Hip Conditions

Question 1

What attaches to the greater trochanter?

Answer 1

Abductors and rotators

Question 2

What attaches to the lesser trochanter?

Answer 2

Psoas

Question 3

What is the blood supply to the femur?

Answer 3

MFCA - to femoral head
LFCA

Blood enters via the capsule at NOF

Question 4

What is OA?

Answer 4

Progressive loss of articular cartilage

Secondary bony changes

Question 5

What characterises OA?

Answer 5

worsening pain and stiffness

Question 6

What is trochanteric bursitis?

Answer 6

Inflammation of the bursa

Question 7

What causes trochanteric bursitis?

Answer 7

Trauma
Over use
Abnormal movements
-Scoliosis
-Muscle wasting
-Replacements
-OA

Question 8

What is the presentation and examination of trochanteric bursitis?

Answer 8

Pain
Look + feel + move
Scars, muscle wasting, tenderness, worsening pain in abduction

Question 9

Investigations for trochanteric bursitis?

Answer 9

X-ray
MRI
USS

Question 10

Treatment for trochanteric bursitis?

Answer 10

NSAID's
Activity modification
Physio
Injection of steroids
Surgery = bursectomy

Question 11

What is avascular necrosis?

Answer 11

Death of bone due to loss of blood supply

Usually bilateral

Question 12

What are the RF’s for avascular necrosis?

Answer 12

Trauma to femoral head (irradiation, fracture, iatrogenic)

Systemic (idiopathic, steroids, haematological (sickle, lymphoma or leukaemia), alcoholism) = IV coagulation

Question 13

What are the symptoms and examination of avascular necrosis?

Answer 13

S = insidious onset of groin pain, pain on movement and limp

E = normal but may replicate early arthritis

Question 14

What is the treatment for avascular necrosis?

Answer 14

Reduce weight baring
NSAID's
Bisphosphonates
Anticoagulants
Physio

Restore blood supply or hip replacement

Question 15

What is femoroacetabular impingement?

Answer 15

Cause of hip pathology and secondary OA

Divided into

• Cam lesion
• Pincer

=Impingement of femoral neck against anterior edge of acetabulum

Question 16

What is FAI pincer?

Answer 16

Acetabulum based impingement

Question 17

What is FAI cam?

Answer 17

Femoral head based impingement

Question 18

What are some FAI associated injuries?

Answer 18

Labral degeneration
Cartilage Damage
Secondary hip OA

Question 19

What are the FAI presentations?

Answer 19

Groin pain - worse on flexion and other movements

Reduced movement

Question 20

What are the FAI examination and investigations?

Answer 20

FADIR test positive

X-ray and MRI

Question 21

What are the FAI treatment?

Answer 21

Activity modification
NSAID's
Physio
Arthroscopy
Resection
Periacetabular osteotomy
Hip arthroplasty = resurfacing and replacement

Question 22

What care the causes for labral tears?

Answer 22

Most common anterosuperior tear

FAI, trauma, OA, dysplasia and collagen disease

Question 23

What is the presentation of labral tears?

Answer 23

Groin or hip pain
Snapping sensation
Jamming or locking

Question 24

What is the examination of labral tear?

Answer 24

Can be normal

Positive FABER test

Question 25

What are the investigations for a labral tear?

Answer 25

X-ray
MRI
Diagnostic injection (local anaesthesia)

Question 26

What is the treatment for a labral tear?

Answer 26

Activity modification
NSAID's
Physio
Steriod injection
Arthoscopy = repair and ressection