Othropaedic Hip Conditions Flashcards
What 3 bones make up the pelvis?
Ischium, ileum, pubis
What does the head of the femur articulate with?
The acetabulum
What muscles attach to the greater trochanter?
Abductors and rotators
What muscles attach to the lesser trochanter?
Psoas
What is the labrum?
Fibrocartilagious lining of acetabulum
What is the purpose of the labrum?
Deepen socket,
Adds stability
Blood supply of pelvis and femur?
Profunda femoris- medial and lateral circumflex arteries,
Ligamentum teres artery
How many branches does the medial femoral circumflex artery have?
2 branches
How many branches does the lateral femoral circumflex artery have?
3 branches
Difference between a intracapsular and extracapsular fracture?
In a intracapsulr fracture the blood supply is disrupted
What is osteoarthritis?
Degenerative changes of synovial joints,
There is progressive loss of articular cartilage and secondary bony changes
What is trochanteric bursitis?
Inflammation of the trochanteric bursa
Causes of trochanteric bursitis?
Trauma,
Overuse (eg athletes)
Abnormal movements (eg distant problem- scoliosis or local problem- OA, total hip replacement)
Trochanteric bursitis presentation?
Lateral hip pain and tenderness,
Tenderness at greater tuberosity,
Worse pain in active abduction
Trochanteric bursitis investigations?
Xray,
MRI,
US
Trochanteric bursitis treatments?
NSAIDs, Rest, Activity modification, Physiotherapy, Corticosteroids injection, Bursectomy
Define avascular necrosis?
Death of bone due to loss of blood supply
Trauma risk factors of avascular necrosis?
Irradiation,
Fracture,
Dislocation,
Iatrogenic
Systemic risk factors of avascular necrosis?
Idiopathic, Hypercoaguable states, Steroids, Sickle cell disease, Lymphoma, Leukaemia, Caisson’s disease, Alcoholism
Idiopathic avascular necrosis pathoanatomic cascade?
Coagulation of intraosseous microcirculation, Venous thrombosis, Retrograde arterial occlusion, Intraosseous hypertension, Reduced blood flow, Cell death, Chondral fracture and collapse
Avascular necrosis symptoms?
Insidious onset of groin pain, Pain with stairs, walking uphill, impact activities, Limp, Reduced ROM, Stiff joint
Treatment of avascular necrosis ?
Reduce weight bearing, NSAIDs, Bisphosphonates, Anticoagulants, Physiotherapy, Core decompression, Vascularised graft, Rotational osteotomy, Total hip replacement
What is femoroacetabular impingement?
Impingement of femoral neck against anterior edge of acetabulum
The 2 categories of femoracetabular impingement?
Cam lesion,
Pincer
FAI pincer define
Abutment of lesion on edge of acetabulum
In FAI pincer there is an abnormal acetabulum which can lead to?
Anterosuperior acetabular rim overhang,
Acetabular protrusion
Femoracetabular impingement presentation?
Groin pain,
Groin pain worse with flexion,
Pain with certain manoeuvres
Associated injuries with femoroacetabular impingement
Labral degeneration and tears,
Cartilage damage and flap tears,
2ndary hip osteoarthritis
Expected findings of Femoracetabular impingement on examination
Reduced flexion,
Reduced internal rotation,
Positive FADIR test (flexion ADduction Internal Rotation_
Investigations of FAI
Xray,
MRI
FAI non-operative treatment?
NSAIDs,
Activity modification,
Physiotherapy
Operative treatment of FAI
Arthroscopy,
Resection,
Periacetabular osteotomy,
Hip arthroplasty
Causes of labral tears?
FAI, Trauma, OA, Dysplasia, Collagen diseases
Presentation of labral tears
Groin or hip pain,
Snapping sensation,
Jamming or locking
Examination findings of labral tear?
Positive FABER test (Flexion ABduction External Rotation)
What gives a positive FABER test?
Labral tear
What gives a positive FADIR test?
Femoracetabular impingement
Investigations of labral tear?
Xray,
MRI arthrogram
Treatment of labral tear?
Activity modification, NSAIDs, Physiotherapy, Steroid injection, Arthroscopy
