Hip Conditions

Question 1

8 Precipitating causes of secondary Osteoarthritis

Answer 1

Obesity, trauma, malalignment (developmental dysphasia), infection (septic arthritis/TB), Inflammatory arthritis (Rheumatoid/ ankylosing spondylitis), metabolic disorders (gout), haematological disorders (haemophilia with haemarthrosis), endocrine abnormalities

Question 2

5 risks for Osteoarthritis

Answer 2

Older, female, ethnicity (african-American, American-Indian, Hispanic), lack VC and VE, genetics

Question 3

4 Symptoms of osteoarthritis

Answer 3

Depp aching joint pain exacerbated by use, reduced range of motion, crepitus (grinding), stiffness at rest (morning)

Question 4

Pathology of osteoarthritis

Answer 4

Excessive/ uneven loading joint - damage to hyaline cartilage - swollen increased proteoglycan synthesis by chondrocytes (over several years) - proteoglycan content falls - cartilage soft and lose elasticity - flaking & fibrillation (vertical clefts) develop along articulated surface - cartilage eroded to subchondral bone - loss of joint space - vascular invasion & increased cellular its (eburnation) = subchondral sclerosis on X-rays. Bone may undergo cystic degeneration form subchondral bone cysts (cause Ossetia necrosis from chronic pressure OR intrusion synovial fluid). Articulate margins Ossetia metaplasia lf CT = irregular outgrowths new bone (osteophytes)

Question 5

4 Cardinal signs osteoarthritis on X-rays

WB 1, pg 125

Answer 5

Reduced joint space (A), Subchondral sclerosis (B), bone cysts (C), osteophytes (D)

Question 6

Osteoarthritis of the hip who and 5symptoms

Answer 6

Men over 40. Joint stiffness, pain in hip/gluteal region/ groin/ knee, mechanical pain (exacerbated mobilisation/ weight bearing), crepitus, reduced mobility.

Question 7

11 Treatment OA hip

Answer 7

Weight reduction, activity modification, walking-stick/ frame, strengthening exercises, orthotic footwear, analgesia, anti-inflammatories (NSAIDS, COX-2 inhibitors), nutritional supplements, steroid injections, hyaluronic acid injections, total hip replacement

Question 8

Fractured neck of femur (#NOF) intacapsular: what, who, treatment

Answer 8

Fracture of proximal femur up to & 5cm below lesser trochanter. INTRACAPSULAR- disrupt ascending cervical branches of medial femoral circumflex artery -> avascular necrosis femoral head.

Elderly, post-menopause osteoporotic, minor fall.

If displaced: Surgical replacement of femoral head (hemiarthroplasty or THR)

Question 9

Fractured neck of femur (#NOF) extracapsular classifications, who

Answer 9

Fracture proximal femur, up to 5cm below lesser trochanter. EXTRACAPSULAR - intertrochanteric or subtrochanteric. Retinacular supply likely remain.

Young/ middle-aged, traumatic force

Question 10

3 Symptoms of #NOF and if displaced examination 5 signs

Answer 10

Reduced mobility, can’t bear wight, pain hip/groin/ knee.

If displaced: shortened leg, abducted, externally rotated. (Short lateral rotators of hip contract and laterally rotate femoral shaft, thigh muscles pull distal fragment femur up) Pain on palpation of greater trochanter and rotation of hip.

Question 11

Dislocation of hip: definition, 3 types, positions.

Answer 11

Head of femur fully displaced out of acetabulum of pelvis. Can be developments, dysplasia (not always dislocation, May develop after birth) OR traumatic 16-40yro high-speed traffic collisions. Extreme pain.

90% posterior. Limb shortened (femoral head pulled up strong extensors and adductors) and held in position felxion, MR, adduction. Sciatic nerve palsy 8-20% .

Anterior LR, abduction, flexion. May femoral nerve palsy.

Central fracture- dislocation, head driven into pelvis. Risk intrapelvic haemorrhage = fatal.