Orthopaedic hip conditions Flashcards
What 3 bones make up each hemipelvis?
Ischium
Ileum
Pubis
Why does the femur have high clinical significance?
Neck of femur fracture is very common
Bleeding from fracture
What is the greater trochanter?
Site of attachment for abductors and rotators on the femur
What is the lesser trochanter?
Site of attachment for psoas muscles
What is the acetabulum?
A socket in the pelvis that the head of the femur fits into
What is the labrum?
Fibrocartilaginous lining of the acetabulum which deepens the socket and adds stability
What artery supplies the hip joint?
Profunda femoris artery
What are the 2 main branches of profunda femoris?
Medial femoral circumflex artery
Lateral femoral circumflex artery
Does blood supply for the neck of femur come from within or outside the capsule?
Within
What is the clinical significance of a fracture being intracapsular?
Blood supply is disrupted whereas with an extra capsular fracture supply is maintianed
What are the 5 types of muscles around the hip joint?
Flexors Extensors Abductors Adductors Rotators
What is the purpose of bursae?
Reduce the friction between tissues
What is osteoarthritis?
Progressive loss of articular cartilage with secondary bony changes caused by worsening pain and stiffness of the affected joint
Where is the trochanteric bursa?
Between hip abductors and iliotibial band
Are males or females more likely to get trochanteric bursitis?
Females
What can cause trochanteric bursitis?
Trauma
Overuse - athletes
Abnormal movement - can be caused by other problems such as scoliosis or muscle wasting
How will a patient present with trochanteric bursitis?
Pain - point of tenderness in the lateral hip
What will come up on examination of trochanteric bursitis?
LOOK - Scars from previous surgery, muscle wasting
FEEL - tenderness at greater tuberosity
MOVE - worst pain in active abduction
What investigations should be done into trochanteric bursitis?
X-Ray
MRI - soft tissue and fluid
Ultrasound
How is trochanteric bursitis treated?
NSAIDs Relative rest/activity modification Physiotherapy Corticosteroid injection Rarely surgical bursectomy
What is done in physiotherapy for trochanteric bursitis?
Correct posture
Stretching
Strengthen muscles around the joint
What is avascular necrosis?
Death of bone due to loss of blood supply
What trauma can cause avascular necrosis?
Irradiation
Fracture
Dislocation
Iatrogenic
What systemic issues can cause avascular necrosis?
Idiopathic Hypercoagulable states Steroids Haematological - sickle cell, lymphoma, leukaemia Caisson's disease Alcoholism
What are symptoms of avascular necrosis?
Insidious onset of groin pain
Pain with stairs, walking uphill, impact activities
Limp
What will you find on examination of avascular necrosis?
Largely normal
May replicate early arthritis - reduced range of motion, stiff joint
How is avascular necrosis treated?
Reduce weight bearing NSAIDs Bisphosphonates for early avascular necrosis Anticoagulants Physiotherapy Core decompression
What is femoroacetabular impingement?
Impingement of femoral neck against anterior edge of acetabulum
What is pincer femoroacetabular impingement?
Acetabulum based impingement usually in active females - abnormal acetabulum leads to anterosuperior acetabular rim overhang and acetabular protrusion
What are associated injuries with femoroacetabular impingement?
Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip osteoarthritis
How does femoroacetabular impingement present?
Groin pain worse with flexion
Mechanical symptoms - block to movement, pain getting out of chairs
How is femoroacetabular impingement diagnosed in examination?
Reduced flexion and internal rotation
Positive FADIR test
What is the FADIR test?
Flexion
ADuction
Internal Rotation
What investigations can be done for femoroacetabular impingement?
X-ray for bony pathology
MRI for associated conditions - labral tears and articular cartilage damage
What is non-operative treatment for femoroacetabular impingement?
Activity modification
NSAIDs
Physiotherapy
What is done in physiotherapy for femoroacetabular impingement?
Correct posture
Strengthen muscles around joint
What are operative treatments for femoroacetabular impingement?
Arthroscopy
Open surgery
What can cause labral tear?
Femoroacetabular impingement Trauma Osteoarthritis Dysplasia Collagen diseases
How does labral tear present?
Groin or hip pain
Snapping sensation
Jamming or locking
How is labral tear examined?
Positive FABER tesr
What is the FABER test?
Flexion
ABduction
External Rotation
How is labral tear investigated?
X-ray for osteoarthritis or dysplasia
MRI arthrogram - 92% sensitive
Diagnostic injection
What are treatment options for labral tear?
Non-operative - acitivity modification, NSAIDs, physio, steroid injection
Operative - arthroscopy
