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Musculoskeletal Pathophysiology > Hip > Flashcards

Hip Flashcards

1
Q

What are some common childhood hip disorders?

A
  1. congenital hip dysplasia (CHD)
  2. leg-calve-perthes disease
  3. slipped capital femoral 4. epiphysis
    septic arthritis
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2
Q

Which gender and age prevalence congenital hip dysplasia?

A

females

birth-3 months

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3
Q

What causes congenital hip dysplasia?

A

abnormally lax hip capsule
familial
breech delivery

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4
Q

What are the clinical features of CHD?

A
  1. asymmetrical skin folds at buttocks, adductors
  2. dec hip abduction due to adduction contracture
  3. shortening of dislocated side
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5
Q

What are two special tests for CDH?

A

Barlow test

Ortolani click test

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6
Q

What kind of harness is used for CHD and what does it do?

A

pavlik harness

holds hip in flexion and abduction to allow hip joint to form

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7
Q

How long is pavlik harness used and what is the outcome?

A

6-12 wks 23-24 hrs/day (aka take it off when changing diapers/bathing only)
good outcome when started early

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8
Q

After 3 months, how is CHD treated?

A

may need adductor tenotomy (release adductor tendon origin)

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9
Q

After 5 years, how is CHD treated?

A

ORIF and brace in ABD/flexion

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10
Q

Male to female ratio for legg-calve-perthes disease?

A

5:1

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11
Q

What percent of legg-calve-perthes disease is bilateral?

A

15%

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12
Q

What is legg-calve-perthes disease?

A

self limiting idiopathic osteonecrosis of the femoral head

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13
Q

What is the bone age associated with legg-calve-perthes disease?

A

1-3 years behind true age

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14
Q

What age children tend to have legg-calve-perhes disease?

A

average is 7 yo

4-13 years

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15
Q

Describe the disease process of legg-calve-perthes disease.

A
  1. initial loss of blood supply to capital femoral epiphysis
  2. revascularization and resumption of ossification
  3. subchondral fx and second ischemic episode
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16
Q

How does the femoral head appear with LCPD on X-ray?

A

smaller femoral head initially

later femoral head destruction (may see crescent sign of subchondral collapse)

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17
Q

What are early signs of LCPD?

A

antalgic gait
hip/groin/knee pain
hip adductor spasm

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18
Q

What are later signs of LCPD?

A

trendelenburg or compensated gait pattern

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19
Q

Describe the stages of LCPD:

A

necrosis
fragmentation
re-ossification
remodeling

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20
Q

What orthoses is used for LCPD?

A

scottish rite orthosis or toronto orthosis
Holds hip in IR and ABD
18-24 months

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21
Q

What are 2 surgical treatments for LCPD?

A

Varus Derotation Osteotomy (immobilize 6 weeks)

Adductor tenotomy

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22
Q

outcomes

A

side 20

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23
Q

What is SCFE?

A

slipped capital femoral epiphysis

Salter-Harris 1 epiphyseal slip

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24
Q

How does SCFE sublux?

A

post/inferior due to flattened femoral head

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25
Q

incidence

A

slide 22

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26
Q

intervention

A

slide 25

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27
Q

What age for septic hip arthritis?

A

usually < 2 years

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28
Q

What are the clinical features of septic hip arthritis?

A

Temperature
Irritability
LE held in LPP (flex/ABD/ER)
Pain with movement and with palpation in hip area

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29
Q

What is septic hip arthritis?

A

rapidly progressing hip joint infection with considerable joint effusion

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30
Q

How is septic arthritis treated?

A

aspirate joint quickly
antibiotics
may need spica cast

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31
Q

What are the common sites for hip area avulsion fx in youth?

A

AIIS - rectus femoris
ASIS - sartorius
Greater trochanter - abductors insertion
Lesser trochanter - iliopsoas

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32
Q

What is hip area avulsion fx in youth secondary to?

A

trauma and overuse

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33
Q

What are clinical features of avulsion fx?

A

pain at bony landmark

muscle weakness

34
Q

How is avulsion fx managed?

A

ORIF with wires

35
Q

What are common adult hip joint dysfunctions?

A
  1. arthritis
  2. avascular necrosis
  3. trauma (fx and disclocations)
  4. soft tissue injuries (bursitis, strains)
36
Q

What percent of THR are done for RA?

A

2%

37
Q

What is common hip RA usually treatment?

A

mostly medication

38
Q

Which surfaces of the hip are usually destructed with OA?

A

WB surfaces:

  1. femoral head (posterior and superior surfaces)
  2. acetabulum
39
Q

What are the clinical features of OA at the hip?

A

antalgic gait
limited ROM in capsular pattern
pain with WB

40
Q

Hip OA early intervention?

A

NSAIDS, acetaminophen
assistive devices
AROM
Light resistance training as tolerated

41
Q

Hip OA surgical options?

