Hip Pain

Question 1

Pain in the buttock can be referred from?

Answer 1

Lumbosacral spine

Hip joint

Question 2

Pain in the groin can be referred from?

Answer 2

Hip joint - typically where it’s referred to
Lumbosacral spine
Sacro-iliac joint

Question 3

Pain in the anterior thigh can be referred from?

Answer 3

Hip joint

Question 4

Pain in the lateral pelvis can be referred from?

Answer 4

Gluteal muscles

Trochanteric bursa

Question 5

What is the innervation of the hip joint?

Answer 5

Articular branches from

• Femoral and obturator nerves - L2-4
• Superior gluteal nerve - L4-S1
• Nerve to quadratus femoris - L4-S1

Question 6

What are some risk factors for hip pain?

Answer 6

Obesity
Age
Previous injury
FHx
Previous cancer
Immunosuppression

Question 7

What are the risk factors for avascular necrosis?

Answer 7

Steroid use
Smoking
Severe alcohol use

Question 8

What are some associated symptoms of hip pain?

Answer 8

Stiffness
Clicking/grating
Limping
Leg weakness - sensation of giving way
Limb numbness/paraesthesia

Question 9

How can the severity of hip pain be assessed, aside from a visual analogue scale?

Answer 9

Limitations of ADLs
Walking distance
Sleep disturbance
Analgesic/NSAID use

Question 10

What pathology can cause hip pain?

Answer 10

Fracture
Arthritis
Bursitis
Tendinopathy
Not to be missed
- Infection
- Tumour

Question 11

What are the risk factors for secondary osteoarthritis?

Answer 11

Hx of trauma
Other pre-existing joint disease
- Gout
- Inflammatory arthritis
- Childhood developmental disorders

Question 12

What are the radiological signs of avascular necrosis of the neck of femur?

Answer 12

Flattening of femoral head
Subchondral lucency
Joint space narrowing

Question 13

On which imaging modality is avascular necrosis seen?

Answer 13

MRI

Question 14

What is functional leg length discrepancy?

Answer 14

Feel off-balance > put block under leg > feel on-balance again

Question 15

How is apparent leg length measured?

Answer 15

Umbilicus to medial malleolus

Question 16

How is true leg length measured?

Answer 16

ASIS to medial malleolus

Question 17

How is osteoarthritis of the hip diagnosed?

Answer 17

History - stiffness
Examination - limited range of movement, especially internal and external rotation
Investigations - not blood test
- Blood tests to exclude other arthritides

Question 18

What are the radiological signs of osteoarthritis on x-ray?

Answer 18

LOSS

• L = loss of joint space
• O = osteophytes
• S = sclerosis
• S = subchondral cysts

Question 19

What are the goals of management of osteoarthritis?

Answer 19

Relieve pain

Improve mobility

Question 20

What exercise is recommended in the management of osteoarthritis?

Answer 20

Any regular low impact exercise that doesn’t worsen symptoms

Question 21

What can be done before and after exercise to relieve pain and inflammation in osteoarthritis?

Answer 21

Local heat before

Cold packs after

Question 22

Is physiotherapy effective in the management of osteoarthritis in the lower limb?

Answer 22

Not that effective in hip

Far more effective in knee and ankle

Question 23

What are the pharmacological therapies available for the management of osteoarthritis?

Answer 23

Analgesics
- Paracetamol
- Stronger analgesics; eg:
   - Tramadol
   - Codeine
NSAIDs
Glucosamine and chondroitin - can relieve symptoms of pain and stiffness for some people
Intra-articular corticosteroid injection

Question 24

What are the side effects of NSAIDs?

Answer 24

Nausea
Abdominal pain
Diarrhoea
Gastritis
Ulcerss
GI bleeding, especially if on antiplatelets/anticoagulants

Question 25

What are the indications for a total hip replacement?

Answer 25

Disabling pain with failed non-operative treatment

Question 26

What are the goals of total hip replacement?

Answer 26

``` Relieve pain Correct deformity Restore - Range of movement - ADLs ```

Question 27

What are the intra-operative complications of a total hip replacement?

Answer 27

Injury to neurovascular structures | Fracture

Question 28

What are the early post-operative complications of a total hip replacement?

Answer 28

Haematoma Infection Wound dehiscence

Question 29

What are the late post-operative complications of a total hip replacement?

Answer 29

``` Dislocation Leg length discrepancy Fracture Loosening Heterotopic ossification ```

Question 30

What are the options for anticoagulation post-operatively after a total hip replacement?

Answer 30

``` Keep mobile Chemophylaxis - LMW heparin - Aspirin - Warfarin Mechanical - Foot pump - Compression stocking ```

Question 31

What is greater trochanteric pain syndrome?

Answer 31

Spectrum of diseases including - Gluteus medius tendinopathy - Trochanteric bursitis Analogous to rotator cuff tendon degeneration/subacromial bursistis at shoulder

Question 32

What are the management options for greater trochanteric pain syndrome?

Answer 32

US guided corticosteroid injection Oral NSAIDs Simple analgesics Hip abductor strengthening exercises