Hip

Question 1

What is femeroacteabular impingment syndrome

Answer 1

altered morphology of the femoral neck and or acetabulum where extra bone grows giving friction and pain

Question 2

Types of FAI

Answer 2

Mixed
pincer
CAM

Question 3

CAM type of FAI pathophysiology

Answer 3

femoral deformity where there is an aymmetric femoral head with decreased head to neck ratio. Can be related to previous SUFE

Question 4

Who gets CAM?

Answer 4

Young athletic males

Question 5

Pincer type pathology

Answer 5

acetabular deformity creating acetabular overhang

Question 6

who gets pincer deformity?

Answer 6

Females

Question 7

What complications are there of FAI?

Answer 7

Labrum tears/damage
damage to cartilage
osteoarthritis in later life

Question 8

Patient presentation of FAI

Answer 8

activity related groin pain especially in flexion/rotation
difficulty sitting
C sign positive
FADIR +ve

Question 9

Diagnosis of FAI

Answer 9

Radiographs
CT
MRI: gold standard as shows damage to labrum and bony oedema

Question 10

Management of FAI CAM

Answer 10

observation in asymptomatic patient
arthroscopy/ open surgery to remove CAM/ debride tears
arthroplasty in pt with secondary OA

Question 11

Management of FAI Pincer

Answer 11

observation in asymptomatic patient
peri-acetabular osteotomy /debride lateral tears
arthroplasty in secondary OA

Question 12

What is avascular necrosis?

Answer 12

Failure of blood supply to the femoral head

Question 13

Causes of Avascular necrosis?

Answer 13

Idiopathic or trauma

Question 14

Pathophysiology of trauma and AVN

Answer 14

Trauma stops the blood supply to the femoral head: cuts off the medial circumflex artery

Question 15

Pathophysiology of idiopathic AVN

Answer 15

1) Coagulation of intraosseous circulation
2) venous thrombosis causes retrograde aterial occlusion
3) intraosseous hypertension
4) Decreased blood supply to the femoral head
5) necrosis of the blood supply
6) Chondral fracture and collapse

Question 16

Aetiology of AVN

Answer 16

Males> females
35-50 typical age
Bilateral disease in 80% so much check other leg!!!!!!

Question 17

Patient presentation of AVN

Answer 17

Insidious onset groin pain exacerbated by impact/stairs

Question 18

Examination findings of AVN

Answer 18

usually normal unless advanced and developed OA

Question 19

Diagnosis of AVN

Answer 19

Radiographs normal in early disease

MRI more specific and sensitive

Question 20

Classification of AVN

Answer 20

stages 0-3: pre subchondral collapse and reversible

stages 4-6: post subchondral collapse and irreversible

Question 21

Management of AVN

Answer 21

Prechondral collapse: biphosphonates, core decompression, bone graft/vascularised bone graft and rational osteotomy for small bits
Postchondral collapse: Total hip replacement

Question 22

Risk factors for AVN

Answer 22

alcohol
steroids
blood clotting disorders
dysbaric disorders
trauma 
radiation

Question 23

what is Idiopathic transient osteonecrosis of the hip?

Answer 23

local hyperemia, impaired venous return with marrow oedema and increased intramedullary pressure (not avascular!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)

Question 24

Patient presentation of ITOH

Answer 24

Progressive groin pain over several weeks, difficulty weight bearing and usually unilateral

Question 25

Epidemiology of ITOH

Answer 25

Males> Females 2 groups of people get it: middle aged men and women in late pregnancy rare

Question 26

Diagnosis of ITOH

Answer 26

Elevated ESR Radiograph: osteopenia of head and neck and thinning of the cortices MRI: gold standard shows oedema

Question 27

Management of ITOH:

Answer 27

self limiting usually resolves in 6-9 months analgesia protect weight bearing to prevent stress fracture

Question 28

What is Trochanteric Bursitis?

Answer 28

The iliotibial band rubs against the trochanteric bursitis causing damage, inflammation and pain

Question 29

Aetiology of Trochanteric bursitis

Answer 29

Women bc wider pelvis | Young runners and older patients

Question 30

Presentation of TB

Answer 30

Pain on lateral hip | pain on palpation of the greater trochanter

Question 31

Diagnosis of TB?

Answer 31

mainly clinical radiograph is unremarkable MRI shows inflammation but not usually indicated

Question 32

Management of Trochanteric Bursitis

Answer 32

``` Analgesia NSAIDS Physio Steroid injections No proven benefit of surgery ```

Question 33

WHat is osteonecrosis?

Answer 33

End point of many diseases. | Degenerative disease of the synovial joints with the loss of cartilage and the thickening and fibrosis of the synovium

Question 34

Aetiology of Osteoarthritis?

Answer 34

Female >men inc incidence with inc age genetic component pre-existing hip disease

Question 35

Pathophysiology of osteoarthritis

Answer 35

loss of homeostatic balance of cartilage synthesis and degradation caused by either increased catabolism or decreased synthesis

Question 36

Patient presentation of OA

Answer 36

``` Groin/buttock pain morning stiffness worse on activity night pain start up pain reduced ROM ```

Question 37

Diagnosis of OA

Answer 37

Radiograph:LOSS

Question 38

Management of OA

Answer 38

``` Analgesia NSAIDs weight loss/walking aids physio steroid injections total hip arthroplasty ```