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

Intertrochanteric Fractures

DefinitionHip Intertrochanteric Fracture Type 3

 

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

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

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

 

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