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Orthopaedics > Hip and Knee disorders > Flashcards

Hip and Knee disorders Flashcards

1
Q

two classifications of OA of the hip

A

primary hip OA
-idiopathic
-associated with strong FHx

Secondary hip OA
-after prior injury to joint:
-truma
-infection
-AVN
-DDH
-SUFE (slipped upper femoral epiphysis fracture)

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2
Q

main clinical features of hip OA 3

A

pain

stiffness

loss of function

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3
Q

how can pain in hip OA present

A

in buttock

referred to groin and thigh
-can even present at knee

*-enquire about when pain occurs:
-only during certain activities
-when weight bearing
-at rest
-limiting sleep at night

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4
Q

examaintion findings in OA hip 4

A

antalgiic or tendeleberg gait

may have:
-deformities
-asymmetry
-swelling
-muscle wasting
-previous scars

may be tender on deep palpation over groin or around greater trochanter

ROM will be generally reduced
-noticably internal rotation

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5
Q

radiographic features of hip OA 4

A

reduced joint space

subchondral bone cysts

subchondral sclerosis

osteophyte formation

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6
Q

non-operative hip OA mangemnt 5

A

patient education

weight loss

walking stick in opposite hand to pain

analgesia- NSAIDs, watch GI risk in elderly

physio

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7
Q

operative management of hip OA

A

total hip replacement

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8
Q

overview of total hip replacement 5

A

replaced acetabular w high denisty polyethylene

femoral head replaced with metal

components cemented into bone

major operation - makes sure ptx aware of risks

need prophlyaxtic ABx and thromboprophylaxis
-reduce risk of infection, DVT and PE

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9
Q

classifications for knee OA

A

primary
-idiopathic and assoc w strong FHx

secondary
-develops after prior insult to joint:
-trauma
-infection
-ligament
-menicus injury

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10
Q

which part of knee joint is more commonly affected in OA

A

medial side more frequently affected

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11
Q

main clinical features of knee OA 3

A

pain

stiffness

loss of function

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12
Q

pain in knee OA

A

originates from knee
-may be able to pinpoint particularly painful area

pain can occur walking, at rest and at night
-climbing stairs and discomfort is a common complaint

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13
Q

examination findings in knee OA 7

A

varus malalignment due medial compartment OA

swollen

advanced cases- felxion contracture can develop

osteophytes may be felt esp tibial plateau/joint line

effusions in supra-patellar pouch

globally reduced ROM and stiffness

crepitus

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14
Q

non-operative managment of knee OA 6

A

patient education

weighht loss

walking stick opposite hand

analgesia

physio

alteration of activites/ lifestyle modification

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15
Q

operative options for knee OA 3

A

early OA in young patinet can hvae tibial osteotomy

if confined to single compartment of knee joint
-unicompartmental joint replacement can be performed

total knee replacement can also be done

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16
Q

describe tibial oesteomy

A

wedge of bone is removed from lateral side of tibia
-helps redistribute load travelling across knee joint
-diverts force away from damaged medial compartment

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17
Q

define avascular necrosis

A

also called osteonecrosis

occurs when blood supply to bone is disrupted

hip is common site

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18
Q

traumatic risk factors for AVN 3

A

so disrupting vascular supply:
-femoral head/neck fractue
-hip dislocation
-SUFE

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19
Q

non-traumatic risk factors for AVN 9

A

alcohol abuse- accounts for almost 90%

steroids

irradiation

Haematological disease- leukaemia, lymphoma, sickle cell

dysbaric disorders
-decompression sickness form deep sea diving

hyper-coaguable states
-pregnancy

CT disorders
-SLE
-vasculitis

virtual
-hepatitis
-HIV

idiopathic

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20
Q

pathological process of AVN assoc w trauma

A

direct injury to vasculature supplying femoral head resulting in ischaemia

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21
Q

basic pathophys of non-traumatic AVN 4

A

coagulation of intraossseous microcirculation occurs

-causes venoous thrombosis

then retrograde arterial occlusion

this decreases blood flow to osteocyte in femoral head and causes ischaemia and AVN

