Young Adult Hip problems. Aresh Hashemi-Nejad FRCS(Orth)

Transcription

1 Young Adult Hip problems Aresh Hashemi-Nejad FRCS(Orth)

2 RNOH founded 1837 by William Little

3 14 year old presenting with limp Knee pain on and off 4 months Limps

4 Aresh Hashemi-Nejad FRCS(Orth) The Royal National O

5 Hip Surface Anatomy

6 The Hip Clinical presentation Groin/buttock pain Knee pain Limp Stiffness Limitation of activity

7 Sources of Hip pain Related to the hip Intra-articular Extra-articular Referred pain Spine Intra-pelvic Aresh Hashemi-Nejad FRCS(Orth)

8 Site of Hip pain Contusion rectus femoris avulsion Adductor strain Anterior Intra-articular causes Labral tears Stress fracture AVN / transient osreoporosis Iliopsoas strain, snapping psoas L2/L3 disc Osteitis pubitis or instability, hernias

9 Site of hip pain Posterior Back problems, SIJ pain Piriformis syndrome Avulsion fractures, hamstring tears Ischeal gluteal bursitis Obturator internus bursitis Septic arthritis

10 Site of hip pain Lateral Trochanteric bursitis Gluteus medius injury Snapping TFL Intra-articular causes

11 Look Gait, leg length, spine Examination Palpate Move Loss of IR sensitive to hip pathology FADIR impingement Aresh Hashemi-Nejad FRCS(Orth)

12 Imaging Help diagnose abnormal anatomy Soft tissue, bone Presence of degenerative change and labral pathology Static and dynamic investigations Local anaethestic block

13 17 year old girl with a snapping hip Mum says it is dislocating Lateral hip pain Can make it snap voluntarily Sometimes painful Occasionally affects other hip

14 Snapping TFL Trochanteric bursitis Lateral hip pain Females Instability Runners Hypermobility Snapping on adduction and rotation Tender over posterior aspect GT pain on abduction Aresh Hashemi-Nejad FRCS(Orth)

15 Diagnosis Of Snapping Clicking hips Intra-articular Loose body Torn labrum incongruence Extra-articular Snapping fascia, Psoas tendon Aresh Hashemi-Nejad FRCS(Orth)

16 Snapping psoas Common in females Can be painless US Injection Physio Surgical Lengthening over pelvic brim Aresh Hashemi-Nejad FRCS(Orth)

17 Snapping psoas Clicking on extension from a flexed abducted ER position Aresh Hashemi-Nejad FRCS(Orth)

18 Pain on resisted active abduction 40 year old presents with lateral hip pain Worse on getting up and first few steps Cannot sleep on that side

19 Inflammation of the tendon of Gluteus minimus and medius Lateral hip pain Diagnosed as trochanteric bursitis US or MRI exclude a tear

20 Trochanteric bursitis Beware repeated steroid injections Aresh Hashemi-Nejad FRCS(Orth)

21 28 year old athlete with groin pain on activity Sometimes sharp pain Occ clicks Clasps the hip or points to site of pain Avoids certain activities Owns a fitness tracker watch

22 Causes of Intra-articular hip pain Structural problems Impingement Dysplasia Incongruence Loose body Stress fracture AVN Transient osteoporosis Infection Torn labrum Arthritis

23 Hip Dysplasia

24 Pistol grip Femoro acetabular impingement Cam Type 90% of patients with so-called primary osteoarthritis, when adequately assessed, showed abnormalities of the hip joint, the most common being acetabular dysplasia or a pistol grip deformity Harris Clin Orthop 1986;213:20-33 Solomon JBJS 1976;58B:

25 Non Arthroplasty hip intervention Osteotomy Corrects structural problem Debridement Surgical dislocation Mini anterior approach debridement Hip Arthroscopy Conservative change in lifestyle modifying activities Closed chain exercises hip and core Injections Aresh Hashemi-Nejad FRCS(Orth)

26 Why the explosion in non-arthroplasty hip surgery Mostly in FAI surgey 727% increase in the number of arthroscopic hip procedures performed in England between 2002 and 2013 and a forecast increase of 1388% by 2023, despite limited evidence of long-term efficacy Aresh Hashemi-Nejad RNOH

27 Who Benefits Does surgery affect the natural history Patient factors (activities, sports, hypermobility, chronic pain) Correct diagnosis Correct operation

28 Non Arthroplasty Intervention If you already have cartilage damage irreversible try to lessen symptoms and delay the degenerative process Aresh Hashemi-Nejad RNOH

29 Non-arthroplasty Intervention Surgery to the hip joint to delay arthroplasty has become more common, Aresh Hashemi-Nejad RNOH

30 Non-arthroplasty Intervention most patients with these problems are young, very active and with high demand. They often have unrealistically high expectations of the surgery Aresh Hashemi-Nejad RNOH

31 Patient selection Optimal clinical results depend on the combination of careful patient selection and successful application of the appropriate surgical procedure

32 Thank you