Ortho hip conditions Flashcards
(41 cards)
What are the key pathologies of the (adult) hip?
OA of hip
Bursitis
AVN
Impingement (FAI)
Labral tear
Describe the structure of the pelvis
Hemipelvis made up of 3 bones - ischium, ileum & pubis
Hemipelvis joined together by the pubic symphysis (anteriorly) and the sacrum (posteriorly)
What type of joint is the hip joint?
Synovial ball & socket
What anatomical features does the acetabulum (socket of hip bone) have to add stability?
Describe the structure of these
1) Acetabular labrum - fibrocartilagious lining of acetabulum. Deepens socket & adds stability.
2) Ligaments (x2)
What are the ligaments of the hip?
1) Ligamentum teres - HoF to acetabular notch
2) Transverse ligament - completes the circle of the labrum (note it is not shown in the photo)
Identify the bits
yis
Give an overview of the blood supply to the hip joint
Blood supply from 2 main arteries…
MFCA - Medial femoral circumflex artery
LFCA - Lateral femoral circumfelx artery
These are branches of the Profunda femoris (deep femoral artery)
Describe the distribution of the MFCA
Medial femoral circumflex artery
Major contributor to the femoral head blood supply
Has 2 branches:
- one ascends to head
- one transverses to cruciate anastomosis
Describe the distribution of the LFCA
Lateral femoral circumflex artery
Less important to hip joint…
Has 3 branches:
- ascending branch to joint capsule
- transverse branch to cruciate anastomosis
- descending branch
Aside from the LFCA & MFCA - what other arteries supply the head of femur?
Artery of ligamentum teres - theres an artery inside the ligament
Nutrient arteries of the bone
Heres a nice wee diagram
What is the clinical relevance of the blood supply to the neck & head of the femur?
Fractures risk disrupting blood supply (and causing AVN)
As a general rule:
- Intracapsular fractures = blood supply disruption
- Extracapsular = all good
What is the typical presentation for osteoarthritis of the Hip?
Chronic history of groin pain & stiffness - worsened by exercise & relieved by rest
Pain may radiate down to knee on affected side
(see lecture on OA)
What is trochanteric bursitis?
Describe the relevant anatomy
Trochanteric bursitis (aka Greater T pain syndrome)
Inflammation of the Bursa located over the greater trochanter of the femur
The trochanteric bursa is sandwiched between the insertions of the gluteus medius & minimus (hip abductors) - and is overran by the IT band of Tensor fasciae latae
What are the risk factors for Trochanteric bursitis?
Female
Over-use (athletes etc)
Abnormal movments due to other problem:
- distant problem eg scoliosis
- muscle wasting following surgery
- THR
- OA of hip
Describe the presentation and specific exam findings for trochanteric bursitis
Well localised, lateral hip pain
On examination:
- tenderness over greater trochanter
- painful active abduction
- +/- scars from surgery, gluteal muscle wasting etc
How can trochanteric bursitis be investigated?
Think it can be diagnosed clinically but:
X-ray
MRI
US
How is trochanteric bursitis treated?
First order:
- activity modifcation / rest
- NSAIDs
- physiotherapy
If above fails:
- US guided steroid injections
If all else fails:
- Bursectomy
What is AVN?
Avascular necrosis - death of bone due to disruption in blood supply
What are the risk factors/causes of AVN?
Trauma:
- irradiation
- fractures (intracapsular)
- dislocations
- iatrogenic
Systemic:
- idiopathic
- hypercoagulability
- haematological
- steroids
- Caisson’s disease
- alcoholism
What haematological conditions predispose someone to AVN?
Hypercoagulable states
Sickle cell disease
Lymphoma
Leukaemia
What is Caisson’s disease?
Decompression sickness - aka The bends
Happens to divers
Describe the epidemiology of AVN
Males > females
35-50 y/o
80% bilateral
Describe the typical presentation of AVN
Insidious onset of groin pain
Pain especially on exercise/impact activities
Limp
(similar to OA)
What features on examination could you see with AVN
Largely normal
May have reduced ROM - especially on internal rotation
