Hip Flashcards
where can hip pain radiate and where does it typically present
groin
can radiate to knee - obturator nerve
when does hip pathology purely present as knee pain typically
SUFE
what is the first sign of hip pathology
loss of internal rotation
trendelenburg sign
abductor weakness - superior gluteal nerve
THA
will ultimately fail due to loosening of prosthetic components
loosening is usually due to inflammatory response on the implant-bone surface
when is THA considered
conservative measures (physio, analgesics, use of a stick), weight reduction, activity modification) fail to control symptoms
how can one gage the level of pain during a consultation
ask about analgesic use, rest pain and sleeping disturbance
disability can be determined through walking distance, daily activities and impact on hobbies
revision hip replacement
bigger and more complex surgery- often substantial blood loss
poor functional outcome
doesnt last as long
younger patients have a higher risk of
which patients have a higher risk of revision surgery
younger - longer life and put more demand on hip
which nerve is comonly injured during THA
sciatic nerve
what can cause AVN of femoral head
alcohol, steroid abuse, hyperlipidaemia or thombophilia
imaging of AVN of femoral head
early changes (bone marrow oedema) may show on MRI
later cases show patchy sclerosis of weight bearing areas with granulation tissue from attempted repair
x rays
what is a classic sign seen on x ray of femoral head with AVN
hanging rope sign
what can be done if AVN of femoral head is detected early
drill holes made up femoral neck and into abnormal area to relieve pressure , promote healing and prevent collapse
what can AVN of the femoral head lead to
collapse - can only be treated with THR
secondary OA due to irregular articular surface
gluteal cuff syndrome/trochanteric bursitis
the insertion of the abductor muscles at the greater trochanter of the femur is under considerable strain and subject to tendonitis and degeneration leading to tendon tears
GCS - patient presentation
pain and tenderness in the region of the greater trochanter
pain on resisted abduction
treatment of GCS
analgesis
anti inflammatories
physio
steroid injection
what will an extracapsular fracture of the neck of femur produce
limb shortening and external rotation
(due to pull of iliopsoas muscle no longer resisted by lesser trochanter)
what is there a high incidence of with hip dislocation
other fractures - high energy injury
dislocation of femoral head presentation
limb shortening, adduction, internal rotation
treatment of dislocation
emergency reduction
intenral fixation if large acetabular wall/femoral head fracture
risk of AVN and heterotopic ossification
are posterior or anterior dislocations more common
posterior - sciatic nerve is injured
