Hip OA Flashcards
1
Q
Forces through the hip
1) standing
2) walking level normal
3) walking up stairs
4) running
A
1) 0.5 body weight
2) 2.4 x body weight
3) 2.5 body weight
4) 3-4 x body weight
2
Q
Primary OA Risk factors
A
- wear and tear
- obesity: for every added lbs of BW an additional 3 lbs may act at the hip
- age: mid age to elderly
- overuse and abuse: sports/occupation
3
Q
Secondary OA: risk factors/what is it
A
- follows a traumatic injury
- Disease
- Anatomic alignment
- capsular tightness/hypomobility
4
Q
what traumatic injuries can cause secondary OA
A
- hip dislocation
- hip fracture
(femoral head, femoral neck, intertrochanteric, subtrochanteric/shaft)
5
Q
What conditions can lead to DJD of the hip
A
- congenital hip dysplasia/dislocation
- Legg Perthes: osteochondrosis - 3-10 y/o
- slipped capital femoral epiphysis 10-16 y/o
6
Q
Anatomic alignment issues that can cause OA
A
- abnormal forces at the hip
- excessive anteversion, retroversion
- leg length asymmetry = longer leg has an increase forces on superior lateral acetabulum and femoral head
- femoral-acetabular impingement
7
Q
Hip angle of inclination
A
- forces are not ideally located on the hip when there is an abnormal angle
- coxa vara = <125
- coxa valga = >125
8
Q
Anteversion/retroversion
A
- neck torsion angle
- normal = 15 anterversion
- excessive anteversion = >15
- retroversion <15
9
Q
Femoral acetabular impingement
A
- CAM impingement: large FH and small acetabulum
- Pincer type impingement: larger overhanging acetabulum
- combination of pincer and CAM
- these may result in degeneration of the hip joint labrum and articular cartilage
10
Q
How can a tight capsule of the hip or hypomobilty cause secondary OA
A
- increase compressive forces in a smaller contact area
- “shock loading” = compression in a small contact area coupled with the high compressive forces of WB
- decreased movement of synovial fluid/distribution of nutrients
- leads to less nutrients to articular cartilage
11
Q
Effect of a hip flexor contracture on standing
A
BW is more anterior
- more joint reaction forces due to glute max needing to contract
- increase in forces to hip joint in area of thinner articular cartilage
12
Q
How does articular degeneration occur?
A
- decrease in GAGs, proteoglycans and H2O biding capacity
- chondrocytes turn off = dont keep up with attrition of cells
- cartilage collagen fibers thinner, stiffer, less elastic
- decreased ability to deform, absorb shock, decrease force attenuation
- increase forces to subchondral bone causing sclerosis
13
Q
what else can happen with OA in addition to degradation of articular cartilage
A
- osteophytes at joint margins leading to irritation of synovial capsule
- inflammation/synovitis/thickened synovium leads to capsular fibrosis which decreases ROM and nutrition
- cycle of progression
14
Q
Hip OA diagnosis
A
- DX: X-ray in standing
- decreased joint space = loss of articular cartilage
- sclerosis on the subchondral bone (related to the increase in forces)
- pseudocytes: synovial fluid pushed into bony porous areas
- osteophytes at joint margins
15
Q
Hip OA signs in the history and interview
A
Complaints of:
- pain in groin, anterior thigh, lateral thigh, posterior thigh
- pain worsens with WB or increase hip stresses
Signs:
- decrease ROM = difficulty with donning socks and shoes, squatting, stairs
- gradual onset/post trauma
- morning stiffness (1/2 hr), better mid-day with movement
- increased pain end day due to excessive activity and WB
Hx:
- childhood hip pathology
16
Q
What makes OA pain better /worse
A
- mild activity
- stiff with prolonged static postures
- worse with prolonged WB
17
Q
what are some symptoms of advanced DJD
A
- constant ache
- resting pain
- night pain
18
Q
Hip OA DJD signs and symptoms
A
- patient c/o stiffness and swelling
- decreased ROM
- pain stiffness - unilateral
- muscule atrophy, weakness
- arthrogenic inhibiton (hip abductors, ERs, extensors)
19
Q
What are some observations/inspections that are noted with OA patients
A
- (+) trendelenberg
- contralateral pelvic drop
- hip flexor contracture
- hip alignment: anteversion/retroversion, Toe in/out, femoral torsions (structural)
- knee valgus/varus
- foot pronation/supination
- leg length descrepancy
- gait deviations/compensations
20
Q
AROM/PROM findings with OA patients
A
- end feel: abnormal capsular stiff without creep
capsular pattern:
- marked limitation IR, abduction
- moderate limitation: felxion and extension
- less limtation: ER
21
Q
Joint mobility test/joint play for OA
A
- loose pack position: 30 flexion, abduction and slight ER
- assess hip mobility:
1. long axis distraction
2. hip lateral distraction
3. hip assess end feel OP: IR/ER, add/abd, flex/ext - arthrokinematic glides: convex on concave
22
Q
Muscle testing for hip OA patients
A
- common to see weak abductors, extensors, ER
23
Q
Muscle length tests that can be done with hip OA patients
A
- Hams: SLR, 90/90
- iliopsoas: thomas
- rectus femors: mod thomas/Ely’s test
- ITB/TFL: obers, modified obers
- piriformis: FAIR
- sign of buttock: (+) hip ROM is the same when knee is flexed
24
Q
Special tests for OA patients
A
- trendelenburg test: stand on involved leg, pelvis drops opposite, weak abductors isplaterally
- leg length: screen as in lab or measure
- craig test: prain anteversion = 15 anteversion angle is normal
- compression:
- distraction long axis
- FABERS
- Scour test
- log roll
25
Clinical prediction rule for Hip OA
- limited passive IR (25 or less)
- limited active hip flexion with lateral hip pain
- active hip extension causes pain
- squatting limited and painful
- scour test w/ adduction - lateral hip groin pain
26
hip OA treatment
- weight reduction
- exercise (low impact)
- activity modification/joint protection (shock absorbing shoes/insoles, work matts)
- medications
- supplements: glucosamine chondroitin sulfate, tumeric, omega 3 fatty acids, fish oil, flax seeds (studies show is may provide lubircation but not grow AC)
- Promote ROM
- alternate activites and rest period
- strengthen (low intensity)
- balance activites
27
History/risk factors for hip OA
- advanced age
- previous hip developmental disorder
- legg calve perthes
- slipped capital femoral epiphysis
- hip dysplasia
- previous hip injury
28
OA dx classification
**experts opinion = consider a differential dx if not common presentation as in**
- moderate anterior groin/lateral pain
- >50 years old
- morning stifnfess < 1 hr
- Hip IR, flexion limited >15 to uninvolved
29
Validated outcome measures for Hip OA
- WOMAC western Ontario and McMaster University
- LEFs
- Harris Hip score
30
What additional tests can be used to assess the patients function for Hip OA
- 6 minute walk test - covers 6 meters
- TUG: timed 3 meters returned to chair
- self paced walk - timed walk 4-40 meters
- stair measure - timed going up and down 9 stairs
**hip OA patients demonstrate lower performance on functional testing**
31
What should be included with patient education for hip OA patients
- activity modification
- unloading joints
- weight reduction
- exercise
32
Low impact exercise for hip OA
- ROM/flexibility
- strength = stronger muscles will absorb more force
- endurance
33
Manual therapy for hip OA
- mobs to improve
mobiltiy
- provide short term pain relief
