Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal > Adult Hip Conditions and Surgery > Flashcards

Adult Hip Conditions and Surgery Flashcards

1
Q

What occurs in femoroacetabular impingement syndrome (FAI)?

A

Altered morphology of the femoral neck and/or acetabulum

Causes abutment of the femoral neck on the edge of the acetabulum during movement (flexion, adduction, rotation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two types of deformity that can occur in FAI?

A

CAM type impingement and pincer type impingement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some features of CAM impingement in FAI?

A

Femoral deformity = asymmetrical femoral head with decreased head:neck ratio
Usually young athletic males
Can be related to previous SUFE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some features of pincer type deformity in FAI?

A

Acetabular deformity = acetabular overhang

Usually seen in females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can both types of deformities present in FAI lead to?

A

Labrum damage and tears
Cartilage damage
Osteoarthritis in later life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the presentation of FAI?

A

Activity related pain in groin (particularly in flexion and rotation)
Difficulty sitting
C positive sign
FADIR provocation test positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How may FAI be diagnosed?

A

Radiographs, CT, MRI (best for visualising damage to labrum and bony oedema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the management options for FAI?

A

Observation in asymptomatic patients
Arthroscopic or open surgery to remove CAM/debride labral tears
Peri-acetabular osteotomy/debride labral tears in pincer type impingement
Arthroplasty in older patients with secondary OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is avascular necrosis?

A

Failure of the blood supply to the femoral head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes most cases of avascular necrosis?

A

Most are idiopathic in origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What occurs in the pathogenesis of idiopathic avascular necrosis?

A

Coagulation of intraosseous microcirculation
Venous thrombosis causes retrograde arterial occlusion
Intraosseous hypertension reduces blood flow
Necrosis of femoral head causing chondral fracture and collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some features of avascular necrosis?

A

More common in men, typical age is 35-50, 80% of cases are bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes avascular necrosis associated with trauma?

A

Injury to femoral head blood supply (medial femoral circulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some risk factors for avascular necrosis?

A

Irradiation, trauma, haematological disease, hypercoagulable states, dysbaric disorders (Caisson disease), alcoholism, steroid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do patients with avascular necrosis present?

A

Insidious onset groin pain, exacerbated by stairs/ impact, examination usually normal unless disease has progressed to collapse/OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is avascular necrosis diagnosed?

A 
Radiographs = often normal in early disease
MRI = best option
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is avascular necrosis classed?

A 
Reversible = Stage 0-II
Irreversible = Stage III-VI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is reversible avascular necrosis treated?

A

Bisphosphonates
Core decompression +/- bone grafting
Curettage and bone grafting
Vascularised fibular bone graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some treatments for irreversible avascular necrosis?

A

Rotational osteotomy

Total hip replacement

20
Q

What occurs in idiopathic transient osteonecrosis of the hip (ITOH)?

A

Local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure

21
Q

What are the presentations of ITOH?

A

Progressive groin pain over several weeks, difficulty weight bearing, usually unilateral

22
Q

What are some features of ITOH?

A

More common in men overall

Two groups of common patients = middle aged men or pregnant women in the third trimester

23
Q

How do you diagnose ITOH?

A

Elevated ESR
MRI = gold standard
Bone scan
Radiographs = osteopenia of head and neck, thinning of cortices, preserved joint space

24
Q

How is ITOH managed?

A

Self limiting = resolves in 6-9 months

Analgesia and protected weight bearing to avoid stress fracture

25
Q

How does trochanteric bursitis arise?

A

Repetitive trauma caused by iliotibial band tracing over trochanteric bursa = causes inflammation of the bursa

26
Q

Who gets trochanteric bursitis?

A

Female patients, young runners, older patients (may be linked to gluteal cuff syndrome)

27
Q

How does trochanteric bursitis present?

A

Pain on lateral aspect of hip and on palpation of the greater trochanter

28
Q

What are some imaging techniques used to diagnose trochanteric bursitis?

A 
Radiographs = usually unremarkable
MRI = May be visible but not usually needed
29
Q

How is trochanteric bursitis treated?

A

Analgesia, NSAIDs, physio, steroid injection

No proven benefit from surgery

30
Q

What are some pathologies that cause secondary osteoarthritis?

A

DDH, SUFE, septic arthritis, AVN, FAI, trauma

31
Q

What is primary osteoarthritis?

A

Osteoarthritis with no precipitating cause

32
Q

What is osteoarthritis?

A

Degenerative disease of the synovial joints that causes progressive loss of articular cartilage

33
Q

What does inflammatory changes in osteoarthritis cause in the joint?

A

Thickening and tightness

34
Q

What is the epidemiology of osteoarthritis?

A

More common in females, usually older patients, has genetic element, common with pre-existing hip disease

35
Q

How may osteoarthritis present?

A

Groin pain, worse on activity, pain at night, stiff on testing ROM, start up pain

36
Q

What is assessed in a patient with suspected osteoarthritis?

A

Level of symptoms and impact on quality of life
Medical comorbidities
Social history
Does the patient need surgery?

37
Q

What are some features of osteoarthritis radiographs?

A

Joint space narrowing, subchondral sclerosis, osteophytes, cysts

38
Q

What are some treatments for osteoarthritis?

A

Analgesia, weight loss, walking aids, physio if the patient has weakness, steroid injections, total hip arthroplasty

39
Q

What are some things that must be considered when planning osteoarthritis surgery?

A

Centre of rotation (low/high)
Leg length discrepancy
Offset
Canal width

40
Q

What is the indication for a total hip arthroplasty in osteoarthritis, and what are some benefits of the surgery?

A 
Indication = pain
Benefits = pain relief and secondary improvement of function
41
Q

What are some risks associated with total hip arthroplasties?

A

Scarring, bleeding, neurovascular injury, fracture, clotting (DVT/PE), infection, dislocation, leg length discrepancy, loosening, ongoing symtpoms

42
Q

What are the different bearing choices and approaches for total hip arthroplasties?

A

Bearing choices = metal-on-poly, ceramic-on-poly, ceramic-on-ceramic
Approaches = anterior, anterolateral, posterior

43
Q

What are the different choices of prostheses for total hip arthroplasties?

A

Hybrid, cemented and uncemented

44
Q

What are some features of a hybrid prosthesis in a total hip arthroplasty?

A

Uncemented cup = press fit, biological fixation
Cemented stem = cone-in-a-cone
Used in younger patients

45
Q

What are some features of a cemented prosthesis in a total hip arthroplasty?

A

Cemented cup = mechanical lock
Cemented stem = cone-in-a-cone
Bone cement = PMMA, works by interdigitation into bone surface
Used in older patients

Musculoskeletal (57 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions