Hip and Knee

Question 1

name the early local complications of a hip/knee operation/replacement/

Answer 1

infection
dislocation
nerve injury
leg length discrepancy
MI
PE/DVT
UTI
blood loss

Question 2

why dont we like like to give younger patient a full knee/hip replacement

Answer 2

they will put it under more stress and so more likely to need another one.

Question 3

what is Avascular necrosis?

Answer 3

death of bone due to lack of blood supply

Question 4

where is the most common site for AVN?

Answer 4

hip joint

Question 5

what to patients tend to present with when they have AVN?

Answer 5

groin pain

Question 6

treatment for AVN?

Answer 6

decompression if caught early enough

if not then THR

Question 7

name some signs/symptoms of trochanteric bursitis

Answer 7

pain and tenderness over grearter trochanter

pain on resisted abduction

Question 8

treatment for trochanteric bursitis?

Answer 8

analgesic
anti-inflam
physio
steroid injection

Question 9

when do meniscal injuries classically occur?

Answer 9

twisting force on a loaded knee

Question 10

where is the pain localised to in a meniscal injury?

Answer 10

medial or later joint line (mainly medial)

Question 11

catching sensation/ “locking”

struggle to straighten knee

Answer 11

meniscal injury

Question 12

knee becoming stuck

Answer 12

pseudolocking (in OA)

Question 13

when to ACL ruptures usually occur

Answer 13

turning the upper body laterally on a planted foot causing internal rotation force on tibia

Question 14

“pop” usually felt or heard

Answer 14

ACL rupture

Question 15

rotational force injury
pop is heard or felt
haemarthrosis (effusion due to bleeding in joint) within an hour
deep knee pain

Answer 15

ACL rupture

Question 16

twisting force
localised pain to medial/lateral joint line
catching sensation/ locking of the knee
cant straighten knee
about to give way
effusion develops following day( synovial fluid)

Answer 16

Meniscal injury!

Question 17

what will a valgus stress injurie cause? (rugby tackle from side)

Answer 17

tear the medial collateral ligament also potential damaging ACL

Question 18

what will a direct blow to the anterior tibia with the knee flexed (e.g motor bike crash) or hyper-extension cause?

Answer 18

PCL rupture

Question 19

what will a varus stress rupture?

Answer 19

lateral collateral ligament

Question 20

what other tear/rupture usually occurs which a meniscal tear?

Answer 20

ACL rupture

Question 21

how do you confirm a meniscal tear?

Answer 21

MRI

Question 22

postive steinman’s test

Answer 22

meniscal tear

Question 23

can meniscal tears be degenerative?

Answer 23

yes

Question 24

how do you repair a meniscal tear?

Answer 24

may wont heal by themselves and require

arthroscopic menisectomy

Question 25

what does ACL reconstruction involve?

Answer 25

tendon graft

Question 26

what causes PCL (if it happens alone)?

Answer 26

frequent hyperextension anterior subluxation of femur severe laxity

Question 27

How should a complete knee dislocation be managed?

Answer 27

reduced as an emergency may require external fixation for temporay stabilization vascular assessment should be done

Question 28

what does the extensor mechanism of the knee involve/include?

Answer 28

``` tibial tuberosity patellar tendon patellar quads tendon quads ```

Question 29

what age tend to get patellar tendon ruptures?

Question 30

what age tend to get quad tendon ruptures?

Answer 30

>40

Question 31

predisposing factors for extensor mechanism rupture?

Answer 31

``` history if tendonitis chronic steroid use (body builders) diabetes RA chronic renal failure ```

Question 32

how do you assess the extensor muscle mechanism?

Answer 32

straight leg raise

Question 33

what is patellofemoral dysfunction?

Answer 33

disorder of patellofemoral articulation causing anterior knee pain e.g softening of hyaline cartilage

Question 34

anterior knee pain worse going down hill grinding or clicking sensation of front of knee stiffness after prolonged sitting causing pseudolocking

Answer 34

patellofemoral dysfunction

Question 35

what can cause patellar dislocation?

Answer 35

direct flow or sudden twist of knee

Question 36

what ligament tears with a patellar dislocation?

Answer 36

patellofemoral ligament

Question 37

predisposing factors for patellar instability?

Answer 37

``` hypermobile female genu valgum hight riding patella femoral neck anteversion ```