Orthopaedic hip conditions Flashcards
what point of the femur is the attachment for the abductors and rotators?
greater trochanter
what point of the femur is the attachment of the psoas major?
lesser trochanter
what type of structure is the labrum?
fibrocartilage
what is the main blood supply of the hip joint?
branches of the profunda femoris to the capsule
- left and middle femoral circumflex arteries
a patient presents with pain and worsening stiffness of the hip joint. what is the most likely diagnosis?
osteoarthritis of the hip
where is the trochanteric bursa located?
between the hip abductors and the illiotibial band
what are the causes of trochanteric bursitis?
trauma
overuse; (athletes, often runners, repetitive movements)
abnormal movements;
- distant problem i.e. scoliosis
- local problem (muscle wasting following surgery, total hip replacement, osteoarthritis)
what is the presentation of trochanteric bursitis ?
localised pain in the lateral hip
what is the clinical presentation like in trochanteric bursitis?
look:
- may have scars from previous usrgyer
- may have muscle wasting of gluteals
feel:
- tenderness over greater tuberosity
move:
- worst pain in active abduction
what investigations would you carry out if you suspected trochanteric bursitis?
MRI
X-ray
USS (therapeutic as well as diagnostic i.e. guided injection)
what is the treatment for trochanteric bursitis?
non-operative:
- NSAIDS
- rest / activity modification
- physiotherapy
- steroid injection
surgical:
- bursectomy
what is avascular necrosis?
death of bone due to loss of blood supply
in what age and sex is avascular necrosis more common?
Is it more commonly unilateral or bilateral?
females > males
age: 35-50yrs
80% bilateral
what are the risk factors for avascular necrosis?
trauma i.e. intracapsular fracture systemic: - idiopathic - hypercoaguable states - steroids - haematological (sickle cell, lymphoma, leukaemia) caisson's disease alcoholism
briefly describe the pathway involved in development of idiopathic avascular necrosis.
coagulation of interosseous microcirculation venous congestion retrograde arterial thrombosis intraosseous hypertension reduced blood flow cell death chondral fracture and collapse
what is the presentation of avascular necrosis?
insidious onset of groin pain
pain with stairs, walking uphill and impact activities
limp
what is the examination of someone with avascular necrosis like?
mostly normal
may present like early arthritis with stiffness and decreased range of motion (esp internal rotation)
what action of the hip does avascular necrosis restrict?
internal rotation
what are the treatments for avascular necrosis?
non-operative:
- reduce weight bearing
- NSAIDS
- bisphosphonates
- anti coagulants
- physiotherapy
surgery:
- core decompression (restore blood supply)
- rotation osteotomy
- total hip replacement (last resort)
what are the 2 categories of femoral acetabular impingement ? (FAI)
cam lesion
pincer
what is femoral acetabulum impingement? (FAI)
anatomical phenomenon which results in impingement of the femoral neck against the anterior edge of acetabulum
what is the pathology in a cam lesion which causes FAI?
extra bone resulting in decreased femoral head:neck ratio
aspherical head
in what type of patients is a cam lesion in FAI most commonly found?
usually in young athlete males who do a lot of hip flexion i.e. rowers
what is the difference between cam lesion and pincer FAI?
cam lesion = femoral based impingement
piper = acetabulum based impingement
in what patients does since FAI usually occur?
active females
what is the pathology that causes pincer FAI?
abnormal acetabulum leading to;
- anteriosuperior rim overhang
- acetubular protrusion
what are associated injuries with FAI?
label degeneration and tears
cartilage damage and flap tears
secondary hip osteoarthritis
what is the presentation of FAI?
groin pain - worse with flexion
mechanical symptoms;
- block to movement
- pain with certain manoeuvres i.e. squatting, lunging, getting out of a chai
what clinical signs are present with FAI?
positive FADIR test - flexion adduction and internal rotation
what are the treatment options for FAI?
non-operative;
- activity modification
- NSAIDS
- physiotherapy
operative:
- arthroscopy
- resection
- periacetubular osteotomy
- hip arthroplasty
in what group of patients is labral tear most commonly found in?
all age groups
commonly active females
- pincer FAI
- more flexible
what are the causes of a labral tear?
FAI trauma osteoarthritis dysplasia collagen diseases i.e. Ehlers-danlos syndrome DDH
what is the presentation of a labral tear of the hip?
extreme groin or hip pain
snapping sensation
jamming or locking of the hip
what clinical sign may be positive on examination in a patient with a labral tear?
positive FABER test
- flexion, abduction, external rotation (for anterior tears)
examination can be normal
what is the treatment for a labral tear?
non-operative:
- activity modification
- NSAIDS
- physiotherapy
- steroid injection
operative:
- arthroscopy (repair or resection)
