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MSK lectures > Adult Hip conditions - 26/10/18 > Flashcards

Adult Hip conditions - 26/10/18 Flashcards

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1
Q

What is the VITAMIN acronym for what causes things?

A 
Vascular
Infective/Inflammatory
Traumatic
Autoimmune
Metabolic
Iatrogenic/idiopathic
Neoplastic
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2
Q

What are the three layers of the femoral head?

A

Hyaline articular cartilage
Subchondral bone
Cancellous bone

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3
Q

What is femeroacetabular inpingement syndrome?

A

Altered morphology of the femoral neck or acetabular
Causes abutment of the meoral neck on the edge of the acetabulum during movement
Fledxion adduction and intenal rotation

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4
Q

what s CAM type impingement?

A

Femoral deformity

Assymetic femoral head with decreased head:neck ratio

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5
Q

Who gets CAM impingement?

A

Usually young males

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6
Q

What can CAM impingement be related to?

A

SUFE

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7
Q

What is Pincer type impingement?

A

Acetabular deformity

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8
Q

Who gets pincer type impingement?

A

Usually seen in females

Acetabular overhang

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9
Q

What do CAM and Pincer impingement cause?

A

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

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10
Q

What do patients with FAI present with?

A 
Activity related pain in the groin
Particular in flexion and rotation
Difficulty sitting
C sign positive
FADIR provocation test +ve
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11
Q

How are FAIs diagnosed?

A

Radiographs
CT
MRI

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12
Q

How is FAI managed?

A

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

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13
Q

What causes Avascular necrosis (AVN)?

A

Failure of blood supply to the femoral head

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14
Q

What is the pathophysiology of AVN?

A

Idiopathic AVN
-Coagulation of the intraosseous microcirculation
-venous thrombosis causes retrograde arterial occlusion
-Intraosseous hypertension
-Decreased blood flow to femoral head
-Necrosis of femoral head
-chondral fracture and collapse
AVN associated with trauma
-Due to injury of the femoral head blood supply

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15
Q

Who gets AVN?

A

Males>Female
35-50
Bilateral

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16
Q

What are the risk factors for AVN?

A 
Irradiation
Trauma
Haematologic diseases, sickle cell, leukaemia etc
Dysbaric disorders
Alcoholism
Steroid use
Idiopathic!
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17
Q

What do patients present with AVN?

A

Insidious onset of groin pain
Exacerbated by stairs or impact
Examination is usually normal unless disease has advances

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18
Q

How is AVN diagnosed?

A

Radiographs -hanging rope sign

MRI is most specific and sensitive

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19
Q

What is the staging for AVN?

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A

Steinberg classification

20
Q

What steinberg stages are reversible?

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A

0,1,2
No permanent changes of the femoral head
Pre-subchondral collapse

21
Q

What steinberg stages are irreversible?

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A

3,4,5,6

Subchondral collapse

22
Q

How are stages 0,1,2 steinberg treated?

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A

Bisphosphonates
core decompression +/- bone grafting
curretage and bone grafting
Vascularised fibular bone graft

23
Q

How are stages 3,4,5 and 6 steinbergs treated?

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A

Rostational osteotomy for small bits

Total hip replacement

24
Q

What is idiopathic transient osteonecrosis of the hip (ITOH)?

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A

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

25
What do ITOH patients present with?
Progressive groin pain over several weeks Difficulty weight bearing Unilateral
26
Who gets ITOH?
Males>Females Middle aged men heavily pregnant women
27
How is ITOH diagnosed?
``` Elevated ESR Radiographs -Osteopaenia of head and neck Thinning of cortices Preserved joint space MRI (golden) Bone scan ```
28
How is ITOH treated?
Self-limiting 6-9 months to resolve analgesia Protected weight bearing to avoid stress fracture
29
What is Trochanteric bursitis?
Repetitive trauma caused by iliotibial band tracking over trochanteric bursa Causes inflammation of the bursa
30
Who gets trochanteric bursitis?
Females Young runners Older patients
31
How does trochanteric bursitis present?
Pain on the lateral aspect of hip | Pain on palpation of greater trochanter
32
How is trochanteric bursitis?
Clinical diagnosis Radiographs usually unremarkable visible on MRI but not usually needed
33
how is trochanteric bursitis treated?
``` Analgesia NSAIDs Physiotherapy Steroid injection No proven benefit from surgery ```
34
What can cause OA?
``` DDH SUFE Septic arthrits AVN FAI Trauma ```
35
What is OA of the hip?
Degenerative disease of the synovial joints that cause progressive loss of articular cartilage Inflammatory changes in the capsule leading to thickening and tightness
36
Who gets OA of the hip?
Females>Males Older age Genetics Pre-existing hip disease
37
What does OA of the hip present with?
``` Groin pain Worse on activity Pain at night Start up pain Stiff on testing ROM ```
38
How is OA assessed?
Level of symptoms and impact on quality of life Medical comorbidities Social history Do they want history
39
How is OA diagnosed?
``` Radiographs Loss of joint space Osteophyte formation Subchondral Cysts Subchondral sclerosis ```
40
How is OA managed?
``` Analgesia Weight loss Walking aids Physiotherapy if weakness identified ?Steroid injections Total hip arthroplasty ```
41
What surgical planning should be done for OA?
``` Centre of rotation -High or Low Leg length Offset - distance between centre of femoral head and the greater trochanter Canal width ```
42
What are the steps in the preparation of a total hip arthropasty?
``` Discussion of management with patients Indication - pain Consent - benefits/risks Approach - Posterior, Anterolateral, Anterior Prosthesis choice - Cemented Uncemented Hybrid Bearing choice - Metal on poly, Ceramic on poly, ceramic on ceramic ```
43
What are the benefits of a total hip arthroplasty?
Pain relief and secondary improvement of function
44
What are the risks of a total hip arthroplasty?
Scar, bleeding, neurovascular injury, fracture, clotting, infection, dislocation, leg length discrepancy, loosening
45
What is a hybrid THA and who is it used in?
``` Uncemented cup Press fit Biological fixation Cemented stem Cone-in-a-cone Younger patients ```
46
What is a cemented THA and who is it used in?
``` Cemented cup Mechanical look Cemented stem Cone-in-a-cone Older patients ```
47
What is bone cement and how does it work?
PMMA | Interdigitation into bone surface

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