Hip Pathology Flashcards
Name four pathologies of the hip
- femoroacetabular impingement syndrome
- avascular necrosis
- idiopathic transient osteonecrosis
- trochanter bursitis
What is femoroacetabular impingement syndrome?
Altered morphology of the femoral neck/acetabulum causes abutment of the femoral neck on the acetabulum during movement
Name the three types of femoroacetabular impingement
CAM
Pincer
Mixed
Describe CAM impingement
Femoral deformity usually in young male athletes asymmetric femoral head with decreased head;neck
Describe pincer impingement
Acetabular deformity usually in females
What does disease does impingement cause?
Damage to the labrum and cartilage leading to osteoarthritis
How does impingement present?
Activity related groin pain - flexion and rotation
Difficulty sitting down
C sign positive
How is impingement diagnosed?
X-ray
CT
MRI
Describe the management for impingement?
OA - replacement
What is avascular necrosis?
Failure of blood supply to femoral head
Name the causes of avascular necrosis
Idiopathic
Secondary to: irradiation, haematological disorders, diabetes, alcohol, steroids, trauma
Describe the pathophysiology of avascular necrosis
Coagulation leads to venous thrombosis and hypertension which reduces blood flow to the femoral head causing necrosis and chrondral fracture
How will avascular necrosis present?
Insidious onset of groin pain
Exacerbated by stairs
Normal examination
How is avascular necrosis diagnosed?
MRI
Xray
Patchy sclerosis with lytic zone formed by granulation tissue - hanging rope sign
Describe the management of avascular necrosis
Reversible - medication, bone graft, decompression
Irreversible - hip replacement
What is idiopathic transient osteonecrosis?
Local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure
How will idiopathic transient osteonecrosis present?
Pain over groin, difficulty weight bearing
Middle aged men
Pregnant women in third trimester
How is idiopathic transient osteonecrosis diagnosed?
Increased ESR
Radiographs
MRI
Bone scan
Describe the management for idiopathic osteonecrosis
Self limiting 6-9 months
Analgesia
Protection
What is tronchanteric bursitis?
Repetitive trauma caused by IT band tracking over trochanteric bursa causing inflammation
How does tronchanteric bursitis present?
Pain on lateral aspect of hip and palpation of greater trochanter
How is tronchanteric bursitis diagnosed?
MRI possible but usually clinical
How is tronchanteric bursitis managed?
Analgesia, NSAIDs, physio, steroids
