Non-OA hip

Question 1

Describe the relative orientation of the proximal and distal femur in the transverse plane

Answer 1

proximal femur is oriented anterior to the distal femoral condyles creating a medial torsion of 14-18 degrees

Question 2

what non arthritic pathologies are suggested by the hip CPG

Answer 2

1. FAI
2. structural instability
3. acetabular labral teras
4. osteochondral lesions
5. loose bodies
6. ligamentum teres injury
7. sepctic conditions

Question 3

what are the pathoanatomic categories recommended by the hip CPG

Answer 3

1. FAI
2. structural instability
3. intra-articular pathology

Question 4

what are the FAI catgories

Answer 4

1. CAM - loss of femoral head shape
2. Pincer - loss of acetbular shape or deep acetabulum
3. Combo

Question 5

What pathologies can lead to CAM impingements

Answer 5

1. slipped capital femoral epiphysis

2. anatomical protrusion of the femoral head

Question 6

what are some anatomical risk factors for developing hip structural instability

Answer 6

1. increase anteversion or retroversion
2. interior acetabular insufficiency
3. neck shaft angle greater than 140 degree

Question 7

What is acetabular dysplasia

Answer 7

shallow acetabulum

Question 8

what is the prevalence of adult hip dysplasia

Answer 8

• cross sectional study 5.4-12.8
• hip pain study 32%
• no difference in prevalence in symptomatic versus asymptomatic individuals
• prospective mulitcenter exam 35%

Question 9

what is the prevalence of hip labral tears

Answer 9

1. in people with mechanical hip pain as high as 90%

2. in people with hip or groin pain 22-55%

Question 10

what is the typical mechanism of injury for labral tears

Answer 10

1. forceful rotation with extension
2. repetitive forces
3. insidious - with as much as 74% without a specific incident

Question 11

How are labral tears classified

Answer 11

1. radial flap - free margin of the labrum is disrupted
2. radial fibrillated - fraying of the free margin
3. longitudinal peripheral - tear along the acetabular labral junction (least common)
4. abnormally mobile (partial detachment)

Question 12

what role does ligamentum teres play in hip stability

Answer 12

• more recently thought to play a role in intrinsic stability
• ER in flexion and IR in extension are its position of influence

Question 13

what is the prevalence of ligamentum teres injuries in orthoscopic surgeries

Answer 13

8%

Question 14

what motions of the hip is ligamentum teres thought to stabilize

Answer 14

• ER in flexion

- IR in extension

Question 15

what are risk factors for chondral lesions of the hip

Answer 15

• labral injury
• FAI
• anterior joint laxity
• dysplasia
• young active with traumatic injury involving force through the greater trochanter

Question 16

what risk factor have been identified for hip impingement

Answer 16

• level III - genetic - siblings versus spouses are more likely to simlar patterns of hip impingement
• level III - sex - CAM type more in men, PINCER type more in women
• Hip retroversion

Question 17

what are the risk factors for developing him joint laxity

Answer 17

level V - genetics

level V - ligamentus laxity associated with EhlersDanlos, Down and Marfan syndromes

Question 18

what role does osseous abnormalities play in intra-articular hip injuries

Answer 18

• questionable role
• high incidence of osseous abnormalities are noted, but when compared with the un-involved side similar changes are noted
• CAM type hips with increased intra-articular problems, PINCER type hips with less intra-articular problems

Question 19

What is the evidence grade regarding risk factors for non arthritic hip pain risk factors

Answer 19

F

Question 20

what clinical finding does the non-OA hip pain CPG suggest looking for to indentify hip impingment

Answer 20

1. pain in the anterior hip, groin or lateral hip region
2. sharp or aching type pain
3. aggravated by sitting
4. pain production with FADIR test position, flex,add,IR
5. ROM loss with hip flexion and abd
6. Supine IR less than 20
7. mechanical symptoms of popping, locking or snapping of the hip
8. lack of other findings

