Orthopaedic Hip Conditions Flashcards
Describe the blood supply to the femoral head?
Femoral head has limited blood supply:
- Profunda femoris
- Branches medial and lateral circumflex arteries
- MFCA (main supply)
- 2 branches
- Ascends to head
- Transverse to form cruciate anastomosis
- 2 branches
- LFCA
- 3 branches
- Ascending branch to joint capsule
- Transverse branch to cruciate anastomosis
- Descending branch
- 3 branches
- Minor contributors
- Artery of ligamentum teres
- Nutrient arteries of bone
What is the main blood supply to the femoral head?
- Profunda femoris
- Branches medial and lateral circumflex arteries
-
MFCA (main supply)
- 2 branches
- Ascends to head
- Transverse to form cruciate anastomosis
- 2 branches
- LFCA
- 3 branches
- Ascending branch to joint capsule
- Transverse branch to cruciate anastomosis
- Descending branch
- 3 branches
What are the branches of the MFCA?
- 2 branches
- Ascends to head
- Transverse to form cruciate anastomosis
What are the branches of the LFCA?
- 3 branches
- Ascending branch to joint capsule
- Transverse branch to cruciate anastomosis
- Descending branch
Describe the blood supply to the femoral neck?
- Primary blood supply enters via capsule
- Significant because fracture of neck of femur disrupts supply (intracapsular)
- Extracapsular fractures blood supply maintained
What is osteoarthritis?
Osteoarthritis = degenerative change of synovial joint, causing progressive loss of articular cartilage and secondary bony changes
What is osteoarthritis characterised by?
Characterised by worsening pain and stiffness of affected joint
What is the main treatment of osteoarthritis of the hip?
- Hip replacement
What is trochanteric bursitis?
Trochanteric bursa = fluid filled sac sandwiched between hip abductors and ITB
What is bursitis?
Bursitis = inflammation of bursa
Describe the epidemiology of trochanteric bursitis in terms of sex?
- F>M
What are some causes of trochanteric bursitis?
- Trauma
- Over-use
- Athletes, often runners
- Abnormal movements
- Distinct problem
- Scoloiosis
- Local problems
- Muscle wasting following surgery
- Total hip replacement
- Osteoarthritis
- Distinct problem
What are the clinical features of trochanteric bursitis?
- Pain
- Worse lying on side and walking
- Swelling
What investigations are done for trochanteric bursitis?
- X-rays
- Exclude arthritis
- MRI
- Shows soft tissues and fluid
- Ultrasound
What is the treatment of trochanteric bursitis?
- NSAIDs
- Relative rest/activity modifications
- Physiotherapy
- Correct posture
- Stretching
- Strengthen muscles around joint
- Injection
- Corticosteroids
- Surgery
- Bursectomy
What is avascular necrosis?
Is death of the bone due to loss of bony supply
Describe the epidemiology of avascular necrosis in terms of sex and age?
- M>F
- Average age 35-50
What are risk factors for avascular necrosis?
- Trauma
- Irradiation
- Fracture
- Injury to femoral head
- Dislocation
- Iatrogenic
- Systemic
- Idiopathic
- Hypercoagulable states
- Steroids
- Haematologica
- Sickle cell disease
- Lymphoma
- Leukaemia
- Caisson’s disease
- Alcoholism
Describe the pathophysiology of avascular necrosis?
What are the clinical features of avascular necrosis?
- 80% of time bilateral
- 3% of time multifocal
- Insidious onset of groin pain
- Limp
- Reduced range of motion
- Stiff joint
What investigations are done for avascular necrosis?
- X-ray
- MRI
- Will identify earliest changes
What is the treatment of avascular necrosis?
- Non-operative
- Reduced weight bearing
- NSAIDs
- Bisphosphonates
- Anticoagulants
- Physiotherapy
- Surgical
- Restore blood supply
- Core decompression
- Core decompression and vascularised graft
- Move lesion away from weight bearing area
- Rotational osteotomy
- Total hip replacement
- Restore blood supply
What does FAI stand for?
Femoroacetabular impingement
What is impingement?
Impingement is two surfaces hitting together
FAI is a common cause of what?
- Hip pathology in younger patient
- Secondary osteoarthritis
What are the 2 categories of femoroacetabular impingement?
-
Cam lesion
- Femoral-based impingement
- Usually young athletic mnales
- Excess bone leading to
- Decreased head to neck ratio
- Aspherical head
-
Pincer
- Acetabulum based impingement
- Usually in active females
- Abnormal acetabulum leading to
- Anteriosuperior acetabular rim overhang
- Acetabular protrusion
Cam lesion is a what based impingment?
Femoral based impingement
Pincer is a what based impingement?
Acetabulum based impingement
Which of cam lesion and pincer FAI affect males more than females?
Cam lesion - males
Pincer - females
What bony changes does cam lesion FAI cause?
- Excess bone leading to
- Decreased head to neck ratio
- Aspherical head
What bony changes does pincer FAI cause?
- Abnormal acetabulum leading to
- Anteriosuperior acetabular rim overhang
- Acetabular protrusion
What are associated injuries to FAI?
- Labral degeneration and tears
- Cartilage damage and flap tears
- Secondary hip osteoarthritis
What is the presentation of FAI?
- Groin pain
- Mechanical symptoms
- Block to movement
- Pain with certain movements
- Reduced range of motion
- Flexion and internal rotation
What investigations are done for FAI?
- FADIR test
- X-ray
- Identify bony pathology
- MRI
- Assesses associated conditions like labral tears and articular cartilage damage
What is the treatment of FAI?
- Non-operative
- Activity modification
- NSAIDs
- Physiotherapy
- Correct posture
- Strengthen muscles around joint
- Operative
- Arthroscopy
- Shave down defect
- Deal with labral tears
- Resect articular cartilage flaps
- Open surgery
- Resection
- Periacetabular osteotomy
- Hip arthroplasty
- Resurfacing
- Replacement
- Arthroscopy
What is the most common kind of labral tear?
Most commonly is an anterosuperior tear
Describe the epidemiology of labral tear in terms of age and sex?
- All age groups
- Commonly active females
What are causes of labral tear?
- FAI
- Trauma
- OA
- Dysplasia
- Collagen disease
- Ehler’s-Danlos
What is the presentation of labral tear?
- Groin or hip pain
- Snapping sensation
- Jamming or locking
- Positive FEBER test
What investigations are done for labral tear?
- X-ray
- MRI
- Diagnostic injection (contrast)
What is the treatment of labral tear?
- Non-operative
- Activity modification
- NSAIDs
- Physiotherapy
- Injection of steroids
- Operative
- Arthroscopy
- Repair
- Resection
- Arthroscopy
What is arthroscopy?
A minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision
