Hip

Question 1

What type of hip dislocation is most common?

Answer 1

Posterior Dislocation, Anterior is from a forced abduction when flexed

Question 2

T/F: A posterior hip dislocation is a medical emergency.

Answer 2

True. A posterior hip dislocation is a medical emergency needing early reduction to prevent AVN.

Question 3

Mechanism of Injury for a Posterior Hip Dislocation

Answer 3

Impact forcing the femoral head posteriorly tearing the ligamentum teres and posterior capsule. The posterior acetabulum may be fractured, vascular supply to the femoral head may be disrupted. This may also lead to a sciatic nerve injury.

Question 4

Patient Presentation with a Posterior Hip Dislocation

Answer 4

Posterior Hip Dislocation will give neurological findings, which might be subtle. A limb in internal rotation with hip flexed and adducted. Evaluate sciatic nerve injury by having patient dorsiflex foot and plantar flex/invert foot.

Question 5

Treatment for Posterior Hip Dislocation

Answer 5

If no fracture present, immediate reduction. If reduction cannot be obtained, open reduction. Evaluated sciatic nerve function after reduction.

Question 6

Mechanism of Injury for a Anterior Hip Dislocation

Answer 6

Forceful abduction and external rotation

Question 7

Patient Presentation with a Anterior Hip Dislocation

Answer 7

Abducted and externally rotated limb with a palpable groin mass. Displaced femoral head can compress femoral vein and produce thrombus. Evaluate femoral nerve function with quadriceps contraction, thigh sensation and knee extension.

Question 8

Treatment for a Anterior Hip Dislocation

Answer 8

Similar to posterior, if no fracture present- immediate reduction. If reduction cannot be obtained, open reduction. Evaluate femoral nerve function after reduction.

Question 9

With a Posterior Hip Dislocation we need to be cautious of the ________ nerve where as with a Anterior Hip Dislocation we are concerned about the ________ nerve.

Answer 9

Sciatic; Femoral

Question 10

Mechanism of Injury of Trochanteric Bursitis

Answer 10

Can be due to: leg length discrepancy, broad pelvis in females, poor runnng mechanics, or tight tensor fascia.

Question 11

Cause of Bursitis

Answer 11

Caused by friction from overuse or trauma from a direct blow.

Question 12

Patient Presentation with Bursitis

Answer 12

Pain with motion, lying on side (affected or non-affected). Localized tenderness and fullness. “Snapping” may develop of condition is chronic. Erythema and Rubor may be present.

Question 13

Special Test for Trochanteric Bursitis

Answer 13

Can have a positive Ober Test.

Question 14

Treatment for Bursitis (Trochanteric Bursitis)

Answer 14

Rest/Ice, NSAIDs, Steroid injections. Physical Therapy to restore flexibility, ROM and strength. IT Band strectching.

Question 15

Ischial Bursitis

Answer 15

“Benchwarmers” - pain when seated probably secondary to sciatic nerve irritation.

Question 16

Ilio-pectineal bursitis

Answer 16

Due to microtrauma. Symptoms include anterior hip pain and antalgic gait. Symptoms lessen with flexion and external rotation.

Question 17

Patient Presentation with Trochanteric Bursitis

Answer 17

Adduction and external rotation aggravates the symptoms. Pain with rising, night pain or lying on affected side.

Question 18

Osteonecrosis of the Femoral Head

Answer 18

Avascular necrosis, necrosis of the femoral head- microfractures.

Question 19

Cause of Osteonecrosis of the Femoral Head

Answer 19

Several: EtOH, Steroid Use, Sickle Cell and Hx of Chemotherapy

Question 20

Patient Presentation with Osteonecrosis of the Femoral Head

Answer 20

Dull ache or throbbing pain in groin, laterally in buttocks

Question 21

Treatment for Osteonecrosis of the Femoral Head

Answer 21

Before the collapse:
No TX- PWB, core decompression, Strut grafting, vascularized strut grafting.

After the collapse:
Pain management, Hemi-arthroplasty, Total Hip Arthroplasty.

Question 22

Who is more likely to develop Osteonecrosis of the Femoral Head

Answer 22

Males, Usually 30-50 years old.

Question 23

Progression of Osteonecrosis of the Femoral Head

Answer 23

50-90% bilateral with in 2 years

Question 24

Radiographic Classifications for Osteonecrosis of the Femoral Head

Answer 24

Stage 0- no x-ray change, + MRI.
Stage 1- Motted densities/osteopenia.
Stage 2- Increased densities in femoral head (CRESENT SIGN), no collapse.
Stage 3- Flattening of femoral head; normal joint space.
Stage 4- Joint space narrowing, acetabular changes or both.
Stage 5- Advanced degenerative changes.

Question 25

Osteoarthritis of the Hip

Answer 25

Loss of cartilage in the Hip

Question 26

Presentation of Osteoarthritis of the Hip

Answer 26

Pain in the GROIN (must differentiate from SI joint and greater trochanteric bursitis). Possible loss of motion. Possible limp.

Question 27

Radiographic signs for Osteoarthritis of the Hip

Answer 27

Loss of joint space (cartilage ht), sclerosis of femoral head, osteophytes, bone cysts (filled with gelatinous material), loss of spherical shape of the femoral head.

Question 28

Treatment for Osteoarthritis of the Hip

Answer 28

Non-operative: NSAIDs, Maintain ROM, Activity modification, steroid injection, cane.

Operative: Arthroplasty, Osteotomy, Resection of femoral head, hip fusion.

Question 29

Hemi-arthroplasty

Answer 29

Only femoral side of hip is replaced. Not good if there is acetabular degeneration.

Question 30

Total Hip Arthroplasty

Answer 30

Both femoral head and acetabulum are replaced