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Flashcards in Hip orthopaedics and trauma Deck (52):
1

What can cause secondary osteoarthritis in the hip?

Trauma

AVN

DDH

Perthes disease

SUFE

2

Where might hip pain present?

Pain in groin, anterior or lateral thigh

Referred pain in the knee

Pain at night

Limp

Stiffness (morning - RA)

Reduced walking distance

3

For most patients, what are the indications for total hip replacement?

Severe pain and disability usually with accompanying radiological changes at the hip, in patients where non-operative treatment has failed or is futile

4

Why is total hip replacement not favoured in younger patients?

Increased risk of loosening

Increased risk of osteolysis

5

What other treatments might be considered in place of total hip replacement in a younger patient?

Osteotomies of pelvis and/or femur

Hip resurfacing

Arthrodesis (with ORIF)

Vascularized fibular graft in early AVN

6

What are some of the symptoms of hip osteoarthritis?

Pain in the hip joint that may include pain in the groin, outer thigh, or buttocks

Difficulty walking or walking with a limp

Pain that worsens with vigorous or extended activity

Stiffness in the hip or limited range of motion

7

What are some of the symptoms of hip rheumatoid arthritis?

Pain in the hip joint that may include pain in the groin, outer thigh, or buttocks

Difficulty walking or walking with a limp

Stiffness in the hip or limited range of motion

Bilateral involvement

Small joints (hands, cervical spine) involvement

8

How do patients with avascular necrosis tend to present?

Groin pain

9

What can avascular necrosis of the femoral head be secondary to?

Alcohol abuse

Hyperlipidaemia

Thrombophilia

10

Which form of imaging might be required to show early changes due to avascular necrosis?

MRI

11

What does this image show?

Q image thumb

Femoral head removed during total hip replacement with a loose flap of cartilidge (osteochondritis dessicans) due to avascular necrosis

12

What are the two main causes of hip impingement?

Deformity of head of femur

Deformity of acetabulum

13

What are the symptoms of hip impingement?

Stiffness in groin or front of thigh
Loss of full range of motion of hip

Pain near limit of movement of hip

14

What is bone marrow oedema syndrome?

Transient osteoporosis

15

How might bone marrow oedema syndrome of the hip present?

Worsening hip pain - worse on exercise
Usually unilateral

16

What radiological changes occur in bone marrow oedema syndrome?

Osteoporotic changes on Xray

Bone inflammation on MRI

17

Which patients tend to be affected by bone marrow oedema syndrome?

Middle aged men

Women in third trimester of pregnancy

18

What is the treatment for transient osteoporosis?

Painkillers

Bisphosphonates

(Self-limiting)

19

What kinds of hip impingement are there?

A image thumb
20

What is trochanteric bursitis?

Painful inflammation of the bursa just superficial to the greater trochanter

 

21

What is snapping hip syndrome?

A condition characterized by a snapping sensation felt when the hip is flexed and extended, which may be associated with an audible snap or pain

22

Which type of snapping hip syndrome is more common?

 

Lateral extra-articular, involving the snapping of the iliotibial band, the tensor fascia lata or the tendon of the gluteus medius sliding back and forth over the greater trochanter

 

 

23

What can untreated snapping hip syndome lead to?

Bursitis

Effusion/inflammation of the area

Muscle trauma

24

What is the pain associated with trochanteric bursitis/gluteal cuff syndrome?

Patients have pain and tenderness in the region of the greater trochanter with pain on resisted abduction

25

What is gluteal cuff syndrome?

Tearing, inflammation and degradation of the tendons of the abductor muscles, particularly gluteus medius, due to the immense strain they are under

26

What are the treatments avaliable for trochanteric bursitis/gluteal cuff syndrome?

Anti-inflammatories

Analgesia
Physiotherapy

Steroid injection

27

What is the treatment for avascular nercosis?

