Osteoarthritis - Hip

Question 1

Where is pain felt in osteoarthritis of the hip

Answer 1

Groin or anterior thigh. May be referred to the knee

Made worse on walking. Can wake the patient from sleep if severe

Question 2

Where might scars be found on the hip

Answer 2

Lateral and posterior scars

Question 3

What does a positive Trendelenburg test indicate

Answer 3

Hip abductor weakness in the side which the patient is standing on

Question 4

What are some causes of hip abductor weakness

Answer 4

Chronic hip pain
Multiple surgeries
Underlying structural abnormalities - DDH
Neuromuscular diseases - polio

Question 5

What is a positive Trendelenburg lurch

Answer 5

When the patient throws the upper part of the body over the affected hip to compensate for lack of balance

Question 6

What is a Trendelenburg gait

Answer 6

Due to abductor weakness

Presence of a sideways lurch of the trunk to bring the body weight over the affected limb

Question 7

What is an antalgic gait

Answer 7

Due to pain

Decreased stance phase and increased swing phase

Question 8

What would you expect to find when testing leg length of a patient with a fixed aDduction deformity of the hip

Answer 8

The apparent leg length is shorter on the affected side (from xiphisternum to medial malleolus)

Question 9

What would you expect to find when testing leg length of a patient with a fixed aBduction deformity of the hip

Answer 9

The apparent leg length is greater on the affected side

Question 10

What is the degree of expected movement in hip flexion

Answer 10

140

Question 11

What muscle groups are involved in hip flexion

Answer 11

Iliopsoas
Rectus femoris
Tensor fascia lata
Quads

Question 12

What is the degree of expected movement in hip extension

Answer 12

10

Question 13

What muscles are involved in hip extension

Answer 13

Gluteus maximus

Hamstrings

Question 14

What is the degree of expected movement in hip abduction

Answer 14

45

Question 15

What muscles are involved in hip abduction

Answer 15

Gluteus medius and minimus

Question 16

What is the degree of expected movement in hip adduction

Answer 16

30

Question 17

What muscles are involved in hip adduction

Answer 17

Adductors (longus, brevis, magnus)

Question 18

What is the degree of expected movement in internal rotation of the hip

Answer 18

40

Question 19

What muscles are involved in internal rotation of the hip

Answer 19

Gluteus medius and minimus

Iliopsoas

Question 20

What is the degree of expected movement in external rotation of the hip

Answer 20

40

Question 21

What muscles are involved in external rotation of the hip

Answer 21

Gluteus maximus

Question 22

What are the X-ray features of osteoarthritis

Answer 22

LOSS

Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts

Question 23

What are the surgical options for osteoarthritis of the hip

Answer 23

Osteotomy (cutting of the bone)
Arthroplasty (hip resurfacing or hip replacement)
Arthrodesis (artificial induction of joint ossification)

Question 24

What are the indications for total hip replacement

Answer 24

Instability
Severe pain or disability - not relieved by extended course of non-surgical managament
Rest pain or pain with movement
Loss of mobility

Question 25

What are the intraoperative complications of total hip replacement

Answer 25

Fracture of the acetabulum or femur

Question 26

What are the immediate complications of total hip replacement

Answer 26

Dislocation - due to malalignment of the prosthetic components

Question 27

What are the early complications of total hip replacement

Answer 27

DVT and PE
Sciatic nerve palsy - more common in the posterior surgical approach to the hip joint
Infection
Fat embolism syndrome

Question 28

What are the late complications of total hip replacement

Answer 28

Infection
Loosening (septic or aseptic)
Heterotopic ossification (bone formation in an anatomically abnormal site)
Leg length discrepancy
Periprosthetic fractures
Thigh pain

Question 29

How long can you expect a hip prosthesis to last

Answer 29

95% last 10 years (according to NICE guidelines)