Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

K2 - Reumatologi & Ortopædi - Katrine egne redigeret > Degenerative hoftelidelser og hoftedysplasi > Flashcards

Degenerative hoftelidelser og hoftedysplasi Flashcards

1
Q

Ikke traumatiske hoftelidelser hos voksne

A

Degenerative / inflammatoriske lidelser *

Følger efter børnesygdomme

Medfødte lidelser *

Impingement tilstande - labrumskader *

Bløddelsproblemer: Bursitis trochanterica, springhofte *

Infektiøse lidelser

Knogle nekrose

Neurologiske lidelser: parese- spasticitet

Tumores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptomer ved hoftelidelser

A

Smerter / ømhed

Klik

Aflåsning, svigt

Udtrætning

Nedsat bevægelse

Nedsat funktion: ADL
Gang, løb, cykling,
svømning, golf,
anden sport, etc

Tab af arbejdsevne

Nedsat livskvalitet

  • Anamnesen skal give anledning til tentative diagnoser, der afprøves ved den objektive undersøgelse
    og ved parakliniske undersøgelser
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tænk på differentialdiagnoser im. hoftelidelser

A

Rygsygdomme

Arteriel insufficiens

Hernie

Abdominalt / Gynækologisk

Inflammatoriske lidelser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptomatologien ved hoftelidelser?

A

Hoftesmerter/ømhed
- Hvor er
hoftesmerter
lokaliseret ?
- Lyske
- Trochantor
major
- Sæde region
- Lår
- Knæ
- Crus

  • Karakte?
    • Pludselige uden
      traume?
    • Natlige?
    • Hvile eller
      belastnings
      relaterede
      smerter?
    • Uprovokerede?
    • Bedst i
      bevægelse?
    • Smerte triade?
      • Igangsætnings
        smerter
      • Smertefri
        periode
      • Tilbagevende
        af smerter

Smerte score: VAS, Verbal rating scale (VRS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Den objektive undersøgelse af hoften

A

Gangfunktion

Patienten stående

Patienten liggende

  • Den objektive undersøgelse skal være fokuseret
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Billeddiagnostiske undersøgelser af hofter

A

Rtg.

Forskellige projektioner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Kunstigt hofteled:
Total hoftealloplastik

A

Indikation

Billeddiagnostisk
udredning

Protesekoncepter

Komplikationer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indikation total hoftealloplastik

A

Smerter
- Udbydes

Nedsat funktion

Nedsat livskvalitet

Ikke kirurgisk behandling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Behandling af hofter

A

Afhænger af smerteintensitet. Ved slemme smerter overvejer man superviseret kirurgi og non kirurgiske interventioner så som injektioner, NSAID, fysioterapi osv.

Hos de mere milde cases anbefaler man selvhjælp, simple analgesics, topicale agenser, livsstilintenvention og nutraceuticals og ellers information og råd, dannelse i god livsstil osv. Alle får sidstnævnte form for hjælp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ikke operativ behandling af hofte

A

Effekt af træning
- Artrose skole /
information
- Træning og
bevægeapparatslidelser - Træning og operation

Ændret fysisk aktivitet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Glucosamin til hoftelidelser

A

Glucosamin virker ikke ved smerter forårsaget af hofteartrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Smertestillende medicin ved hoftelidelser

A

Paracetamol

Acetylsalicylsyre

NSAID

Morfica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Blokade behandling ved hoftelidelser

A

10 ml 2% lidocain intraartikulært
Depomedrol 40 mg
Adgang: lateral vejledt af ultralyd/røntgengennemlysning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Protesekoncepter til hoftelidelser

A

Ucementeret: < 70 år

Cementeret: > 70 år

Hybrid: Særlig indikation

Ucementeret:
- Umiddelbar
mekanisk
fiksation
- Efterfølgende
biologisk
forankring

Cementeret:
- Umiddelbar
fiksation ved
cementen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Komplikationer ved hoftealloplastik

A

Tidlige:
- Benlængde forskel
- Nervepåvirkning
(peroneus)
- Infektion
(overfladisk og
dyb): <1%
- Luksation (Bagud
og fremad): ca. 1-5
%
- Trombose - emboli
- Fraktur
(Peroperativ): ca. 1%

Sene:
- Aseptisk løsning
- Slid af
komponenter
- Infektion (Dyb)
- Luksation
- Fraktur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes for recurrent hip dislocation

A

Primary total hip alloplastia (THA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of recurrent THA dislocation

A

Conservative procedures:
- Instructions in
relevant
precautions
- Aids and orthoses

Type B. Fracture around stem or just below the tip of the stem
B2: loose stem, adequate bone stock

B2: loose stem, adequate bone stock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hoftedysplasi

A

Acetabular dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acetabular hip dysplasi - definition?

