Hip conditions and surgery

Question 1

What are the 4 X-ray features of osteoarthritis?

Answer 1

LOSS
Loss of articular space
Osteophytes
Sclreosis of subchondral bone
Subchondral cysts

Question 2

What pain is present in trochanteric bursitis?

Answer 2

Pain on the greater trochanter of the femur

• no pain in the groin
• no pain on movement

Question 3

What are the causes of femoroacetabular impingement?

Answer 3

Extra growth of bone on the neck of the femur (CAM) or the rim of acetabulum (pincer)

Question 4

Osteotomy of the acetabulum involves a controlled fracture of the hip and realigning of the acetabulum. When is it appropriate?

Answer 4

In osteoarthritis, when the acetabulum has been eroded and there is a risk of fracture

Question 5

What procedure can be carried out for Avascular Necrosis of the femoral head, if caught early?

Answer 5

Drill into the femoral head to relive pressure

Question 6

How long would you expect a THR prosthesis to last?

Answer 6

10-15 years

Question 7

What risks are associated with THR?

Answer 7

blood loss
DVT/PE
nerve damage
post-op dislocation

Question 8

What are the risk factors of proximal hip fractures?

Answer 8

Age >50
Osteoporosis
Smoking
Malnutrition
Alcohol
Neurological impairment
Vision impairment

Question 9

What is the blood supply of the femoral head?

Answer 9

1. intramedullary artery of shaft of femur
2. medial and lateral branches of profunda femoris
3. artery of ligamentum teres

-nutrients also from synovial fluid

Question 10

Extracapsular proximal femoral fractures do not sequester the blood supply to the femoral head (T/F)

Answer 10

True

-blood supply from the branches of profunda femoris is uncompromised

Question 11

What are three important extracapsular fractures?

Answer 11

Basicervical
Subtrochanteric
…

Question 12

What is the treatment of an undisplaced intracapsular femoral fracture in the young or old and active patient ?

Answer 12

Fixation of the head to femoral shaft with screws

Question 13

What type of hip replacement is suitable for a displaced intracapsular fracture in:

1. an active / young patient
2. an elderly low-demand patient

Answer 13

1. Total hip replacement
   - better functionaloty and durability
2. Heiarthroplasty
   - does not dislocate easily
   - allows early mobilisation

Question 14

If an AP X-ray does not clearly show a suspected proximal femoral fracture, what should be done?

Answer 14

Request a lateral X-ray