Hip Flashcards

1
Q

Why does pathology in the hip commonly radiate the knee

A

The obturator nerve supplies both joints

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2
Q

Where can hip pathology present i.e. where can it produce pain

A

Groin
Buttock pain
Knee pain

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3
Q

What is usually the first sign of hip pathology

A

Loss of internal rotation

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4
Q

What are the hip abductor muscles

A

gluteus medius and minimus

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5
Q

What causes a positive Trendelenburg sign

A

abductor muscle weakness

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6
Q

What is the gold standard material THR

A

cemented metal stainless steel stem and a high density polyethylene cup

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7
Q

What is the ultimate cause of failure of a THR

A

loosening of one or both prosthetic components

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8
Q

How long does a THR usually last for

A

15-20 years

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9
Q

Generally, what is the principal of uncemented THR

A

the aim is for bone to grow into a roughened porous surface of the stem

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10
Q

What causes the loosening of the materials in THR

A

Wear particles from the implant cause an inflammatory reaction at the implant-bone interface. The release of inflammatory mediators results in osteoclastic bone resorption

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11
Q

Why were ceramics materials not previously used as the material for THR

A

They were too brittle, so fatigued too easily

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12
Q

Why are metal-on-metal THR replacements not used

A

They can lead to a local reaction to the metal debris and cause a “inflammatory pseudotumour”

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13
Q

What are the conservative Mx options for arthritic hip pain

A

Simple analgesics
Physio
Use of a stick (reduces joint force)
Weight reduction

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14
Q

Early local complications of THR

A

Infection
Dislocation
Nerve injury (sciatic)
Leg length discrepancy

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15
Q

Early general complications of THR

A

medical complications from surgery

  • MI
  • chest infection
  • UTI
  • blood loss
  • hypovolaemia
  • DVT & PE
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16
Q

Late local complications of THR

A

Early loosening
Late infection
Late dislocation

17
Q

If a primary THR fails, what can be done

A

it can be re-done - revision hip replacement

18
Q

Problems with revision hip replacements

A
bigger and more complex surgery 
more blood loss 
twice the complication rates 
poorer functional outcomes 
don't last as long as primary replacements
19
Q

Why are THR in younger patient’s not recommended?

A

they have a higher risk of requiring revision surgery in later life as they put more demand on prosthetic hip

20
Q

Causes of hip AVN

A
idiopathic 
alcohol abuse 
steroids 
hyperlipidaemia 
thrombophilia
21
Q

presentation of hip AVN

A

groin pain

22
Q

Ix for AVN

A

MRI
- best for seeing early changes, as these won’t show on xray

patchy sclerosis of weight bearing area of femoral head
lytic zone underneath (formed by granulation tissue attempting repair)

23
Q

Classic sign of AVN on xray

A

Hanging rope sign

  • caused by the lytic lesion forming underneath the weight bearing part of the femoral head
24
Q

What is the consequence of undetected AVN

A

Femoral head collapse, with subsequent secondary OA

25
Tx of hip AVN
pre-collapse of femoral head: drill holes up to femoral neck to relieve pressure if femoral head has collapsed: THR
26
hip abductor muscles
gluteus medius and minimus | tensor fasciae latae
27
where do the gluteus medius and minimus attach to
greater trochanter of femur
28
what is trochanteric bursitis
inflammation of the broad tendinous insertion of the hip abductor muscles
29
What is trochanteric bursitis also known as
gluteal cuff syndrome
30
presentation of trochanteric bursitis
pain and tenderness in region of greater trochanter region | pain on resisted abduction
31
Tx of trochanteric bursitis
analgesia NSAIDs physio steroid injection
32
What are the types of hip impingement
1. CAM = a deformity of the femur 2. Pincer = a deformity of the acetabulum - most patients with hip impingement have a combo of these deformities
33
What are patients with hip impingement more susceptible to
Perthes/SUFE