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Year 3 - MSK > Orthopaedic Hip Conditions > Flashcards

Orthopaedic Hip Conditions Flashcards

1
Q

what are some common conditions of the hip?

A

Osteoarthritis

Bursitis (causes lateral hip pain) - Gluteal tendinopathy (differential diagnosis)

Avascular Necrosis (AVN)

Impingement

Labral Tear

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2
Q

what make sup the pelvis?

A

Each hemipelvis = fusion of 3 bones (Ischium, Ileum and Pubis)

joined by Sacrum posteriorly and pubic symphysis anteriorly

Acetabulum - Socket

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3
Q

Femur is long bone, what is its high clinical significance?

A

NoF

Bleeding

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4
Q

what are the different parts of the femur and their function?

A

Head - Articulates with Acetabulum, Head covered in smooth hyaline cartilage and if damaged wont regenerate and beginning of arthritis

Neck - Blood supply

Greater Trochanter - Attachment for Abductors and Rotators (external)

Lesser trochanter - Attachment for Psoas

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5
Q

what is the acetabulum?

A

Part of Pelvis

Cup-shape socket

Ligamentum teres in middle

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6
Q

what is the labrum and its function?

A

Fibrocartilagious lining of acetabulum

Deepen socket

Add stability

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7
Q

what is the blood supply?

A

Profunda femoris (branch of femoral)

Branches medial and lateral circumflex arteries

MFCA (Major contributor to femoral head) - 2 branches - Ascend to head and Transverse to form cruciate anastomosis

LFCA (lateral femoral circumflex artery) - 3 branches - Ascending branch to joint capsule, Transverse branch to cruciate anastomosis, Descending branch

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8
Q

hwat are other minor contributors to the blood supply?

A

Artery of Ligamentum Teres

Nutrient Arteries of Bone (vessels in the femur so when fractured blood supply to head is disrupted

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9
Q

where does the blood supply to the neck of the femur enter and what is its clinical significance?

A

Neck Of Femur - Primary blood supply enters via Capsule

Clinical Significance - Fracture Neck of Femur

Intracapsular Fracture = Blood supply disrupted

Extracapsular Fracture = Blood supply maintained

Anastomosis on the neck of femur and ascend to the head

Fractures out of the capsule don’t have risk of avascular necrosis

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10
Q

13 muscles around the hip joint which do what actions?

A

Flexors

Extensors

Abductors

Adductors

Rotators

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11
Q

what are bursae?

A

Fluid-filled sacs

Reduce friction between tissues

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12
Q

what is osteoarthritis?

A

Degenerative change of synovial joints

Progressive loss of articular cartilage

Secondary bony changes

Can be primary or secondary (a pathology that’s caused damage)

Hip replacement is main treatment for people with bad arthritis

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13
Q

how does osteoarthritis present?

A

Characterised by worsening pain and stiffness of the affected joint

Limiting everyday life

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14
Q

what is Trochanteric Bursitis?

A

Trochanteric Bursa is a Fluid-filled sac that is Sandwiched between hip abductors and ITB

Bursitis - Inflammation of the bursa, Swelling

Epidemiology - Females > Males

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15
Q

what are the causes of trochanteric bursitis?

A

Trauma

Over-use - Athletes, often runners, Repetitive movements

Abnormal movements:

  • Distant problem, e.g. Scoliosis
  • Local problem - Muscle wasting following surgery (so have to tense harder), Total Hip Replacement, Osteoarthritis
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16
Q

what is the presentation of trochanteric bursitis?

A

Pain (well localised)

Point tenderness

Lateral hip

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17
Q

what would be found on examination of trochanteric bursitis?

A

LOOK:

  • May have scars from previous surgery
  • May have muscle wasting - Gluteals

FEEL:

  • Tenderness at Greater Tuberosity

MOVE:

  • Worst pain in active abduction
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18
Q

how do you investigate trochanteric bursitis?

A

X-ray - May be normal, OA, THR, Spine abnormalities

MRI - Shows soft tissues and fluid

Ultrasound - Can be therapeutic as well as diagnostic, Guided injection

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19
Q

what is the treatment of trochanteric bursitis?

A

NSAIDs

Relative rest / Activity modification

Physiotherapy:

  • Correct posture, abnormal movements
  • Stretching
  • Strengthen muscles around joint

Injection - Corticosteroids

Surgery - Bursectomy (leaves scar which may be painful and not helpful, divide ITB aswell), Rarely required

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20
Q

what is avascular necrosis?

A

Death of bone due to loss of blood supply

onset of hip pain

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21
Q

what is the epidemiology of avascular necrosis?

A

Males > Females

Average age 35-50 years old

80% = bilateral (May be offset in time)

3% = multifocal (3 or more joints)

22
Q

what are the risk factos for avascular necrosis? (trauma)

A

Irradiation

Fracture

Dislocation

Iatrogenic

23
Q

what are the risk factos for avascular necrosis? (systemic)

A

Idiopathic

Hypercoaguable states

Steroids

Haematological - Sickle Cell Disease, Lymphoma, Leukaemia

Caisson’s disease (divers)

Alcoholism (commonest risk factor)

24
Q

avascular necrosis can be caused by trauma to what area?

