Orthopaedic Hip Conditions Flashcards
Femur fractures may lead to what clinical observation?
Hypotension, especially in cases of major trauma- the femur has a large blood supply and if damaged can bleed significantly
Define osteoarthritis.
Degenerative change of synovial joints
->progressive loss of articular cartilage and secondary bony changes as a result
What is osteoarthritis characterised by?
Worsening pain and stiffness of the affected joint affecting day to day life
Trochanteric burtsitis?
Inflammation of the bursa found between the trochanter and the iliotibial band
F>M
What characterises bursitis?
Swelling
What are some of the causes of trochanteric bursitis?
Trauma
Over-use e.g. athletes or runners
Abnormal movements e.g. after surgery, muscle wasting, hip replacements, scoliosis
Presentation of trochanteric bursitis?
Pain- lateral hip
Swelling
What may be seen during MSK examination of someone with trochanteric bursitis?
LOOK- muscle wasting, previous surgery scars
FEEL- tenderness at greater tuberosity
MOVE- worst pain in active abduction, passive adduction painful too (crossing leg over)
Investigations for trochanteric bursitis?
X-ray- usually to exclude arthritis diagnosis
MRI- helps to confirm if not sure
Ultrasound- useful at localising it, sometimes used as US guided steroid injection
Treatment of trochanteric bursitis?
NSAIDs- topical and oral
Relative rest/activity modification
Physio
Corticosteroid injection
->sometimes surgery of bursectomy but rarely required
Avascular necrosis?
Death of bone due to loss of blood supply
Who is more likely to get avascular necrosis?
M>F
Average age 35-50 yrs
Risk factors which can lead to avascular necrosis?
Trauma; fracture, dislocation
Systemic; steroids, alcoholism, hypercoagulable states
Other conditions; lymphoma, sickle cell disease, leukaemia, Caisson’s disease
Which trauma related incident can lead to avascular necrosis?
Femoral head injury e.g. fracture
More displaced the fracture, the higher risk of avascular necrosis
How does intravascular coagulation lead to avascular necrosis?
Coagulation of blood, leading to venous thrombosis, increased pressure which reduces blood supply to bone and cells die
Symptoms of avascular necrosis?
Insidious onset of pain- gradual but with serious effects
Pain usually in groin, associated with stairs, walking uphill
Limp
Examination of a patient with avascular necrosis may be fairly normal but what may the symptoms replicate?
Early arthritis as reduced range of motion and stiff joints
Which investigation is best to confirm diagnosis of avascular necrosis?
MRI
->more sensitive and picks up 99%. X-ray only helpful if condition has progressed to the stage where the bone has started to collapse or become arthritic
Non-operative treatment of avascular necrosis?
Reduce weight bearing
NSAIDs
Bisphosphonates
Anticoagulants
Physio
Which cells remove dead bone?
Osteoclasts
Surgical treatments for avascular necrosis are in the early stages and can be controversial…
What can be done?
Restoration of blood supply
Move lesion away from weight-bearing area
Total hip replacement
What is impringement?
Two surfaces hitting together
Femoroacetabular impingement can be the common cause of which other conditions?
Hip pathologies in younger patients
Hip osteoarthritis
What are the two categories of femoroacetabular impingement?
Cam lesion impingement
Pincer impingement
Cam lesions are primarily a problem of which bone?
Femur
Femoral-based impingement is seen most in which type of person?
Young athletic males, often rowers
In cam lesions, there is excess bone, often around the femoral head. What happens anatomically?
Decreased head to neck ratio
Aspherical head
Pincer impingement is usually based with which bone?
Acetabulum
Who is more likely to get acetabulum based pincer impingement?
Active females
What other injuries are associated with femoroacetabular impingement?
Labral degeneration
Cartilage damage and flap tears
Secondary hip osteoarthritis
How does femoroacetabular impingement present?
Groin pain, worse with flexion
Pain with movements such as squatting, lunging, getting out a chair
->apparently Andy Murray has femoroacetabular impingement, think of him doing these movements in tennis trying to get to the bal
What are the test for both cam and pincer femoroacetabular impingement?
FADIR test
-flexion, adduction, internal rotation all of hip at once and reproduces the pain
Which investigations can be useful for femoroacetabular impingement?
X-ray to identify bony pathology
MRI useful for assessing associated conditions like labral tears and articular cartilage damage
Treatment of femoroacetabular impingement?
Activity modification
NSAIDs
Physio- correct posture and strengthen muscles around the joint
What are some potential operative treatments for femoroacetabular impingement?
Arthroscopy- shave down defect, deal with labral tears and resect articular cartilage flaps
Open surgery- resection, periacetabular osteotomy, hip replacement or resurfacing
Most common anterosuperior tear?
Labral tear
Who is more likely to get a labral tear?
Active females
Can affect all age groups
What are some of the causes of labral tears?
Femoroacetabular impingement
Trauma
Old age
Dysplasia
Collagen disease e.g. Ehlers-Danlos
Presentation of a labral tear?
Groin or hip pain, usually intermittent and comes on with certain movements
Snapping sensation
Jamming or a locking feeling
What may be seen in examination in someone with a labral tear?
Can be normal
Often positive FABER test (flexion, abduction and external rotation of hip)
Okayyyy so there’s FABER and FADIR
When is FABER positive?
Labral tears
->FABER sounds more like labral
Okayyyy so there’s FABER and FADIR
When is FADIR positive?
Femoroacetabular impingement
Investigation of choice for labral tears?
MRI Arthrogram
Non-operative management for labral tears?
Activity modification
NSAIDs
Physio
Operative management for labral tears?
Arthroscopy for repair and resection of the labrum
