hip injuries

Question 1

what is osteoarthritis?

Answer 1

degenerative disorder caused by breakdown of articular hyaline cartilage

non-inflammatory condition

Question 2

what are the risk factors associated with primary osteoarthritis?

Answer 2

• Age
• Female sex
• Ethnicity
• Genetics (OA runs in families)
• Nutrition

Question 3

what are the risk factors associated with secondary osteoarthritis?

Answer 3

• Obesity
• Trauma (including sports and occupational risk factors)
• Malalignment (incorrect alignment)
• Infection e.g. septic arthritis, tuberculosis
• Inflammatory arthritis
• gout
• haematological disorders
• endocrine abnormalities

Question 4

what are the symptoms of osteoarthritis?

Answer 4

• a deep aching joint pain
• reduced range of motion and crepitus (grinding)
• stiffness during rest

Question 5

what is the pathology of osteoarthritis?

Answer 5

1. risk factors cause damaged to hyaline cartilage covering the articular surface
2. hyaline cartilage is swollen due to increased proteoglycan synthesises by chondrocytes (attempt to repair cartilage damage)
3. proteoglycan content eventually falls and cartilage softens and loses elasticity — flaking and fibrillation develops along the smooth articular surface
4. cartilage is eroded down to bone resulting in lose of joint space
5. eburnation occurs — bone becomes thickened and denser at areas of pressure

Question 6

what are the 4 cardinal signs of osteoarthritis on an X-ray?

Answer 6

L - loss of joint space
O - osteophytes
S - subchondral scelrosis
S - sunchondral cysts

Question 7

what measures can be taken to control symptoms of osteoarthritis?

Answer 7

• weight loss
• walking sticks
• pain killers
• anti-inflammatories (NSAID’s)
• steroid injections into joint

Question 8

how is hip osteoarthritis cured?

Answer 8

total hip replacement

Question 9

what is a fractured neck of femur?

Answer 9

fracture of proximal femur up to 5 cm below the lesser trochanter

Question 10

what are the 2 types of fractured neck of femur?

Answer 10

1. intracapsular
2. extracapsular

Question 11

which blood supply is likely to be compromised in an intracapsular neck of femur fracture?

Answer 11

ascending cervical branches of medial femoral circumflex artery (MFCA)

• this increases risk of avascular necrosis since artery of ligamentum teres cant meet metabolic demands

Question 12

which blood supply is likely to be compromised in an extracapsular neck of femur fracture?

Answer 12

retinacular arterial supply

Question 13

what are the symptoms of neck of femur fractures?

Answer 13

reduced mobility

pain which may be felt in hip, groin or knee

Question 14

what are the observations seen in a neck of femur fracture?

Answer 14

leg is shortened, abducted and laterally rotated

pain on palpation of greater trochanter + pain exacerbated by rotation of the hip

Question 15

why does the leg appear shorter, abducted and laterally rotated in neck of femur fracture?

Answer 15

shorter - thigh muscles pull fragment of femur upwards

abducted - strong abductors that attach to the greater trochanter abduct the femur distal to fracture site

laterally rotated - the deep muscles of the hip contract and laterally rotate the femoral shaft

Question 16

what is meant by dislocation of the hip?

Answer 16

head of femur is fully displaced out of the cup shaped acetabulum

Question 17

what is the term given to describe a partially displaced hip?

Answer 17

subluxation

Question 18

what are the 2 category of causes of a hip dislocation?

Answer 18

congenital causes:

• developmental dysplasia of the hip (DDH)

traumatic causes:

• severe injury

Question 19

what are the most common types of hip dislocations?

Answer 19

posterior

(1 posterior ligament vs 2 anterior ligaments)

Question 20

what are the observations seen in a posterior hip dislocation?

Answer 20

limb is shortened, flexed, adducted and medially rotated

Question 21

why does the leg appear shorter, medially rotated after posterior hip dislocation?

Answer 21

shorter - head of femur is pulled up by gluteus maximus and hamstrings

medially rotated - fibres of gluteus medius and minimus pull on posteriorly displaced greater trochanter

Question 22

what are the observations seen in an anterior hip dislocation?

Answer 22

leg is laterally rotated and abducted with slight flexion

Question 23

What observations are seen in a central hip dislocation?

Answer 23

head of femur is driven into pelvis through the acetabulum

femoral head is palpable on rectal examination