Orthopaedics - Hip and Spine Flashcards
(55 cards)
Define Osteoarthritis
Degenerative joint disease characterised by a loss of articular cartilage, with associated periarticular bone response
What are the findings on an X ray that indicate osteoarthritis?
- Narrowing of joint space
- Osteophyte formation
- Subchondral sclerosis
- Cysts
Which joints are most commonly affected by osteoarthritis?
Knee
Hip
What are the systemic risk factors for hip OA?
> 45yrs
Women > Men
Genetic link
Vitamin D deficiency
What are the local risk factors for hip OA?
Obesity History of trauma to hip Anatomic abnormality Myopathy Joint laxity Participation in high impact sports
What is the usual presenting complaint of a patient with hip OA?
- Dull aching pain around the hip - can extend up to the knee
- Pain is aggravated by activity and relieved by rest
- Joint may feel stiff after a period of immobility
What examination findings may be found on a patient with hip OA?
- Muscle wasting of quads and glutes
- Reduced power of the hip joint
- Leg length discrepancy
- Fixed flexion deformity
- Antalgic or Trendelenberg gait
- Crepitus
- Reduced range of movement
What are the main DDx of hip OA?
- Trochanteric bursitis
- Gluteus medius tendinopathy
- Sciatica
- AVN of femoral head
- # NOF
What system can be used to classify OA progression?
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) Combines: - 5 items for pain (0-20) - 2 for stiffness (0-8) - 17 for function (0-68) To give a total out of 96
What initial management is given for hip OA?
Analgesia
Lifestyle modification
Physiotherapy
What surgical intervention can be indicated in hip OA?
Hip replacement – total vs hemi arthroplasty
What common post operative complications are there of a hip replacement?
Thromboembolic disease Bleeding Dislocation Infection Losening of prosthesis Leg length discrepancy
How long on average are modern hip protheses designed to last for?
15-20 years
Which approach for hip replacement surgery has the highest risk of sciatic nerve damage?
Posterior approach
Which approach gives full exposure of the acetabulum in hip replacement surgery?
Anterolateral approach
Which approaches preserve the abductor mechanism in hip replacement surgery?
Posterior and anterior approach - allows for fast rehabilitation
Which approach has the lowest dislocation rate in hip replacement surgery?
Anterior approach
What is the one year mortality for a #NOF?
30%
Describe the blood supply to the femoral head
The majority arrives from the medial femoral circumflex artery (arising from the deep femoral artery)
The blood supply is primarily uni-directional
During early life what additional supply is there to the femoral head?
Ligamentum arteriosum (within the ligamentum teres)
What classification system is used to differentiate intracapsular #NOF types? Briefly describe it?
Garden Classification I = Non displaced + incomplete II = Complete but non displaced III = Complete with partial displacement IV = Complete and fully displaced
How can a #NOF be classified based on the fracture line?
Intracapsular – Subcapital or basovervical
Extracapsular – Intertrochanteric or subtrochanteric
What will a #NOF generally look like on examination? Why is this?
Leg is characteristically shortened and externally rotated - pull of short external rotators
What movements will be limited in a patient with a #NOF?
Patient unable to straight leg raise
Pain on pin rolling the leg
Pain on axial loading
