Hip Conditions Flashcards
What are the most common adult hip conditions?
Femoro-acetabular impingement syndrome (FAI)
Avascular necrosis
Idiopathic transient osteonecrosis of the hip (ITOH)
Trochanteric bursitis
Osteoarthritis
What is femoroacetabular impingement syndrome?
Altered morphology of the femoral neck and/or acetabulum that causes abutment of the femoral neck on the edge of the acetabulum during movement
What is CAM type impingement in femoroacetabular impingement syndrome?
Where a femoral deformity causes abutment of the femur on the acetabulum
What is pincer type impingement in femoroacetabular impingement syndrome?
Where an acetabular deformity causes abutment of the femur on the acetabulum
What is mixed type impingement in femoroacetabular impingement syndrome?
Where both femoral and acetabular deformities cause abutment of the femur on the acetabulum
What does femoroacetabular impingement syndrome lead to?
Damage to the labrum and tears
Lamage to cartilage
Osteoarthritis in later life
Who are generally affected by different types of femoroacetabular impingement syndrome?
CAM - young athletic males
Pincer - females
How does femoroacetabular impingement syndrome present?
Activity related pain in the groin
Pain particularly in flexion and rotation
Difficulty sitting
C sign positive (cupping hand over groin to show where pain is)
FADIR provocation test positive
How is femoroacetabular impingement syndrome diagnosed?
Radiographs
CT
MRI
What is the management for femoroacetabular impingement syndrome?
Observation if asymptomatic
Arthroscopic or open surgery
Peri-acetabular osteotomy in pincer type
Arthroplasty in older patients with secondary OA
What is avascular necrosis of the femoral head?
Failure of the blood supply to the femoral head causing death of bone tissue
What is the pathophysiology of idiopathic AVN of the femoral head?
Coagulation of the microcirculation inside bone
Venous thrombosis causes retrograde arterial occlusion
Intraosseous hypertension
Decreased blood flow to femoral head - necrosis
Chondral fracture and collapse
What is the pathophysiology of AVN of the femoral head associated with trauma?
Due to injury of femoral head blood supply
What is the main blood supply to the femoral head?
Medial femoral circumflex
What are risk factors for avascular necrosis of the femoral head?
Irradiation Trauma Haematological diseases Dysbaric disorders Alcoholism Steroid use
What is the presentation of avascular necrosis of the femoral head?
Insidious onset of groin pain
Majority (80%) bilateral
Exacerbated by starts or impact
Examination is usually normal unless disease has advanced to collapse/OA
How is diagnosis done for avascular necrosis of the femoral head?
Radiographs (but often normal in early disease)
MRI scan is best
What radiographic factors are indicative of reversible avascular necrosis of the femoral head?
Normal or cystic or sclerotic changes
What radiographic features are indicative of irreversible avascular necrosis of the femoral head?
Crescent sign (subchondral collapse) Flattening of femoral head Narrowing of joint
What is the treatment for reversible avascular necrosis of the femoral head?
Bisphosphates
Core decompression
Curettage and bone grafting
Vascularised fibular bone graft
What is the treatment for irreversible avascular necrosis of the femoral head?
Total hip replacement
What is idiopathic transient osteonecrosis of the hip?
Local hyperaemia (increased blood flow) and impaired venous return with marrow oedema and increased intramedullary pressure Self-limiting, resolves after a few months
What is the presentation of idiopathic transient osteonecrosis of the hip?
Progressive groin pain appearing over several weeks
Difficulty weight bearing
Usually unilateral
Who usually present with idiopathic transient osteonecrosis of the hip?
Middle aged men
Pregnant women in third trimester
