Common hip conditions Flashcards
What blood vessel mainly supplies the femoral head
The medial femoral circumflex artery
What is osteoarthritis
Joint destruction - degenerative change of synovial joints
How is osteoarthritis characterised
Worsening pain and stiffness of the specific joint
What is bursitis
inflammation of the bursa
What are symptoms of trochanteric bursitis
Pain when lying on side and when walking
Which gender is trochanteric bursitis more common in
Females
What are the causes of trochanteric bursitis
Trauma
Athletes - over use
Abnormal movements
Muscle wasting
osteoarthritis
hip replacements
What is the presentation of trochanteric bursitis
tenderness at the greater tuberosity
May have scars from surgery or muscle waisting
Pain when actively abducting hip
What investigations are done for trochanteric bursitis
X-ray
MRI
Ultrasound - can be therapeutic to guide steroid injection
What is the treatment of trochanteric bursitis
NSAIDs
Rest
physiotherapy
Injection of corticosteroids
Surgical: bursectomy
What is avascular necrosis
Death of bone due to loss of blood supplu
Who does avascular necrosis of the hip more commonly occur in
Males
35-50
Is avascular necrosis usually bilateral or unilateral
80% bilateral
What are the risk factors of avascular necrosis
Commonest risk factor is alcoholism
steroids are a common cause
Trauma - fraction or dislocation
Systemic - steroids, alcoholism, hypercoaguable states , haematological - sickle cell
Caisson’s disease is also common – people who worked as divers or as tunnelers
What are the symptoms of avascular necrosis
Insidious onset of groin pain (gradual onset)
Pain with stairs and walking uphill
A limp
What is the presentation of avascular necrosis on examination
Normally normal
Similar to early arthritis with a stiff joint with reduced range of motion
What is the investigation of for avascular necrosis
MRI is most effective
X-ray
How is avascular necrosis treated
Reduce weight bearing
NSAIDs
Bisphosphonates in early avascular necrosis
Anticoagulants
Physiotherapy - maintain movement
Surgical treatment -
core decompression - drilling holes into femur head to relieve pressure
Hip replacement
rotational osteotomy
What is the function of bisphosphonates
Inhibit the activity of osteoclasts
What is impingement
Two surfaces hitting each other
What is femoroacetabular impingement
The edge of the acetabulum impinging on the femoral neck
What does femoroacetabulae impingement cause
Hip issues in younger issues and secondary osteoarthritis
What is a cam lesion
Femoroacetabular impingement at the femoral neck mainly
Who is a cam lesion more common in
Young athletic males
What is a pincer lesion
Acetabulum based impingement
Who is pincer lesion more common in
Active females
What are femoroacetabular inmipingement associated with
Labral damage
cartilage damage
secondary hip osteoarthritis
How does femoroacetabular impingement present
Groin pain - worse in flexion
Pain with certain movements like squatting
What are the tests for cam and pincer lesions in femoroacetabular impingement
FADIR test -
F - flexion
AD- adduction
I - internal
R - rotatii
What is the treatment of femoroacetabular impingement
NSAIDs and physiotherapy
Surgical -
arthroscopy - shave down defect - deal with labral issues and resect cartilage flaps
open surgery :
resection
periacetabular osteotomy
Hip arthroplasty - replacement of articular cartilage
What are causes of labral tears
Femoroacetabuular imingement
trauma
osteoarthritis
dysplasia
What are symptoms of labral tears
groin or hip pain
snapping sensation
jamming or locking
What is seen on examination of labral tears
Can be normal
positive FABER test
F- flex
AB - abduction
E - external
R - rotation
What onvestigations are done for labral tears
MRI arthrogram - MRI with contrast injection into joint
What is the treatment for labral tears
NSAIDs
Physiotherapy
steroid injection
Surgical:
Arthroscopy - repair or resection
