hip

Clinically

Unwell / irritable

Fever

Not feeding

Unable to weight bear / limp

Knee pain

Examination

Fever

Limited / painful ROM

Hip held flexed and externally rotated

- maximises volume of capsule

Lab tests

WCC > 12 000

ESR > 40

CRP > 10

Blood cultures

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

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

Definition

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

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex

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

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

Concept

THR in dysplastic hips has a higher failure rate

- due to anatomic abnormalities

- due to generally younger age

Aim

Restore normal biomechanics and preserve bone stock

Issues

Soft tissues