Osteoarthritis of the hip Flashcards
What is osteoarthritis (OA) of the hip?
Osteoarthritis of the hip is the second most common presentation of OA after the knee and accounts for significant morbidity.
What is one of the most common operations performed in the developed world?
Total hip replacement is one of the most common operations performed in the developed world.
What are the risk factors for osteoarthritis of the hip?
Risk factors include increasing age, female gender (twice as common), obesity, and developmental dysplasia of the hip.
What are the features of osteoarthritis of the hip?
Features include a chronic history of groin ache following exercise, relieved by rest, and red flag features such as rest pain, night pain, and morning stiffness > 2 hours.
What is the Oxford Hip Score?
The Oxford Hip Score is widely used to assess the severity of osteoarthritis of the hip.
What does NICE recommend for diagnosing osteoarthritis of the hip?
NICE recommends that if the features are typical, a clinical diagnosis can be made; otherwise, plain x-rays are the first-line investigation.
What are the management options for osteoarthritis of the hip?
Management options include oral analgesia, intra-articular injections for short-term benefit, and total hip replacement as the definitive treatment.
What are some complications of total hip replacement?
Complications include perioperative issues, venous thromboembolism, intraoperative fracture, nerve injury, surgical site infection, leg length discrepancy, and posterior dislocation.
How does posterior dislocation typically present?
It typically presents acutely with a ‘clunk’, pain, and inability to weight bear, with internal rotation and shortening of the affected leg on examination.
What is the most common reason for revision after total hip replacement?
Aseptic loosening is the most common reason for revision after total hip replacement.
What is a potential infection risk after total hip replacement?
Prosthetic joint infection is a potential risk after total hip replacement.
What did NICE update in 2022 regarding osteoarthritis management?
NICE updated its guidelines on the management of osteoarthritis (OA) in 2022.
What should all patients with osteoarthritis be offered?
All patients should be offered help with weight loss, given advice about local muscle strengthening exercises and general aerobic fitness.
What are the first-line analgesics for osteoarthritis?
Topical NSAIDs are first-line analgesics.
For which patients may topical NSAIDs be particularly beneficial?
Topical NSAIDs may be particularly beneficial for patients with OA of the knee or hand.
What is the second-line treatment for osteoarthritis?
The second-line treatment is oral NSAIDs.
What should be co-prescribed with NSAIDs?
A proton pump inhibitor should be co-prescribed with NSAIDs.
When should NSAIDs be avoided?
These drugs should be avoided if the patient takes aspirin.
When does NICE recommend not to offer paracetamol or weak opioids?
NICE recommends not offering paracetamol or weak opioids unless they are only used infrequently for short-term pain relief and all other pharmacological treatments are contraindicated, not tolerated, or ineffective.
What treatments are not recommended for osteoarthritis?
Glucosamine and strong opioids are not recommended.
What non-pharmacological treatment options are available for knee and hip OA?
Non-pharmacological treatment options include walking aids for knee and hip OA.
What may be tried if standard pharmacological treatment is ineffective?
Intra-articular steroid injections may be tried if standard pharmacological treatment is ineffective.
What should patients be aware of regarding intra-articular steroid injections?
Patients should be aware that they only provide short-term relief (2-10 weeks).
What should be considered if conservative methods fail?
If conservative methods fail, then refer for consideration of joint replacement.
