Common conditions of the hip

Question 1

Osteoarthritis

Answer 1

degenerative change of synovial joints, progressive loss of articular cartilage, secondary bony changes, worsening pain and stiffness of the effected joint limiting everyday life.

Question 2

Trochanteric Bursitis - what is the trochenteric bursa?

Answer 2

fluid filled sac, sandwiched between abductors and the ITB (iliotibial band)

Question 3

causes and epidemiology…Trochanteric Bursitis

Answer 3

trauma, overuse, scoliosis, muscle wasting, total hip replacement, osteoarhtritis, effects females more

Question 4

Signs and symptoms of Trochanteric Bursitis

Answer 4

point tenderness at lateral hip, look for muscle wasting at glutes, there will be a tenderness at the greater tuberosity, movement pain worse on abduction.

Question 5

Ix of Trochanteric Bursitis

Answer 5

xray, MRI, US

Question 6

Tx of Trochanteric Bursitis

Answer 6

NSAID’s, pyhsio, rest, corticosteroid injections, surgery - bursectomy

Question 7

Avascular necrosis (AVN) and its rf’s

Answer 7

death of bone due to loss of blood supply, effects males more35-50, 80% bilateral. RF’s - trauma (injury to femoral head blood supply), systemic (steroids, hypercoaguable states, haematological, alcoholism, caissons disease)

Question 8

Avascular necrosis (AVN) Symptoms and examination

Answer 8

groin pain, pain withh stairs and walking uphill, impact activities, limp. Examination may replicate early arthritis (reduced range of motion and a stiff joint).

Question 9

Avascular necrosis (AVN) Tx

Answer 9

reduced weighht bearing, NSAID’s, bisphosphonates, anticoagulants, physio. Surgical - restore blood supply by core decompression and a vascular graft, total hip replacement.

Question 10

Femoroacetabular impingement (FAI) - cause and anatomical phenomenon

Answer 10

usually younger patient, secondary to osteoarthritis. Divided into 2 categories: Cam lesion and Pincer lesion. This results in the impingement of the femoral neck against the anterior edge of the acetabulum.

Question 11

describe pincer impingement

Answer 11

acetabulum based impingement, usually in active females. Abnormal acetabulum leading to anterosuperior acetabulum rim overhang and acetabulum protrusion. Abutment of lesion on the edge of the acetabulum.

Question 12

presenation of FAI

Answer 12

groin pain (worse with flexion), mechanical symptoms (block movemement, there is also pain with certain manoevures (squatting, getting out of chairs, lunging))

Question 13

Femoroacetabular impingement (FAI) - what is found on examination and investigations?

Answer 13

reduced flexion and internal rotation, positive FADIR test (flexion, adduction, internal rotation). XRAY and MRI

Question 14

Femoroacetabular impingement (FAI) - Tx

Answer 14

activity modification, NSAID’s, physio. Operative - arthroscopy, open surgery, periacetabular osteotomy, hip arthroplasty

Question 15

Labral tear epidemiology

Answer 15

most commonly anteriorsuperior tears, all age groups, common in active females

Question 16

causes of a labral tear

Answer 16

FAI, Trauma, OA, dysplasia, collagen diseases (ehlers danlos)

Question 17

presentation of a Cabral tear

Answer 17

groin, hip pain, snapping sensation, jamming or locking, positive FABER test (flexion, abduction, external rotation)

Question 18

Tx of a Labral tear

Answer 18

activity modification, NSAID’s, physio. Operative - arthroscopy.

Question 19

What can happen if a hip fracture is left for too long? Complication wise…

Answer 19

Rhabdomylosis - impacting the lkidneys due to Creatine kinase, very low GFR found

Question 20

How does a hip fracture present?

Answer 20

Leg shortened and EXTERNALLY rotated