Hip Flashcards
What are the causes of hip dysplasia?
= laxity and instability of the hip joint
- large breed dogs
Congenital, nutritional, body weight, growth rate
What is the clinical presentation of hip dysplasia?
- Immature dogs
Subluxation of the femoral head
Effusion of the hip joint
Subside at 12-18 moths - Adult dogs - present with OA
What is the presentation in immature dogs?
Less than 1 year old Unilateral / bilateral hindlimb lameness Bunny hopping gait Reluctance to exercise Pain upon hip flexion Positive ortolani test
What is the clinical presentation of hip dysplasia in adult dogs?
Mature dogs Stiffness after rest / exercise Bunny hopping Usually bilateral Pain upon joint manipulation Reduced ROM Palpate the spine to differentiate from lumbosacral disease
What are the primary radiographic changes seen on VD radiographs in hip dysplasia?
Wide joint space with medial divergence of cranial joint space
Centre of the femoral head lies outside the acetabular edge
Coxa valga >150 degree angle of femoral shaft to neck
What are the secondary changes seen in hip dysplasia when there is osteoarthritis due to hip dysplasia?
New bone formation at the femoral head = Morgan line
Remodelling / thickening of the femoral head / neck
Remodelling of the cranial effective acetabular rim
Acetabulum is flattened
How should you conservatively manage hip dysplasia in a young dog?
Rule out concurrent stifle disease
Rest - only 5-10 minute walks per day on a lead
NSAIDS and paracetamol
Gabapentin if you suspect neuropathic pain
Weight loss
80% success rate
What is a triple pelvic osteotomy?
Triple pelvic osteotomy
- 3 osteotomies, acetabulum rotated and stabilised with a slocum plate
- increases the cover of the femoral head
90% success rate
Only indicated in immature dogs with no secondary radiologic changes
What are the surgical treatment options for immature dogs with hip dysplasia?
Triple pelvic osteotomy
Femoral head and neck excision
Total hip replacement
Juvenile symphydesis
When can a hip replacement be placed in an immature dog?
From 12 months old
Indicated in very severe cases
Keep pain free until a hip replacement can be performed
What is a juvenile symphydesis and when can it be performed?
Less than 6 months old
Uses diathermy to arrest the growth of the pubic symphysis
How can hip dysplasia in a mature dog be managed?
Conservative treatment - pain relief and other treatments for OA
Surgical treatment
- for cases that aren’t responsive to conservative management
- total hip replacement
When is a femoral head and neck excision indicated?
Only recommended in dogs under 15 kg
Salvage procedure - femoral head and neck removed
A false hip joint will be formed
Indicated in:
Hip dysplasia in mature small dogs that has failed to respond to conservative management
Legg calve perthes
Unreducible fractures
When is a total hip replacement recommended in mature dog with hip dysplasia?
Over 15kg
Dogs that have failed to response to surgical management
When is a total hip replacement contraindicated?
Previous hip surgery
Chronic systemic illness - skin problems
Too small for implants
What is the common clinical presentation of legg calve perthes?
WHWT, poodles and terriers - ischaemic necrosis of the femoral head Onset at 5 months Unilateral lameness Pain on palpation and manipulation of the hip Crepitus in the hip
What radiographic changes will you see with legg calve perthes disease?
Remodelling around the femoral head
Loss of mineral density of the femoral head
Collapse of the articular cartilage
How can you treat legg calve perthes?
Surgical management
- FHNE
- THR
Where are the most locations of fractures of the femoral head and neck?
Capital and capital physeal - femoral head
Femoral neck
Greater trochanter
What is a typical clinical presentation of a capital physeal fracture?
Immature animals - 4-7 months old cats
Following trauma eg RTA
Pain upon hip manipulation
Dx: radiography
How should you treat capital physeal fractures?
3 diverging or parallel Kirschner (K) wires
Or Arthrodesis wires
How does a coxofemoral joint luxation usually present?
Young dog - less than 12mo
Following minor trauma eg RTA
Leg carried in flexion - stifle out, hock in
Decreased distance between the greater trochanter of the femurs and the wing of the illum on the luxated side when palpating the pelvis
How can you attempt closed reduction of a coxofemoral luxation?
Within 48 hours of injury
Out under GA and tie dog to table
Pull the leg in the opposite direction lot the way it came out and rotate back into place
If re-luxation occurs - open, reduce and stabilise
Place an Ehmer sling and cage rest for 7-10 days
How can you perform an open reduction on a coxofemoral subluxation?
Craniolateral approach to the hip Remove haematoma and bone fragments from the acetabulum and lavage Replace the femoral head with caudal traction Suture the joint capsule back together Or apply: - toggle fixation - trans-articular pin - iliofemoral suture
