HIP DISORDERS Flashcards
Primary Risk factors of OA
-Age
-Female
-Ethnicity
-Genetics
-Nutrition
Secondary Risk factors of OA
Obesity
Trauma
Mal-alignment
Infection
Pathology of OA
- precipitating risk factors lead to excessive loading of joint and damage to articular cartilage
- causes increased proteoglycan synthesis by chondrocytes in an attempt to repair cartilage
- articular cartilage replaced by fibrocartilage causing flaking and fibrillation
- erosion of cartilage down to subchonral bone causing pain
Symptoms of OA
-Joint stiffness (getting out of bed/long durations sitting)
-Pain in hip,gluteal,groin regions radiating to the knee
-Mechanical pain
-Crepitus
-Reduced mobility
Four cardinal signs of OA
ROBS
-Reduced joint space
-Osteophytes
-Bony cysts
-Subchondral sclerosis
non-operative management of osteoathritis
activity modification
weight loss (less force going through hips)
stick/walker
physiotherapy
medications for osteoarthritis (3)
NSAIDs
COX-2 inhibitors
Nutritional supplements
what injections can be given for osteoarthritis?
corticosteroid to dampen inflammation
viscosupplementation (injecting synovial fluid)
Operative treatment of OA
Total hip replacement- only cure to releive pain and restore mobility
What is OA
-degenerative dosprder arising from the breakdown of articular hyaline cartilage.
-joint pain accompanied by functional limitation and reduced quality of life.
Most common joints affected in OA
-Hips
-Knee
-Cervical spine
-Lumbar spine
-Small joint of the hands
What are fractures of the femoral neck (NOF)
-Fracture of the proximal femur up to 5cm below the lesser trochanter
How can NOF fracture be classified
-Intracapsular (more common in elderly,especially post menopausal women with osteoporotic bone)
-Extracapsular (further divided into intertrochanteric and subtrochanteric)
Describe risk of AVN in intracapsular NOF fracture?
-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.
Impact on the supply to the femoral head in extracapsular fractures?
In extracapsular fractures the arterial supply to the femoral head is likely to remain intact
What are symptoms of NOF fracture
-reduced mobility / sudden inability to bear weight
-pain felt in hip/groin and/or knee
Describe NOF fracture on examination
Affected leg is usually:
-Shortened
-Abducted
-Externally rotated
-Exacerbation of pain on palpatation of the greater trochanter + rotation of the hip
what surgery would be done after a displaced intracapsular fracture?
high risk of AVN so either hemiarthroplasty or total hip replacment
what is the difference between hemiarthroplasty surgery and total hip replacement?
-hemiarthroplasty is femoral head only
-total hip replacement is femoral head and acetabular cup
What is dislocation fo the Hip
Head of femur being fully displaced out of the cup-shaped acetabulum of the pelvis.
Less than complete displacement is known as subluxation.
How can dislocations be classified
-Congenital
-Traumatic
State a Congenital hip dislocations
-Developmental dysplasia of the hip (DDH)
Describe traumatic hip dislocation
-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
List the types of Hip dislocations
-Posterior (90%)
-Anterior
-Central
Describe posterior hip dislocation
-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)
Why is limb shortened and internally rotated in posterior dislocation?
-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
Describe limb in anterior dislocation
-Limb is held in a position of external roatation and abduction with slight flexion.
-May result in femoral nerve pasly (uncommon)
Describe central dislocation
-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)