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14. Year 2: Musculoskeletal > Orthopaedic Hip Conditions > Flashcards

Orthopaedic Hip Conditions Flashcards

1
Q

Describe the blood supply to the femoral head?

A

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
    • LFCA
      • 3 branches
        • Ascending branch to joint capsule
        • Transverse branch to cruciate anastomosis
        • Descending branch
  • Minor contributors
    • Artery of ligamentum teres
    • Nutrient arteries of bone
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2
Q

What is the main blood supply to the femoral head?

A
  • Profunda femoris
    • Branches medial and lateral circumflex arteries
    • MFCA (main supply)
      • 2 branches
        • Ascends to head
        • Transverse to form cruciate anastomosis
    • LFCA
      • 3 branches
        • Ascending branch to joint capsule
        • Transverse branch to cruciate anastomosis
        • Descending branch
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3
Q

What are the branches of the MFCA?

A
  • 2 branches
    • Ascends to head
    • Transverse to form cruciate anastomosis
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4
Q

What are the branches of the LFCA?

A
  • 3 branches
    • Ascending branch to joint capsule
    • Transverse branch to cruciate anastomosis
    • Descending branch
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5
Q

Describe the blood supply to the femoral neck?

A
  • Primary blood supply enters via capsule
    • Significant because fracture of neck of femur disrupts supply (intracapsular)
    • Extracapsular fractures blood supply maintained
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6
Q

What is osteoarthritis?

A

Osteoarthritis = degenerative change of synovial joint, causing progressive loss of articular cartilage and secondary bony changes

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7
Q

What is osteoarthritis characterised by?

A

Characterised by worsening pain and stiffness of affected joint

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8
Q

What is the main treatment of osteoarthritis of the hip?

A
  • Hip replacement
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9
Q

What is trochanteric bursitis?

A

Trochanteric bursa = fluid filled sac sandwiched between hip abductors and ITB

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10
Q

What is bursitis?

A

Bursitis = inflammation of bursa

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11
Q

Describe the epidemiology of trochanteric bursitis in terms of sex?

A
  • F>M
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12
Q

What are some causes of trochanteric bursitis?

A
  • Trauma
  • Over-use
    • Athletes, often runners
  • Abnormal movements
    • Distinct problem
      • Scoloiosis
    • Local problems
      • Muscle wasting following surgery
      • Total hip replacement
      • Osteoarthritis
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13
Q

What are the clinical features of trochanteric bursitis?

A
  • Pain
    • Worse lying on side and walking
  • Swelling
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14
Q

What investigations are done for trochanteric bursitis?

A
  • X-rays
    • Exclude arthritis
  • MRI
    • Shows soft tissues and fluid
  • Ultrasound
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15
Q

What is the treatment of trochanteric bursitis?

A
  • NSAIDs
  • Relative rest/activity modifications
  • Physiotherapy
    • Correct posture
    • Stretching
    • Strengthen muscles around joint
  • Injection
    • Corticosteroids
  • Surgery
    • Bursectomy
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16
Q

What is avascular necrosis?

A

Is death of the bone due to loss of bony supply

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17
Q

Describe the epidemiology of avascular necrosis in terms of sex and age?

A
  • M>F
  • Average age 35-50
18
Q

What are risk factors for avascular necrosis?

A
  • Trauma
    • Irradiation
    • Fracture
      • Injury to femoral head
    • Dislocation
    • Iatrogenic
  • Systemic
    • Idiopathic
    • Hypercoagulable states
    • Steroids
    • Haematologica
      • Sickle cell disease
      • Lymphoma
      • Leukaemia
    • Caisson’s disease
    • Alcoholism
19
Q

Describe the pathophysiology of avascular necrosis?

A
20
Q

What are the clinical features of avascular necrosis?

A
  • 80% of time bilateral
  • 3% of time multifocal
  • Insidious onset of groin pain
  • Limp
  • Reduced range of motion
  • Stiff joint
21
Q

What investigations are done for avascular necrosis?

A
  • X-ray
  • MRI
    • Will identify earliest changes
22
Q

What is the treatment of avascular necrosis?

A
  • 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
23
Q

What does FAI stand for?

A

Femoroacetabular impingement

24
Q

What is impingement?

A

Impingement is two surfaces hitting together

25
Q

FAI is a common cause of what?

A
  • Hip pathology in younger patient
  • Secondary osteoarthritis
26
Q

What are the 2 categories of femoroacetabular impingement?

A
  • 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
27
Q

Cam lesion is a what based impingment?

A

Femoral based impingement

28
Q

Pincer is a what based impingement?

A

Acetabulum based impingement

29
Q

Which of cam lesion and pincer FAI affect males more than females?

A

Cam lesion - males

Pincer - females

30
Q

What bony changes does cam lesion FAI cause?

A
  • Excess bone leading to
    • Decreased head to neck ratio
    • Aspherical head
31
Q

What bony changes does pincer FAI cause?

A
  • Abnormal acetabulum leading to
    • Anteriosuperior acetabular rim overhang
    • Acetabular protrusion
32
Q

What are associated injuries to FAI?

A
  • Labral degeneration and tears
  • Cartilage damage and flap tears
  • Secondary hip osteoarthritis
33
Q

What is the presentation of FAI?

A
  • Groin pain
  • Mechanical symptoms
    • Block to movement
    • Pain with certain movements
  • Reduced range of motion
    • Flexion and internal rotation
34
Q

What investigations are done for FAI?

A
  • FADIR test
  • X-ray
    • Identify bony pathology
  • MRI
    • Assesses associated conditions like labral tears and articular cartilage damage
35
Q

What is the treatment of FAI?

A
  • 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
36
Q

What is the most common kind of labral tear?

A

Most commonly is an anterosuperior tear

37
Q

Describe the epidemiology of labral tear in terms of age and sex?

A
  • All age groups
  • Commonly active females
38
Q

What are causes of labral tear?

A
  • FAI
  • Trauma
  • OA
  • Dysplasia
  • Collagen disease
    • Ehler’s-Danlos
39
Q

What is the presentation of labral tear?

A
  • Groin or hip pain
  • Snapping sensation
  • Jamming or locking
  • Positive FEBER test
40
Q

What investigations are done for labral tear?

A
  • X-ray
  • MRI
  • Diagnostic injection (contrast)
41
Q

What is the treatment of labral tear?

A
  • Non-operative
    • Activity modification
    • NSAIDs
    • Physiotherapy
    • Injection of steroids
  • Operative
    • Arthroscopy
      • Repair
      • Resection
42
Q

What is arthroscopy?

A

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

14. Year 2: Musculoskeletal (40 decks)

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