Disorders of the Hip Flashcards
Types of Hip Arthritis
1ary OA –> due to wear on the hip joint
2nary OA –> Developmental diseases, AVN, sickle cell, inflammatory arthritis, infections, traumatic, protrusio, neurological dysfunction
Protrusio
A defect of the acetabulum where the femoral head lies too deep in the pelvis - may be primary or secondary
Can occur unilaterally or bilaterally depending on the cause
Treatment of bony hip dysfunction
Arthrodesis
Osteotomy
Athroplasty
Arthrodesis
Artificially fusing the hip joint - accelerates wear in the surrounding joints (back, contralateral hip and ipsilateral knee)
Was common as pain removing operations but now rarer
Osteotomy
An operation to remove bone to improve the life of the hip –> ideally should be done before the onset of osteoarthritis
Athroplasty
Can be totally or partially or non-cemeted - more reliable but with a limited lifespan. Hybrid THR have a cemented femoral part and a uncemented acetabular part
Coxa vara
A deformity of the hip where the angle between the head and the shaft becomes less than 120 degrees - Coxa valga is when the angle is greater than 135 degrees
Bearing surfaces in Hip replacements
Traditionally metal on polyethylene - in young people can use ceramic on ceramic, metal on metal/cross-linked poly, or oxynium
Resurfacing
THRs have a definite shelf-life so resurfacing is a bone preserving alternative which buys time for the young patient –> stable and with less wear. But there is a risk of femoral neck # and possibly SEs from metal ions
Complications of hip replacements
Infection Loosening it
Dislocation DVT/PE
Limb length inequality Neurovascular injuries
Minimally invasive Hip replacement surgery
Pros –> claims to have short recovery time
Cons –> higher complication rate (infection, malposition, femoral #), life span unclear
Pethre’s Disease
AVN of femoral head in children leading to collapse, deformity, progressive hip and groin pain, stiffness and reduced RoM, M>F (5:1). Has also been associated with small stature, hyperactivity and other congenital abnormalities. onset 4-8yrs. 10% bilateral. Can present as knee pain
SUFE (Slipped upper femoral epiphysis) or SCFE
Most common hip disorder in adolescence - presenting with groin pain, distal thigh pain and difficulty walking - 1/5 is bilateral - young black males - gradual onset pain with reduced RoM (internal rotation) - onset later in boys normally (10-16yrs) Mostly stable (can walk) but 10% unstable (cant walk). bilateral in 20%. Caused by obesity & endocrine dysfunction
CDH (Congential dysplasia of the hip)
1-3% of newborns - 80% girls - 17x risk if breech and 7x if breech CS. Can present at any age (0-2yrs usually) or at screening - may present with reduced RoM or dislocation
Can be bilateral or unilateral - may also have leg length disparities or asymmetric gluteal folds
Hip pain can be referred from?
Spine
Intra-abdominal or hernia
Genitalia
Soft tissue diseases of the Hip
Trochanteric bursitis
Ischial bursitis
Adductor tendinitis
Meralgia paraesthetica
Meralgia paraesthetica
Entrapment of the lateral femoral nerve – purely sensory causing burning or numbness down the upper lateral aspect of the thigh (L2/3)
More common in men, linked to pressure on the lateral thigh or increased abdominal pressure (pregnancy, obesity, ascites) - reproduced by deep pressure below ASIS or leg extension
Trochanteric bursitis
Pain and tenderness over the bursa at the upper, lateral aspect of the thigh – particularly on walking or lying on that side
Causes: trauma, idiopathic, 2nary to gluteal tendon disease (middle aged women), unequal leg length
Adductor tendinitis
Groin pain/tenderness from inflammation of the adductor tendon/insertion - due to trauma or overuse - running and particularly turning at high speed. Pain may be reproduced by squeezing the legs together or abducting the leg. Treat with physiotherapy or rest (should self limit)
Ischial bursitis
Pain/tenderness in the lower buttock when sitting, standing or walking up stairs
Caused by prolonged sitting or impact on the bursa
Treat with physiotherapy or rest (should self limit)
After having a hip replacement
Physiotherapy and home exercises - walking sticks/crutches are usually used for 6wks
Should be one LMWH for the first six weeks
To minimise the risk of Hip displacement
avoid flexing the hip greater than 90 degrees
Avoid low chairs
Dont cross their legs
Sleep on their backs for the first six weeks
Transient idiopathic osteoporosis
A rare condition causing groin pain with reduced RoM in women in the 3rd trimester. Will be unable to weight bare and ESR may be elevated.
Referred lumbar spine pain
femoral nerve compression may cause referred pain in the hip. Femoral stretch test will be positive.
Management of DDH
Most will spontaneously stabilise by 3-6wks. Before 4-5months a Pavlik harness (flexion-abduction orthosis) can be used. After this surgery is needed.
