Orthopaedic Hip Conditions

Question 1

What is the main treatment of osteoarthritis of the hip?

Answer 1

• Hip replacement

Question 2

What is trochanteric bursitis?

Answer 2

Trochanteric bursa = fluid filled sac sandwiched between hip abductors and ITB

Question 3

Describe the epidemiology of trochanteric bursitis in terms of sex?

Answer 3

• F>M

Question 4

What are some causes of trochanteric bursitis?

Answer 4

• Trauma
• Over-use
  
  • Athletes, often runners
• Abnormal movements
  
  • Distinct problem
    
    • Scoloiosis
  • Local problems
    
    • Muscle wasting following surgery
    • Total hip replacement
    • Osteoarthritis

Question 5

What are the clinical features of trochanteric bursitis?

Answer 5

• Pain
  
  • Worse lying on side and walking
• Swelling

Question 6

What investigations are done for trochanteric bursitis?

Answer 6

• X-rays
  
  • Exclude arthritis
• MRI
  
  • Shows soft tissues and fluid
• Ultrasound

Question 7

What is the treatment of trochanteric bursitis?

Answer 7

• NSAIDs
• Relative rest/activity modifications
• Physiotherapy
  
  • Correct posture
  • Stretching
  • Strengthen muscles around joint
• Injection
  
  • Corticosteroids
• Surgery
  
  • Bursectomy

Question 8

What is avascular necrosis?

Answer 8

Is death of the bone due to loss of bony supply

Question 9

Describe the epidemiology of avascular necrosis in terms of sex and age?

Answer 9

• M>F
• Average age 35-50

Question 10

What are risk factors for avascular necrosis?

Answer 10

• Trauma
  
  • Irradiation
  • Fracture
    
    • Injury to femoral head
  • Dislocation
  • Iatrogenic
• Systemic
  
  • Idiopathic
  • Hypercoagulable states
  • Steroids
  • Haematologica
    
    • Sickle cell disease
    • Lymphoma
    • Leukaemia
  • Caisson’s disease
  • Alcoholism

Question 11

Describe the pathophysiology of avascular necrosis?

Answer 11

Question 12

What are the clinical features of avascular necrosis?

Answer 12

• 80% of time bilateral
• 3% of time multifocal
• Insidious onset of groin pain
• Limp
• Reduced range of motion
• Stiff joint

Question 13

What investigations are done for avascular necrosis?

Answer 13

• X-ray
• MRI
  
  • Will identify earliest changes

Question 14

What is the treatment of avascular necrosis?

Answer 14

• Non-operative
  
  • Reduced weight bearing
  • NSAIDs
  • Bisphosphonates
  • Anticoagulants
  • Physiotherapy
• Surgical
  
  • Restore blood supply
    
    • Core decompression
    • Core decompression and vascularised graft
  • Move lesion away from weight bearing area
    
    • Rotational osteotomy
  • Total hip replacement

Question 15

What does FAI stand for?

Answer 15

Femoroacetabular impingement

Question 16

What is impingement?

Answer 16

Impingement is two surfaces hitting together

Question 17

FAI is a common cause of what?

Answer 17

• Hip pathology in younger patient
• Secondary osteoarthritis

Question 18

What are the 2 categories of femoroacetabular impingement?

Answer 18

• Cam lesion
  
  • Femoral-based impingement
  • Usually young athletic mnales
  • Excess bone leading to
    
    • Decreased head to neck ratio
    • Aspherical head
• Pincer
  
  • Acetabulum based impingement
  • Usually in active females
  • Abnormal acetabulum leading to
    
    • Anteriosuperior acetabular rim overhang
    • Acetabular protrusion

Question 19

Cam lesion is a what based impingment?

Answer 19

Femoral based impingement

Question 20

Pincer is a what based impingement?

Answer 20

Acetabulum based impingement

Question 21

Which of cam lesion and pincer FAI affect males more than females?

Answer 21

Cam lesion - males

Pincer - females

Question 22

What bony changes does cam lesion FAI cause?

Answer 22

• Excess bone leading to
  
  • Decreased head to neck ratio
  • Aspherical head

Question 23

What bony changes does pincer FAI cause?

Answer 23

• Abnormal acetabulum leading to
  
  • Anteriosuperior acetabular rim overhang
  • Acetabular protrusion

Question 24

What are associated injuries to FAI?

Answer 24

• Labral degeneration and tears
• Cartilage damage and flap tears
• Secondary hip osteoarthritis

Question 25

What is the presentation of FAI?

Answer 25

* Groin pain * Mechanical symptoms * Block to movement * Pain with certain movements * Reduced range of motion * Flexion and internal rotation

Question 26

What investigations are done for FAI?

Answer 26

* FADIR test * X-ray * Identify bony pathology * MRI * Assesses associated conditions like labral tears and articular cartilage damage

Question 27

What is the treatment of FAI?

Answer 27

* Non-operative * Activity modification * NSAIDs * Physiotherapy * Correct posture * Strengthen muscles around joint * Operative * Arthroscopy * Shave down defect * Deal with labral tears * Resect articular cartilage flaps * Open surgery * Resection * Periacetabular osteotomy * Hip arthroplasty * Resurfacing * Replacement

Question 28

What is the most common kind of labral tear?

Answer 28

Most commonly is an anterosuperior tear

Question 29

Describe the epidemiology of labral tear in terms of age and sex?

Answer 29

* All age groups * Commonly active females

Question 30

What are causes of labral tear?

Answer 30

* FAI * Trauma * OA * Dysplasia * Collagen disease * Ehler’s-Danlos

Question 31

What is the presentation of labral tear?

Answer 31

* Groin or hip pain * Snapping sensation * Jamming or locking * Positive FEBER test

Question 32

What investigations are done for labral tear?

Answer 32

* X-ray * MRI * Diagnostic injection (contrast)

Question 33

What is the treatment of labral tear?

Answer 33

* Non-operative * Activity modification * NSAIDs * Physiotherapy * Injection of steroids * Operative * Arthroscopy * Repair * Resection

Question 34

What is arthroscopy?

Answer 34

A minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision