture have clinical significance with blood supply?

A

If intracapsular fracture then blood supply disrupted
If extracapsular fracture then blood supply maintained

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9
Q

How many muscles are around the hip joint?

A

13 muscles

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10
Q

What are the function of bursae?

A

Fluid filled sacs
Reduce friction between tissues

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11
Q

Describe osteoarthritis

A

Degenerative change of synovial joints
Progressive loss of articular cartilage
Secondary bone changes

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12
Q

What is osteoarthritis characterised by?

A

Worsening pain and stiffness of affected joint
Limiting everyday life

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13
Q

Describe trochanteric bursitis

A

Inflammation of the fluid filled sac sandwiched between hip abductors and ITB
More females then males

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14
Q

What are some of the causes of trochanteric bursa?

A

Trauma, over use - athletes and repetitive movements, abnormal movements - distant problem like scoliosis or local like muscle wasting from surgery or hip replacement

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15
Q

What is the presentation of trochanteric bursitis?

A

Pain with point tenderness and on lateral hip

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16
Q

What should be looked for in examination of trochanteric bursitis?

A

Look for scars of previous surgery and may have wasting muscle in gluteals
Feel for tenderness over greater tuberosity
Move - worst pain in active abduction

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17
Q

What are the investigations used for trochanteric bursitis?

A

X-ray - may be normal or show OA, THR and spine abnormalities
MRI - soft tissues and fluid
US - can be therapeutic with injection and diagnostic

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18
Q

What is the treatment for trochanteric bursitis?

A

NSAIDS
Relative rest and activity modification
Physiotherapy
Injection - corticosteroids
Surgery - bursectomy rare

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19
Q

What is avascular necrosis?

A

Death of bone due to loss of blood supply
Males over females and average age is 35-50 years old
80% bilateral and 3% multifocal

20
Q

What are the risk factors for avascular necrosis?

A

Trauma - irradiation, fracture, dislocation and iatrogenic
Systemic - idiopathic, hypercoagulable state, steroids, haematological (sickle cell, lymphoma, and leukaemia), Caisson’s disease and alcoholism

21
Q

What is a trauma which can cause avascular necrosis?

A

Injury to femoral head blood supply - intra-capsular fractures

22
Q

What is an idiopathic cause for avascular necrosis?

A

Intravascular coagulation is the final common pathway

23
Q

What is the pathoanatomic cascade of idiopathic avascular necrosis?

A

Coagulation of intraosseous microcirculation - venous thrombosis - retrograde arterial occlusion - intraosseous hypertension - reduced blood flow to head - cell death - chondral fracture and collapse

24
Q

What are the symptoms of avascular necrosis?

A

Insidious onset of groin pain
Pain with stairs, walking uphill and impact activities
Limp

25
Q

What is seen on examination of avascular necrosis?

A

Largely normal
May replicate early arthritis - reduced range of motion and stiff joint

26
Q

What imaging is done for avascular necrosis and what is seen?

A

X-ray
MRI - can see earlier sings like crescent sign (lytic area under chondral surface)
Later changes are architecture and femur collapse - goes to arthritic stage

27
Q

What is the non-operative treatment of avascular necrosis?

A

Reduce weight bearing, NSAIDs, bisphosphonates, anticoagulants and physiotherapy

28
Q

What is the surgical treatment of avascular necrosis?

A

Restore blood supply - core depression and vascularised graft
Move lesion away from weight bearing area - rotational osteotomy
Total hip replacement

29
Q

What is femoracetabular impingement (FAI)?

A

Hip pathology in younger patients
Secondary osteoarthritis

30
Q

What is femoroacetabular impingement (FAI)?

A

Broadly defined into 2 categories - Cam lesion and Pincer
Results in impingement of femoral neck against anterior edge of acetabulum

31
Q

Describe Cam lesion of FAI

A

Femoral based impingement - usually young athletic males
Excess bone leading to decreased head to neck ratio and aspherical head
Abutment of lesion on edge of acetabulum - flexion

32
Q

Describe FAI - pincer

A

Acetabulum based impingement
Usually in active females
Abnormal acetabulum leading to anterosuperior acetabular rim overhang and protrusion
Abutment of lesion on edge of acetabulum

33
Q

What are associated injuries to FAI?

A

Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip OA

34
Q

What is the presentation of FAI?

A

Groin pain worse with flexion, mechanical symptoms - block movement and pain with certain manoeuvres (getting out chair, squatting and lunging)

35
Q

What is seen on examination of FAI?

A

Reduced flexion and internal rotation
Positive FADIR test - flexion, adduction, and internal rotation

36
Q

What are the investigations of FAI?

A

X-ray - identify bony pathology
MRI - useful for assessing associated conditions like labral tears and articular cartilage damage

37
Q

What is the non-operative treatment of FAI?

A

Activity modification, NSAIDs, and physiotherapy

38
Q

What is the operative treatment for FAI?

A

Arthroscopy - shave down defect, deal with labral tears and resect artic cartilage flaps
Open - resection, periacetabular osteotomy and hip arthroscopy (resurfacing or replacement)

39
Q

What is the epidemiology of labral tears?

A

Most commonly anterosuperior tear
All age groups and commonly active females - pincer and more flexible

40
Q

What are the causes of labral tear?

A

FAI, trauma, OA, dysplasia and collagen disease - Ehlers-Donlos

41
Q

What is the presentation of labral tears?

A

Groin and hip pain
Snapping sensation
Jamming or locking

42
Q

What is looked for in examination of labral tear?

A

Can be normal
Positive FABER - flexion, abduction, external rotation - anterior tears

43
Q

What are the investigations used for labral tears?

A

Ensure adequate imaging
X-ray - OA and dysplasia
MRI arthrogram
Diagnostic injections under local anaesthetic

44
Q

What is the non-operative treatment for labral tear?

A

Activity modification, NSAIDs and physio
Injection of steroids

45
Q

What is the operative treatment for labral tear?

A

Arthroscopy - repair and resection

MSK (39 decks)

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