Final: Hip, Stifle Flashcards
What is the surgical option for puppies <20 weeks old with hip dysplasia?
Juvenile pubic symphysiodesis
Close part of growth plate to get more coverage of acetabulum
How much drawer is normal in an adult dog? Puppy?
Adult= NONE
Puppy = 4-5mm but with abrupt stop at cranial extent
T/F: Most dogs outlive their orthropedic impants.
True
Are lateral patellar luxations more common in small or large breed dog?
Large
What are the functions of the collateral stifle ligaments?
Provide joint stability medially and laterally
Prevent varus-valgus motion
Which of these is the cranial and which is the caudal cruciate ligament? Which ligament is torn?
Red= Caudal
Blue= Cranial
Torn Cranial, should be same width as caudal
What makes the cranial drawer sign limited or ‘constrained’ in a chronic case of CCL rupture?
Scar tissue /fibrosis
When is the highest risk of dislocation post THR?
First 2 weeks post-op
How long after an extracapsular repair do you expect a return to peak function?
6 months
Why do you do rads when you have a CCL rupture?
To rule out other injuries and visualize joint effusion (medial butress)
What surgery is indicated for Legg-Perthes disease?
FHO (asap)
What is the ‘Common Triad’ of multiple ligament injuries?
Cranial and Caudal cruciate
Collateral ligaments
Medial meniscus
Deranged stifle
When is surgery indicated for a grade II MPL?
Young dog, open growth plates
What is used to assess joint laxity in immature dogs with early stages of hip dysplasia?
Ortolani sign
Only do on dogs <2yrs old
What are 3 indications for an open hip reduction?
Avulsion of fovea capitis
Closed reduction unsuccessful
Unable to maintain closed reduction
If you are replacing the removed portion of the patellar groove what type of trochleoplasty have you performed?
Recession (block or wedge)
What does a positive cranial tibial thrust indicate?
Cranial subluxation of the tibia/ Completely torn ligament
What makes up the ‘triangle’ of structures you palpate or see on rads to ensure proper hip placement?
Tuber ischii
Crest of ileum
Greater trochanter
How many grades of patellar luxation are there?
4
(1-4)
What part of the meniscus is often injured when CCL rupture occurs? Why?
Caudal body of medial meniscus
CCL rupture displaces medial femoral condyle caudally in flexion leading to wedging/crushing when limb is extended or bares weight
Lateral patellar luxation is often associated with coxa ____.
Valga
Knock-kneed
What type of bandgae do you need to place post closed hip reduction? For how long?
Ehmer sling
7-10 days
Why is surgery recommended for most dogs with CCL insufficiency?
Need to establish joint stability
To less secondary DJD
To address any concurrent meniscal injury (which is painful)
What is the most common congential deformity in dgos? What is the typical signalment and presentation?
Medial patellar luxation
Small/Toy breed dog
Bilateral
What is a surgical procedure you can do for a 5-8 month of dog with hip dysplasia and without evidence of DJD? What angle of reduction provides the most favorable prognosis?
Triple Pelvic Osteotomy (TPO)
Improves dorsal coverage of head of femur by axially rotating and lateralizing the acetabulum
<30 deg
If you feel joint effusion in the stifle in a dog with a CCL tear is it more likely acute or chronic?
Acute
T/F: Lameness with MPL is always associated with the grade.
False
Where is suture passed for the extracapsular lateral suture technique of reconstruction of the CCL?
Through deep facia around flabella and through predrilled hole in tibial crest
What is the most common surgical management technique for a meniscal tear?
Partial menisectomy
What is the typical signalment for a dog with Legg-Perthes disease?
Young (6-7 mo)
Toy or Small breed dog
Usually unilateral
Progressive weight baring lameness
Pain (irritability, inappetence, chewing at skin over hip)
What are the medical management options for a puppy showing signs of hip laxity?
Reduce food intake (low fat and protein)
Keep dog lean
Do not supplement diet (esp w/Ca)
Maintain strength and joint motion - use NSAIDs, passive exercises, glucosamine…
What is the first sign of hip displasia?
