Pathophysiology of the Hip

Question 1

Anteversion

Answer 1

Femoral head faces anterior in the acetabulum

Question 2

The hip is the….

Answer 2

Largest weight bearing joint in the body

Question 3

Someone with excessive anteversion will..

Answer 3

Walk with excessive internal rotation

Question 4

Orientation of acetabulum

Answer 4

Lateral
Slightly inferior
Slightly anterior

Question 5

Angle of inclination of the femur

Answer 5

125 degrees is normal
Less than 125 degrees is coxa vera
-More shear forces
More than 125 degrees is coxa valga
-More compression forces

Question 6

Angle of torsion

Answer 6

Anteversion or retroversion

Question 7

Adult pathophysiologies of the hip

Answer 7

Degenerative Joint disease
Hip fracture
Traumatic dislocation
Avascular necrosis of the femoral head
Bursitis

Question 8

Osteochondritis can be a cause of..

Answer 8

Atraumatic hip fracture

Question 9

Percentage of falls resulting in hip fracture

Answer 9

5%

Question 10

One of every ___ white women will have a hip fx in their lifetime

Answer 10

6

90% occur in persons 65 or older

Question 11

Hip fx prognosis

Answer 11

Approximately 4% of people die after a hip fracture because of:
-Complications
-Surgical treatment
-Immobilization consequences
25% over 64 years old die within 1 year
10% over 64 years old become functionally dependent

Question 12

Hip fracture zone of weakness

Answer 12

Bottom of the neck of the femur

Question 13

Types of hip fracture

Answer 13

Femoral shaft fracture
Intertrochanteric (Extra-capsular)
Femoral neck fracture (Intracapsular)

Question 14

Femoral Neck fracture

Answer 14

Difficult to manage
Most common >60 years old
Females more than men

Question 15

Garden’s classification of intracapsular fractures of femoral neck

Answer 15

Type I: Incomplete
Type II: Complete but undisplaced
Type III: Partially displaced
Type IV: Completely displaced

Question 16

Type III and IV Garden fractures of femoral neck have high rates of…

Answer 16

Avascular necrosis of the femoral head

Question 17

Do hip fracture undershorts work?

Answer 17

No

Question 18

Hip Bursitis Pathology

Answer 18

Inflammation of the bursa

Question 19

Hip Bursitis Etiology

Answer 19

• Direct blow or impact in area of greater trochanter

- Friction due to overuse

Question 20

Hip bursitis clinical picture

Answer 20

Pain on the outside of the hip

• May worsen with activity
• Pain upon palpation of greater trochanter
• Intense pain and swelling near greater trochanter
• Pain that travels down the thigh at night

Question 21

Hip Bursitis Medical Management

Answer 21

Rest
Aspiration of the bursa
Anti-Inflammatory medication
Steroid injection + Rest
Orthotics

Question 22

Traumatic Dislocation

Answer 22

Can dislocate anterior or posteriorly
-Most common posteriorly
MOI
-Dashboard injury
-Fall onto flexed knee

Question 23

Avascular necrosis of femoral head

Answer 23

Blood supply to the femoral head and neck is compromised

-May be a tear of the ligamentum teres

Question 24

Congenital Pathophysiology of the hip

Answer 24

• Developmental dysplasia
• Congenital Hip Dislocation, Infantile hip dislocation, Congenital dislocation of the hip
• Slipped femoral Capital epiphysis
• Legg-Perthes disease

Question 25

Congenital Dislocation incidence

Answer 25

.25-.85% of newborns
Males 8 times more likely
Most unilateral; usually on the left

Question 26

Congenital Dislocation Etiology

Answer 26

Perinatal or post natal
Ligamentous laxity of joint capsule
Breech presentation at birth

Question 27

Congenital Dislocation clinical picture

Answer 27

Most stabilize in the first 2 months

Cannot predict who would and would not stabilize

Question 28

CHD Physical signs

Answer 28

Assymetry in ROM, gluteal folds, thigh folds
Leg length discrepency
Trendelenburg
Flexion contractures

Question 29

Developmental Dysplasia of the hip

Answer 29

Children w/ spasticity:

• IS pulls down and adductors initiate force
• Medial joint capsule compressed and femoral head pushed lateral
• IS insertion becomes COM
• Femoral head displaces completely laterally and dislocates posteriorly with further hip flexion

Question 30

Slipped femoral capital epiphysis description

Answer 30

Unusual disorder of adolescent hip characterized by a posterior slippage of the head of the femur

Question 31

Slipped femoral capital epiphysis etiology

Answer 31

Weakness of the growth plate, may occur shortly after puberty

Question 32

Slipped femoral capital epiphysis clinical picture

Answer 32

X rays confirm diagnosis

-Antalgic gait, reluctance to weight bear

Question 33

Slipped femoral capital epiphysis treatment

Answer 33

ORIF

Question 34

Legg-Calve-Perthes disease

Answer 34

Osteochondrosis of femoral head

• Epiphyseal aseptic necrosis of the head of the femur
• slipped capital epiphysis

Question 35

Leg-Calve-Perthes disease etiology

Answer 35

Unknown and insidious onset
1/1200 children between age 3-12
Primarily affects white males (4x more)

Question 36

Pathophysiology of Leg-Calve-Perthes disease

Answer 36

Predictable, self-limiting course during 12-36 month period
Lack of blood to femoral head leads to aseptic necrosis w/ softening and resorption of bone
Revascularization results in reossification
Four stages

Question 37

Four stages of Leg-Calve-Perthes disease

Answer 37

Synovitis
Avascular
Resorption
Regeneration

Question 38

Impairments related to Legg-Calve-Perthes disease

Answer 38

• Pain in groin, thigh and knee, especially with walking and running
• Antalgic gait
• Decreased ROM and atrophy of gluteal and thigh muscles

Question 39

Clinical implications of legg-calve-perthes disease

Answer 39

• Femoral head may become flattened
• Resolves with little hip deformity if treated appropriately
• Goal is to limit deformity by preventing stress on femoral head and keeping it within the joint capsule
• Utilize A frame, hip spica, abduction

Question 40

Differential diagnosis

Answer 40

Past medical or surgical hx
Diagnostic imaging
Night pain
Sequence of diagnostic movements