Flashcards in Hip and Knee Deck (71):
when is genu varum normal?
in children for 1-2 yrs after starting to walk
when is genu valgum normal?
in children 2-4 yrs of age
what is genus varum?
reduced Q angle= angle between the femur and the tibia, with a medial angulation of the leg in relation to the thigh (bowleg).
puts excess pressure on medial aspect of knee joint, and overstresses the fibular collateral ligament.
what is Lachman's test?
used to test for injury to ACL
displacement of femur and tibia assessed
benefits of a unicompartmental (partial) knee replacement?
same level of pain relief as TKR, but with less scarring and bruising
range of movement often better than with TKR
why is a unicompartmental knee replacement not suitable for everyone?
need strong healthy ligaments in knee
disease affecting >1 compartment
more likely to need knee revised than with TKR
red flag symptoms in ptnt presenting with hip pain?
unable to bear weight
severe night pain
history of malignancy and hip pain
rapid worsening of symtoms
considerations in site of hip pain?
radiation to groin- likely to be hip
greater trochanter- ?trochanteric bursitis, NOF#
how can intensity of hip pain be assessed?
how far can ptnt walk?- also assess loss of function, do they need a walking aid?- stick, or walker?
scale of 1-10
how can aggravating factors to hip pain be asked about?
pain at night?
exercise?- mechanical pain, biological-rest
walking up and down stairs?
pain post sitting down for long periods, getting out of a chair?- start-up pain?
how is stiffness asked about in hip pain?
can they reach their feet, can they put socks and shoes on?
how difficult is it to get into and out of a car, or bath?
what does start-up pain indicate?
why does start-up pain occur with OA?
articular cartilage has been lost, and during inactivity, there is a reduction in fluid film, so bone ends up grinding on bone, causing pain when ptnt first moves.
other than assessment of hip pain and secondary symptoms, what else is it important to ask in history of ptnt with hip pain?
drug history- pain relief?- has it helped?
SH: occupation?- can they still do this?
exercise, activities enjoyed- how have they been disrupted? how are they managing at home, live alone? stairs? house adjustments e.g. lowered seats, bars?
**classical history of ptnt with greater trochanteric pain syndrome (GTPS)?
terrible, constant pain over lateral hip, can't sleep on that side
what are you looking for when ptnt on bed in hip exam?
symmetry, scars, muscle wasting- indicate not been walking on that side? erythema, hernias
limb length- can assess by feeling medial malleoli
what do you palpate in hip exam.?
distal pulses- must ensure good blood supply intact if thinking of operating
iliac crest, ASIS, PSIS, greater trochanter, ischial tuberosity
types of extracapsular hip fractures?
trochanteric- inter- and reverse oblique
how does a tibial osteotomy work for tment of knee OA?
a wedge of bone is removed from the outside of the tibia, under the healthy side of the knee
on closing the wedge, the leg is straightened, which brings the bones on the healthy side of the knee closer together, creating more space between the bones on the damaged side.
3 goals of knee osteotomy?
transfer weight from arthritic part of join to healthier area
correct poor knee alignment
prolong lifespan of knee joint
hip blood supply?
mainly medial lateral circumflex femoral artery, also lateral circumflex, both give rise to retinacular arteries
also artery of ligamentum teres
and nutrient (medullary) artery
how does avascular necrosis of hip joint appear on radiograph?
appears white as loss of stability causes compression
what provides nourishment of articular cartilage?
why must a hip infection be treated quickly?
to stop progression to septic arthritis in which lost cartilage will result in hip pain for life
requires urgent decompression*
comparisons regarding benefits and risks associated with THR and hemiarthroplasty for treating hip fractures?
both assoc. with lower reoperation rates and better function than internal fixation in ptnt with displaced IC hip fractures
THR may be assoc. with lower reoperation rates and better function than hemi
but THR has slightly higher risk of dislocations and general comlications- tnt must be fitter?
how do bone edges appear in a hip fracture in contrast to smooth edges normally seen?
where is apparent leg length measured?
from umbilicus or xiphisternum to medial malleolus
where is true leg length measured?
from ASIS to medial malleolus
inspecting ptnt from a far in hip exam., what are you looking for?
look at hips, any pelvic tilting? are they symmetrical
look at spine- any scoliosis?
