hip conditions Flashcards
what type of conditions can cause hip problems
Vascular Infective/inflammatory Trauma Autoimmune Metabolic Iatrogenic Neoplastic
what is femoroacetabular impingement syndrome
altered morphology of femoral neck and/or acetabular
-causes abutment of the femoral neck on the edge of the acetabulum during movement
what are the two types of impingement in FAI
- CAM type
- pincer type
what is a cam type impingement
femoral deformity
-asymmetric femoral head with decreased head:neck ratio
who gets cam type impingement
young athletic males
what is pincer type inpingement
- acetabular deformity
- acetabular overhang
who gets pincer type impingement
females
what do both types of impingement cause
- damage to the labrum and tears
- damage to cartilage
- OA in later life
presentation of FAI
- activity related pain in groin
- flexion and rotation pain
- difficulty sitting
- C sign positive
- FADIR provocation test positive
diagnosis of FAI
- radiographs
- CT
- MRI
management of FAI
- observation in asymptomatic
- arthroscopic or open surgery to remove CAM/debride laberal tears
- peri-articular osteotomy/debride labral tears in pincer impingement
- arthroplasty older patients with secondary OA
what is avascular necrosis
failure of blood supply to the femoral head
pathophysiology of avascular necrosis
- coagulation of the intraosseous microcirculation
- venous thrombosis
- intraosseous hypertension
- decreased blood flow to femoral head
- necrosis of head
- chondral fracture and collapse
who gets avascular necrosis
males
35-50
risk factors of avascular necrosis
- irradiation
- trauma
- hematologic disease
- sickle cell
- dysbaric disorders
- alcoholism
- steroids
presentation of avascular necrosis
- insidious onset of groin pain
- worse on stairs and impact
diagnosis of avascular necrosis
- radiographs
- MRI
what shows irreversible avascular necrosis on a radiograph
- crescent sign
- flattening of femoral head
- narrowing of joint
- advanced degenerative changes
management of avascular necrosis
- bisphosphonates
- core decompression +/- bone grafting
- curettage and bone grafting
- vascularised fibular bone graft
- rotational osteotomy
- total hip replacement
what is trochanteric bursitis
repetitive trauma cause by iliotibial band tracking over trochanteric bursa
-inflammation of bursa
who gets trochanteric bursitis
- female
- young runners
- any age
presentation of trochanteric bursitis
- pain on lateral aspect of hip
- pain on palpitation of greater trochanter
diagnosis of trochanteric bursitis
-clinical diagnosis
management of trochanteric bursitis
- analgesia
- NSAIDs
- physio
- steroid injection
who gets OA
females
old
pre-existing hip disease
presentation of OA
- groin pain
- worse on activity
- pain at night
- start up pain
- stiff on testing range of motion
diagnosis of OA
radiographs
what are the radiographic signs of OA
- joint space narrowing
- subchondral sclerosis
- osteophytes
- cyst formation
management of OA
- analgesia
- weight loss
- walking aids
- physio
- steroid injections
- total hip arthroplasty
what are the types of prothesis for a total hip arthroplasty
- cemented
- uncemented
- hybrid
what are the bearing choices for hip replacements
- metal on poly
- ceramic on poly
- ceramic on ceramic
risks of hip replacement
- scar
- bleeding
- neurovascular injury
- fracture
- clotting
- infection
- dislocation
- leg length discrepancy
- loosening
- ongoing symptoms
is cemented used in older or younger patients
older
is hybrid used in younger or older
younger