A

Injury to femoral head blood supply

Intracapsular fracture

Anastomosis of blood vessels around neck of femur

25
Q

what is the process of avascular necrosis being caused by idiopathic?

A

Intravascular coagulation is the final common pathway

Pathoanatomic cascade:

Coagulation of intraosseous microcirculation =

Venous thrombosis =

Retrograde arterial occlusion =

Intraosseous hypertension =

Reduced blood flow to head =

Cell death =

Chondral fracture and collapse =

26
Q

what ar ethe symptoms of avascular necrosis?

A

Insidious onset of groin pain

Pain with stairs, walking uphill and impact activities

Limp

27
Q

what would be seen on examination of avascular necrosis?

A

Largely normal

May replicate early arthritis:

  • Reduced range of motion (partic internal rotation)
  • Stiff joint
28
Q

what imaging would be done for avascular necrosis?

A

X-Ray

MRI:

  • 99% sensitive and specific
  • Will identify earliest changes
  • MRI shows where bone is affected so can help to plan treatment
29
Q

what is the non-operative treatment of avascular necrosis?

(First make diagnosis, then stop cause if possible)

A

Reduce weight-bearing

NSAIDs

Bisphosphonates - Early AVN, controversial

Anticoagulants

Physiotherapy - Maintain range of motion, Keep the ball round!

30
Q

what is the surgical treatment of avascular necrosis?

A

Restore blood supply

  • Core decompression (drill hole in head to avascular area to reduce venous hypertension and to allow new blood supply to grow in and restore bone strength)
  • Core decompression and vascularised graft

Move the lesion away from the weight-bearing area - Rotational Osteotomy (osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment)

Total Hip Replacement

31
Q

what is Femoroacetabular Impingement (FAI)?

A

Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement

2 surfaces hitting together

32
Q

what is the commonest cause of FAI?

A

Hip pathology in younger patient

Secondary osteoarthritis

33
Q

what are the different types of FAI?

A

Broadly divided into 2 categories:

  • Cam lesion
  • Pincer

Results in impingement of femoral neck against anterior edge of acetabulum

34
Q

FAI - what is a Cam lesion?

A

Femoral-based impingement

Usually in young athletic males - Rowers

Excess bone leading to Decreased head to neck ratio and Aspherical head

Abutment of lesion on edge of acetabulum - Flexion

35
Q

what is shown here?

A

FAI cam lesion

Slight bump

Easier to see on 3D imaging

36
Q

what is a FAI pincer?

A

Acetabulum-based impingement

Usually in active females

Abnormal acetabulum leading to:

  • Anterosuperior acetabular rim overhang
  • Acetabular protrusion

Abutment of lesion on edge of acetabulum

More prominence of the edge of the acetabulum

37
Q

what is shown here?

A

FAI - Pincer

38
Q

what are associated injuries of FAI?

A

labral degeneration and tears

cartilage damage and flap tears

secondary hip osteoarthritis

39
Q

what is the presentation of FAI?

A

Groin pain - Worse with flexion

Mechanical symptoms:

  • Block to movement
  • Pain with certain manoeuvres - Getting out of a chair, Squatting, Lunging
40
Q

what would be seen on examination of FAI?

A

Reduced flexion and internal rotation

Positive FADIR test - Flexion, ADduction, Internal Rotation

41
Q

what investigations would be used in FAI?

A

X-ray - Identify the bony pathology

MRI - Useful for assessing associated conditions:

  • Labral tears
  • Articular cartilage damage
42
Q

what is the non-operative treatment of FAI?

A

Activity modification

NSAIDs

Physiotherapy:

  • Correct posture
  • Strengthen muscles around joint
43
Q

whatis the operative surgery of FAI?

A

Arthroscopy:

  • Shave down the defect
  • Deal with labral tears
  • Resect artic cartilage flaps

Open Surgery:

  • Resection
  • Periacetabular Osteotomy
  • Hip Arthroplasty
  • Resurfacing
  • Replacement
44
Q

what is a Labral Tear?

A

A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum (socket) of the hip. A hip labral tear can be caused by injury, structural problems, or degenerative issues. Symptoms include pain in the hip or stiffness

Most commonly anterosuperior tear

45
Q

what is the epidemiology of a labral tear?

A

All age groups

Commonly active females:

  • Pincer
  • More flexible

In older age group often degenerative changes

46
Q

what are the cuases of a labral tear?

A

FAI

Trauma

OA

Dysplasia

Collagen diseases – Ehlers-Danlos

47
Q

what is the presentation of a labral tear?

A

Groin or Hip Pain - Intermittent pain that comes on on certain movements of the hip and not a constant pain

Snapping sensation

Jamming or locking

48
Q

what would the examination of a labral tear be like?

A

can be normal

Positive FABER test - Flexion, ABduction, External Rotation

Anterior tears

49
Q

what investigationg would be used for a labral tear?

A

Ensure adequate imaging so identify any root causes of pathology

X-ray - OA, Dysplasia

MRI Arthrogram - 92% sensitive

Diagnostic injection - Local anaesthetic

50
Q

what is the non-opertative treatment of a labral tear?

A

Activity modification, NSAIDs, Physiotherapy

Injection of Steroids

51
Q

what is the operative treatment of a labral tear?

A

Arthroscopy (more of a role in younger people)

Repair

Resection

Year 3 - MSK (45 decks)

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