Cortex- Lower limb: Hip

Question 1

hip pathology typically produces pain felt where- why

Answer 1

in the groin, may radiate to the knee or be purely felt in the knee- due to the obturator nerve supplying both joints

Question 2

what else can cause buttock pain

Answer 2

lumbar spine and SI joint problems

Question 3

name a hip pathology than can be only felt in the knee

Answer 3

SUFE

Question 4

what might be the first clinical sign of hip pathology

Answer 4

reduced range of motion with loss of internal rotation usually the first sign

pain may be exacerbated by rotational movements

Question 5

what produces a trendellenberg gait or sign

Answer 5

altered hip biomechanics 
weakness from chronic disuse 
abductor weakness (gluteus medius and minimus)

Question 6

what is shortening of the lower limb seen in

Answer 6

severe OA, perthes, SUFE, AVN, fracture

Question 7

what else can cause groin pain

Answer 7

hernia (inguinal or femoral),
tendonitis (especially adductor tendonitis),
pubic symphysis dysfunction,
a high lumbar disc prolapse (with L1/2 radiculopathy- rare)

Question 8

what pathologies often need total hip arthroplasty or total hip replacement

Answer 8

primary OA, 
arthritis due to RA,
seronegative inflammatory arthropathy,
AVN,
dysplasia,
perthes,
SUFE

Question 9

what is the difference between total hip arthroplasty and total hip replacement

Answer 9

total hip arthroplasty is a broader term that includes procedures such as hip resurfacing (dont involve replacement of the entire femoral head

Question 10

why will a THA ultimately fail

Answer 10

loosening of one or both the prosthetic components

Question 11

how long will the stem and cup of a hip replacement last in an eldery patient

Answer 11

cup- 15 years

stem- 20 years

Question 12

what decides whether or not a THA should be done

Answer 12

level of pain and disability of the patient- and if conservative treatment fails to control symptoms

Question 13

what are the conservative measures for hip pain

Answer 13

simple analgesics, physio, use of stick, weight reduction, modification of activities

Question 14

how can a patients level of pain be determined

Answer 14

asking about analgesic use, rest pain, sleep disturbance

Question 15

how can level of disability be assessed

Answer 15

ask about walking distance, activities of daily living (dressing, bathing), impact on hobbies

Question 16

what are the early local complications of a THA

Answer 16

infection, dislocation, nerve injury (sciatic nerve), leg length discrepancy

general surgery complications- MI, chest infection, UTI, blood loss, hypovolaemia

Question 17

what are the late complications of a THA

Answer 17

early loosening, late infection (haematogenous spread from a distant site), late dislocation

Question 18

what is a revision hip replacement

Answer 18

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)

Question 19

what are the implications of doing a total hip replacement in a younger patient

Answer 19

have a higher risk of requiring revision hip replacement- put more demand on their replacement- delay for as long as possible

Question 20

what can cause avascular necrosis of the hip

Answer 20

primary, idiopathic

secondary: alcohol abuse, steroids, hyperlipidaemia, thrombophilia

Question 21

what do patients present with in AVN

Answer 21

groin pain

Question 22

what is pre radiographic AVN

Answer 22

when early cases only show changes on MRI

Question 23

what do late cases of AVN show on x ray

Answer 23

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

Question 24

why might the femoral head collapse in AVN

Answer 24

with the irregularity of the articular surface and subsequent secondary OA

Question 25

once the femoral head has collapsed in AVN what is the treatment

Answer 25

THR

Question 26

what is the treatment for AVN when detected early (pre-collapse)

Answer 26

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

Question 27

what is a common tendon tear in the hip and why does it happen

Answer 27

the broad tendinous insertion of the abductor muscles (mostly gluteus medius)

is under considerable strain and is subject to tendonitis and degeneration

Question 28

what is gluteal cuff syndrome

Answer 28

tear of tedinosus insertion of the abductor muscles +/- inflammation of trochanteric bursa (trochanteric bursitis)

Question 29

how does trochanteris bursitis/ gluteal cuff syndrome present

Answer 29

pain and tenderness in the region of the greater trochanter with pain on resisted abduction

Question 30

what is the treatment for trochanteric bursitis/ gluteal cuff syndrome

Answer 30

analgesia, anti-inflammtories, physio, steroid abduction

no surgical option