Hip and Knee Flashcards
name the early local complications of a hip/knee operation/replacement/
infection dislocation nerve injury leg length discrepancy MI PE/DVT UTI blood loss
why dont we like like to give younger patient a full knee/hip replacement
they will put it under more stress and so more likely to need another one.
what is Avascular necrosis?
death of bone due to lack of blood supply
where is the most common site for AVN?
hip joint
what to patients tend to present with when they have AVN?
groin pain
treatment for AVN?
decompression if caught early enough
if not then THR
name some signs/symptoms of trochanteric bursitis
pain and tenderness over grearter trochanter
pain on resisted abduction
treatment for trochanteric bursitis?
analgesic
anti-inflam
physio
steroid injection
when do meniscal injuries classically occur?
twisting force on a loaded knee
where is the pain localised to in a meniscal injury?
medial or later joint line (mainly medial)
catching sensation/ “locking”
struggle to straighten knee
meniscal injury
knee becoming stuck
pseudolocking (in OA)
when to ACL ruptures usually occur
turning the upper body laterally on a planted foot causing internal rotation force on tibia
“pop” usually felt or heard
ACL rupture
rotational force injury
pop is heard or felt
haemarthrosis (effusion due to bleeding in joint) within an hour
deep knee pain
ACL rupture
twisting force
localised pain to medial/lateral joint line
catching sensation/ locking of the knee
cant straighten knee
about to give way
effusion develops following day( synovial fluid)
Meniscal injury!
what will a valgus stress injurie cause? (rugby tackle from side)
tear the medial collateral ligament also potential damaging ACL
what will a direct blow to the anterior tibia with the knee flexed (e.g motor bike crash) or hyper-extension cause?
PCL rupture
what will a varus stress rupture?
lateral collateral ligament
what other tear/rupture usually occurs which a meniscal tear?
ACL rupture
how do you confirm a meniscal tear?
MRI
postive steinman’s test
meniscal tear
can meniscal tears be degenerative?
yes
how do you repair a meniscal tear?
may wont heal by themselves and require
arthroscopic menisectomy
what does ACL reconstruction involve?
tendon graft
what causes PCL (if it happens alone)?
frequent hyperextension
anterior subluxation of femur
severe laxity
How should a complete knee dislocation be managed?
reduced as an emergency
may require external fixation for temporay stabilization
vascular assessment should be done
what does the extensor mechanism of the knee involve/include?
tibial tuberosity patellar tendon patellar quads tendon quads
what age tend to get patellar tendon ruptures?
what age tend to get quad tendon ruptures?
> 40
predisposing factors for extensor mechanism rupture?
history if tendonitis chronic steroid use (body builders) diabetes RA chronic renal failure
how do you assess the extensor muscle mechanism?
straight leg raise
what is patellofemoral dysfunction?
disorder of patellofemoral articulation causing anterior knee pain e.g softening of hyaline cartilage
anterior knee pain
worse going down hill
grinding or clicking sensation of front of knee
stiffness after prolonged sitting causing pseudolocking
patellofemoral dysfunction
what can cause patellar dislocation?
direct flow or sudden twist of knee
what ligament tears with a patellar dislocation?
patellofemoral ligament
predisposing factors for patellar instability?
hypermobile female genu valgum hight riding patella femoral neck anteversion
