Extra Hip Pathology

Question 1

What are some causes of apparent leg length discrepancy

Answer 1

Defect in the spine:-
Scoliosis

Defect in the pelvis:-
Fixed adduction deformity of the hip (affected leg shorter)
Fixed abduction deformity of the hip (affected leg longer)

Question 2

What are some causes of true leg length discrepancy

Answer 2

Congenital:-
Congenital shortening of the femur or tibia

Developmental:-
Growth plate injury
Infection
Inflammation - juvenile arthritis

Post-traumatic:-
After a fracture heals in a shortened position

Question 3

How can leg length discrepancy be managed

Answer 3

Treatment is generally not needed if discrepancy less than 2cm

Nonsurgical:-
Shoe lift

Surgical:-
Epiphysiodesis - fusion of growth plate to delay growth of long bone (on unaffected leg)
Bone resection - shorten longer leg
Bone lengthening - lengthen shorter leg

Question 4

What is femeroacetabular impingement

Answer 4

Bones of the hip are abnormally shaped, so do not fit together perfectly. They rub against each other and cause damage to the joint.

Usually causes pain in the groin area. Most patients will present between 15-45yrs

Question 5

What is the cause of femeroacetabular impingement

Answer 5

Due to hip bones not forming properly during childhood

Either a pincer bone spur, or a cam bone spur

Question 6

What would you expect to find on history and examination of a patient with femeroacetabular impingement

Answer 6

Pain on:-
Prolonged sitting
Leaning forward
Getting in and out of a car
Pivoting in sport

Pain reproduce on hip:-
Flexion
ADduction
Internal rotation

Question 7

How can you manage a patient with femeroacetabular impingement

Answer 7

Physiotherapy

Arthroscopy

Question 8

What is avascular necrosis of the femoral head

Answer 8

Interruption of blood supply to the bone causing femoral head ischaemia

Question 9

How would a patient with AVN of the femoral head present

Answer 9

Pain, commonly in the groin area, exacerbated with weight bearing and relieved by rest

Question 10

What is the complication of AVN of the femoral head

Answer 10

Leads to osteoarthritis of the hip

Question 11

What are the risk factors for AVN of the femoral head

Answer 11

Injury - hip dislocations, hip fractures
Corticosteroids
Excessive alcohol use
Other medical conditions - sickle cell, myeloproliferative disorders, SLE

Question 12

How do you investigate AVN of the femoral head

Answer 12

X-ray

MRI - most sensitive

Question 13

How do you manage AVN of the femoral head

Answer 13

Non-surgical:-
Analgesia
Reduced weight bearing (avoid/delay surgery)
ROM exercises

Surgical:-
Core decompression (better in earlier stages of disease)
Osteotomy
Bone graft
Arthroplasty