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Musculoskeletal System > Hip Joint > Flashcards

Hip Joint Flashcards

1
Q

Parts of the hip joint

A 
Articular cartilage 
head of the femur 
ligamentum teres 
obturator artery 
transverse acetabular ligament 
acetabular labrum (fibrocartilagenous)
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2
Q

Hip joint

A

strong and stable joint

comprised of th articulation between the acetabulum of the innominate bone and the head of the femur

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3
Q

The orientation of the acetabulum and head of the femur

A

anteverted and the angle is about 15 degrees

-allows for great deal of stability posteriorly

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4
Q

Intertrochanteric region

A

occurs along the base of the neck of the femur

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5
Q

Blood supply to the head of the femur

A

Medial circumflex femoris artery actually comes off the profunda femoris in a posterior direction rather than a medial one
Lateral circumflex femoris a. comes around anteriorly not laterally
they both come off profunda and deep femoral a.

also, minor branches from the artery of ligamentum trees

obturator artery

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6
Q

Anastomotic network

A

the lateral circumflex artery gives off a descending branch along the shaft of the femur and an ascending branch which anastomoses with the medial circumflex. this anastomotic network forms the reticular arteries which are really the main concern in fx of the femoral head and neck

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7
Q

Normal neck-shaft hip angulation

A

115-135

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8
Q

greater than 135 neck-shaft hip angulation

A

coxa valga

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9
Q

less than 115 neck-shaft hip angulation

A

coxa varus

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10
Q

angle of femoral head in kids

A

higher than 15 = explains why they are pigeo-footed or have a in-toeing gait

the angle will reduce to a value closer to 15 as kids mature
otherwise it is a developmental pathology

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11
Q

angle of acetabulum

A

anteverted to 15
medial wall of the acetabulum is very thin
does not provide much support but the posterior and anterior columns are very thick

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12
Q

what is the inverted Y of acetabulum

A

the oblique angle is 45
tilted downward
thinness of the medial wall of the acetabulum

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13
Q

PE of the hip

A 
pain 
ROM 
palpation 
mandatory neurovascular exam
leg length discrepancies 
Trendenlenberg sign 
Thomas test 
Faber test
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14
Q

What are the normal HIP ROM

A 
always compare normal vs non normal 
Extension : 20-30 
Flexion: 135 
Abduction: 45-50
Adduction: 20-30 
Internal rotation: 30-40 
External rotation: 30-40
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15
Q

Trendelenberg test

A

maneuver for assessing hip abductor function
the contralateral iliac crest should rise indicating that the planted side’s gluteus medius is contracting and holding the innominate up
A POSITIVE TEST = contralateral iliac crest dropping down
even if the iliac crests stay medial, the gluteus medius function is abnormal
because the hip is not rising

abductor weakness or hip dysplasia (hip is dying!!)

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16
Q

Galeazzi test

A

anatomic short leg or functional short leg

useful for kids

assessing the femur by putting the knees in flexion which takes the tibia out of the equation, this person has a shorter femur

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17
Q

Etiology of short leg

A

hip degeneration
-not actually caused by hip degeneration
degeneration -> pertusio -> short leg

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18
Q

Pertusio

A

femoral head breaches the ishioilial line (vertical white line seen in XR)

caused by joint degeneration as in the case of osteoarthritis

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19
Q

Thomas test

A

test hip flexion contracture

Flex the hip and knee and if the opposite thigh elevates off the table then there is a flexion contracture = this is evaluating the extended hip and you must take into account pelvic tilt/lumber lordosis
Maximum flexion is the point at which the elvis begins to rotate - then allow the hip to extend - if the patient has a hip flexion contracture, the pelvis will start to rock before the leg reaches the examination table when extending the leg

20
Q

Faber test

A

detects sacroiliac pathology
nonspecific
stress manuever
positive test = increased pain

Flexion
Abduction
Extension
Rotation

21
Q

What is DTR?

A

deep tendon reflex

22
Q

What other physical findings are important for PE of hip?

