Hip conditions Flashcards
what attaches to the greater trochanter of the femur ?
abductors and rotators
what attaches to the lesser trochanter of the femur ?
psoas
what type of cartilage is in the acetabulum ?
fibrocartilage
what are the branches of the profound femoris artery ?
medial femoral circumflex artery
lateral femoral circumflex artery
what are the features of the MFCA ?
2 branches
ascend to head
transverse to form cruciate anastomosis
what are features of the LFCA ?
3 branches
ascending to joint capsule
transverse tp cruciate anastomosis
descending branch
what is the clinical significance of the femur head blood supply ?
the primary supply enters via capsule
in fractures the intracapsular supply is disrupted
extra capsular supply is maintained
what is osteoarthritis and what are its characteristics ?
progressive loss of articular cartilage, secondary bony changes
pain and stiffness of affected joint, limiting everyday life
what is trochanteric bursitis ?
the bursa on the greater trochanter communicating with the ileotibial band is inflammed
what causes trochanteric bursitis ?
F>M
trauma
over use - runners
abnormal movements - scoliosis, total hip replacement, OA
how does trochanteric bursitis present ?
pain - point tenderness on lateral hip
what are signs of trochanter bursitis ?
look - scars from previous surgery, gluteal muscle wasting
feel - tenderness at greater tuberosity
move - worse pain in active abduction
what are investigations of trochanter bursitis ?
Xray - may be normal, OA
MRI
USS - guided injection
what is the treatment for trochanter bursitis ?
rest NSAIDs physio corticosteroid injection surgery - bursectomy
what is avascular necrosis ?
death of bone due to loss of blood supply
what gets avascular necrosis ?
M>F
35-50
80% bilateral
3% multifocal
what are traumatic risk factors for avascular necrosis ?
irradiation
fracture
dislocation
iatrogenic
what are systemic risk factors for avascular necrosis ?
idiopathic hypercoaguable states steroids haematological - sickle cell, lymphoma, leukaemia Caisson's disease alcoholism
what are symptoms of avascular necrosis ?
insidious onset of groin pain
pain with stairs, walking uphill, impact activities
what is seen on exam of avascular necrosis ?
largely normal
may replicate early arthritis - reduced ROM, stiff joint
how is avascular necrosis investigated ?
Xray
MRI
what is the non-operative treatment of avascular necrosis ?
reduce weight bearing NSAIDs bisphosphonates anticoagulants physio - keep moving
what is the surgical treatment of avascular necrosis ?
restore blood supply - core decompression, vascularised graft
move lesion away from weight bearing are
total hip replacement
what is femoroacetabular impingement FAI
impingement of femoral neck against anterior edge of acetabulum
younger patients, can develop secondary arthritis
what are the different types of FAI ?
cam lesion - young athletic males, excess bone on head of femur
pincer - young females, abnormal acetabulum overhangs
what are associated injuries with FAI ?
labral degeneration and tears
cartilage damage and flap tears
secondary OA
what is the presentation of FAI ?
groin pain - worse with flexion
mechanical symptoms - block to movement, pain with certain movements squatting lunging etc
what is seen on exam of FAI ?
reduced flexion and internal rotation
positive FADIR - flexion adduction and internal rotation
what are the examinations for FAI ?
Xray
MRI
what is the non-operative treatment for FAI ?
activity modulation
NSAIDs
physio
what is the operative treatment for FAI ?
arthroscopy - shave down defect, deal with tears
open - resection, periacetabular osteotomy, hip arthroplasty (replacement)
what is the most common labral tear ?
anterosuperior tear
who is most at risk of a labral tear ?
mostly active females of all ages
what causes labral tears ?
FAI trauma OA dysplasia collagen disease - Ehlers-Danlos
how does a labral tear present ?
groin or hip pain
snapping sensation
jamming or locking
what is seen on exam of labral tears ?
can be normal
positive FABER - flexion, abduction, external rotation
what are the investigations for labral tears ?
Xray
MRI
diagnostic injection
how do you treat labral tears ?
non-op - NSAIDs, rest, physio, steroid injection
op - arthroscopy
