Orthopaedic Hip Problems Flashcards
When is blood supply disrupted in neck of femur fractures?
In intracapsular fractures the blood supply is disrupted
In extracapsular fractures the blood supply is maintained
What are the causes of trochanteric bursitis?
- Trauma
- Over-use (often runners)
- Abnormal movements
- Local problem (muscle wasting post-operatively, hip replacement, osteoarthritis)
What sex is more affected by trochanteric bursitis?
Females
How does trochanteric bursitis present?
Pain and tenderness at the lateral hip
How is trochanteric bursitis diagnosed?
Mainly clinical
Examination involves looking for scars from surgery or muscle wasting, feeling for tenderness at the greater tuberosity and moving, with pain being worst in active abduction
Investigations are x-ray, MRI or ultrasound (gold standard)
How is trochanteric bursitis treated?
- NSAIDs
- Rest/activity modification
- Physiotherapy
- Injection of corticosteroids
- Surgery- bursectomy (very rarely required)
What is avascular necrosis?
Death of bone due to lack of blood supply
What are the causes of avascular necrosis?
Trauma
No known cause
What populations are most commonly affected by avascular necrosis?
Males > females
Average affected age 35-50
What are the risk factors for avascular necrosis?
Trauma: - Irradiation - Fracture - Dislocation - Iatrogenic Systemic: - Idiopathic - Hypercoaguable states - Steroids - Sickle Cell Disease - Lymphoma - Leukaemia - Caisson’s disease - Alcoholism
What are the symptoms of avascular necrosis?
- Insidious onset groin pain
- Pain with stairs, walking uphill and impact activities
- Limp
What is the most common finding on examination of avascular necrosis?
Struggling with internal rotation
What is the non-operative treatment of avascular necrosis?
- Reduce weight-bearing
- NSAIDs
- Bisphosphonates (early AVN)
- Anticoagulants
- Physiotherapy (maintain range of motion, keep ball round)
What is the operative treatment of avascular necrosis?
Operative treatment can involve a core decompression with or without a vascularised graft to restore the blood supply, a rotational osteotomy to move the lesion away from the weight-bearing area or a total hip replacement.
What are the complications of femoroacetabular impingement?
Hip pain
Secondary osteoarthritis
What are the two possible lesions causing femoroacetabular impingement?
Cam lesion
Pincer lesion
What are the characteristics of cam lesions?
Femoral based
Usually in young athletic males
Excess of bone causes decreased head to neck ratio and an asymmetrical head
Abutment of the lesion against the acetabulum occurs on flexion
What are the characteristics of pincer lesions?
Acetabulum based
Usually in active females
Abnormal acetabulum leads to an anterosuperior acetabular rim overhang and acetabular protrusion
What injuries are associated with femoroacetabular impingement?
- labral degeneration and tears
- cartilage damage and flap tears
- secondary hip osteoarthritis
What are the symptoms of femoroacetabular impingement?
- Groin pain (worse with flexion)
- Mechanical symptoms (block to movement)
- Pain with certain manoeuvres
What findings are present on examination of femoroacetabular impingement?
Examination often normal
FADIR test can be helpful
What investigations are useful in femoroacetabular impingement?
X-ray to assess bony pathology
MRI to assess associated pathologies
What is the non-operative treatment of femoroacetabular impingement?
- Activity modification
- NSAIDs
- Physiotherapy (correct posture, strengthen muscles around joint)
What is the operative treatment of femoroacetabular impingement?
- Arthroscopy (shave down bone)
- Open surgery (resection, periacetabular osteotomy, hip arthroplasty)
What are the possible causes of a labral tear?
- FAI
- Trauma
- OA
- Dysplasia
- Collagen diseases – Ehlers-Danlos
What are the symptoms of a labral tear?
- Groin or Hip Pain
- Snapping sensation
- Jamming or locking
How is a labral tear examined and investigated?
Examination is often normal, but will have a positive FABER test. Investigations involve an x-ray, MRI arthrogram and a diagnostic injection with local anaesthetic.
How is a labral tear treated?
Non-operative treatment is as follows: - Activity modification - NSAIDs - Physiotherapy - Steroid injections Operative treatment involves an arthroscopy, which can be a repair or resection.
