Orthopaedic Hip Conditions Flashcards
What is the pelvis made up from?
2 hemi pelvises
Each hemipelvis is made up from which bones?
Ischium, ileum and pubis
What is the acetabulum?
The hip socket
What does the head of the femur do?
Articulate with the acetabulum
What is the importance of the neck of the femur?
Blood supply
What doe the lesser trochanter does (on the femur)?
Attachment for the psaos
What is the labrum?
The fibrocartilaginous lining of the acetabulum
What is the function of the labrum?
- Deepens socket
* Adds stability
What is the profound femoris?
A major branch of the femoral artery
What 2 branches come off the profunda femoris?
- Medial femoral circumflex artery (MFCA) (posterior)
* Lateral femoral circumflex artery (LFCA) (anterior)
How many branches does the MFCA have and what do they do?
•2
- Ascends to head
- Transverses to form cruciate anastomosis
How many branches does the LFCA have and what do they do?
•3
- Ascends to joint capsule
- Transverses to form cruciate anastomosis
- Descending branch
What are 2 other minor contributors to hip blood supply?
- Artery of ligament teres
2. Nutrient arteries of bone
How is the neck of the femur supplied with blood?
Primary blood supply enters via capsule
What is the clinical significance of the blood supply of the neck of the femur?
- Intracapsular fracture - blood supply disrupted
* Extracapsular fracture - blood supply maintained
How many muscles are there around the hip joint. and what are their functions (5)?
•13
- flexors
- extensors
- abductors
- adductors
- rotators
What are bursae?
Fluid-filled sacs
What is the function of bursae?
Reduce friction between tissues
What is osteoarthritis?
•Degenerative change of synovial joints
- Progressive loss of articular cartilage
- Secondary bone changes
How is osteoarthritis characterised?
Pain and stiffness
What is the trochanteric bursa?
Bursa sandwiched between hip abductors and ITB
TROCHANTERIC BURSA
What is trochanteric bursitis?
- Inflammation of trochanteric bursa
* Females > males
What causes trochanteric bursitis?
- Trauma
- Over-use
- Abnormal movements - distant movements e.g. scoliosis
- Abnormal movements - local problem e.g. muscles wasting following surgery, total hip replacement, osteoarthritis
How does trochanteric bursitis present?
•Pain
- point tenderness
- lateral hip
How might examination indicate trochanteric bursitis?
- Look - scars from previous surgery, muscle wasting
- Feel - tenderness at greater tuberosity
- Move - worst pain in active abduction
How would you investigate for trochanteric bursitis?
•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)
How is throchanteric bursitis be treated?
•NSAIDs •Rest/activity modification •Physiotherapy -correct posture/abnormal movements -stretching -strengthen muscles around joint •Injection - corticosteroids •Surgery - bursectomy (rarely required)
What is avascular necrosis?
Death of bone due to loss of blood supply
Who gets avascular necrosis?
- Males>females
- 35-50 years
- 80% bilateral
- 3% multifocal (3 or more joints)
What are the traumatic risk factors for avascular necrosis?
- Irradiation
- Fracture (intracapsular)
- Dislocation
- Iatrogenic
What are the systemic risk factors for avascular necrosis?
•Idiopathic •Hypercoaguable states •Steroids •Haematological -Sickle Cell Disease -Lymphoma -Leukaemia •Caisson’s disease •Alcoholism
How does avascular necrosis occur idiopathically?
•Pathoanatomic cascade
- Coagulation of intraosseous microcirculation ->
- Venous thrombosis ->
- Retrograde arterial occlusion ->
- Intraosseous hypertension ->
- Reduced blood flow to head ->
- Cell death ->
- Chondral fracture and collapse
What are the symptoms of avascular necrosis?
- Insidious onset of groin pain
- Pain with stairs, walking uphill and impact activities
- Limp
How would an examination indicate avascular necrosis?
•Largely normal •May replicate early arthritis -Reduced range of motion (partic internal rotation) -Stiff joint IMAGING - x-ray and MRI
How is avascular necrosis treated non-operatively?
•Reduce weight-bearing •NSAIDs •Bisphosphonates -Early AVN -Controversial •Anticoagulants •Physiotherapy -Maintain range of motion -Keep the ball round!
How is avascular necrosis treated surgically?
•Restore blood supply
-core decompression
-core decompression and vascularised graft
•Move the lesion away from the weight-bearing area - rotational Osteotomy
•Total Hip Replacement
What is 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. Results in impingement of femoral neck against anterior edge of acetabulum
What is FAI a cause of?
- Hip pathology in younger patient
* Secondary osteoarthritis
What 2 broad categories is FAI divided into?
- Cam lesion
* Pincer
What is a cam lesion?
•Femoral-based impingement
•Excess bone leading to
-decreased head to neck ratio
-aspherical head
Who gets cam lesions?
Typically young athletic males
What is a pincer?
•Acetabulum (socket) based impingement
•Abnormal acetabulum leading to
-anterosuperior acetabular rim overhang
-acetabular protrusion
Who gets pincer FIA?
Typically active females
What are injuries associated with FAI?
- Labral degeneration and tears
- Cartilage damage and flap tears
- Secondary hip osteoarthritis
How does FAI present?
•Groin pain -Worse with flexion •Mechanical symptoms -Block to movement -Pain with certain manoeuvres *Getting out of a chair *Squatting *Lunging
How might an examination indicate FAI?
•Reduced flexion and internal rotation
•Positive FADIR test
FADIR - flexion, adduction, internal rotation
What investigations do you carry out to diagnose FAI?
- X-ray - identifies bony pathology
* MRI - useful for associated conditions e.g. labral tears and articular cartilage damage
How is FAI treated non-operatively?
•Activity modification •NSAIDs •Physiotherapy -Correct posture -Strengthen muscles around joint
How is FAI treated operatively?
•ARTHROSCOPY -Shave down the defect -Deal with labral tears -Resect artic cartilage flaps •OPEN SURGERY -Resection -Periacetabular Osteotomy -Hip Arthroplasty -Resurfacing, Replacement
What is the most common type of labral tear?
•Most commonly anterosuperior tear
Who gets labral tears?
•All age groups
•Commonly active females
-pincer
-more flexible
What are the causes of labral tears?
- FAI
- Trauma
- OA
- Dysplasia
- Collagen diseases – Ehlers-Danlos
How does a labral tear present?
- Groin or Hip Pain
- Snapping sensation
- Jamming or locking
How might an examination indicate labral tear?
- Can be normal
- Positive FABER test
- Flexion, ABduction, External Rotation (Anterior tears)
What investigations do you carry out to diagnose labral tear?
•X-ray -OA, Dysplasia •MRI Arthrogram -92% sensitive •Diagnostic injection -Local anaesthetic
How is a labral tear treated non-operatively?
- Activity modification
- NSAIDs
- Physiotherapy
- Injection of Steroids
How is a labral tear treated operatively?
•Arthroscopy
- Repair
- Resection
