Hip Flashcards
Describe typical hip pain?
Usually causes pain in the groin which may radiate to the knee
Why may hip pain be felt in the knee?
Due to shared hip and knee sensory supply from the obturator nerve
Apart from the groin and the knee, where else can hip pain be felt? What else can cause pain there?
Buttock - pain here may also be from the lumbar spine and SI joints
In what condition does hip pathology sometimes present purely as knee pain?
SUFE
What may examination of a hip condition show?
Reduced range of movement, loss of internal rotation is often the first clinical sign
What may exacerbate hip pain?
Rotational movements
What can cause abductor weakness?
Altered hip biomechanics or chronic disuse
What may abductor weakness present as?
Positive Trendelenberg test / Trendelenberg gait
In what conditions of the hip might there be shortening of the limb?
Severe OA, Perthes, SUFE or AVN
What are some other causes of groin pain?
Hernias, tendonitis, pubic symphysis dysfunction, high lumbar disc prolapse (L1/2)
What is acetabular dysplasia?
When the femoral head sits more lateral than it should to the acetabulum
Patients with acetabular dysplasia have often had previous treatment for what?
DDH
In conditions such as Perthes or SUFE which have extra protruding bone which is going to jam, when is the hip at higher risk of damage?
When the joint is in high demand
What are some treatment options for conditions which cause protruding bone which jams on movement?
Nothing / arthroscopy (screws) / open repair or shaving
What usually happens in hip joint trauma?
The head is forced out of the joint
Management of altered hip mechanics (e.g. dysplasia) usually involves what?
Osteotomy
How can you treat AVN before there has been any necrosis?
Drill holes into the femoral neck and into the abnormal area of the head to try and relieve pressure
What is the management for AVN after there has been necrosis?
THR
What non-surgical options must be explored for hip arthritis before surgery can be considered?
Weight loss, analgesia, physiotherapy
What treatment can be useful in those whose hip arthritis is causing lower back/hip pain?
Steroid injections
Most patients who undergo THR are what age?
> 65
What are 4 criteria for undergoing THR?
Reduced walking distance, uncontrolled pain, night pain, impairment of activities of daily living/hobbies
What are the outcomes of THR?
Usually really good. Gets rid of pain, proprioception isn’t really an issue. May also improve stiffness but this is not a primary indication.
If a THR cannot be done for hip arthritis, what could be tried instead?
Resurfacing
What is the difference between THA and THR?
They are almost the same, except that THA is a slightly broader term including procedures such as resurfacing which don’t technically replace the hip
What are the gold standard materials for THR?
Cemented metal on polyethylene
Any THA will ultimately begin to fail as a result of loosening. In a low demand, older patient, how long should this last before failing?
15 years (cup) and 20 years (stem)
Why do the components of a THA loosen?
Wear particles on the surface cause an inflammatory response at the implant/bone interface. This releases inflammatory mediators and results in osteoclastic resorption.
What are some conservative management options for hip arthritis?
Analgesia, physiotherapy, use of a stick, weight reduction and activity modification
What factors should be considered when deciding who should be considered for THA?
Pain and disability
What are some ways of assessing a patient’s pain?
Analgesic use, rest pain, sleep disturbance
What are some ways of assessing a patient’s disability?
Walking distance, activities of daily living, hobbies
What are some early local complications of THA?
Infection, dislocation, nerve injury, leg length discrepancies
What nerve is most likely to be injured in THA?
Sciatic nerve
What are some early medical complications of THA?
MI, chest infection, UTI, blood loss, hypovolaemia, DVT/PE
What are some late local complications of THA?
Early loosening, late infection, late dislocation
Late infections to a site of THA are usually spread how?
Haematogenously
Why are THAs not recommended in younger patients?
Higher risk of requiring revision surgery later in life, put more demand on the prosthetic
When may a THA be considered in a younger patient?
If the pain and disability is severe enough
What are the risks of revision hip replacement surgery?
Bigger and more complex surgery, often substantial blood loss, twice the complication rates, poorer functional outcome, don’t last as long
AVN in the hip can be primary (idiopathic) or it can be secondary. What are some causes of secondary AVN?
Alcohol abuse, steroids, hyperlipidaemia or thrombophilia
Patients with AVN tend to have pain where?
Groin
Early cases of AVN may only be seen on what imaging?
MRI
Later stage AVN can be seen on x-ray, what will it look like?
Patchy sclerosis on the femoral head with a lytic zone underneath (formed by granulation tissue from attempted repair)
Once AVN is severe, what can happen?
The femoral head can collapse with irregularity of the articular surface and subsequent OA
What happens in trochanteric bursitis?
The abductor muscle tendons become inflamed and degeneration leads them to tear. The trochanteric bursa also becomes inflamed.
When will patients with trochanteric bursitis have pain?
The region of the greater trochanter, especially on resisted abduction and lying on it at night
What is the treatment for trochanteric bursitis?
Self limiting - NSAIDs, analgesia, physiotherapy and steroid injections
