Osteoarthritis of Hip — MCQs
Severe disability in primary osteoarthritis of hip is best managed by -
Which of the following is the most common cause of secondary osteoarthritis?
Trendelenburg sign is positive due to the involvement of:
Osteoarthritis is associated with all of the following except -
After chronic use of steroids severe pain in right hip with immobility is due to
Which of the following movements is typically restricted in Perthes disease?
A 70-year-old woman with chronic osteoarthritis of the hip presents with worsening pain and limited mobility despite conservative management. What is the next appropriate step?
Osteoarthritis not seen in ?
A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?
Primary osteoarthritis affects all except:
Osteoarthritis of Hip Indian Medical PG Practice Questions and MCQs
Question 1: Severe disability in primary osteoarthritis of hip is best managed by -
- A. Arthroplasty (Correct Answer)
- B. Arthrodesis
- C. Mc Murray's osteotomy
- D. Intra-articular hydrocortisone and physiotherapy
Explanation: ***Arthroplasty*** - **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement. - It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage. *Arthrodesis* - **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint. - While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients. *Mc Murray's osteotomy* - **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint. - It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis. *Intra-articular hydrocortisone and physiotherapy* - **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function. - These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.
Question 2: Which of the following is the most common cause of secondary osteoarthritis?
- A. Congenital dislocation
- B. Inflammatory arthritis
- C. Trauma (Correct Answer)
- D. Infection
Explanation: ***Trauma*** - **Prior joint injury** (macrotrauma) or repetitive microtrauma is a major risk factor for developing secondary osteoarthritis via post-traumatic arthritis. - Trauma directly damages articular cartilage and alters joint mechanics, accelerating degenerative changes. *Congenital dislocation* - While **developmental dysplasia of the hip** and other congenital joint abnormalities can lead to secondary osteoarthritis, these are less common causes overall compared to trauma. - The abnormal joint morphology and biomechanics lead to uneven stress distribution and accelerated wear. *Inflammatory arthritis* - Conditions like **rheumatoid arthritis** or **gout** can cause secondary osteoarthritis by damaging cartilage and bone through chronic inflammation. - However, the prevalence of these inflammatory conditions as the initiating factor for secondary OA is lower than that of trauma. *Infection* - **Septic arthritis** can destroy joint cartilage rapidly, leading to secondary osteoarthritis. - While a severe cause, its incidence as a predisposing factor for secondary OA is considerably less frequent than trauma-related injuries.
Question 3: Trendelenburg sign is positive due to the involvement of:
- A. Gluteus maximus
- B. Psoas major
- C. Gluteus medius (Correct Answer)
- D. Adductor magnus
Explanation: ***Gluteus medius*** - The **Trendelenburg sign** indicates weakness or paralysis of the hip abductor muscles, primarily the **gluteus medius** and **gluteus minimus**. - When standing on one leg, these muscles contract on the supported side to keep the pelvis level; if they are weak, the unsupported side of the pelvis drops. *Gluteus maximus* - This muscle is the primary **extensor of the hip** and is crucial for activities like climbing stairs or standing up from a seated position. - Its weakness would primarily affect hip extension, not the ability to keep the pelvis level during single-leg stance. *Psoas major* - The **psoas major** is a powerful **hip flexor** and contributes to lumbar spine stability. - Weakness of this muscle would impair hip flexion, making it difficult to lift the leg forward, but it is not directly involved in stabilizing the pelvis in the frontal plane during standing. *Adductor magnus* - The **adductor magnus** is an important **hip adductor** and also functions as an extensor in certain positions. - Its primary role is to bring the leg towards the midline, and its weakness would not cause the characteristic pelvic drop seen in a positive Trendelenburg sign.
