Adult Hip + Knee Problems Flashcards by S B

what can go wrong in the hip

altered mechanics
block to movement
failure of bone
degeneration
injury

How well did you know this?

Not at all

Perfectly

what can be causes of block to movement

Perthes Disease

How well did you know this?

Not at all

Perfectly

what are the 4 types of hip joint

normal
CAM - high demand more at risk
Pincer - high demand more at risk
Mixed

How well did you know this?

Not at all

Perfectly

what can cause failure of bone

avascular necrosis

How well did you know this?

Not at all

Perfectly

what can be an uncommon complication of RA and Perthes disease

Protrusio acetabuli
intrapelvic displacement of the acetabulum and femoral head, so that the femoral head projects medial to the ischioilial line

How well did you know this?

Not at all

Perfectly

Surgical management of arthritic hip joint

Total Hip Replacement (THR)

How well did you know this?

Not at all

Perfectly

Surgical management of Pethes hip joint

osteotomy

How well did you know this?

Not at all

Perfectly

what are the indications for THR in people over 65 y/o

Reduced walking distance
Pain not controlled by analgesics
Night pain
Impairment of activities of daily living 
Impairment of hobbies

How well did you know this?

Not at all

Perfectly

complications/risks of THR

Blood loss
 DVT / PE
 Nerve damage
 Dislocation
 Medical complications

How well did you know this?

Not at all

Perfectly

what is the history for Trochanteric bursitis

sharp, localised pain

How well did you know this?

Not at all

Perfectly

Tx for Trochanteric bursitis

usually self limiting

treated conservatively +/- injections

How well did you know this?

Not at all

Perfectly

what factors are indicative of referral of hip pain from GP

pain at night
loss of function
age of pain

How well did you know this?

Not at all

Perfectly

common causes of hip pain

OA
RA
AS
Fracture 
Referred from back
Malignancy

How well did you know this?

Not at all

Perfectly

rare causes of hip pain

Soft tissue
Paget’s disease
Infection
AVN

How well did you know this?

Not at all

Perfectly

what is the role of the menisci in the knee

distribute load from convex femoral condyles to relatively flat tibial articular surfaces

How well did you know this?

Not at all

Perfectly

why are medial meniscal tears more common

medial meniscus is fixed whilst lateral meniscus is more mobile
medial meniscus under greater amount of sheer stress

How well did you know this?

Not at all

Perfectly

what are the roles of the ligaments in the knee

MCL resists valgus stress
LCL resists varus stress
ACL resists anterior subluxation of the tibia and internal rotation of the tibia in extension
PCL resists posterior subluxation of the tibia ie anterior subluxation of the femur and hyperextension of the knee

How well did you know this?

Not at all

Perfectly

which is the only ligament we expect to heal

the medial collateral ligament

How well did you know this?

Not at all

Perfectly

what would a rupture of the MCL, ACL and PCL cause separately

MCL rupture - valgus instability
ACL rupture - rotatory instability
PCL rupture - recurrent hyperextension or instability descending stairs

How well did you know this?

Not at all

Perfectly

what does posterolateral corner or multiligament ruptures cause

PL corner - various and rotatory instability

Multi - gross instability

How well did you know this?

Not at all

Perfectly

what are the patterns of meniscal tear

longitudinal - along longitudinal fibres
radial - from the centre (will not heal)
parrot beak - flaps about, folds underneath its self
bucket handle - flicks in and out, catches in inter-condyle notch

How well did you know this?

Not at all

Perfectly

what is a sign of a bucket handle tear

knee cannot go straight

How well did you know this?

Not at all

Perfectly

what causes meniscal tears in younger patients

sporting injury

getting up from squatting position

How well did you know this?

Not at all

Perfectly

what causes meniscal tears in older patients

atraumatic spontaneous degenerate tears

How well did you know this?

