W14 - Hip and Knee Conditions

Question 1

• Describe the blood supply to the femoral head

Answer 1

Medial Cx Fem. Art. (Major contributor to femoral head)

alongside LFCA

Question 2

• Describe the principles of management of trochanteric bursitis

Answer 2

Troachanteric bursa sandwiched between hip abductors and Iliotibial band
*F>M, dt overuse, abn movements, post-sx muscle wasting, OA

*pain, point tenderneess @ greater tuberosity

• XR, MRI, USS (+ guided injection)

> NSAIDs
> Rest
> Physio
> Corticosteroid injection
> Bursectomy Sx

Question 3

• The presentation, risk factors and management of AVN of the hip

Answer 3

• M>Fm 35-50yo, common bilateral (offset in time)
• RF: trauma, irradiation, hypercoaguable states, steroids, haematological: sickle, lymphoma, leukaemia

*insidious groin pain, stairs, walking uphill
may replicate arthritis

> ⇩wt bearing
> NSAIDs
> Biphosphonates
> Anticoags
> Physio

> Sx: core decrompression +graft, hip replacement

Question 4

• The presentation, risk factors and management of Femoroacetabular Impingment

Answer 4

commonly presents in younger patient, or 2º to OA
* groin pain, worse w/ flexion, affect movements

• CAM LESION: commonest, A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum
• PINCER: extra bone extends out over the normal rim of the acetabulum.

= Impingment of femoral neck against anterior edge of acetabulum

+ for reduced: FLEXION, ADDUCTION, INT. ROT.

> activity mod,
NSAIDs
Physio

> Sx: Arthroscopy shaves defect
Open Sx: resection, osteotomy, hip arthroplasty

Question 5

Most common labral tear

Answer 5

anterosuperior tear: commonly active females

• pincer (FAI)
• or dt trauma, OA, dysplasia, collagen disease
• Groin/hip pain, snapping sensation
• FABER

• XR, MRI

> Activity
NSAIDs
Physio
Steroid injection

> Sx: arthrscpy, repair, resection

Question 6

• Describe the radiological features of OA

Answer 6

Osteoarthritis results in characteristic X-ray appearances including joint space narrowing, formation of osteophytes (bone spurs), articular surface cortical irregularity and/or sclerosis, and formation of sub-cortical cysts (geodes)

Question 7

Describe the common mechanisms of injury of knee ligaments and menisci, and the associated clinical features mgmt, and outcomes

Answer 7

MOST COMMON; valgus stress severe

• Twisting = Acute Meniscal Tears
• OA = Degenerative Meniscal Tear
• Medial meniscal tears more common dt more fixed structure

= pain, clicking, locking, intermittent swelling
+ Positive for McMurray’s, and Thassaly’s Tests, fail deep squat

= unlikely to heal
> rest
> NSAIDs
> Physio
------
> Arthroscopy

Question 8

Most sens diagnostic for meniscal tear

Answer 8

MRI

Question 9

Describe the principles of management and rehabilitation of knee injuries

Answer 9

a

Question 10

The presentation and conservative management of knee osteoarthritis

Answer 10

Progressive loss of articular cartilage and seconday bone changes
* WORSENING PAIN AND STIFFNESS OF AFFECTED*

> ## Conservative: Wt, Analgesia, Activity, Braces, Aids, Steroid InjectionTotal knee replacement: cruciate retaining vs sacrficiing
Unicompartmental

Question 11

Blood and Nerve Supply of ACLigament

Answer 11

Middle Geniculate Artery

Posterior Articular N. (Tibial N.)

Question 12

Presentation of an ACL Tear

Answer 12

audible pop/crack w/ IMMEDIATE SWELLING

+ deep pain

Question 13

ACL Tear Mgmt

Answer 13

> ## Focussed quads programmeACL Reconstruction: meniscus/ligmnt/ hamstring graft

Question 14

Osteochondritis Dissecans: aetiology, presentation

Answer 14

• Lesion affecting articular cartilage and subchondral bone
• Mostly @ knee, w/ hereditary, trauma, or vascular factors
• poorly localised activity related pain, recurrent effusions, locking or block to full movement

Question 15

Osteochondritis Dissecans: Mgmt

Answer 15

> Restrict wt bearing
> Rom brace
----
> Arthroscopy
> Open fixation