Period of pain relief after disc surgery
- followed by increasing back pain & occasional leg pain
Pain may be disproportionate to physical findings
Low grade fever common
SLR & femoral stretch tests elicit pain in some cases
Good initial results but unacceptably high failure rate with longer follow-up
Problems
1. Too stiff (low ultimate strain)
- poor resistance to abrasion
- ligament failure by attrition most common
2. Recurrent synovitis, infection, loosening and osteolysis
OCD
OA - Osteophytes
Meniscus
Pain
Locking
Clicking
Can cause chondral damage
OA Loose Bodies
Patella may develop from one or multiple ossification centres at 3 years
Failure of centres to fuse may produce bipartite or tripartite patella
- usually bilateral and painless
Classically superolateral
I Inferior Pole 5%
II Lateral 20%
Humeral Avulsion of Glenohumeral Ligament
Bokor et al JBJS Br 1999
- 514 cases surgical treatment traumatic instability
- incidence 7.5%
- 25% associated SSC tear
- likelihood of HAGL if no Bankart or MDI 27%
Subtrochanteric
Lateral femoral shaft
Stress fractures
Associated with long term bisphonate use
Black et al. NEJM 2020
- reduction of hip fracture risk v risk of atypical femur fracture
- 10 year period
Self limiting syndrome of unknown aetiology
- hip pain associated with osteoporosis of proximal femur
AVN
- AVN of the hip in pregnancy is rare but possible
- TOH tends to be diffuse on MRI, while AVN is localised
- extends to neck and metaphysis
- transient osteoporosis has normal bone scan
Rare
- M: F 3:1
Non-traumatic or traumatic condition of femoral head with bone death
20 - 50 yo (average 38)
- M: F 4:1
70-80% with AVN will progress within 1 year
Largely related to degree of displacement
Hawkins Type I
- 0% to 13%
Hawkins Type II
- 20% to 50%
- usually only patchy and not a problem (rarely collapses)
Disorder of immune system
- antigen-antibody complexes
- stimulate release of proteolytic enzymes
- leading to vasculitis, synovitis and cartilage destruction
Articular Effects
- synovitis
- ligamentous and capsular laxity
- cartilage destruction
- osseous erosion
Vasculitis
- rheumatoid nodules