Disorders Of The Hip

Question 1

Types of osteoarthritis and their causes

Answer 1

Primary - unknown cause
Secondary - obeisity, trauma (sport injures), Malalignment (congenital hip dislocation), infection e.g TB, inflammatory arthritis , metabolic disorders affecting the joints, haematological disorders e.g haemophilia and endocrine abnormalities e.g diabetes with neuromuscular impairment

Question 2

Risk factors of osteoarthritis

Answer 2

Age, female sex, ethnicity, (increased in African American, American Indian or Hispanic), genetic if it runs in family and nutrition (diet rich in vit C and E protect against OA)

Question 3

Symptoms of OA

Answer 3

Aching joint pain
Reduced range of motion
Stiffness during rest

Question 4

Describe the pathology of osteoarthritis

Answer 4

Excessive joint loading leads to damaged hyaline cartilage. Body tries to fix this by increasing proteoglycan synthesis by chondrocytes but as disease progresses this falls nd the cartilage becomes soft and looses elasticity. Eventually it begins to flake and fibrillate. these create rough edges which cause the erosion cartilage to subchondral bone reducing going space. this leads to subchondral sclerosis, subchondral bone cysts and osteophytes

Question 5

What is subchondral sclerosis and osteophytes

Answer 5

Subchondral sclerosis - bone formation as cartilage loss increases (appears dense on X-ray)
Osteophytes - bony projection

Question 6

Describe what you would see on a hip X-ray of someone with osteoarthritis

Answer 6

Reduced joint space, subchondral sclereosis, bone cysts (darkish fluid lumps) and osteophytes

Question 7

Treatment of osteoarthritis of the hip

Answer 7

Weight reduction
Modifying activity so do ones that don’t hurt or using walking stick
Strengthening muscles
Analgesia (paracetamol) and anti-inflammatories
Steroid injections to reduce swelling
Hyaluronic acid injection to increase lubrication and promote cartilage repair
Total hip replacement = BEST OPTION = most quality of life changing surgery

Question 8

What are the 2 types femoral neck fracture and the difference

Answer 8

Intracapsular - blood supply is disrupted (where just head breaks off)
extracpasular - blood supply is maintained

Question 9

What is the risk of a intracapsular break and who is at risk

Answer 9

May lead to avascular necrosis as blood supply is cut off and usallly effects older people who’ve had a fall

Question 10

How to treat an intracapsular break

Answer 10

Surgical replacement of femoral head or total hip replacement

Question 11

What are the symptoms of a broken femoral head

Answer 11

Reduced mobility and pain which may be felt in hip, groin and or knee.
Iffracture is displaced the leg is shortened, abducted and externally rotated and pain when greater trochanter is palpated and when hip is rotated

Question 12

What happens during traumatic dislocation of the hip

Answer 12

Femur is fully displaced out of the cup-shaped acetabulum.

Question 13

What is developmental dysphasia of the hip

Answer 13

Congenital dislocation of the hip or it develops just after birth.

Question 14

What are the symptoms of a person who has traumatic posterior hip dislocation

Answer 14

Extreme pain , limb will be shortened and held in position of flexion, adducation and internal rotation. Sciatic nerve palsy is present in 8-20% of cases.

Question 15

Symptoms of someone who has undergone anterior hip dislocation

Answer 15

Lim is held in a position of external rotation and abduction with slight flexion. Femoral nerve palsies can be present but are uncommon

Question 16

Symptoms of someone who has ha a central hip dislocation

Answer 16

Had of femur is driven into pelvis through acetabulum. It’s always fracture and dislocation. Very high risk of haemorrhage due to pelvic venous Lexuses disruption. Can be life threatening injury