Case 1 – Back in the Bank
January 20, 2014
MALLET FINGER
April 30, 2014

HIP OSTEOARTHRITIS

Definition:  A degenerative condition of the hip joint associated with symptoms of stiffness, pain, reduced range of motion and/or crepitus with movement of joint. Osteoarthritis is associated with a history of trauma, obesity, genetic predisposition, and advancing age.
The pain can be located in the anterior proximal thigh, groin and lateral hip as well as occasionally posteriorly.

Exam:
Inspection – Alignment deformity, swelling
Palpation – Crepitus with passive and active range of motion
AROM – Reduced range of motion, flexion, internal rotation, external rotation and extension, abduction and adduction
PROM – Reduced range of motion, flexion, internal rotation, external rotation and extension, abduction and adduction
Special Tests – FADIR – Flexion adduction and internal rotation
FABER – Flexion abduction and external rotation
Thomas Test – Looking for hip flexor contracture
Investigations:
Xray – AP Pelvis, Lateral, Frogview, Dunn View.  Joint space narrowing, osteophyte formation, subchondral cysts, and osteosclerosis.  CAM on femoral neck, pincer off of acetabulum.
US – May reveal bursitis, effusion, calcific tendionosis of surrounding tendons.
MRI – Chondral surface loss, subchondral cysts, osteophytes, meniscal cysts.
Management:
Range of motion exercises, strengthening of surrounding muscles
Ice/heat for analgesia
Acetaminophen
NSAIDs
Physiotherapy
Registered Massage Therapy
Intraarticular Corticosteroid injection (under Fluoroscopy or US -guidance)
Intaarticular Hyaluronic Acid injection (under Fluoroscopy or US-guidance)

Surgical:
Total Hip Arthroplasty
Total Hip Resurfacing

Hip Xrays:
LeftHipnormalLateral RightlateralhipOA RighthipOAAPpelvis

Left Hip MRI (58 yo Male with left Anterior Groin Pain)

Axial View:

Sagital View:

Coronal View:

Coronal Bilateral View:

Locator:

MRI Report:
Bilateral irregular linear high signal clefts through the acetabular labrum extending from the superior portion posterior inferiorly consistent with degenerative labral tearing.
Very mild chondral thinning, without gross degenerative change consistent with patient’s age.  Degenerative changes in the lower lumbrosacral spine and pubic symphysis bilaterally.  No hip joint effusions.   No gluteal or iliopsoas muscle insertional tendinosis.
Bilateral degenerative changes within the acetabular labrum of both right and left hip joints.

(April 22, 2014) Dr. Neil Dilworth CCFP Dip Sport Med