orthopaedic hip problems

Question 1

OA hip

Answer 1

degenerative change synovial joints

worsening pain and stiffness affected joints - decreased joint space, worn cartilage, roughbone, osteophytes

Question 2

causes of trochanteric bursitis

Answer 2

trauma

over use e.g. runners
abnormal movements e.g. distal problem - scoliosis

local problem - muscle wasting post-surgery, total hip replacement, OA

Question 3

presentation of trochanteric bursittis

Answer 3

pain - point tenderness, lateral hip

tenderness at greater tuberosity

worse pain in active abduction and passive adduction

Question 4

investigations trochanteric bursitis

Answer 4

x-ray
MRI
USS

Question 5

trochanteric bursitis Rx

Answer 5

NSAIDs- cream, tablets
rest, activity modification
physiotherapy
corticosteroid injection

surgery - bursectomy (rarely needed)

Question 6

avascular necrosis

Answer 6

death of bone due to loss of blood supplies

Question 7

traumatic risk factors for avascular necrosis hip

Answer 7

irradiation
fracture
dislocation
iatrogenic

Question 8

systemic risk factors for avascular necrosis hip

Answer 8

idiopathic
hypercoaguable stress
steroids
heamatological: sickle cell, lymphoma, leukaemia
caisson's disease
alcoholism

Question 9

pathophysiology of avascular necrosis

Answer 9

coagulation of intraosseous microcirculation

venous thrombosis

retrogade arterial occulsion

intraosseous HTN

reduced bloow flow to femur head

cell death

chondral fracture and collapse

Question 10

presentation of avascular necrosis hip

Answer 10

insidious onset groin/thigh pain
pain w stairs, walking uphill, impact activites

reduced ROM
stiff joint

Question 11

imaging avascular necrosis

Answer 11

X-ray

MRI

Question 12

non-operative management avascular necrosis

Answer 12

reduce weight bearing e.g. crutches
NSAIDs
bisphosphonates 
anticoagulants
physiotherapy

Question 13

surgical management avascular necrosis

Answer 13

restore blood supply

move lesion away from weight-bearing area: rotational osteotomy

total hip replacement

Question 14

two types of femoroacetabular imppingement

Answer 14

cam lesion

pincer

Question 15

femoroacetabular impingement

Answer 15

impingement of femoral neck against anterior edge acetabulum

common cause of hip pathology in younger pt and secondary OA

Question 16

cam lesion (femoroacetabular impingement)

Answer 16

femoral based impingement - prob w femoral neck

excess bone leading to aspherical head and decreased heack to neck ratio

abutement of lesion on edge of acetabulum - flexion

Question 17

pincer lesion (femoroacetabular impingement)

Answer 17

acetabulum based impingement

abnormal acetabulum leadng to anteriosuperior actetabular rim overhand (acetabular protrusion)

Question 18

presentation femoroacetabular impingement

Answer 18

groin pain worse w flexion

feel something catching/blocking movement

pain squatting, getting out chair, lunging

reduced flexion and internal rotation

positive FADIR test

Question 19

positive FADIR test

Answer 19

flexion, adduction, internal rotation –> pain

Question 20

non operative Rx femoroacetabular impingement

Answer 20

activity modification
NSAIDs
physiotherapy

Question 21

operative Rx femoroacetabular impingement

Answer 21

arthroscopy

open surgery

Question 22

injuries assoc with femoroacetabular impingement

Answer 22

labral degeneration and tears
cartilage damage and flap tears
secondary hip OA

Question 23

most common labral tear

Answer 23

most commonly anterosuperior treat

Question 24

causes labral tears

Answer 24

FAI
trauma 
OA
dysplasia 
collagen diseases - Ehlers-Danlos

Question 25

presentation labral tear

Answer 25

groin/hip pain
snapping sensation over hip
jammin or locking

positive FABER test in anterior tears

Question 26

positive FABER test

Answer 26

flexion, abduction, external rotation –> pain

Question 27

labral tear investigations

Answer 27

X-ray
MRI arthrogram
diagnostic injection

Question 28

Rx labral tears

Answer 28

activity modification 
NSAIDs
physio 
steroid injection 
arthroscopy