Conditions of the Hip Flashcards
Name the three bones that are fused to form the hip
Ileum
Ischium
Pubis
The three bones of the hip are fused by which 2 structures
Sacrum
Pubic symphysis
Which muscles attach to the greater trochanter of the femur?
Abductors
Rotators
What muscle attaches to the lesser trochanter of the femur?
Psoas
Blood supply to the hip joint
Medial and Lateral circumflex - branches of profunda femoris
Artery of ligamentum teres
Blood supply enters through capsule
Difference between effect on blood supply in intracapsular and extracapsular fracture of femur
Intracapsular- fracture of neck - blood supply disrupted
Extracapsular - blood supply maintained
2 changes in osteoarthritis
Progressive loss of articular cartilage
Secondary bone changes
What is osteoarthritis?
Degenerative change in synovial joints
Symptoms of osteoarthritis
Worsening pain
Stiffness
Causes of trochanteric bursitis
Trauma Over-use; athletes, runners, repetitive movement Abnormal movements - Distant -Local
Which ‘distant’ problem can cause abnormal movement in the hip joint leading to trochanteric bursitis?
Scoliosis
Which local problems to the hip can cause abnormal movement that can lead to trochanteric bursitis?
Muscle wasting following surgery
Total hip replacement
Osteoarthritis
Presentation of trochanteric bursitis
Point to tenderness
Tenderness in lateral hip
Examination findings in trochanteric bursitis
Scars from previous surgery?
Muscle wasting (glutes)
Tenderness at greater tuberosity
Worst pain at active abduction
Investigations for trochanteric bursitis
X ray
MRI
Ultrasound
Treatment for trochanteric bursitis
NSAIDs Rest Activity modification Physio - posture, movements, strengthening and stretching Injection - glucocorticosteroids Surgery - bursectomy
What happens in avascular necrosis?
Loss of blood supply –> death of bone
What age is avascular necrosis more likely to be diagnosed>
35-50
Is avascular necrosis more common in males or females>
Males
Risk factors for avascular necrosis fall under which 2 categories
Trauma
Systemics
Traumatic causes of avascular necrosis
Irradiation
Fracture
Dislocation
Iatrogenic
Systemic causes of avascular necrosis
Idiopathic Hypercoagulable states Steroids Haematological - sickle cell disease, leukaemia, lymphoma Caisson's disease Alcoholism
What symptom is common is Caisson’s disease?
Decompression sickness
What does decompression sickness occur with Caisson’s disease?
Nitrogen bubbles throughout body
Symptoms of avascular necrosis
Insidious onset of groin pain
Pain with stairs, walking uphill, on impact
Limp
Findings of avascular necrosis on examination
Can replicate OA - stiffness, reduced ROM
Non-operative treatment of avascular necrosis
Activity modification NSAIDs Bisphosphonates Anticoagulants Physio
Operative treatment of avascular necrosis
Core decompression and vascularised graft : Blood supply
Rotational osteotomy: Move lesion from weight-bearing area
Total Hip Replacement
Types of femoroacetabular impingement
Cam Lesion - femur based
Pincer - acetabulum based
3 steps in formation of pincer impingement
Abnormal acetabulum
- -> anterosuperior overhang
- -> acetabular protrusion
–>abutement of lesion on edge of acetabulum
Associated injury of pincer impingement
Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip osteoarthritis
Signs and symptoms of femoroacetabular impingement
Groin pain - worse with flexion
Mechanical symptoms
- block to movement
- pain; getting up, chair, squat, lunge
Examination findings of impingement
Reduced flexion and internal rotation Positive FADIR test -Flexion Addcution Internal Rotation
A positive FADIR tests indicates which hip pathology?
Femoroacetabular impingement
Investigations for femoroacetabular impingement - imaging
X-ray
MRI
Non-operative treatment of FA impingement
Physio
NSAIDs
Activity modification
Operative treatment of FA impingement
Arthroscopy - shave off impingement, deal with labral tears, resect cartilage flaps
Open surgery -Resection, Periacetabular osteotomy, Hip arthroplasty - resurfacing, replacement
Most common type of labral tear
Anterosuperior
Labral tears occur most commonly in active females as a result of what pathology
Pincer impingement - flexibility
Causes of labral tears
Femoroacetabular Impingement Trauma Dysplasia Osteoarthritis Collagen diseases - Ehler Danlos
Symptoms of labral tear
Hip or groin pain
Snapping sensation
Jamming or locking
Findings on examination
Positive FABER
Flexion
Abduction
External Rotation
Investigation for labral tear
X ray
MRI
Diagnostic injection
Non- operative treatment of labral tear
NSAIDs
Activity
Steroids
Physio
Operative treatment of labral tear
Arthroscopy - resection and repair
A positive FABER test indicated which hip pathology?
Labral tear
