Hip Problems Flashcards
Describe femoroacetabular impingement syndrome? (FIS)
altered morphology of the femoral neck or acetabulum that causes contact with the femoral neck on the edge of the acetabulum during movement
What are the types of FIS?
CAM impingement
Pincer type impingement
Describe a CAM impingement?
femoral deformity
asymmetrical femoral head with decreased head:neck ratio
Who is susceptible to CAM impingement?
young athletic males - can have previous SUFE
Describe a pincer type impingement?
acetabular deformity
Who is susceptible to a pincer type impingement?
females
What are the consequences of FIS?
damage to labrum and tears
damage to cartilage
osteoarthritis in later life
What is the presentation of FIS?
C shaped pain in groin - esp on adduction, flexion and internal rotation
difficulty sitting
How is FIS diagnosed?
Xray
CT - allows multiple planes
MRI - can visualise damage to labrum and bony oedema
How is FIS managed?
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
Describe idiopathic transient osteonecrosis?
local hyperaemia and impaired venous return with marrow oedema and intramedullary pressure
Who is more prone to ITO?
males>females
middle aged men
pregnant women in their third trimester
What is the presentation of ITO?
progressive groin pain over several weeks
difficulty weight bearing
usually unilateral
How is ITO diagnosed?
Gold: MRI
increased ESR
Xray - osteopenia, thinning or cortices, preserved joint space
Bone scan
What is the management of ITO?
self limiting in 6-9 months
analgesia
no weight bearing
What is trochanteric bursitis?
repetitive trauma caused by iliotibial band tracking over the trochanteric bursa which results in bursa inflammation
What is the presentation of trochanteric bursitis?
pain on lateral aspect of the hip
pain on palpatation of the greater trochanter
Which age group/gender is most susceptible to trochanteric bursitis?
young runners and older patients (gluteal cuff syndrome)
females > males
How is trochanteric bursitis diagnosed?
clinical examination/history
seen on MRI but not normally needed
How is trochanteric bursitis treated?
analgesia
NSAIDS
physiotherapy
steroid injections
What is the best hip replacement option for a younger patient?
hybrid THA -uncemented cup and cemented stem
What is the best hip replacement option for an older patient?
cemented THA - cemented cup and cemented set and bone cement
What is the normal angle between the femoral neck and femoral shaft?
130 degrees
