Degenerative hoftelidelser og hoftedysplasi Flashcards

Question

Hip dysplasia, typical patient history?

Answer 1

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

Answer 2

ROM: Normal or hyper-mobility Apprehension: positive in some cases: Apprehension Extended hip- external rotation Impingement: low diagnostic validity: Flexed – adducted hip- internal rotation

Answer 3

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

Answer 4

Non-surgical No validated exercise program Pain killers Reduced activity level Many patients say “I can live with it”

Answer 5

``` 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?

Answer 6

Operationen: Røntgen-gennemlysning, snit i lysken Standard osteotomy

Answer 7

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

Answer 8

Normal Pincer CAM CAM+pincer

Answer 9

Dutch word meaning “cog” (tak på tandhjul)) - Abnormal femoral head radius - Low head neck offset (predisposing)- Pistolgrip

Answer 10

Acetabular retroversion Acetabular protrusion & profunda Local increased anterior coverage

Answer 11

Definition: - Posterior oriented opening of acetabulum. Ætiologi: - Congenital and developmental dysplasia. - Alone or in combination with general hip dysplasia - Posttraumatic

Answer 12

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

Answer 13

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

Answer 14

Increased risk of osteoarthrosis. "The role of acetabulum geometry and femoral head-neck ratio in the development of osteoarthritis in young men"

Answer 15

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

Answer 16

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

Answer 17

``` Fittness Running Handball Soccer Tennis Etc. ```

Answer 18

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

Answer 19

Positive impingement test Reduced range of motion: flexion Asymmetry

Answer 20

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

Answer 21

Cross-over / figure of eight sign Posterior wall sign Ischial spine sign --> CT-scanning Opening posterior

Answer 22

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

Answer 23

Persistent pain Reduced range of motion Positive impingement test No or slight osteoarthrosis Clear radiologic diagnose Willingness to undergo surgery

Answer 24

Open Arthroscopically

Answer 25

Standard osteotomy + wedge osteotomy on illium Reorientation - Flexion - Internal rotation

Answer 26

``` 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

Answer 27

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

Answer 28

Fjerne udløsende faktorer Udstrækningsøvelser Smertestillende medicin Steroid-Blokade

Answer 29

Z- plastik Fjernelse af bursa

Answer 30

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

Answer 31

Mobilisering med to krykkestokke med fuld belastning Ingen aktiv abduktions træning i 6 uger Sport og evt. udstrækning efter ca. 3 måneder

Answer 32

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