Hip & Knee Flashcards
What kind of presentations of the knee are commonly seen?
- Pain (anterior, often well-localised)
- Stiffness
- Swelling/lump
- Giving way
- Deformity
- Loss of sleep
- Loss of function
What are the look, feel, moves relevant to the knee?
Look: - Deformity
- How the patient walks
- Swelling
- Scars
Feel: - Bony landmarks
- Any tenderness
- Any effusion
- Knee stability
- Get the patient to show where it is sore
- Patellar apprehension test
MOVE : - Extension
- Flexion
- Quads strength
What are investigations relevant to knee presentations?
Usually none
X-Ray
MRI
Viscosity (if inflammation is relevant)
Urate (gout usually affect big toe joint, but can affect knee as well)
What are common causes of knee presentations?
Ligament strain often medial collateral
Bursitis
Osgood-Schlatter’s
Osteoarthritis (Patello-femoral>knee)
What are less common, but important causes of knee presentations?
Chondromalacia patellae
Meniscus injury (though common in A&E)
Cruciate damage
Gout
Rheumatoid arthritis
Patellar subluxation/dislocation
Where does most part of weight pass through the knee? hence most commonly arthritis
The medial side
How is osteoarthritis treated?
Non-operative:
Operative:
What are risks of total knee replacement/total hip replacement?
Can ACL be repaired in adults?
Not really
What is the usual location for hip pain?
especially site, pain from hip usually groin radiating to anterior thigh.
If patient indicates buttock pain, that is probably coming from back.
What is the look, feel, move for hip joint?
LOOK
-Deformity
- Asymmetry
- Scars
FEEL
- Bony landmarks
- Tenderness
MOVE
- Range of movement
- Stiffness especially limited internal rotation
- Pain on moving, how they walk
What are the investigations for hip joint?
X-RAY
- only if it will affect your management
CRP/Viscosity
FBC-?Infection
Calcium, Alkaline Phosphatase
- if you suspect bone damage such as by metastases
What are cardinal signs of osteoarthritis on X-ray?
Loss of joint space
Osteophytes
Sclerosis
Subarticular cysts
What are primary care management strategies for knee/hip problems?
Education / explanation
Weight reduction
Home adaptations (occupational therapy)
Walking stick
Analgesia
NSAIDs
Physio
Complementary therapies
Mobility Allowance, disability badge for car
What are common causes of hip problems?
Ostearthritis
Rheumatoid arthritis
Fracture
Referred from back
Malignancy
What are rare, but important causes of knee presentations?
Soft tissue e.g. trochanteric bursitis
Paget’s disease
Infection e.g. septic, TB
Avasular necrosis
What factors affect when to refer from primary care?
Pain(Especially night pain)
Loss of function
Physical fitness, co-morbidities
Mental fitness (capacity to understand, consent)
Support at home
Patient expectations
Age of patient, possibly
Uncertainty about diagnosis
What are causes of meniscal tears and how are they usually presented?
Medial meniscal tears approx. 9-10 times more common than lateral meniscal tears
What are the different patterns of mechanical meniscal tears?
bucket handle meniscal tears cause acute locked knee
What is the sign of acute locked knee and how to manage it?
How to treat mechanical meniscal tears?
Limited healing potential
What are causes of degenerate meniscus tears and how to manage them?
What are the ligaments of the knee?
Medial collateral ligament - well innervated so very sore when injured
How to grade ligament injuries of the knee?
What are the (biomechanic) consequences of MCL rupture and how to manage them?
- MCL rupture - valgus
- ACL rupture
What are the (biomechanic) consequences of ACL rupture and how to manage them?
If ACL is damaged, meniscal repair alone would not be sufficient, ACL reconstruction is required
What are the outcomes of ACL reconstruction?
What are the (biomechanic) consequences of LCL rupture and how to manage them?
What are the (biomechanic) consequences of PCL rupture and how to manage them?
Posterior draw test
How does knee dislocation present and what are associated injuries? How to manage it?
Which groups are more likely to get patellar dislocation and how to manage it?
What is patellofemoral pain syndrome and what can cause it?
What is extensor mechanism rupture and which groups are more likely to have it? How does it present?
How to manage osteochondral injuries? (not very efficient)
What is osteochondritis dissecans? (a mysterious and controversial condition)
What is bone marrow oedema/bone bruising and how is it managed?
What are loose bodies? How to diagnose and how to manage?
What are baker’s cyst and bursitis?
What are some classic scenarios with knee soft tissue injuries?
What is osteoarthritis?
What are causes of OA (especially knee)?
How might knee alignment predispose to osteoarthritis?
How to treat osteoarthritis in the knee?
How to manage osteoarthritis conservatively?
Steroid injection reserved only for flare-ups!
When is total knee replacement indicated and what is the impact/limitations of it?
Which groups of patients are more likely to have bad outcomes of TKR?
young, obesity, psychologic distress, chronic pain syndrome, less severe OA, very active lifestyle
What is an IDEAL patient for TKR like?
Only for older, medically fit, appropriate patient with END STAGE arthritis and SEVERE PAIN refractory to conservative management
*constant severe pain
*sleep disturbance
*pain limiting function
*frequent bad flare-ups
What are realistic outcomes of TKR?
What are alternatives of TKR and what are the benefits/limitations of them?
