Orthopaedic Hip Conditions

Question 1

Trochanteric Bursa

Answer 1

• Fluid-filled sac
• Sandwiched between hip abductors and ITB

Question 2

Bursitis

Answer 2

• Inflammation of the bursa
• Swelling

Question 3

Trochanteric Bursitis Causes

Answer 3

• Trauma
• Over-use
  
  • Athletes, often runners
  • Repetitive movements
• Abnormal movements
  
  • Distant problem e.g. Scoliosis
• Local problem
  
  • Muscle wasting following surgery
  • Total Hip Replacement
  • Osteoarthritis

Question 4

Trochanteric Bursitis Presentation

Answer 4

• Pain
  
  • Point tenderness
  • Lateral hip

Question 5

Trochanteric Bursitis examination look

Answer 5

• may have scars from previous surgery
• may have muscle wasting
  
  • gluteals

Question 6

Trochanteric Bursitis examination feel

Answer 6

Tenderness at Greater Trochanter

Question 7

Trochanteric Bursitis examination move

Answer 7

worst pain in active abduction

Question 8

Trochanteric Bursitis Investigations

Answer 8

• X-Ray
• MRI
  
  • Shows soft tissues and fluid
• Ultrasound
  
  • Can be therapeutic as well as diagnostic
  • Guided injection

Question 9

Trochanteric Bursitis Treatment

Answer 9

• NSAIDs
• Relative rest / Activity modification
• Physiotherapy
  
  • Correct posture, abnormal movements
  • Stretching
  • Strengthen muscles around joint
• Corticosteroid Injection
• Surgery
  
  • Bursectomy - rarely required

Question 10

Avascular Necrosis Definition

Answer 10

death of bone due to loss of blood supply

Question 11

Avascular necrosis epidemiology

Answer 11

• Males > Females
• Average age 35-50 years old
• 80% = bilateral
  
  • May be offset in time
• 3% = multifocal
  
  • 3 or more joints

Question 12

Avascular Necrosis – Risk Factors

Answer 12

Trauma

• Irradiation
• Fracture
• Dislocation
• Iatrogenic

Systemic

• Idiopathic
• Hypercoaguable states
• Steroids
• Haematological

Question 13

Avascular Necrosis Symptoms

Answer 13

• Insidious onset of groin pain
• Pain with stairs, walking uphill and impact activities
• Limp

Question 14

Avascular necrosis examination

Answer 14

• Largely normal
• May replicate early arthritis
  
  • Reduced range of motion (particularly internal rotation)
  • Stiff joint

Question 15

Avascular Necrosis Non-operative Treatment

Answer 15

• Reduce weight-bearing
• NSAIDs
• Bisphosphonates
  
  • Early AVN
  • controversial
• Anticoagulants
• Physiotherapy
  
  • Maintain range of motion
  • Keep the ball round

Question 16

Avascular necrosis operative treatment

Answer 16

• Restore blood supply
  
  • Core decompression and vascularised graft
• Move the lesion away from the weight-bearing area
  
  • Rotational Osteotomy
• Total Hip Replacement

Question 17

Femoroacetabular Impingement (FAI)

Answer 17

• Results in impingement of femoral neck against anterior edge of acetabulum
• Broadly divided into 2 categories
  
  • Cam lesion
  • Pincer

Question 18

FAI Associated injuries

Answer 18

• labral degeneration and tears
• cartilage damage and flap tears
• secondary hip osteoarthritis

Question 19

FAI presentation

Answer 19

• Groin pain
  
  • Worse with flexion
• Mechanical symptoms
  
  • Block to movement
• Pain with certain manoeuvres
  
  • Getting out of a chair
  • Squatting
  • Lunging

Question 20

FAI examination

Answer 20

• Reduced flexion and internal rotation
• Positive FADIR test -Flexion, ADduction, Internal Rotation

Question 21

FAI Investigations

Answer 21

• X-ray
  
  • Identify the bony pathology
• MRI
  
  • Useful for assessing associated conditions
    
    • Labral tears
    • Articular cartilage damage

Question 22

FAI non-operative treatment

Answer 22

• activity modification
• NSAIDs
• physiotherapy
  
  • correct posture
  • strengthen muscles around joint

Question 23

FAI operative treatment

Answer 23

• Arthroscopy
  
  • Shave down the defect
  • Deal with labral tears
  • Resect artic cartilage flaps
• Open Surgery
  
  • Resection
  • Periacetabular Osteotomy
  • Hip Arthroplasty

Question 24

Labral Tear Causes

Answer 24

• FAI
• Trauma
• OA
• Dysplasia
• Collagen diseases - Ehlers-Danlos

Question 25

Labral Tear Presentation

Answer 25

• Groin or Hip Pain
• Snapping sensation
• Jamming or locking

Question 26

Labral tear examination

Answer 26

• can be normal
• Positive FABER test -Flexion, ABduction, External Rotation

Question 27

Labral Tear Investigations

Answer 27

• X-ray
• MRI Arthrogram
• Diagnostic injection
  
  • Local anaesthetic

Question 28

Labral Tear - Treatment

Answer 28

Non-Operative

• Activity modification, NSAIDs, Physiotherapy
• Injection of Steroids

Operative

• Arthroscopy
  
  • Repair
  • Resection