Hip Pathology

Question 1

What is trochanteric bursitis/greater trochanteric pain syndrome

Answer 1

Inflammation of the fluid-filled sac sandwiched between hip abductors and ilio-tibial band

Question 2

What sex is more likely to be affected by trochanteric bursitis?

Answer 2

F>M

Question 3

What causes trochanteric bursitis?

Answer 3

Trauma

Over-use

• Athletes
• Repetitive movements

Abnormal movements

• Scoliosis
• Muscle wasting following surgery
• Total hip replacement
• Osteoarthritis

Question 4

How does trochanteric bursitis present?

Answer 4

Pain at lateral hip

• Worsening in active abduction and lying on it at night
• Deep palpation recreates pain

Full range of movement, differentiate from osteoarthritis

Muscle wasting

Minor narrowing of joint space on xray

Question 5

How is trochanteric bursitis managed?

Answer 5

NSAIDS

Relative rest/activity modification

Physiotherapy

Corticosteroid injections

Bursectomy, yet is rarely required

Question 6

What is avascular necrosis?

Answer 6

Death of bone due to loss of blood supply

Question 7

What sex is more likely to be affected by avascular necrosis?

Answer 7

M>F

Question 8

What are causes and risk factors of avascular necrosis?

Answer 8

Trauma

• Irradiation
• Fracture
• Dislocation
• Iatrogenic
• Injury to femoral head blood supply

Idiopathic

Hypercoagulable states

Steroids

Haematological

• Sickle cell disease
• Lymphoma
• Leukaemia

Caisson’s disease

Alcoholism

Question 9

How does avascular necrosis present?

Answer 9

Insidious onset of groin pain

Pain with stairs, walking uphill and impact activities

Limp

Examination is largely normal

Reduced range of motion

Stiff joint

Question 10

What is the non-operative management of avascular necrosis?

Answer 10

Reduce weight bearing

NSAIDS

Bisphosphonates

Anticoagulants

Physiotherapy: Maintain range of motion

Question 11

What is the surgival management of avascular necrosis?

Answer 11

Restores blood supply with core decompression

Move the lesion away from the weight bearing area with rotational osteotomy

Total hip replacement

Question 12

What sex is more likely to be affected by labral tears

Answer 12

(Active) females

Question 13

What causes labral tears?

Answer 13

Femoroacetabular impingement (FAI)

Trauma

Osteoarthritis

Dysplasia

Collagen diseases: Ehlers-Danlos

Question 14

How do labral tears present?

Answer 14

Groin or hip pain

Snapping sensation

Jamming or locking

Examination can be normal

Positive FABER test (flexion, abduction, external rotation), anterior tears

Question 15

How are labral tears managed?

Answer 15

Activity modification

NSAIDS

Physiotherapy

Injection of steroids

Arthroscopy: Repair and resection

Question 16

What are the two cateogories of Femoroacetabular Impingement (FAI)?

Answer 16

Cam Lesion

Pincer

Question 17

Describe cam lesion FAI

Answer 17

Usually in young athletics males

Excess bone leading to decreased head to neck ratio, aspherical head

Abutment of lesion on edge of acetabulum

Question 18

Describe pincer FAI

Answer 18

Acetabulum-based impingement

Usually in active females

Abnormal acetabulum leading to anterosuperior acetabular rim overhang and acetabular protrusion

Abutment of lesion on edge of acetabulum

Question 19

What is Femoroacetabular Impingement (FAI)?

Answer 19

Impingement of femoral neck against anterior edge of acetabulum

Question 20

What injuries are associated with FAI?

Answer 20

Labral degeneration and tears

Cartilage damage and flap tears

Secondary hip osteoarthritis

Question 21

How does FAI present?

Answer 21

Groin pain, worse with flexion

Mechanical symptoms: Block to movement, pain with certain manoeuvres (getting out of a chair, squatting, lunging)

Reduced flexion and internal rotation

Positive FADIR test

Question 22

How is FAI managed?

Answer 22

Activity modification

NSAIDS

Physiotherapy

Arthroscopy: Shave down the defect, deal with labral tears, resect artic cartilage flaps

Open surgery: Resection, periacetabular osteotomy

Hip arthroplasty: Resurfacing and replacement