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Surgery Block > Orthopaedics - Hip and Spine > Flashcards

Orthopaedics - Hip and Spine Flashcards

1
Q

Define Osteoarthritis

A

Degenerative joint disease characterised by a loss of articular cartilage, with associated periarticular bone response

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2
Q

What are the findings on an X ray that indicate osteoarthritis?

A
  • Narrowing of joint space
  • Osteophyte formation
  • Subchondral sclerosis
  • Cysts
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3
Q

Which joints are most commonly affected by osteoarthritis?

A

Knee

Hip

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4
Q

What are the systemic risk factors for hip OA?

A

> 45yrs
Women > Men
Genetic link
Vitamin D deficiency

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5
Q

What are the local risk factors for hip OA?

A 
Obesity
History of trauma to hip
Anatomic abnormality 
Myopathy
Joint laxity
Participation in high impact sports
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6
Q

What is the usual presenting complaint of a patient with hip OA?

A
  • Dull aching pain around the hip - can extend up to the knee
  • Pain is aggravated by activity and relieved by rest
  • Joint may feel stiff after a period of immobility
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7
Q

What examination findings may be found on a patient with hip OA?

A
  • Muscle wasting of quads and glutes
  • Reduced power of the hip joint
  • Leg length discrepancy
  • Fixed flexion deformity
  • Antalgic or Trendelenberg gait
  • Crepitus
  • Reduced range of movement
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8
Q

What are the main DDx of hip OA?

A
  • Trochanteric bursitis
  • Gluteus medius tendinopathy
  • Sciatica
  • AVN of femoral head
  • # NOF
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9
Q

What system can be used to classify OA progression?

A 
The Western Ontario and McMaster Universities Arthritis Index (WOMAC)
Combines:
- 5 items for pain (0-20)
- 2 for stiffness (0-8)
- 17 for function (0-68)
To give a total out of 96
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10
Q

What initial management is given for hip OA?

A

Analgesia
Lifestyle modification
Physiotherapy

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11
Q

What surgical intervention can be indicated in hip OA?

A

Hip replacement – total vs hemi arthroplasty

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12
Q

What common post operative complications are there of a hip replacement?

A 
Thromboembolic disease
Bleeding
Dislocation
Infection
Losening of prosthesis
Leg length discrepancy
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13
Q

How long on average are modern hip protheses designed to last for?

A

15-20 years

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14
Q

Which approach for hip replacement surgery has the highest risk of sciatic nerve damage?

A

Posterior approach

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15
Q

Which approach gives full exposure of the acetabulum in hip replacement surgery?

A

Anterolateral approach

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16
Q

Which approaches preserve the abductor mechanism in hip replacement surgery?

A

Posterior and anterior approach - allows for fast rehabilitation

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17
Q

Which approach has the lowest dislocation rate in hip replacement surgery?

A

Anterior approach

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18
Q

What is the one year mortality for a #NOF?

A

30%

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19
Q

Describe the blood supply to the femoral head

A

The majority arrives from the medial femoral circumflex artery (arising from the deep femoral artery)
The blood supply is primarily uni-directional

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20
Q

During early life what additional supply is there to the femoral head?

A

Ligamentum arteriosum (within the ligamentum teres)

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21
Q

What classification system is used to differentiate intracapsular #NOF types? Briefly describe it?

A 
Garden Classification
I = Non displaced + incomplete
II = Complete but non displaced
III = Complete with partial displacement 
IV = Complete and fully displaced
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22
Q

How can a #NOF be classified based on the fracture line?

A

Intracapsular – Subcapital or basovervical

Extracapsular – Intertrochanteric or subtrochanteric

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23
Q

What will a #NOF generally look like on examination? Why is this?

A

Leg is characteristically shortened and externally rotated - pull of short external rotators

24
Q

What movements will be limited in a patient with a #NOF?

A

Patient unable to straight leg raise
Pain on pin rolling the leg
Pain on axial loading

25
Q

What may be a cause of a #NOF to exclude if there is no history of trauma?

A

Pathological fracture

26
Q

Which types of #NOF are best managed by a dynamic hip screw?

A

Intertrochanteric

Basocervical

27
Q

What is the main surgical option for a subcapital #NOF?

A

Hemiarthroplasty

28
Q

When is a cannulated hip screw indicated?

A

Non-displaced + intracapsular #NOF

29
Q

What surgical option may be used for a subtrochanteric #NOF?

A

Intramedullary femoral nail

30
Q

What are the possible immediate postoperative complications of hip surgery?

