Disorders of the hip

Question 1

Osteoarthritis (OA) of the hip is most common in

Answer 1

males over the age of 40 years.

Question 2

presentation of OA of the hip

Answer 2

It usually presents with joint stiffness, mechanical pain in the hip, gluteal and groin regions that radiates to the knee, and reduced mobility.

Question 3

cause of OA of the hip

Answer 3

The primary cause of OA is unknown, but it can occur secondarily to trauma, infection, rheumatoid arthritis and metabolic disorders.

Question 4

Radiological features of osteoarthritis

Answer 4

1. Reduced joint space
2. Cysts noted in bone of femur head
3. Sclerosis of bone
4. Reduced joint space

Question 5

First line treatment for OA of the hip

Answer 5

is over the counter painkillers and lifestyle changes to increase fitness and lose weight.

Eventually, a hip replacement may be needed.

Question 6

Anatomy of femoral head

Answer 6

Question 7

Neck of Femur Fracture

Answer 7

The neck of the femur connects the head of the femur to the shaft. Neck of femur fractures can be divided into two categories – intracapsular and extracapsular.

Question 8

sympotoms of NOF

Answer 8

• Reduced mobility/ sudden inability to bear weight on the limb
• Pain which may be felt in the hip, groin or knee

Question 9

signs of NOF

Answer 9

• Short/ externally rotated

Due to muscles contracting and pulling gluteal and quad

Question 10

Intracapsular fractures most common in

Answer 10

are more common in women and the elderly (those with osteoporosis, which is most common in these demographics).

Question 11

presenation of intracapsular fracture

Question 12

Hip fractures (neck of femur) are defined as

Answer 12

as a fracture of the proximal femur, up to 5cm below the lesser trochanter.

Question 13

intracapsular fractures found between

Answer 13

the greater trochanter and the femoral head

Question 14

extracapsular fractures are divided into

Answer 14

intertrochanteric and subtrochanteric

Question 15

which is more dangerous: intracapsular fracture or extracapsular fracture

Answer 15

intracapsular

The medial femoral circumflex artery is at risk of injury (this risk is increased if the fracture is displaced) and damage to this artery can cause avascular necrosis to the femoral head, as it is the main artery that supplies the head of the femur. As a result, it is vital that the blood supply is restored quickly, to prevent permanent damage to the femoral head. Treatment often involves a full or partial hip replacement especially in the elderly.

Question 16

extracapsular fractures most common in

Answer 16

in young/middle-aged people.

Question 17

presentation of extracapsular fracture

Answer 17

They also present with a shortened, abducted and externally rotated leg at the hip due to the distal fragment being pulled upwards and rotated laterally.

Question 18

why is avascular necrosis rare in extracapsular fracture

Question 19

Avascular necrosis

Answer 19

- when the blood supply of the femoral head is disrupted

Question 20

Causes of AVN

Answer 20

• Mechanical disruption (broken hip)
• Alcoholism
• Excessive steroid use
• Post-trauma
• Thrombosis (blood clot)
• Hypertension (high blood pressure)
• Deep sea diving

Question 21

hip dislocation

Answer 21

Dislocation of the hip is defined as the head of the femur being fully displaced out of the cup-shaped acetabulum of the pelvis (less than complete displacement = subluxation). The X-ray below shows a dislocation of the left hip.

Question 22

types of hip dislocation

Answer 22

posterior

anterior

central

Question 23

which type of hip dislocation is most common

Answer 23

posterior (90%)

Question 24

cause of hip dislocation

Answer 24

Causes

• Dislocations may be congenital
• traumatic

Question 25

causes of posterior dislocation

Answer 25

car crash ( caused by injuries similar to the knee impacting on the dashboard in a car accident) and sport injury

The hip joint is a stable joint, with many ligaments to support it, meaning that any dislocation needs to have significant force behind it.

Question 26

presentation of posterior hip dislocation

Answer 26

They present with a shortened, flexed, adducted and internally rotated leg (anterior fibres of gluteus medius and minimus)at the hip.

Question 27

Posterior dislocations are often associated with

Question 28

causes of anterior dislocation

Answer 28

islocations a much less common and the mechanism of injury is usually linked to skiing.

Question 29

presentation of anterior dislocation

Answer 29

They present with a flexed, abducted and externally rotated leg at the hip.

Question 30

what may also be present with an anterior dislocation

Question 31

central dislocation

Answer 31

• Always fracture dislocation
• Femoral head palpable per rectum
• Intrapelvic haemorrhage
  
  • Can be catastrophic –> BP loss

Question 32

hip dislocation treatment