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MB2 Rheumatology and Orthopaedics > Knee and hip orthopaedics > Flashcards

Knee and hip orthopaedics Flashcards

1
Q

what 2 joints make up the knee

A

tibiofemoral

patellofemoral

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2
Q

lateral and medial menisci are important for what

A

joint congruence and shock absorption

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3
Q

function of ACL

A

prevents anterior tibial subluxation and internal rotation during extension

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4
Q

function of MCL

A

resists valgus force

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5
Q

function of LCL

A

resists varus force and external rotation

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6
Q

function of PCL

A

prevents hyperextension and posterior tibial translation or anterior femur translation

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7
Q

consequence of TKR on a young patient?

A

may need revision surgery, deemed inferior to primary TKR

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8
Q

when is TKR indicated

A

pain and disability where conservative management ineffective

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9
Q

how does a meniscal tear classically occur and which meniscus is it

A

twisting force on a loaded knee or die to ACL rupture

usually medial

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10
Q

what is true knee locking

A

15 degree spongy block to extension due to bucket handle meniscal tear

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11
Q

what is knee pseudolocking

A

non-meniscal knee injury - temporary difficulty in straightening joint

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12
Q

how do degenerate meniscus tears occur

A

older age, thought to be the first stage of OA

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13
Q

what types of meniscal tears should be considered for repair

A

tears in a younger patient in the outer 1/3

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14
Q

when is a partial menisectomy considered

A

if pain and inflammation from meniscal injury does not settle following injury

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15
Q

who is indicated for ACL repair

A

professional athletes or those whos knees give way on sedentary activity despite physio

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16
Q

what causes ACL rupture

A

high rotational force

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17
Q

what causes PCL rupture

A

direct blow to anterior knee or hyperextension

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18
Q

indication for isolated PCL rupture repair

A

ligament laxity, recurrent hyperextension with instability or unstable descending stairs

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19
Q

what causes LCL injury, how is it managed, what type of instability do patients have

A

varus injury
reconstruction
instability on rotation due to excessive external rotation

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20
Q

what causes MCL injury, how is it managed

A

valgus stress injury

usually well healing, only requires knee brace with little to no instability

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21
Q

what happens to see complete knee dislocation

A

all 4 ligaments would have to rupture

compromised popliteal artery and common fibular artery

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22
Q

what must you check following knee dislocation

A

distal pulses

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23
Q

what extensor mechanism tendon is usually ruptured iun <20

A

patellar tendon

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24
Q

what extensor mechanism tendon is usually ruptured in >40

A

quadriceps tendon

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25
Q

risk factors for ruptured extensor mechanism

A 
steriods 
ciprofloxacin 
chronic renal failure 
tendinitis 
diabetes 
rheumatoid arthritis
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26
Q

clinical features of patellofemoral dysfunction

A 
adolescents 
pain going downhill
grinding/clicking at front of knee 
anterior knee pain 
stiffness/pseudolocking in flexed position
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27
Q

true/false - patellar dislocations are almost always medial

A

false - theyre almost always lateral

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28
Q

risk factors for patellar dislocation

A 
ligament laxity 
females 
valgus deformity 
shallow trochlear groove 
high riding patella 
femoral neck anteversion
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29
Q

rule of thirds in ACL rupture?

A

1/3 compensate
1/3 avoid instability by avoiding activity
1/3 do not compensate with frequent instability

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30
Q

what is osteochondritis dissecans

A

area of surface of joint loses blood supply and piece of bone/cartilage fragments

31
Q

what is bone marrow oedema

A

impact to articular surface leads to microscopic fracture of trabecular bone with bleeding/inflammation
can take months to repair

32
Q

why may a loose body in the knee become a problem and how can it be fixed

A

may cause painful locking/catching or mobile lump iwth occasional pain
may be managed arthroscopically

33
Q

conservative management of knee pain

A 
explanation 
support 
analgesia 
short term NSAIDS for flare up 
support 
physiotherapy
steroid injection for acute 
referral
34
Q

conservative management of hip pain

A 
education 
weight reduction 
home adaptation 
stick
analgesia 
NSAIDS
physiotherapy 
complementary medicine 
mobility allowance, disability badge
35
Q

when to refer for hip pain?

A 
Pain, and pain at night 
lost function 
physical/mental fitness 
support at home 
patient expectation 
age of patient 
uncertain diagnosis
36
Q

3 patterns of hip pain?

