Download - Arthritic Hip Examination
ARTHRITIC HIP -EXAMINATIONdr vaibhav bagaria
joint replacement surgeonsir h n reliance foundation hospital
girgaum, mumbai, india
‘A CASE OF IDENTITY’Watson: You appeared to read a good deal upon [your client] which was quite invisible to me.
Holmes: Not Invisible but unnoticed, Watson
USUAL SEQUENCEHistory
Look
Feel
Move
Special tests
PAINDuration
Onset
Progress
Site
Severity
Character
Radiation
Aggravating and Relieving factors
Diurnal variation
Associated Symptoms
DEFORMITYHow Long has ist been present?
Didi it Progress?
What initiated it?
What other symptoms accompany it?
Any History of trauma/ Infection?
FUNCTION ASSESSMENT & SCORING
Walking ability/ Aids
Ability to Squat/ Sit cross legged
Drive
Tie Shoes
Expectations from treatment
PAST HISTORYHT
DM
Sepsis
TB
Prolonged IV infusion as child
Bleeding episodes
Prior Trauma Surgery
Allergies
OTHER HISTORYSporting History
Drug Abuse/ Alchol/ Smoking
Occupational History
Treatment History
Family History
INSPECTIONAttitude
Deformity
Landmarks - Bone & Soft tissue
Swelling/ Wasting/ Skin
LLD
DEFORMITY/ CONTRACTURES
ATTITUDE
FEEL - PALPATION
Systematic
Anterior
Lateral
Posterior
MOVE
MEASURE
SPECIAL TESTSTests for deformity assessment
Tests for LLD
Tests for stability
Tests for impingement
Tests for muscle contracture
SINGLE MOST IMP TEST???
GAIT
Normal Gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
LIMPING
Any abnormality of normal rhythmic biphasic walking
ARTHRITIC HIPOsteoarthritis: Wear & Tear
FAI: Mechanical cause
DDH: Late Presentation
Post Traumatic
Osteonecrosis & 2ry Arthritis
Inflammatory Arthritis
Septic Arthritis/ TB Arthritis
Pagets; Gauchers; Sickle: SLE; Hemophilia;
WHY?Reconfirming that this is cause!
Decide Surgical vs Non Surgical Management
Plan for your Surgery; Possible detours
Take care of associated things!
Decide Unilateral vs Bilateral
Re examination of the hip: Otto Aufranc noted that “more is missed by not looking than by not knowing.”Aufranc OE. The patient with a hip problem. In Aufranc OE, editor. (ed):
Constructive Surgery of the Hip. St. Louis, CV Mosby, 1962;15–49
COMMON PRESENTATIONJoint Stiffness and pain often Groin, in front of hip, occasionally thigh
Start up pain and stiffness
Aching that increases with weather change
Loss of ROM
Limping
Weakness esp getting up
CO - FACTORS
Obesity
Professional sports
Injury
Risk factors for AVN
INFLAMMATORY ARTHRITISPrevious steroid treatment
Skin condition - dermatitis/ Prone to Infection
Osteoporosis
Choice of anaesthesia
Other Joint Evaluation: Muscle Wasting
Post op Complications: Myositis, Sp Physio needs
DRUG HISTORY
Important in Inflammatory Arthritis
Specifically ask for steroids and Biologicals
Ayurvedic/ Alternate medicine
What to stop?
DO NOT FORGETWhich joint to do first?
Uni vs Bilateral
contractures
protrusion
LLD
Implant Choice
ANKYLOSING SPONDYLITIS
Younger
Stiffness is a bigger issue
Spine and Chest examination
Positioning / Cup Placements/ landmarks
WHAT TO REMEMBERModified New York criteria
When to stop Biologicals?
Anaesthesia Issues
What to do: Spine Vs Hip
Approach - Landmarks
FAI
FAIAnterolateral Hip Pain, Typical C shaped fashion
Flexion, Adduction and Internal Rotation is the most sensitive test ( FADIR)
Compare the contralateral side
Dunn view radiography, in which the hip is flexed 90 degrees and abducted 20 degrees
FAI
OSTEOARTHRITIS
Usually Straight Forward
Ensure that this is the main cause of symptoms
LLD
Flexion/ ER/ adduction - Apparent Shortening
AVN
Cause
Reconfirm the stage on examination
Loss of IR
Obligatory ER
OBLIGATORY ER
CONCLUSIONSystematic Approach
Know what you are looking for !
In Clinical Setting: Focussed Assessment is Key.
The clues are endless, and the game is played by everyone ( qualified or lay) at each new encounter throughout life.
THANK YOU
Questions?