Hip Clinical Conditions PDF

# Hip Clinical Condition - MSK Anatomy Lecturer ## Younger patients * Apophysitis * Athletic injury/fracture/dislocation * Bursitis * Cam deformity/Femoroacetabular impingement * Congenital hip dysplasia * Juvenile idiopathic arthritis/juvenile rheumatoid arthritis * Perthes (Avascular necro...

# Hip Clinical Condition - MSK Anatomy Lecturer ## Younger patients * Apophysitis * Athletic injury/fracture/dislocation * Bursitis * Cam deformity/Femoroacetabular impingement * Congenital hip dysplasia * Juvenile idiopathic arthritis/juvenile rheumatoid arthritis * Perthes (Avascular necrosis) * Slipped capital (upper) femoral epiphysis (SCFE/SUFE) * Synovitis ## Older patients * Avascular necrosis * Bursitis * Neck of femur fractures (NOF #) * Osteoarthritis * Rheumatoid arthritis * Synovitis * Total hip replacement (THR) ## Inflammation - itis | Symptoms | | | | |:----------------------------------------------------|--------|---------|----------| | Pain | | Osteo-arthritis | Rheumatoid arthritis | | Swelling | | | | | Heat | | | | | Limp | | | | | Change in gait | | | | | Change in structure (if untreated/aggressive) | Apophysitis| Synovitis | Bursitis | | | | | iliopsoas | | | | | | | | | | Infective | | | | | | | | Juvenile arthritis| | | ## Arthritis * Osteoarthritis is caused by mechanical wear and tear on joints. * Rheumatoid arthritis is an autoimmune disease in which the body's own immune system attacks the body's joints. * Juvenile idiopathic arthritis: Autoimmune/inflammatory (not same as rheumatoid): oligoarthritis (=/<4), polyarthritis (5+), systemic, psoriatic, enthesitis (spondyloarthritis), undifferentiated ## Bursitis * Repetitive stress (overuse) injury * Hip injury: trauma/fall/pressure * Spine/lower back issues (e.g scoliosis, other spinal issues) * Leg length difference/discrepancy/inequality * Weak gluteals * Rheumatoid arthritis * Previous surgery. Surgery around the hip implants can irritate the bursa * Bone spurs or calcium deposits. ## Avascular Necrosis ### What can cause Avascular Necrosis? * Mechanical disruption (broken hip) * Alcoholism * Excessive steroid use * Post-trauma (injury) * Thrombosis (blood clot) * Hypertension (high blood pressure) ## Perthes "Disease" * Perthes disease is a rare childhood hip condition. * Blood supply to head of the femur is temporarily disrupted. * Without an adequate blood supply, the bone cells die, a process called avascular necrosis. * Initial/Necrosis * Fragmentation * Reossification * Healing * 1-2 year process ## Hip Fractures (Top 1/4 Femur) * **Femoral neck fracture** * **Intertrochanteric fracture** ## Intra/Extracapsular fractures * **Intracapsular fractures** * Subcapital * Midcervical * Basicervical * Greater trochanter * **Extracapsular fractures** * Intertrochanteric * Subtrochanteric (15cm below lesser trochanter) * Femoral shaft ## Hip fracture management ## SUFE (SCFE) * The growth plate suffers a form of fracture, and the head of the femur slips out of position. * A child with a SUFE may feel like they have a pulled muscle in their hip, thigh or knee. * The exact cause of this condition is not known, (?link between increased weight and puberty hormones) * A SUFE is not usually associated with an injury. * It is important to get an early diagnosis and treatment before the slip gets worse. Treatment always involves surgery ### Symptoms of SUFE * Sudden or slow onset: * Pain in their groin, hip, thigh and knee * A limp, or holding their leg in a position. * Reduced movement of their hip. ## Hip dislocation * **Anterior hip dislocation** * **Posterior hip dislocation** ## Total hip replacement (THR) * **Total hip arthroplasty** * **Hemi-arthroplasty** ## Femoroacetabular Impingement * **Extra bone grows along one or both of the bones that form the hip joint - giving the bones an irregular shape.** * **Pincer:** Extra bone extends out over the normal rim of the acetabulum. The labrum can be crushed under the prominent rim of the acetabulum. * **Cam:** The femoral head is not round and cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum. * **Combined:** Both the pincer and cam types are present ## Developmental Dysplasia of the Hip (DDH) * DDH sometimes called "clicky hips" * In all cases of DDH, the hip socket is too shallow and the femur cannot fit in correctly. Sometimes, the ligaments around the hip are loose. * The degree of hip instability can vary widely in children with DDH. * Often detected at birth and treated with braces or surgery. * More complex if not diagnosed early. * Issues can present in a child at birth. ### Types of DDH * **Dislocation:** The femur is completely out of place. It is also called "luxation". * **Dislocation:** Head of the femur is very poorly seated in the acetabulum. May occur spontaneously as the hip is used physically during developmental years. * **Subluxation:** Although the head of the femur remains in the socket, it is poorly seated and may subluxate when the hip is examined. ## Rotation of the Femur * **Anteversion or retroversion of femur** ## In Children This section shows pictures of feet with varying degrees of toeing in and out and a child kneeling. ## References * [https://www.arthritis.org/diseases/juvenile-idiopathic-arthritis](https://www.arthritis.org/diseases/juvenile-idiopathic-arthritis) * [https://emedicine.medscape.com/article/333364-workup](https://emedicine.medscape.com/article/333364-workup) * [https://insightsimaging.springeropen.com/articles/10.1007/s13244-015-0406-0](https://insightsimaging.springeropen.com/articles/10.1007/s13244-015-0406-0) * [https://orthoinfo.aaos.org/en/diseases--conditions/hip-bursitis/](https://orthoinfo.aaos.org/en/diseases--conditions/hip-bursitis/) * [https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement/](https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement/) * [https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/](https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/) * [https://www.physio-pedia.com/Craig%27s Test](https://www.physio-pedia.com/Craig%27s Test) (Anteversion test) * [https://radiopaedia.org/articles/hip-dislocation?lang=gb](https://radiopaedia.org/articles/hip-dislocation?lang=gb) * [https://radiopaedia.org/articles/perthes-disease-summary?lang=gb](https://radiopaedia.org/articles/perthes-disease-summary?lang=gb) * [https://radiopaedia.org/articles/femoroacetabular-impingement-syndrome?lang=gb](https://radiopaedia.org/articles/femoroacetabular-impingement-syndrome?lang=gb) * [https://radiopaedia.org/articles/trochanteric-bursitis](https://radiopaedia.org/articles/trochanteric-bursitis)