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Orthopaedics > Hip > Flashcards

Hip Flashcards

1
Q

What can help you to determine the cause of adult groin pain

A

Internal rotation
If internal rotation is not intact - then likely to be OA or secondary OA
If internal rotation is normal - diff diag - snapping iliopsoas
Pain on all movement AVN/tumour
Pain on internal rotation - ?femoroacetabular impingement

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2
Q

What can help you determine the cause of adult lateral pain

A

Whether the pain is well localised to the greater trochanter
Is yes - then likely to be bursitis/ greater trochanteric pain syndrome
No - referred from back pain
Are there any corresponding red flags to suggest something more sinister

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3
Q

How to be sure the OA is in the hip

A

The examination if internal rotation is preserved then it is a back problem
In OA the IR is the first thing to go then there is progressive loss of ER
Pain in the groin and the knee

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4
Q

When to consider arthroplasty in OA?

A

Pain is uncontrolled by non-op means
QualOL restricted enough to take the risk
Hip resurfacing should not be considered less risky that a THR

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5
Q

Tx OA

A

Con - Physio, walking aids, weight loss, exercise
Med - analgesia, steroid joint injections
Surg - THR, resurfacing

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6
Q

What are the surgical approaches to THR

A

Direct lateral
Anterior
posterior

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7
Q

What does hip resurfacing have over THR

A

Preserves femoral bone

Lower risk if dislocation

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8
Q

Complication of THR

A 
Infection 
Disslocation
Leg length difference
DVT PR
Anaesthetic risk 
Neuromuscular injury
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9
Q

Features of infection following THR

A

Presents with just pain usually not usually septic
Common organisms -staph
Causes - surgery inoculation haemogenously
BIOFILM - makes it a bastard to treat - difficult to erradicate
Usually need stage 2 reunion - basically take it out load them with abx and then put a new one in

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10
Q

If there is a persistently discharging wound what should you do

A

Contact the consultant - do not start abx

Do not know why

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11
Q

What do you need to rule out calf swelling that does not decrease on elevation

A

DVT

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12
Q

What is likely cause of a short painful leg

A

Ned to rule out with radiograph

Dislocation

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13
Q

What is the level of activity that can be conducted post op

A

Depends on the Bearing
All hip arthroplasties with wear treated than the native hip
Need to be conscious and balance the is of wear vs desire to do sports

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14
Q

Causes of avascular necrosis of the hip

A 
Idiopathic 
Hip fracture hip dislocation 
Alcoholic
Steroids
Sickle cell disease 
Caisson disease (divers)
Metabolic disorders 
HIV
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15
Q

Ix avascular necrosis of hip

A

X-ray

MRI

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16
Q

Tx of avascular necrosis of the hip

A 
Core decompression 
Joint replacement
Bisphosphonates 
Bone graft 
Osteotomy
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17
Q

Cause of femoroacetabular impingement

A

Contact between the femoral head-neck Justin and the acetabular rim
Can be boney spurs
Impingement occurs with the combined movement of hip flexion, adduction and internal rotation

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18
Q

Problems with the paediatric hip

A 
DDH
Transient synovitis
Perthes
SUFE
Sepsis 
If these are mild they may not present in childhood but as an adult they could be a secondary cause of OA of the hip
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19
Q

What is transient synovitis

A

Average age 3
Most common cause of irritable hi pain - is a diagnosis sof exclusion
M:F 2:1
Inflamm of the synovium
Though to be a reactive monoarthropathy from a URTI
Acute onset self healing

20
Q

Tx of transient synovitis

A

Acute onset self -limiting

Rest +/- analgesia

21
Q

How to diagnose transient synovitis

A

Diagnosis of exclusion there is not abnormal it of the X-ray or blood tests

22
Q

If more than one joint is involved with transient synovitis what is it called

A

Juvenile idiopathic arthritis

23
Q

What is the kocher criteria and what is it used in

A 
It is criteria for the likelihood of septic arthritis if all 4 criteria are met there is a 99.6% likelihood of it being septic arthritis 
Fever >38.5
WBC >12000 mm3
Non weight bearing on affected side 
ESR >40
24
Q

Cause of septic arthritis

A

Haematogenous seeding
Extension from adjacent bone -osteomyelitis
Inoculation from trauma or surgery

25
Q

What happens to the joint in septic arthritis

A

Release of proteolytic enzymes cause articular surface damages within 8 hours
Inc joint pressure causes femoral heads osteonecrosis if not relieved promptly

26
Q

Ix septic arthritis

A

USS and aspiration

MC&S

27
Q

Tx septic arthritis

A

Local guidelines for Abx
Commonly flucloacillin
If penicillin allergic clindamycin
Need to blast the ab - 2 weeks IV and 2-4 weeks oral

28
Q

Risk factors for developmental dysplasia of the hip

A 
First born
Breech 
Oligohydraminos
Sibling had DDH
High birth weight
Older mother
29
Q

What is DDH

A

It is a spectrum of pathology from stable acetabular dysplasia to established hip dislocation

30
Q

Epidemiology of DDH

A

Girls more than boys
Left >right
Associations with joint laxative
Metatarsus adductor torticolus

31
Q

How is DDH detected

A

New born screen

6 week check

32
Q

What manoeuvre detect DDH

A

Barlow
Ortolani
Galeazzi

33
Q

Tx for DDH

A

If <6months diagnosis
PAVLIK harness
Diagnosed >6 months spica cast
>18 months surgery - femoral pelvic osteotomies

34
Q

What is perthes disease

A

Idiopathic avascular necrosis of the Proximal femoral epiphysis
This ischaemia is self - healing
It is the subsequent bone remodelling hat distorts the epiphysis and generates abnormal ossification

35
Q

Epidemiology of perthes

A

4-8 yo

M>F

36
Q

What does perthes present with

A

Hip or knee pain
Cause a lip
Insidious onset
LLD

37
Q

On exam of perthes

A

All movement are reduced esp IR

38
Q

Ix perthes and what does it show

A 
X-ray MRI
Joint space widening 
Dec size fem head 
Collapse deformity of fem head 
New bone formation
39
Q

Long term complication of perthes

A

OA

40
Q

Tx perthes

A

<8 yo con - observe NSAID physio
>8 yo surgery osteotomy
Dependent on how much of the fem head is affected

41
Q

What is SUFE

A

Slipped upper femoral epiphysis

Displacement through the growth plate with the epiphysis slipping down and back

42
Q

When does it present

Symp

A

Presents after minor injury
Limping
Pain in groin ant thigh or knee

43
Q

Epidemiology risk factor for SUFE

A 
10-16 years 
Obese 
M>F
FHx
Renal osteodystrophy 
Endocrine disorders hypogonadism , hypothyroidism
44
Q

What to do in knee and groin strain on 10 -15 years

A

X-ray

45
Q

What does delayed diagnosis risk

SUFE

A

Progression of slip - inc risk of early OA and stable lesions becoming unstable

46
Q

Exam signs SUFE

A

Flexion
Abduction
Internal rotation
Limited

47
Q

What should you never do to a joint replacement

A

Inject in or around it

Orthopaedics (7 decks)

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