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MSK > Adult Hip Conditions and Surgery > Flashcards

Adult Hip Conditions and Surgery Flashcards

1
Q

what is the VITAMIN acronym and what does it stand for?

A 
types of causes of disease
V- vascular
I - infective/inflammatory
T - traumatic
A - autoimmune
M - metabolic
I - iatrogenic/idiopathic
N - neoplastic
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2
Q

what are the 3 layers of the femoral head?

A

hyaline cartilage
subchondral bone
cancellous bone

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3
Q

why is damage to hyaline cartilage dangerous?

A

because you cant make more

can form new fibrocartilage but its not as effective

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4
Q

what is femoroacetabular impingement syndrome?

A

altered morphology of femoral head and/or acetabulum

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5
Q

what does FAI cause?

A

abutment of the femoral neck on the edge of the acetabulum during movement - flexion, adduction and internal rotation
damage to labrum and tears
damage to cartilage
OA later in life

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6
Q

what are the 3 types of FAI?

A

CAM impingement
Pincer impingement
Mixed

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7
Q

describe CAM impingement

A

femoral deformity causing asymmetrical femoral head with decreased head to neck ratio

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8
Q

who is CAM impingement more common in?

A

young athletic males

related to previous SUFE

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9
Q

describe pincer impingement

A

acetabular deformity causing acetabular overhang

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10
Q

who does pincer impingement usually affect?

A

females

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11
Q

how does FAI present?

A

activity related pain in groin, esp in flexion and rotation
difficulty sitting
C sign positive
FADIR provocation test positive

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12
Q

how is FAI diagnosed?

A

radiograph
CT
MRI (better for damage to labrum and bony oedema)

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13
Q

how is FAI managed?

A

observed if asymptomatic
if symptomatic
- arthroscopic/open surgery to remove CAM/debide labral tears
- peri-acetabular osteotomy/debride labral tears in pincer impingement
- arthroplasty in older patients with secondary OA
takes around 6 weeks to heal

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14
Q

what is avascular necrosis?

A

failure of the blood supply to the femoral head

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15
Q

how does idiopathic ecrosis occur?

A

idiopathic
- coagulation in intraosseous circulation > venous thrombosis causes retrograde arterial occlusion > intraosseous hypertension (due to back pressure) > decreased blood flow to femoral head > necrosis of femoral head > chondral fracture and collapse

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16
Q

how does trauma cause avascular necrosis?

A

due to injury of femoral head blood supply - medial femoral circumflex

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17
Q

what are the risk factors for avascular necrosis?

A 
males
35-50
irradiation
trauma
haematological disease or hypercoagulable states
dysbaric disease
alcoholism
steroid use
however most are idiopathic
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18
Q

how does avascular necrosis present?

A

insidious onset of groin pain
exacerbated by stairs or impact
normal examination (unless disease advanced to collapse/OA)

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19
Q

how is avascular necrosis diagnosed?

A

radiographs (can be normal in early disease)

MRI scan is best

20
Q

what can be seen in MRI in avascular necrosis?

A

oedema etc

21
Q

what are the 2 overall groups of avascular necrosis?

A 
reversible 
- stages 0-2
- pre-subchondral collapse
irreversible
- stages 3-6
- post-subchondral collapse
22
Q

how is reversible avascular necrosis managed?

A 
bisphosphonates
core decompression +/- bone graft
curettage and bone grafting
vascularised fibular bone graft
rotational osteotomy
23
Q

how is irreversible avascular necrosis managed?

A

total hip replacement

rotational osteotomy

24
Q

what is idiopathic osteonecrosis of the hip (ITOH)?

A

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

25
Q

how does ITOH present?

A

progressive groin pain over several weeks
difficulty weight bearing
unilateral

26
Q

what groups does ITOH affect?

A

pregnant women

middle aged men

27
Q

how is ITOH diagnosed?

A

elevated ESR
radiograph - osteopenia of head and neck, thinning of cortices, preserved joint space
MRI (gold standard)
Bone scan

28
Q

how is ITOH managed?

A

self limiting in 6-9 months
analgesia
protected weight bearing to avoid stress fracture

29
Q

what is trochanteric bursitis?

A

repetitive trauma caused by iliotibial band tracking over trochanteric bursa
causes inflammation of the bursa

30
Q

who is trochanteric bursitis typically seen in?

A 
young active women
- due to shape of pelvis
runners
older patients
can be linked to gluteal cuff syndrome
31
Q

how does trochanteric bursitis present?

A

pain on lateral aspect of hip

pain on palpation of greater trochanter

32
Q

how is trochanteric bursitis diagnosed?

A

clinically

visible on MRI but not usually needed

33
Q

how is trochanteric bursitis managed?

A 
analgesia
NSAIDs
physiotherapy
steroid injection
no surgical benefit
34
Q

what can cause OA?

A

end point for many pathologies

  • DDH
  • SUFE
  • septic arthritis
  • AVN
  • FAI
  • trauma
  • many more
35
Q

is there always a cause for OA?

A

no

can be idiopathic

36
Q

what is OA?

A

degenerative disease of synovial joints that causes progressive loss of articular cartilage
inflammatory changes in capsule lead to thickening and tightness

37
Q

who does OA usually effect?

A

females
older age
genetic
pre-existing hip disease (can cause earlier onset)

38
Q

how does OA of the hip present?

A 
groin pain
worse on activity
pain at night
start up pain
stiff on testing ROM
39
Q

how is OA assessed?

A

level of symptoms and impact on life
comorbidities (can they cope with surgery?)
social history
would they like surgery?

40
Q

how is OA diagnosed?

A

radiographs

  • loss of joint space
  • osteophytes
  • subchondral sclerosis
  • subchondral cysts
41
Q

how is OA managed?

A 
analgesia
weight loss
walking aids
physio if there's weakness
steroid injections in some
total hip arthroplasty
42
Q

what must be considered when planning for total hip arthroplasty?

A

centre of rotation - high or low?
leg length discrepancy
offset (distance between centre of the femoral head and the greater trochanter)
canal width

43
Q

what are the steps in a total hip arthroplasty?

A

discussion with patient (only used for pain, not stiffness etc)
obtain consent by giving benefits and risks
choose approach - anterior, posterior, anterolateral
prosthesis choice - cemented, uncemented, hybrid
bearing choice - metal on poly, ceramic on poly, ceramic on ceramic

44
Q

what are the risks of total hip arthroplasty?

A 
scars
bleeding
NV injury
fracture
clotting
infection
dislocation
leg length discrepancy
loosening
ongoing symptoms
45
Q

what is a hybrid total hip arthroplasty and when is it used?

A 
uncemented cup(biological fixation) with cemented stem (cone in a cone)
used in younger patients
46
Q

what is a cemented total hip arthroplasty and when is it used?

A 
cemented cup (mechanical lock) with cemented stem (cone in a cone)
used in older patients

MSK (66 decks)

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