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2PACES COPY y6 > MSK: Hip & Knee > Flashcards

MSK: Hip & Knee Flashcards

1
Q

What are the hip adductors?

A

GAASP

Gracilis 
Adductor longus 
Adductor magnus 
Sartorius
Pectineus
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2
Q

What are some of the extra-articular manifestations of RhA?

A

Ocular: keratoconjunctivitis sicca (most common), episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, chloroquine retinopathy

Respiratory: pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy

IHD: RA carries a similar risk to T2DM

Systemic:
osteoporosis, infections (e.g. septic arthritis), depression

Less common:
Felty’s syndrome (RA + splenomegaly + low white cell count), Amyloidosis

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3
Q

What can cause a positive trendelenburg test and what does it test for?

A

Tests for hip abductor strength

Muscle weakness:
Weakness of gluteus medius minimus or Tensor Fascia Lata (TFL)

Joint issues:
Hip OA
Initially post Total Hip Replacement
Hip instability and subluxation
Lower back pain

Nerve issues:
Superior Gluteal Nerve Palsy

Chronic childhood conditions:
Legg-Calvé-Perthes Disease
Congenital hip dislocation

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4
Q

X-Ray changes for OA

A

Loss of joint space
Subchondral cysts
Subchondral sclerosis
Osteophyte formation at the joint margin

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5
Q

Clinical features of femoral nerve damage

A

Supplies the quadriceps and so you get weakness in knee extension

Loss of the patella reflex

Numbness of the thigh

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6
Q

Features of Ankylosing Spondylosis

A 
Anterior uveitis
Apical fibrosis
AV node block
Aortic regurgitation
Amyloidosis
Achilles tendonitis
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7
Q

What are the four main types of knee replacement?

A

Total knee replacement (bicompartmental)
Unicompartmental (partial) knee replacement
Kneecap replacement (patellofemoral arthroplasty)
Complex/revision knee replacement

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8
Q

What are some causes of apparent shortening of the leg and true shortening of leg length?

A

True Shortening

 e.g. NOF
 Hip dislocation
 Growth disturbance of tibia/fibula
 Osteomyelitis, #s
 Surgery: e.g. THR
 SUFE
 Perthes’ disease

Apparent (problem above the hip)

Scoliosis

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9
Q

What are the features of OA in the hip?

A 
 ± Trendelenberg gait or +ve Test
 Pain
 Stiffness
 ↓ ROM: esp. internal rotation
 Fixed flexion deformity
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10
Q

What are some of the surgical options for knee OA?

A 
Arthroscopic Washout
Realignment Osteotomy
Arthroplasty
Arthrodesis
Microfracture
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11
Q

What are the types of hip arthroplasty?

A

THR: Replace femoral head, neck and acetabulum

Hemi-arthroplasty: Replace femoral head and neck only (can be unipolar or bipolar)

Resurfacing: replacement of the femoral head

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12
Q

What techniques are used for Hip arthroplasty?

A

Posterior approach:

 Access joint and capsule posteriorly, reflecting of the short external rotators.
 Gives good access
 May have higher dislocation rate
 Sciatic N. may be injured → foot drop

Anterolateral Approach

 Incision over greater trochanter, dividing fascia lata.
 Abductors are reflected to access joint capsule.
 May have lower dislocation risk
 Sup. Gluteal N. may be injured → Trendelenberg gait

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13
Q

Benefits and disadvantages of hip resurfacing

A

Advantages

 Metal-on-metal bearings wear less
 Larger head → ↓ dislocation / ↑ stability
 Preserve bone stock making revision easier

Disadvantages

 Cobalt and chromium metal ion release may cause pathology (e.g. leukaemia)
 Risk of NOF # if mal-positioned

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14
Q

Indications for a hip resurfacing procedure

A

May be used in young (<65), active people who are expected to outlive the replacement.

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15
Q

Surgical management of RA in the knee

A 
Indicated in failed medical Mx
 Synovectomy and debridement (can be done arthroscopically)
 Removal of pannus and cartilage
 Supracondylar osteotomy
 Total knee arthroplasty
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16
Q

Causes of fixed flexion deformity in the hip

A

 Osteoarthritis

 #NOF

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17
Q

Causes of knee effusion

A

Synovial fluid: synovitis (inflammatory arthritis)

Blood:
 90% = ACL rupture
 PCL rupture, intra-articular #, meniscal tear
 Bleeding diathesis

Pus: septic arthritis

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18
Q

Definition of osteoarthritis

A

Degenerative joint disorder in which there is a progressive loss of hyaline cartilage and new bone formation at the joint surface and its margin.

