orthopaedics: hip

Question 1

what muscles are weakened if trendenelburg gait positive

Answer 1

abducter weakness - gluteus minimus and maximus

Question 2

what is the difference between total hip arthroplasty (THA) and THR

Answer 2

same apart THA slightly broader term

Question 3

what is the main indication for a THA

Answer 3

pain

Question 4

how long do THA’s usually last and why do they fail

Answer 4

15 years, wear and tear

Question 5

what are criteria for THA

Answer 5

pain and disability eg sleep disturbance, difficulty walking and low QOL. failed conservative measures: analgesia, walking aid, physio, weight loss

Question 6

what type of prosthetics are there and when are they used

Answer 6

hybrid (uncemented cup and cemented cone, young), cemented (cemented cup + cone, elderl), uncemented

Question 7

why should you delay THR in young patients as long as possible

Answer 7

as need revision surgery later, more wear and tear than elderly

Question 8

what are early complications of THA

Answer 8

infection, dislocation, nerve injury (Sciatic), DVT/ PE, loosening

Question 9

what are risks of THA

Answer 9

higher complication rates that first time, more blood loss, dont last as long

Question 10

what is AVN of hip

Answer 10

ischaemia to femoral head (usually idiopathic)

Question 11

who normally gets AVN of the hip

Answer 11

males 35-50

Question 12

what are risk factors for AVN (7)

Answer 12

alcohol, steroids, hyperlipidaemia, thrombophillia, trauma, necrosis, chondral fracture

Question 13

what is presentation of AVN

Answer 13

pain (usually in groin), worse on impact eg stairs, usually unremarkable examination

Question 14

how do you diagnose AVN

Answer 14

MRI (patchy sclerosis, granulation tissue), x ray, femoral head collapse

Question 15

how do you treat AVN

Answer 15

bisphosphates, drill holes pre collapse to relieve pressure, THR after collapse

Question 16

who commonly gets idiopathic transient osteoporosis of the hip (ITOH)

Answer 16

middle aged men, pregnant women

Question 17

what pathology is associated with ITOH

Answer 17

local hyperaemia, impared venous return, marrow oedema and increased pressure

Question 18

what are symptoms of ITOH

Answer 18

unilateral progressive groin pain and difficulty bearing weight

Question 19

how do you diagnose ITOH

Answer 19

MRI (best), x ray, bone scan, bloods: PV/ ESR

Question 20

how do you manage ITOH

Answer 20

limiting 6-9 months, analgesia, walking aid

Question 21

what is trochanteric bursitis/ gluteal cuff syndrome

Answer 21

repeated trauma bu iliotibial (IT) band over trochanteric bursa –> tendonitis, tears and bursitis

Question 22

how does trochanteric bursitis present

Answer 22

pain on lateral hip, pain on palpitation of greater trochanter, pain on abduction

Question 23

how do you diagnose trochanteric bursitis

Answer 23

clinical - xray if needed

Question 24

how do you treat trochanteric bursitis

Answer 24

analgesia, NSAIDs, physio, steroid injection (no surgery)

Question 25

what is femoroacetabular impingement syndrome (FAI)

Answer 25

altered femoral neck and/or acetabulum causing thickening of femoral neck which can damage joint

Question 26

what types of FAI are there

Answer 26

CAM and pincer type

Question 27

describe CAM type FAI

Answer 27

femoral deformity, common in young athletic males, asymmetric femoral head, previous SUFE

Question 28

what is pincer type impingement FAI

Answer 28

acetabular deformity, females - acetabular overhang

Question 29

what is damaged in FAI

Answer 29

labrum (cartilage between femur and acetabulum)

Question 30

what are symptoms of FAI

Answer 30

groin pain, esp flexion and rotation, pain sitting, C sign positive, FADIR positive

Question 31

what investigations are done for FAI

Answer 31

Xray, CT, MRI

Question 32

what management is there for FAI

Answer 32

surgery to remove/ debride, osteomy, arthroplasty (elderly)