hip

Hip

Aims

 

Prevent contractures

Prevent dislocations

Improve walking 

Provide stable and painless sitting

Allow perineal care

 

Issues

 

Hip Dislocation

Adductor contractures

Flexion contractures

In-toeing

Windswept hips

 

Hip Dislocation

 

Natural History

 

Accepted that a dislocated hip in CP is painful

PVNS

Definition

 

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

 

Epidemiology

 

Age: 20 - 50

Sex: M > F

 

Types

 

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

 

Synovial Chondromatosis

DefinitionSynovial Chondromatosis Knee MRI

 

Chondroid Metaplasia of synovium affecting large joints

 

Nodules of hyaline cartilage

- formed in the subsynovial layer of joint capsules

 

Epidemiology

 

Rare lesion

Most common in 20's and 30's

Sex: M > F (2:1)

Monoarticular

 

Site

 

Management

Management Summary

 

Stage 0

 

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

 

Stage 1 / Normal X-ray, abnormal MRI

 

Forage: 80% G/E

Bisphosphonates

 

Stage 2 / Abnormal X-ray with cysts and sclerosis

 

A:  As for Stage I

Background

Bilateral Hip AVN Xray

 

Definition

 

Non-traumatic or traumatic condition of femoral head with bone death

 

Epidemiology

 

20 - 50 yo (average 38)

- M: F 4:1

 

NHx  

 

70-80% with AVN will progress within 1 year

 

Arthrodesis

IndicationsHip Fusion

 

Young adult 

- 16 - 30 years old

- monoarticular disease

- heavy demand 

 

Exhausted options of osteotomy

- risk of THA failure  / multiple revision surgeries considered too high

 

Aims of arthrodesis

 

Maximise bony contact

Minimise shortening

Metaphyseal Chondrodysplasia

Type

 

Short limbed dwarfism, normal trunk and spine

 

Characteristics

 

Metaphyseal changes of tubular bones

- Normal epiphyses

- metaphysis adjacent to physis very broad and mildly scalloped

- resembles healing rickets

 

Pathology

 

Defect in proliferative and hypertrophic zones of physis

 

Types:

 

Jansens (Rare)

- most severe

Hip Exam

Look

 

Walking aid

 

Footwear - shoe raises

 

Front

- Overall alignment of Lower Limb

 

Side

- lumbar lordosis

- flexed attitude of hip / knee

- scars

 

Back

- lumbar spine

- buttock wasting

- popliteal creases

- examine ROM

- try to differentiate spine and hip