A

dermatomes
motor testing
pulses

23
Q

Etiology of hip pain

A 
extra-articular 
intra-articular 
regional 
extra regional 
soft tissue defects
osseous defects
24
Q

Ddx of the hip

A

Trauma - hip fx (IT/neck) ; hip dislocation

Extra-articular - trochanteric bursitis, iliotibial band tendonitis, sacroilitis (+FABER), tumor, inguinal hernia, lumber disc herniation

Intra-articular - labral tears, loose bodies-fragments, synovitis (PVNS), septic arthritis (esp. with replacements), synovial chondromatosis, osteoarthritis, osteoarthritis, osteonecrosis

25
Q

extra-regional ddx of the hip

A

lumber spine, viscera, and abdominal contents can refer pain to hip and groin

26
Q

Referred pain from the hip

A

knee and buttocks
pain to the medial thigh and knee may be from the obturator nerve whereas pain from the hip felt in the buttock may be from sciatic nerve

27
Q

osteoarthritis

A

affects larger joints
degenerative
noninflammatory
manifestations of the disease - inflammatory but the disease itself is not secondary to inflammation

28
Q

presentation of osteoarthritis

A 
groin 
buttock 
thigh 
knee pain 
obturator irritation = referred to medial thigh and knee
29
Q

Etiology of osteoarthritis

A

primary - idiopathic, wear/tear

secondary - insult to the hip - trauma, AVN, development, or congenital

30
Q

Result of osteoarthritis

A

subchondral sclerosis
subchondral cysts
-due to loss of articular cartilage which increases the coefficient of friction between two bones

31
Q

XR will show subchondral sclerosis

A

very radiopaque area at the articulation

  • indicates that the cartilage has rubbed away from the bone and the bone has become hard
  • occurs at the superior dome of the acetabulum
32
Q

XR of osteoarthritis

A

joint space narrowing
hardening and thickening of the bones
hyaline cartilage is gone

33
Q

Tx of OA

A

disease usually gets worse - does not get better - will only get worse
hip replacement is indicated if first line tx does not work

34
Q

Pertrusio in OA

A

femoral head “herniates” through the acetabulum as will be evidenced by a breach of the ischioilial line on XR

35
Q

Conservative Tx of OA

A

preserve activity and motion and control of pain

-avoid high impact activities, WEIGHT CONTROL

-Tylenol+NSAIDs
injections and assistive devices

36
Q

Surgical tx of OA - second line

A

Total hip replacement
osteotomy
hip resurfacing
arthrodesis

37
Q

Osteotomy - OA

A

cut the bone to shorten lengthen or change its alignment and redirect it so that good cartilage is interacting with good cartilage

38
Q

hip resurfacing - OA

A

preserves some of the neck of the femur

especially best for younger patient that can have total hip replacement later - can have metal on metal

39
Q

arthrodesis - OA

A

furse the bone

artificial induction of joint ossification bn two bones via surgery

40
Q

athroplasty - OA

A

joint surface is replaced with something better

41
Q

Hip replacement

A

98% success rate

metal on ceramic is GOOD

42
Q

Complications of total hip arthroplasty THA

A

periprosthetic fx
periprosthetic infection
periprosthetic dislocation- caused by malpositioning of the polyethylene liner in the acetabulum
osteolysis - will see bubbling of the bone - indicates that the bone is becoming osteopenic - may be autoimmune response
component loosening - usually a gradual process that is accompanied by pain and often leads to surgical revision
component wear

43
Q

bacteremia in THA

A

bacteremia immediately after surgery or even years later (dental work) can settle out on the metal, since there is no vasculature like a normal joint = no immune system
safe ground for bacteria to breed

44
Q

More complications of THA

A 
DVT 
tx with low molecular weight heparin 
MAy lead to infection 
loss of motion 
LEG LENGTH DISCREPENCY
45
Q

leg length discrepancy due to THA

A

most serious
problems with gait
result of 2 cm difference between the prosthesis and native hip

Musculoskeletal System (27 decks)

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