Hip Disorders Flashcards
define avascular necrosis of the hip (AVN)
occurs when there is limited blood supply to the bone (femoral head)
risk factors of necrosis of the hip
alcoholism
steroid use
immunosuppression
sickle cell anaemia
clinical features of necrosis of the hip
insidious onset of the pain
⬇️ ROM (internal rotation)
stiffness of joint
limp
investigations of necrosis of the hip
MRI
XR
conservative management of necrosis of the hip
⬇️ weight bearing
physiotherapy
analgesic relief (e.g. NSAIDs)
biphosphonates
surgical management of necrosis of the hip
early stages:
- core decompression
late stages:
- total hip replacement
- hip joint effusion (younger males)
define femoroacetabular impingement (FIA)
an orthopaedic condition in which extra bones grow along either one or both bones of the hip joint causing pain and damage to the joint
types of FIA
cam impingement:
associated with SUFE
causes loss of femoral head roundness
seen as concavity of femoral head on XR
pincer impingement:
occurs due to extra bone extending out acetabulum rim
causes crushing of prominent acetabulum rim
clinical features of FIA
groin pain that:
worsens on flexion
worsens on standing from seated position
worsens on squatting and lunging
examination findings in FIA
replication of pain on FADIR test
investigations for FIA
CT scan
XR
MRI
non-operative management for FIA
activity modification
analgesic relief
physiotherapy
operative management for FIA
arthroscopy open surgery (mainly in men)
define trochanteric bursitis
an inflammation of the bursa overlying the greater trochanter of the femur
causes of trochanteric bursitis
soft tissue trauma strain injuries leg length differences prolonged sitting excessive running
clinical features of trochanteric bursitis
lateral hip pain that worsens at night and is aggravated by physical activity
swelling of the area
+ve Trendelenberg test
examination findings of trochanteric bursitis
point tenderness
+ve Trendelenberg test
antalgic gait
pain on restricted active abduction or passive adduction
investigations of trochanteric bursitis
gold: US of hip
XR
MRI
initial non-operative management of trochanteric bursitis
rest and avoidance of activity
application of ice packs
analgesic relief
medical non-operative management of trochanteric bursitis
peri-trochanteric corticosteroid injections
physiotherapy (ITB stretch and glute strength)
operative management of trochanteric bursitis
bursectomy - as a last resort in selected cases
define an intracapsular hip fracture
fracture involving the femoral neck between the edge of the femoral head and insertion of capsule of hip joint
define an extracapsular hip fracture
fracture occurring distal to insertion of the capsule either involving or between trochanters
describe Garden I and II classification
I: undisplaced + incomplete fracture
II: undisplaced + complete fracture
describe Garden III and IV
III: partial displacement and complete fracture
IV: total displacement and complete fracture
clinical features of a hip fracture
pain within outer upper thigh or groin that can radiate to the knee
inability to weight bear
shortened, abducted and externally rotated leg
investigations of a hip fracture
bloods (FBC, U+E and cross-match)
AP and lateral hip XR
management of Garden I + II intracapsular fractures
internal fixation (with screws)
management of Garden III + IV fractures in those < 55yrs
internal fixation (with screws)
management of Garden III + IV fractures in those >75yrs
hemi-arthroplasty
management of Garden III + IV fractures in those between 55 - 75yrs
total hip replacement
management of intertrochanteric extracapsular fracture
ORIF with dynamic hip screw
management of subtrochanteric extracapsular fracture
intramedullary nail
