Orthopaedic Hip Conditions Flashcards
What is the blood supply to the hip?
- Profundus femoris: medial and lateral circumflex arteries
- Smaller arteries: artery of ligamentum teres and nutrient arteries of the bone
What is trochanteric bursitis?
Inflammation of the trochanteric bursus (sits between the hip abductors and ITB)
What is the presentation of trochanteric bursitis?
- Females
- Pain: point tenderness and lateral hips
- Muscle wasting if recent surgery
- Tenderness at greater tuberosity
- Worst pain is in active abduction
What is the aetiology of trochanteric bursitis?
- Trauma
- Overuse
- Abnormal movements
- Muscle wasting following surgery
- Total hip replacement
- OA
What investigations can be used to diagnose trochanteric bursitis?
- XR
- MRI
- USS
How can trochanteric bursitis be treated?
- NSAIDs
- Relative rest/activity modification
- Physio
- Steroid injections
- Bursectomy
What are the risk factors for avascular necrosis?
- Irradiation
- Fracture
- Dislocation
- Iatrogenic
- Hypercoagulable states
- Steroids
- Sickle cell disease
- Lymphoma and leukaemia
- Caissons disease
- Alcoholism
What is the presentation of avascular necrosis?
- Groin pain
- Pain with stairs, walking upstairs and impact activities
- Limp
- May replicated early arthritis (reduced range of movement and stiff joint)
What are the treatment options for avascular necrosis?
- Reduce weight bearing
- NSAIDs
- Bisphosphonates
- Anticoagulants
- Physio
- Surgical: restore blood supply, move the lesion away from the weight bearing area or total hip replacement
What is a femoroacetabular impingement and what are the two types?
- Impingement of the femoral nerve against the anterior edge of the acetabulum
- Cam lesion or pincer
Which injuries are associated with femoroacetabular impingement?
- Labral degeneration and tears
- Cartilage damage and flap tears
- Secondary hip osteoarthritis
How does FAI present?
- Groin pain (worse with flexion)
- Block to movement
- Pain with certain manouveres: getting out of a chair, squatting and laughing
- Reduced flexion and internal rotation
What investigations should be done for FAI?
- XR
- MRI
What are the treatment options for FAI?
- Activity modification
- NSAIDs
- Physio
- Arthroscopy
- Open surgery: resection, periacetabular osteotomy and hip arthroplasty
What are the causes of a labral tear?
- FAI
- Trauma
- OA
- Dysplasia
- Collagen diseases
