Hip Problems Flashcards
where does hip pathology usually produce pain
in groin which may radiate to knee due to obturator nerve supplying both joints
where would hip pathology present with purely knee pain
SUFE
weakness of what muscles causes trendellenburg gait
gluteus medius and minimus
what is total hip arthroplasty (THA)
broad term that includes procedures like hip resurfacing
what is total hip replacement (THR) and what material is gold standard
involves replacement of entire femoral head cemented metal / polyethene
why will any THA ultimately fail
result of loosening of one or more prosthetic joints
what are the early complications of THA/THR
infection dislocation nerve injury leg length discrepancy medical complications = MI, chest infection, UTI, blood loss and hypovolaemia DVT and PE
what are the late complications of THA/THR
early loosening late infection (haematogenous spread from distal site) late dislocation (due to component wear)
what is avascular necrosis (AVN) of the hip
death of bone tissue due to interruption of blood supply
AVN of hip can be primary / idiopathic but also secondary to what
alcohol abuse steroids hyperlipidaemia thrombophilia
AVN is staged by the steinberg classification, what is this
what is symptoms of AVN of hip
groin pain exacerbated by stairs or impact
how may early cases of AVN be diagnosed
may only show changes on MRI (pre-radiographic AVN)
how may later cases of AVN be diagnosed
patchy sclerosis of weight bearing area of femoral head with a lytic zone underneath formed by granulation tissue from attempted repair
what is the characteristic xray sign of AVN
lytic zone gives rise to “hanging rope sign”
what is consequence of the lytic zone seen in xray of later cases of AVN
femoral head may collapse with irregularity of the articular surface and subsequent secondary OA
what is treatment of AVN if it is detected before collapse
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
what is treatment of AVN once collapse has occurred
only surgical option is THR
what is trochanteric bursitis aka gluteal cuff syndrome
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
who does trochanteric bursitis occur most commonly in and what is this condition similar to
female, young runners or older patients (gluteal cuff) similar to rotator cuff problems of shoulder
what is symptom of trochanter bursitis
pain and tenderness in region of greater trochanter (lateral aspect of hip) pain on resisted abduction
how is trochanteric bursitis diagosed
clinically radiographs usually unremarkable visible on MRI but not usually needed
how is trochanteric bursitis treated
analgesics anti-inflammatories physio (strengthen muscles and avoid abductor weakness) steroid injection no surgical treatment
what is femoroactetabular impingement syndrome (FAI)
altered morphology of femoral neck and/or acetabular which causes abutment of the femoral neck on the edge of acetabulum during movement
what are the different kinds of FAI
CAM type
Pincer type
what is the CAM type of FAI and who does it occur in
femoral deformity asymmetric femoral head with decreased head:neck ratio usually young athletic males
what is pincer type of FAI and who does it occur in
acetabular deformity resulting in acetabular overhang
what is symptoms of FAI
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
how is FAI diagnosed
radiographs CT MRI (better for visualising damage to labrum and bony oedema)
how is FAI treated
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
what is idiopathic transient osteonecrosis of hip (ITOH)
local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure
who is most commonly affected in ITOH
males > females middle aged men / pregnant women in 3rd trimester
what is symptoms of ITOH
progressive groin pain over several weeks, difficulty weight bearing, usually unilateral
how is ITOH diagnosed
elevated ESR radiographs MRI (gold standard) bone scan
what is seen on xray in ITOH
osteopenia of head and neck thinning of cortices preserved joint space
how is ITOH diagnosed
self limiting = resolves in 6-9 months analgesia protected weight bearing to avoid stress fracture
