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K2 - Reumatologi & Ortopædi > 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

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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
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3
Q

Tænk på differentialdiagnoser im. hoftelidelser

A

Rygsygdomme

Arteriel insufficiens

Hernie

Abdominalt / Gynækologisk

Inflammatoriske lidelser

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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)

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5
Q

Den objektive undersøgelse af hoften

A

Gangfunktion

Patienten stående

Patienten liggende

  • Den objektive undersøgelse skal være fokuseret
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6
Q

Billeddiagnostiske undersøgelser af hofter

A

Rtg.

Forskellige projektioner

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7
Q

Kunstigt hofteled:

Total hoftealloplastik

A

Indikation

Billeddiagnostisk
udredning

Protesekoncepter

Komplikationer

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8
Q

Indikation total hoftealloplastik

A

Smerter
- Udbydes

Nedsat funktion

Nedsat livskvalitet

Ikke kirurgisk behandling

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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.

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10
Q

Ikke operativ behandling af hofte

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

Ændret fysisk aktivitet

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11
Q

Glucosamin til hoftelidelser

A

Glucosamin virker ikke ved smerter forårsaget af hofteartrose

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12
Q

Smertestillende medicin ved hoftelidelser

A

Paracetamol

Acetylsalicylsyre

NSAID

Morfica

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13
Q

Blokade behandling ved hoftelidelser

A

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

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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

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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
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16
Q

Causes for recurrent hip dislocation

A

Primary total hip alloplastia (THA)

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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

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18
Q

Hoftedysplasi

A

Acetabular dysplasia

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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

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20
Q

Acetabular hip dysplasi - ætiologi?

A

Congenital genuin idiopathic dysplasia

Secundary
 - Congenital hip   
   dislocation  
 - Calve-Legg-  
   Perthes  
 - Epiphysiolysis
 - Fracture in child    
 - Other
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21
Q

Acetabular hip dysplasi - epidemiologi?

A

Radiological : CE<20

Prevalence:
App. 5 % in Denmark

Female / male = 1/1

Bilateral in 50 %

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22
Q

Prognosis for untreated acetabular hip

A

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

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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 (38 decks)

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