Non-OA hip Flashcards
Describe the relative orientation of the proximal and distal femur in the transverse plane
proximal femur is oriented anterior to the distal femoral condyles creating a medial torsion of 14-18 degrees
what non arthritic pathologies are suggested by the hip CPG
- FAI
- structural instability
- acetabular labral teras
- osteochondral lesions
- loose bodies
- ligamentum teres injury
- sepctic conditions
what are the pathoanatomic categories recommended by the hip CPG
- FAI
- structural instability
- intra-articular pathology
what are the FAI catgories
- CAM - loss of femoral head shape
- Pincer - loss of acetbular shape or deep acetabulum
- Combo
What pathologies can lead to CAM impingements
- slipped capital femoral epiphysis
2. anatomical protrusion of the femoral head
what are some anatomical risk factors for developing hip structural instability
- increase anteversion or retroversion
- interior acetabular insufficiency
- neck shaft angle greater than 140 degree
What is acetabular dysplasia
shallow acetabulum
what is the prevalence of adult hip dysplasia
- cross sectional study 5.4-12.8
- hip pain study 32%
- no difference in prevalence in symptomatic versus asymptomatic individuals
- prospective mulitcenter exam 35%
what is the prevalence of hip labral tears
- in people with mechanical hip pain as high as 90%
2. in people with hip or groin pain 22-55%
what is the typical mechanism of injury for labral tears
- forceful rotation with extension
- repetitive forces
- insidious - with as much as 74% without a specific incident
How are labral tears classified
- radial flap - free margin of the labrum is disrupted
- radial fibrillated - fraying of the free margin
- longitudinal peripheral - tear along the acetabular labral junction (least common)
- abnormally mobile (partial detachment)
what role does ligamentum teres play in hip stability
- more recently thought to play a role in intrinsic stability
- ER in flexion and IR in extension are its position of influence
what is the prevalence of ligamentum teres injuries in orthoscopic surgeries
8%
what motions of the hip is ligamentum teres thought to stabilize
- ER in flexion
- IR in extension
what are risk factors for chondral lesions of the hip
- labral injury
- FAI
- anterior joint laxity
- dysplasia
- young active with traumatic injury involving force through the greater trochanter
what risk factor have been identified for hip impingement
- level III - genetic - siblings versus spouses are more likely to simlar patterns of hip impingement
- level III - sex - CAM type more in men, PINCER type more in women
- Hip retroversion
what are the risk factors for developing him joint laxity
level V - genetics
level V - ligamentus laxity associated with EhlersDanlos, Down and Marfan syndromes
what role does osseous abnormalities play in intra-articular hip injuries
- questionable role
- high incidence of osseous abnormalities are noted, but when compared with the un-involved side similar changes are noted
- CAM type hips with increased intra-articular problems, PINCER type hips with less intra-articular problems
What is the evidence grade regarding risk factors for non arthritic hip pain risk factors
F
what clinical finding does the non-OA hip pain CPG suggest looking for to indentify hip impingment
- pain in the anterior hip, groin or lateral hip region
- sharp or aching type pain
- aggravated by sitting
- pain production with FADIR test position, flex,add,IR
- ROM loss with hip flexion and abd
- Supine IR less than 20
- mechanical symptoms of popping, locking or snapping of the hip
- lack of other findings
what radiographic findings would you expect with hip CAM impingement
CAM
increased femoral neck diameter approaching the size of the femoral head
- alpha angel greater than 60
- head neck off set ration less than 0.14
what radiographic findings would you expect with hip PINCER impingement
PINCER
Increased acetabular depth
- cox profunda (lateral center-edge angel greater than 35 degrees)
- acetabular protrusion
decreased acetabular inclination
- tonnis angle less than 0 (angle of the superior acetabulum, normal 7ish, 0 suggest flat roof)
Acetabular retroversion
what is coxa profunda
imaging finding of the hip where bright ischial line overlaps with the acetabulum
- the line of the acetabulum should appear medial to the ischial line
- suggests deep acetabulum
what clinic finding does the non-OA hip CPG suggest looking with hip instability
- anterior groin and lateral hip pain
- painful FADIR or FABER
- Hip apprehension
- supine IR greater than 30 degree
- mechanical symptoms such as popping, locking or snapping
what radiographic findings would you expect with hip instability
- tonnis angle greater than 10 degrees
- increase acetabular inclination (angle of edge to edge of the acetabulum)
- decreased femoral head coverage (anterior center edge angle less than 20 degree, vertical angle oblique
what clinic finding does the non-OA hip CPG suggest looking with hip intra articular pathology
- anterior groin or general hip pain
- pain production with FADIR or FABER tests
- feeling of instability with deep squats
- no conflicting findings
- MRI findings
what imaging studies are recommended for detecting hip ossessos changes
- cross table lateral view - slightly side rolled
- 45 or 90 dunn view - GYN position
- frog lateral view - FABER position
- false profile view - standing ER’d
what x-ray finding would suggest hip dysplasia
- tonnis angle greater than 10
- wiberg less than 25 - lateral center edge, other sources place normal 20-40 with less than 15 as dysplasia
- Lequesne less than 25 - anterior center edge
- neck shaft angle greater than 140
that x-ray findings would expect with a retorverted hip
- cross over sign -AP view shows a “X” like over lap of the posterior acetabulum and anterior acetabulum
- projection of the isheial spine intot hte pelvis
what is the alpha angle
The angle is formed by the acetabular roof to the vertical cortex of the ilium and thus reflects the depth of the bony acetabular roof. This is a similar measurement to the acetabular angle.
The normal value is greater than or equal to 60 degrees.
- Less than 60 degrees suggests dysplasia of the acetabulum.
- greater is correlated to CAM impingment
what imaging procedure is typically used to diagnosis hip labral tears
MRA - MRI with joint contrast dye SPINE 44-71 SNOUT 71-100
what outcome measures are recommend for non-OA hip pain
- BEST - Hip Outcome score - 17 items rated 0-4, MDC 3 point, MCI 9 points (6 points on sport subscale)
- Copenhagen HIP and Groin Outcome score - young active MDC 5.2 no MCI report
- International hip Outcome score - 33 point MCI 6 points after hip arthorscopy
- HHS
- WOMAC - arthritis oriented
- LOWEST- HOOS - various hip pain
what is the trendelenburg sign
Standing in single stance by flexing the opposite hip
- raise the opposite hip as high as possible
- maintain for 30 seconds
grade based on time held and angle
- positive if unable to hold, flat or dropped position
- MDC 4 degrees
What is the FABER test
Test for hip joint pathology
- heel on opposite knee and measure tibia angle
Describe the quality of the data surround PT interventions for non-OA hip pain
F - for education, manual therapy, exercises and NMR
