Hip Flashcards
List four ‘red flags’ of hip symptoms
- Severe nocturnal pain
- Inability to weight bear
- History of malignancy with hip pain
- Rapid deterioration of hip symptoms
What is greater trochanteric pain syndrome?
- A regional pain syndrome
- Chronic intermittent pain around the greater trochanter
- Inflammation/trauma in muscles, tendons, fascia or bursa
List two clinical features of greater trochanteric pain syndrome
- Lateral hip pain
- Point tenderness adjacent to greater trochanter
- Positive trendelenburg test
What is the initial management of greater trochanteric pain syndrome?
- Reassurance condition is usually self-limiting
- Lifestyle
- Activity modification
- Ice pack applied for 10-20min
- Weight loss
- Paracetamol and NSAIDs
- Peri-trochanteric corticosteroid injection
- Physiotherapy
Outline the types of femoroacetabular impingement (FAI)
- CAM: abnormal femoral head
- Pincer: abnormal extension of acetabulum
- Mixed: both CAM + Pincer types
State three clinical features of femoroacetabular impingement
- Activity related groin or hip pain
- Difficulty sitting
- Mechanical symptoms
- locking, giving way, catching
- Reduced hip flexion: esp with internal rotation
- Externally rotated limb
What test can be used to diagnose femoroacetabular impingement?
Anterior impingement test
Positive: anterior hip pain present on flexion, adduction, internal rotation.
Outline the treatment of femoroacetabular impingement?
- Observation: if minimally symptomatic with no mechanical symptoms
- Arthroscopic hip surgery
- Open surgical hip dislocation + osteotomy
- Periacetabular osteotomy: improves coverage of femoral head
- Total hip arthroplasty: age >60 with end-stage hip degeneration
Which artery supplies the majority of blood supply to the femoral head?
Medial femoral circumflex artery
Name three risk factors specific for femoral head AVN
- Alcohol
- Steroids
- Trauma
- Femoral neck fracture
- Posterior hip dislocation
- Transplant surgery
- Liver disease
- Sickle cell disease
Describe the illness course of AVN of femoral head
- May initially be asymptomatic
- Symptomatic as femoral head begins to collapse
- Uniform progression if untreated
- Cartilage initially intact as it receives nutrients from the synovial fluid
- Breaks down when underlying bone collapses
What features on examination suggest femoral head collapse?
- Pain with internal rotation
- Clicking of the hip
- Reduced range of motion
Request one imaging modality for suspected AVN of femoral head
- MRI hip: Gold standard
- AP and lateral x-ray of hip: may be normal
- Always image contralateral hip due to bilateral involvement in 40-80% of cases
Outline the treatment options for AVN of femoral head
- Footwear and walking aids
- Education, sitting position
- Treat any underlying factors
- Bisphosphonates
- Stages I-II (before collapse): core decompression
- Reduces intraosseous pressure
- Promotes new bone formation; angiogenesis
- Stages III-V (collapsed): arthroplasty
What is Crescent sign of the femur?
Subchondral lucency at the femoral head
Indicates imminent articular collapse requiring arthroplasty
Defines Stage III AVN of femoral head
Describe three clinical features of osteoarthritis of the hip
- Chronic history of groin ache
- Exacerbated by exercise and relieved by rest
- May radiate to knee
- Stiffness after rest, with later difficulty reaching toes
- Abnormal gait: positive Trendelenburg test
- Leg usually externally rotated and adducted, fixed flexion
