Hip

Question 1

Legg calve perthes

Answer 1

Avascular necrosis of the femoral head in the child.
Common association with knee pain
Male>female
Increased incidence in children that have previously suffered of transient synovitis.
Bilateral in 20% of cases
Associations: Trauma, hemachromatosis, alcoholism
Presentations:
Limp with pain and lateral hip and anterior thigh and knee

Question 2

Slipped capital femoral epiphysis

Answer 2

Separation of the proximal femoral epiphysis during adolescence, rapid growth
Mc boys 10-15yo
Displaced, mediately and posteriorly
presentations :
Vague symptoms of pain anterior Laurel groin, eventually, appearing with a limp and medial knee pain
Painful ROM in all directions with a marked, limited, internal rotation and abduction
When hip is flexed, external rotation occurs to protect

Question 3

Transient synovitis

Answer 3

Most common cause of a limp and pain in childhood
Mc 3-10yo boys 2x mc
Inflammation of the hip synovium
Rx: show normal
A self limiting acute inflammatory reaction that most commonly follows an upper respiratory infection, or a history of trauma
-Pain referred into the groin and thigh, restriction, and extension and internal rotation with a temperature 38°
Complications could be AVN

Question 4

Spontaneous osteonecrosis of the femoral head

Answer 4

30-70yo male
Bilateral asymmetrical hip involvement
Subchondral osteolysis-> ache and stiffness, weakness, referred pain->capsular dysfunction
Remodel phase-mushroom cap femoral head ->DJD
Presentations:
Pain in Pathak groin find any gradual increase in intensity reduced ROM and a limp

Question 5

Osteomyelitis

Answer 5

More common and children under the age of 16
Results from a hematogenous spread
Presentations :
Irritability, localized, Limb edema and muscle guarding.
No fever or systemic toxicity present
DDX septic arthritis

Question 6

FAI

Answer 6

Femoral acetabular impingement
This is a mechanical disorder that is linked to LCP, dysplasia, septic hip previous fractures
Activities, such as gymnastics, dancing, and regular sports are linked
Age 20 to 40
Painful with reduced ROM
Associated with DJD

Question 7

Capsulitis of the hip

Answer 7

Similar to adhesive capsulitis in the shoulder
Affects women, 35 to 50 years old
Unknown cause with of stiffness and pain rapid onset
Early stage -> stiffness in capsular pattern
Later stage -> less pain increased ROM
Associated with diabetes, osteoarthritis, and osteoid osteoma