Patient Presentation - Hip Flashcards
what are the roles of the GP in presentation of hip pain?
history physical exam investigations options of diagnosis management
important parts of history?
pain and loss of function are subjective so focus on how the problem affects the individual
components of physical examination of hip?
look (deformity, asymmetry, scars)
feel (swelling, bony landmarks, tenderness heat)
Move (range of movement, stiffness, pain on movement)
how is hip pain investigated?
only X ray if it will affect management (only 38% need x ray)
ESR/viscosity
FBC (infection)
calcium, alkaline phosphatase
radiological features of OA?
loss of joint space
osteophytes
sclerosis
subarticular cyst
how can hip pain be managed?
education weight loss home adaption (occ therapy) walking aids analgesia NSAIDs (short term) physio complementary medicines mobility allowance, blue badge etc surgery = last resort
what factors affect whether or not to refer a patient?
pain level (night?) loss of function physical fitness mental fitness support at home patient expectations age of patient uncertain about diagnosis balance between benefit and risk basically
list 5 common causes of hip pain
OA rheumatoid arthritis and other arthritides (e.g ankylosing spondylitis) fracture referred from back malignancy
list 4 rarer causes of hip pain
soft tissue (bursitis, snapped ilio-psoas tendon)
pagets disease
infection (septic etc)
avascular necrosis
how is an infection within a hip replacement managed?
if < 3 months, can do a washout
if after 3 months need to remove the hip and leave it out for up to 6 months
total vs semi hip replacement?
total = replace acetabulum and femoral head? semi = ?
how is the acetabulum replaced?
acetabulum grinded down with cheese grater like ball
cement or non-cemented cup inserted into the hole
how is the femoral head replaced?
cut at the femoral neck
canal created by removing bone marrow from middle and femoral stem (cemented or non-cemented) inserted into the canal
cemented vs non-cemented stem?
cemented = can see the cement around it un-cemented = closer to the surrounding bone, no line of cement around/beneath it
risk with un-cemented stem?
splintering of the femur as its just wedged in
