Orthopaedic Hip Conditions Flashcards
What are the causes of trochanteric bursitis?
- trauma
- overuse
- abnormal movements
- distance problems (e.g. scoliosis)
- local problems (e.g. musle wasting
- F > M
What are the features of trochanteric bursitis?
- pain (point tenderness, lateral hip)
- scars (from previous surgery)
- muscle wasting
- tenderness at greater tuberosity
- worst pain in active abduction
What are the investigations for trochanteric bursitis?
- XR
- MRI
- US (+ guided injection)
What is the treatment for trochanteric bursitis?
- NSAIDs
- relative rest/activity modification
- physiotherapy
- corticosteroid injections
- bursectomy
What is the epidemiology of avascular necrosis?
Death of bone due to loss of blood supply
- M > F
- 35-50 yrs
- 80% bilateral
- 3% multifical (3 joints or more)
What are risk factors for avascular necrosis?
- trauma
- irradiation
- fracture
- dislocation
- iatrogenic
- systemic
- idiopathic
- hypercoaguable states
- steroids
- haematological
- Caisson’s disease
- alcoholism
What are the symptoms and signs of avascular necrosis?
- insideous onset of groin pain
- pain; stairs, uphill walking, impact activities
- limp
- stiffness
- limited range of motion (esp. internal rotation)
What are the investigations for avascular necrosis?
- XR
- MRI
What is the treatment for avascular necrosis?
- reduce weight bearing
- NSAIDs
- biphosphonates
- anticoagulant
- physiotherapy
- surgery
- restore blood supply
- move lesion from weight bearing area
- total hip replacement
What is the cause of femoroacetabular impingement (FAI)?
- cam lesion or pincer, cause impingement of femoral neck against anterior edge of acetabulum
- excess bone -> rec. head to neck ratio -> aspherical head (M > F)
OR
abnormal acetabulum -> anterosuperior acetabular rim overhang -> acetabular protrusion (F > M) - common cause of; hip pathology in younger patients, osteoarthritis
What are injuries associated with femoroacetabular impingement (FAI)?
- labral degeneration and tears
- cartilage damage and flap tears
- secondary hip osteoarthritis
What are the presentations of femeroacetabular impingement (FAI)?
- groin pain- worse on flexion
- block on movement
- pain with certain manoeuvres- getting out a chair, squating, lunging
- reduced flexion + internal rotation
- +ve FADIR test
What are the investigations for femoroarcetabular impingement (FAI)?
- XR
- MRI
What is the treatment for femoroacetabular impingement (FAI)?
- activity modification
- NSAIDs
- physiotherapy
- arthroscopy
- shave down defect
- treat labral tears
- resect arctic capsual flaps
- open surgery
- resection
- periacetabular osteotomy
- hip arthroplasty
What are the causes of labral tear?
- femoroacetabular impingement (FAI)
- trauma
- osteoarthritis
- dysplasia
- collagen diseases- Ehlers-Danlos
- F > M
* most commonly anterosuperior tear
