Hip Pathology and Conditions

Question 1

The hip joint is a _______ synovial joint

It allows a wide range of movements with great _______ but sacrifices degree of movement

The head of femur is deeply inserted into the _______

Answer 1

Ball and socket, stability, acetabulum

Question 2

Answer 2

Question 3

Describe the innervation to the hip joint

What is the relevance of this to reffered pain?

Answer 3

The hip joint is innervated primarily by the sciatic, femoral and obturator nerves

These same nerves innervate the knee, hence pain can be referred to the knee from the hip and vice versa

Question 4

What is DDH?

Is it more common in boys or girls?

Answer 4

Developmental Dysplasia of the Hip

More common in girls (risk factor)

Question 5

Give the pathology of DDH

Answer 5

Associated with shallow acetabulum; femoral head not properly located in the acetabulum

Question 6

DDH results in an Inability to ______ the thigh.

The affected limb is ______ because the dislocated femoral head is placed more ______.

Answer 6

abduct, shorter, superiorly

Question 7

How do we test for DDH (3)?

Answer 7

1. Screening for ‘clicking hips’
2. Ortolani’s and Barlow’s tests
3. Hip ultrasound for at risk babies

Question 8

How do we treat DDH? (conservative and surgical)

Answer 8

Conservative: Pavlick harness

Surgical: Open reduction (for more severe)

Question 9

What is SUFE and how does it present?

Is it more common in boys or girls?

Answer 9

Slipped upper femoral epiphysis

Presents with traumatic or atruamatic hip pain and ‘limping child’

Tends to occur in boys of 10-15 years.

Question 10

How is SUFE treated?

Answer 10

Needs surgery and protected weight bearing

Question 11

How would a dislocated hip appear?

Answer 11

• Posterior dislocation (90%) : shortened, adducted, and internally rotated
• Anterior dislocation: abducted and externally rotated

Question 12

Posterior dislocation of the hip may damage what nerve?

How would patient present?

Answer 12

Can develop sciatic nerve lesion

Presents with foot drop and paraesthesia

Question 13

List the 2 bursa of the hip and highlight the one of importance in bursitis

Answer 13

trochanteric bursa and iliopsoas bursa

Question 14

Trochanteric Bursitis causes pain where?

Answer 14

When inflammed it causes lateral buttock pains.

Question 15

List 2 investigations for Trochanteric Bursitis

Answer 15

1. USS or MRI
2. XR - but only shows hip anatomy and/or underlying OA

Question 16

List 2 treatments for Trochanteric Bursitis

Answer 16

1. Steroid injection.
2. Open Trochanteric bursectomy.

Question 17

What is arthritis?

What determines the degree of damage?

Answer 17

‘Inflammation of a joint’

Condition in which there is inflammation of a joint synovium and damage to cartilage (“osteochondrosis” or “osteoarthrosis”)

Proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis

Question 18

Compare the cause of pain in early vs late arthritis

Answer 18

Early stages➞ due to inflammation

Later stages ➞ due to the mechanical friction of raw bones rubbing on each other (as cartilage is destroyed)

Question 19

What is osteoarthritic hip?

Answer 19

Cartilage cushion is thinner than normal, leaving “bare spots” on the bone

This causes grinding of bone surfaces resulting in mechanical pain; fragments of cartilage floating in the joint may cause inflammation

Question 20

List the 4 x-ray signs of OA

Answer 20

• Loss of joint space
• Osteophyte formation
• Cyst formation
• Periarticular osteosclerosis

Question 21

List 5 treatment options for hip OA (in order)

Answer 21

• Weight loss and activity modulation
• Analgesia
• Physiotherapy
• Steroid injection
• Total Hip Replacement

Question 22

Briefly compare OA and RA in terms of:

1. Structures damaged?
2. Inflammation?
3. Risk factors?

Answer 22

Osteoarthritis

1. Mainly damages the joint cartilage
2. There is some inflammation
3. Joint fractures may predispose hip to OA

Rheumatoid Arthritis

1. Starts in synovium, eventually destroys joint cartilage and bone next to cartilage (becomes soft)
2. Mainly Inflammatory
3. Genes, hormones, smoking may increase risk

Question 23

Give the pathology of AVN of femoral head

Why is pain felt?

Answer 23

Disruption to blood supply of femoral head

Crescentic segment of bone dies (beneath the surface cartilage), and crumbles

Head shape becomes non spherical ➞ causes pain

Question 24

List 4 causes of AVN and highlight the most common

Answer 24

Frequently idiopathic

Other causes = chemotherapy, alcoholism, steroid, post trauma, Caisson disease (decompression sickness), Sickle cell disease

Question 25

3 treatments for AVN of the hip?

Answer 25

1. Hip injection
2. Forage
3. Total hip replacement

Question 26

What is Legg-Calve-Perthes disease of the hip?

Answer 26

Usually referred to as Perthes (unknown aetiology)

Childhood equivalent of AVN of the hip ➞ altered blood supply results in flattening of femoral head and hip pain

Question 27

How is Perthes treated and what is the prognosis?

Answer 27

• Avoid impact sports
• Bed rest or splinting for severe pains
• Varus femoral osteotomy
• Acetabular osteotomy

Younger (<5) have better prognosis, older gradually worse