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Musculoskeletal > Orthopaedic Hip Conditions > Flashcards

Orthopaedic Hip Conditions Flashcards

1
Q

Describe the blood supply to the femoral head?

A

Femoral head has limited blood supply:

  • Profunda femoris
    • Branches medial and lateral circumflex arteries
    • MFCA (main supply)
      • 2 branches
        • Ascends to head
        • Transverse to form cruciate anastomosis
    • LFCA
      • 3 branches
        • Ascending branch to joint capsule
        • Transverse branch to cruciate anastomosis
        • Descending branch
  • Minor contributors
    • Artery of ligamentum teres
    • Nutrient arteries of bone
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2
Q

What is the main blood supply to the femoral head?

A
  • Profunda femoris
    • Branches medial and lateral circumflex arteries
    • MFCA (main supply)
      • 2 branches
        • Ascends to head
        • Transverse to form cruciate anastomosis
    • LFCA
      • 3 branches
        • Ascending branch to joint capsule
        • Transverse branch to cruciate anastomosis
        • Descending branch
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3
Q

What are the branches of the MFCA?

A
  • 2 branches
    • Ascends to head
    • Transverse to form cruciate anastomosis
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4
Q

What are the branches of the LFCA?

A
  • 3 branches
    • Ascending branch to joint capsule
    • Transverse branch to cruciate anastomosis
    • Descending branch
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5
Q

Describe the blood supply to the femoral neck?

A
  • Primary blood supply enters via capsule
    • Significant because fracture of neck of femur disrupts supply (intracapsular)
    • Extracapsular fractures blood supply maintained
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6
Q

What is osteoarthritis?

A

Osteoarthritis = degenerative change of synovial joint, causing progressive loss of articular cartilage and secondary bony changes

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7
Q

What is osteoarthritis characterised by?

A

Characterised by worsening pain and stiffness of affected joint

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8
Q

What is the main treatment of osteoarthritis of the hip?

A
  • Hip replacement
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9
Q

What is trochanteric bursitis?

A

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

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10
Q

What is bursitis?

A

Bursitis = inflammation of bursa

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11
Q

Describe the epidemiology of trochanteric bursitis in terms of sex?

A
  • F>M
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12
Q

What are some causes of trochanteric bursitis?

A
  • Trauma
  • Over-use
    • Athletes, often runners
  • Abnormal movements
    • Distinct problem
      • Scoloiosis
    • Local problems
      • Muscle wasting following surgery
      • Total hip replacement
      • Osteoarthritis
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13
Q

What are the clinical features of trochanteric bursitis?

A
  • Pain
    • Worse lying on side and walking
  • Swelling
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14
Q

What investigations are done for trochanteric bursitis?

A
  • X-rays
    • Exclude arthritis
  • MRI
    • Shows soft tissues and fluid
  • Ultrasound
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15
Q

What is the treatment of trochanteric bursitis?

A
  • NSAIDs
  • Relative rest/activity modifications
  • Physiotherapy
    • Correct posture
    • Stretching
    • Strengthen muscles around joint
  • Injection
    • Corticosteroids
  • Surgery
    • Bursectomy
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16
Q

What is avascular necrosis?

A

Is death of the bone due to loss of bony supply

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17
Q

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

A
  • M>F
  • Average age 35-50
18
Q

What are risk factors for avascular necrosis?

A
  • Trauma
    • Irradiation
    • Fracture
      • Injury to femoral head
    • Dislocation
    • Iatrogenic
  • Systemic
    • Idiopathic
    • Hypercoagulable states
    • Steroids
    • Haematologica
      • Sickle cell disease
      • Lymphoma
      • Leukaemia
    • Caisson’s disease
    • Alcoholism
19
Q

Describe the pathophysiology of avascular necrosis?

20
Q

What are the clinical features of avascular necrosis?

A
  • 80% of time bilateral
  • 3% of time multifocal
  • Insidious onset of groin pain
  • Limp
  • Reduced range of motion
  • Stiff joint
21
Q

What investigations are done for avascular necrosis?

A
  • X-ray
  • MRI
    • Will identify earliest changes
22
Q

What is the treatment of avascular necrosis?

A
  • 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
23
Q

What does FAI stand for?

A

Femoroacetabular impingement

24
Q

What is impingement?

A

Impingement is two surfaces hitting together

25
FAI is a common cause of what?
* Hip pathology in younger patient * Secondary osteoarthritis
26
What are the 2 categories of femoroacetabular impingement?
* **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
27
Cam lesion is a what based impingment?
Femoral based impingement
28
Pincer is a what based impingement?
Acetabulum based impingement
29
Which of cam lesion and pincer FAI affect males more than females?
Cam lesion - males Pincer - females
30
What bony changes does cam lesion FAI cause?
* Excess bone leading to * Decreased head to neck ratio * Aspherical head
31
What bony changes does pincer FAI cause?
* Abnormal acetabulum leading to * Anteriosuperior acetabular rim overhang * Acetabular protrusion
32
What are associated injuries to FAI?
* Labral degeneration and tears * Cartilage damage and flap tears * Secondary hip osteoarthritis
33
What is the presentation of FAI?
* Groin pain * Mechanical symptoms * Block to movement * Pain with certain movements * Reduced range of motion * Flexion and internal rotation
34
What investigations are done for FAI?
* FADIR test * X-ray * Identify bony pathology * MRI * Assesses associated conditions like labral tears and articular cartilage damage
35
What is the treatment of FAI?
* 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
36
What is the most common kind of labral tear?
Most commonly is an anterosuperior tear
37
Describe the epidemiology of labral tear in terms of age and sex?
* All age groups * Commonly active females
38
What are causes of labral tear?
* FAI * Trauma * OA * Dysplasia * Collagen disease * Ehler’s-Danlos
39
What is the presentation of labral tear?
* Groin or hip pain * Snapping sensation * Jamming or locking * Positive FEBER test
40
What investigations are done for labral tear?
* X-ray * MRI * Diagnostic injection (contrast)
41
What is the treatment of labral tear?
* Non-operative * Activity modification * NSAIDs * Physiotherapy * Injection of steroids * Operative * Arthroscopy * Repair * Resection
42
What is arthroscopy?
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

Musculoskeletal (41 decks)

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