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22
Q

clinical features of hip AVN 6

A

risk factors present in history
-may be an idiopathic presentation

insidious onset of buttock, groint/anterior hip or thigh pain
-sudden increase in pain may indicate femoral head collapse
-can be asymptomatic until late stage disease

examination:
-hip joint stiff
-patient may walk with limp

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23
Q

imaging for AVN of hip 2

A

plain radiograph will detect advanced disease

MRI will detect earlier changes

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24
Q

non-operative mangemet of AVN of hip 2

A

observe w syx control

-bisphosphonates may be beneficial in early stage disease

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25
Q

operative manageent of AVN of hip

A

core decompression with or without bone grafting (in an attempt to re-vascularise bone)

options:
-rotational osteotomy (offlad small areas of AVN when weight bearing)
-total hip resurfacing/replacement- once OA changes have appeared

26
Q

define SUFE

A

slipped upper femoral epiphysis

fracture through the capital femoral physis
-causing the epiphysis to ‘slip’ posteriorly and inferiorly

27
Q

who gets SUFE 3

A

10-16yo (during rapid growth)

male gender

obseity =single biggest risk factor
-increased forces travelling through physis (growth plate)

28
Q

clinical features of SUFE 6

A

can be acute aftery injury
-or subacute (<3wks)
-or chronic and more insidious (>3wks)

may have limp

groin pain- often referred to thigh or knee

leg externally rotated and appears shortened

localised tenderness around hip joint

pain on hip rotation
-decreased ROM -esp internal rotation

29
Q

radiograph features of sUFE 5

A

disruption to shentons line

always need AP and frog-leg lateral to diagnose

shadow behind superior femoral neck- Steel sign

apparent widening of physics and reciprocal decrease in height of epiphysis

prominent lesser trochanter due to external rotation of hip joint

30
Q

define developmental dysplasia of the hip
-three possible findings 3

A

abnormal development of hip joint due to resulting in dysplasia
-shallow underdeveloped acetabulum

possible subluxation of joint
-partial displacement

potential hip dislocation
-complete displacement

31
Q

risk factors for developmental dysplasia of the hip 6

A

females

first born

left hip
-60% due to common intrauterine position

breech position in utero or delivery

FHx in parent or first degree relative

other MSK anomalies (foot deformity)

32
Q

clinical features of developmental dysplasia of the hip for the following age:
neonates to <3mnth 3

A

asymmetry
-extra or deeper thigh creases

positive ortolani and barlow tests (palpable hip subluxation on exam)

reduced abduction

USS of hip joint to aid diagnosis

33
Q

clinical features of developmental dysplasia of the hip for the following age:
>3mnths -18mnths 3

A

asymetry
-leg length discrepancy

limitation in hip abduction

after 6 months femoral head begins to ossify meaning plain radiographs can help to diagnose

34
Q

clinical features of developmental dysplasia of the hip for the following age:
>1yr to walking child 4

A

lumbar lordosis

trendelenberg gait (abducotr weakness)

toe-walking

feel-pelvic obliquity

35
Q

clinical features of developmental dysplasia of the hip for the following age:
delayed presentation into lateral childhood and adolescent 3

A

leg length discrepancy

unexpecteldy large range of motion

radiographs may show early onset OA |

36
Q

management of developmental dysplasia of the hip for the following ages:
-neonates to <3mnths 1

A

splintage of joints in abduction and flexion with hips in reduced positon
-can cause remodelling of acetabluum

37
Q

management of developmental dysplasia of the hip for the following ages:
>3mtnsh to 18mtnhs 1

A

closed or open reduction of hip joint under anaethesia w immobilisation in hip spica cast for minimum 3mnths

38
Q

management of developmental dysplasia of the hip for the following ages:
>1yr to walking child 2

A

closed or open reduction of hip joint under anaethesia w immobilisation in hip spica cast for minimum 3mnths

+/-
femoral or acetabular osteotomy if significant dysplasia

39
Q

management of developmental dysplasia of the hip for the following ages:
delayed presentation into lateral childhood and adolsecene 2

A

femoral or acetabular osteotomy

if OA has already begun will likely require early total hip replacement

40
Q

what is the extensor mechanism made up of in the leg 3

-function

A

quadriceps tendon (inserts into superior pole of the pattela)

the patella

patella tendon (originates from interior pole of patella to insert into the tibial tuberosity)

-enables extension of the leg at the knee joint

41
Q

define extensor mechanisms injury

A

injury to any part of the extendsor mechanism (patella, quad tendons, patella tendon) disrupts this mechanism and results in an inability to maintain knee extension

42
Q

who gets quadriceps tendon rupture 2

A

elderly men with pre-exisiting tendonpathy resulting from fall or eccentric loading of tendon

in younger patients - usually direct trauma

43
Q

where is the most common site of quadriceps tendon rupture

A

typically at insertion of tendon into the patella
-can be complete or partial

44
Q

clinical features of quadriceps tendon rupture 4

A

pain in area before rupure indicating tendonopathy

significant bruising and swelling around the quadriceps tendon

tenderness at site of rupture
-palpable defect may be present

unable to extend knee against resistance
-iif complete tendon rupture is present patient may be unable to perform straight leg raise

45
Q

imaging in quadriceps tendon rupture

A

ap and lateral radiographs of knee may show effusion and possibly patella baja (abnormally low lying patella)

46
Q

management of quadriceps tendon rupture 2

A

requires open repair followed by protection in extension cast or splint

47
Q

who gets patella tendon rupture 2

A

affects younger age group than quad rupture

usually male 20-40

rupture can be partial or complete
-occurs within tendon substance or avulse part of tibial tuberosity

48
Q

clinical features of patella tendon rupture 5

A

infra-patellar pain after sudden quadriceps contraction with knee in flexed position
-may note popping sensation

elevated patella with large haemarthorsis

tenderness at site of rupture
-palpable defect may be present

if complete tear will be unable to straight leg raise or maintain extension of knee

reduced ROM at knee joint w difficulty weight bearing

49
Q

imaging in patella tendon rupture

A

AP and lateral
show proximal migration of patella, known as patella alta

50
Q

managment of patella tendon rupture 2

A

non-oeprative (for partial tears w intact extensor mechanism)
-immonilisation in full extension with progressive exercise programme)

operative- for complete rupture
-open repair of tenodn
-multiple techniques

51
Q

risk factors for extensor mechanism injury (quadriceps and patella tendon rupture) 6

A

previous tendon injury

exisitng tendonopathy

previous corticosteoird injection

steroid use

co-morbidities- SLE,RA, chronic renal disease, DM

increasing age (for quadriceps rupture)

52
Q

common meniscal tears 2

A

medial collateral ligament

anterior cruciate ligament

53
Q

presenation of meniscal tears 6

A

pain -can localise to area

report instability when knee flexed
-often related to sporting injury

swelling and effusion around knee which develops gradually following initial injury

localised joint tnederness

ROM limited due to swelling and effusion

compression and twisting the knee joint may reproduce pain (McMurrays test)

54
Q

imagign for meniscus tears 1

A

MRI scan
-show torn meniscus as well as soft tissue injuries

diagnostic arthroscopy can be used to directly visualise pathology

55
Q

main ligaments of the knee 4

A

ACL

PCL

medial collateral

lateral collateral

56
Q

typically sx and syx of meniscal tear 2

A

locked knee

giving way

57
Q

typical sx and syx of ligament injury 3

A

sudden swelling

pain

feeling a ‘pop’ in knee

inability to finish match

58
Q

examination findgins of ACL 2

A

positive anterior drawer test

positive lachmans test

59
Q

examination findings of PCL 1

A

positive posteiror drawer test

60
Q

examinaitno findings of medial collateral

A

brusing over medial aspect of knee

laxity on MCL testing
-apply valgus stress

61
Q

examination findings on lateral collateral

A

brusing over lateral aspect of knee

laxity on LCL testing
-apply a varus stress

62
Q

mechanism of ACL tear

A

forced felxion or hyperfelxion of knee
-twisting injruy or direct blow behind upper tibia

*-ptx may describe snapping sound or sensation

Orthopaedics (15 decks)

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