Hip

Question 1

Angle of inclination

Answer 1

-angle between head and shaft of femur

coxa vara <120 deg

normal 120-135 deg

coxa valga > 135 deg

Question 2

Hip ligaments

Answer 2

iliofemoral ligament- from AIIS to intertrochanteric line. Taut in extension. promotes stabilization in erect posture.

pubofemoral ligament- from inf acetabular rim to inf femoral neck. Helps limit abd and ext

ischiofemoral- ischial portion of acetabulum to fem neck. Prevents excessive ext and IR of hip jt

Question 3

Children pathologies

Answer 3

transient synovitis

legg-calve-perthes (avoid weight bearing-avascular necrosis)

juvenile rheumatoid arthritis

septic arthritis, septic bursitis, osetomyelitis

Question 4

Teenager pathologies

Answer 4

Slipped capital femoral epiphysis

Snapping hip syndrome

Femorofacetabular impingement (use arthrogram for impinge)

Question 5

Adult pathologies

Answer 5

osteoarthritis

osteoporosis

Question 6

Routine radiographs of pelvis/hip

Answer 6

pelvis- AP projections which shw entire pelvis, sacrum, coccyx, and lumbosacral articulations, and bilateral hip joints.

unilateral hip- AP and lateral frog leg

Question 7

AP pelvic projection

Answer 7

used for: bilateral comparison of hip joints, identify trauma, and identify need for unilateral hip radiograph.

Can show fracture, dislocation, or pathology

Look for: ABCs

Question 8

AP hip projection

Answer 8

hip jt, lesser trochanter, cortical margins of femoral shaft (bone density-looking for stressed areas)

normal ball and socket configuration seen

can see avascular necrosis, RA, DJD, and destructive tumors

Question 9

Lateral from leg

Answer 9

view: hip positioned in flx, ER, and lateral abd

the lesser trochanter is now seen in profile

Question 10

Basic MRI indications for the hip

Answer 10

osteonecrosis of fem head, MARROW abnormalities, fractures, childhood hip disorders and their adult sequelae, FAI, acetabular labral tears, musculotendinous disorders and assoc bursitis, athletic pubalgia, osteochondral anormalities, sacral plexus abnormalities

T1- weighted sequence to define anatomy (darker)
T2-weight sequence to detect abnormal fluid and thus highlight pathology (white)

ABCDs

Question 11

Basic CT protocol for the hip

Answer 11

assessment of severe trauma, assess alignment and displacement of fracture fragments, identify loose bodies in jt, eval fractures of acetabulum or sacrum, eval bone alignment, eval any condition contraindicated by MRI

axial slices, sagittal and coronal places

ABCs

Question 12

MSUS indications of the hip

Answer 12

detect soft tissue injury, visualize capsule/synovium, and bursa, define ligament/muscle/or tenson, eval soft tissue massses, identify loose intra-articular bodies, differentiate effusion, guide needle, eval anormalities

Question 13

Fracture of proximal femur

Answer 13

Can occur from osteoporosis and falls

Radiographs with AP and lateral views most appropriate. MRI can be used for stress fractures.

Question 14

Hip dislocation

Answer 14

Can occur from falls, trauma, MVA

90% occur posteriorly

AP pelvic radiographs most appropriate. Post hip dislocations the fem head appear smaller.

CT scans can be obtained after closed reduction to assess the femoral head and congruency

Question 15

Degenerative joint disease (osteoarthritis)

Answer 15

Pain and loss of motion

Radiograph findings: jt space narrowing, sclerotic subcondral bone, osteophyte formation of jt margins, cyst or pseudocyst formation, and migration of fem head

Question 16

Rheumatoid arthritis of the hip

Answer 16

radiographs and MRI for more detailed imaging

deminerzliazation of femoral head, jt space narrowing, axial migration of fem head into acetabulum, and articular loss of ball and socket jt configuration

Question 17

Avascular necrosis of proximal femur

Answer 17

Interruption of blood supply to the femoral head, causing bone tissue death

Can be associated with femoral neck fractures posttraumatically

AVN is expressed as Legg-Calve_perhtes disease

LCP is common in young boys (avg 6 yrs)

Radiographs may appear normal in initial stages. Advanced stages show collapsed femoral head from structural weakness and inability to withstand weight bearing.

MRI most appropriate for early SENS and SPEC in diagnosing AVN

Question 18

Slipped Capital Femoral Epiphysis (SCFE)

Answer 18

Postero-medio-inferior displacement of the proximal femoral epiphysis.

Childhood and adolescence

Radiographs will show the amount of slippage present

AP projection shows burring and widening of the physis and dec height of epiphysis relative to contralateral hip

Lateral frog leg projection shows amount of epiphyseal displacement

Question 19

Development of Hip dysplasia (DDH)

Answer 19

malformation of the hip found a birth or younger children beginning to walk

Usually affects the left hip of girls most often

MRI or ultrasound very vaulable for DDH in infant. Deformation of the acetaulum and femoral head can be well visualized prior to ossificiation

Question 20

Femoral acetabular impinegment

Answer 20

abutment of the femoral head with the acetabulum

Cam (fem head-neck junction) and pincer (overcoverage of fem head by acetabulum(

Pelvic and hip radiographs assessed first

MR arthrography is used to assess labral tears