Conditions of the Hip Joint Flashcards
Coxo-femoral Luxation
- pathophysiology / types
- what direction of luxation is most common? what is rare?
- Congenital
vs - Traumatic
> Violent trauma (vehicular trauma, fall, etc)
> Soft tissue trauma includes: - Rupture of the ligament of the femoral head
- Rupture of the joint capsule
- ± Rupture of the deep gluteal muscle
- ± Femoral head fracture
<><><><> - Craniodorsal luxation common (> 90%)
- Ventral luxation rare
Coxo-femoral Luxation
clinical signs
- Acute non-weight bearing lameness
- Pain and crepitus
- Reduced range of motion
- Dorsal displacement of the greater trochanter
Coxo-femoral Luxation
radiographs to rule out what?
- Rule out fractures of the femoral head/acetabulum
- Rule out HIP DYSPLASIA > Salvage procedures
Coxo-femoral Luxation
Treatment Options - closed reduction
> when to do it?
> success rate?
> follow up?
<><>
- is it easy?
- contraindications?
- Closed reduction and sling:
- As soon as possible (m. contracture)
- 50% success
> Ehmer sling if DORSAL, 10 days > ESSENTIAL for success
> Hobbles if VENTRAL - Restricted activity for 4-8 weeks
<><><> - General anesthesia +/- epidural
- Hard!
<><><>
Contraindications - Any signs of hip dysplasia
- Any fractures
- Multiple leg injuries
Coxo-femoral Luxation
- open reduction
> how to do it
Open reduction and stabilization
* Prosthetic joint capsule
* Toggle pin
Surgical salvage procedures for Coxo-femoral Luxation
- Femoral head and neck excisional arthroplasty
- Total hip replacement
Surgical Stabilization for Coxo-femoral Luxation
- how do we do it? what do we do?
- Capsulorrhaphy:
> Joint capsule repaired with sutures - Prosthetic capsule:
> 2 screws with washers - Retention suture:
> Between ilium and greater trochanter - Requires Ehmer Sling for 14 days
“Toggle Pin” Technique for Coxo-femoral Luxation
- when should we do this?
- advantages?
- follow up?
- what even is it?
- Preferred surgical method in medium- large breeds
> Allows immediate use of the leg
> Restricted exercises for 6-8 weeks - Large polyester suture replacing round ligament
Coxo-femoral Luxation prognosis
- for closed vs open reduction
- function
- salvage procedures
- Closed reduction: 50% success…but no surgery!
- Open reduction: 80-90% success
<><> - 70% return to good function, 20% remain lame
- DJD will develop
<><>
Salvage procedures include: - Femoral head and neck excisional arthroplasty (FHO) * Total hip replacement (THR)
Femoral Head and Neck Excisional Arthroplasty (FHO)
- indications
- what is the purpose? what do we do?
<><>
- how do we do it?
Indications:
* Fractures, failure of reduction after surgery, chronic luxation (>14 days), hip dysplasia, Legg- Perthes disease, financial constraint
<><>
* Decrease “bone-bone” contact
* Creates a “fibrous pseudoarthrosis”
<><>
* Cranio-lateral approach to hip
* Hip is luxated and externally rotated 90°
* Remove entire neck
> Osteotomy from medial aspect of greater trochanter to just proximal to the lesser trochanter
Femoral Head and Neck Excisional Arthroplasty (FHO) post op care
- Good analgesia
- Early return to activity / Physiotherapy
- The sooner they use the leg, the better
Femoral Head and Neck Excisional Arthroplasty (FHO)
- complications
- prognosis? what can improve success rate?
Complications
* Persistence of lameness
* Decreased range of motion
* Limb shortening and muscle atrophy
<><><>
Prognosis
* 60%-83% success rate
* Improved success rate with
> Lighter animals vs heavier animals
> Good preoperative hip muscle mass
> Preservation of lesser trochanter
> No remnants of the femoral neck
Legg-Calve-Perthes Disease
- what is this?
- how does it arise?
- who is at risk?
- onset?
- progression
- signs
Avascular Necrosis of the Femoral Head
* Non-inflammatory necrosis of the femoral head
* The cause for the vascular insufficiency is unknown
> Hormonal, metabolic, trauma, toxemia, allergy, infectious, hereditary (recessive )
<><><><>
* Small breeds, 5-8 months (3-13)
* Onset: gradual or sudden
* Progress to non-weight bearing
* Pain, may chew at flank
* Crepitations, decreased ROM
* Bilateral in 12-16%
Legg-Calve-Perthes Disease
- radiographic signs, what progression can look like
- how it can develop
- 1st degree radiolucent patches
> Femoral head + neck - 2nd degree femoral head collapse
> Flat and irregular
<><> - Severe degenerative joint disease if left untreated
- Fracture of femoral head or neck
Legg-Calve-Perthes Disease
treatment, prognosis
- Femoral head and neck excision (FHO)
- Prognosis very good to excellent
