Lecture 6 - Disorders of the hip Flashcards
Osteoarthritis
Degenerative disorder due to the breakdown of articular hyaline cartilage.
Clinical syndrome:
- Joint pain
- Functional limitation
- Reduced quality of life
Non-inflammatory without systemic involvement
Primary osteoarthritis
Unknown cause
Secondary osteoarthritis
Has a known precipitating cause
Risk factors of osteoarthritis
Age Female Nutrition - diet rich in vitamin C and E can reduce the risk Ethnicity Genetics
Causes of secondary osteoarthritis
Obesity - BMI 30+
Trauma - sports or occupation risk factors
Malalignment - developmental dysplasia of the hip
Infection - septic arthritis, tuberculosis
Inflammatory arthritis - rheumatoid, ankylosing spondylitis
Metabolic disorders affecting the joint - gout
Haematological disorder - haemophilia with haemarthrosis (bleeding in joints)
Endocrine abnormalities- Diabetes with neurovascular impairment - chronic malalignment (Charcot joint)
Symptoms of osteoarthritis
Deep aching joint pain exacerbated by use
Reduced range of movement
Crepitus - grinding
Stiffness during rest - morning stiffness
Pathology of osteoarthritis
- Excessive or uneven loading of the joint
- Damage to articular hyaline cartilage
- Hyaline cartilage becomes swollen due to increased proteoglycan production by chondrocytes.
- Increased chondrocytes are produced from the differentiation of chondroprogenitor cells
Can last several years - attempt to repair itself
- Proteoglycan content decreases
- Cartilage softens and loses its elasticity
- Flaking and fibrillation (vertical clefts) along the normally smooth cartilage
- Over time the cartilage becomes eroded to the subcondral bone
- Loss of joint space
- Surface changes alter the distribution of forces
Affect of osteoarthritis on subchondral bone
Vascular invasion
Eburnation: increased cellularity - thicker and denser at areas of pressure
Cystic degeneration forming subchondral bone cysts due to osseus necrosis secondary to chronic impaction (pressure) or intrusion of synovial fluid
Osseus metaplasia of CT occurs therefore outgrowths of new bone - osteophytes
Presentation of osteoarthritis on an Xray
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral bone cysts
Eburnation
Increased cellularity of subchondral bone therefore it is thicker and denser at areas of pressure
Symptoms of osteoarthritis in the hip
Joint stiffness - especially after rest
Pain in the hip - gluteal and groin region radiating to the
knee (obturator nerve)
Mechanical pain - when weight bearing or moving
Crepitus
Reduced mobility - difficulty walking, putting on socks, tying shoelaces, getting in and out pf the car/ bath
Treatment of osteoarthritis
- Weight reduction
- Activity modification
- Walking stick/frame - reduce load through joint
- Muscle strengthening exercises ( deep gluteal muscles)
- Orthotic footwear - realign joint
- Analgesia and NSAIDS (anti-inflammatory)
- Steroid injections - into the joint to reduce swelling
- Hyaluronic acid injection - increase lubrication and promote cartilage repair (limited evidence)
Cure = total hip replacement
Location of a fractured neck of femur
Fracture of the proximal femur up to 5 cm below the lesser trochanter
2 types of classification of NOF
Intracapsular
Extracapsular - intertrochanteric and subtrochanteric
Intracapsular fractures
Likely to disrupt the ascending cervical (retinacular) branch of the MFCA
The ligamentum teres is unable to sustain the blood supply to the femoral head therefore there is a high risk of avascular necrosis
Increased risk in dispaced NOF and adults