Hip Flashcards
What can help you to determine the cause of adult groin pain
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
What can help you determine the cause of adult lateral pain
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
How to be sure the OA is in the hip
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
When to consider arthroplasty in OA?
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
Tx OA
Con - Physio, walking aids, weight loss, exercise
Med - analgesia, steroid joint injections
Surg - THR, resurfacing
What are the surgical approaches to THR
Direct lateral
Anterior
posterior
What does hip resurfacing have over THR
Preserves femoral bone
Lower risk if dislocation
Complication of THR
Infection Disslocation Leg length difference DVT PR Anaesthetic risk Neuromuscular injury
Features of infection following THR
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
If there is a persistently discharging wound what should you do
Contact the consultant - do not start abx
Do not know why
What do you need to rule out calf swelling that does not decrease on elevation
DVT
What is likely cause of a short painful leg
Ned to rule out with radiograph
Dislocation
What is the level of activity that can be conducted post op
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
Causes of avascular necrosis of the hip
Idiopathic Hip fracture hip dislocation Alcoholic Steroids Sickle cell disease Caisson disease (divers) Metabolic disorders HIV
Ix avascular necrosis of hip
X-ray
MRI
Tx of avascular necrosis of the hip
Core decompression Joint replacement Bisphosphonates Bone graft Osteotomy
Cause of femoroacetabular impingement
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
Problems with the paediatric hip
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
What is transient synovitis
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
Tx of transient synovitis
Acute onset self -limiting
Rest +/- analgesia
How to diagnose transient synovitis
Diagnosis of exclusion there is not abnormal it of the X-ray or blood tests
If more than one joint is involved with transient synovitis what is it called
Juvenile idiopathic arthritis
What is the kocher criteria and what is it used in
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
Cause of septic arthritis
Haematogenous seeding
Extension from adjacent bone -osteomyelitis
Inoculation from trauma or surgery
What happens to the joint in septic arthritis
Release of proteolytic enzymes cause articular surface damages within 8 hours
Inc joint pressure causes femoral heads osteonecrosis if not relieved promptly
Ix septic arthritis
USS and aspiration
MC&S
Tx septic arthritis
Local guidelines for Abx
Commonly flucloacillin
If penicillin allergic clindamycin
Need to blast the ab - 2 weeks IV and 2-4 weeks oral
Risk factors for developmental dysplasia of the hip
First born Breech Oligohydraminos Sibling had DDH High birth weight Older mother
What is DDH
It is a spectrum of pathology from stable acetabular dysplasia to established hip dislocation
Epidemiology of DDH
Girls more than boys
Left >right
Associations with joint laxative
Metatarsus adductor torticolus
How is DDH detected
New born screen
6 week check
What manoeuvre detect DDH
Barlow
Ortolani
Galeazzi
Tx for DDH
If <6months diagnosis
PAVLIK harness
Diagnosed >6 months spica cast
>18 months surgery - femoral pelvic osteotomies
What is perthes disease
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
Epidemiology of perthes
4-8 yo
M>F
What does perthes present with
Hip or knee pain
Cause a lip
Insidious onset
LLD
On exam of perthes
All movement are reduced esp IR
Ix perthes and what does it show
X-ray MRI Joint space widening Dec size fem head Collapse deformity of fem head New bone formation
Long term complication of perthes
OA
Tx perthes
<8 yo con - observe NSAID physio
>8 yo surgery osteotomy
Dependent on how much of the fem head is affected
What is SUFE
Slipped upper femoral epiphysis
Displacement through the growth plate with the epiphysis slipping down and back
When does it present
Symp
Presents after minor injury
Limping
Pain in groin ant thigh or knee
Epidemiology risk factor for SUFE
10-16 years Obese M>F FHx Renal osteodystrophy Endocrine disorders hypogonadism , hypothyroidism
What to do in knee and groin strain on 10 -15 years
X-ray
What does delayed diagnosis risk
SUFE
Progression of slip - inc risk of early OA and stable lesions becoming unstable
Exam signs SUFE
Flexion
Abduction
Internal rotation
Limited
What should you never do to a joint replacement
Inject in or around it
