Hip conditions

Question 1

what attaches to the greater trochanter of the femur ?

Answer 1

abductors and rotators

Question 2

what attaches to the lesser trochanter of the femur ?

Answer 2

psoas

Question 3

what type of cartilage is in the acetabulum ?

Answer 3

fibrocartilage

Question 4

what are the branches of the profound femoris artery ?

Answer 4

medial femoral circumflex artery

lateral femoral circumflex artery

Question 5

what are the features of the MFCA ?

Answer 5

2 branches
ascend to head
transverse to form cruciate anastomosis

Question 6

what are features of the LFCA ?

Answer 6

3 branches
ascending to joint capsule
transverse tp cruciate anastomosis
descending branch

Question 7

what is the clinical significance of the femur head blood supply ?

Answer 7

the primary supply enters via capsule
in fractures the intracapsular supply is disrupted
extra capsular supply is maintained

Question 8

what is osteoarthritis and what are its characteristics ?

Answer 8

progressive loss of articular cartilage, secondary bony changes
pain and stiffness of affected joint, limiting everyday life

Question 9

what is trochanteric bursitis ?

Answer 9

the bursa on the greater trochanter communicating with the ileotibial band is inflammed

Question 10

what causes trochanteric bursitis ?

Answer 10

F>M
trauma
over use - runners
abnormal movements - scoliosis, total hip replacement, OA

Question 11

how does trochanteric bursitis present ?

Answer 11

pain - point tenderness on lateral hip

Question 12

what are signs of trochanter bursitis ?

Answer 12

look - scars from previous surgery, gluteal muscle wasting
feel - tenderness at greater tuberosity
move - worse pain in active abduction

Question 13

what are investigations of trochanter bursitis ?

Answer 13

Xray - may be normal, OA
MRI
USS - guided injection

Question 14

what is the treatment for trochanter bursitis ?

Answer 14

rest
NSAIDs 
physio
corticosteroid injection
surgery - bursectomy

Question 15

what is avascular necrosis ?

Answer 15

death of bone due to loss of blood supply

Question 16

what gets avascular necrosis ?

Answer 16

M>F
35-50
80% bilateral
3% multifocal

Question 17

what are traumatic risk factors for avascular necrosis ?

Answer 17

irradiation
fracture
dislocation
iatrogenic

Question 18

what are systemic risk factors for avascular necrosis ?

Answer 18

idiopathic
hypercoaguable states
steroids
haematological - sickle cell, lymphoma, leukaemia
Caisson's disease
alcoholism

Question 19

what are symptoms of avascular necrosis ?

Answer 19

insidious onset of groin pain

pain with stairs, walking uphill, impact activities

Question 20

what is seen on exam of avascular necrosis ?

Answer 20

largely normal

may replicate early arthritis - reduced ROM, stiff joint

Question 21

how is avascular necrosis investigated ?

Answer 21

Xray

MRI

Question 22

what is the non-operative treatment of avascular necrosis ?

Answer 22

reduce weight bearing
NSAIDs
bisphosphonates
anticoagulants
physio - keep moving

Question 23

what is the surgical treatment of avascular necrosis ?

Answer 23

restore blood supply - core decompression, vascularised graft
move lesion away from weight bearing are
total hip replacement

Question 24

what is femoroacetabular impingement FAI

Answer 24

impingement of femoral neck against anterior edge of acetabulum
younger patients, can develop secondary arthritis

Question 25

what are the different types of FAI ?

Answer 25

cam lesion - young athletic males, excess bone on head of femur pincer - young females, abnormal acetabulum overhangs

Question 26

what are associated injuries with FAI ?

Answer 26

labral degeneration and tears cartilage damage and flap tears secondary OA

Question 27

what is the presentation of FAI ?

Answer 27

groin pain - worse with flexion | mechanical symptoms - block to movement, pain with certain movements squatting lunging etc

Question 28

what is seen on exam of FAI ?

Answer 28

reduced flexion and internal rotation | positive FADIR - flexion adduction and internal rotation

Question 29

what are the examinations for FAI ?

Answer 29

Xray | MRI

Question 30

what is the non-operative treatment for FAI ?

Answer 30

activity modulation NSAIDs physio

Question 31

what is the operative treatment for FAI ?

Answer 31

arthroscopy - shave down defect, deal with tears | open - resection, periacetabular osteotomy, hip arthroplasty (replacement)

Question 32

what is the most common labral tear ?

Answer 32

anterosuperior tear

Question 33

who is most at risk of a labral tear ?

Answer 33

mostly active females of all ages

Question 34

what causes labral tears ?

Answer 34

``` FAI trauma OA dysplasia collagen disease - Ehlers-Danlos ```

Question 35

how does a labral tear present ?

Answer 35

groin or hip pain snapping sensation jamming or locking

Question 36

what is seen on exam of labral tears ?

Answer 36

can be normal | positive FABER - flexion, abduction, external rotation

Question 37

what are the investigations for labral tears ?

Answer 37

Xray MRI diagnostic injection

Question 38

how do you treat labral tears ?

Answer 38

non-op - NSAIDs, rest, physio, steroid injection | op - arthroscopy