Hip Flashcards
(31 cards)
What is femoroacetabular impingement syndrome (FAI)?
Altered morphology of femoral neck or acetabulum, causing pain during movement
What are the three hip movements most commonly affected in FAI
FADIR
- Flexion
- Adduction
- Internal rotation
Compare CAM type and Pincer type impingement in FAI
CAM - femoral neck deformity, usually young, athletics males
Pincer - acetabular deformity, usually females
What condition is commonly related to a CAM type FAI?
Previous SUFE
What are the effects of FAI
- Damage to labrum & cartilage
- Increased risk OA in future
FAI clinical presentation
- Activity related pain in the groin
- Difficulty sitting
- C sign positive
- FADIR provocation test positive
FAI Investigations
- XRay or CT
- MRI to visualise damage to labrum & cartilage
FAI management
- Asymptomatic ⇒ Observation
- CAM type? ⇒ Surgical removal +/- labral tear debridement
- Pincer type? ⇒ Osteotomy +/- labral tear debridement
- Secondary OA ⇒ Arthroplasty
AVN hip Risk factors/ Aetiology
- Alcohol, steroids
- Haematological disease, hyper-coagulable states
- Trauma, decompression disease
OR Idiopathic
AVN can be caused by trauma & injury of femoral head blood supply. Which artery supplies the femoral head?
Medial femoral circumflex
AVN hip Clinical presentation
- Insidious onset of groin pain
- Pain exacerbated by stairs or impact
Describe the examination findings of an individual with AVN of the hip
Examination usually normal (unless advanced to collapse/ OA)
AVN hip Investigations
MRI - Most sensitive & specific, will show changes in any stage of disease
X-ray - Often normal in early disease
Describe the X-ray findings of AVN hip in lateral stage disease (where visible on XRay)
- Patchy slecorsis of femoral head weight bearing area
- Lytic zone underneath
- ‘hanging rope sign’
In what two hip conditions will an X-ray show a ‘hanging rope sign’
- AVN of hip
- Perthes disease
What distinguishes reversible to irreversible AVN
- Reversible - articular surface not collapsed
- Irreversible - articular surface has collapsed
Reversible AVN hip management options
- Bisphosphonates (non-surgical)
- Core decompression +/- bone graft (most common surgical)
- OR curettage and bone grafting
- OR vascularised fibular bone graft
Irreversible AVN hip management options
- Total hip replacement (most common surgical)
- OR (if <15% femoral head damaged) rotational osteotomy
Idiopathic transient osteonecrosis of the hip (ITOH) pathophysiology
- Local hyperaemia & impaired venous return
- bone marrow oedema & increased intramedullary pressure
- osteonecrosis & temporary bone loss
- progressive groin pain & difficulty weight bearing
Who are the two groups of people more commonly affected by ITOH?
- Middle aged men
- Pregnant women, third trimester
ITOH clinical presentation
- Progressive groin pain (over several weeks)
- difficulty weight bearing & walking
ITOH investigations (first line & gold standard)
First line
- Bloods - Raised inflammatory markers
- X-ray - osteopenia, thin cortices, preserved joint space
Gold standard
- MRI
Other
- Bone scan
ITOH XRay findings
- Osteopenia of femoral head & neck
- Thinning of cortices
- preserved joint space
ITOH management
- Self limiting, resolved over 6-9 months
- Analgesia & e.g. crutches (prevent stress fractures)
