MSK - Hip

Question 1

Cemented vs Uncemented hip replacements

Answer 1

Cemented: Synthetic bone cement inserted into bone cortex to create interlock between bone and prosthesis. Done in patients with osteopenic or osteoporotic bones, where you can’t rely on bone ingrowth to stabilise the prosthesis

Uncemented: No cement used. Relies on bone ingrowth to fix the prosthesis in place

Question 2

Aseptic loosening

Answer 2

More common in cemented prostheses - cement breakage, inflammation and micromotion leads to loosening of the prosthesis over time

Question 3

Trochanteric bursitis presentation

Answer 3

Middle aged patient
Gradual onset pain on lateral side of hip (hurts to lie on etc.) - may radiate to the knee

Pain on palpation of greater trochanter
Reduced ROM (restricted by pain)

Question 4

Trochanteric bursitis Mx

Answer 4

RICE
Analgesia (NSAIDS)
Physio
Intraarticular steroid injections

Question 5

Causes of trochanteric bursitis

Answer 5

Infection (septic bursitis - warmth/erythema of area O/E)
Inflammatory diseases e.g. RA
Trauma
Repetitive movement (iliotibial band rubs on trochanteric bursa)

Question 6

Garden classification of hip fracture

Answer 6

Stage 1: Incomplete Undisplaced intracapsular fracture
Stage 2: Complete Undisplaced intracapsular fracture
Stage 3: Complete fracture incompletely displaced
Stage 4: Complete fracture with complete displacement

Question 7

Causes of unilateral hip pain

Answer 7

Infection (septic arthritis)
Inflammation (trochanteric bursitis)
Trauma (NOF)
Congenital/anatomical (SUFE, Perthes)

Question 8

Hip osteoarthritis RFs

Answer 8

Progressive degeneration of articular cartilage leading to joint destruction

Age
Gender (Female > male)
Congenital deformities of the hip joint

Trauma
Overuse (occupational, sports)

Question 9

Hip osteoarthritis presentation

Answer 9

Function limiting hip pain (can be at rest)
Stiffness
Instability/locking

Question 10

Hip osteoarthritis Mx

Answer 10

Conservative
Weight loss
Physio and activity
Walking sticks

Medical
Oral NSAIDs
Intraarticular steroid injections

Surgical
Hemiarthroplasty
THR
Other (osteotomy, resurfacing)

Question 11

Hip dislocation types, mechanisms

Answer 11

Posterior hip dislocation (90%)
- High energy trauma e.g. dashboard injury (axial loading on femur): very commonly have other associated injuries so do full ATLS

Anterior hip dislocation
Femoral head impaction, normally with hip in abduction and external rotation

Question 12

Approaches for hip surgeries and risks

Answer 12

Anterior approach

• Lateral femoral cutaneous nerve
• Femoral nerve
• Lateral femoral circumflex artery

Anterolateral approach
- Femoral nerve, artery and vein

Posterior approach (most common)
- Sciatic nerve

Question 13

NOF Mx

Answer 13

Resuscitate + analgesia (paracetamol/nerve block)

Undisplaced intracapsular NOF: Cannulated screws
Displaced intracapsular NOF in <55yo: Cannulated screws
Displaced intracapsular NOF: THR/hemiarthroplasty
Intertrochanteric: DHS
Subtrochanteric: IM nail