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MSK > Clinical Conditions Of The Hip > Flashcards

Clinical Conditions Of The Hip Flashcards

1
Q

What is the fovea?

A

A depression in the femoral head where the ligementum teres attaches

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2
Q

What is significant about the artery of Ligamentum Teres in children?

A

Main blood supply to femoral head

Runs from acetabulum to femoral head

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3
Q

What other blood vessels supply the femoral head with blood?
(Other than ligamentum teres)

A

Medial and lateral femoral circumflex arteries

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4
Q

What are the branches coming off of the circumflex arteries called?

A

Ascending cervical branches or Retinacular arteries

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5
Q

What are the risk factors for primary osteoarthritis?

A

Age
Female
Ethnicity
Nutrition
Genetics

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6
Q

What are the causes of secondary arthritis?

A

Obesity
Trauma
Infection
Inflammatory arthritis (Rheumatoid)
Metabolic disorders affecting the joints (gout)
Haematological disorders

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7
Q

Describe the pathology of osteoarthritis:

A

Excessive loading on joint damages the articular cartilage
Chondrocytes try and replace cartilage (proteoglycans)
Cartilage erodes away and the joint space is reduced

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8
Q

What is Osseous metaplasia of connective tissue?

A

When bony spurs (osteophytes) form on the articular cartilage instead of cartilage usually following osteoarthritis

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9
Q

What does sclerosis mean?
How does it appear on an xray?

A

Abnormal hardening or thickening of tissue

Whiter region on xray

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10
Q

Why can sclerosis happen in an arthritic hip?

A

As the bone is remodelled it can be made thicker

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11
Q

What are the symptoms of osteoarthritis of the hip?

A

Stiffness
Very painful
Crepitus

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12
Q

What is Crepitus?

A

A sound or feeling (crunching) of bone rubbing against bone (grinding)

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13
Q

What is the Trendelenburg sign/gait?

A

A examination done to evaluate hip stability

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14
Q

If a patient has a suspected right arthritic hip, describe how you would examine them and what you would see (Trendelenburg sign)?

A

Get them to lift their left leg off the ground
If they have a right arthritic hip, their right hip will raise up causing an uneven pelvis (right Trendelenburg sign)

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15
Q

What non operative managements are there for Osteoarthritis of the hip?

A

Activity modification
Weight loss
Walking sticks
Physiotherapy
Medication
Injections

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16
Q

What medications can be give for osteoarthritis of the hip?

A

Analgesics
NSAIDs
COX-2 inhibitors

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17
Q

What injections are given in patients with osteoarthritis?

A

Corticosteroids to reduce inflammation

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18
Q

What surgical procedures are done to treat osteoarthritic hips?

A

Hip replacement

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19
Q

What is the goal of hip replacement surgery?

A

Reduce pain
Improve patient wellbeing
Implants replace the damaged surfaces

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20
Q

Where do intracapsular hip fractures occur?

A

The neck of the femur

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21
Q

Where do extracapsular fractures of the hip occur?

A

In the region of the greater trochanter and just underneath this region before the femoral shaft

22
Q

Which type of fracture usually leads to Avascular necrosis of the femoral head?

A

Intracapsular fractures

23
Q

What is the rule of thirds (1/3s) when it comes to repairing an intracapsular fracture?

A

If it is repaired
1/3 of cases heal
1/3 get Avascular necrosis of the femoral head
1/3 never heal

24
Q

Why does Avascular necrosis tend to follow an intracapsular fracture?

A

Retinacular arteries/ascending cervical branches disrupted by fracture
Blood supply from artery of ligamentum teres not sufficient to supply femoral head

25
Q

What are the signs of a hip fracture?

A

Leg shortened
Leg externally rotated

26
Q

Why does the leg get shortened in a hip fracture?

A

Rectus femoris and adductor Magnus pull leg up

27
Q

Why does the leg get externally rotated in a hip fracture?

A

Gluteus maximus
Piriformis
Superior and inferior gomellus
Obturator internus
Quadratus femoris
All Externally rotate leg

28
Q

Why do extracapuslar fractures reliably heal but intracapsular fractures do not?

A

Extracapuslar fractures do not have an interruption to the blood supply of the femoral head whereas intracapsular fractures do

29
Q

What type of surgery is performed to an undisplaced intracapsular fracture?

A

Immobilise/fix in place

(Cannulated screws through the femoral head)

30
Q

How can extracapsular fracture surgeries be done?

A

With pin and plate or nail
(Irrelevant)

31
Q

What is hemiarthroplasty?

A

When only the femoral head sides the joint is replaced

32
Q

What happens in a total hip replacement?

A

Both sides of the joint are replaced (femoral head and acetabula’s cup)

33
Q

What can cause Avascular necrosis?

A

Broken hip (mechanical disruption)
Alcoholism
Steroid use
Thrombosis
Hypertension

34
Q

What does idiopathic mean?

A

Unknown cause

35
Q

What are the 3 types of hip dislocation?

A

Posterior
Anterior
Central

36
Q

Which is the most common type of hip dislocation?

A

Posterior dislocation

37
Q

Why is posterior dislocation most common with hip dislocations?

A

The ischiofemoral ligament is the weakest ligament and its the only ligament supporting the posterior part of the hip

38
Q

Upon physical examination, how does a posterior dislocation present?

A

Shortened
Internally rotated
Flexed
Adducted

39
Q

How can a posterior dislocation cause sciatic nerve palsy?

A

Dislocated hip can press on sciatic nerve

40
Q

Where are Posterior hip dislocations commonly seen?

A

Car crashes
Sport

41
Q

How does an anterior dislocation of the hip present on physical examination?

A

Externally rotated
ABducted

42
Q

Which nerve is rarely damaged in an anterior dislocation of the hip?

A

Femoral nerve

43
Q

Why does the leg get shortened in a posterior dislocation?

A

Gluteus maximus
Hamstrings
Adductor Magnus
ALL PULL SUPERIORLY

44
Q

Why does the leg get internally rotated in a posterior dislocation?

A

Gletus medius and minimus have anterior fibres that internally rotate

45
Q

Why does the leg get externally rotated in an anterior dislocation?

A

Glut Maximus
Piriformis
Sup + inf gomellus
Obturator internus
Quadratus femoris all pull outwards

46
Q

What happens in a central dislocation?

A

Fracture dislocation
Femoral head driven through the socket/acetabulum

47
Q

What are the life treating complications that can happen as a result of a central dislocation>

A

Intrapelvic haemorrhage

48
Q

Complications of hip dislocation:

A

Avascular necrosis
Post traumatic Osteoarthritis
Sciatic nerve injury
Infection

49
Q

What abnormalities on a hip x-ray suggests osteoarthritis?

A

Reduced joint space
Osteophytes
Whitened region around joint from Subchondral Sclerosis
Bone cysts

50
Q

What is subchondral sclerosis?

A

Thickening of bone around joints affected by osteoarthritis

MSK (36 decks)

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