Pre-collapse: drill holes can be made up the femoral neck and into the abnormal area in the head in an attempt to relieve pressure (decompression), promote healing and prevent collapse

Post-collapse: total hip replacement

28

What is the difference between total hip arthroplasty (THA) and total hip replacement (THR)

THA encompasses procedures such as hip resurfacing

29

Which total hip replacement is the 'gold standard' to which all other results must be compared?

Cemented metal/polyethylene THR

30

How long are hip replacements expected to last in a low demand older patient?

Cup - 15 years

Stem - 20 years

31

Why does loosening of hip replacements occur?

Wear particles from the bearing surface cause an inflammatory response at the implant-bone/cement-bone interface

Macrophages ingest microscopic wear particles and release inflammatory mediators resulting in osteoclastic bone resorption

32

Why are ceramic hip replacements widely used?

Favourable friction properties

33

What problem was caused in a small number of metal-on-metal hip replacements?

There was a reaction to metal debris resulting in the formation of an inflammatory pseudotumour which can cause necrosis of muscle and bone

34

What are the early local complications of hip replacement?

Infection

Dislocation

Nerve injury (sciatic nerve)

Leg length discrepancy

35

What are the late complications of a total hip replacement?

Early loosening

Late infection (haematogenous spread from a distant site)

Late dislocation (due to component wear).

36

What are the extra risks associated with a revision hip replacement?

Bigger, more complex surgery

Substantial blood lose

Double the complication rate as primary procedure

Poor functional outcome

37

Which acetabulum fracture is associated with hip dislocation?

Posterior wall - this is fractured as the head of the femur is pushed through the wall

38

What kind of injury in which patient is the most common for acetabulum fractures?

High energy injury, young patients

Can be low energy injury in older patients

39

What radiological investigations should be requested for an acetabulum fracture?

X-rays - oblique view may help as fracture can be hard to see on AP

CT scan - essential for surgical planning

40

How is acetabulum fracture treated?

 

Undisplaced or small wall fractures can be treated conservitively

Displaced or unstable fractures must be treated with anatomic reduction and rigid fixation to prevent development of OA in a younger patient

THR can be considered in older patients

41

Which condition are hip fractures generally associated with in the aging population?

Osteoporosis

42

Which is the most common kind of patient to present with hip fracture?

Over 80 years old

Female

Co-morbidities (cerebrovascular insufficiency, cardiac arrhythmias, postural hypotension etc.) which contribute to falls

43

Which complications are common following surgical fixation of a fractured hip?

Chest infections

Respiratory failure

MI

Acute renal failure

DVT

44

What is the mortality rate one year after fixation of a hip fracture?

30%

45

What are the two broad classifications of hip fracture and what is the relevance of this classification?

Intracapsular

Extracapsular

Related to the blood supply: describes the liklihood of disruption to the femoral blood supply

46

Which kind of hip fracture can disrupt the arterial supply of the femoral head?

Intra-capsular

47

What is the best treatment for intracapsular hip fractures?

Femoral head replacement due to disruption to the arterial supply: either hemi-arthroplasty (replacing just the femoral head) or THR

48

In which patients is an intracapsular hip fracture best treated with a hemi-arthroplasty?

Impaired cognitive function

Restricted mobility

This is due to greater risk of dislocation with THR

49

What is the best treatment for extracapsular hip fracture?

Internal fixation: compression or dynamic hip screw

 

50

What is a dynamic hip screw?

This consists of a large screw, inserted into the femoral head across the fracture line, and a plate with a barrel which engages with the lateral end of the screw and is fixed to the femoral shaft

As the patient weight bears, the screw is allowed to slide in the barrel of the plate, which results in compression at the fracture site which promotes fracture healing

51

What are the associated complications with intracapsular fracture?

Avascular necrosis

Non-union

52

What is the best treatment for subtrochanteris proximal femoral fractures?

Intramedullary nail - avoids further disruption to blood supply