Hip Conditions Flashcards
What is antalgic gait? Caused by?
Pt has short stance phase on affected leg (spends little time on that leg). Caused by pain in the leg/hip on affected side.
What is trendelenburg gait?
Sound side of the hip sags when walking. Caused by weakness of the contralateral hip abductors (gluteus medius).
What is festinant gait and when do you see it?
Short, shuffling steps
Seen in parkinsons
What is high steppage gait and what is it caused by?
Patient lifts up leg to walk, foot lands flat or on ball of foot.
Caused by foot drop (common peroneal nerve palsy) or propioception loss
What is spastic gait?
Jerky, foot in quinus, hips abducted. Caused by UMN lesion
What causes true limb shortening?
1) Distal to trochanter: old tibia/femur fracture, growth disturbances
2) Proximal to trochanter: Hip dislocation, coxa vara, Perthes’ disease
What is coxa vara?
Angle between femoral neck & femoral shaft <120deg.
What is Perthes’ disease?
Necrosis and fracture of femoral head due to interruption of blood supply to the femoral head
What are some risk factors for avascular necrosis of the hip?
1) Steroids, TCM
2) Trauma (NOF #, dislocation, septic arthritis)
3) Alcohol, obesity
4) Diving - decompression sickness
5) sickle cell anaemia, clotting disorders (thrombophilia)
Clinical presentation of AVN
Joint pain w stiffness - exacerbated by weight bearing & motion
Rest pain in 2/3, night pain in 1/3
Restricted ROM (*ESPECIALLY INTERNAL ROTATION)
80% AVN is bilateral
___ staging for AVN
Ficat-Arlet Staging
- Stage 0: hip at risk
- Stage 1: pain in groin. no structural failure but have bone death (MRI shows edema)
- Stage 2: pain + stiffness. early structural failure + repair by laying new bone (sclerosis)
- Stage 3: pain + stiffness + limping. major structural change w crumbling of necrotic bone, distorted outline. femoral head flattened.
- Stage 4: very painful, stiffness, limping. articular cartilage destruction + secondary OA. Femoral head & articular surfaces collapse, LIMB SHORTENS
Aetiologies of OA Hip
1) Primary: small/bumpy femoral head, thick femoral neck = more contact bw femoral head & acetabulum (asian hips less common this shape)
2) Secondary: AVN, acetabular dysplasia (shallow), post-trauma, post-infection, crystal arthropathy
RA hip Xray findings
Minimal findings initially -> synovitis usually causes pain at presentation, not evident on XR. Progressive hyaline cartilage destruction eventually causes joint space narrowing.
Types of pelvic fractures (Tile classification)
Type A: stable, minimally displaced - avulsion fractures/fracture not involving pelvic ring
Type B: partially unstable, rotationally unstable, vertically stable. “open book” fractures. (rotational force)
Type C: unstable, rotationally+vertically unstable. Rupture of ipsilateral ligament. (vertical shear fracture)
Impt complication of pelvic fractures
Haemorrhage - life threatening, can accumulate up to 4L in retroperitoneal spaces. (from rupture of superior gluteal artery, iliac vessels)
