Common conditions of the hip Flashcards
What is the role of the Head of the femur Neck Greater trochanter Lesser trochanter
Head of the femur- articulates with acetabulum
Neck- blood supply
Greater trochanter- attachement for abductors and rotators
Lesser trochanter- attachment for psoas
What is the labrum?
What is the blood supply of the hip
Fibrous lining of the acetabulum used to deepen socket and and stability.
medial circumflex artery- major contributor to femoral head
Lateral circumflex artery- big contributor
Artery of ligamentum teres- minor
Nutrient arteries of bone
blood enters through capsule
What is osteoarthritis?
Progressive loss of articular cartilage
Secondary bone cartilage
Characterised by bone pain and stiffness
What is trochanteric bursisits
Inflammation of the fluid filled sac between the hip and the abductors. More common in females
What causes trochanteric bursitis?
Trauma
Over-use-athletes, often runners, repetitive movements
Abnormal movements- distant problems- scoliosis
Local problems- muscle wasting following surgery, total hip replacement, osteoathritis
How does trochanteric bursitis present?
What signs are found on examination
Pain, point tenderness, lateral hip
Examination- look (may have scars, may have gluteal wasting)
Feel-tenderness at greater tuberosity
Move- worst pain in active abduction
What investigations are carried out in trochanteric bursitis?
X-ray- may be normal, OA, THR, spine abnormalitis
MRI - shows soft tissue and fluid
Ultrasound scan-can be therapeutic as well as diagnosed
How do you treat trochanteric bursitis?
NSAIDS Relative rest Physio- correct posturem abnormal movements, stretching, strenghthen muscles around joint Injection- corticosteroids Surgery- bursectomy (rarely required)
What is avascular necrosis?
Death of bone due to lack of blood supply
Males more common, 35-50 years olf
80% bilateral
3% multifocal
What are the risk factors of avascular necrosis
Irradiation Fracture Dislocation Iatrogenic Hyoercoaguble states Steroids Sickle cell, lymphoma, leukaemia Alcoholism
What is the pathogenesis of idiopathic avascular necrosis
coagulation of interossues microcirculation venous thrombosis retrograde arterial conclusion Intraosseus hypertension Reduced blood flow to head Cell death Chondral fracture and collapse
What are the symptoms of avascualr necrosis
Insidous groin pain
Pain with stairs, walking uphill
limp
Examinaton- fairly normal, may replciate arthritis, reduced range of motion, stiff joint
What is the treatment of avascular necrosis
Non operative Reduced weight bearing NSAIDs Bisphosphonates Early AVN Anticoagulants Physio
What are the surgical treatments of avascular necrosis
Surgical- restore blood supply, core decompression,core decompression and vascularised graft
Move the lesion away from the weight bearing area
Rotational osteomy
total hip replacement
What is femeroacetabular impingement (FAI)
anatomical phenomenon that can be broadly divided into two categories, pincer lesion and cam lesions
Commonest cause hip pathology or secondary osteoarthritis
What is a pincer lesion in FAI
Usually in active females,abnormal acetablum leading to acetabular rim overheating and acetabulum pertrusion
How does a pincer present
What are the associated injuries
Groin pain, worse with flexion, pain to get out of chair, squat and lunge
Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip osteoarthritis
How do you examine a suspected FAI
FADIR- flexion, adduciton, internal rotation
X-ray- bony pathology
MRI- accesing associated conditions,labral tears, articular cartilage damage
What is the treatment of FAI
Activity modification
NSAIDS
Phsiotherapy- correct posture, strengthen muscles around joint
operative- arthroscopy, shave defect
open surgery-resect, periacetabualr osteotomy, resurfacing and replacement
What is a labral tear?
Who gets it
What are the causes of it?
Most commonly anterosiperior tear
All age groups
Common in active females
FAI Trauma OA Dysplasia Collagen disease
How does a labral tear present?
How do you investigate it?
Groin or hip pain, snapping sensation, jamming or locking
Can be normal, positive faber test (flexion, abduction ,external rotation)
X-ray OA,dysplasia
MRI arthrogram
Diagnositc injection
What is the treatment of a labral tear?
Non operative- activity modification, NSAIDS, physio
Injection of steroids
Operative arthoscopy-repair, resection
