Hip Problems

Question 1

Describe femoroacetabular impingement syndrome? (FIS)

Answer 1

altered morphology of the femoral neck or acetabulum that causes contact with the femoral neck on the edge of the acetabulum during movement

Question 2

What are the types of FIS?

Answer 2

CAM impingement

Pincer type impingement

Question 3

Describe a CAM impingement?

Answer 3

femoral deformity

asymmetrical femoral head with decreased head:neck ratio

Question 4

Who is susceptible to CAM impingement?

Answer 4

young athletic males - can have previous SUFE

Question 5

Describe a pincer type impingement?

Answer 5

acetabular deformity

Question 6

Who is susceptible to a pincer type impingement?

Answer 6

females

Question 7

What are the consequences of FIS?

Answer 7

damage to labrum and tears
damage to cartilage
osteoarthritis in later life

Question 8

What is the presentation of FIS?

Answer 8

C shaped pain in groin - esp on adduction, flexion and internal rotation
difficulty sitting

Question 9

How is FIS diagnosed?

Answer 9

Xray
CT - allows multiple planes
MRI - can visualise damage to labrum and bony oedema

Question 10

How is FIS managed?

Answer 10

nothing can improve the condition
arthroplasty for older patients with secondary OA
debride the labral tears
peri-acetabular osteotomy - PINCER
surgery to remove deformity - CAM

Question 11

Describe idiopathic transient osteonecrosis?

Answer 11

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

Question 12

Who is more prone to ITO?

Answer 12

males>females
middle aged men
pregnant women in their third trimester

Question 13

What is the presentation of ITO?

Answer 13

progressive groin pain over several weeks
difficulty weight bearing
usually unilateral

Question 14

How is ITO diagnosed?

Answer 14

Gold: MRI
increased ESR
Xray - osteopenia, thinning or cortices, preserved joint space
Bone scan

Question 15

What is the management of ITO?

Answer 15

self limiting in 6-9 months
analgesia
no weight bearing

Question 16

What is trochanteric bursitis?

Answer 16

repetitive trauma caused by iliotibial band tracking over the trochanteric bursa which results in bursa inflammation

Question 17

What is the presentation of trochanteric bursitis?

Answer 17

pain on lateral aspect of the hip

pain on palpatation of the greater trochanter

Question 18

Which age group/gender is most susceptible to trochanteric bursitis?

Answer 18

young runners and older patients (gluteal cuff syndrome)

females > males

Question 19

How is trochanteric bursitis diagnosed?

Answer 19

clinical examination/history

seen on MRI but not normally needed

Question 20

How is trochanteric bursitis treated?

Answer 20

analgesia
NSAIDS
physiotherapy
steroid injections

Question 21

What is the best hip replacement option for a younger patient?

Answer 21

hybrid THA -uncemented cup and cemented stem

Question 22

What is the best hip replacement option for an older patient?

Answer 22

cemented THA - cemented cup and cemented set and bone cement

Question 23

What is the normal angle between the femoral neck and femoral shaft?

Answer 23

130 degrees