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Musculoskeletal Pathophysiology > Hip > Flashcards

Flashcards in Hip Deck (80):
1

What are some common childhood hip disorders?

1. congenital hip dysplasia (CHD)
2. leg-calve-perthes disease
3. slipped capital femoral 4. epiphysis
septic arthritis

2

Which gender and age prevalence congenital hip dysplasia?

females
birth-3 months

3

What causes congenital hip dysplasia?

abnormally lax hip capsule
familial
breech delivery

4

What are the clinical features of CHD?

1. asymmetrical skin folds at buttocks, adductors
2. dec hip abduction due to adduction contracture
3. shortening of dislocated side

5

What are two special tests for CDH?

Barlow test
Ortolani click test

6

What kind of harness is used for CHD and what does it do?

pavlik harness
holds hip in flexion and abduction to allow hip joint to form

7

How long is pavlik harness used and what is the outcome?

6-12 wks 23-24 hrs/day (aka take it off when changing diapers/bathing only)
good outcome when started early

8

After 3 months, how is CHD treated?

may need adductor tenotomy (release adductor tendon origin)

9

After 5 years, how is CHD treated?

ORIF and brace in ABD/flexion

10

Male to female ratio for legg-calve-perthes disease?

5:1

11

What percent of legg-calve-perthes disease is bilateral?

15%

12

What is legg-calve-perthes disease?

self limiting idiopathic osteonecrosis of the femoral head

13

What is the bone age associated with legg-calve-perthes disease?

1-3 years behind true age

14

What age children tend to have legg-calve-perhes disease?

average is 7 yo
(4-13 years)

15

Describe the disease process of legg-calve-perthes disease.

1. initial loss of blood supply to capital femoral epiphysis
2. revascularization and resumption of ossification
3. subchondral fx and second ischemic episode

16

How does the femoral head appear with LCPD on X-ray?

smaller femoral head initially
later femoral head destruction (may see crescent sign of subchondral collapse)

17

What are early signs of LCPD?

antalgic gait
hip/groin/knee pain
hip adductor spasm

18

What are later signs of LCPD?

trendelenburg or compensated gait pattern

19

Describe the stages of LCPD:

necrosis
fragmentation
re-ossification
remodeling

20

What orthoses is used for LCPD?

scottish rite orthosis or toronto orthosis
Holds hip in IR and ABD
18-24 months

21

What are 2 surgical treatments for LCPD?

Varus Derotation Osteotomy (immobilize 6 weeks)
Adductor tenotomy

22

outcomes

side 20

23

What is SCFE?

slipped capital femoral epiphysis
Salter-Harris 1 epiphyseal slip

24

How does SCFE sublux?

post/inferior due to flattened femoral head

25

incidence

slide 22

26

intervention

slide 25

27

What age for septic hip arthritis?

usually < 2 years

28

What are the clinical features of septic hip arthritis?

Temperature
Irritability
LE held in LPP (flex/ABD/ER)
Pain with movement and with palpation in hip area

29

What is septic hip arthritis?

rapidly progressing hip joint infection with considerable joint effusion

30

How is septic arthritis treated?

aspirate joint quickly
antibiotics
may need spica cast

31

What are the common sites for hip area avulsion fx in youth?

AIIS - rectus femoris
ASIS - sartorius
Greater trochanter - abductors insertion
Lesser trochanter - iliopsoas

32

What is hip area avulsion fx in youth secondary to?

trauma and overuse

33

What are clinical features of avulsion fx?

pain at bony landmark
muscle weakness

34

How is avulsion fx managed?

ORIF with wires

35

What are common adult hip joint dysfunctions?

1. arthritis
2. avascular necrosis
3. trauma (fx and disclocations)
4. soft tissue injuries (bursitis, strains)

36

What percent of THR are done for RA?

2%

37

What is common hip RA usually treatment?

mostly medication

38

Which surfaces of the hip are usually destructed with OA?

WB surfaces:
1. femoral head (posterior and superior surfaces)
2. acetabulum

39

What are the clinical features of OA at the hip?

antalgic gait
limited ROM in capsular pattern
pain with WB

40

Hip OA early intervention?

NSAIDS, acetaminophen
assistive devices
AROM
Light resistance training as tolerated

41

Hip OA surgical options?