A

pain in groin
pain in buttock
referred knee pain

37
Q

signs of hip pathology on examination

A

lost internal rotation
leg shortening
abductor weakness by +ve trendelenberg
exacerbated pain on rotation

38
Q

what are other differentials for groin pain beside hip pathology

A

hernia
tendonitis
high lumbar disc prolapse
pubic symphysis dysfunction

39
Q

how long does a THA/THR last

A

cup last 15 years and ball 20

40
Q

what determines whether someone needs THR

A

levels of pain and disability failing conservative management

41
Q

conservative measures for hip pain/disability

A 
analgesia 
physiotherapy 
use of stick
weight reduction 
activity modification
42
Q

early local THR complications

A

infection
dislocation
leg length discrepancy
nerve injury

43
Q

early general THR complications

A 
chest infection 
MI
Hypovolaemia/blood loss
Cardiac arrest
DVT/PE
UTI
44
Q

late local THR complications

A

dislocation
late infection
early loosening

45
Q

why are hip revision surgeries more difficulty

A

higher blood loss
more complicated
poorer outcome
dont last as long

46
Q

why should you delay a young person getting a THR

A

theyll need a revision surgery

47
Q

risk factors/epidemiology for AVN

A 
males
35-50
alcohol abuse 
steroids 
thrombophilia 
hyperlipidaemia
decompression sickness
48
Q

how is AVN managed if detected early?

A

drill holes up femoral neck and head to relieve pressure and to promote healing and prevent collapse

49
Q

what can you do with the hip once avascular necrosis has occurred

A

replace it with THR

50
Q

how does AVN appear on X ray

A

patchy sclerosis of weight bearing femoral head with a lytic zone beneath
“hanging rope sign”

51
Q

what is gluteal cuff syndrome/trochanteric bursitis

A

tendinous insertion of gluteal muscles in greater trochanter is subject to tendonitis
trochanteric bursa may become inflamed

52
Q

what primary and secondary factors may lead to knee osteoarthritis

A 
obesity 
older age 
genetics 
work/hobbies 
meniscal tear 
trauma 
ACL rupture 
malalignment 
heavy workload
53
Q

when would TKR be considered in a patient

A

in pain or disability refractory to conservative management
constant pain and limited walking
sleep disturbance
frequent flare up

54
Q

true/false - 10% of patients who have a TKR have unexplained pain and these patients are usually older

A

false - 20% do and patients are usually younger, obese, chronic pain syndrome, mild OA in original joint, psychological distress

55
Q

what is the satisfaction rate of a TR and how long would you expect it to last in an ideal patient

A

expected to last 15-20 years

75-80% satisfaction

56
Q

true/false - sport and heavy work may cause TKR to loosen and fial sooner than expected

A

true

57
Q

true/false - revision is a more complex surgery but works just as well as TKR

A

no, it is way more complicated and doesnt work nearly as well

58
Q

what are surgical options in a failed TKR revision

A

fusion

amputation

59
Q

in patients with chronic pain following TKR, would redoing the TKR be expected to work?

A

no

60
Q

alternatives to TKR

A

unicompartmental knee replacement for heavily affected and localised OA of the knee, reop rate is high
osteotomy for younger patients who would trash a TKR, unfavoured

61
Q

when would you offer a clean out surgery for the knee

A

never, ever

62
Q

presentation of avascular necrosis

A

insidious onset groin pain
exacerbated by stairs/impact
normal examination

63
Q

conservative management of avascular necrosis

A

bisphosphonates with core decompression

64
Q

who is trochanteric bursitis more common in

A

runners

women

65
Q

presentation of trochanteric bursitis?

A

pain on lateral aspect of hip and greater trochanter

66
Q

management of trochanteric bursitis

A

analgesia
NSAIDs
physiotherapy
steroid injection

67
Q

causes of OA of the hip

A 
DDH
SUFE 
Septic arthritis 
FAI
Trauma 
AVN
primary
68
Q

presentation of OA of hip

A 
groin pain 
worse on activity 
pain at night 
stiff ROM 
start up pain
69
Q

what is CAM femoroacetabular impingement syndrome, who is is more common in

A

femoral deformity with asymmetric head and decreased head/neck ratio
usually young and athletic males and may be related to previous SUFE

70
Q

what is pincer femoroacetabular impingement syndrome and who is it more common in

A

acetabular deformity with overhang

more common in females

71
Q

what actions cause pain in femoroacetabular impingement syndrome

A

flexion, adduction, internal rotation

72
Q

presentation of FA impingement syndrome

A

activity related pain in groin
difficulty sitting
C sign positive
FADIR provocation positive

73
Q

management of FA impingement syndrome

A

observe if incidental
manage conservatively
arthroscopic/open removal of CAM or debride labral tears/osteotomy
arthroplasty in older patients

MB2 Rheumatology and Orthopaedics (22 decks)

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