Pathophysiology of the Hip Flashcards by Sam Rugg

Anteversion

Femoral head faces anterior in the acetabulum

How well did you know this?

Not at all

Perfectly

The hip is the….

Largest weight bearing joint in the body

How well did you know this?

Not at all

Perfectly

Someone with excessive anteversion will..

Walk with excessive internal rotation

How well did you know this?

Not at all

Perfectly

Orientation of acetabulum

Lateral
Slightly inferior
Slightly anterior

How well did you know this?

Not at all

Perfectly

Angle of inclination of the femur

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

How well did you know this?

Not at all

Perfectly

Angle of torsion

Anteversion or retroversion

How well did you know this?

Not at all

Perfectly

Adult pathophysiologies of the hip

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

How well did you know this?

Not at all

Perfectly

Osteochondritis can be a cause of..

Atraumatic hip fracture

How well did you know this?

Not at all

Perfectly

Percentage of falls resulting in hip fracture

How well did you know this?

Not at all

Perfectly

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

90% occur in persons 65 or older

How well did you know this?

Not at all

Perfectly

Hip fx prognosis

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

How well did you know this?

Not at all

Perfectly

Hip fracture zone of weakness

Bottom of the neck of the femur

How well did you know this?

Not at all

Perfectly

Types of hip fracture

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

How well did you know this?

Not at all

Perfectly

Femoral Neck fracture

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

How well did you know this?

Not at all

Perfectly

Garden’s classification of intracapsular fractures of femoral neck

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

How well did you know this?

Not at all

Perfectly

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

Avascular necrosis of the femoral head

How well did you know this?

Not at all

Perfectly

Do hip fracture undershorts work?

Hip Bursitis Pathology

Inflammation of the bursa

Hip Bursitis Etiology

Direct blow or impact in area of greater trochanter

- Friction due to overuse

Hip bursitis clinical picture

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

Hip Bursitis Medical Management

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

Traumatic Dislocation

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

Avascular necrosis of femoral head

Blood supply to the femoral head and neck is compromised

-May be a tear of the ligamentum teres

Congenital Pathophysiology of the hip

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

Congenital Dislocation incidence

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

Congenital Dislocation Etiology

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

Congenital Dislocation clinical picture

Most stabilize in the first 2 months | Cannot predict who would and would not stabilize

CHD Physical signs

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

Developmental Dysplasia of the hip

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

Slipped femoral capital epiphysis description

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

Slipped femoral capital epiphysis etiology

Weakness of the growth plate, may occur shortly after puberty

Slipped femoral capital epiphysis clinical picture

X rays confirm diagnosis | -Antalgic gait, reluctance to weight bear

Slipped femoral capital epiphysis treatment

ORIF

Legg-Calve-Perthes disease

Osteochondrosis of femoral head - Epiphyseal aseptic necrosis of the head of the femur - slipped capital epiphysis

Leg-Calve-Perthes disease etiology

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

Pathophysiology of Leg-Calve-Perthes disease

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

Four stages of Leg-Calve-Perthes disease

Synovitis Avascular Resorption Regeneration

Impairments related to Legg-Calve-Perthes disease

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

Clinical implications of legg-calve-perthes disease

- 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

Differential diagnosis

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