A

Pain
Bleeding
Leg length discrepancy
Potential NV damage

31
Q

What long term complications are there following surgical repair of a #NOF?

A

Joint dislocation
Aseptic loosening
Peri-prosthetic fracture

32
Q

At what age is the peak onset of cauda equina syndrome?

A

40-50yrs

33
Q

Where does the cauda equina begin?

A

L1

34
Q

What are the most common causes of cauda equina?

A
  • Disc herniation
  • Trauma
  • Neoplasm
  • Infection
  • Chronic spinal inflammation
  • Iatrogenic (eg. haematoma due to anaesthesia)
35
Q

What are the red flag symptoms for cauda equina?

A
  • Bilateral sciatica
  • Severe or progressive bilateral neurological deficit in the legs
  • Urinary or faecal incontinence
  • Saddle anaesthesia
  • Lack of anal tone
36
Q

What should be done as part of the examination in cauda equina syndrome?

A

DRE

Post-void bladder scan

37
Q

How can cauda equina be classified?

A
  1. Cauda equina syndrome with retention
  2. Incomplete cauda equina syndrome
  3. Suspected cauda equina syndrome
38
Q

What are the DDx for cauda equina syndrome?

A
  • Radiculopathy

- Cord compression

39
Q

What is the gold standard investigation for cauda equina?

A

Whole spine MRI

40
Q

What is the management for cauda equina syndrome?

A
  • Early neurosurgical review
  • High dose steroids eg. dexamethasone
  • Surgical decompression
  • Radiotherapy +/- chemo if malignancy is underlying cause
41
Q

Define a radiculopathy

A

Conduction block in the axons of a spinal nerve or its roots, causing an impact on motor axons (leading to weakness) and sensory axons (causing paraesthesia)

42
Q

Distinguish radiculopathy from radicular pain

A

Radiculopathy - state of neurological loss

Radicular pain - pain servicing from damage/irritation of spinal nerve tissue (particularly the dorsal root ganglion)

43
Q

What are common causes of nerve compression?

A
  • Intervertebral disc prolapse
  • Degenerative diseases of the spine
  • Fracture
  • Malignancy
  • Infection
44
Q

What are pseudoradicular pain syndromes?

A

Conditions that do not arise directly from nerve root dysfunction, but cause radiating limb pain in an approximate radicular pattern

45
Q

What are the main differential diagnoses for radicular pain?

A
  • Referred pain
  • Myofascial pain
  • Thoracic outlet syndrome
  • Greater trochanteric bursitis
  • Iliotibial band syndrome
  • Meralgia paraesthetica
  • Piriformis syndrome
46
Q

What symptomatic management can be given for radicular pain?

A
  • WHO analgesic ladder
  • Neuropathic pain meds (eg. Amitriptyline + gabapentin)
  • Benzodiazepines +/- baclofen (for muscle spasms)
  • Physiotherapy
47
Q

What are the main causes of acute spinal cord compression?

A
  • Metastatic
  • Fracture
  • Facet joint dislocation
  • Infective (abscess formation)
  • Disc prolapse
  • Inflammatory conditions eg. RA, Ank spons
  • Degenerative disease (eg. ligament flavum hypertrophy)
48
Q

What are the main clinical features of spinal cord compression?

A
  • Impaired sensation and proprioception at dermatomal levels below
  • Pain (often aggravated by straining)
  • UMN signs
  • Autonomic dysfunction (late stage)
49
Q

What are the main upper motor neurone lesion signs?

A
  • Hypertonia
  • Hyperreflexia (initial flaccidity)
  • Babinski’s sign
  • Clonus
50
Q

What are the main DDx to consider for spinal cord compression?

A
  • Lumbago (lower lumbar pain)
  • Sciatica (lower back pain)
  • Cauda equina syndrome
51
Q

What is the gold standard investigation for suspected spinal cord compression? Within what timescale should this be done?

A

MRI of the spine

  • Within a week if spinal mets suggested
  • Within a day if compression
52
Q

What is the management for spinal cord compression?

A
  • High dose corticosteroids –> improve functional prognosis + PPI (for gastric protection)
  • Immediate referral to neurosurgery + oncology opinion
53
Q

What is the definitive management for metastatic spinal cord compression?

A

Decompression

54
Q

What indicator can be used for prognosis of metastatic spinal cord compression?

A

Mobility state at time of treatment

55
Q

What is the average survival time for metastatic spinal cord compression?

A

6 months after onset (due to often being an advanced stage of disease)

Surgery Block (12 decks)

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