Lecture 6 - Disorders of the hip Flashcards

1
Q

Osteoarthritis

A

Degenerative disorder due to the breakdown of articular hyaline cartilage.

Clinical syndrome:

  • Joint pain
  • Functional limitation
  • Reduced quality of life

Non-inflammatory without systemic involvement

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2
Q

Primary osteoarthritis

A

Unknown cause

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3
Q

Secondary osteoarthritis

A

Has a known precipitating cause

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4
Q

Risk factors of osteoarthritis

A
Age
Female 
Nutrition - diet rich in vitamin C and E can reduce the risk 
Ethnicity 
Genetics
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5
Q

Causes of secondary osteoarthritis

A

Obesity - BMI 30+
Trauma - sports or occupation risk factors
Malalignment - developmental dysplasia of the hip
Infection - septic arthritis, tuberculosis
Inflammatory arthritis - rheumatoid, ankylosing spondylitis
Metabolic disorders affecting the joint - gout
Haematological disorder - haemophilia with haemarthrosis (bleeding in joints)
Endocrine abnormalities- Diabetes with neurovascular impairment - chronic malalignment (Charcot joint)

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6
Q

Symptoms of osteoarthritis

A

Deep aching joint pain exacerbated by use
Reduced range of movement
Crepitus - grinding
Stiffness during rest - morning stiffness

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7
Q

Pathology of osteoarthritis

A
  1. Excessive or uneven loading of the joint
  2. Damage to articular hyaline cartilage
  3. Hyaline cartilage becomes swollen due to increased proteoglycan production by chondrocytes.
  4. Increased chondrocytes are produced from the differentiation of chondroprogenitor cells

Can last several years - attempt to repair itself

  1. Proteoglycan content decreases
  2. Cartilage softens and loses its elasticity
  3. Flaking and fibrillation (vertical clefts) along the normally smooth cartilage
  4. Over time the cartilage becomes eroded to the subcondral bone
  5. Loss of joint space
  6. Surface changes alter the distribution of forces
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8
Q

Affect of osteoarthritis on subchondral bone

A

Vascular invasion

Eburnation: increased cellularity - thicker and denser at areas of pressure

Cystic degeneration forming subchondral bone cysts due to osseus necrosis secondary to chronic impaction (pressure) or intrusion of synovial fluid

Osseus metaplasia of CT occurs therefore outgrowths of new bone - osteophytes

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9
Q

Presentation of osteoarthritis on an Xray

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral bone cysts

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10
Q

Eburnation

A

Increased cellularity of subchondral bone therefore it is thicker and denser at areas of pressure

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11
Q

Symptoms of osteoarthritis in the hip

A

Joint stiffness - especially after rest
Pain in the hip - gluteal and groin region radiating to the
knee (obturator nerve)
Mechanical pain - when weight bearing or moving
Crepitus
Reduced mobility - difficulty walking, putting on socks, tying shoelaces, getting in and out pf the car/ bath

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12
Q

Treatment of osteoarthritis

A
  1. Weight reduction
  2. Activity modification
  3. Walking stick/frame - reduce load through joint
  4. Muscle strengthening exercises ( deep gluteal muscles)
  5. Orthotic footwear - realign joint
  6. Analgesia and NSAIDS (anti-inflammatory)
  7. Steroid injections - into the joint to reduce swelling
  8. Hyaluronic acid injection - increase lubrication and promote cartilage repair (limited evidence)
    Cure = total hip replacement
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13
Q

Location of a fractured neck of femur

A

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

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14
Q

2 types of classification of NOF

A

Intracapsular

Extracapsular - intertrochanteric and subtrochanteric

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15
Q

Intracapsular fractures

A

Likely to disrupt the ascending cervical (retinacular) branch of the MFCA

The ligamentum teres is unable to sustain the blood supply to the femoral head therefore there is a high risk of avascular necrosis

Increased risk in dispaced NOF and adults

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16
Q

Who commonly gets intracapsular fractures

A

Elderly

Post- menopausal women - osteoporosis

17
Q

Who commonly gets extracapsular fractures

A

Young and middle-aged population

Requires significant force e.g. RTA

18
Q

How to treat intracapsular fractures

A

Surgical replacement of the femoral head:

  • hemiarthroplasty
  • total hip replacement (head and acetabular cup)
19
Q

Symptoms of NOF

A

Reduced mobility
Sudden inability to bear weight on the limb
Pain in hip, groin and knee

20
Q

Presentation of a displaced fracture

A

Leg is:
Shortened
Abducted
Externally rotated

Exacerbation of pain when the greater trochanter is palpated and when the hip is rotated

21
Q

Traumatic dislocation of the knee

A

Head of the femur fully dispaced out of the acetabulum

Can be congenital - developmental dyslpasia
Traumatic

22
Q

Who commonly gets traumatic hip dislocations

A

16- 40 yrs old
Requires significant force - RTA

  • Extremely painful
  • Resists any attempt to move the limb
  • 90% posterior
23
Q

Presentation of a posterior dislocated hip

A

Affected limb will be:

  • Shortened
  • Flexed
  • Adducted
  • Internal rotated
  • Sciatic nerve palsy - 8- 20% of cases
24
Q

Presentation of an anterior dislocated hip

A

The affected limb will be:

  • Shortened
  • slightly flexed
  • Abducted
  • Laterally rotated
  • Femoral nerve palsy (uncommon)
25
Q

Presentation of central dislocated hip

A

Femoral head driven into the acetabulum
Always a fracture-dislocation
Life-threatening

Femoral head palpable on rectal examination
High risk of intrapelvic haemorrhage (disruption of pelvic venous plexuses)

26
Q

Risk factors for congenital hip dislocation

A
Female 
Breech presentation 
FHx
First born 
Oligohydramnios