Orthopaedic Hip conditions Flashcards
What is Osteoarthritis?
Degenerative change of synovial joints (‘wear and tear’) - progressive loss of the articular cartilage and secondary bony changes
It is characterised by worsening pain and stiffness of the affected joint which can become quite limiting in every day life.
What is Trochanteric Bursitis?
Inflammation of the Trochanteric bursa that lies between the trochanter and the iliotibial band
Causes of Trochanteric Bursitis?
- Trauma
- Over-use - athletes (often runners), repetitive movements - often presents in young, active patients
- Distant problem i.e scoliosis
- Local problem i.e muscle wasting following surgery, total hip replacement or osteoarthritis
How does Trochanteric Bursitis present?
Pain/tenderness on the lateral hip
Examination of Trochanteric Bursitis
Look - scars from previous surgery, muscle wasting (gluteals)
Feel - tenderness at Greater Tuberosity
Move - worst pain in active abduction
Key investigations for Trochanteric Bursitis (3)
- X-ray - may be normal or may see evidence of OA, total hip replacement or spine abnormalities
- MRI - soft tissues and fluid
- USS - can be therapeutic as well as diagnostic i.e guided injection
Treatment for Trochanteric Bursitis
- NSAIDs
- Relative rest / Activity modification
- Physiotherapy - correct posture and abnormal movements, stretching, strengthen muscles around joint
- Injection - corticosteroids
- Surgery - bursectomy - rarely required
What is avascular necrosis of the hip?
Death of bone due to the loss of blood supply in the femur head
- M>F
- Average age 35-50 years old
- 80% = bilateral
Risk factors of Avascular Necrosis
- Trauma
- Irradiation - exposure to radiation
- Fracture - i.e intracapsular fracture which injures the blood supply to the femoral head
- Dislocation
- Iatrogenic
- Systemic
- Idiopathic
- Hypercoaguable states
- Steroids
- Haematological - sickle cell disease, lymphoma, leukaemia
- Alcoholism
In idiopathic avascular necrosis of the hip, what is known about the pathogenesis?
- The microcirculation of the femoral head becomes static which leads to venous thrombosis
- When the pressure rises there is retrograde arterial occlusion
- Which leads to intraosseous hypertension
- Reduced blood flow to the head
- Cell death
- Chondral fracture and collapse - esp if weight bearing
Symptoms of Avascular necrosis of the hip
- Insidious onset of groin pain
- Pain with stairs, walking uphill and impact activities
- Limp - unable to weight bear
Treatment of Avascular necrosis
- Non-operative
- Reduce weight-bearing
- NSAIDs
- Bisphosphonates - reduce fracture risk
- Anti-coagulants
- Physio - maintain range of motion, keep the ball round
- Surgical
- Restore blood supply - core decompression +/- vascularised graft
- Decompression - surgical drilling into the area of dead bone near the joint. This reduces pressure, allows for increased blood flow, and slows or stops bone and/or joint destruction.
- Move the lesion away from the weight-bearing area - rotational osteotomy
- Total hip replacement
- Restore blood supply - core decompression +/- vascularised graft
What is Femoroacetabular Impingement (FAI)?
A condition where the bones of your hip joint come too close and pinch tissue or cause too much friction.
- 2 types: Cam lesion or Pincer.
- Results in impingement of femoral neck against the anterior edge of the acetabulum
- Restriction of movement and pain
- A common cause of hip pathology in younger patients
- Can cause secondary osteoarthritis
Cam lesion
Primarily a problem with the femur
- Formation of extra bone on the head of the femur resulting impingement on the acetabulum with joint movement.
- Usually in young athletic males i.e rowers
FAI - Pincer
An acetabulum-based impingement
- Usually in active females
- Abnormal acetabulum
Investigations for Labral tears
- Ensure adequate imaging so you identify any root causes of pathology
- X-ray - OA or dysplasia
- MRI Arthrogram 92% sensitive
- Diagnostic injection under local anaesthetic
