Hip and Knee Flashcards
Acute painful/swollen joint - causes
Septic arthritis Gout Pseudogout Haemarthrosis Reactive arthritis Monoarticular presentation of inflammatory arthritis Traumatic synovitis
Knee effusion - clinical features
specific sign of joint inflammation
Pain - osteoarthritis
Swelling
Stiffness
Bruising (trauma)
Acute painful/swollen joint - assessment and investigation
As septic arthritis - bloods, cultures, USS guided aspiration, cytology, microscopy and culture of aspirate and X-Ray (usually normal in early disease)
Acute painful/swollen joint - periprosthetic infections
Important to identify as the prosthetic joint will be need to be removed if the joint is infected - staged surgery Stage 1 - removal of arthroplasty - washout - debridement - antibiotic spacer Then 6 weeks of IV antibiotics Stage 2 - new joint arthroplasty
Osteoarthritis of hip and knee - clinical features
Functionality limiting pain Pain at night/rest Stiffness Decreased range of movement Mechanical - sticking - locking/catching sensation
Hip pain - differentials
Osteoarthritis Rheumatoid arthritis Femoral neck fracture Avascular necrosis Septic arthritis Trauma SCFE/Perthes - paediatrics Bursitis Labrum tear - acetabulum Adductor longus strain (groin strain)
Osteoarthritis of hip and knee - non-operative management
NSAIDs/tramadol Walking stick Lifestyle management Physical therapy Corticosteroid joint injections
Osteoarthritis of hip and knee - operative management
Total hip arthroplasty indications
- extreme functional impairment on activities of daily living
- severe osteoarthritis on X-Ray
- if conservative management inadequate
Abnormal gait - causes
RA/OA Parkinson's Disease Multiple Sclerosis Stroke/TIA Cerebral palsy Muscular dystrophy SCFE/Perthes in children
AVN of hip - pathophysiology
Vascular occlusion occurs due to the coagulation of the intraosseous microcirculation
- leads to intraosseous hypertension and decreased blood flow to the femoral head
- lack of blood causes osteocyte death and femoral AVN
AVN of hip - causes
Idiopathic Trauma - femoral neck fracture Irradiation Haematological disease Dysbaric disorders Marrow-replacing disease
Slipped capital femoral epiphysis - presentation
Dull pain in thigh, knee, groin or hip Sudden limp Hip held in passive external rotation Boys aged 1-16 (during period of rapid growth) Restricted range of movement - reduced internal rotation and abduction Unstable SCFE - can't walk Weakness Abnormal leg alignment
Slipped capital femoral epiphysis - diagnosis
X-Ray
- AP and frog lateral
AP findings
- Klein’s line - reduced intersection of lateral femoral head in SUFE (drawn along the superior border of the femoral neck)
- epiphysiolysis
- blurring of proximal femoral metaphysis
Developmental dysplasia of hip - risk factors
Family history Firstborn Female Breech position Oligohydramnios
Developmental dysplasia of hip - clinical signs
Barlow's test - dislocates a dislocatable hip - adduction and depression - exit click Ortolani's maneuver - reduces a dislocated hip - elevation and adduction of fixed femur - entry click Galeazzi sign - apparent limb length discrepancy due to unilateral hip dislocation
Developmental dysplasia of hip - management
Abduction splinting/bracing if reducible
No-operations until 18 months
Developmental dysplasia of hip - clinical features in older infants (3 months - 1 year)
Limited hip abduction
Leg length discrepancy
Klisic test - line points to pelvis rather than umbilicus
Developmental dysplasia of hip - treatment in older infants (3 months - 1 year)
Abduction splinting/bracing if reducible (<6 months)
Closed reduction and spica casting (6-18 months)
Developmental dysplasia of hip - clinical features in children >1 year
Pelvic obliquity
Lumbar lordosis
Trendelenburg gait - abductor insufficiency
Toe-walking (compensation for leg length discrepancy)
Developmental dysplasia of hip - treatment in children >1 year
Closed reduction and spica casting (<18 months)
Surgical
- open reduction and spica casting
- open reduction and femoral/pelvic osteotomy
Quadriceps and patella tendon rupture - importance
Very subtle and easy to miss
Physiotherapy needs to be started early to prevent stiffness
- loss of knee flexion
Quadriceps and patella tendon rupture - clinical features
Supra/infra patellar pain Popping sensation Hard to weight-bear Bruising Droop/elevated patella Tenderness Cramping Indentation Can't actively straight leg raise or maintain passive extension Reduced range of movement due to pain
Quadriceps and patella tendon rupture - acute management
Non-surgical (small or partial tears)
- immobilisation in extension
- physiotherapy after initial pain and swelling
Surgical
- primary repair (fully torn)
- tendon reconstruction (severe partial tear)
Rehabilitation
- weight-bearing with brace and physiotherapy
Meniscal tears - clinical features
History of axial load and rotation with a fixed foot Joint effusion - delayed, slow onset Pop, click or locking on maneuver Localised pain - medial or lateral Joint line tenderness