A

Steep roof (sourcil):
AIA - angle
Abnormal: Steeper than 10 degrees

Reduced lateral coverage of the femoral head:
CE - angle
Abnormal: less than 20-25 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Acetabular hip dysplasi - ætiologi?

A

Congenital genuin idiopathic dysplasia

Secundary
- Congenital hip
dislocation
- Calve-Legg-
Perthes
- Epiphysiolysis
- Fracture in child
- Other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Acetabular hip dysplasi - epidemiologi?

A

Radiological : CE<20

Prevalence:
App. 5 % in Denmark

Female / male = 1/1

Bilateral in 50 %

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prognosis for untreated acetabular hip

A

Patients with hip dysplasi has a know predictable risk of developing osteoarthritis untreated (CE<20)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why should joint preserving surgery be
considered?

A

Total hip replacement is associated with increase risk of reoperation in younger patients

Total hip replacement is associated with increase risk of reoperation in younger patients: Danish Hip Arthroplasty Register
Hip survial ; 1. time revision all causes

24
Q

Hip dysplasia: The diagnose

A
  • Patient history
  • Physical
    examination
  • X-ray

Patient historie:
- Suspect hip
dysplasia in
younger patients
and patients without
osteoarthrosis

  • Do not trust
    radiologists or other
    colleagues
  • You have to know
    what you are
    looking for
25
Q

Hip dysplasia, typical patient history?

A

Debut: 30 (15-60) years of age

Pain
- Activity: Mild groin
pain; C-sign- later
severe pain- VRS
5-8 (0-10))
- Weakness in the
end of the day
- Sharp pain in the
groin (labrum)
- Later pain during
rest and night

Other symptoms:
- Click, locking or
sensation of giving
way (labrum)

Reduced level of activity:
- Jogging, hiking,
soccer, shopping

Sick leave

Reduced quality of life

26
Q

Hip dysplasia - Physical examination

A

ROM: Normal or hyper-mobility

Apprehension: positive in some cases:
Apprehension
Extended hip-
external rotation

Impingement: low diagnostic validity:
Flexed – adducted
hip- internal
rotation

27
Q

Hip dysplasia: X-ray

A

AP of the pelvis

Rule out for osteoarthrosis:
- AP of the hip
- False profile
- CT/MRI

28
Q

Hip dysplasia - Treatment

A

Non-surgical

No validated exercise program Pain killers

Reduced activity level

Many patients say
“I can live with it”

29
Q

Hofte dysplasi - Indication periacetabular osteotomy

A

Patient history:
- Pain: VRS score
- Reduced function
- Reduced quality
of life.

Physical examination:
- Free range of
motion

Radiology:
- Acetabular
dysplasia (CE < 25
and AA > 10)
- No osteoarthritis
- Joint congruency :
x-ray abduction
view

Age?

30
Q

Periacetabular osteotomy?

A

Operationen: Røntgen-gennemlysning, snit i lysken

Standard osteotomy

31
Q

Femuro-Acetabular Impingement definition

A

Impingement occurs between acetabulum/labrum and the femoral head-neck junction

32
Q

Typer af impingement?

A

Normal

Pincer

CAM

CAM+pincer

33
Q

CAM - Ætiologi? Og hvad står CAM for?

A

Dutch word meaning “cog” (tak på tandhjul))

  • Abnormal femoral head radius
  • Low head neck offset (predisposing)- Pistolgrip
34
Q

Pincer (Knibtang/To pinch (knibe)), ætiologi?

A

Acetabular retroversion

Acetabular protrusion & profunda

Local increased anterior coverage

35
Q

Acetabular retrovertion - definition og ætiologi?

A

Definition:
- Posterior oriented
opening of
acetabulum.

Ætiologi:
- Congenital and
developmental
dysplasia.

  • Alone or in
    combination with
    general hip
    dysplasia
  • Posttraumatic
36
Q

CAM - epidemiologi?

