Orthopedic hip conditions

Question 1

What conditions are considered?

Answer 1

• OA
• Trochanteric bursitis
• Avascular necrosis
• Femoacetabular impingement
• Labral tear

Question 2

What is Trocanteric bursitis?

Answer 2

Inflammation of the trochanteric bursa

Question 3

What is the aetiology of Trochanteric bursitis?

Answer 3

1- Trauma
2- Over-use
-Athletes, often runners
-Repetitive movements

3- Abnormal movements
-Distant problem
•	e.g. Scoliosis
- Local problem
•Muscle wasting following surgery
•Total Hip Replacement
•Osteoarthritis

Question 4

Presentation of Trocanteric bursitis?

Answer 4

Pain in lateral hip and tenderness at greater trochanter

Worst pain at abduction

Question 5

Investigations of trochanteric bursitis

Answer 5

• XRAY
• MRI
• Ultrasound

Question 6

Treatment of Trocanteric bursitis

Answer 6

-NSAIDs
-Relative rest/ activity modification
-Physiotherapy :
•Correct posture
•Stretching
•Strengthen muscles around joints
-Injection of corticosteroids
-Surgery: Bursectomy

Question 7

What Is avascular necrosis

Answer 7

Death of bone due to reduced blood supply

Question 8

Risk factors for Avascular necrosis

Answer 8

1- trauma

• irradiation
• fracture
• dislocation
• iatrogenic

2- Systemic

• Idiopathic
• Hypercoagulable state
• Steroids
• Haematological e.g. lymphoma
• Caisson’s disease
• Alcoholism

Question 9

Presentation of Avascular necrosis

Answer 9

• Sudden onset of groin pain
• Pain with stairs/ walking uphill
• Limp

Question 10

Treatment of avascular necrosis

Answer 10

-Non-operative: 
•	Reduce weight bearing 
•	NSAIDs 
•	Bisphosphonates 
•	Anticoagulants 
•	Physio 

• Surgical
  • Restore blood supply
   Core decompression
   Core decompression and vascularised graft
  • Move the lesion away from the weight bearing area
   Rotational osteotomy
  • Total hip replacement

Question 11

What is a femoacetabular impingement?

Answer 11

A condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.

Question 12

What are the two broad categories of impingements?

Answer 12

CAM: femoral based impingement
-Usually in athletic males
PINCER: acetabulum based impingement
-Usually in athletic females

Question 13

Presentation of impingement

Answer 13

• Groin pain which gets worse with flexion
• Blocked movement
• Pain with certain movements e.g. getting out of a chair, squatting, lunging
• Positive Fadir test

Question 14

Investigation of impingement

Answer 14

XRAT
MRI
FADIR TEST: flexion, Adduction, internal rotation.

Question 15

What is an impingement associated with?

Answer 15

• Labral tears and degeneration
• Cartilage damage and flap tears
• Secondary hip conditions

Question 16

Treatment for impingement?

Answer 16

Non operative:

• Activity modification
• NSAIDs
• physiotherapy

Operative

• Anthroscopy : shave down the defect, deal with labral tears, resect artic cartilage flaps
• Open surgery : resection, periacetabular osteotomy, hip arthroplasty.

Question 17

What is a labral tear?

Answer 17

tear to the labrum- the soft tissue which covers the acetabulum.

Question 18

Aetiology of a labrum tear?

Answer 18

	FAI
	Trauma
	OA
	Dysplasia
	Collagen diseases – Ehlers-Danlos

Question 19

Presentation of a labrum tear?

Answer 19

• Groin or Hip Pain
• Snapping sensation
• Jamming or locking
• Positive FABER test

Question 20

Investigation of a labrum tear?

Answer 20

-XRAY: OA, dysplasia
-MRI
-Diagnostic injection : local anaestetic to identify site of pain
FABER test

Question 21

Treatment of a labrum tear?

Answer 21

Non-operative: 
-	Activity modification 
-	NSAIDs 
-	Physio
-	Injection of steroids 
Operative
-Arthroscopy: repair and resection

Question 22

What is the most common type of labrum tear?

Answer 22

anterior superior tear.