What are the different areas of the body which can experience pain as a result of hip pathology ?
- Typically produces pain in the groin
- This pain can radiate to the knee due to obturator nerve also supplying the knee
- May cause buttock pain
- And can present with just knee pain esp in SUFE
Surgery for primary OA or arthritis due to RA, seronegative inflammatory arthropathy, AVN, dysplasia, Perthes or SUFE usually involves Total Hip Arthroplasty (THA) or Total Hip Replacement (THR).
These two terms are almost synonymous, the only difference being that the former is a slightly broader term that includes procedures like Hip Resurfacing, which as they don't involve replacement of the entire femoral head, aren't strictly speaking THRs.
What is the gold standard for which all other THA (total hip arthroplasty) must be compared to ?
THR (total hip replacement):
Involves a stainless steel stem with a small head (to reduce wear) and a high density polyethylene cup with both components being cemented in place using a bone cement (PMMA)
Why will any THA fail ?
Due to loosening:
- Predominantly due to wear particles from the bearing surface causing an inflammatory response at the implant‐bone
- Macrophages ingest microscopic wear particles and release inflammatory mediators resulting in osteoclastic bone resorption.
What does the decision of undergoing THA depend on ?
The level of pain and disability experienced
Conservative measures e.g. simple analgesics, physio, sticks, weight loss and activity modification. If these fail THA may be considered
What are some of the early and late complications associated with THA ?
- Nevre injury
- Late infection
- Late dislocation
Appreciate that a revision (2nd time) hip replacement is unlikely to have as good an outcome and has more complications than a first time op
What is one of the most common areas in the body for the development of AVN ?
What are some of the causes of AVN ?
May be primary/idiopathic
Or secondary due to alcohol, steroid abuse, hyperlipidaemia or thrombophilia.
How does AVN present on X-ray ?
Later cases show patchy sclerosis of the weight bearing area of the femoral head with a lytic zone underneath formed by granulation tissue from attempted repair.
What is the treatment of AVN ?
- If detected early enough (pre-collapse) then can drill holes up the femoral neck into the abnormal area to promote healing and prevent collapse
- Once collapse occured - the only surgical option is THR
What is Trochanteric bursitis / gluteal cuff syndrome?
The broad tendinous insertion of the abductor muscles (predominantly the gluteus medius) is under considerable strain and is subject to tendonitis and degeneration leading to tendon tears. The trochanteric bursa can also become inflamed. The condition is similar to rotator cuff problems of the shoulder.
Describe the main presenting symptoms of Trochanteric bursitis / gluteal cuff syndrome
Pain and tenderness in the region of the greater trochanter with pain on resisted abduction.
What is the treatment of trochanteric bursitis ?
Analgesics, anti-inflammatories, physio (to strengthen muscles and avoid abductor muscle weakeness), and steroid injection
When can knee replacement be considered ?
Patient with substantial pain and disability where conservative management is no longer effective
What are the different types of knee replacements available ?
Knee replacements can resurface all 3 compartments of the knee (total knee replacement, TKR) or be a partial knee replacement (unicompartmental knee replacement, UKR or patellofemoral replacement).
What are some of the causes of OA (think it is OA which then results in eventually potentially needing a knee replacement)
Previous meniscal tears, ligament injuries (especially ACL deficiency) and malalignment (genu varum > medial OA, genu valgum > lateral OA).