Hip conditions

Question 1

Which muscle groups attach to greater trochanter?

Answer 1

Abductors and rotators

Question 2

Which muscle attaches to lesser trochanter of femur?

Answer 2

Psoas

Question 3

What is the labrum?

Answer 3

Fibrocartilaginous lining of acetabulum

Question 4

What is the purpose of the labrum?

Answer 4

Deepens socket

Adds stability

Question 5

What are the branches of the profunda femoris artery?

Answer 5

Medial and lateral circumflex arteries

Question 6

What is the main blood supply to the hip joint?

Answer 6

Medial and lateral circumflex arteries from profonda femoris a.

Question 7

What is the significance of the blood supply to the hip?

Answer 7

Fracture of neck of femur can disrupt blood supply and lead to avascular necrosis

Question 8

What is the function of the hip bursae?

Answer 8

Reduce friction between tissues

Question 9

What is osteoarthritis?

Answer 9

Degenerative change of synovial joints
Progressive loss of articular cartilage
Results in secondary bony changes

Question 10

What is the presentation of osteoarthritis?

Answer 10

Pain and stiffness of affected joint

Question 11

What is the trochanteric bursa and where is it?

Answer 11

Fluid-filled sac between hip abductors and ITB

Question 12

What happens in trochanteric bursitis?

Answer 12

Inflammation of bursa and swelling

Question 13

Which sex does trochanteritic bursitis tend to affect more?

Answer 13

Females

Question 14

What are the causes of trochanteric bursitis?

Answer 14

Trauma
Over-use: athletes (runners), repetitive movements
Abnormal movements: distant problem: scoliosis OR local problem: muscle wasting following surgery, THR, OA

Question 15

How does trochanteric bursitis present?

Answer 15

Pain: point tenderness on lateral hip

Question 16

What is the examination for trochanteric bursitis?

Answer 16

LOOK:
?scars previous surgery
?muscle wasting (gluteals)
FEEL:
?tenderness greater tuberosity
MOVE:
?worst pain active abduction

Question 17

What is the worst pain in trochanteric bursitis?

Answer 17

Active abduction

Question 18

What are the investigations for trochanteric bursitis?

Answer 18

XR
MRI
USS

Question 19

What else can be done in an USS for trochanteric bursitis?

Answer 19

Guided steroid injection

Question 20

What is the treatment for trochanteric bursitis?

Answer 20

NSAIDs
Rest/activity modification
Physio: strength muscles around joint, stretching
Corticosteroid injections
Surgery: bursectomy

Question 21

What is avascular necrosis?

Answer 21

Death of bone due to loss of blood supply

Question 22

Which sex does avascular necrosis affect more?

Answer 22

Males

Question 23

What are the risk factors for avascular necrosis?

Answer 23

Trauma: irradiation, fracture, dislocation, iatrogenic
Systemic: idiopathic, hypercoaguable states, steroids, haematological (sickle cell disease, lymphoma, leukaemia), Caisson’s disease, alcoholism

Question 24

What is Caisson’s disease?

Answer 24

Decompression sickness

Question 25

What kind of fracture can cause injury to femoral head blood supply?

Answer 25

Intracapsular fracture

Question 26

What is the pathoanatomic cascade of avascular necrosis?

Answer 26

``` Coagulation of intraosseous microcirculation -> Venous thrombosis -> Retrograde arterial occlusion -> Intraosseous hypertension -> Reduced blood flow to head -> Cell death -> Chondral fracture and collapse ```

Question 27

What are the symptoms of avascular necrosis?

Answer 27

Insidious onset of groin pain Pain with stairs/walking uphill Limp

Question 28

On examination, how might avascular necrosis present?

Answer 28

Largely normal | May replicate early arthritis: reduced ROM, stiff joint

Question 29

What is the non-operative treatment for avascular necrosis?

Answer 29

``` Reduce weight-bearing NSAIDs Biphosphonates Anticoagulants Physio ```

Question 30

What are the surgical management options for avascular necrosis?

Answer 30

- Core decompression = restore blood supply - Rotational osteotomy = move lesion away from weight bearing area - THR

Question 31

What is femoroacetabular impingement (FAI) a common cause of?

Answer 31

- Hip pathology in younger patient | - Secondary osteoarthritis

Question 32

What 2 categories is femoroacetabular impingement (FAI) divided into?

Answer 32

Cam lesion | Pincer

Question 33

What is femoroacetabular impingement (FAI?

Answer 33

Impingement of femoral neck against anterior edge of acetabulum

Question 34

What is a cam lesion in FAI?

Answer 34

A deformity on the femoral head, grinds the cartilage in the acetabulum

Question 35

What is a pincer lesion in FAI?

Answer 35

Acetabulum-based impingement | Extra bone extends out over the normal rim of the acetabulum

Question 36

What does abnormal acetabulum lead to?

Answer 36

Anterosuperior acetabular ring overhand | Acetabular protrusion

Question 37

Who is more commonly affected by pincer lesion in FAI?

Answer 37

Active females

Question 38

What are associated injuries of FAI?

Answer 38

Labral degeneration and tears Cartilage damage and flap tears Secondary hip OA

Question 39

How does femoroacetabular impingement (FAI) usually present?

Answer 39

Groin pain - worse with flexion Block to movement Pain with certain manoeuvres: getting out chair/squatting/lunging

Question 40

How does femoroacetabular impingement (FAI) usually present on examination?

Answer 40

Reduced flexion and internal rotation Positive FADIR test - Flexion, Adduction, Internal Rotation

Question 41

What is the FADIR test?

Answer 41

The FADIR (flexion, adduction, and internal rotation) test is a passive motion test to help diagnose hip impingement

Question 42

What are the investigations for femoroacetabular impingement (FAI)?

Answer 42

XR | MRI

Question 43

What is the treatment for femoroacetabular impingement (FAI)?

Answer 43

Activity modification NSAIDs Physio Arthroscopy: shaves down defect, deals with labral tears Open surgery: resection, periacetabular osteotomy or hip arthroplasty (resurfacing or replacement)

Question 44

What is the most common anterosuperior tear of the hip joint?

Answer 44

Labral tear

Question 45

Who is commonly affected by labral tears?

Answer 45

Any age | Active females

Question 46

What are causes of labral tear?

Answer 46

``` FAI Trauma OA Dysplasia Collagen diseases - Ehlers-Danlos ```

Question 47

What is the presentation of a labral tear?

Answer 47

Groin or hip pain Snapping sensation Jamming or locking

Question 48

How does a labral tear present on examination?

Answer 48

Can be normal | Positive FABER test (Flexion, Abduction, External Rotation)

Question 49

What is the FABER test?

Answer 49

The FABER test is used to identify the presence of hip pathology by attempting to reproduce pain in the hip, lumbar spine or sacroiliac region (Flexion, Abduction, External Rotation)

Question 50

What are investigations for a labral tear?

Answer 50

XR MRI arthrogram Diagnostic injection

Question 51

What are the treatment options for a labral tear?

Answer 51

Non-operative: activity modification, NSAIDs, physio, steroid injections Operative: arthroscopy (repair or resection)