Not at all

Perfectly

what are 50% ACL ruptures associated with

meniscal tears

how are meniscal tears investigated

MRI

Tx of meniscal tear issues

limited healing potential | only peripheral 1/3 has blood supply

Tx of meniscal tear

arthroscopic repair in acute peripheral tears in younger patients arthroscopic menisectomy for mechanical symptoms (locking) or failed meniscal repair

what are the signs of a bucket handle tear and Tx

acute locked knee springy block to extension urgent surgery required - arthroscopic repair if that does not work - partial meniscectomy

what can happen if knee remains locked in bucket handle tear

fixed flexion deformity

surgery helps in degenerate tears - true or false

false | steroid injection may help

what are the grades of knee ligament injuries

grade 1 - sprain grade 2 - partial tear grade 3 - complete tear

MCL injury prognosis

usually heals well unless combined with ACL or PCL rupture

Tx for MCL

brace, early motion, physic pain can take several months to settle rarely requires surgery - advancement or reconstruction with tendon graft

ACL function and mechanism for rupture

main stabiliser against internal rotation of tibia | usually sporting injury

Tx for ACL rupture

Physio - to help stabilise knee ACL repair does not work - reconstruction only Autograft - patellar tendon or hamstrings Allograft - achilles Can stick ACL to PCL for stability

rule of 1/3rds for ACL rupture

1/3 compensate and are able to function well 1/3 can avoid instability by avoiding certain activities 1/3 do not compensate and have frequent instability or can’t get back to high impact sport

when is surgery indicated for ACL rupture

rotatory instability not responding to physio return to high intensity sports multiligament reconstruction

surgery can treat pain and prevent arthritis in ACL rupture - true or false

false | does not treat pain or prevent arthritis

what does LCL injury cause

varus and hyperextension | rotatory instability

complication of LCL injury

common peroneal nerve palsy

what does LCL injury often occur in combination with

PCL/ACL injury

Tx of LCL

``` Complete rupture needs urgent repair if early (within 2-3 wks) Later reconstruction (hamstring or other tendon) ```

MOI of PCL rupture

Direct blow to anterior tibia, (Dashboard / Motorbike) or hyperextension injury

what can be seen in a PCL rupture

popliteal knee pain | brusing

isolated PCL rupture common - true or false

false | usually with other injury

complications post PCL rupture

instability -- recurrent hyperextension/feeling unstable when going down stairs

MOI of knee dislocation

high energy injury

complications of knee dislocation

Popliteal artery injury Nerve injury - common peroneal nerve Compartment syndrome

Tx of knee dislocations

emergency reduction recheck neurovascular status vascular surgery if needed multi-ligament reconstruction

MOI of patellar dislocation

rapid turn to direct blow

who is more likely to get patellar dislocation and why

females adolescents ligamentous laxity valgus knee torsional abnormalities

how many get recurrent patellar dislocations

10%

what happens when you fall onto flexed knees with quads contraction

extensor mechanism rupture

risk factors for extensor mechanism rupture

previous tendonitis steroids chronic renal failure drugs e.g. Ciprofloxacin

signs of extensor mechanism rupture

unable to straight leg raise | palpable gap

what type of swelling are ACL and fractures associated with

haemarthrosis - blood, immediately swells

what type of swelling is associated with meniscal or chondral injury

effusion - next day swelling

what does pain on the joint line suggests

meniscal/chondral, generalised haemarthrosis

football injury, twist, pop, haemarthrosis, generalised pain, pain settles after a few days, rotatory instability - injury?

ACL rupture

Getting up from squatting, sudden sharp pain medial joint line, effusion, recurrent medial pain & catching +/- locking

Meniscal tear

what is hyaline cartilage comprised of

water, collagen, proteoglycans and chondrocytes

what do chondrocytes secrete

collagen PGs Enzyme Regulate ECM

how does hyaline cartilage get nutrition

synovial fluid and subchondral bone

what are defects of articular cartilage

trauma - ligament injury, dislocation atraumatic - Osteochondritis dissecans, Osteoarthritis, Inflammatory arthritis

what type of cartilage injuries heal

only full thickness injuries - healing still not perfect

why is healing in cartilage injuries not perfect

healing with fibrocartilage greater friction less wear resistant

what is Osteochondritis dissecans

when An area of the surface of the knee loses its blood supply and cartilage +/- bone can fragment off most common in teens can heal spontaneously

how is Osteochondritis dissecans TX if detachment is seen on MRI

can pin in place with internal fixation

what are cartilage regeneration techniques

Drilling / microfracture - simplest + cheapest Osteochondral autograft or allograft - for larger defects Mosaicplasty MACI – membrane induced autologous chondrocyte implantation

early OA non operative treatments

Weight loss, stick, exercise, analgesics, activity modification Hyaluronic acid injections Steroid injection - acute flare ups

who gets knee replacement

elderly patients with end stage arthritis | TKR lasts 15-20 years

Sx of Osteochondritis dissecans

Pain after exercise Intermittent knee swelling Locking may occur Seen in ages 13-21 commonly

Adult Hip + Knee Problems Flashcards

(73 cards)