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ARTHRITIC HIP -
EXAMINATION
dr vaibhav bagaria
joint replacement surgeon
sir h n reliance foundation hospital
girgaum, mum...
‘A CASE OF IDENTITY’
Watson: You appeared to read a good deal
upon [your client] which was quite invisible to
me.
Holmes: ...
USUAL SEQUENCE
History
Look
Feel
Move
Special tests
PAIN
Duration
Onset
Progress
Site
Severity
Character
Radiation
Aggravating and Relieving factors
Diurnal variation
Associa...
DEFORMITY
How Long has ist been present?
Didi it Progress?
What initiated it?
What other symptoms accompany it?
Any Histor...
FUNCTION ASSESSMENT & SCORING
Walking ability/ Aids
Ability to Squat/ Sit cross legged
Drive
Tie Shoes
Expectations from t...
PAST HISTORY
HT
DM
Sepsis
TB
Prolonged IV infusion as child
Bleeding episodes
Prior Trauma Surgery
Allergies
OTHER HISTORY
Sporting History
Drug Abuse/ Alchol/ Smoking
Occupational History
Treatment History
Family History
INSPECTION
Attitude
Deformity
Landmarks - Bone & Soft tissue
Swelling/ Wasting/ Skin
LLD
DEFORMITY/ CONTRACTURES
ATTITUDE
FEEL - PALPATION
Systematic
Anterior
Lateral
Posterior
MOVE
MEASURE
SPECIAL TESTS
Tests for deformity assessment
Tests for LLD
Tests for stability
Tests for impingement
Tests for muscle cont...
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 HIP
Osteoarthritis: Wear & Tear
FAI: Mechanical cause
DDH: Late Presentation
Post Traumatic
Osteonecrosis & 2ry ...
WHY?
Reconfirming that this is cause!
Decide Surgical vs Non Surgical Management
Plan for your Surgery; Possible detours
T...
Re examination of the hip: Otto Aufranc noted
that “more is missed by not looking than by not
knowing.”
Aufranc OE. The pa...
COMMON PRESENTATION
Joint Stiffness and pain often Groin, in front of hip, occasionally
thigh
Start up pain and stiffness
...
CO - FACTORS
Obesity
Professional sports
Injury
Risk factors for AVN
INFLAMMATORY ARTHRITIS
Previous steroid treatment
Skin condition - dermatitis/ Prone to Infection
Osteoporosis
Choice of a...
DRUG HISTORY
Important in Inflammatory Arthritis
Specifically ask for steroids and Biologicals
Ayurvedic/ Alternate medici...
DO NOT FORGET
Which 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/ landm...
WHAT TO REMEMBER
Modified New York criteria
When to stop Biologicals?
Anaesthesia Issues
What to do: Spine Vs Hip
Approach...
FAI
FAI
Anterolateral Hip Pain, Typical C shaped
fashion
Flexion, Adduction and Internal Rotation is the
most sensitive test (...
FAI
OSTEOARTHRITIS
Usually Straight Forward
Ensure that this is the main cause of symptoms
LLD
Flexion/ ER/ adduction - Appare...
AVN
Cause
Reconfirm the stage on examination
Loss of IR
Obligatory ER
OBLIGATORY ER
CONCLUSION
Systematic Approach
Know what you are looking for !
In Clinical Setting: Focussed Assessment is
Key.
The clues ...
THANK YOU
Questions?
Arthritic Hip Examination
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Arthritic Hip Examination

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Hip examination needs to be methodical and focussed. Tips Tricks and traps about the same.

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Arthritic Hip Examination

  1. 1. ARTHRITIC HIP - EXAMINATION dr vaibhav bagaria joint replacement surgeon sir h n reliance foundation hospital girgaum, mumbai, india
  2. 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
  3. 3. USUAL SEQUENCE History Look Feel Move Special tests
  4. 4. PAIN Duration Onset Progress Site Severity Character Radiation Aggravating and Relieving factors Diurnal variation Associated Symptoms
  5. 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. 6. FUNCTION ASSESSMENT & SCORING Walking ability/ Aids Ability to Squat/ Sit cross legged Drive Tie Shoes Expectations from treatment
  7. 7. PAST HISTORY HT DM Sepsis TB Prolonged IV infusion as child Bleeding episodes Prior Trauma Surgery Allergies
  8. 8. OTHER HISTORY Sporting History Drug Abuse/ Alchol/ Smoking Occupational History Treatment History Family History
  9. 9. INSPECTION Attitude Deformity Landmarks - Bone & Soft tissue Swelling/ Wasting/ Skin LLD
  10. 10. DEFORMITY/ CONTRACTURES
  11. 11. ATTITUDE
  12. 12. FEEL - PALPATION Systematic Anterior Lateral Posterior
  13. 13. MOVE
  14. 14. MEASURE
  15. 15. SPECIAL TESTS Tests for deformity assessment Tests for LLD Tests for stability Tests for impingement Tests for muscle contracture
  16. 16. SINGLE MOST IMP TEST???
  17. 17. GAIT Normal Gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
  18. 18. LIMPING Any abnormality of normal rhythmic biphasic walking
  19. 19. 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;
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. CO - FACTORS Obesity Professional sports Injury Risk factors for AVN
  24. 24. 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
  25. 25. DRUG HISTORY Important in Inflammatory Arthritis Specifically ask for steroids and Biologicals Ayurvedic/ Alternate medicine What to stop?
  26. 26. DO NOT FORGET Which joint to do first? Uni vs Bilateral contractures protrusion LLD Implant Choice
  27. 27. ANKYLOSING SPONDYLITIS Younger Stiffness is a bigger issue Spine and Chest examination Positioning / Cup Placements/ landmarks
  28. 28. WHAT TO REMEMBER Modified New York criteria When to stop Biologicals? Anaesthesia Issues What to do: Spine Vs Hip Approach - Landmarks
  29. 29. FAI
  30. 30. 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
  31. 31. FAI
  32. 32. OSTEOARTHRITIS Usually Straight Forward Ensure that this is the main cause of symptoms LLD Flexion/ ER/ adduction - Apparent Shortening
  33. 33. AVN Cause Reconfirm the stage on examination Loss of IR Obligatory ER
  34. 34. OBLIGATORY ER
  35. 35. 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.
  36. 36. THANK YOU Questions?

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