Joint laxity
The lateral suture and tightrope technique are passive constrain methods of CCL fixation. What type of method is TPLO?
Active/dynamic constraint
If you feel crepitus when doing a ROM test on a dog post-FHO, what does it indicate?
You left a shelf of bone caudally (did not remove enough of the neck)
What is an imbrication?
Tightening
What type of suture is indicated for extracapsular CCL repair?
Monofilament nylon fishing line
(#6 Nylon is tested to 40-100lbs)
Why is a craniodorsal luxation of the hip most common?
Middle and deep gluteal muscles insert on the greater trochanter and originate on the pelvis so the femor gets pulled cranially and dorsally
T/F: A dog should be put under general anesthesia for a closed hip reduction.
True
If during a physical exam you are trying to luxate the patella medially, the leg should be held in _____ and the leg should be rotated ______.
Flexion
Internally
What is your plan of action if there are no radiographic changes but all of the clinical signs point to a cruciate ligament tear?
Joint tap
What is an important ddx for collateral ligament injury?
Fracture of the condyle
If the craniomedial band of the CCL tears but the caudolateral band remains intact, when will you see a cranial drawer sign?
In flexion
What are the options for reconstruction of the hip?
Capsulorraphy
Translocation of greater trochanter
Medial luxation of the patella causes ____ bowing of the distal third of the _____.
Lateral
Femur
Which bands of the CCL is taut in extension only and which is taut in all phases?
Caudolateral= taut in extension
Craniomedial= taut in flexion and extension
What approach do you take to the joint during an FHO?
Craniolateral
What is the most common type of meniscal tear?
Caudal bucket handle tear
Which type of THR has a higher risk of loosening and infection? Which one has a higher risk failing to ingrow?
Cemented
Cementless
What complication following THR requires removal of the impant? What surgery must follow?
Infection
FHO
Is this gait/stance/posture more characteristic of early or later stage hip dysplasia
Early
Due to acute pain- weight is shifted forward to take weight off the rear limbs
What CCL procedure eliminates cranial tibial thrust but not the cranial drawer sign? What angle between the tibial plateau and the patella is needed to eliminate thrust?
Tibial Tuberocity Advancement (TTA)
90deg
What are the prosthetic implant options for hip repair?
Prosthetic capsule made of sututre
Toggle pin
What is a prerequisite for TPLO?
Intact caudal cruciate ligament
What is the most commonly luxated joint in dogs and cats?
Coxofemoral joint
What is the noninflammatory aseptic necrosis of the femoral head that occurs in young patients before the closure of the capital femoral physis?
Legg-Perthes Disease
T/F: You should rule out growing pains as a cause of hip laxity before diagnosing hip dysplasia.
False, not a real thing
Pain is caused by the stretching of the joint capsule due to laxity
What are the radiographic signs seen with Legg-Perthes disease?
Deformity of femoral head (moth eaten, lucency)
Shortening and thickening of femoral head
Foci of bone opacity in epiphysis
May not see changes even if disease is present, important to repeat rads in a month is suspect disease (Or do CT)
What distraction index value indicates hip dysplasia? For what method of diagnosis is this from?
>/= 0.3
Penn-Hip method (distraction/stress radiography)
0= no subluxation at all, 1= complete luxation
What is the typical gait for a dog with patellar luxation under grade V?
Skipping gait
What are the 2 surgical options for hip dysplasia in mature dogs?
Total Hip Replacement (THR)
Replacing acetabulum, femoral head and neck- better for large active dogs
Femoral Head and neck Ostectomy (FHO)
Best before skeletal maturity
T/F: Early neutering is a significant risk factor dor excess TPA, which can predispose to CCL rupture.
True
Dogs affected with hip dysplasia have a disproportionately rapid _____ growth and a relatively delayed ______ growth.
Skeletal
Muscle
When performing the Ortolani test, the greater tha angle of ____ the greater the degree of laxity.
Reduction
What other reconstruction technique, in addition to the lateral suture technique, involves using suture to mimic the path of the CCL?
TightRope CCL
