Week 1 Lecture 1

Question 1

Clinical features for osteoarthritis of the hip

Answer 1

• Pain with loading/activity
• Limitation of AROM and PROM (Equal proportion)
• Loss of function
  • Assorted secondary soft tissue effects
  • Deformity in later stages
  • Pain, loss of joint mobility

Question 2

diagnostic methods for OA of hip

Answer 2

(flexed, adducted and ER’d) Open pack position
Minimimised joint compression & congruency

-Associated or secondary effects on muscle length

Gait:
Weak hip abductors
Reduced hip abductor action
Reduced compressive force on hip t/f pain
Compensated trendelenburg leaning COM closer to hip joint

Impingement

Altered EF ( earlier in ROM, pathological)

Physiological ROM loss in CAPSULAR PATTERN
-Loss of IR > extension > abduction > flexion > ER

Reduced PAMS

Question 3

management principles for OA of hip

Answer 3

-Education/advice on joint care
Active restl pacing, pharamacotherapy, holistic management (wght, diet, sleep)

• Restore/maintain joint mobility and alignment
  Passive mobilization, active exercise, aquatic exercise
  Address muscle length impairment
  -Optimise lower quarter muscle performance
  Especially gluteal function and strength
  -Optimise motor patterning
  Can include walking aid prescription
  -Optimise general fitness
  Unloaded CV exercise – cycling, aquarobics

Question 4

outcome measures for OA of hip

Answer 4

• Harris hip score
• Patient specific functional scale
• Walking distance, distance/time or WB’ing time tolerated
  
  • Pain and/or stiffness – Rest and during activity

Question 5

Dynamic factors in hip joint dysfuntion

Answer 5

Result in abnormal engagement between femoral head & acetabulum due to underlying hip morphology & NOT abnormal motion ( during motion of hip)

Common dynamic factors:
Loss of spherity of femoral head (CAM)
Acetabular overcoverage (PINCER)
Femoral retroversion
Femoral varus

Question 6

Static factors in hip joint dsyfunction

Answer 6

Factors which cause abnormal stress & assymetric load B/n femoral head and acetabulum in AXIALLY LOADED POSITION

result of sub optimal congruency b/n femoral head & socket assymetrical wear of chondral surfaces
* does NOT require motion across the hip to be painful

• Developmental dysplasia(underdeveloped acetabulum
  T/f locally elevated contact pressures on AC + static overload > cartilage degeneration.

Question 7

• Describe the aetiology, pathology, methods of diagnosis and clinical features of femoroacetabular impingement (FAI)

Answer 7

Methods of diagnosis: MRI, FABER/FADIR, Athroscopy (gold standard), CT Scan, Plain radiographs
Clinical features FAI:
-Majority (50-60%) with FAI report insidious onset of symptoms (Sx).
-Pain onset following traumatic episode and acute symptoms without a traumatic event are also reported
-Pain is the most common complaint
-groin/anteromedial thigh area is the most common location of pain 81-83%
-Sx also reported in lateral hip, buttock, thigh, and Lx region
-Mechanical symptoms and feelings of instability are also reported
-Sx usually worsen with sports and particular ADLs
-C sign for symptom location

Question 8

Clinical features of femoroacetabular impingement (FAI)

Answer 8

Clinical features FAI:
-Majority (50-60%) with FAI report insidious onset of symptoms (Sx).

-Pain onset following traumatic episode and acute symptoms without a traumatic event are also reported

• Pain is the most common complaint
• groin/anteromedial thigh area is the most common location of pain 81-83%
• Sx also reported in lateral hip, buttock, thigh, and Lx region
• Mechanical symptoms and feelings of instability are also reported
• Sx usually worsen with sports and particular ADLs
• C sign for symptom location

Question 9

Describe the Pathology of FAI/ define

Define the 2 types

Answer 9

Hip pain when Morphological abnormalities with acetabulum and or femur cause abnormal contact between femoral head and acetabulum leading to compression/impingement + potential tearing of the acetabular labrum

CAM impingement – non-spherical head
When abnormally shaped femoral head/neck contacts a normal acetabulum

PINCER impingement – excessive acetabular cover
when abnormally shaped acetabulum contacts a normal femoral head/neck

Question 10

Describe the Pathology of FAI/ define

Define the 2 types

Answer 10

Hip pain when Morphological abnormalities with acetabulum and or femur cause abnormal contact between femoral head and acetabulum leading to compression/impingement + potential tearing of the acetabular labrum

CAM impingement – non-spherical head
When abnormally shaped femoral head/neck contacts a normal acetabulum

PINCER impingement – excessive acetabular cover
when abnormally shaped acetabulum contacts a normal femoral head/neck

Question 11

Developmental deformities that lead to pincer impingements

Answer 11

-Acetabular retroversion
Opening of acetabulum does not face normal anterolateral direction but is inclined more posterolaterally

Crossover/figure 8 sign
Increased risk of focal FAI

Question 12

Define angle of inclination

Answer 12

Angle between shaft axis and NOF axis in frontal/coronal plane

Question 13

Angle of torsion

Answer 13

Angle between NOF axis & femoral condyle axis in a Transverse plane

Question 14

What is normal angle of torsion

Answer 14

approx 15 degrees anteversion

Question 15

What is (excessive) femoral anteversion
Give numerical value

Answer 15

(an angle of torsion) of
greater that 15 degrees anteversion

Distal femur is excessively externally rotate relative to femoral head and neck in transverse plane

Feet (externally rotated) duck feet

Increased functional external rotation and decreased functional internal rotation

Question 16

What is femoral retroversion

Give numerical value

Answer 16

(an angle of torsion)
less than 5 degrees anteversion

Distal femur is excessively internally rotated relative to femoral head & neck in transverse plane

Feet ( internally rotated) pigeon toed

Increased functional internal rotation and decreased functional external rotation

Question 17

Methods of diagnosis of FAI

Answer 17

MRI, FABER/FADIR, Athroscopy (gold standard), CT Scan, Plain radiographs

Question 18

Describe the aetiology of labral tears

Answer 18

Non traumatic 74%
Insideous onset with gradual increasing pain
Due to repetative microtrauma (twisting EOR)

Direct Trauma
Axial loading in flexion

Question 19

What 3 Aetiology groups are

Labral injuries classified into ?

Answer 19

Insideous onset + repetative microtrauma

Pain involving a particular triggering event

• Anterior injuries (hyperextension w external rotation)
• Posterior injuries( axial loading on a flexed hip)

Secondary to developmental dysplasia

Question 20

pathology of hip labral tears

Answer 20

Poor primary blood supply
Anterior labral injuries
- least boney contraints anteriorly
- region subject to most stress
- mechanically weakest

Question 21

methods of diagnosis of hip labral tears

Answer 21

Methods of diagnosis:
 Athroscopy (gold standard)
 MRI
CT Scan ( similar sensitivity)
FABER/FADIR( quadrant) 
 Plain radiographs

Question 22

Clinical features of labral tears in the hip

Answer 22

Anterior hip/groin pain (ant labral tear)

+- trochanteric/gluteal pain ( posterior labral tear)

Deep & sharp(acute) or dull (Chronic)
activity induced or positional eg prolonged sitting

Mechanical signs (click, clunk, catching withactivity ROM)

Trendelenburg gait

            - >2 years duration of symptoms
          	- ROM unrewarding/unremarkable
          	- Provocative tests FABER/FADIR