Orthopaedic Hip conditions Flashcards Preview

3RD YEAR SYSTEMS: MSK > Orthopaedic Hip conditions > Flashcards

Flashcards in Orthopaedic Hip conditions Deck (24)
Loading flashcards...
1
Q

What is Osteoarthritis?

A

Degenerative change of synovial joints (‘wear and tear’) - progressive loss of the articular cartilage and secondary bony changes

It is characterised by worsening pain and stiffness of the affected joint which can become quite limiting in every day life.

2
Q

What is Trochanteric Bursitis?

A

Inflammation of the Trochanteric bursa that lies between the trochanter and the iliotibial band

3
Q

Causes of Trochanteric Bursitis?

A
  • Trauma
  • Over-use - athletes (often runners), repetitive movements - often presents in young, active patients
  • Distant problem i.e scoliosis
  • Local problem i.e muscle wasting following surgery, total hip replacement or osteoarthritis
4
Q

How does Trochanteric Bursitis present?

A

Pain/tenderness on the lateral hip

5
Q

Examination of Trochanteric Bursitis

A

Look - scars from previous surgery, muscle wasting (gluteals)

Feel - tenderness at Greater Tuberosity

Move - worst pain in active abduction

6
Q

Key investigations for Trochanteric Bursitis (3)

A
  • X-ray - may be normal or may see evidence of OA, total hip replacement or spine abnormalities
  • MRI - soft tissues and fluid
  • USS - can be therapeutic as well as diagnostic i.e guided injection
7
Q

Treatment for Trochanteric Bursitis

A
  • NSAIDs
  • Relative rest / Activity modification
  • Physiotherapy - correct posture and abnormal movements, stretching, strengthen muscles around joint
  • Injection - corticosteroids
  • Surgery - bursectomy - rarely required
8
Q

What is avascular necrosis of the hip?

A

Death of bone due to the loss of blood supply in the femur head

  • M>F
  • Average age 35-50 years old
  • 80% = bilateral
9
Q

Risk factors of Avascular Necrosis

A
  • Trauma
    • Irradiation - exposure to radiation
    • Fracture - i.e intracapsular fracture which injures the blood supply to the femoral head
    • Dislocation
    • Iatrogenic
  • Systemic
    • Idiopathic
    • Hypercoaguable states
    • Steroids
    • Haematological - sickle cell disease, lymphoma, leukaemia
    • Alcoholism
10
Q

In idiopathic avascular necrosis of the hip, what is known about the pathogenesis?

A
  • The microcirculation of the femoral head becomes static which leads to venous thrombosis
  • When the pressure rises there is retrograde arterial occlusion
  • Which leads to intraosseous hypertension
  • Reduced blood flow to the head
  • Cell death
  • Chondral fracture and collapse - esp if weight bearing
11
Q

Symptoms of Avascular necrosis of the hip

A
  • Insidious onset of groin pain
  • Pain with stairs, walking uphill and impact activities
  • Limp - unable to weight bear
12
Q

Treatment of Avascular necrosis

A
  • Non-operative
    • Reduce weight-bearing
    • NSAIDs
    • Bisphosphonates - reduce fracture risk
    • Anti-coagulants
    • Physio - maintain range of motion, keep the ball round
  • Surgical
    • Restore blood supply - core decompression +/- vascularised graft
      • Decompression - surgical drilling into the area of dead bone near the joint. This reduces pressure, allows for increased blood flow, and slows or stops bone and/or joint destruction.
    • Move the lesion away from the weight-bearing area - rotational osteotomy
    • Total hip replacement
13
Q

What is Femoroacetabular Impingement (FAI)?

A

A condition where the bones of your hip joint come too close and pinch tissue or cause too much friction.

  • 2 types: Cam lesion or Pincer.
  • Results in impingement of femoral neck against the anterior edge of the acetabulum
  • Restriction of movement and pain
  • A common cause of hip pathology in younger patients
  • Can cause secondary osteoarthritis
14
Q

Cam lesion

A

Primarily a problem with the femur

  • Formation of extra bone on the head of the femur resulting impingement on the acetabulum with joint movement.
  • Usually in young athletic males i.e rowers
15
Q

FAI - Pincer

A

An acetabulum-based impingement

  • Usually in active females
  • Abnormal acetabulum
16
Q

How does Femoroacetabular Impingement (FAI) present?

A
  • Groin pain - worse with flexion
  • Mechanical symptoms
    • Block to movement
    • Pain with certain movements - getting out of a chair, squatting, lunging
17
Q

What is the FADIR test?

A

FADIR (flexion, adduction, and internal rotation) test is a passive motion test to help diagnose hip impingement.

This will be positive in FAI patients.

18
Q

Investigations for FAI

A

X-ray - identify the bony pathology

MRI - Useful for assessing associated conditions

19
Q

Treatment of FAI

A
  • Non-operative
    • Activity modification
    • NSAIDs
    • Physiotherapy - correct posture, strengthen muscles around the joint
  • Operative
    • Arthroscopy - shave down the defect, deal with labral tears, resect articular cartilage flaps
    • Open surgery i.e resection, hip arthroplasty, periarticular osteotomy
20
Q

What is a Labral Tear?

A

A tear/injury to the labrum of the hip (the soft tissue that covers the acetabulum).

  • Most commonly an anterosuperior tear
  • Causes = FAI, trauma, OA, dysplasia or collagen diseases
21
Q

How does a labral tear present?

A
  • Groin or hip pain
  • Snapping sensation
  • Jamming or locking of the hip
22
Q

What is the FABER test?

A

Tests Flexion, ABduction, External Rotation movements of the hip. Will be positive in patients with a labral tear.

23
Q

Investigations for Labral tears

A
  • Ensure adequate imaging so you identify any root causes of pathology
  • X-ray - OA or dysplasia
  • MRI Arthrogram 92% sensitive
  • Diagnostic injection under local anaesthetic
24
Q

Treatment for a Labral tear

A
  • Non-operative
    • Activity modification
    • NSAIDs
    • Physio
    • Steroid injection
  • Operative
    • Arthoscopy - repair or resection