Question 21

what radiographic findings would you expect with hip CAM impingement

Answer 21

CAM
increased femoral neck diameter approaching the size of the femoral head
- alpha angel greater than 60
- head neck off set ration less than 0.14

Question 22

what radiographic findings would you expect with hip PINCER impingement

Answer 22

PINCER
Increased acetabular depth
- cox profunda (lateral center-edge angel greater than 35 degrees)
- acetabular protrusion
decreased acetabular inclination
- tonnis angle less than 0 (angle of the superior acetabulum, normal 7ish, 0 suggest flat roof)
Acetabular retroversion

Question 23

what is coxa profunda

Answer 23

imaging finding of the hip where bright ischial line overlaps with the acetabulum

• the line of the acetabulum should appear medial to the ischial line
• suggests deep acetabulum

Question 24

what clinic finding does the non-OA hip CPG suggest looking with hip instability

Answer 24

• anterior groin and lateral hip pain
• painful FADIR or FABER
• Hip apprehension
• supine IR greater than 30 degree
• mechanical symptoms such as popping, locking or snapping

Question 25

what radiographic findings would you expect with hip instability

Answer 25

- tonnis angle greater than 10 degrees - increase acetabular inclination (angle of edge to edge of the acetabulum) - decreased femoral head coverage (anterior center edge angle less than 20 degree, vertical angle oblique

Question 26

what clinic finding does the non-OA hip CPG suggest looking with hip intra articular pathology

Answer 26

1. anterior groin or general hip pain 2. pain production with FADIR or FABER tests 3. feeling of instability with deep squats 4. no conflicting findings 5. MRI findings

Question 27

what imaging studies are recommended for detecting hip ossessos changes

Answer 27

1. cross table lateral view - slightly side rolled 2. 45 or 90 dunn view - GYN position 3. frog lateral view - FABER position 4. false profile view - standing ER'd

Question 28

what x-ray finding would suggest hip dysplasia

Answer 28

1. tonnis angle greater than 10 2. wiberg less than 25 - lateral center edge, other sources place normal 20-40 with less than 15 as dysplasia 3. Lequesne less than 25 - anterior center edge 4. neck shaft angle greater than 140

Question 29

that x-ray findings would expect with a retorverted hip

Answer 29

- cross over sign -AP view shows a "X" like over lap of the posterior acetabulum and anterior acetabulum - projection of the isheial spine intot hte pelvis

Question 30

what is the alpha angle

Answer 30

The angle is formed by the acetabular roof to the vertical cortex of the ilium and thus reflects the depth of the bony acetabular roof. This is a similar measurement to the acetabular angle. The normal value is greater than or equal to 60 degrees. - Less than 60 degrees suggests dysplasia of the acetabulum. - greater is correlated to CAM impingment

Question 31

what imaging procedure is typically used to diagnosis hip labral tears

Answer 31

MRA - MRI with joint contrast dye SPINE 44-71 SNOUT 71-100

Question 32

what outcome measures are recommend for non-OA hip pain

Answer 32

1. BEST - Hip Outcome score - 17 items rated 0-4, MDC 3 point, MCI 9 points (6 points on sport subscale) 2. Copenhagen HIP and Groin Outcome score - young active MDC 5.2 no MCI report 3. International hip Outcome score - 33 point MCI 6 points after hip arthorscopy 4. HHS 5. WOMAC - arthritis oriented 6. LOWEST- HOOS - various hip pain

Question 33

what is the trendelenburg sign

Answer 33

Standing in single stance by flexing the opposite hip - raise the opposite hip as high as possible - maintain for 30 seconds grade based on time held and angle - positive if unable to hold, flat or dropped position - MDC 4 degrees

Question 34

What is the FABER test

Answer 34

Test for hip joint pathology | - heel on opposite knee and measure tibia angle

Question 35

Describe the quality of the data surround PT interventions for non-OA hip pain

Answer 35

F - for education, manual therapy, exercises and NMR