Common disorders of the Hip

Question 1

What are some Common Disorders of the Hip

Answer 1

Osteoarthritis

Bursitis
- Gluteal tendinopathy

Avascular Necrosis (AVN)

Impingement

Labral Tear

Question 2

What characterises osteoarthritis

Answer 2

Progressive loss of articular cartilage

Characterised by worsening pain and stiffness of the affected joint

Limiting everyday life

Question 3

What is Trochanteric bursitis

Answer 3

Inflammation of the Fluid-filled sac sandwiched between hip abductors and ITB (the trochanteric bursa)

Question 4

What is epidemiology of Trochanteric bursitis

Answer 4

F>M

Question 5

What is aetiology of Trochanteric bursitis

Answer 5

Trauma
Over-use

Abnormal movements

Local problem
-	Muscle wasting following surgery
-	Total Hip 
Replacement
-	Osteoarthritis

Question 6

Where do you feel for tenderness in Trochanteric bursitis

Answer 6

Tenderness at Greater Tuberosity

Question 7

What is the presentation of Trochanteric bursitis

Answer 7

Pain

• Point tenderness
• Lateral hip

Question 8

What investigations are used for Trochanteric bursitis

Answer 8

X-ray
MRI
Ultrasound

Question 9

What is treatment for Trochanteric bursitis

Answer 9

NSAIDs
Relative rest / Activity modification
Physiotherapy
-	Correct posture, abnormal movements
-	Stretching
-	Strengthen muscles around joint
Injection
-	Corticosteroids

Surgery
- Bursectomy (Rarely required)

Question 10

What is Avascular necrosis

Answer 10

Death of bone due to loss of blood supply

Question 11

What is Epidemiology of avascular necrosis

Answer 11

Males > Females
Average age 35-50 years old 
80% = bilateral
-	May be offset in time
3% = multifocal
-	3 or more joints

Question 12

What are risk factors of avascular necrosis

Answer 12

Trauma

Systematic

Question 13

Where in particular can trauma occur and cause vascular necrosis

Answer 13

Injury to femoral Intracapsular fracture

Intracapsular fracture

Question 14

What systematic conditions can cause vascular necrosis

Answer 14

Hypercoaguable states
Steroids
Haematological 
-	Sickle Cell Disease
-	Lymphoma
-	 Leukaemia
Caisson’s disease
Alcoholism
Ideopathic

Question 15

What are symptoms of avascular necrosis

Answer 15

Insidious onset of groin pain
Pain with stairs, walking uphill and impact activities
Limp
Examination
Largely normal
May replicate early arthritis
-	Reduced range of motion (partic internal rotation)
-	Stiff joint

Question 16

What are treatment options of avascular necrosis

Answer 16

Non-operarive

Surgery

Question 17

What are non operative treatment options of avascular necrosis

Answer 17

• Reduce weight-bearing
• NSAIDs
• Bisphosphonates
  o Early AVN
  o Controversial
• Anticoagulants
• Physiotherapy
  o Maintain range of motion
  o Keep the ball round!

Question 18

What are operative treatment options of avascular necrosis

Answer 18

• Restore blood supply
  o Core decompression
  o Core decompression and vascularised graft
• Move the lesion away from the weight-bearing area
  o Rotational Osteotomy
• Total Hip Replacement

Question 19

What is Femoroacetabular Impingement (FAI)

Answer 19

Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.

Question 20

What categories are Femoroacetabular Impingement (FAI) divided into?

Answer 20

Cam lesion

Pincer

Question 21

What is the pincer category of Femoroacetabular Impingement

Answer 21

Acetabulum-based impingement

Usually in active females

This type of impingement occurs because extra bone extends out over the normal rim of the acetabulum. The labrum can be crushed under the prominent rim of the acetabulum.

Question 22

What is the cam category of Femoroacetabular Impingement

Answer 22

Cam-type femoroacetabular impingement (FAI) is a known cause of groin pain and a condition that can give rise to osteoarthritis of the hip (1). Patients suffering from this condition are mainly young and experience pain when the hip is moved through internal rotation and adduction at 90° of hip flexion

Excess of bone along the upper surface of the femoral head,

Question 23

What is the presentation of Femoroacetabular Impingement

Answer 23

Groin pain
-	Worse with flexion
Mechanical symptoms
-	Block to movement
-	Pain with certain manoeuvres
o	Getting out of a chair
o	Squatting
o	Lunging

Question 24

What is Examination for Femoroacetabular Impingement

Answer 24

Reduced flexion and internal rotation
Positive FADIR test
- Flexion, ADduction, Internal Rotation

Question 25

What are investigations for Femoroacetabular Impingement

Answer 25

``` X-ray - Identify the bony pathology MRI - Useful for assessing associated conditions o Labral tears o Articular cartilage damage ```

Question 26

What are non-operative treatment options for Femoroacetabular Impingement

Answer 26

``` Non-operative - Activity modification - NSAIDs - Physiotherapy o Correct posture o Strengthen muscles around joint ```

Question 27

What are operative treatment options for Femoroacetabular Impingement

Answer 27

Arthroscopy o Shave down the defect o Deal with labral tears o Resect artic cartilage flaps ``` Open Surgery o Resection Periacetabular Osteotomy o Hip Arthroplasty ♣ Resurfacing ♣ Replacement ```

Question 28

What is a labral tear

Answer 28

A labral tear results when a part of the labrum separates or pulls away from the socket. Most commonly, a labral tear is the result of repetitive stress (loading) irritating the hip, often due to long-distance running or performing repeated, sharp, sports movements, such as twisting and cutting.

Question 29

What is the most common labral tear

Answer 29

Most commonly anterosuperior tear

Question 30

What is Presentation for labral tear

Answer 30

Groin or Hip Pain Snapping sensation Jamming or locking

Question 31

What is Examination for labral tear

Answer 31

can be normal Positive FABER test - Flexion, ABduction, External Rotation o Anterior tears

Question 32

What is Investigations for labral tear

Answer 32

``` Ensure adequate imaging so identify any root causes of pathology X-ray - OA, Dysplasia MRI Arthrogram - 92% sensitive Diagnostic injection - Local anaesthetic ```

Question 33

What is Non-operative treatment for labral tear

Answer 33

- Activity modification, NSAIDs, Physiotherapy | - Injection of Steroids

Question 34

What is Operative treatment for labral tear

Answer 34

- Arthroscopy o Repair o Resection