CORTEXT 4 - Hip and Knee Flashcards
How does pain in the groin radiate to the knee?
Obturator nerve
What hip pathology purely presents with knee pain?
SUFE
What examination finding is usually the first sign of hip pathology?
Reduced range of movement
Loss of internal rotation
What muscles are affected by Trendellenburg?
Gluteus medius and minimus
What diseases cause shortening of the lower limb?
OA Perthes SJFE AVN Fracture
What diseases cause groin pain?
Hernia Tendonitis Pubic symphysis dysfunction Lumbar disc prolapse (rare) AVN
What treatment will be used for the following treatments:
OA, RA, Seronegative inflammatory arthropathy, AVN, dysplasia, perthes, SUFE
Total hip replacement/Total hip arthroplasty
(they are kind of the same, THA is a wider term and used for e.g. hip resurfacing which technically isn’t a THR as it doesn’t replace the entire femoral head)
Why do we try to avoid THR in young patients
Higher risk of them needing another hip replacement later on in life (called a revision surgery) because they will put more demand on their prosthetic hip compared to the elderly
Revision surgery has more complications and less successful
AVN
What is primary and secondary causes?
Primary = idiopathic Secondary = alcohol, steroid use, hyperlipidaemia or thrombophilia
What do patients clinically present with when they have AVN?
Groin pain
AVN
Ix (and what will you see)
MRI - patchy sclerosis
X-Ray - ‘hanging rope sign’
AVN
Mx (early and late)
Early = Decompression by drilling holes (to relieve pressure) Late = THR
What is trochanteric bursitis/gluteal cuff syndrome?
When the broad tendinous insertion of the abductor muscles (commonly, the gluteus medius) becomes STRAINED so is vulnerable to tendonitis and tendon tears
The trochanteric bursa also become inflamed
Trochanteric bursitis/gluteal cuff syndrome:
Mx
Analgesics Anti-inflammatories Physiotherapy Steroid injection NO SURGERY REQUIRED
The knee joint is one big synovial joint, but what 2 smaller joints does it consist of?
Tibiofemoral and patellofemoral
What do the menisci do?
Shock absorbers
Name the 4 ligaments of the knee joint
Anterior and posterior cruciate ligaments
Medial and lateral collateral ligaments
What movements do the 4 ligaments of the knee resist?
ACL = Internal rotation and anterior translation PCL = Hyperextension and posterior translation MCL = Valgus force LCL = Varus force & External rotation
Advantages and Disadvantages to an osteotomy compared to a total knee replacement or partial knee replacement or conservative management
- When subject to heavy work (manual workers), osteotomy is preferred and will last longer
- Results of osteotomy are less predictable than knee replacement
- The results of a TKR after an osteotomy are inferior to those in an unoperated knee
- Partial knee replacement = higher risk of failure than a TKR
- TKR good for when pain & disability on conservative treatment is too much
Meniscal tears:
Clinical signs + symptoms
Twisting injury
Localized pain to medial/lateral joint lines
Effusion forms next day
‘Catching/locking’ sensation (difficulty straightening their leg)
Difference between locking and pseudo-locking
True locking = meniscal tear
Due to the torn meniscal flipping over and getting stuck in the joint line
Pseudo-locking = Arthritis
Temporary difficulty straightening the leg (usually when standing after sitting for ages). It will spontaneously resolve or patient will describe a ‘trick manoeuvre’ that relieves issue
Typical history of an ACL rupture
Occurs due to a high rotational force (football, skiing, rugby)
A ‘pop’ is heard
Deep pain in the knee
Thereafter, there is rotary instability
O/E, what will you use in an ACL rupture and why?
Swelling due to a haemarthrosis (effusion due to bleeding from the vascular supply to the ACL)
Valgus stress injuries: when do they typically occur?
And on what ligament most commonly?
Rugby tackle from the side
Usually MCL but could potentially also damage ACL