Question 4: Osteoarthritis is associated with all of the following except -
- A. Subchondral sclerosis
- B. Ca++deposition in joint space (Correct Answer)
- C. Osteophyte formation
- D. Decreased joint space
Explanation: ***Ca++deposition in joint space*** - **Calcium pyrophosphate dihydrate (CPPD) crystal deposition** in the joint space is characteristic of **pseudogout**, not osteoarthritis [1]. - While some **calcification** may occur in osteophytes, direct **calcium crystal deposition** in the synovial fluid is not a primary feature of osteoarthritis [1]. *Subchondral sclerosis* - **Subchondral sclerosis** refers to the increased bone density that occurs beneath the cartilage in areas of stress in osteoarthritis. - This is a common radiological finding in osteoarthritis, reflecting the bone's response to increased mechanical load. *Osteophyte formation* - **Osteophytes** (bone spurs) are bony projections that form along the joint margins in osteoarthritis [2]. - They are a hallmark feature of the disease, resulting from the body's attempt to repair and stabilize the damaged joint [2]. *Decreased joint space* - **Decreased joint space** on radiographs is a classic sign of osteoarthritis, indicating loss of articular cartilage thickness [2]. - As the cartilage erodes, the distance between the bones within the joint decreases. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 683-684. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1210-1212.
Question 5: After chronic use of steroids severe pain in right hip with immobility is due to
- A. Avascular necrosis (Correct Answer)
- B. Perthes disease
- C. Hip dislocation
- D. Osteoarthritis
Explanation: ***Avascular necrosis*** - Chronic **steroid use** is a major risk factor for avascular necrosis (AVN), particularly affecting the **femoral head** of the hip. - Reduced blood supply leads to bone death, resulting in severe pain and impaired mobility. *Perthes disease* - This is a condition of idiopathic **avascular necrosis of the femoral head** occurring in **children**, primarily between ages 4-10. - It is not associated with steroid use and typically presents in a different age group. *Hip dislocation* - Hip dislocation presents with **acute, severe pain** and an inability to bear weight or move the hip, often due to significant trauma. - While it causes immobility, it is an **acute traumatic event** rather than a chronic consequence of steroid use. *Osteoarthritis* - Osteoarthritis is a degenerative joint disease characterized by **cartilage breakdown** and joint pain that typically **worsens with activity** and improves with rest. - While chronic hip pain can be due to osteoarthritis, its direct link to steroid use for severe pain and immobility as described is less prominent than AVN.
Question 6: Which of the following movements is typically restricted in Perthes disease?
- A. Abduction & internal rotation (Correct Answer)
- B. Abduction & external rotation
- C. Adduction & internal rotation
- D. Adduction & external rotation
Explanation: ***Abduction & internal rotation*** - **Perthes disease** affects the femoral head, leading to pain and stiffness that most commonly restricts **abduction** and **internal rotation** of the hip. - This restriction is an early and consistent clinical finding, often accompanied by a ** Trendelenburg gait** due to gluteal muscle weakness or pain avoidance. *Abduction & external rotation* - While abduction can be restricted, a primary restriction in **external rotation** is less typical in early Perthes disease. - Reduced external rotation is more characteristic of conditions like **slipped capital femoral epiphysis (SCFE)**, especially in older children. *Adduction & internal rotation* - **Adduction** is generally preserved or even increased in Perthes disease as the hip seeks a position of comfort due to pain, making it an unlikely primary restriction. - While internal rotation is restricted, the combination with adduction restriction is not the classical presentation. *Adduction & external rotation* - Neither **adduction** nor **external rotation** are typically the primary hip movements restricted in Perthes disease. - Restriction in adduction is rare, and external rotation is often compensatory or less affected than internal rotation.
Question 7: A 70-year-old woman with chronic osteoarthritis of the hip presents with worsening pain and limited mobility despite conservative management. What is the next appropriate step?
- A. NSAIDs
- B. Physical therapy
- C. Intra-articular corticosteroid injections
- D. Total hip replacement (Correct Answer)
Explanation: ***Total hip replacement*** - For **severe osteoarthritis (OA)** causing significant pain and **functional impairment** despite failed conservative management, **total hip replacement** is the most definitive and effective treatment. - This procedure alleviates pain and restores **mobility**, dramatically improving the patient's quality of life. *NSAIDs* - **NSAIDs** are typically part of **initial conservative management** for symptomatic relief in mild to moderate OA, but they have already failed in this patient. - Continued use in elderly patients carries risks of **gastrointestinal, renal, and cardiovascular side effects**, making it a less desirable long-term solution. *Physical therapy* - **Physical therapy** is a crucial component of conservative management to improve **strength, flexibility, and function**, but it often becomes insufficient in advanced OA. - Since this patient has worsening symptoms despite conservative measures, physical therapy alone is unlikely to provide adequate relief. *Intra-articular corticosteroid injections* - **Corticosteroid injections** can provide temporary pain relief by reducing inflammation but do not address the underlying **structural damage** of severe OA. - Their effectiveness diminishes over time, and repeated injections are discouraged due to potential cartilage damage.
