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
what is trochanteric bursitis?
inflammation of the trochanteric bursa
what causes trochanteric bursitis?
repetitive trauma caused by ilitibial band tracking over trochanteric bursa
who is usually affected by trochanteric bursitis?
females
young runners and older patients
how does trochanteric bursitis present?
- pain on lateral aspect of the hip
- pain on palpation of greater trochanter
how is trochanter bursitis diagnosed?
- clinical diagnosis
- radiographs usually remarkable
- visible on MRI but not usually needed
what is the management for trochantric bursitis?
- analgesia
- NSAIDs
- physio
- steroid injection
there is no proven benefit of surgery!
what is osteoarthritis?
- degenerative disease of synovial joints that causes progressive loss of articular cartilage
- inflammatory changes in capsule lead to thickening and tightness
what is osteoarthritis?
- degenerative disease of synovial joints that causes progressive loss of articular cartilage
- inflammatory changes in capsule lead to thickening and tightness
who is more commonly affected by OA?
females> males
older age
family history of OA
pre existing hip disease
how does hip OA present?
groin pain worse on activity pain at night start up pain stiff on testing ROM
how is OA diagnosed?
Radiographs!
Xray
what is management for OA?
analgesia weight loss walking aids physio steroid injections? total hip replacement
primary indication for a hip replacement in OA?
PAIN!
what are risks of total hip replacement?
- scar
- bleeding
- neurovascular injury
- fracture
- clotting (DVT/PE/CVA)
- infection
- dislocation
- leg length discrepency
- loosening
- ongoing symptoms