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19
Q

X-Ray changes of RA

A
  • Soft tissue swelling
  • Periarticular osteopenia
  • Periarticular erosions
  • Severe deformity
  • Joint space narrowing
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20
Q

Complications of Hip Arthroplasty

A

Immediate
 Nerve injury
 Fracture
 Cement reaction

Early
 DVT: up to 50% w/o prophylaxis
 Deep infection: 0.5-1.5%
 Must remove metalwork before revision.
 Dislocation (3%): squatting and adduction

Late
 Loosening: septic or aseptic
 Leg length discrepancy
 Metalosis
 Revision: most replacements last 10-15yrs
 Peri prosthetic fracture
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21
Q

Complications of Knee arthroplasty

A

Immediate
 Fracture
 Cement reaction
 Vascular injury (superficial femoral artery + (Popliteal and genicular vessels)
 Nerve injury (peroneal nerve → foot drop (1%))

Early
 DVT
 Deep infection: 0.5-15%

Late
 Loosening: septic or aseptic
 Periprosthetic #s
 ↓ ROM and instability (due to loss of ACL)

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22
Q

What are some ddx of knee locking?

A

 Meniscal tear
 Cruciate ligament injury
 Osteochondritis dissecans: adolescents
 Loose body

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23
Q

Describe the ACL repair

A

 Gold-standard is autograft repair
 Usually semitendinosus ± gracilis (can use patella)
 Tendon threaded through heads of tibia and femur and
held using screws.

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24
Q

What is meant by charcots joints?

A

 Progressive destructive joint arthropathy
 Secondary to disturbance of sensory innervation to the joint
 Painless deformed joint resulting from repetitive minor
trauma.

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25
Q

What are the four phases of gait?

A
  1. Initial contact / heel strike
  2. Stance
  3. Toe off
  4. Swing
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26
Q

What are the three compartments of the knee?

A

Medial
Lateral
Patello femoral

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27
Q

Indications for total knee replacement

A

Traumatic injury
OA (refractory to medical Mx)
RA (refractory to medical Mx)

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28
Q

Hip examination: When doing active flexion which hip do you stabilise?

A

Ipsilateral: flexion, extension, internal and external rotation
Contralateral: hip abduction and adduction

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29
Q

Which patients should you not perform Thomas’s test in?

A

Hip replacement patients

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30
Q

What would you expect in a positive patellar tap?

A

Empty the suprapatellar pouch

If there is an effusion the patellar will float up and when you press down there would be a knock

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31
Q

How do you test meniscal damage?

A

McMurrays

Medial rotation: lateral meniscus
Lateral rotation: medial meniscus

32
Q

Classification of fractures

A

1) Traumatic
- direct
- indirect (fall on out stretched hand)
- avulsion (ligament pulling off bone)

2) Stress
3) Pathological

33
Q

Describing an X-Ray

A

Patient details
Location
Soft tissue: open/ closed?
Displacement:
- translation (horizontal movement)
- angulation (movement of the fracture from its normal
angle)
- dislocation (distally, proximally etc)
Pieces: comminuted
Pattern: Incomplete, transverse, oblique, spiral, impacted

34
Q

When would you do an ORIF?

A
  • Comminuted fractures
  • Open fractures
  • Intra-articular fracture (because synovial fluid contains collagenase enzymes that stop bone healing)
  • Failure
35
Q

Complications of fractures

A

Early:

  • compartment syndrome
  • visceral damage
  • neurovascular damage

Late:

  • avascular necrosis
  • malunion
  • OA of the joint
  • reduced mobility
36
Q

RF for OA

A

Genetics
Unmodifiable: female, bone density, age
Modifiable: obesity
Biomechanical: repetitive use of a joint

37
Q

Surgical Management of OA

A 
Arthroscopic washouts 
Arthroplasty
Microfractures
Osteotomy
Athrodesis
38
Q

X-ray you would request for the knee

A

AP
Lateral
Skyline (dislocated patellar)

39
Q

What are the muscles used for hip abduction?

