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633: Human Imaging II > Pelvis and Hip > Flashcards

Pelvis and Hip Flashcards

1
Q

What are the 6 landmarks that designate an intact acetabulum?

A
  • acetabular roof
  • anterior rim
  • posterior rim
  • iliopubic line
  • ilioischial line
  • radiographic teardrop
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2
Q

The iliopubic line represents the _____ column and the ilioischial line represents the _____ column

A

anterior

posterior

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3
Q

What does the anterior lip of the acetabulum represent?

A

The anterior margins of the acetabular cup

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4
Q

What does the posterior lip of the acetabulum represent?

A

The cortical rim of the acetabular cup

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5
Q

What does the acetabular roof represent?

A

The superior cortical aspect of the acetabular cup, which corresponds to the major weight-bearing portion of acetabulum

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6
Q

What is Klein’s line?

A

The line drawn along the lateral femoral neck intersecting the femoral head bilaterally

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7
Q

What is the most common disease affecting the hips?

A

Degenerative joint disease (DJD), aka osteoarthritis

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8
Q

What is the clinical presentation of hip DJD?

A
  • increased pain upon weight-bearing
  • loss of ROM
  • loss of joint congruity
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9
Q

What are the 5 radiographic hallmarks of hip DJD?

A
  • Joint space narrowing
  • Sclerotic subchondral bone
  • Osteophyte formation at joint margins
  • Cyst or pseudocyst formation
  • Migration of femoral head
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10
Q

Cysts associated with hip DJD are the result of what?

A

The degeneration of articular cartilage which results in microfractures in the subchondral bone which permits the intrusion of joint synovial fluid into periarticular bone

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11
Q

Cysts in the acetabulum are called what?

A

Egger’s cysts

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12
Q

In what direction does the femoral head migrate in DJD?

A

superomedial

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13
Q

What are 5 surgical interventions that may be necessary in patients with hip DJD?

A
  • Wedge osteotomy
  • Femoral head and neck resection
  • Hemiarthroplasty
  • Total hip arthroplasty
  • Hip resurfacing
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14
Q

When can hip resurfacing be used over hip arthroplasty?

A

In younger patients with good bone density

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15
Q

What is RheumatoidArthritis?

A

a progressive, systemic, autoimmune inflammatory disease primarily affecting synovial joints

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16
Q

Does RA affect men or women more often?

A

Women, 3 times more

17
Q

When is RA onset most common?

A

In young adulthood

18
Q

What are the 6 clinical features of RA?

A
  • Morning joint stiffness
  • Bilateral and symmetrical swelling of joints
  • Pain and functional disability
  • Rheumatoid nodules
  • Positive rheumatoid factor test
  • Radiographic changes consistent with RA
19
Q

RA of the hip is characterized by what 7 things?

A
  • Osteoporosis of periarticular areas
  • Symmetrical and concentric joint space narrowing
  • Articular erosions located either centrally or peripherally in joint
  • Synovial cysts located within nearby bone
  • Periarticular swelling and joint effusions
  • Axial migration of femoral head
  • Acetabular protrusion
20
Q

Where is osteoporosis seen first in the hip joint?

A

In the femoral head

21
Q

As hip joint spaces narrow in what direction does the femoral head migrate?

A

Axially into the acetabulum, which can cause acetabular protrusion (an expansion of the acetabulum into the pelvis)

22
Q

When do articular erosions become evident?

A

When joint surfaces lose their optimal congruity

  • Spherical shape of femoral head becomes distorted and acetabulum loses its cuplike appearance
23
Q

What is the distinct difference between DJD and RA?

A

RA has minimal or absent reparative processes which means radiographic features such as sclerotic subchondral bone and osteophyte formation (hallmarks of DJD) are not features of RA

24
Q

What are 5 treatment options for RA patients?

A
  • Non-steroidal anti-inflammatories (NSAIDs)
  • Corticosteroids
  • Gold salts
  • Immunosuppressive drugs
  • Rehab to focus on pain relief modalities, splinting, adaptive functional and ambulatory devices, and exercise to promote strength/ROM to minimize deformity
25
Q

What causes AVN of the hip?

A

An interruption of blood supply to the femoral head causing bone tissue death

26
Q

If AVN affects local segments of bone what is it called?

A

osteochondritis dissecans

27
Q

If AVN affects an entire epiphysis in a growing child what is it called?

A

epiphyseal ischemic necrosis

28
Q

Where is the most common location for epiphyseal ischemic necrosis to occur?

A

In the proximal femur

29
Q

What are the 3 categories in which disruption of blood supply to the femoral head is divided?

A
  • Conditions that result in external blood vessel compression or disruption near/within bone such as trauma, infection, or steroid administration
  • Conditions that result in blood vessel occlusion because of thickening of vessel wall such as radiation therapy, systemic lupus erythematosus, or giant cell arteritis
  • Conditions that result in blood vessel blockage from thromboembolic process such as alcoholism, diabetes, or sickle cell disease
30
Q

Epiphyseal ischemic necrosis is aka what?

A

Legg-Calvé-Perthes disease

31
Q

What type of patient is Legg-Calvé-Perthes disease seen predominantly?

A

in young boys with average age around 6 years

32
Q

What is the clinical presentation of Legg-Calvé-Perthes disease?

A

Non-specific dull pain in joint, thigh, or leg

- waddling-type gait may be seen

33
Q

What is one of the earliest radiographic signs of Legg-Calvé-Perthes disease?

A

A radiolucent crescent

34
Q

What does the radiolucent crescent represent?

A

A collapse of necrotic subchondral bone of the femoral head

35
Q

Where does the crescent sign typically appear?

A

Parallel to the superior rim of the femoral head subjacent to the articular surface

36
Q

Because both OA and AVN are both represented with sclerotic lesions how can you tell the difference between the two?

A

AVN has normal preservation of radiographic joint space that are not involved in necrotic processes

37
Q

What is the most appropriate imaging technique to evaluate AVN?

A

MRI or bone scans

38
Q

How are patients with AVN treated?

A
  • Prolonged avoidance of weight-bearing
  • Traction
  • Bracing
  • Casting
  • Exercise

633: Human Imaging II (11 decks)

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