Conditions of the Hip

Question 1

Name the three bones that are fused to form the hip

Answer 1

Ileum
Ischium
Pubis

Question 2

The three bones of the hip are fused by which 2 structures

Answer 2

Sacrum

Pubic symphysis

Question 3

Which muscles attach to the greater trochanter of the femur?

Answer 3

Abductors

Rotators

Question 4

What muscle attaches to the lesser trochanter of the femur?

Answer 4

Psoas

Question 5

Blood supply to the hip joint

Answer 5

Medial and Lateral circumflex - branches of profunda femoris
Artery of ligamentum teres
Blood supply enters through capsule

Question 6

Difference between effect on blood supply in intracapsular and extracapsular fracture of femur

Answer 6

Intracapsular- fracture of neck - blood supply disrupted

Extracapsular - blood supply maintained

Question 7

2 changes in osteoarthritis

Answer 7

Progressive loss of articular cartilage

Secondary bone changes

Question 8

What is osteoarthritis?

Answer 8

Degenerative change in synovial joints

Question 9

Symptoms of osteoarthritis

Answer 9

Worsening pain

Stiffness

Question 10

Causes of trochanteric bursitis

Answer 10

Trauma
Over-use; athletes, runners, repetitive movement
Abnormal movements
- Distant
-Local

Question 11

Which ‘distant’ problem can cause abnormal movement in the hip joint leading to trochanteric bursitis?

Answer 11

Scoliosis

Question 12

Which local problems to the hip can cause abnormal movement that can lead to trochanteric bursitis?

Answer 12

Muscle wasting following surgery
Total hip replacement
Osteoarthritis

Question 13

Presentation of trochanteric bursitis

Answer 13

Point to tenderness

Tenderness in lateral hip

Question 14

Examination findings in trochanteric bursitis

Answer 14

Scars from previous surgery?
Muscle wasting (glutes)
Tenderness at greater tuberosity
Worst pain at active abduction

Question 15

Investigations for trochanteric bursitis

Answer 15

X ray
MRI
Ultrasound

Question 16

Treatment for trochanteric bursitis

Answer 16

NSAIDs
Rest
Activity modification
Physio - posture, movements, strengthening and stretching
Injection - glucocorticosteroids
Surgery - bursectomy

Question 17

What happens in avascular necrosis?

Answer 17

Loss of blood supply –> death of bone

Question 18

What age is avascular necrosis more likely to be diagnosed>

Answer 18

35-50

Question 19

Is avascular necrosis more common in males or females>

Answer 19

Males

Question 20

Risk factors for avascular necrosis fall under which 2 categories

Answer 20

Trauma

Systemics

Question 21

Traumatic causes of avascular necrosis

Answer 21

Irradiation
Fracture
Dislocation
Iatrogenic

Question 22

Systemic causes of avascular necrosis

Answer 22

Idiopathic
Hypercoagulable states
Steroids
Haematological - sickle cell disease, leukaemia, lymphoma
Caisson's disease
Alcoholism

Question 23

What symptom is common is Caisson’s disease?

Answer 23

Decompression sickness

Question 24

What does decompression sickness occur with Caisson’s disease?

Answer 24

Nitrogen bubbles throughout body

Question 25

Symptoms of avascular necrosis

Answer 25

Insidious onset of groin pain Pain with stairs, walking uphill, on impact Limp

Question 26

Findings of avascular necrosis on examination

Answer 26

Can replicate OA - stiffness, reduced ROM

Question 27

Non-operative treatment of avascular necrosis

Answer 27

``` Activity modification NSAIDs Bisphosphonates Anticoagulants Physio ```

Question 28

Operative treatment of avascular necrosis

Answer 28

Core decompression and vascularised graft : Blood supply Rotational osteotomy: Move lesion from weight-bearing area Total Hip Replacement

Question 29

Types of femoroacetabular impingement

Answer 29

Cam Lesion - femur based | Pincer - acetabulum based

Question 30

3 steps in formation of pincer impingement

Answer 30

Abnormal acetabulum - -> anterosuperior overhang - -> acetabular protrusion -->abutement of lesion on edge of acetabulum

Question 31

Associated injury of pincer impingement

Answer 31

Labral degeneration and tears Cartilage damage and flap tears Secondary hip osteoarthritis

Question 32

Signs and symptoms of femoroacetabular impingement

Answer 32

Groin pain - worse with flexion Mechanical symptoms - block to movement - pain; getting up, chair, squat, lunge

Question 33

Examination findings of impingement

Answer 33

``` Reduced flexion and internal rotation Positive FADIR test -Flexion Addcution Internal Rotation ```

Question 34

A positive FADIR tests indicates which hip pathology?

Answer 34

Femoroacetabular impingement

Question 35

Investigations for femoroacetabular impingement - imaging

Answer 35

X-ray | MRI

Question 36

Non-operative treatment of FA impingement

Answer 36

Physio NSAIDs Activity modification

Question 37

Operative treatment of FA impingement

Answer 37

Arthroscopy - shave off impingement, deal with labral tears, resect cartilage flaps Open surgery -Resection, Periacetabular osteotomy, Hip arthroplasty - resurfacing, replacement

Question 38

Most common type of labral tear

Answer 38

Anterosuperior

Question 39

Labral tears occur most commonly in active females as a result of what pathology

Answer 39

Pincer impingement - flexibility

Question 40

Causes of labral tears

Answer 40

``` Femoroacetabular Impingement Trauma Dysplasia Osteoarthritis Collagen diseases - Ehler Danlos ```

Question 41

Symptoms of labral tear

Answer 41

Hip or groin pain Snapping sensation Jamming or locking

Question 42

Findings on examination

Answer 42

Positive FABER Flexion Abduction External Rotation

Question 43

Investigation for labral tear

Answer 43

X ray MRI Diagnostic injection

Question 44

Non- operative treatment of labral tear

Answer 44

NSAIDs Activity Steroids Physio

Question 45

Operative treatment of labral tear

Answer 45

Arthroscopy - resection and repair

Question 46

A positive FABER test indicated which hip pathology?

Answer 46

Labral tear