Osteoarthritis - Hip Flashcards
Where is pain felt in osteoarthritis of the hip
Groin or anterior thigh. May be referred to the knee
Made worse on walking. Can wake the patient from sleep if severe
Where might scars be found on the hip
Lateral and posterior scars
What does a positive Trendelenburg test indicate
Hip abductor weakness in the side which the patient is standing on
What are some causes of hip abductor weakness
Chronic hip pain
Multiple surgeries
Underlying structural abnormalities - DDH
Neuromuscular diseases - polio
What is a positive Trendelenburg lurch
When the patient throws the upper part of the body over the affected hip to compensate for lack of balance
What is a Trendelenburg gait
Due to abductor weakness
Presence of a sideways lurch of the trunk to bring the body weight over the affected limb
What is an antalgic gait
Due to pain
Decreased stance phase and increased swing phase
What would you expect to find when testing leg length of a patient with a fixed aDduction deformity of the hip
The apparent leg length is shorter on the affected side (from xiphisternum to medial malleolus)
What would you expect to find when testing leg length of a patient with a fixed aBduction deformity of the hip
The apparent leg length is greater on the affected side
What is the degree of expected movement in hip flexion
140
What muscle groups are involved in hip flexion
Iliopsoas
Rectus femoris
Tensor fascia lata
Quads
What is the degree of expected movement in hip extension
10
What muscles are involved in hip extension
Gluteus maximus
Hamstrings
What is the degree of expected movement in hip abduction
45
What muscles are involved in hip abduction
Gluteus medius and minimus
What is the degree of expected movement in hip adduction
30
What muscles are involved in hip adduction
Adductors (longus, brevis, magnus)
What is the degree of expected movement in internal rotation of the hip
40
What muscles are involved in internal rotation of the hip
Gluteus medius and minimus
Iliopsoas
What is the degree of expected movement in external rotation of the hip
40
What muscles are involved in external rotation of the hip
Gluteus maximus
What are the X-ray features of osteoarthritis
LOSS
Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts
What are the surgical options for osteoarthritis of the hip
Osteotomy (cutting of the bone)
Arthroplasty (hip resurfacing or hip replacement)
Arthrodesis (artificial induction of joint ossification)
What are the indications for total hip replacement
Instability
Severe pain or disability - not relieved by extended course of non-surgical managament
Rest pain or pain with movement
Loss of mobility
What are the intraoperative complications of total hip replacement
Fracture of the acetabulum or femur
What are the immediate complications of total hip replacement
Dislocation - due to malalignment of the prosthetic components
What are the early complications of total hip replacement
DVT and PE
Sciatic nerve palsy - more common in the posterior surgical approach to the hip joint
Infection
Fat embolism syndrome
What are the late complications of total hip replacement
Infection Loosening (septic or aseptic) Heterotopic ossification (bone formation in an anatomically abnormal site) Leg length discrepancy Periprosthetic fractures Thigh pain
How long can you expect a hip prosthesis to last
95% last 10 years (according to NICE guidelines)
