Hip pathology Flashcards
OA on xray
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
RF for OA
Age > 45 yrs old Female Ethnicity - African FHx Obesity Trauma Malalignment - developmental dysplasia Infection - sepsis Inflammatory arthritis - RA, ankylosing spondylitis Gout DM - charcot foot
Presentation of OA
Ache exacerbated by movement, relieved by rest
Pain radiates to knee
Reduced ROM - difficulty putting socks on
Crepitus
Stiffness - less than 1 hr in morning
End stage OA:
Fixed flexion deformity
Trendelenurg gait
Pathophysiology of OA
Non-inflammatory damage to the hyaline cartilage due to excessive uneven loading.
- Swelling - increased proteoglycan synthesis
- Flaking and fibrillation - softer and less elastic
- Loss of hylaine cartilage
- Eburnation - subchondral bone thickens
Treatment of OA
Conservative:
- weight reduction
- avoid sports that precipitates pain
- walking aid
- analgesia
- hot water bottle
- strengthening + exercise
Surgery:
- arthroscopy
- total or hemiarthroplasty
- steroid injection
3 types of NOF
Intracapsular - between head and intertrochanteric line
Extracapsular:
- intertrochanteric - involves lesser trochanter
- subtrochanteric - within 5cm of lesser trochancter
Intracapsular fracture summary
Fracture of femoral neck involving capsule
Likely to disrupt the medial femoral circumflex artery causing avascular necrosis
Mx:
- hemiarthroplasty - if elderly with low mobility
- total hip replacement - if good mobility
- Cannulated screws - if less than 60 as hip replacement lasts 10 - 15 years
RF for NOF fracture
Menopause - osteoporosis
What position would NOF leg be in
Shortened
Slightly abducted
Externally rotated
Symptoms of NOF fracture
Reduced mobility
Inability to bear weight
Pain in hip, groin and knee
Most common way to dislocate hip
Posteriorly
Causes of hip dislocation
Developmental dysplasia
Trauma - high energy
Complications of hip dislocation
Sciatic nerve palsy
Position of leg with dislocated hip
Shortened
Slightly flexed
Adducted
Internally rotated
Central hip dislocation
Head of femur driven into acetabulum.
Always fracture and dislocation
Requires hemiarthroplasty or total hip replacement
Investigations of hip fracture
AP and lateral hip Xray
Bloods - FBC, U+Es, coagulation, group + save, CK if rhabdomyolysis suspected
ECG - cause of fall
Urine dip - WCC - UTI may cause confusion and fall
CXR - anaesthetic
Hip Xray
Shenton’s lines
If disturbed - fracture
Extracapsular fracture mx
Internal fixation:
Intertrochanteric - Dynamic hip screw
Subtrochanteric - Inter medullary nail
Protection against osteoporosis
Bisphophonates
Calcium and Vitamin D
Thyroid function control
Prevent falls
Post surgery risks
DVT - TED compression stockings and LMWH bridging stopped 12 hrs before surgery
How to assess mx of hip and knee OA
Oxford hip/knee score
Ix for OA
Bloods - FBC, U+Es, LFTs, ESR, CRP
Xray
Hand changes in OA
Herbeden’s nodes
Bouchard’s nodes
Square thumb
Leg changes in OA
Fixed flexion deformity
Varus deformity
RA
Autoimmune inflammatory response causing symmetrical polyarthropathy commonly of small joints
RF for RA
Smoking
Genetics - HLA DR
60+ yo
Women
Presentation of RA
Morning stiffness that occurs longer than 1 hr Swelling of joints especially hands Symmetrical Rheumatoid nodules Abnormal serum RF Erosions on Xray
Tratment of RA
Conservative:
- weight loss
- Smoking cessation
- occupational therapist
Pharmacological:
Paracetamol
NSAIDS
DMARDs
DMARDS
Methotrexate - 1st line
Sulfasalazine
Perthe’s disease presentation and pathophysiology
Idiopathic avascular necrosis of femoral head
Presentation: Pre - puberty - 4 - 8 yo M>F 5:1 Progressive hip pain - weeks Limp Stiff and reduced ROM
Septic arthritis presentation
Pyrexia
Drowsiness
Pain
Limited ROM
Developmental dysplasia
Congenital hip joint deformity in which the femoral head is or can be completely / partially displaced.
More common in females
Often identified in newborns with Barlow’s test or Ortolani’s test
- unequal skin folds and leg length
Transient synovitis
Acute hip pain associated with viral infection commonly in children ages 2 -10 yo
Settles after 2-3 days
SUFE
Slipped upper femoral epiphysis
- postero - inferiorly
- ages 10 - 15
- obese males
Causes pain radiating to knee or distal thigh
Loss of internal rotation of the leg in flexion
Symptoms over weeks to months
Garden classification of intracapsular NOF fractures
I - Non displaced, incomplete
II - Non displaced, complete
III - Partially displaced, complete
IV - Fully displaced, complete
Investigations for developmental dysplasia of hip
- Screening
- Asymmetric skin folds
- Limp / abnormal gait
- US is v. specific
Mx of developmental hip dysplasia
Mx: maintain abduction • Double nappies • Pavlik harness • Plaster hip spica • Open reduction: derotation varus osteotomy
Perthe’s disease X-ray
Decreased femoral head size and flattening
Complications of hip fracture
Joint dislocation
Aseptic loosening
Peri-prosthetic fracture
Deep infection/prosthetic joint infection
