Hip And Knee

Question 1

Name the unhappy triad of the knee

Answer 1

ACL,MCL,medial meniscus

Question 2

Which meniscus is more prone to acute which and is prone to lateral injury

Answer 2

Medial: chronic
Lateral: acute

Question 3

Gardens classification is?

Answer 3

Neck of femur fracture

G1:partial fracture with valgus impaction
G2: complete fx undisplaced
G3:complete fx partial displacement
G4:complete fx complete displacement

Question 4

What is Segond fracture and what is it associated with

Answer 4

Avulsion fx of tibial tuberosity
A/w ACL tear

Question 5

What does disruption of Shentons line suggest

Answer 5

Displaced NOF fx

Question 6

General principle for surgical mx of NOF fx

Answer 6

Displaced replace
Undisplaced fix

Question 7

Radiological invx for OA knee

Answer 7

1. AP lateral knee
   2.Skyline
   3.Long bone weight bearing

Question 8

What do posterior and anterior drawer test for

Answer 8

Posterior drawer is PCL
Anterior drawer is ACL

Question 9

Injectable options for knee OA

Answer 9

1. Corticosteroids
2. Hyaluronic acid with Lignocaine
3. +-Autologous Protein Solution

Question 10

Surgical mx of knee OA

Answer 10

1. High Tibial osteotomy
2. Unicompartmental KR
3. TKR

Question 11

XR findings for ACL tear

Answer 11

Segonds sign/fracture:avulsion fx from ALL
Terminalis sign?
Osteochondral bodies
Signs of joint effusion

Question 12

Most common mechanism of injury

Answer 12

Twisting injury where knee is flexed,valgus and externally rotated

Question 13

Types of ACL reconstruction grafts

Answer 13

Allogenic vs autologous
Hamstring vs Bone Patella Tendon graft

Question 14

Absolute CIs for total knee replacement

Answer 14

Knee sepsis, chronic infection,severe vascular disease,etc

Question 15

Three compartments of the knee

Answer 15

Medial, lateral and patellofemoral

Question 16

Three compartments of the knee

Answer 16

Medial, lateral and patellofemoral

Question 17

Main indications for TKR

Answer 17

Tricompartmental knee disease causing significant morbidity to patient

Question 18

Demographic for high tibial osteotomy

Answer 18

Young or active patients with unicompartmental knee OA

Question 19

Goals of TKR

Answer 19

1. Restore neutral alignment of joint
2. Restore joint line
3. Balance ligaments
4. Normal Q angle

Question 20

How to dydx Gardens 3 and 4 fx

Answer 20

Presence of trabeculae is grade 4

Question 21

Types of femur fracture more common in each age group

Answer 21

Older: IT fx( Osteoporotic area)
Younger:NOF fx

Question 22

Type of femur fx that can heal well without surgical intervention

Answer 22

Intertrochanteric fx as it is cancellous bone

Question 23

What does the Crescent sign indicate

Answer 23

Fixation Arlet stage 3, subchondral collapse has collapsed and collapse of femoral head impending

Question 24

Direct risk factors for hip AVN

Answer 24

Irradiation
Haematologic diseases - leukemia, lymphoma)
Dysbaric disorders - Caisson disease
Marrow replacing diseases
Sickle cell disease

Question 25

Indirect risk factors for hip AVN

Answer 25

Alcoholism Hypercoagulable states Steroids (endogenous or exogenous) SLE Transplant patient Virus (CMV, HIV, rubella) Protease inhibitors (HIV medications) Idiopathic

Question 26

Characteristic of hip dysplasia

Answer 26

Shallow acetabulum with lack of anterior and lateral coverage:femoral head prone to subluxation and lateralisation, coxa valga

Question 27

Radiological dx of AVN hip

Answer 27

XR sufficient if gross changes MRI if early/clinical suspicion strong for AVN hip

Question 28

Mx of Hip AVN

Answer 28

Conservative: Mixed evidence for bisphospho

Question 29

Classifying management of intratrochanteric fx

Answer 29

? Stable:

