Hip conditions and surgery Flashcards
Altered biomechanics of the hip is caused by which pathology?
Dysplasia of the hip
Which pathology can cause block to movement of the hip joint?
Perthe’s disease –> avascular necrosis
Femoroacetabular impingement
Labral tear
How might acetabular dysplasia be surgically managed?
Periacetabular osteotomy
What are the different types of femoracetabular impingement?
CAM
Pincer
Mixed
What are possible causes of femoacetaular impingement?
SUFE
Perthe’s
Anatomical variation
How is a labral tear managed?
Nothing
Arthroscopy
Open shaving/repair
Which pathology is caused by bone failure?
Steroids
Dialysis
Venous sludging
How does venous sludging occur?
Increased venous pressure of the femoral head > Compartment syndrome > Cuts off blood supply > Necrosis > Cysts & osteophytes > Collapse of head
Which bone injuries cause hip pathology?
Fractures
What type of cartilage will injury spanning down to the tidemark be replaced with?
Fibrocartilage
What types of degeneration affect the hip?
Osteoarthritis
Rheumatoid arthritis
What may result from rheumatoid arthritis?
Secondary osteoarthritis
When should surgery be considered for hip dysplasia?
Symptomatic older patients
High risk of developing further problems
How can perthes be managed?
Head reshaping (not done in tayside)
How can femoroacetabular impingement be managed?
Laproscopic shave if symptomatic
What is the risk of femoracetabular impingement?
Secondary osteoarthritis
How can avascular necrosis be managed?
Pre-collapsed - x-ray guided pilot hole
Collapse - hip replacement
How is osteoarthritis of the hip managed?
Weight loss Analgesia Physiotherapy Injections (gastrographin, anaesthetic, steroids) Replacement
What are the indications for a total hip replacement?
Over 65 Reduced walking Pain uncontrolled by analgesia Night pain Impairment of AoDL Impairment of hobbies
What does a total hip replacement improve and what does it not improve?
Pain
May not improve stiffness
What is the risk with hip resurfacing?
Pseudotumours
What are the risks of joint replacement surgery?
Hypovolaemia
Nerve injury
DVT/PE
Dislocation
Is trochanteric bursitis self limiting?
Yes
How is trochanteric bursitis managed?
Conservatively +/- injections
How does trochanteric bursitis present?
Pain over hip joint Doesn't change with walking Single point of tenderness Lying on side is painful Doesn't last longer than a year
