Hip conditions Flashcards
Where is the trochanteric bursa?
Sandwiched between hip abductors and ITB
What is Trochanteric Bursitis?
Inflammation of the bursa, Swelling
More common in females
Cause of Trochanteric Bursitis?
1) Trauma
2) Over-use
- Athletes, often runners
- Repetitive movements
3) Abnormal movements
- Distant problem e.g. Scoliosis
- Local problem
> Muscle wasting following surgery
> Total Hip Replacement
> Osteoarthritis
Presentation of Trochanteric Bursitis?
Pain = Point tenderness, Lateral hip
Examination of Trochanteric Bursitis?
1) LOOK
- May have scars from previous surgery
- May have muscle wasting, Gluteals
2) FEEL
- Tenderness at Greater
- Tuberosity
3) MOVE
- Worst pain in active abduction
Investigation for Trochanteric Bursitis?
1) X-ray
- May be normal
- OA, THR, Spine abnormalities
2) MRI
- Shows soft tissues and fluid
3) Ultrasound
- Can be therapeutic as well as diagnostic
- Guided injection
Treatment of Trochanteric Bursitis?
1) NSAIDs
2) Relative rest / Activity modification
3) Physiotherapy
- Correct posture, abnormal movements
- Stretching
- Strengthen muscles around joint
4) Injection = Corticosteroids
5) Surgery
- Bursectomy
- Rarely required
What is avascular necrosis?
Death of bone due to loss of blood supply
Epidemiology of avascular necrosis?
Males > Females
Average age 35-50 years old
80% = bilateral
May be offset in time
3% = multifocal
3 or more joints
Risk factors for avascular necrosis?
1) Trauma
- Irradiation
- Fracture
- Dislocation
- Iatrogenic
2) Systemic
- Idiopathic
- Hypercoaguable states
- Steroids
- Haematological
> Sickle Cell Disease
> Lymphoma
> Leukaemia
- Caisson’s disease
- Alcoholism
If there is fracture to the neck of the femur what may occur?
Avascular necrosis of the femoral head due to loss of blood supply from the medial/lateral circumflex artery
Symptoms of avascular necrosis?
- Insidious onset of groin pain
- Pain with stairs, walking uphill and impact activities
- Limp
Examination of avascular necrosis?
> Largely normal
May replicate early arthritis
- Reduced range of motion (partic internal rotation)
- Stiff joint
Investigations in avascular necrosis?
X-Ray (Wont identify early stages)
MRI
- 99% sensitive and specific
- Will identify earliest changes
Treatment of avascular necrosis?
Non-Operative
- Reduce weight-bearing
- NSAIDs
- Bisphosphonates
- Anticoagulants
- Physiotherapy
Surgical
- Restore blood supply
- Core decompression
- Core decompression and vascularised graft
- Move the lesion away from the weight-bearing area
- Rotational Osteotomy
- Total Hip Replacement
What is the most common cause of hip pathology in younger patients?
Femoroacetabular Impingement (FAI)
What can Femoroacetabular Impingement (FAI) often lead to?
Secondary osteoarthritis
What is Femoroacetabular Impingement (FAI)?
Broadly divided into 2 categories
1) Cam lesion (Lesion on head of femur)
2) Pincer (Lesion on acetabulum)
Results in impingement of femoral neck against anterior edge of acetabulum
Associated injuries of femoroacetabular impingement?
Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip osteoarthritis
Presentation of femoroacetabular impingement?
Groin pain = Worse with flexion
Mechanical symptoms - Block to movement - Pain with certain manoeuvres: > Getting out of a chair > Squatting > Lunging
Examination of femoroacetabular impingement?
Reduced flexion and internal rotation
Positive FADIR test = Flexion, ADduction, Internal Rotation
Investigations for femoroacetabular impingement?
X-ray - Identify the bony pathology
MRI = Useful for assessing associated conditions:
- Labral tears
- Articular cartilage damage
Treatment in femoroacetabular impingement?
Non-operative
- Activity modification
- NSAIDs
- Physiotherapy
> Correct posture
> Strengthen muscles around joint
Operative
- Arthroscopy
> Shave down the defect
> Deal with labral tears
> Resect artic cartilage flaps
- Open Surgery
> Resection
> Periacetabular Osteotomy
> Hip Arthroplasty
- Resurfacing
- Replacement
Labral tear?
Most commonly anterosuperior tear
Causes of a labral tear?
FAI
Trauma
OA
Dysplasia
Collagen diseases – Ehlers-Danlos
Epidemiology of a labral tear?
All age groups
Commonly active females
- Pincer
- More flexible
Presentation of a labral tear?
Groin or Hip Pain
Snapping sensation
Jamming or locking
Examination of a labral tear?
Can be normal
Positive FABER test = Flexion, ABduction, External Rotation (Anterior tears)
Investigations of a labral tear?
Ensure adequate imaging so identify any root causes of pathology
X-ray
- OA, Dysplasia
MRI Arthrogram
- 92% sensitive
Diagnostic injection
- Local anaesthetic
Labral Tear - Treatment?
Non-Operative
- Activity modification,
- NSAIDs,
- Physiotherapy
- Injection of Steroids
Operative
- Arthroscopy
> Repair
> Resection
