Orthopaedic Hip Conditions

Question 1

Femur fractures may lead to what clinical observation?

Answer 1

Hypotension, especially in cases of major trauma- the femur has a large blood supply and if damaged can bleed significantly

Question 2

Define osteoarthritis.

Answer 2

Degenerative change of synovial joints

->progressive loss of articular cartilage and secondary bony changes as a result

Question 3

What is osteoarthritis characterised by?

Answer 3

Worsening pain and stiffness of the affected joint affecting day to day life

Question 4

Trochanteric burtsitis?

Answer 4

Inflammation of the bursa found between the trochanter and the iliotibial band

F>M

Question 5

What characterises bursitis?

Answer 5

Swelling

Question 6

What are some of the causes of trochanteric bursitis?

Answer 6

Trauma
Over-use e.g. athletes or runners
Abnormal movements e.g. after surgery, muscle wasting, hip replacements, scoliosis

Question 7

Presentation of trochanteric bursitis?

Answer 7

Pain- lateral hip
Swelling

Question 8

What may be seen during MSK examination of someone with trochanteric bursitis?

Answer 8

LOOK- muscle wasting, previous surgery scars
FEEL- tenderness at greater tuberosity
MOVE- worst pain in active abduction, passive adduction painful too (crossing leg over)

Question 9

Investigations for trochanteric bursitis?

Answer 9

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

Question 10

Treatment of trochanteric bursitis?

Answer 10

NSAIDs- topical and oral
Relative rest/activity modification
Physio
Corticosteroid injection

->sometimes surgery of bursectomy but rarely required

Question 11

Avascular necrosis?

Answer 11

Death of bone due to loss of blood supply

Question 12

Who is more likely to get avascular necrosis?

Answer 12

M>F
Average age 35-50 yrs

Question 13

Risk factors which can lead to avascular necrosis?

Answer 13

Trauma; fracture, dislocation
Systemic; steroids, alcoholism, hypercoagulable states
Other conditions; lymphoma, sickle cell disease, leukaemia, Caisson’s disease

Question 14

Which trauma related incident can lead to avascular necrosis?

Answer 14

Femoral head injury e.g. fracture
More displaced the fracture, the higher risk of avascular necrosis

Question 15

How does intravascular coagulation lead to avascular necrosis?

Answer 15

Coagulation of blood, leading to venous thrombosis, increased pressure which reduces blood supply to bone and cells die

Question 16

Symptoms of avascular necrosis?

Answer 16

Insidious onset of pain- gradual but with serious effects
Pain usually in groin, associated with stairs, walking uphill
Limp

Question 17

Examination of a patient with avascular necrosis may be fairly normal but what may the symptoms replicate?

Answer 17

Early arthritis as reduced range of motion and stiff joints

Question 18

Which investigation is best to confirm diagnosis of avascular necrosis?

Answer 18

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

Question 19

Non-operative treatment of avascular necrosis?

Answer 19

Reduce weight bearing
NSAIDs
Bisphosphonates
Anticoagulants
Physio

Question 20

Which cells remove dead bone?

Answer 20

Osteoclasts

Question 21

Surgical treatments for avascular necrosis are in the early stages and can be controversial…
What can be done?

Answer 21

Restoration of blood supply
Move lesion away from weight-bearing area
Total hip replacement

Question 22

What is impringement?

Answer 22

Two surfaces hitting together

Question 23

Femoroacetabular impingement can be the common cause of which other conditions?

Answer 23

Hip pathologies in younger patients
Hip osteoarthritis

Question 24

What are the two categories of femoroacetabular impingement?

Answer 24

Cam lesion impingement
Pincer impingement

Question 25

Cam lesions are primarily a problem of which bone?

Answer 25

Femur

Question 26

Femoral-based impingement is seen most in which type of person?

Answer 26

Young athletic males, often rowers

Question 27

In cam lesions, there is excess bone, often around the femoral head. What happens anatomically?

Answer 27

Decreased head to neck ratio Aspherical head

Question 28

Pincer impingement is usually based with which bone?

Answer 28

Acetabulum

Question 29

Who is more likely to get acetabulum based pincer impingement?

Answer 29

Active females

Question 30

What other injuries are associated with femoroacetabular impingement?

Answer 30

Labral degeneration Cartilage damage and flap tears Secondary hip osteoarthritis

Question 31

How does femoroacetabular impingement present?

Answer 31

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

Question 32

What are the test for both cam and pincer femoroacetabular impingement?

Answer 32

FADIR test -flexion, adduction, internal rotation all of hip at once and reproduces the pain

Question 33

Which investigations can be useful for femoroacetabular impingement?

Answer 33

X-ray to identify bony pathology MRI useful for assessing associated conditions like labral tears and articular cartilage damage

Question 34

Treatment of femoroacetabular impingement?

Answer 34

Activity modification NSAIDs Physio- correct posture and strengthen muscles around the joint

Question 35

What are some potential operative treatments for femoroacetabular impingement?

Answer 35

Arthroscopy- shave down defect, deal with labral tears and resect articular cartilage flaps Open surgery- resection, periacetabular osteotomy, hip replacement or resurfacing

Question 36

Most common anterosuperior tear?

Answer 36

Labral tear

Question 37

Who is more likely to get a labral tear?

Answer 37

Active females Can affect all age groups

Question 38

What are some of the causes of labral tears?

Answer 38

Femoroacetabular impingement Trauma Old age Dysplasia Collagen disease e.g. Ehlers-Danlos

Question 39

Presentation of a labral tear?

Answer 39

Groin or hip pain, usually intermittent and comes on with certain movements Snapping sensation Jamming or a locking feeling

Question 40

What may be seen in examination in someone with a labral tear?

Answer 40

Can be normal Often positive FABER test (flexion, abduction and external rotation of hip)

Question 41

Okayyyy so there's FABER and FADIR When is FABER positive?

Answer 41

Labral tears ->FABER sounds more like labral

Question 42

Okayyyy so there's FABER and FADIR When is FADIR positive?

Answer 42

Femoroacetabular impingement

Question 43

Investigation of choice for labral tears?

Answer 43

MRI Arthrogram

Question 44

Non-operative management for labral tears?

Answer 44

Activity modification NSAIDs Physio

Question 45

Operative management for labral tears?

Answer 45

Arthroscopy for repair and resection of the labrum