Adult Hip Problems

Question 1

What is the VITAMIN acronym for what conditions can cause

Answer 1

V-vascular 
I-infective/inflammatory 
T-traumatic 
A-autoimmune 
M-metabolic 
I-iatrogenic/idiopathic 
N-neoplastic

Question 2

you can make new hyaline cartilage true/false

Answer 2

false

can only make new fibrocartilage

Question 3

what is femoroacetabular impingement syndrome (FAI)

Answer 3

altered morphology of femoral neck and/or acetabular

causes abutment of the femoral neck on the edge of the acetabulum during movement

Question 4

what are the two types of femoroacetabular impingement syndrome

Answer 4

CAM -femoral deformity,

Pincer -acetabular deformity

Question 5

who gets CAM

Answer 5

young athletic males

Question 6

what does a CAM FAI look like

Answer 6

asymmetric femoral head with decreased neck:head ratio

Question 7

what does a pincer FAI look like

Answer 7

acetabular overhang

Question 8

who gets pincer FAIs

Answer 8

females

Question 9

what do FAIs cause

Answer 9

damage to labrum and tears
damage to cartilage
osteoarthritis in later life

Question 10

What do patients with FAI present with

Answer 10

actively related pain in groin particularly in flexion and rotation
difficulty sitting
FADIR provocation test positive

Question 11

what do u use to diagnose FAI

Answer 11

radiographs
CT
MRI

Question 12

Management for CAM FAI

Answer 12

arthroscopic scan or open surgery to remove CAM/debride labral tears

Question 13

Management for pincer FAI

Answer 13

peri-acetabular osteotomy/debride labral tears in pincer impingement

arthroplasty in older patients with secondary OA

Question 14

What is avascular necrosis

Answer 14

failure of blood supply to the femoral head

Question 15

Pathophysiology of idiopathic avascular necrosis

Answer 15

coagulation of intraosseous microcirculation > venous thrombus causing retrograde arterial occlusion> intreaosseous hypertension>decreased blood flow to femoral head>chondral fracture and collapse

Question 16

pathophysiology of AVN associated with trauma

Answer 16

due to injury of femoral head blood supply (medial femoral circumflex)

Question 17

risk factors for AVN

Answer 17

males 
35-50
irradiation 
trauma 
hematologic diseases 
dysbaric disorders alcoholism 
steroid use 
most idiopathic

Question 18

patient presentation with AVN

Answer 18

insidious onset groin pain
exacerbated by stairs or impact
normal examination unless progressed to collapsed

Question 19

how to diagnose AVN

Answer 19

radiography (often normal in early disease)

MRI most sensitive/specific

Question 20

stages of AVN

Answer 20

either reversible (0,1,2) presubchondral collapse or irreversible stage (3,4,5,6) post subchondral collapse

Question 21

management for reversible AVN

Answer 21

biphosphonates 
core decompression +/- bone graft 
curettage and bone grafting 
vascularised fibular bone graft 
rotational osteotomy

Question 22

treatment for irreversible AVN

Answer 22

total hip replacement

Question 23

what is idiopathic transient osteonecrosis of the hip (ITOH)

Answer 23

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

Question 24

how do ITOH patients present

Answer 24

progressive groin pain over several weeks
difficulty weight bearing
usually unilateral

Question 25

who gets ITOH

Answer 25

males>females | 2 groups: middle aged men and pregnant women in 3rd trimester

Question 26

how do u diagnose ITOH

Answer 26

elevated ESR radiographs MRI (gold standard) bone scan

Question 27

Management for ITOH

Answer 27

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

Question 28

what is trochanteric bursitis

Answer 28

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

Question 29

who gets trochanteric bursitis

Answer 29

female patients | young runners and older patients

Question 30

how to patients with trochanteric bursitis present

Answer 30

pain on the LATERAL aspect of the hip | pain on palpation of the greater trochanter

Question 31

how to diagnose trochanteric bursitis

Answer 31

clinical diagnosis (pain when u press on the trochanter) radiographs usually unremarkable visible on MRI but not usually needed

Question 32

how to you manage trochanteric bursisity

Answer 32

``` analgesia NSAIDS physiotherapy steroid injection. no proven benefit from surgery ```

Question 33

what is the endpoint for multiple pathologies in the hip

Answer 33

osteoarthritis

Question 34

Who gets osteoarthritis

Answer 34

females>males typically in older age genetic element pre-existing hip disease

Question 35

how do osteoarthritis patients present

Answer 35

``` GROIN pain worse on activity pain at night start up pain stiff on testing range of movement ```

Question 36

how should you asses patients with osteoarthritis

Answer 36

level of symptoms and impact on quality of life medical comorbidities social history would the patient like surgery

Question 37

how do you diagnose osteoarthritis

Answer 37

with radiographs L- loss of joint space O-osteocytes S-sclerosis S-subchondral cysts

Question 38

management of osteoarthritis

Answer 38

``` analgesia weight loss walking aids physio steroid injections total hip arthroplasty ```

Question 39

things to think about in surgical planning for total hip arthroplasty

Answer 39

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

Question 40

risks for total arthroplasty

Answer 40

scar, bleeding, neuromuscular injury, fracture, clotting, infection, dislocation, length discrepancy, loosening, ongoing symptoms

Question 41

types of prothesis for total arthroplasty

Answer 41

cemented uncemented hybrid

Question 42

bearing choices for arthroplasty

Answer 42

metal on poly ceramic on poly ceramic on ceramic

Question 43

what is a hybrid total hip arthroplasty

Answer 43

uncemented cup (press fit, biological fixation) cemented stem (cone in a cone) used in younger patients

Question 44

what is a cemented total hip arthroplasty

Answer 44

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