A

Gluteus minimus
Gluteus medius
Tensor Fascia Lata

40
Q

How would a hip dislocation present?

A

Posterior dislocation: Accounts for 90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated.

Anterior dislocation: The affected leg is usually abducted and externally rotated.

41
Q

What is a Baker’s cyst?

A

Baker’s cysts are not true cysts but distension of the gastrocnemius-semimembranosus bursa.

Primary: no underlying pathology, typically seen in children

Secondary: underlying condition such as osteoarthritis, typically seen in adults

42
Q

Surgery in RA

A

Debridement
Removal of pannus and cartilage
Supracondylar osteotomy
TKA

43
Q

How would L3 nerve root compression present?

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

44
Q

How would L4 nerve root compression present?

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

45
Q

How would L5 nerve root compression present?

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

46
Q

How would S1 nerve root compression present?

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

47
Q

What are you looking for from the front in a hip exam?

A

Scars
Pelvic tilt
Quadriceps wasting

48
Q

What are you looking for from the side in a hip exam?

A

Lumbar lordosis
Knee flexion
Foot arches

49
Q

What are you looking for from behind in a hip exam?

A

Scoliosis
Iliac crest alignment
Gluteal muscle bulk

50
Q

What are you looking for from the front in a knee exam?

A

Quadriceps bulk
Knee swelling and deformity
Foot deformity

51
Q

What are you looking for from the side in a knee exam?

A

Knee flexion
Foot arches
Toe deformity

52
Q

What are you looking for from behind in a knee exam?

A

Iliac crest alignment
Gluteal muscle bulk
Popliteal swelling
Hindfoot abnormality

53
Q

What does posterior sag indicate?

A

Rupture of the PCL

54
Q

Surgical mx of a displaced subcapital NOF?

A

Hemiarthroplasty or THR

55
Q

Surgical mx of a non-displaced intracapsular NOF?

A

Cannulated hip screws

Can consider hemi or THR

56
Q

Surgical mx of an intertrochanteric or basocervical NOF?

A

Dynamic Hip Screw (or short IM nail)

57
Q

Surgical mx of a sub-trochanteric NOF?

A

Anterograde Intramedullary Femoral Nail

58
Q

Tool to classify OA Progression?

A

WOMAC score

59
Q

What is the Unhappy Triad of O’Donoghue

A
  • ACL
  • MCL
  • Medial Meniscus

Usually occurs at the same time

60
Q

What is the normal angle of hip flexion?

A

120 (acute angle 60)

61
Q

What is the normal angle of hip internal and external rotation?

A

45 degrees

62
Q

What is the normal angle of hip abduction?

A

45 degrees

63
Q

What is the normal angle of hip adduction?

A

25 degrees

64
Q

What is the normal angle of hip extension?

A

20 degrees

65
Q

What are the hip flexors?

A 
Psoas
Iliacus
Sartorius
Pectineus
Adductor longus and brevis
Rectus femoris
66
Q

What are the hip extensors?

A 
Gluteus maximus
Hamstrings:
- semitendinosis
- semimembranosus
- biceps femoris
67
Q

What are the hip abductors?

A

Gluteus medius
Gluteus minimus
Tensor fascia lata

68
Q

What are you looking for in the front for the knee exam?

A

Varus deformity
Valgus deformity
Hyperextension
Fixed flexion deformity

69
Q

What is the normal angle of flexion of the knee?

A

40 degrees acute

70
Q

What is the normal angle of extension of the knee?

A

<10 degrees

71
Q

What are the knee flexors?

A
  • semitendinosis
  • semimembranosus
  • biceps femoris
72
Q

What are the knee extensors?

A

Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis

73
Q

3 compartments of the knee?

A

Medial
Lateral
Patellofemoral

74
Q

Indications for a cemented hip replacement?

A

Irradiated bone
Osteopenic/osteoporotic bone
Abnormally wide femoral canal

75
Q

Kocher criteria for septic arthritis?

A

Non weight-bearing
Temp > 38.5°C
ESR >40mm/hr
WBC >12,000 cells/mm3

2PACES COPY y6 (12 decks)

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