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Hip Flashcards

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1
Q

What are some common childhood hip disorders?

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

Which gender and age prevalence congenital hip dysplasia?

A

females

birth-3 months

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3
Q

What causes congenital hip dysplasia?

A

abnormally lax hip capsule
familial
breech delivery

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4
Q

What are the clinical features of CHD?

A
  1. asymmetrical skin folds at buttocks, adductors
  2. dec hip abduction due to adduction contracture
  3. shortening of dislocated side
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5
Q

What are two special tests for CDH?

A

Barlow test

Ortolani click test

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6
Q

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

A

pavlik harness

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

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7
Q

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

A

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

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8
Q

After 3 months, how is CHD treated?

A

may need adductor tenotomy (release adductor tendon origin)

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9
Q

After 5 years, how is CHD treated?

A

ORIF and brace in ABD/flexion

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10
Q

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

A

5:1

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11
Q

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

A

15%

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12
Q

What is legg-calve-perthes disease?

A

self limiting idiopathic osteonecrosis of the femoral head

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13
Q

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

A

1-3 years behind true age

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14
Q

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

A

average is 7 yo

4-13 years

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15
Q

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

A
  1. initial loss of blood supply to capital femoral epiphysis
  2. revascularization and resumption of ossification
  3. subchondral fx and second ischemic episode
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16
Q

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

A

smaller femoral head initially

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

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17
Q

What are early signs of LCPD?

A

antalgic gait
hip/groin/knee pain
hip adductor spasm

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18
Q

What are later signs of LCPD?

A

trendelenburg or compensated gait pattern

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19
Q

Describe the stages of LCPD:

A

necrosis
fragmentation
re-ossification
remodeling

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20
Q

What orthoses is used for LCPD?

A

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

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21
Q

What are 2 surgical treatments for LCPD?

A

Varus Derotation Osteotomy (immobilize 6 weeks)

Adductor tenotomy

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22
Q

outcomes

A

side 20

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23
Q

What is SCFE?

A

slipped capital femoral epiphysis

Salter-Harris 1 epiphyseal slip

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24
Q

How does SCFE sublux?

A

post/inferior due to flattened femoral head

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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

Musculoskeletal Pathophysiology (14 decks)

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