Hip Management

Question 1

Loose Bodies

Answer 1

standard arthroscopic methods

Question 2

Labral Tears

Answer 2

Coronal MRI shows evidence for labral pathology

Question 3

Chondral Damage

Answer 3

lateral impact - direct blow to greater troch
- contact/collision activities - little adipose tissue over troch to dissipate force of impact = impact transferred unchecked to joint surface due to high bone density

Question 4

Ligamentum Teres

Answer 4

trauma or degenerative arthritis; twisting injury in absence of dislocation/subluxation

Question 5

FAI

Answer 5

limited ROM (esp IR), chronic groin pain (w/ rotation and sitting)

Cam - big head (jamming into acet); flex/IR, acet art cart compressed by fem head = chondral abrasion and labral detachment (pistol grip deformity)

Pincer - big acet; labral deterioration; associated with retro (flex = small band of acet cart and labrum crushed)

Question 6

Instability

Answer 6

Post - microtrauma; hip stable to post translation

• MOI - dashboard, axial loading onto flexed hiup (pile up in collision sports)
• associated with ant labral tears

Ant - atraumatic or repetitive microtrauma
- accentuated ant translation

Question 7

AP

Answer 7

acute macro/repetitive microtrauma from twisting, turning, kicking
MOI - hypertext (pivot point ant pelvic/pub symph)
Site - distal rec abd, prox add

Question 8

Snapping Iliopsoas (Internal)

Answer 8

cross ant fem head/capsule on pectineal eminence

weak - hip ext/abd, core/trunk
concominant with intra-articular hip pathology

Question 9

Snapping ITB (External)

Answer 9

repetitive micro, occasionally acute trauma
judicious injection

weak - hip ext/abd, core/trunk, poor NMC

Question 10

Piriformis

Answer 10

localized steroid/anesthetic junction (CT guided helpful)

Question 11

SCFE

Answer 11

sudden (traumatic) or gradual ant displacement of fem neck from cap fem epip - failure of growth plate from shear forces, hx of groin/med thigh pain

45% knee/lower thigh as initial symptoms
neck comes up/out while head remains in acet due to lig teres injury (fuses together at end of adolescence

2 major complications - AVN, chondrolysis

Question 12

Intra-articular Pathologies

Answer 12

labral tear, FAI, chondral injury/loose bodies, OA, lig teres, ONecrosis

Modifications

• avoid deep squatting/loaded hip flex (>45 deg) (deep lunging, leg press)
• avoid loaded rotationa movements (plant, twist, pivot)
• no ASLR
• modify CV activity for less compressive forces

Question 13

Routine Arthroscopy

Answer 13

WBAT, crutches 5-7 days, no ROM limitations

Question 14

Femoroplasty

Answer 14

WBAT (avoid loaded torsional forces), crutches 1 mo, no ROM limitations

Question 15

Acetabuloplasty

Answer 15

WBAT, crutches 2 weeks, no ROM limitations

Question 16

Labral Repair

Answer 16

50% WB, crutches 1 mo, ROM restrictions (90 deg, no ER for 4 weeks; full A/PROM after 6 weeks)

Question 17

Capsular Closure

Answer 17

WBing and crutches dictated by concominant procedures

ROM - no hip ext beyond present, normal gait for 4 weeks

Question 18

Microfracture

Answer 18

WBing (30 lbs PWB), 2 mo crutches, no ROM limitations

Question 19

Tendon Release

Answer 19

WBAT, 2 weeks crutches, no PROM limitations, limited AROM (encourage hip ext PROM for healing)