Othropaedic Hip Conditions

Question 1

What 3 bones make up the pelvis?

Answer 1

Ischium, ileum, pubis

Question 2

What does the head of the femur articulate with?

Answer 2

The acetabulum

Question 3

What muscles attach to the greater trochanter?

Answer 3

Abductors and rotators

Question 4

What muscles attach to the lesser trochanter?

Answer 4

Psoas

Question 5

What is the labrum?

Answer 5

Fibrocartilagious lining of acetabulum

Question 6

What is the purpose of the labrum?

Answer 6

Deepen socket,

Adds stability

Question 7

Blood supply of pelvis and femur?

Answer 7

Profunda femoris- medial and lateral circumflex arteries,

Ligamentum teres artery

Question 8

How many branches does the medial femoral circumflex artery have?

Answer 8

2 branches

Question 9

How many branches does the lateral femoral circumflex artery have?

Answer 9

3 branches

Question 10

Difference between a intracapsular and extracapsular fracture?

Answer 10

In a intracapsulr fracture the blood supply is disrupted

Question 11

What is osteoarthritis?

Answer 11

Degenerative changes of synovial joints,

There is progressive loss of articular cartilage and secondary bony changes

Question 12

What is trochanteric bursitis?

Answer 12

Inflammation of the trochanteric bursa

Question 13

Causes of trochanteric bursitis?

Answer 13

Trauma,
Overuse (eg athletes)
Abnormal movements (eg distant problem- scoliosis or local problem- OA, total hip replacement)

Question 14

Trochanteric bursitis presentation?

Answer 14

Lateral hip pain and tenderness,
Tenderness at greater tuberosity,
Worse pain in active abduction

Question 15

Trochanteric bursitis investigations?

Answer 15

Xray,
MRI,
US

Question 16

Trochanteric bursitis treatments?

Answer 16

NSAIDs, 
Rest, 
Activity modification,
Physiotherapy,
Corticosteroids injection,
Bursectomy

Question 17

Define avascular necrosis?

Answer 17

Death of bone due to loss of blood supply

Question 18

Trauma risk factors of avascular necrosis?

Answer 18

Irradiation,
Fracture,
Dislocation,
Iatrogenic

Question 19

Systemic risk factors of avascular necrosis?

Answer 19

Idiopathic, 
Hypercoaguable states, 
Steroids, 
Sickle cell disease,
Lymphoma, 
Leukaemia,
Caisson’s disease, 
Alcoholism

Question 20

Idiopathic avascular necrosis pathoanatomic cascade?

Answer 20

Coagulation of intraosseous microcirculation, 
Venous thrombosis,
Retrograde arterial occlusion, 
Intraosseous hypertension, 
Reduced blood flow, 
Cell death, 
Chondral fracture and collapse

Question 21

Avascular necrosis symptoms?

Answer 21

Insidious onset of groin pain, 
Pain with stairs, walking uphill, impact activities, 
Limp,
Reduced ROM, 
Stiff joint

Question 22

Treatment of avascular necrosis ?

Answer 22

Reduce weight bearing, 
NSAIDs, 
Bisphosphonates,
Anticoagulants, 
Physiotherapy,
Core decompression, 
Vascularised graft, 
Rotational osteotomy, 
Total hip replacement

Question 23

What is femoroacetabular impingement?

Answer 23

Impingement of femoral neck against anterior edge of acetabulum

Question 24

The 2 categories of femoracetabular impingement?

Answer 24

Cam lesion,

Pincer

Question 25

FAI pincer define

Answer 25

Abutment of lesion on edge of acetabulum

Question 26

In FAI pincer there is an abnormal acetabulum which can lead to?

Answer 26

Anterosuperior acetabular rim overhang, | Acetabular protrusion

Question 27

Femoracetabular impingement presentation?

Answer 27

Groin pain, Groin pain worse with flexion, Pain with certain manoeuvres

Question 28

Associated injuries with femoroacetabular impingement

Answer 28

Labral degeneration and tears, Cartilage damage and flap tears, 2ndary hip osteoarthritis

Question 29

Expected findings of Femoracetabular impingement on examination

Answer 29

Reduced flexion, Reduced internal rotation, Positive FADIR test (flexion ADduction Internal Rotation_

Question 30

Investigations of FAI

Answer 30

Xray, | MRI

Question 31

FAI non-operative treatment?

Answer 31

NSAIDs, Activity modification, Physiotherapy

Question 32

Operative treatment of FAI

Answer 32

Arthroscopy, Resection, Periacetabular osteotomy, Hip arthroplasty

Question 33

Causes of labral tears?

Answer 33

``` FAI, Trauma, OA, Dysplasia, Collagen diseases ```

Question 34

Presentation of labral tears

Answer 34

Groin or hip pain, Snapping sensation, Jamming or locking

Question 35

Examination findings of labral tear?

Answer 35

Positive FABER test (Flexion ABduction External Rotation)

Question 36

What gives a positive FABER test?

Answer 36

Labral tear

Question 37

What gives a positive FADIR test?

Answer 37

Femoracetabular impingement

Question 38

Investigations of labral tear?

Answer 38

Xray, | MRI arthrogram

Question 39

Treatment of labral tear?

Answer 39

``` Activity modification, NSAIDs, Physiotherapy, Steroid injection, Arthroscopy ```