A

Overall prevalence approximately 17 % in men and 4 % in women

37
Q

Epidemiology: Retroverted acetabulum

A

Of the 201 hips with a cam-impingement deformity, 42% (84) had also a
pincer deformity (retroverted acetabulum)

38
Q

Significance of impingement

A

Increased risk of osteoarthrosis.

“The role of acetabulum geometry and femoral head-neck ratio in the development of osteoarthritis in young men”

39
Q

femuro-acetabular impingement - symptomer?

A

Symptoms, slow onset:
- Pain
- Reduced level of
activity
- Reduced quality
of life

40
Q

femuro-acetabular impingement - symptoms, pain?

A

Groin pain
Greater trochantor
Gluteal region

Pain following physical activity

Pain following or during sports

Pain at rest

Pain at stair climbing

Pain when sitting in deep/low chairs

41
Q

femuro-acetabular impingement - symptoms, Reduced level of activity

A

Fittness
Running
Handball
Soccer
Tennis
Etc.

42
Q

femuro-acetabular impingement - symptoms, Reduced quality of life

A

EQ-5D
Self reported health-related quality of life

Five dimensions:
1. mobility
2. self-care
3. usual activities
4. pain/discomfort
5. anxiety/depression

43
Q

Femuro-acetabular impingement - Clinical findings

A

Positive impingement test

Reduced range of motion: flexion

Asymmetry

44
Q

Radiological evaluation: CAM

A

Alm. rtg.us:
Bækken og hofte incl. axial(lat.)opt.

Lauenstein

45
Q

The retroverted acetabulum in femoro-acetabular impingement

Radiological findings?

A

Cross-over / figure of eight sign

Posterior wall sign

Ischial spine sign

–> CT-scanning
Opening
posterior

46
Q

Treatment Impingement

A

Non-surgical:
- Patient information
and education
- Modification of
activity
- Avoidance of
symptomatic
motion
- Exercise

Surgical:

47
Q

Surgical treatment
Impingement - indikation?

A

Persistent pain

Reduced range of motion

Positive impingement test

No or slight osteoarthrosis

Clear radiologic diagnose

Willingness to undergo surgery

48
Q

Treatment CAM

A

Open

Arthroscopically

49
Q

Periacetabular osteotomy of the retroverted acetabulum in femoro- acetabular impingement

A

Standard osteotomy

+ wedge osteotomy on illium

Reorientation
- Flexion
- Internal rotation

50
Q

Klik / spring ved hofteleddet - årsager?

A

Externe :
- tractus iliotibialis :
coxa saltans
- bursitis
trochanterica
- gluteus maximus

Interne:
- iliopsoas senen
- tenosynovitis
- caput longum
biceps

Intraarticulære:
- Labrum
- mus
- synovitis
- chondromatose
- lig. iliofemorale

Instabilitet:
idiopatisk dynamisk subluksation

51
Q

DIAGNOSE: COXA SALTANS OG STRAM TRACTUS

KLINISKE BILLEDE

A

Obers test for stram tractus iliotibialis
1) Sidelejr
2) Flektion
3) Abduktion
4) Ekstension
5) Adduktion

Test positiv:
Syge side kan ikke adduceres til lejet,
men forbliver passivt abduceret

52
Q

BEHANDLING COXA SALTANS OG STRAM TRACTUS - ikke operativ

A

Fjerne udløsende faktorer

Udstrækningsøvelser

Smertestillende medicin

Steroid-Blokade

53
Q

BEHANDLING COXA SALTANS OG STRAM TRACTUS - operativ

A

Z- plastik

Fjernelse af bursa

54
Q

Procedure: Z-plastik

A

1) Longitudinel hud incision

2) Longitudinel incision i tractus iliotibialis

3) Z:
Proximale ben af z: distalt anteriort

Distale ben af z: proximalt posteriort

4) Lapperne løsnes, mobiliseres og sutureres

55
Q

Procedure Z-plastik - Efterbehandling?

A

Mobilisering med to krykkestokke med fuld
belastning

Ingen aktiv abduktions træning i 6 uger

Sport og evt. udstrækning efter ca. 3 måneder

56
Q

Operation for intern springhofte

A

Tenotomi af psoassenen

Postoperativt:
- Fuld belastning
- Fri bevægelighed
- Træning gradvis
øget aktivitet og
styrke over 6 mdr.

K2 - Reumatologi & Ortopædi - Katrine egne redigeret (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions