Hip Conditions Flashcards

1
Q

What are the most common adult hip conditions?

A

Femoro-acetabular impingement syndrome (FAI)
Avascular necrosis
Idiopathic transient osteonecrosis of the hip (ITOH)
Trochanteric bursitis
Osteoarthritis

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2
Q

What is femoroacetabular impingement syndrome?

A

Altered morphology of the femoral neck and/or acetabulum that causes abutment of the femoral neck on the edge of the acetabulum during movement

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3
Q

What is CAM type impingement in femoroacetabular impingement syndrome?

A

Where a femoral deformity causes abutment of the femur on the acetabulum

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4
Q

What is pincer type impingement in femoroacetabular impingement syndrome?

A

Where an acetabular deformity causes abutment of the femur on the acetabulum

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5
Q

What is mixed type impingement in femoroacetabular impingement syndrome?

A

Where both femoral and acetabular deformities cause abutment of the femur on the acetabulum

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6
Q

What does femoroacetabular impingement syndrome lead to?

A

Damage to the labrum and tears
Lamage to cartilage
Osteoarthritis in later life

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7
Q

Who are generally affected by different types of femoroacetabular impingement syndrome?

A

CAM - young athletic males

Pincer - females

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8
Q

How does femoroacetabular impingement syndrome present?

A

Activity related pain in the groin
Pain particularly in flexion and rotation
Difficulty sitting
C sign positive (cupping hand over groin to show where pain is)
FADIR provocation test positive

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9
Q

How is femoroacetabular impingement syndrome diagnosed?

A

Radiographs
CT
MRI

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10
Q

What is the management for femoroacetabular impingement syndrome?

A

Observation if asymptomatic
Arthroscopic or open surgery
Peri-acetabular osteotomy in pincer type
Arthroplasty in older patients with secondary OA

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11
Q

What is avascular necrosis of the femoral head?

A

Failure of the blood supply to the femoral head causing death of bone tissue

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12
Q

What is the pathophysiology of idiopathic AVN of the femoral head?

A

Coagulation of the microcirculation inside bone
Venous thrombosis causes retrograde arterial occlusion
Intraosseous hypertension
Decreased blood flow to femoral head - necrosis
Chondral fracture and collapse

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13
Q

What is the pathophysiology of AVN of the femoral head associated with trauma?

A

Due to injury of femoral head blood supply

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14
Q

What is the main blood supply to the femoral head?

A

Medial femoral circumflex

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15
Q

What are risk factors for avascular necrosis of the femoral head?

A
Irradiation
Trauma
Haematological diseases
Dysbaric disorders
Alcoholism
Steroid use
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16
Q

What is the presentation of avascular necrosis of the femoral head?

A

Insidious onset of groin pain
Majority (80%) bilateral
Exacerbated by starts or impact
Examination is usually normal unless disease has advanced to collapse/OA

17
Q

How is diagnosis done for avascular necrosis of the femoral head?

A

Radiographs (but often normal in early disease)

MRI scan is best

18
Q

What radiographic factors are indicative of reversible avascular necrosis of the femoral head?

A

Normal or cystic or sclerotic changes

19
Q

What radiographic features are indicative of irreversible avascular necrosis of the femoral head?

A
Crescent sign (subchondral collapse)
Flattening of femoral head
Narrowing of joint
20
Q

What is the treatment for reversible avascular necrosis of the femoral head?

A

Bisphosphates
Core decompression
Curettage and bone grafting
Vascularised fibular bone graft

21
Q

What is the treatment for irreversible avascular necrosis of the femoral head?

A

Total hip replacement

22
Q

What is idiopathic transient osteonecrosis of the hip?

A
Local hyperaemia (increased blood flow) and impaired venous return with marrow oedema and increased intramedullary pressure
Self-limiting, resolves after a few months
23
Q

What is the presentation of idiopathic transient osteonecrosis of the hip?

A

Progressive groin pain appearing over several weeks
Difficulty weight bearing
Usually unilateral

24
Q

Who usually present with idiopathic transient osteonecrosis of the hip?

A

Middle aged men

Pregnant women in third trimester

25
Q

How is diagnosis done for idiopathic transient osteonecrosis of the hip?

A

Elevated ESR
Radiographs
MRI (best)
Bone scan

26
Q

What are radiographic signs of idiopathic transient osteonecrosis of the hip?

A

Osteopenia of the head and neck of femur
Thinning or cortices
Preserved joint space
No sclerosis

27
Q

What is the management of idiopathic transient osteonecrosis of the hip?

A

Self-limiting and resolves on its own in 6-9 months
Analgesia
Protected weight bearing to avoid stress fracture

28
Q

What is trochanteric bursitis?

A

Repetitive trauma caused by iliotibial band tracking over trochanteric bursa causing inflammation of the bursa

29
Q

Who generally present with trochanteric bursitis?

A

Females

Young runners and older patients

30
Q

What is the presentation of trochanteric bursitis?

A

Pain and tenderness on lateral aspect of the hip (very characteristic)
Pain on palpation of greater trochanter

31
Q

How is diagnosis done for trochanteric bursitis?

A

Clinical (pain and tenderness on lateral aspect of the hip)

MRI

32
Q

What is the management of trochanteric bursitis?

A

Analgesia
NAIDs
Physio
Steroid injection

33
Q

What is osteoarthritis?

A

Degenerative disease of synovial joints act causes progressive loss of articular cartilage

34
Q

What is the presentation of osteoarthritis?

A
Groin pain
Worse on activity
Pain at night
Start-up pain (pain when they get up for a bit which then lettles)
Stiff on testing ROM
35
Q

What needs to be assessed in osteoarthritis?

A

Level of symptoms and impact on quality of life
Medical comorbidities
Social history
Would the patient like surgery

36
Q

What are the radiographic signs of osteoarthritis?

A

Narrowing of joint space
Subchondral sclerosis
Osteophytes
Cyst formation

37
Q

What is the management for osteoarthritis?

A
Analgesia
Weight loss
Walking aids
Physiotherapy if weakness
Steroid injection in flare up
Total hip arthroplasty
38
Q

What is the indication for a total hip arthroplasty in osteoarthritis?

A

Severe pain

39
Q

What are the benefits and risks of total hip arthroplasty in osteoarthritis?

A

Benefits: pain relief and secondary improvement in function
Risks: bleeding, neuromuscular injury, fracture, clotting, infection, dislocation, leg length discrepancy, loosening