Orthopaedic hip conditions

Question 1

What 3 bones make up each hemipelvis?

Answer 1

Ischium
Ileum
Pubis

Question 2

Why does the femur have high clinical significance?

Answer 2

Neck of femur fracture is very common

Bleeding from fracture

Question 3

What is the greater trochanter?

Answer 3

Site of attachment for abductors and rotators on the femur

Question 4

What is the lesser trochanter?

Answer 4

Site of attachment for psoas muscles

Question 5

What is the acetabulum?

Answer 5

A socket in the pelvis that the head of the femur fits into

Question 6

What is the labrum?

Answer 6

Fibrocartilaginous lining of the acetabulum which deepens the socket and adds stability

Question 7

What artery supplies the hip joint?

Answer 7

Profunda femoris artery

Question 8

What are the 2 main branches of profunda femoris?

Answer 8

Medial femoral circumflex artery

Lateral femoral circumflex artery

Question 9

Does blood supply for the neck of femur come from within or outside the capsule?

Answer 9

Within

Question 10

What is the clinical significance of a fracture being intracapsular?

Answer 10

Blood supply is disrupted whereas with an extra capsular fracture supply is maintianed

Question 11

What are the 5 types of muscles around the hip joint?

Answer 11

Flexors
Extensors
Abductors
Adductors
Rotators

Question 12

What is the purpose of bursae?

Answer 12

Reduce the friction between tissues

Question 13

What is osteoarthritis?

Answer 13

Progressive loss of articular cartilage with secondary bony changes caused by worsening pain and stiffness of the affected joint

Question 14

Where is the trochanteric bursa?

Answer 14

Between hip abductors and iliotibial band

Question 15

Are males or females more likely to get trochanteric bursitis?

Answer 15

Females

Question 16

What can cause trochanteric bursitis?

Answer 16

Trauma
Overuse - athletes
Abnormal movement - can be caused by other problems such as scoliosis or muscle wasting

Question 17

How will a patient present with trochanteric bursitis?

Answer 17

Pain - point of tenderness in the lateral hip

Question 18

What will come up on examination of trochanteric bursitis?

Answer 18

LOOK - Scars from previous surgery, muscle wasting
FEEL - tenderness at greater tuberosity
MOVE - worst pain in active abduction

Question 19

What investigations should be done into trochanteric bursitis?

Answer 19

X-Ray
MRI - soft tissue and fluid
Ultrasound

Question 20

How is trochanteric bursitis treated?

Answer 20

NSAIDs
Relative rest/activity modification
Physiotherapy
Corticosteroid injection
Rarely surgical bursectomy

Question 21

What is done in physiotherapy for trochanteric bursitis?

Answer 21

Correct posture
Stretching
Strengthen muscles around the joint

Question 22

What is avascular necrosis?

Answer 22

Death of bone due to loss of blood supply

Question 23

What trauma can cause avascular necrosis?

Answer 23

Irradiation
Fracture
Dislocation
Iatrogenic

Question 24

What systemic issues can cause avascular necrosis?

Answer 24

Idiopathic
Hypercoagulable states
Steroids
Haematological - sickle cell, lymphoma, leukaemia
Caisson's disease
Alcoholism

Question 25

What are symptoms of avascular necrosis?

Answer 25

Insidious onset of groin pain Pain with stairs, walking uphill, impact activities Limp

Question 26

What will you find on examination of avascular necrosis?

Answer 26

Largely normal | May replicate early arthritis - reduced range of motion, stiff joint

Question 27

How is avascular necrosis treated?

Answer 27

``` Reduce weight bearing NSAIDs Bisphosphonates for early avascular necrosis Anticoagulants Physiotherapy Core decompression ```

Question 28

What is femoroacetabular impingement?

Answer 28

Impingement of femoral neck against anterior edge of acetabulum

Question 29

What is pincer femoroacetabular impingement?

Answer 29

Acetabulum based impingement usually in active females - abnormal acetabulum leads to anterosuperior acetabular rim overhang and acetabular protrusion

Question 30

What are associated injuries with femoroacetabular impingement?

Answer 30

Labral degeneration and tears Cartilage damage and flap tears Secondary hip osteoarthritis

Question 31

How does femoroacetabular impingement present?

Answer 31

Groin pain worse with flexion | Mechanical symptoms - block to movement, pain getting out of chairs

Question 32

How is femoroacetabular impingement diagnosed in examination?

Answer 32

Reduced flexion and internal rotation | Positive FADIR test

Question 33

What is the FADIR test?

Answer 33

Flexion ADuction Internal Rotation

Question 34

What investigations can be done for femoroacetabular impingement?

Answer 34

X-ray for bony pathology | MRI for associated conditions - labral tears and articular cartilage damage

Question 35

What is non-operative treatment for femoroacetabular impingement?

Answer 35

Activity modification NSAIDs Physiotherapy

Question 36

What is done in physiotherapy for femoroacetabular impingement?

Answer 36

Correct posture | Strengthen muscles around joint

Question 37

What are operative treatments for femoroacetabular impingement?

Answer 37

Arthroscopy | Open surgery

Question 38

What can cause labral tear?

Answer 38

``` Femoroacetabular impingement Trauma Osteoarthritis Dysplasia Collagen diseases ```

Question 39

How does labral tear present?

Answer 39

Groin or hip pain Snapping sensation Jamming or locking

Question 40

How is labral tear examined?

Answer 40

Positive FABER tesr

Question 41

What is the FABER test?

Answer 41

Flexion ABduction External Rotation

Question 42

How is labral tear investigated?

Answer 42

X-ray for osteoarthritis or dysplasia MRI arthrogram - 92% sensitive Diagnostic injection

Question 43

What are treatment options for labral tear?

Answer 43

Non-operative - acitivity modification, NSAIDs, physio, steroid injection Operative - arthroscopy