Hip Pathology and Conditions Flashcards
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 _______
Ball and socket, stability, acetabulum
Describe the innervation to the hip joint
What is the relevance of this to reffered pain?
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
What is DDH?
Is it more common in boys or girls?
Developmental Dysplasia of the Hip
More common in girls (risk factor)
Give the pathology of DDH
Associated with shallow acetabulum; femoral head not properly located in the acetabulum
DDH results in an Inability to ______ the thigh.
The affected limb is ______ because the dislocated femoral head is placed more ______.
abduct, shorter, superiorly
How do we test for DDH (3)?
- Screening for ‘clicking hips’
- Ortolani’s and Barlow’s tests
- Hip ultrasound for at risk babies
How do we treat DDH? (conservative and surgical)
Conservative: Pavlick harness
Surgical: Open reduction (for more severe)
What is SUFE and how does it present?
Is it more common in boys or girls?
Slipped upper femoral epiphysis
Presents with traumatic or atruamatic hip pain and ‘limping child’
Tends to occur in boys of 10-15 years.
How is SUFE treated?
Needs surgery and protected weight bearing
How would a dislocated hip appear?
- Posterior dislocation (90%) : shortened, adducted, and internally rotated
- Anterior dislocation: abducted and externally rotated
Posterior dislocation of the hip may damage what nerve?
How would patient present?
Can develop sciatic nerve lesion
Presents with foot drop and paraesthesia
List the 2 bursa of the hip and highlight the one of importance in bursitis
trochanteric bursa and iliopsoas bursa
Trochanteric Bursitis causes pain where?
When inflammed it causes lateral buttock pains.
List 2 investigations for Trochanteric Bursitis
- USS or MRI
- XR - but only shows hip anatomy and/or underlying OA
List 2 treatments for Trochanteric Bursitis
- Steroid injection.
- Open Trochanteric bursectomy.
What is arthritis?
What determines the degree of damage?
‘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
Compare the cause of pain in early vs late arthritis
Early stages➞ due to inflammation
Later stages ➞ due to the mechanical friction of raw bones rubbing on each other (as cartilage is destroyed)
What is osteoarthritic hip?
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
List the 4 x-ray signs of OA
- Loss of joint space
- Osteophyte formation
- Cyst formation
- Periarticular osteosclerosis
List 5 treatment options for hip OA (in order)
- Weight loss and activity modulation
- Analgesia
- Physiotherapy
- Steroid injection
- Total Hip Replacement
Briefly compare OA and RA in terms of:
- Structures damaged?
- Inflammation?
- Risk factors?
Osteoarthritis
- Mainly damages the joint cartilage
- There is some inflammation
- Joint fractures may predispose hip to OA
Rheumatoid Arthritis
- Starts in synovium, eventually destroys joint cartilage and bone next to cartilage (becomes soft)
- Mainly Inflammatory
- Genes, hormones, smoking may increase risk
Give the pathology of AVN of femoral head
Why is pain felt?
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
List 4 causes of AVN and highlight the most common
Frequently idiopathic
Other causes = chemotherapy, alcoholism, steroid, post trauma, Caisson disease (decompression sickness), Sickle cell disease
3 treatments for AVN of the hip?
- Hip injection
- Forage
- Total hip replacement
What is Legg-Calve-Perthes disease of the hip?
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
How is Perthes treated and what is the prognosis?
- Avoid impact sports
- Bed rest or splinting for severe pains
- Varus femoral osteotomy
- Acetabular osteotomy
Younger (<5) have better prognosis, older gradually worse