1. arthroplasty (most common)
2. osteotomy
3. arthrodesis (fusion - salvage procedure)

42

Describe the osteotomy procedure for hip OA:

usually VARUS; take wedge from medial femoral shaft to change WB surface (usually performed on younger patients)

43

Pros and cons of cemented THR?

PRO: immediate WBAT
CON: cement may loosen

44

Pros and cons of non-cemented THR?

PRO: lower failure rate, little loosening
CON: restricts early WB status to PWB for 6-12 wks

45

What are the 3 most common surgical approaches to THR?

posterior (most common)
anterolateral
trans-trochanteric

46

Describe posterior precautions:

AVOID the following to prevent dislocation
1. Hip flexion past 90*
2. ADDuction past midline
3. IR past neutral

47

Describe anterolateral precautions:

RESTRICTIONS
1. Extension
2. ADD
3. ER

48

With ______ THR approach, dissect through gluteus medius.

anterolateral

49

Describe trans-trochanteric precautions:

RESTRICTIONS
1. Extension
2. ADD
3. IR

LIMIT early active abduction until trochanter heals

50

With trans-trochanteric THR approach, osteotomize the _____.

greater trochanter

51

What types of patients have higher failure rates with THA?

men
its who weigh > 165 lbs

52

The chance of hip replacement lasting 20 years is approx. __%.

80

53

What is the role of PT in THR?

bed mobility
transfer training
gait training with device
ROM
muscle performance

54

What are the pros to minimally invasive arthroplasty?

1-2 small incisions
shorter hospital say
less post-op pain

55

What are common THR complications?

infection
DVT
dislocation
loosening of cement
fracture of femoral shaft near stem

56

What is the position of hip arthrodesis?

neutral abduction
0-30* ER
20-25* flexion

57

What are the precautions for hip arthrodesis?

AVOID
abduction
IR

58

The position of hip arthrodesis is designed to minimize _________ which helps minimize pain.

excessive lumbar spine motion and opposite knee motion

59

Age/gender prevalance for osteonecrosis of hip in adults?

30-70 yo
male > female

60

Subchondral bone death occurs secondary to:

ischemia

61

What are sources of AVN?

blood supply interruption secondary to hip fx
long term corticosteroid use
ETOH abuse
decompression injuries from scuba diving
sickle cell disease
SLE (Systemic lupus erythamtosis)

62

Early radiological evidence of AVN of femoral head:

more lucent as bone dies

63

Common sites for AVN?

femoral head
scaphoid (prox fx)
talus

64

What are clinical signs of AVN at the hip?

inner thigh pain
antalgic gait

65

Later radiological evidence of AVN of femoral head:

crescent sign
(indicative of subchondral bone death and collapse)

66

Hip AVN surgical treatment options?

drill core into bone and graft
varus osteotomy
hip arthroplasty

67

Acetabular fx is most associated with:

posterior hip dislocation
(AKA dashboard dislocation)

68

What is the likely position of the femur on impact with acetabular fx?

Femur is ADD/IR on impact

69

What is the treatment for acetabular fx?

skeletal traction then PWB

70

Intracapsular capital femoral fx is usually due to:

osteoporosis

71

Intracapsular femoral neck fx is usually due to:

trauma

72

Intracapsular femoral neck fx surgical treatment for impacted vs displaced:


impacted: ORIF with pin
displaced: ORIF with dynamic screw

73

What % incidence of AVN with intracapsular femoral neck fx?

25%

74

Intertrochanteric (extracapsular) fx treatment:

ORIC with dynamic screw (most are comminuted and heal without complication)

75

Acetabular labral tear management:

NSAIDS
cortisone
arthroscopic repair if limited fxn

76

How to acetabular labral tears present?

twisting injury with immediate pain
pain with hip flexion
catching, clinciking, locking

77

Gluteal bursitis pain with:

location: buttocks
pain with resisted hip extension

78

Iliopectineal bursitis location and pain provocation:

location: between psoas and anterior hip joint
pain with resisted hip flexion

79

Trochanteric bursitis pain provocation:

pain posterolaterally with resistance into ABD

80

Hamstring muscle strain often secondary to:

eccentric loading