Hip

Question 1

What nerve supplies both of the hip joints?

Answer 1

Obturator nerve

Question 2

What is the cause of a positive Trendelenburg test?

Answer 2

Weakness in the hip abductor muscles

Question 3

What conditions can cause shortening of the lower limb?

Answer 3

Osteoarthritis (severe cases)
Perthe’s disease
SUFE
Avascular necrosis (AVN)

Question 4

All hip replacements eventually fail, how long do they tend to last for?

Answer 4

15 - 20 years

Question 5

What are conservative measures for managing OA before total hip replacement?

Answer 5

Analgesia, physiotherapy, weight loss. exercise and a walking stick where possible.

Question 6

The hip is one of the most common sites for avascular necrosis (AVN) to occur. True/false

Answer 6

True

Question 7

What features are apparent in AVN?

Answer 7

Usually presents with groin pain
On x-ray, there is a ‘‘Hanging rope’’ sign.
In some cases, the femoral head may collapse leading to seconadary osteoarthritis.

Question 8

What is trochanteric bursitis?

Answer 8

Trochanteric bursitis also known as gluteal cuff syndrome arises as a result of considerable strain placed upon the broad tendinous insertion of the abductor muscles (mainly gluteus medius). Result is tendonitis and degeneration leading to tendon tears. The trochanteric bursa becomes inflamed.

Question 9

What is treatment of trochanteric bursitis?

Answer 9

Mostly conservative treatments: analgesics, anti-inflammatories, steroids and physiotherapy.

Surgery does not provide useful treatment.

Question 10

Posterior hip dislocations are more common than anterior hip dislocations. True/false

Answer 10

True, this is because the anterior ligaments are stronger. Posterior hip dislocations take up 90% of these cases.

Question 11

In the case of infection. Trochanteric bursitis can be treated with antibiotics. True/false

Answer 11

True, if there is infection present it can present with erythema, swelling and warmth.

Question 12

What is transient synovitis?

Answer 12

AKA irritable hip. It is caused by temporary irritation and inflammation of the synovial membrane within the joint (synovitis).

Question 13

How does transient synovitis present and what age group does it occur in?

Answer 13

Occurs in children aged 3-10

Presents with:
Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature

This usually happens a few weeks after a viral infection.

Question 14

How is transient synovitis treated?

Answer 14

Usually based on symptoms. Child given analgesics if in pain.

Important that septic arthritis is excluded as a cause.

Safety netting is important. Child should return if they develop fever or if symptoms worsen.

Question 15

What is avascular necrosis (AVN)?

Answer 15

When the blood supply to a part of bone is disrupted, resulting in death of bone tissue. Causing the bone to breakdown and joint to collapse.

Question 16

What x-ray sign is associated with AVN?

Answer 16

“Hanging rope sign” - a late stage of perthes disease.

Question 17

What age group of children does perthes disease most affect?

Answer 17

Children aged 4-12 (mainly boys 5-8 years old).

Question 18

Clinical presentation of perthes disease?

Answer 18

Pain in hip or groin
Limp
Reduced hip movements
May be referred pain to the knee.

There will be NO history of trauma. If there is, think SUFE.

Question 19

Conservative management of perthes disease?

Answer 19

Reduce risk of damage and deformity to the femoral head with:

• Bed rest
• Analgesia
• Crutches
• Traction

Question 20

What type of children is slipped upper femoral epiphyses (SUFE) most common in?

Answer 20

Obese pre-pubertal (around 11 years old) boys

Usually undergoing growth spurt.

Question 21

Perthes disease can be triggered by minor trauma. True/false

Answer 21

False, if there is minor trauma in patient history, think SUFE.

Question 22

Initial investigations of choice for perthes disease and SUFE?

Answer 22

X-ray

Question 23

Management of SUFE

Answer 23

Surgery to relocate femoral head back to the correct position to prevent it from slipping further.

Question 24

What movement is restricted in children with SUFE?

Answer 24

Restricted internal rotation of the hip, so when examining the patient, they will prefer to keep their hip in external rotation.

Question 25

What does the leg look like with a displaced femoral fracture?

Answer 25

Shortened and externally rotated

Question 26

What does the leg look like with a femoral head dislocation?

Answer 26

Shortened and internally rotated