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Y4 SA - Orthopaedics > Common conditions of the coxofemoral (hip) joint > Flashcards

Common conditions of the coxofemoral (hip) joint Flashcards

1
Q

Name the primary stabiliser structure of the hip

A

Ligament of the round head of the femur/teres ligament

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2
Q

Name two developmental conditions of the hip

A

Hip dysplasia
Legg-Perthes disease

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3
Q

Name the traumatic conditions of the hip

A

Fractures - acetabulum, femoral head and neck
Pelvic fractures
Luxation/Dislocation (RP- joint stability lectures)

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4
Q

Name some key anatomical/structural features of the hip

A

Diarthrodial joint - ball and socket
Wide range of movement
Stability augmented by surrounding structure esp. teres ligament and joint capsule

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5
Q

The approach to the hip is centred on which structure?

A

Greater trochanter

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6
Q

To get to the greater trochanter you have to go between which muscles?

A

Tensor fascia lata and the biceps femoris
Underneath are the superficial and deep gluteals to then reach the hip

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7
Q

Which nerve must be avoided in the hindlimb?

A

Sciatic
- divides into tibial and perineal

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8
Q

Where are the landmarks for palpating the coxofemoral/hip region

A

Wing of the ileum, ischiatic tuberosity and greater trochanter – form a triangular shape

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9
Q

How are the landmarks of the hip changes by cranial luxation?

A

When there is a cranial luxation of the hip joint your landmarks change because the greater trochanter is moved more cranially and the distance between this and the wing of the ileum is shortened
Assess symmetry

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10
Q

How can you assess movement of the hip of a clinical exam?

A

Flexion and extension
Internal and external rotation
Adduction and abduction

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11
Q

Name 3 acquired conditions of the hip

A

Hip OA
Neoplasia
Immune mediated arthropathy

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12
Q

Describe the aetiopathogenesis of hip dysplasia, include predisposing factors

A
  • Laxity and instability of hip joint
  • Laxity due to poor soft tissue cover, then OA change as response
  • Large breed dogs/Devon Rex cat
  • Genotype and then bodyweight, nutrition, growth rate
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13
Q

Why does hip dysplasia cause pain?

A

Pain as femoral head hits dorsal effective acetabular rim

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14
Q

Which two groups of animals usually present with hip dysplasia?

A

Immature dogs<12mo
Adult dogs with OA secondary to hip dysplasia

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15
Q

List the clinical signs of hip dysplasia in dogs less than one year old

A
  • Unilateral/bilateral HL lameness
  • “bunny-hopping”
  • Reluctance to exercise
  • Pain upon hip extension/flexion
  • Positive Ortolani test
  • Labradors, Rottweilers, Collies, Setters
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16
Q

List the clinical signs of hip dysplasia in mature dogs

A

Stiffness after rest/ exercise
“Bunny-hopping”
Usually bilateral
Pain upon joint manipulation and reduced ROM

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17
Q

Hip dysplasia in mature dogs should be differentiated from which conditions?

A

Bilateral stifle, hock and lumbosacral disease

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18
Q

How is hip dysplasia diagnosed?

A

History
Clinical signs
Radiography
- VD extended/frog-legged
- Lateromedial view
- Special views

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19
Q

What is the Dynamic-Distraction index (DI)?

A

Used to predict dogs that will get hip dysplasia at a young age
DI: 0 (in) -1 (completely out) scale
<0.3 no risk
>0.7 has HD

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20
Q

Describe the early/primary radiographic changes of hip dysplasia

A

Important to note for Double/Triple pelvic osteotomy (DPO/TPO)
Wide joint space with medial divergence
Centre of femoral head lateral to dorsal acetabular edge

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21
Q

Describe the secondary radiographic changes of hip dysplasia

A

New bone formation of femoral neck (Morgan line)
Remodelling of femoral head/neck
Remodelling of cranial effective acetabular rim

22
Q

Describe the conservative treatment for hip dysplasia

A
  • Always worth trying unless very painful, hips are obviously luxoid and the owners are very keen to do something
  • Analgesia- NSAIDs
  • Weight control
  • Exercise/Environment modification: keep them stimulated but not strenuous
  • Nutritional management (including nutraceuticals)
  • Adjunct medications
  • Adjunct therapies
23
Q

When is surgical treatment of hip dysplasia indicated?

A

Only if non-responsive to conservative management

24
Q

Describe surgical treatment of hip dysplasia used only in young dogs

A

Juvenile pubic symphisiodesis

25
Q

Describe surgical treatment of hip dysplasia in all dogs

A

Femoral head and neck excision (FHNE)
(> 9 months) Total hip replacement (THR)
Triple pelvic osteotomy (TPO)- aim to increase cover of femoral head

26
Q

Describe a suitable candidate for a Triple pelvic osteotomy (TPO) procedure

A

immature and no secondary radiologic changes

27
Q

Describe the key features of the Juvenile pubic symphisiodesis procedure for hip dysplasia

A
  • Has to be done before 20 weeks old, so need to diagnose by 14-16weeks old
  • Causes thermal arrest of pubic chondrocytes by electrocautery/staples
  • Shortening of pubic bones and fixed in pelvis
  • Results in ventrolateral rotation of acetabulum and better congruity
28
Q