A
  1. arthroplasty (most common)
  2. osteotomy
  3. arthrodesis (fusion - salvage procedure)
42
Q

Describe the osteotomy procedure for hip OA:

A

usually VARUS; take wedge from medial femoral shaft to change WB surface (usually performed on younger patients)

43
Q

Pros and cons of cemented THR?

A

PRO: immediate WBAT
CON: cement may loosen

44
Q

Pros and cons of non-cemented THR?

A

PRO: lower failure rate, little loosening
CON: restricts early WB status to PWB for 6-12 wks

45
Q

What are the 3 most common surgical approaches to THR?

A

posterior (most common)
anterolateral
trans-trochanteric

46
Q

Describe posterior precautions:

A

AVOID the following to prevent dislocation

  1. Hip flexion past 90*
  2. ADDuction past midline
  3. IR past neutral
47
Q

Describe anterolateral precautions:

A

RESTRICTIONS

  1. Extension
  2. ADD
  3. ER
48
Q

With ______ THR approach, dissect through gluteus medius.

A

anterolateral

49
Q

Describe trans-trochanteric precautions:

A

RESTRICTIONS

  1. Extension
  2. ADD
  3. IR

LIMIT early active abduction until trochanter heals

50
Q

With trans-trochanteric THR approach, osteotomize the _____.

A

greater trochanter

51
Q

What types of patients have higher failure rates with THA?

A

men

its who weigh > 165 lbs

52
Q

The chance of hip replacement lasting 20 years is approx. __%.

A

80

53
Q

What is the role of PT in THR?

A 
bed mobility
transfer training
gait training with device
ROM
muscle performance
54
Q

What are the pros to minimally invasive arthroplasty?

A

1-2 small incisions
shorter hospital say
less post-op pain

55
Q

What are common THR complications?

A 
infection
DVT
dislocation
loosening of cement
fracture of femoral shaft near stem
56
Q

What is the position of hip arthrodesis?

A

neutral abduction
0-30* ER
20-25* flexion

57
Q

What are the precautions for hip arthrodesis?

A

AVOID
abduction
IR

58
Q

The position of hip arthrodesis is designed to minimize _________ which helps minimize pain.

A

excessive lumbar spine motion and opposite knee motion

59
Q

Age/gender prevalance for osteonecrosis of hip in adults?

A

30-70 yo

male > female

60
Q

Subchondral bone death occurs secondary to:

A

ischemia

61
Q

What are sources of AVN?

A 
blood supply interruption secondary to hip fx
long term corticosteroid use
ETOH abuse
decompression injuries from scuba diving
sickle cell disease
SLE (Systemic lupus erythamtosis)
62
Q

Early radiological evidence of AVN of femoral head:

A

more lucent as bone dies

63
Q

Common sites for AVN?

A

femoral head
scaphoid (prox fx)
talus

64
Q

What are clinical signs of AVN at the hip?

A

inner thigh pain

antalgic gait

65
Q

Later radiological evidence of AVN of femoral head:

A

crescent sign

indicative of subchondral bone death and collapse

66
Q

Hip AVN surgical treatment options?

A

drill core into bone and graft
varus osteotomy
hip arthroplasty

67
Q

Acetabular fx is most associated with:

A

posterior hip dislocation

AKA dashboard dislocation

68
Q

What is the likely position of the femur on impact with acetabular fx?

A

Femur is ADD/IR on impact

69
Q

What is the treatment for acetabular fx?

A

skeletal traction then PWB

70
Q

Intracapsular capital femoral fx is usually due to:

A

osteoporosis

71
Q

Intracapsular femoral neck fx is usually due to:

A

trauma

72
Q

Intracapsular femoral neck fx surgical treatment for impacted vs displaced:

A

impacted: ORIF with pin
displaced: ORIF with dynamic screw

73
Q

What % incidence of AVN with intracapsular femoral neck fx?

A

25%

74
Q

Intertrochanteric (extracapsular) fx treatment:

A

ORIC with dynamic screw (most are comminuted and heal without complication)

75
Q

Acetabular labral tear management:

A

NSAIDS
cortisone
arthroscopic repair if limited fxn

76
Q

How to acetabular labral tears present?

A

twisting injury with immediate pain
pain with hip flexion
catching, clinciking, locking

77
Q

Gluteal bursitis pain with:

A

location: buttocks

pain with resisted hip extension

78
Q

Iliopectineal bursitis location and pain provocation:

A

location: between psoas and anterior hip joint

pain with resisted hip flexion

79
Q

Trochanteric bursitis pain provocation:

A

pain posterolaterally with resistance into ABD

80
Q

Hamstring muscle strain often secondary to:

A

eccentric loading

Musculoskeletal Pathophysiology (14 decks)

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