Hip Flashcards
(47 cards)
What can help you to determine the cause of adult groin pain
Internal rotation
If internal rotation is not intact - then likely to be OA or secondary OA
If internal rotation is normal - diff diag - snapping iliopsoas
Pain on all movement AVN/tumour
Pain on internal rotation - ?femoroacetabular impingement
What can help you determine the cause of adult lateral pain
Whether the pain is well localised to the greater trochanter
Is yes - then likely to be bursitis/ greater trochanteric pain syndrome
No - referred from back pain
Are there any corresponding red flags to suggest something more sinister
How to be sure the OA is in the hip
The examination if internal rotation is preserved then it is a back problem
In OA the IR is the first thing to go then there is progressive loss of ER
Pain in the groin and the knee
When to consider arthroplasty in OA?
Pain is uncontrolled by non-op means
QualOL restricted enough to take the risk
Hip resurfacing should not be considered less risky that a THR
Tx OA
Con - Physio, walking aids, weight loss, exercise
Med - analgesia, steroid joint injections
Surg - THR, resurfacing
What are the surgical approaches to THR
Direct lateral
Anterior
posterior
What does hip resurfacing have over THR
Preserves femoral bone
Lower risk if dislocation
Complication of THR
Infection Disslocation Leg length difference DVT PR Anaesthetic risk Neuromuscular injury
Features of infection following THR
Presents with just pain usually not usually septic
Common organisms -staph
Causes - surgery inoculation haemogenously
BIOFILM - makes it a bastard to treat - difficult to erradicate
Usually need stage 2 reunion - basically take it out load them with abx and then put a new one in
If there is a persistently discharging wound what should you do
Contact the consultant - do not start abx
Do not know why
What do you need to rule out calf swelling that does not decrease on elevation
DVT
What is likely cause of a short painful leg
Ned to rule out with radiograph
Dislocation
What is the level of activity that can be conducted post op
Depends on the Bearing
All hip arthroplasties with wear treated than the native hip
Need to be conscious and balance the is of wear vs desire to do sports
Causes of avascular necrosis of the hip
Idiopathic Hip fracture hip dislocation Alcoholic Steroids Sickle cell disease Caisson disease (divers) Metabolic disorders HIV
Ix avascular necrosis of hip
X-ray
MRI
Tx of avascular necrosis of the hip
Core decompression Joint replacement Bisphosphonates Bone graft Osteotomy
Cause of femoroacetabular impingement
Contact between the femoral head-neck Justin and the acetabular rim
Can be boney spurs
Impingement occurs with the combined movement of hip flexion, adduction and internal rotation
Problems with the paediatric hip
DDH Transient synovitis Perthes SUFE Sepsis If these are mild they may not present in childhood but as an adult they could be a secondary cause of OA of the hip
What is transient synovitis
Average age 3
Most common cause of irritable hi pain - is a diagnosis sof exclusion
M:F 2:1
Inflamm of the synovium
Though to be a reactive monoarthropathy from a URTI
Acute onset self healing
Tx of transient synovitis
Acute onset self -limiting
Rest +/- analgesia
How to diagnose transient synovitis
Diagnosis of exclusion there is not abnormal it of the X-ray or blood tests
If more than one joint is involved with transient synovitis what is it called
Juvenile idiopathic arthritis
What is the kocher criteria and what is it used in
It is criteria for the likelihood of septic arthritis if all 4 criteria are met there is a 99.6% likelihood of it being septic arthritis Fever >38.5 WBC >12000 mm3 Non weight bearing on affected side ESR >40
Cause of septic arthritis
Haematogenous seeding
Extension from adjacent bone -osteomyelitis
Inoculation from trauma or surgery
