Hip Pathology Flashcards
What is trochanteric bursitis/greater trochanteric pain syndrome
Inflammation of the fluid-filled sac sandwiched between hip abductors and ilio-tibial band
What sex is more likely to be affected by trochanteric bursitis?
F>M
What causes trochanteric bursitis?
Trauma
Over-use
- Athletes
- Repetitive movements
Abnormal movements
- Scoliosis
- Muscle wasting following surgery
- Total hip replacement
- Osteoarthritis
How does trochanteric bursitis present?
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
How is trochanteric bursitis managed?
NSAIDS
Relative rest/activity modification
Physiotherapy
Corticosteroid injections
Bursectomy, yet is rarely required
What is avascular necrosis?
Death of bone due to loss of blood supply
What sex is more likely to be affected by avascular necrosis?
M>F
What are causes and risk factors of avascular necrosis?
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
How does avascular necrosis present?
Insidious onset of groin pain
Pain with stairs, walking uphill and impact activities
Limp
Examination is largely normal
Reduced range of motion
Stiff joint
What is the non-operative management of avascular necrosis?
Reduce weight bearing
NSAIDS
Bisphosphonates
Anticoagulants
Physiotherapy: Maintain range of motion
What is the surgival management of avascular necrosis?
Restores blood supply with core decompression
Move the lesion away from the weight bearing area with rotational osteotomy
Total hip replacement
What sex is more likely to be affected by labral tears
(Active) females
What causes labral tears?
Femoroacetabular impingement (FAI)
Trauma
Osteoarthritis
Dysplasia
Collagen diseases: Ehlers-Danlos
How do labral tears present?
Groin or hip pain
Snapping sensation
Jamming or locking
Examination can be normal
Positive FABER test (flexion, abduction, external rotation), anterior tears
How are labral tears managed?
Activity modification
NSAIDS
Physiotherapy
Injection of steroids
Arthroscopy: Repair and resection
What are the two cateogories of Femoroacetabular Impingement (FAI)?
Cam Lesion
Pincer
Describe cam lesion FAI
Usually in young athletics males
Excess bone leading to decreased head to neck ratio, aspherical head
Abutment of lesion on edge of acetabulum
Describe pincer FAI
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
What is Femoroacetabular Impingement (FAI)?
Impingement of femoral neck against anterior edge of acetabulum
What injuries are associated with FAI?
Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip osteoarthritis
How does FAI present?
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
How is FAI managed?
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
