![‘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](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Arthritic Hip Examination
- 1. ARTHRITIC HIP - EXAMINATION dr vaibhav bagaria joint replacement surgeon sir h n reliance foundation hospital girgaum, mumbai, india
- 2. ‘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
- 4. PAIN Duration Onset Progress Site Severity Character Radiation Aggravating and Relieving factors Diurnal variation Associated Symptoms
- 5. DEFORMITY How Long has ist been present? Didi it Progress? What initiated it? What other symptoms accompany it? Any History of trauma/ Infection?
- 6. FUNCTION ASSESSMENT & SCORING Walking ability/ Aids Ability to Squat/ Sit cross legged Drive Tie Shoes Expectations from treatment
- 7. PAST HISTORY HT DM Sepsis TB Prolonged IV infusion as child Bleeding episodes Prior Trauma Surgery Allergies
- 8. OTHER HISTORY Sporting History Drug Abuse/ Alchol/ Smoking Occupational History Treatment History Family History
- 9. INSPECTION Attitude Deformity Landmarks - Bone & Soft tissue Swelling/ Wasting/ Skin LLD
- 11. ATTITUDE
- 13. MOVE
- 15. MEASURE
- 16. SPECIAL TESTS Tests for deformity assessment Tests for LLD Tests for stability Tests for impingement Tests for muscle contracture
- 17. SINGLE MOST IMP TEST???
- 18. GAIT Normal Gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
- 19. LIMPING Any abnormality of normal rhythmic biphasic walking
- 20. ARTHRITIC HIP Osteoarthritis: Wear & Tear FAI: Mechanical cause DDH: Late Presentation Post Traumatic Osteonecrosis & 2ry Arthritis Inflammatory Arthritis Septic Arthritis/ TB Arthritis Pagets; Gauchers; Sickle: SLE; Hemophilia;
- 21. 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
- 22. 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
- 23. COMMON PRESENTATION Joint 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
- 24. CO - FACTORS Obesity Professional sports Injury Risk factors for AVN
- 25. INFLAMMATORY ARTHRITIS Previous steroid treatment Skin condition - dermatitis/ Prone to Infection Osteoporosis Choice of anaesthesia Other Joint Evaluation: Muscle Wasting Post op Complications: Myositis, Sp Physio needs
- 26. DRUG HISTORY Important in Inflammatory Arthritis Specifically ask for steroids and Biologicals Ayurvedic/ Alternate medicine What to stop?
- 27. DO NOT FORGET Which joint to do first? Uni vs Bilateral contractures protrusion LLD Implant Choice
- 28. ANKYLOSING SPONDYLITIS Younger Stiffness is a bigger issue Spine and Chest examination Positioning / Cup Placements/ landmarks
- 29. WHAT TO REMEMBER Modified New York criteria When to stop Biologicals? Anaesthesia Issues What to do: Spine Vs Hip Approach - Landmarks
- 30. FAI
- 31. FAI Anterolateral 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
- 32. FAI
- 33. OSTEOARTHRITIS Usually Straight Forward Ensure that this is the main cause of symptoms LLD Flexion/ ER/ adduction - Apparent Shortening
- 34. AVN Cause Reconfirm the stage on examination Loss of IR Obligatory ER
- 35. OBLIGATORY ER
- 36. CONCLUSION Systematic 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.