Hip Problems

Question 1

describe developmental dysplasia of the hip (DDH)

Answer 1

the ball and socket joint does not form correctly leading to dislocation

Question 2

who is DDH more common in?

Answer 2

females
L hip
breech
oligohydramnios

Question 3

diagnosis of DDH

Answer 3

baby checks with examination showing asymmetry, loss of knee height less abduction and flexion
specific tests include Barlow’s (adduction and downwards pressure)
Ortolani (abduction and lift)

Question 4

management of DDH

Answer 4

pavlik harness
if late presentation may be pelvic osteotomy
if left untreated the acetabulum is very shallow and a false acetabulum can develop leading to a shortened lower limb

Question 5

what age does slipped upper femoral epiphysis (SUFE) occur in ?

Answer 5

ages 8-18 (pubertal growth associated with weight gain)

Question 6

presentation of SUFE

Answer 6

pain
limp
short
externally rotated
loss of internal rotation and deep flexion
antalgic gait

Question 7

diagnosis of SUFE

Answer 7

XR to assess degree of slip

Question 8

management of SUFE

Answer 8

manage with surgery to pin femoral head or hip replacement

if acute slip then manipulation but chronic requires osteotomy

Question 9

define transient synovitis

Answer 9

inflammation of the synovium, secondary to viral illness

Question 10

presentation of transient synovitis

Answer 10

pain

hip flexed and externally rotated

Question 11

diagnosis of transient synovitis

Answer 11

Kocher’s criteria

USS +/- aspiration

Question 12

management of transient synovitis

Answer 12

short course NSAIDs

rest

Question 13

define septic arthritis of the hip

Answer 13

intra-articular infection of the hip joint

Question 14

is septic arthritis a surgical emergency?

Answer 14

yes due to destruction of the joint by proteolytic enzymes and osteonecrosis potential

Question 15

presentation of septic arthritis

Answer 15

quick onset
pyrexial
unable to bear weight
hip lying flexed and externally rotated

Question 16

diagnosis of septic arthritis of the hip

Answer 16

cultures
Kocher’s criteria
USS +/- aspiration

Question 17

management of septic arthritis of the hip

Answer 17

open surgical washout and antibiotics

Question 18

define perthes disease

Answer 18

avascular necrosis of the hip in 4-8 year olds (usually male) which leads to abnormal growth with fractures and collapse, subsequent remodelling occurs

Question 19

risk factors for Perthes disease

Answer 19

positive family history
low birth weight
passive smoke
Asian
inuit
central European

Question 20

presentation of Perthes disease

Answer 20

pain
limb
positive Trendellenburg test (gluteal weakness)
loss of internal rotation

Question 21

management of Perthes disease

Answer 21

avoid physical activity

Question 22

shortened leg and externally rotated

Answer 22

displaced fracture neck of femur

Question 23

shortened leg and internally rotated

Answer 23

dislocated femoral head