orthopaedics: hip Flashcards
what muscles are weakened if trendenelburg gait positive
abducter weakness - gluteus minimus and maximus
what is the difference between total hip arthroplasty (THA) and THR
same apart THA slightly broader term
what is the main indication for a THA
pain
how long do THA’s usually last and why do they fail
15 years, wear and tear
what are criteria for THA
pain and disability eg sleep disturbance, difficulty walking and low QOL. failed conservative measures: analgesia, walking aid, physio, weight loss
what type of prosthetics are there and when are they used
hybrid (uncemented cup and cemented cone, young), cemented (cemented cup + cone, elderl), uncemented
why should you delay THR in young patients as long as possible
as need revision surgery later, more wear and tear than elderly
what are early complications of THA
infection, dislocation, nerve injury (Sciatic), DVT/ PE, loosening
what are risks of THA
higher complication rates that first time, more blood loss, dont last as long
what is AVN of hip
ischaemia to femoral head (usually idiopathic)
who normally gets AVN of the hip
males 35-50
what are risk factors for AVN (7)
alcohol, steroids, hyperlipidaemia, thrombophillia, trauma, necrosis, chondral fracture
what is presentation of AVN
pain (usually in groin), worse on impact eg stairs, usually unremarkable examination
how do you diagnose AVN
MRI (patchy sclerosis, granulation tissue), x ray, femoral head collapse
how do you treat AVN
bisphosphates, drill holes pre collapse to relieve pressure, THR after collapse
who commonly gets idiopathic transient osteoporosis of the hip (ITOH)
middle aged men, pregnant women
what pathology is associated with ITOH
local hyperaemia, impared venous return, marrow oedema and increased pressure
what are symptoms of ITOH
unilateral progressive groin pain and difficulty bearing weight
how do you diagnose ITOH
MRI (best), x ray, bone scan, bloods: PV/ ESR
how do you manage ITOH
limiting 6-9 months, analgesia, walking aid
what is trochanteric bursitis/ gluteal cuff syndrome
repeated trauma bu iliotibial (IT) band over trochanteric bursa –> tendonitis, tears and bursitis
how does trochanteric bursitis present
pain on lateral hip, pain on palpitation of greater trochanter, pain on abduction
how do you diagnose trochanteric bursitis
clinical - xray if needed
how do you treat trochanteric bursitis
analgesia, NSAIDs, physio, steroid injection (no surgery)
what is femoroacetabular impingement syndrome (FAI)
altered femoral neck and/or acetabulum causing thickening of femoral neck which can damage joint
what types of FAI are there
CAM and pincer type
describe CAM type FAI
femoral deformity, common in young athletic males, asymmetric femoral head, previous SUFE
what is pincer type impingement FAI
acetabular deformity, females - acetabular overhang
what is damaged in FAI
labrum (cartilage between femur and acetabulum)
what are symptoms of FAI
groin pain, esp flexion and rotation, pain sitting, C sign positive, FADIR positive
what investigations are done for FAI
Xray, CT, MRI
what management is there for FAI
surgery to remove/ debride, osteomy, arthroplasty (elderly)
