Intra-Articular Disorders of the Hip Flashcards
What is the most common cause of hip pain in adults?
Hip Osteoarthritis
What defines primary and secondary hip OA?
Primary: Idiopathic
Traumatic- Secondary: as a result of trauma or congenital abnormalities altering biomechanics
What are some of the congenital abnormalities altering biomechanics of the hip?
- Hip Dysplasia
- Shape of the femoral head
- Leg-Calve-Perthes disease
- Congenital Dislocation
- Slipped Capital Femoral Epiphysis
- Leg Length Discrepancy
What is the clinical presentation of hip OA?
Moderate- Lateral or Anterior hip pain with weight bearing.
Can progress to anterior thigh or knee region.
Adults greater than 50 years of age.
Limited passive ROM in at least 2 of 6 directions. Morning hip stiffness that improves in less than one hour.
Hip Pain Referral Patterns
Hip joint innervation: obturator, femoral, sciatic nerves
Intra articular hip disorders referred to where the most?
Buttocks then anterior thigh, then groin.
Altman’s criteria for Hip OA Cluster 1 , Cluster 2
Cluster 1: Hip Pain, hip int rot 15 deg . –> Painful hip int rot, >50 years of age, hip stiffness
Birrell’s Criteria for Hip OA:
ER
Sutlive’s Criteria for hip OA- Unilateral hip pain
1) Self reported squatting aggravating factor
2) Active hip Flexion causing lateral hip pain
3) Scour test causing lateral hip or groin pain
4) Active hip extension causing pain
5) Passive hip internal rot
Examination of Hip OA: What to look for in a gait analysis?
Antalgic Gait
Excessive lumbar lordosis in terminal stance
Lurching or leaning of trunk toward the affected side
Positive Trendelenberg
HIP OA: What happens to their hip joint ROM?
Decreases particular the hip flexors. Assess mobility
HIP OA: Decrease hip joint muscle strength and endurance
Measure hip abductors especially
What are 2 self reported outcome measures to use?
WOMAC and LEFS
LEFS?
Lower Extremity Function Scale. Score from 0-80
WOMAC
24 question western ontario and McMaster OA Index. 5 pain , 2 stiffness, 17 physical function
Functional Tests for HIP OA:
6 Minute Walk, TUG, Self Paced Walk Test
Which bone is affected by Osteonecrosis?
Trabecular bone in the femoral head
How can osteonecrosis occur?
Trauma to the femoral head.
Neck fracture. Femoral head dislocation.
Patients with history of alchohol abuse or corticosteroid abuse.
Sickle Cell Disease
Vasculitis is what?
Inflammation of blood vessels
What causes vasculitis?
Inflammatory arthropathy:
SLE, Rheumatoid Arthitis
Osteonecrosis: is most common in which age range
30-50 years old.
Clinical Presentation in History of Osteonecrosis:
Onset of pain gradual in onset and duration.
Can begin suddenly with collapse of femoral head.
Can report dullache of throbbing pain in groin, lateral to hip, or in buttock.
Pain can radiate into thigh and upper knee region.
Initially hip range of motion minimally effected although pain substantial.
Management for Osteonecrosis:
NSAIDS= pain relief
Ambulation with an assistive device.
Total Hip Arthroplasty.
Conservative management outcomes are very ____
Poor; unless it is Legg-Perthes disease in children. Leading to better outcomes with the younger the child.
Hip Fractures: How many percent die in the following year?
What is the cost per episode?
In adults 85 or older, what percent will fracture hip?
Twice as many fractures occur in _____ .
30%
40k$
43.3%
Twice
Mechanism of hip fracture injury?
Caused by balance loss and twisting of LE on a fixated foot.
High torque between femoral shaft and head leading to neck fracture.
Femoral head can also be affected as a result of ________.
Osteoporosis.
Clinical Presentation of hip fracture?
Inability to move after a fall. Severe pain in hip or groin. Inability to weight bear. Stiffness, bruising and swelling around hip. Apparent shortening of the LE.
What examination would be ideal for a hip fracture test?
Patella-Pubic Compression Test
Treatment options for hip fracture?
ORIF.
Mortality rate for ORIF?
20-25%, up to 40-50%. Rehab needs to take place early.
Subtrochanteric and intertrochanteric fractures have ____ prognosis compared to femoral neck fractures
Better
Complications following ORIF?
Avascular Necrosis Infection Arthritis Dislocation Coxa Vara/Valgus Nail Penetration.
THA incision length?
> 10cm
THA Anterolateral approach, between what 2 muscles and how is the hip dislocated?
Between TFL, Glute Med. Hip ABD released from greater Tro, hip dislocated anteriorly ( extension and ER)
Posterolateral approach, how is hip disloacted.
Split Glute Max
Short EXT ROT are cut and Glut Med retracted anteriorly.
Hip dislocated posteriorly (flex, adducting, INT rot)
Which THA procedure is best?
Doesnt matter. Evidence inconclusive.
Cemented vs Cementless Fixation. Cemented survivorship. Cementless?
98% at 10 years, 93% 25 years
Similiar to above numbers for femoral component but better prognosis with acetabular component at 15 years.
Which THA technique is preferred? In younger.
Cementless. You can weight bear earlier in cementless. WBAT/FWB with assistive device.
Which post THA complication is most worrisome?
DVT. 50-75% risk of DVT without action taken to prevent.
Clinical detection of DVT:
Wells Criteria.
Wells Criteria :
Localized tenderness along venous system. Entire LE swelling Calf Swelling > cm Pitting Edema Collateral superficial veins
Prevention of DVT
Compressive Devices, TED HOSE, Anti coagulants. Ankle Pumps. Early mobilization.
THA Precautions: Posterior Lateral
No hip flexion over 90.
No hip IR past neutral
No hip adduction past neutral
THA precaution lateral
Varies by surgeon but avoid ER and extension.
THA procedure?
Hip joint removed during surgery. Ligaments resected. Supporting musculature has trauma, after surgery joint very unstable.
How long for a patient can maintain THA precautions.
6-12 weeks. Incidence of dislocation is reduced by 95% after 12 weeks.
Long term impairments after THA (3 month mark)
Ant hip, groin pain, back pain. Decreases in endurance, strength, ROM/ flexibility Gait deviations Decrease balance Activity limitations. Leg Length Discrepancy
What are some causes of leg length discrepancy
Improper stem length, hip muscle imbalance, muscle contracture, capsular tightness.