look at knees
can observe muscle wasting e.g. from disuse, infection, polio
can look for a rotational deformity- common in OA*
ptnt must be inspected from front, side and behind. what are we looking for from the side and back?
increased lumbar lordosis- suggestive of fixed flexion deformity of hip- tested in Thomas test
back- scoliosis- may be secondary to pelvic tilting, gluteal muscle wasting e.g. from disuse, infection, and sinus scars- e.g. secondary to TB
what to look at 1st when inspecting gait of an individual?
look at heel strike
why does limb appear short in apparent shortening?
adduction contracture of hip, which is compensated for by tilting of pelvis
how might a ptnt noticeably compensate for limb shortening?
plantarflexion of foot on affected side
flexion of knee on unaffected side
pelvic tilting, may compensate for by development of a lumbar scoliosis
in true limb shortening, what will be notes when ptnt supine?
heels will not be level, but pelvis will not be tilted
where does iliopsoas insert?
lesser trochanter of femur
origin of hamstrings?
except short head of biceps femoris- posterior aspect of femur
a loss affecting hip extension only is often 1st detectable sign of what?
hip joint effusion
normal hip extension range?
normal range of hip flexion?
normal range of hip abduction?
how can the faber sign be elicited?
both hips and knees flexed, place (L) foot on opp. knee and gently press down on knee of (L) leg
normal range of hip adduction?
normal range of internal rotation of hip at 90 degrees flexion?
normal range of hip external rotation at 90 degrees flexion?
normal range of hip internal rotation in extension?
normal range of hip external rotation in extension?
causes of coxa vara?
causes of coxa valga?
what is Perthe's disease?
condition in which blood supply to epiphysis of femoral head is disturbed, so a portion undergoes avascular necrosis
commonly presents between ages of 4 and 6, and commoner in boys than girls
assoc. with anteversion of femoral neck
usually presents with a limp, and vague pains in hips, thighs or knees
tment of acute symptoms in perthe's disease?
bed rest and traction
followed by physio
what happens in a SUFE (slipped upper femoral epiphysis) of hip?
attachment of femoral epiphysis to femoral neck loosens, so head appears to slide downwards on femoral neck, eventually producing a coxa vara hip deformity.
may be history of preceding
may be hormonal disturbance
disease of adolescence, more common in boys
late complications of SUFE?
femoral head avascular necrosis
presentation of SUFE?
pain in groin or knee
may be impossible to weight bear
internal rotation and abduction of affected hip restricted
tment of SUFE?
internal fixation of epiphysis without reduction
if large amount of acute displacement, may reduce before fixation, but this may increase risk of AN
osteotomy of femoral neck if longstanding
may do prophylactic pinning of other hip if not bilateral, but only if high risk
swelling should be noted on knee observation, what might be indicated if swelling extends beyond limits of joint cavity?
infection- of joint, femur or tibia
what might be cause of swelling in joint line of knee?
importance if noting knee bruising?
not usually seen with meniscus tears
why is evidence of psoriasis important to note in looking at the knee? e.g. red, scaly patches, may have nail changes- nail pitting and onycholysis (nail plate separation from nail bed)
may be a psoriatic arthritis
why might knee be warm and foot cold?
popliteal artery block
normal knee flexion range?
135 degrees or more
with what disease is genu valgum most commonly assoc. with in adults?
what is a Girdlestone procedure?
an excision arthroplasty of the hip
indications for a Girdlestone procedure?
failed internal fixation of femoral neck fractures
benefits of SA over GA in THR operation?
reduced blood loss during surgery- reduce need for blood transfusion, as reduction in arterial and venous pressure with sympathetic blockage
decreased bleeding at operative site, improved cement bonding and reduced surgical time
reduce VTE incidence
avoid -ve effects on pulmonary function of GA
good early PO analgesia
what do the cruciate ligaments lie within?
the intercondylar notch of the femur
why do meniscal tears involving central portion have poor healing?
only peripheral edges of menisci have an appreciable blood supply
describe Apley's test and Thessaly's test?
used to test for meniscal tears
origin of rectus femoris?
difference between locking and pseudolocking of the knee?*
locking- mechanical obstruction to knee joint being extended e.g. a loose body in the joint, torn meniscus
pseudolocking- knee is being prevented from being moved due to pain, but no physical obstruction
how much time should be left if repeat steroid injections into joint?
must be given at least 3 mnths apart