Normal Gait is rhythmical bipedal biphasic
walking in which the lumbar spine, hip and legs
move in unison
Any abnormality of normal rhythmic biphasic
Osteoarthritis: Wear & Tear
FAI: Mechanical cause
DDH: Late Presentation
Osteonecrosis & 2ry Arthritis
Septic Arthritis/ TB Arthritis
Pagets; Gauchers; Sickle: SLE; Hemophilia;
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
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
Joint Stiffness and pain often Groin, in front of hip, occasionally
Start up pain and stiffness
Aching that increases with weather change
Loss of ROM
Weakness esp getting up
CO - FACTORS
Risk factors for AVN
Previous steroid treatment
Skin condition - dermatitis/ Prone to Infection
Choice of anaesthesia
Other Joint Evaluation: Muscle Wasting
Post op Complications: Myositis, Sp Physio needs
Important in Inflammatory Arthritis
Specifically ask for steroids and Biologicals
Ayurvedic/ Alternate medicine
What to stop?
DO NOT FORGET
Which joint to do first?
Uni vs Bilateral
Stiffness is a bigger issue
Spine and Chest examination
Positioning / Cup Placements/ landmarks
WHAT TO REMEMBER
Modified New York criteria
When to stop Biologicals?
What to do: Spine Vs Hip
Approach - Landmarks
Anterolateral Hip Pain, Typical C shaped
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
Know what you are looking for !
In Clinical Setting: Focussed Assessment is
The clues are endless, and the game is played
by everyone ( qualified or lay) at each new
encounter throughout life.