orthopaedic hip problems Flashcards
OA hip
degenerative change synovial joints
worsening pain and stiffness affected joints - decreased joint space, worn cartilage, roughbone, osteophytes
causes of trochanteric bursitis
trauma
over use e.g. runners
abnormal movements e.g. distal problem - scoliosis
local problem - muscle wasting post-surgery, total hip replacement, OA
presentation of trochanteric bursittis
pain - point tenderness, lateral hip
tenderness at greater tuberosity
worse pain in active abduction and passive adduction
investigations trochanteric bursitis
x-ray
MRI
USS
trochanteric bursitis Rx
NSAIDs- cream, tablets
rest, activity modification
physiotherapy
corticosteroid injection
surgery - bursectomy (rarely needed)
avascular necrosis
death of bone due to loss of blood supplies
traumatic risk factors for avascular necrosis hip
irradiation
fracture
dislocation
iatrogenic
systemic risk factors for avascular necrosis hip
idiopathic hypercoaguable stress steroids heamatological: sickle cell, lymphoma, leukaemia caisson's disease alcoholism
pathophysiology of avascular necrosis
coagulation of intraosseous microcirculation
venous thrombosis
retrogade arterial occulsion
intraosseous HTN
reduced bloow flow to femur head
cell death
chondral fracture and collapse
presentation of avascular necrosis hip
insidious onset groin/thigh pain
pain w stairs, walking uphill, impact activites
reduced ROM
stiff joint
imaging avascular necrosis
X-ray
MRI
non-operative management avascular necrosis
reduce weight bearing e.g. crutches NSAIDs bisphosphonates anticoagulants physiotherapy
surgical management avascular necrosis
restore blood supply
move lesion away from weight-bearing area: rotational osteotomy
total hip replacement
two types of femoroacetabular imppingement
cam lesion
pincer
femoroacetabular impingement
impingement of femoral neck against anterior edge acetabulum
common cause of hip pathology in younger pt and secondary OA
cam lesion (femoroacetabular impingement)
femoral based impingement - prob w femoral neck
excess bone leading to aspherical head and decreased heack to neck ratio
abutement of lesion on edge of acetabulum - flexion
pincer lesion (femoroacetabular impingement)
acetabulum based impingement
abnormal acetabulum leadng to anteriosuperior actetabular rim overhand (acetabular protrusion)
presentation femoroacetabular impingement
groin pain worse w flexion
feel something catching/blocking movement
pain squatting, getting out chair, lunging
reduced flexion and internal rotation
positive FADIR test
positive FADIR test
flexion, adduction, internal rotation –> pain
non operative Rx femoroacetabular impingement
activity modification
NSAIDs
physiotherapy
operative Rx femoroacetabular impingement
arthroscopy
open surgery
injuries assoc with femoroacetabular impingement
labral degeneration and tears
cartilage damage and flap tears
secondary hip OA
most common labral tear
most commonly anterosuperior treat
causes labral tears
FAI trauma OA dysplasia collagen diseases - Ehlers-Danlos
presentation labral tear
groin/hip pain
snapping sensation over hip
jammin or locking
positive FABER test in anterior tears
positive FABER test
flexion, abduction, external rotation –> pain
labral tear investigations
X-ray
MRI arthrogram
diagnostic injection
Rx labral tears
activity modification NSAIDs physio steroid injection arthroscopy
