Hip Problems

Question 1

where does hip pathology usually produce pain

Answer 1

in groin which may radiate to knee due to obturator nerve supplying both joints

Question 2

where would hip pathology present with purely knee pain

Answer 2

SUFE

Question 3

weakness of what muscles causes trendellenburg gait

Answer 3

gluteus medius and minimus

Question 4

what is total hip arthroplasty (THA)

Answer 4

broad term that includes procedures like hip resurfacing

Question 5

what is total hip replacement (THR) and what material is gold standard

Answer 5

involves replacement of entire femoral head cemented metal / polyethene

Question 6

why will any THA ultimately fail

Answer 6

result of loosening of one or more prosthetic joints

Question 7

what are the early complications of THA/THR

Answer 7

infection dislocation nerve injury leg length discrepancy medical complications = MI, chest infection, UTI, blood loss and hypovolaemia DVT and PE

Question 8

what are the late complications of THA/THR

Answer 8

early loosening late infection (haematogenous spread from distal site) late dislocation (due to component wear)

Question 9

what is avascular necrosis (AVN) of the hip

Answer 9

death of bone tissue due to interruption of blood supply

Question 10

AVN of hip can be primary / idiopathic but also secondary to what

Answer 10

alcohol abuse steroids hyperlipidaemia thrombophilia

Question 11

AVN is staged by the steinberg classification, what is this

Answer 11

Question 12

what is symptoms of AVN of hip

Answer 12

groin pain exacerbated by stairs or impact

Question 13

how may early cases of AVN be diagnosed

Answer 13

may only show changes on MRI (pre-radiographic AVN)

Question 14

how may later cases of AVN be diagnosed

Answer 14

patchy sclerosis of weight bearing area of femoral head with a lytic zone underneath formed by granulation tissue from attempted repair

Question 15

what is the characteristic xray sign of AVN

Answer 15

lytic zone gives rise to “hanging rope sign”

Question 16

what is consequence of the lytic zone seen in xray of later cases of AVN

Answer 16

femoral head may collapse with irregularity of the articular surface and subsequent secondary OA

Question 17

what is treatment of AVN if it is detected before collapse

Answer 17

biphosphonates drill holes can be made up the femoral neck and into the abnormal area in the head in attempt to relieve pressure (decompression), promote healing and prevent collapse or bone graft

Question 18

what is treatment of AVN once collapse has occurred

Answer 18

only surgical option is THR

Question 19

what is trochanteric bursitis aka gluteal cuff syndrome

Answer 19

the tendinous insertion of abductor muscles (mostly gluteus medius) is under strain and is subject to tendonitis and degeneration. This can lead to trochanteric bursa becoming inflamed

Question 20

who does trochanteric bursitis occur most commonly in and what is this condition similar to

Answer 20

female, young runners or older patients (gluteal cuff) similar to rotator cuff problems of shoulder

Question 21

what is symptom of trochanter bursitis

Answer 21

pain and tenderness in region of greater trochanter (lateral aspect of hip) pain on resisted abduction

Question 22

how is trochanteric bursitis diagosed

Answer 22

clinically radiographs usually unremarkable visible on MRI but not usually needed

Question 23

how is trochanteric bursitis treated

Answer 23

analgesics anti-inflammatories physio (strengthen muscles and avoid abductor weakness) steroid injection no surgical treatment

Question 24

what is femoroactetabular impingement syndrome (FAI)

Answer 24

altered morphology of femoral neck and/or acetabular which causes abutment of the femoral neck on the edge of acetabulum during movement

Question 25

what are the different kinds of FAI

Answer 25

CAM type

Pincer type

Question 26

what is the CAM type of FAI and who does it occur in

Answer 26

femoral deformity asymmetric femoral head with decreased head:neck ratio usually young athletic males

Question 27

what is pincer type of FAI and who does it occur in

Answer 27

acetabular deformity resulting in acetabular overhang

Question 28

what is symptoms of FAI

Answer 28

activity related pain in groin difficult sitting C sign positive (gripping the lateral hip, just above the greater trochanter, between the abducted thumb and index finger) FADIR provocation test positive

Question 29

how is FAI diagnosed

Answer 29

radiographs CT MRI (better for visualising damage to labrum and bony oedema)

Question 30

how is FAI treated

Answer 30

observation in asymptomatic patients arthroscopic or open surgery to remove CAM / debride labral tears peri-acetabular osteotomy / debride labral tears in pincer impingement arthroplasty in older patients with secondary OA

Question 31

what is idiopathic transient osteonecrosis of hip (ITOH)

Answer 31

local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure

Question 32

who is most commonly affected in ITOH

Answer 32

males > females middle aged men / pregnant women in 3rd trimester

Question 33

what is symptoms of ITOH

Answer 33

progressive groin pain over several weeks, difficulty weight bearing, usually unilateral

Question 34

how is ITOH diagnosed

Answer 34

elevated ESR radiographs MRI (gold standard) bone scan

Question 35

what is seen on xray in ITOH

Answer 35

osteopenia of head and neck thinning of cortices preserved joint space

Question 36

how is ITOH diagnosed

Answer 36

self limiting = resolves in 6-9 months analgesia protected weight bearing to avoid stress fracture