Common disorders of the Hip Flashcards
What are some Common Disorders of the Hip
Osteoarthritis
Bursitis
- Gluteal tendinopathy
Avascular Necrosis (AVN)
Impingement
Labral Tear
What characterises osteoarthritis
Progressive loss of articular cartilage
Characterised by worsening pain and stiffness of the affected joint
Limiting everyday life
What is Trochanteric bursitis
Inflammation of the Fluid-filled sac sandwiched between hip abductors and ITB (the trochanteric bursa)
What is epidemiology of Trochanteric bursitis
F>M
What is aetiology of Trochanteric bursitis
Trauma
Over-use
Abnormal movements
Local problem - Muscle wasting following surgery - Total Hip Replacement - Osteoarthritis
Where do you feel for tenderness in Trochanteric bursitis
Tenderness at Greater Tuberosity
What is the presentation of Trochanteric bursitis
Pain
- Point tenderness
- Lateral hip
What investigations are used for Trochanteric bursitis
X-ray
MRI
Ultrasound
What is treatment for Trochanteric bursitis
NSAIDs Relative rest / Activity modification Physiotherapy - Correct posture, abnormal movements - Stretching - Strengthen muscles around joint Injection - Corticosteroids
Surgery
- Bursectomy (Rarely required)
What is Avascular necrosis
Death of bone due to loss of blood supply
What is Epidemiology of avascular necrosis
Males > Females Average age 35-50 years old 80% = bilateral - May be offset in time 3% = multifocal - 3 or more joints
What are risk factors of avascular necrosis
Trauma
Systematic
Where in particular can trauma occur and cause vascular necrosis
Injury to femoral Intracapsular fracture
Intracapsular fracture
What systematic conditions can cause vascular necrosis
Hypercoaguable states Steroids Haematological - Sickle Cell Disease - Lymphoma - Leukaemia Caisson’s disease Alcoholism Ideopathic
What are symptoms of avascular necrosis
Insidious onset of groin pain Pain with stairs, walking uphill and impact activities Limp Examination Largely normal May replicate early arthritis - Reduced range of motion (partic internal rotation) - Stiff joint
What are treatment options of avascular necrosis
Non-operarive
Surgery
What are non operative treatment options of avascular necrosis
- Reduce weight-bearing
- NSAIDs
- Bisphosphonates
o Early AVN
o Controversial - Anticoagulants
- Physiotherapy
o Maintain range of motion
o Keep the ball round!
What are operative treatment options of avascular necrosis
- Restore blood supply
o Core decompression
o Core decompression and vascularised graft - Move the lesion away from the weight-bearing area
o Rotational Osteotomy - Total Hip Replacement
What is Femoroacetabular Impingement (FAI)
Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.
What categories are Femoroacetabular Impingement (FAI) divided into?
Cam lesion
Pincer
What is the pincer category of Femoroacetabular Impingement
Acetabulum-based impingement
Usually in active females
This type of impingement occurs because extra bone extends out over the normal rim of the acetabulum. The labrum can be crushed under the prominent rim of the acetabulum.
What is the cam category of Femoroacetabular Impingement
Cam-type femoroacetabular impingement (FAI) is a known cause of groin pain and a condition that can give rise to osteoarthritis of the hip (1). Patients suffering from this condition are mainly young and experience pain when the hip is moved through internal rotation and adduction at 90° of hip flexion
Excess of bone along the upper surface of the femoral head,
What is the presentation of Femoroacetabular Impingement
Groin pain - Worse with flexion Mechanical symptoms - Block to movement - Pain with certain manoeuvres o Getting out of a chair o Squatting o Lunging
What is Examination for Femoroacetabular Impingement
Reduced flexion and internal rotation
Positive FADIR test
- Flexion, ADduction, Internal Rotation
What are investigations for Femoroacetabular Impingement
X-ray - Identify the bony pathology MRI - Useful for assessing associated conditions o Labral tears o Articular cartilage damage
What are non-operative treatment options for Femoroacetabular Impingement
Non-operative - Activity modification - NSAIDs - Physiotherapy o Correct posture o Strengthen muscles around joint
What are operative treatment options for Femoroacetabular Impingement
Arthroscopy
o Shave down the defect
o Deal with labral tears
o Resect artic cartilage flaps
Open Surgery
o Resection
Periacetabular Osteotomy
o Hip Arthroplasty
♣ Resurfacing
♣ Replacement
What is a labral tear
A labral tear results when a part of the labrum separates or pulls away from the socket. Most commonly, a labral tear is the result of repetitive stress (loading) irritating the hip, often due to long-distance running or performing repeated, sharp, sports movements, such as twisting and cutting.
What is the most common labral tear
Most commonly anterosuperior tear
What is Presentation for labral tear
Groin or Hip Pain
Snapping sensation
Jamming or locking
What is Examination for labral tear
can be normal
Positive FABER test
- Flexion, ABduction, External Rotation
o Anterior tears
What is Investigations for labral tear
Ensure adequate imaging so identify any root causes of pathology X-ray - OA, Dysplasia MRI Arthrogram - 92% sensitive Diagnostic injection - Local anaesthetic
What is Non-operative treatment for labral tear
- Activity modification, NSAIDs, Physiotherapy
- Injection of Steroids
What is Operative treatment for labral tear
- Arthroscopy
o Repair
o Resection
