HIP DISORDERS

Question 1

Primary Risk factors of OA

Answer 1

-Age
-Female
-Ethnicity
-Genetics
-Nutrition

Question 2

Secondary Risk factors of OA

Answer 2

Obesity
Trauma
Mal-alignment
Infection

Question 3

Pathology of OA

Answer 3

1. precipitating risk factors lead to excessive loading of joint and damage to articular cartilage
2. causes increased proteoglycan synthesis by chondrocytes in an attempt to repair cartilage
3. articular cartilage replaced by fibrocartilage causing flaking and fibrillation
4. erosion of cartilage down to subchonral bone causing pain

Question 4

Symptoms of OA

Answer 4

-Joint stiffness (getting out of bed/long durations sitting)
-Pain in hip,gluteal,groin regions radiating to the knee
-Mechanical pain
-Crepitus
-Reduced mobility

Question 5

Four cardinal signs of OA

Answer 5

ROBS
-Reduced joint space
-Osteophytes
-Bony cysts
-Subchondral sclerosis

Question 6

non-operative management of osteoathritis

Answer 6

activity modification

weight loss (less force going through hips)

stick/walker

physiotherapy

Question 7

medications for osteoarthritis (3)

Answer 7

NSAIDs

COX-2 inhibitors

Nutritional supplements

Question 8

what injections can be given for osteoarthritis?

Answer 8

corticosteroid to dampen inflammation

viscosupplementation (injecting synovial fluid)

Question 9

Operative treatment of OA

Answer 9

Total hip replacement- only cure to releive pain and restore mobility

Question 10

What is OA

Answer 10

-degenerative dosprder arising from the breakdown of articular hyaline cartilage.

-joint pain accompanied by functional limitation and reduced quality of life.

Question 11

Most common joints affected in OA

Answer 11

-Hips
-Knee
-Cervical spine
-Lumbar spine
-Small joint of the hands

Question 12

What are fractures of the femoral neck (NOF)

Answer 12

-Fracture of the proximal femur up to 5cm below the lesser trochanter

Question 13

How can NOF fracture be classified

Answer 13

-Intracapsular (more common in elderly,especially post menopausal women with osteoporotic bone)

-Extracapsular (further divided into intertrochanteric and subtrochanteric)

Question 14

Describe risk of AVN in intracapsular NOF fracture?

Answer 14

-They are more likely to disrupt the ascending cervical branches of the medial femoral circumflex artery.

-due to inability of the artery of ligaments teres to sustain metabolic demand of the femoral head, there is high risk of AVN.

Question 15

Impact on the supply to the femoral head in extracapsular fractures?

Answer 15

In extracapsular fractures the arterial supply to the femoral head is likely to remain intact

Question 16

What are symptoms of NOF fracture

Answer 16

-reduced mobility / sudden inability to bear weight

-pain felt in hip/groin and/or knee

Question 17

Describe NOF fracture on examination

Answer 17

Affected leg is usually:
-Shortened
-Abducted
-Externally rotated
-Exacerbation of pain on palpatation of the greater trochanter + rotation of the hip

Question 18

what surgery would be done after a displaced intracapsular fracture?

Answer 18

high risk of AVN so either hemiarthroplasty or total hip replacment

Question 19

what is the difference between hemiarthroplasty surgery and total hip replacement?

Answer 19

-hemiarthroplasty is femoral head only

-total hip replacement is femoral head and acetabular cup

Question 20

What is dislocation fo the Hip

Answer 20

Head of femur being fully displaced out of the cup-shaped acetabulum of the pelvis.

Less than complete displacement is known as subluxation.

Question 21

How can dislocations be classified

Answer 21

-Congenital
-Traumatic

Question 22

State a Congenital hip dislocations

Answer 22

-Developmental dysplasia of the hip (DDH)

Question 23

Describe traumatic hip dislocation

Answer 23

-acute hip dislocation

-severe injury commonly seen in 16-40yr olds in high speed road traffic collisions.

-Dislocating a normal hip requires a massive amount of force

-Affected hip is extremely painful and patient resists any attempt to move the limb

Question 24

List the types of Hip dislocations

Answer 24

-Posterior (90%)
-Anterior
-Central

Question 25

Describe posterior hip dislocation

Answer 25

-most common cause= knee impacting dashboard in road traffic collision.

-affected limb is shortened and held in a position of flexion, adduction, internal (medial) rotation

-Sciatic nerve palsy may be present (it sits behind the hip so femur can press down on nerve)

Question 26

Why is limb shortened and internally rotated in posterior dislocation?

Answer 26

-Head of femur pulled upwards by strong extensors (glut max and hamstrings) + adductors of the hip= SHORTENED LIMB

-Ant fibres of Glut med + min pull on the posteriorly displaced greater trochanter= INTERNAL ROTATION

Question 27

Describe limb in anterior dislocation

Answer 27

-Limb is held in a position of external roatation and abduction with slight flexion.

-May result in femoral nerve pasly (uncommon)

Question 28

Describe central dislocation

Answer 28

-Head of femur driven into the pelvis through the acetabulum

-femoral head is palpable on rectal examination

-High risk of intrapelvic haemorrage due to disruption of the pelvic venous plexuses (can be life threatening)