Cortex- Lower limb: Hip Flashcards

1
Q

hip pathology typically produces pain felt where- why

A

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

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2
Q

what else can cause buttock pain

A

lumbar spine and SI joint problems

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3
Q

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

A

SUFE

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4
Q

what might be the first clinical sign of hip pathology

A

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

pain may be exacerbated by rotational movements

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5
Q

what produces a trendellenberg gait or sign

A
altered hip biomechanics 
weakness from chronic disuse 
abductor weakness (gluteus medius and minimus)
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6
Q

what is shortening of the lower limb seen in

A

severe OA, perthes, SUFE, AVN, fracture

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7
Q

what else can cause groin pain

A

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

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8
Q

what pathologies often need total hip arthroplasty or total hip replacement

A
primary OA, 
arthritis due to RA,
seronegative inflammatory arthropathy,
AVN,
dysplasia,
perthes,
SUFE
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9
Q

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

A

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

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10
Q

why will a THA ultimately fail

A

loosening of one or both the prosthetic components

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11
Q

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

A

cup- 15 years

stem- 20 years

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12
Q

what decides whether or not a THA should be done

A

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

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13
Q

what are the conservative measures for hip pain

A

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

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14
Q

how can a patients level of pain be determined

A

asking about analgesic use, rest pain, sleep disturbance

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15
Q

how can level of disability be assessed

A

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

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16
Q

what are the early local complications of a THA

A

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

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

17
Q

what are the late complications of a THA

A

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

18
Q

what is a revision hip replacement

A

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)

19
Q

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

A

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

20
Q

what can cause avascular necrosis of the hip

A

primary, idiopathic

secondary: alcohol abuse, steroids, hyperlipidaemia, thrombophilia

21
Q

what do patients present with in AVN

A

groin pain

22
Q

what is pre radiographic AVN

A

when early cases only show changes on MRI

23
Q

what do late cases of AVN show on x ray

A

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

24
Q

why might the femoral head collapse in AVN

A

with the irregularity of the articular surface and subsequent secondary OA

25
once the femoral head has collapsed in AVN what is the treatment
THR
26
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
27
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
28
what is gluteal cuff syndrome
tear of tedinosus insertion of the abductor muscles +/- inflammation of trochanteric bursa (trochanteric bursitis)
29
how does trochanteris bursitis/ gluteal cuff syndrome present
pain and tenderness in the region of the greater trochanter with pain on resisted abduction
30
what is the treatment for trochanteric bursitis/ gluteal cuff syndrome
analgesia, anti-inflammtories, physio, steroid abduction no surgical option