Cortex- Lower limb: Hip Flashcards
hip pathology typically produces pain felt where- why
in the groin, may radiate to the knee or be purely felt in the knee- due to the obturator nerve supplying both joints
what else can cause buttock pain
lumbar spine and SI joint problems
name a hip pathology than can be only felt in the knee
SUFE
what might be the first clinical sign of hip pathology
reduced range of motion with loss of internal rotation usually the first sign
pain may be exacerbated by rotational movements
what produces a trendellenberg gait or sign
altered hip biomechanics weakness from chronic disuse abductor weakness (gluteus medius and minimus)
what is shortening of the lower limb seen in
severe OA, perthes, SUFE, AVN, fracture
what else can cause groin pain
hernia (inguinal or femoral),
tendonitis (especially adductor tendonitis),
pubic symphysis dysfunction,
a high lumbar disc prolapse (with L1/2 radiculopathy- rare)
what pathologies often need total hip arthroplasty or total hip replacement
primary OA, arthritis due to RA, seronegative inflammatory arthropathy, AVN, dysplasia, perthes, SUFE
what is the difference between total hip arthroplasty and total hip replacement
total hip arthroplasty is a broader term that includes procedures such as hip resurfacing (dont involve replacement of the entire femoral head
why will a THA ultimately fail
loosening of one or both the prosthetic components
how long will the stem and cup of a hip replacement last in an eldery patient
cup- 15 years
stem- 20 years
what decides whether or not a THA should be done
level of pain and disability of the patient- and if conservative treatment fails to control symptoms
what are the conservative measures for hip pain
simple analgesics, physio, use of stick, weight reduction, modification of activities
how can a patients level of pain be determined
asking about analgesic use, rest pain, sleep disturbance
how can level of disability be assessed
ask about walking distance, activities of daily living (dressing, bathing), impact on hobbies
what are the early local complications of a THA
infection, dislocation, nerve injury (sciatic nerve), leg length discrepancy
general surgery complications- MI, chest infection, UTI, blood loss, hypovolaemia
what are the late complications of a THA
early loosening, late infection (haematogenous spread from a distant site), late dislocation
what is a revision hip replacement
when a hip replacement fails and is re done- a bigger and more complex surgery (twice the complication rate, often substantial blood loss and poorer functional outcome, don’t last as long)
what are the implications of doing a total hip replacement in a younger patient
have a higher risk of requiring revision hip replacement- put more demand on their replacement- delay for as long as possible
what can cause avascular necrosis of the hip
primary, idiopathic
secondary: alcohol abuse, steroids, hyperlipidaemia, thrombophilia
what do patients present with in AVN
groin pain
what is pre radiographic AVN
when early cases only show changes on MRI
what do late cases of AVN show on x ray
patchy sclerosis on the weight bearing area of the femoral head with a lytic zone underneath formed by granulation tissue from attempted repair
lytic zone makes ‘hanging rope sign’ which is characteristic of AVN
why might the femoral head collapse in AVN
with the irregularity of the articular surface and subsequent secondary OA
once the femoral head has collapsed in AVN what is the treatment
THR
what is the treatment for AVN when detected early (pre-collapse)
drill holes made in femoral neck and into abnormal area in the head to attempt to decompress (relieve pressure) and promote healing to prevent collapse
what is a common tendon tear in the hip and why does it happen
the broad tendinous insertion of the abductor muscles (mostly gluteus medius)
is under considerable strain and is subject to tendonitis and degeneration
what is gluteal cuff syndrome
tear of tedinosus insertion of the abductor muscles +/- inflammation of trochanteric bursa (trochanteric bursitis)
how does trochanteris bursitis/ gluteal cuff syndrome present
pain and tenderness in the region of the greater trochanter with pain on resisted abduction
what is the treatment for trochanteric bursitis/ gluteal cuff syndrome
analgesia, anti-inflammtories, physio, steroid abduction
no surgical option
