Traumatic and Non-Traumatic Causes of Hip Pain

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Questions and Answers

What percentage of hip dislocations occur posteriorly?

60%

50%

90%

80% (correct)

What is the most common mechanism of injury leading to hip dislocation?

Low-energy trauma

Falls from a height

Sports injuries

High-energy trauma (correct)

What occurs to the capsule and ligamentum teres in a hip dislocation?

They are unaffected

They are partially torn

They are stretched

They are completely disrupted (correct)

What type of fracture is treated similarly to a hip dislocation?

Acetabular fracture Signup and view all the answers

In which direction does the force vector applied to the flexed knee cause hip dislocation?

Axial Signup and view all the answers

What is the direction of the dislocation when the hip is in abduction and external rotation?

Anterior Signup and view all the answers

When does an inferior (obturator) dislocation occur?

In flexion Signup and view all the answers

What is the usual state of the Y ligament in a hip dislocation?

Intact Signup and view all the answers

What is the technique used for closed reduction of anterior hip dislocation?

Traction in line with the femur, followed by hip extension and internal rotation Signup and view all the answers

What is the recommended duration of weight-bearing prohibition for patients who are at high risk of collapse?

8 to 12 weeks Signup and view all the answers

When can patients start leg muscle strengthening exercises after hip dislocation?

Once the patient is pain-free and ambulating without crutches Signup and view all the answers

What is the most common nerve injury associated with hip dislocation?

Sciatic nerve Signup and view all the answers

What is the most common complication of hip dislocation reduction via open reduction?

Heterotopic ossification Signup and view all the answers

What is the recommended duration of rehabilitation before resuming high-impact activities like running and jogging?

9 to 12 months Signup and view all the answers

What is the percentage of patients who develop AVN after hip dislocation?

1.7% to 40% Signup and view all the answers

What is the recommended approach for post-reduction care in the acute phase?

Traction in the first 1 to 2 weeks, with minimal ROM Signup and view all the answers

What type of joint is the hip joint?

Synovial, polyaxial ball and socket joint Signup and view all the answers

Which ligament attaches to the anterior inferior iliac spine of the pelvis and the intertrochanteric line of the femur?

Iliofemoral ligament Signup and view all the answers

What is the primary source of blood supply to the femoral head?

Medial circumflex femoral artery Signup and view all the answers

What is the most vulnerable branch of the blood supply to the femoral head?

Lateral branches Signup and view all the answers

What is the purpose of the transverse acetabular ligament?

To cover the acetabular notch Signup and view all the answers

What is the function of the femoral head ligament?

To join the femoral head with the transverse ligament and acetabular notch Signup and view all the answers

Which of the following is NOT a type of ligament that attaches the femur to the acetabulum?

Tibiofemoral ligament Signup and view all the answers

What is the importance of the superior retinacular and lateral epiphyseal arteries in the hip joint?

They supply blood to the femoral head Signup and view all the answers

Study Notes

Hip Anatomy

The hip joint is a synovial, polyaxial ball and socket joint made of the articulation of the head of the femur and the acetabulum of the pelvis.
The hip joint is very mobile, second to the shoulder joint, and sacrifices mobility for stability.

Ligaments of the Hip Joint

Iliofemoral ligament: attaches to the anterior inferior iliac spine of the pelvis and the intertrochanteric line of the femur.
Pubofemoral ligament: originates at the superior ramus of the pubis and attaches to the intertrochanteric line of the femur.
Ischiofemoral ligament: connects the ischium to the greater trochanter of the femur.
Transverse acetabular ligament: consists of the labrum covering the acetabular notch.

Blood Supply to the Femoral Head

Extracapsular ring: major supply is medial circumflex femora artery from posterior.
Lateral circumflex femoral artery: anterior.
Ascending branches: run on the surface of the neck (anterior) and on synovial reflection towards the head (posterior).
Ligamentum artery (fovealis aa-obturator): joins the ascending branches at the epiphyseal end.

Causes of Hip Pain

Joint disorders
Periarticular soft tissue disorders
Extrinsic causes: referred pain and pain from generalized disease manifestations

Traumatic Causes of Hip Pain

Dislocations
Fractures: head of femur, neck of femur, subtrochanteric fractures, trochanteric fractures, soft tissue injuries, etc.

Hip Dislocations

Aetiology: RTA, falls from a height, industrial accidents, sports injuries.
Occurrence: posterior (80%), anterior (10-15%), central fracture dislocations.
Pathoanatomy:
- Capsule and ligamentum teres must be disrupted.
- Labral tears and muscular injury occur as well.
- Anterior dislocations: capsule disrupted anteriorly and inferiorly.
- Posterior dislocations: tear through the capsule either inferoposterior or directly posteriorly, depending on the amount of flexion present.
- The Y ligament is usually intact.
- Fractures of the femoral head result.

Pathomechanics of Hip Dislocations

Most common mechanism of injury: high-energy trauma.
Direction of dislocation dependent on:
- Position of the hip and the direction of the force vector applied.
- Anatomy of the femur.
Posterior dislocations: axial force applied to the flexed knee.
Anterior dislocations: abduction and external rotation; superior (inguinal) dislocations occur in extension, inferior (obturator) dislocations occur in flexion.

Treatment of Hip Dislocations

Anterior closed reduction technique:
- Traction in line with the femur, followed by hip extension and internal rotation.
Open reduction via anterior type approach if closed reduction is unsuccessful.

Post-Reduction Care

Acute phase:
- Traction in the first 1-2 weeks, with minimal ROM in days 5-7.
- Analgesics and icing to the hip.
- Avoid extremes of motion for 4-6 weeks to allow capsular and soft-tissue healing.
Recovery phase:
- Delay full weight-bearing for 4-6 weeks; initially, weight-bearing on crutches can start immediately when the patient is pain-free.
- Full muscle strength expected by 3 months post-injury.
Rehabilitation phase:
- Attempt leg muscle strengthening exercises once the patient is pain-free and ambulating without crutches.
- Running and jogging delayed up to 9-12 months.

Complications of Hip Dislocations

Associated knee ligament injuries
Sciatic nerve injury (10-14% especially posterolateral complex)
Superior gluteal artery injury
AVN may develop up to 3 years post-injury (1.7% to 40% anterior and posterior)
Heterotopic ossification (2% after dislocation or fracture-dislocation of the hip, especially with open reduction)
Neurovascular compromise: direct pressure on femoral artery, vein, or nerve (anterior dislocation)

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Description

This quiz covers the anatomy of the hip joint and the different causes of hip pain, including traumatic and non-traumatic factors. Learn about hip dislocations, fractures, Perthes disease, and more.