Question 8: Osteoarthritis not seen in ?
- A. Ankle joints (Correct Answer)
- B. Knee joints
- C. Hip joints
- D. 1st metacarpophalangeal joint
Explanation: ***Ankle joints*** - While other joints are frequently affected by osteoarthritis, the **ankle joint** is *relatively spared* from primary osteoarthritis. - Osteoarthritis in the ankle is more commonly **secondary** to trauma, inflammation, or structural abnormalities rather than a primary degenerative process. *Knee joints* - The **knee joint** is one of the most frequently affected joints in osteoarthritis due to its weight-bearing function and complex biomechanics. - **Cartilage degeneration** in the knee leads to pain, stiffness, and reduced mobility. *Hip joints* - The **hip joint** is another common site for osteoarthritis, particularly in older adults, due to its significant weight-bearing role. - **Acetabular and femoral head cartilage erosion** causes deep groin pain and restricted range of motion. *1st metacarpophalangeal joint* - The **1st metacarpophalangeal (MCP) joint** of the thumb is a common site for osteoarthritis, especially in women. - This is due to the significant **stress and forces** placed on this joint during pinching and gripping activities.
Question 9: A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?
- A. Conservative management
- B. Total knee replacement (Correct Answer)
- C. Arthroscopic washing
- D. Partial knee replacement
Explanation: ***Total knee replacement*** - For **grade III osteoarthritis** in a 65-year-old, a total knee replacement is the most definitive and effective treatment to relieve pain and restore function in a severely damaged joint. - This procedure addresses widespread cartilage loss and structural changes typical of advanced osteoarthritis. *Conservative management* - This approach is typically favored for **mild to moderate osteoarthritis**, involving physical therapy, NSAIDs, and lifestyle modifications. - For **grade III changes** with significant pain and swelling, conservative measures are unlikely to provide sufficient relief or halt disease progression effectively. *Arthroscopic washing* - **Arthroscopic lavage** and debridement are rarely recommended for osteoarthritis as they have not shown sustained benefits for pain or function. - It is sometimes used for specific mechanical symptoms, but it does not address the underlying cartilage loss and structural damage in severe osteoarthritis. *Partial knee replacement* - A **partial knee replacement** is suitable when osteoarthritis is confined to a single compartment of the knee, and the other compartments are healthy. - Given the indication of "grade III osteoarthritic changes" without specifying a single compartment, a total knee replacement is generally more appropriate for widespread disease.
Question 10: Primary osteoarthritis affects all except:
- A. Metacarpophalangeal joint (Correct Answer)
- B. Hip Joint
- C. Distal interphalangeal joint
- D. Knee joint
Explanation: ***Metacarpophalangeal joint*** - The **metacarpophalangeal (MCP) joints** are typically spared in primary osteoarthritis, making their involvement a less common presentation. - Involvement of the MCP joints, particularly with significant inflammation, might suggest other conditions like **rheumatoid arthritis**. *Hip Joint* - The hip joint is a common site for primary osteoarthritis due to its **weight-bearing function** and susceptibility to mechanical stress. - Patients often experience **groin pain** and reduced range of motion, particularly internal rotation. *Distal interphalangeal joint* - The **distal interphalangeal (DIP) joints** are very commonly affected in primary osteoarthritis, leading to the formation of **Heberden's nodes**. - These nodes are bony enlargements that indicate osteophyte formation and cartilage loss. *Knee joint* - The knee joint is another frequently affected large joint in primary osteoarthritis, often presenting with **pain**, **stiffness**, and **crepitus**. - Its **weight-bearing role** contributes significantly to its vulnerability to degenerative changes.
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