hip conditions and surgery Flashcards
what does groin pain suggest?
intra articular hip pathology
anterior thigh pain suggests?
intra articular hip pathology
what days pain over lateral hip/ greater trochanter suggest?
trochanteric bursitis
what does pain in lower back/buttocks usually relate to?
SI pathology
lower back
what is femoroacetabular impingement syndrome (FAI)?
a condition causing extra bone to grow on both the bones that form the hip joint (acetebulum and femoral neck) causing it to be the wrong shape
how does femoroacetabular impingement present?
- pain (in groin area, particularly on flexion and rotation)
- difficulty sitting
- stiffness
- limping
- C sign positive
- FADIR provocation test positive
what type of femoroacetabular impingements are there?
CAM type and pincer types
what is the difference anatomically between the pincer type and cam type femoroacetabular impingement?
pincer type= acetabular deformity
CAM type= femoral deformity
what is the difference anatomically between the pincer type and cam type femoroacetabular impingement?
pincer type= acetabular deformity
CAM type= femoral deformity
who is usually affected by a CAM type demoroacetabular impingement?
young athletic males
who is usually affected by the pincer type femoroacetabular impingement?
females
what can both CAM and pincer femoroacetabular impingement cause?
- damage to labrum and tears
- damage to cartilage
- OA in later life
what tests must be done for femoroacetabular impingement syndrome?
radiographs
CT
MRI (for better visualising damage to labrum and bony oedema)
what is the treatment for femoracetabular impingement syndrome?
asymptomatic= observe them symptomatic= SURGERY
CAM impingement= arthroscopic or open surgery to remove CAM/ debride labral tears
Pincer imgingement= periacetabular osteotomy/ debride lateral tears
older patients with secondary OA= arthroplasty
what is avascular necrosis?
failure of blood supply to the femoral head
who does avascular necrosis usually affect? (age + sex)
male> females
35-50 years
is avascular necrosis usually unilateral?
no, 80% of cases are bilateral
what are some risk factors for avascular necrosis?
- irridation
- trauma
- haemotologic disease, sickle cell or hypercoagulable states (divers coming out of water too fast)
- dysbaric disorders
- alcoholism
- steroid use
most cases idiopathic
how does avascular necrosis present?
- insidious onset of groin pain
- exacerbated by stairs or impact
- examination is usually normal unless disease has advanced to collapse/OA
what investigations are done for avascular necrosis?
- Xray
- MRI if Xray is normal but asyptomatic as it is more sensitive
is avascular necrosis reversible?
early stages- reversible
late stages- irreversible (when the femoral head has collapsed)
is avascular necrosis reversible?
early stages- reversible
late stages- irreversible (when the femoral head has collapsed)
management for reversible/ early stage avascular necrosis?
- biphopshpatpnates
- core decompression +/- bone grafting
- curettage and bone grafting
- vascularised fibular bone graft
what is the treatment for late stage/irreversible avascular necrosis?
total hip replacement
