Orthopaedic Hip Conditions Flashcards
Trochanteric Bursa
- Fluid-filled sac
- Sandwiched between hip abductors and ITB
Bursitis
- Inflammation of the bursa
- Swelling
Trochanteric Bursitis Causes
- Trauma
- Over-use
- Athletes, often runners
- Repetitive movements
- Abnormal movements
- Distant problem e.g. Scoliosis
- Local problem
- Muscle wasting following surgery
- Total Hip Replacement
- Osteoarthritis
Trochanteric Bursitis Presentation
- Pain
- Point tenderness
- Lateral hip
Trochanteric Bursitis examination look
- may have scars from previous surgery
- may have muscle wasting
- gluteals
Trochanteric Bursitis examination feel
Tenderness at Greater Trochanter
Trochanteric Bursitis examination move
worst pain in active abduction
Trochanteric Bursitis Investigations
- X-Ray
- MRI
- Shows soft tissues and fluid
- Ultrasound
- Can be therapeutic as well as diagnostic
- Guided injection
Trochanteric Bursitis Treatment
- NSAIDs
- Relative rest / Activity modification
- Physiotherapy
- Correct posture, abnormal movements
- Stretching
- Strengthen muscles around joint
- Corticosteroid Injection
- Surgery
- Bursectomy - rarely required
Avascular Necrosis Definition
death of bone due to loss of blood supply
Avascular necrosis epidemiology
- Males > Females
- Average age 35-50 years old
- 80% = bilateral
- May be offset in time
- 3% = multifocal
- 3 or more joints
Avascular Necrosis – Risk Factors
Trauma
- Irradiation
- Fracture
- Dislocation
- Iatrogenic
Systemic
- Idiopathic
- Hypercoaguable states
- Steroids
- Haematological
Avascular Necrosis Symptoms
- Insidious onset of groin pain
- Pain with stairs, walking uphill and impact activities
- Limp
Avascular necrosis examination
- Largely normal
- May replicate early arthritis
- Reduced range of motion (particularly internal rotation)
- Stiff joint
Avascular Necrosis Non-operative Treatment
- Reduce weight-bearing
- NSAIDs
- Bisphosphonates
- Early AVN
- controversial
- Anticoagulants
- Physiotherapy
- Maintain range of motion
- Keep the ball round
Avascular necrosis operative treatment
- Restore blood supply
- Core decompression and vascularised graft
- Move the lesion away from the weight-bearing area
- Rotational Osteotomy
- Total Hip Replacement
Femoroacetabular Impingement (FAI)
- Results in impingement of femoral neck against anterior edge of acetabulum
- Broadly divided into 2 categories
- Cam lesion
- Pincer
FAI Associated injuries
- labral degeneration and tears
- cartilage damage and flap tears
- secondary hip osteoarthritis
FAI presentation
- Groin pain
- Worse with flexion
- Mechanical symptoms
- Block to movement
- Pain with certain manoeuvres
- Getting out of a chair
- Squatting
- Lunging
FAI examination
- Reduced flexion and internal rotation
- Positive FADIR test -Flexion, ADduction, Internal Rotation
FAI Investigations
- X-ray
- Identify the bony pathology
- MRI
- Useful for assessing associated conditions
- Labral tears
- Articular cartilage damage
- Useful for assessing associated conditions
FAI non-operative treatment
- activity modification
- NSAIDs
- physiotherapy
- correct posture
- strengthen muscles around joint
FAI operative treatment
- Arthroscopy
- Shave down the defect
- Deal with labral tears
- Resect artic cartilage flaps
- Open Surgery
- Resection
- Periacetabular Osteotomy
- Hip Arthroplasty
Labral Tear Causes
- FAI
- Trauma
- OA
- Dysplasia
- Collagen diseases - Ehlers-Danlos
Labral Tear Presentation
- Groin or Hip Pain
- Snapping sensation
- Jamming or locking
Labral tear examination
- can be normal
- Positive FABER test -Flexion, ABduction, External Rotation
Labral Tear Investigations
- X-ray
- MRI Arthrogram
- Diagnostic injection
- Local anaesthetic
Labral Tear - Treatment
Non-Operative
- Activity modification, NSAIDs, Physiotherapy
- Injection of Steroids
Operative
- Arthroscopy
- Repair
- Resection
