Disorders Of The Hip

Question 1

Describe the initial pathology of osteoarthritis in 2 steps

Answer 1

Excessive/ uneven loading odd joint-> Hyaline cartilage damage

Cartilage swells due to increased Proteoglycans synthesis by chondrocytes (An attempt to repair cartilage)

Question 2

Describe the late pathology of osteoarthritis in 3 steps

Answer 2

1. Proteoglycan content falls-> Flaking and fibrillation-> eroded cartilage and loss of joint space
2. Vascular invasion+increased cellularity (Eburnation)-> Thicker and denser subchondral bone-> Subcondral sclerosis on X-rays
3. Subchondral bone cysts may form due to cystic degeneration, as well as Osteophyte growth

Question 3

Identify 5 risk factors of osteoarthritis

Answer 3

Age
Female sex
Ethnicity 
Genetics
Nutrition

Question 4

Identify 5 symptoms of osteoarthritis

Answer 4

Joint stiffness
Hip pain
Mechanical pain 
Reduced mobility 
Crepitus (Grating sound or crunching sensation upon joint movement)

Question 5

Name 4 signs of Osteoarthritis on an X-ray

Answer 5

Reduced joint space
Subchondral sclerosis
Bone cysts
Osteophytes

Question 6

Define a #NOF (Fractured Neck of Femur)
What are the 2 classifications
What is one of these divided into

Answer 6

Fracture of proximal femur, up to 5cm below the lesser trochanter

Intra and Extracapsular
Extra- Inter and Subtrochanteric

Question 7

Why are Intracapsular fractures likely to cause Avascular Necrosis

Answer 7

Likely to disrupt the Retinacular branches of Medial Femoral Circumflex Artery.

Artery of Ligamentum Teres can’t provide enough blood to head of femur, for metabolic demands

Question 8

How is a Displaced Intracapsular Fracture in an older person usually treated

What are 2 symptoms
How does the affected leg appear usually

Answer 8

Surgical replacement of Femoral Head ONLY
OR
Surgical replacement of Head AND Acetabular Cup

• Reduced mobility/ sudden inability to bear weight on a limb
• Pain in Hip/ Groin/ Knee
• Shortened, abducted, externally rotated

Question 9

Define Hip dislocation

What are 2 ways it can happen

Answer 9

When femoral head is is fully displaced out of acetabulum

Can be congenital
Can be Traumatic (Often in car accidents)

Question 10

What are 3 types of Traumatic Hip Dislocation

How do the affected legs look in each case

Answer 10

Posterior- Adducted, Medially rotated, Flexed

Anterior- Externally rotated, abducted

Central- Femoral head driven into pelvis, and is palpable on rectal examination