Describe the outcomes of the juvenile pubic symphisiodesis procedure

A
  • JPS dogs do better than conservative with mild/moderate HD
  • No effect if performed after 22 weeks
29
Q

Describe the key features of the Femoral head and neck excision (FHNE) procedure for hip dysplasia

A
  • Salvage procedure
  • Use to treat Legg-Perthe’s, unreducible #s
  • Success rate: Moderate to poor in dogs >15-20 KG
  • Craniolateral approach to hip
  • Remove all neck and bony spurs
  • REMEMBER POINT PATELLA TO THE SKY!
30
Q

Describe the key features of a total hip replacement procedure for hip dysplasia

A

Treatment of choice in dogs (more recently can all dogs and cats (micro and nano)
Maintained on analgesics
Expensive- £4500-7000 + vat

31
Q

When is a total hip replacement contraindicated?

A

Chronic systemic illness e.g skin

32
Q

Legg-Calve-Perthe’s disease is most commonly seen in which animals?

A

Small breeds such as WHWT
Heritable in WHWT and Manchester terriers
Immature dogs(c. 5mo old)
Unilateral lameness-usually

33
Q

What is Legg-Calve-Perthe’s disease?

A

Ischaemia of femoral head bone leads to deformity and collapse

34
Q

How is Legg-Calve-Perthe’s disease diagnosed?

A

Hx and CS
Pain/crepitus upon hip manipulation
Radiography-frog-leg and VD extended

35
Q

How is Legg-Calve-Perthe’s disease treated?

A

Surgical > conservative
Femoral head and neck excision
Total hip replacement
Post op rehabilitation-very important

36
Q

Name the 3 most common locations of femoral head and neck fractures

A

Capital and Capital physeal
Femoral neck
Greater trochanter

37
Q

Describe the aetiology of capital physeal fractures

A

Immature animals (4-7mo)
Secondary to trauma
Pain upon hip manipulation

38
Q

How are capital physeal fractures treated?

A

Three diverging/parallel K or arthrodesis wires
Craniolateral or dorsal approach to hip

39
Q

Describe the steps needed in managing fracture patients

A
  1. Initial overall patient assessment
    - Make sure they have movement in their limbs, if not make sure they have conscious pain perception – poor prognosis if deep pain negative
  2. Clinical assessment
  3. Radiographic assessment
  4. Treatment options (ONLY WHEN PATIENT HAS BEEN STABILISED)
40
Q

Describe the features of the initial overall assessment of pelvic fracture patients

A
  1. Assess urinary tract- is patient urinating? (there may still be a serious injury)
  2. Neurological exam: sciatic with ilial fracture, assess CPS
  3. Asses function of pelvic nerve-anal /perineal reflex
41
Q

Describe the features of the clinical assessment of pelvic fracture patients

A

Unilateral/Bilateral fracture
Palpate pelvis and feel for any crepitus, assess for asymmetry
May be shearing injuries, open wounds
Neurological exam.

42
Q

Describe the general considerations regarding appropriate treatment choices for pelvic fracture patients

A

75% would recover with conservative treatment
Area of pelvis affected
Small animals>Large dogs
Surgery within 5 days
Use of animal
Finance

43
Q

Which pelvic fracture types would be suitable for conservative management?

A

Fractures suitable for conservative management are those of the non weight bearing axes:
- Pubis
- Ischium
- Wing of ilium

44
Q

Describe conservative management of pelvic fractures

A
  1. Cage rest/small room rest for 4-6 weeks
  2. If non-ambulatory- frequent turning and soft bedding
  3. Check bladder qid if not urinating consciously
  4. Analgesia-opioids – full or partial agonists (buprenorphine), NSAIDs
45
Q

Which pelvic fracture types would be suitable for surgical management?

A

Weight bearing axes:
- Acetabulum
- Ipsilateral fractures of ilium, pubis, ischium
- Iliac shaft
- Sacroiliac joint (bilateral)
Fractures causing marked stenosis of pelvic canal
Pain
Neurological deficits

46
Q

Describe the common features of sacroiliac separations

A

Commonly seen post-RTAs
Unilateral> bilateral
Pain +++- if nerve root entrapment

47
Q

What are the indications for surgical treatment in Sacroiliac separations

A

Painful
Non ambulatory
Marked displacement
Other contralateral fractures

48
Q

Describe the surgical treatment methods for Sacroiliac separations

A

Lag screw fixation
Transilial pin

49
Q

How are iliac shaft and acetabular fractures treated?

A

Most fractures will require internal fixation (plating)
Other techniques-lag screws, K or arthrodesis wires
Need to avoid sciatic nerve

50
Q

Describe the Post-operative care for pelvic fractures

A
  • Cage rest/restricted room rest for 4-8 weeks
  • Treat as with conservative management- only short on-lead walks – 5-10 minutes until re-radiograph
  • See at 3, 7-10 days and then 4-8 weeks post-operatively for repeat radiographs
  • Analgesia, soft bedding- important
  • Passive physiotherapy/ hydrotherapy?

Y4 SA - Orthopaedics (7 decks)

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