Question 30

Rhyme for mx of intertrochanteric fx

Answer 30

1 2 screw 3 4 Austin moore (For Gardens)

Question 31

Use of Gardens

Answer 31

Risk of AVN and hence whether to fix or replace

Question 32

Age to guide NOF fx mx

Answer 32

<65 is young NOF: Emergent surgery to fix and preserve native hip

Question 33

Hemiarthroplasty vs THR

Answer 33

Bipolar for relatively low functional needs OR increased comorbids THR for high activity/functional status

Question 34

Risk factors for AVN Hip

Answer 34

Alcoholism Smoking Steroid use:TCM or drugs Endocrinopathy Trauma Diving Hypercoagulable state Congenital hip pathology Retroviral drug use

Question 35

Mx of AVN Hip

Answer 35

Conservative: Analgesia, Bisphosphonates +- Surgical: divided into joint preserving and joint replacing P: Core decompression or osteotomy R: THR

Question 36

main blood supply of femoral head

Answer 36

medial circumflex femoral artery

Question 37

Indication for PFNA

Answer 37

Intertrochanteric hip fx

Question 38

Classification system for Intertrochanteric fx

Answer 38

Evans

Question 39

Differentiating THR vs bipolar hemi vs unipolar hemi

Answer 39

1) THR - femoral + acetabular component (must be screws/some structure going into the pelvic bone) 2) Bipolar - round ball with a cap (nothing done on the acetabular, but acetabulum surface rotating on the round cap) 3) Unipolar - round ball with stem Moore’s - 2 holes (2x OO) Thompson’s - 1 hole

Question 40

Treatment of Osgood Schlatter disease1

Answer 40

Mainly non surgical 1. Pain mx eg NSAIDs 2. Lifestyle changes eg quadriceps stretching

Question 41

Risk factors for Hip AVN

Answer 41

Modifiable 1. Trauma 2. Smoking 3. Corticosteroid/TCM use 4. Deep sea diving 5. Radiation exposure 6. Alcoholism 7. Septic Arthritis 8. Malignant infiltration Non Modifiable 1. Childhood Hip disorders(DDH, Perthes, SCFE) 2. Sickle cell anemia 3. Thrombophilias 4. Autoimmune eg SLE, RA 5.Gaucher 6. Idiopathic

Question 42

Mx of Hip AVN

Answer 42

Nonoperative: - bisphosphonates for pre-collapsed AVN (FA 0-II) Operative: - Core decompression +/- bone graft to relieve IO HTN  early AVN, pre-collapse - Rotational osteotomy for small lesions that have rotated away from WB surface - Curettage + bone grafting for pre-collapsed - Vascularized-free fibular transfer  remove large necrotic area and fill with fibular to prevent collapse - THR -Total hip resurfacing - Hip arthodesis

Question 43

Mx of Hip AVN Ficat Arlet 0-2

Answer 43

1. Bisphosphonates 2. Core decompression 3. Rotational osteotomy( For small lesions) 4. Curettage and bone grafting

Question 44

Mx of Hip ACN Ficat Arlet 3

Answer 44

Removal of necrotic area + replacement with fibular strut

Question 45

Mx of Hip AVN Ficat Arlet 4

Answer 45

1. Hemi-resurfacing arthroplasty(<1/3 of femoral head involved and relatively intact acetabulum) 2. THR 3. Arthrodesis

Question 46

Ficat Arlet staging

Answer 46

For Hip AVN 1: Normal XR +- osteopenia 2. Signs of bone remodelling( Cystic or sclerotic changes) 3. Crescent sign(subchondral collapse) or flattening of femoral head 4. Narrowing of joint space and degenerative changes of acetabulum

Question 47

Causes of positive Trendelenburg sign

Answer 47

1. Iatrogenic – post surgical (direct trauma to muscles, superior gluteal nerve injury from retraction) – usually in anterolateral approach 2. L5 radiculopathy 3. Advanced AVN of the hip 4. Hip OA 5. DDH, SCFE, Perthes