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RUSVM Small Animal Surgery 1 > Hip > Flashcards

Hip Flashcards

1
Q

What are the surgical disorders of the hip?

A

Hip dysplasia
Coxofemoral luxation
Leg-calve perthesis disease

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2
Q

What is the pathogenesis of hip dysplasia ?

A

Abnormal development of coxofemoral joint resulting in joint laxity
— laxity leads to malarticulation and DJD

Associated with disparity of growth of muscle mass vs skeletal structures
—affected dogs have rapid skeletal growth and delayed muscle growth

Bony changes occur because of lack of congruity between femoral head and acetabulum

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3
Q

What is the signalment with hip dysplasia?

A

Large breed

Juveniles present with joint laxity
Mature patients present with DJD and osteoarthritis

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4
Q

What is a common history seen in animals with hip dysplasia ?

A

Exercise intolerance

Difficulty rising
Intermittent/continual lameness
Sits funny/ falls to the side

Bunny hops
Takes stairs with both legs together

Slow, chronic onset

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5
Q

What do you see in the early phase of hip dysplasia during an orthopedic exam?

A

Early phase — lame, pain on extension of hip joints

Bunny hopping, straight stifles, throw weight forward, head and neck extended, narrow base rear, wide Base front

Muscle atrophy and reluctant to rise

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6
Q

What do you see during an orthopedic exam in late phase hip dysplasia?

A

Restricted extension, muscle atrophy, pain on extension, crepitus

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7
Q

What is the Ortolani sign?

A

Dog is in dorsal recumbency with femurs at 90 degree angle to table

Subluxation femoral head dorsally by pressure on stifle joint (adduct slightly)

Maintain pressure white slowly abduct stifle

Palpating (and hearing) head return to acetabulum = positive Ortolani sign

The greater the angle of reduction, the greater the degree of joint laxity

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8
Q

The pain associated with hip dysplasia in a juvenile is caused by?

A

Exposure of pain receptors in subchondral bone and joint capsule

In older dogs, pain is secondary to osteoarthritis

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9
Q

What radiographic changes are see in hip dysplasia?

A

Early stage - increased joint space, flattened acetabulum, coxa valga, osteophyte

Late stage - above +DJD

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10
Q

What is your DDX for hip dysplasia?

A

Neurological
Orthopedic

L-S instability
Herniated disc
Myelopathy
Bilateral CCL

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11
Q

T/F: medical managment is always the first line treatment in hip dysplasia

A

True

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12
Q

How can you medically manage a dog with hip dysplasia ?

A

Reduce food intake — keep dog lean (low fat and protein)

Managed exercise
Swimming and controlled long slow leash walks

Alleviate pain (passive and active exercises and NSAIDS)

Maintain strength and joint motion

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13
Q

You have a 15week old puppy with hip dysplaia. What surgical intervention would be appropriate ?

A

Juvenile pubic symphysiodiesis (JPS)

— alters growth of pelvis and degree of ventroversion of acetabulum

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14
Q

What surgical management for hip dysplasia is appropriate in a 6month dogs without radiographic evidence of DJD?

A

Triple pelvic osteotomy

—> osteotomy of pubis, ischium, and ileum

Ileum is then fixed with an angled TPO plate to achieve axial rotation of the acetabulum

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15
Q

In what cases in triple pelvic osteotomy provide the most favorable prognosis?

A

Stress radiographic evidence of subluxation

Minimal to no DJD

Angle of reduction <30degrees and angle of subluxation <10degrees

Solid distinctive reduction of femoral heal (positive Ortolani sign)

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16
Q

What are surgical procedures for hip dysplasia that can be done in mature dogs?

A

Total hip replacement

Femoral head and neck ostectomy

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17
Q

T/F: total hip replacement for hip dysplaia is only done as a salvage procedure after non-response to medical managment

A

True

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18
Q

What are the two types of total hip replacement?

A

Cemented and cementless prosthesis

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19
Q

T/F: large and active dogs have better function with total hip replacement than with FHO

A

True

20
Q

What are complications to THR?

A

Dislocation PO

Infection

Loosening —cemented
Failure of ingrowth —cementless

Femur fracture

21
Q

What is a femoral head and neck ostectomy?

A

Removal of the head and neck of femur with saw or osteotome

Pesudoarthrosis is formed using gluteal muscles and tendons to support weight

22
Q

What is the approach to the hip joint when doing a FHO?

A

Craniolateral

23
Q

What is the prognosis for surgical correction of hip ?

A

TPO- long term function good to excellent
— progressive degenerative changes

THR - excellent to normal function unless complication

FHO- smaller patients have better results

24
Q

What is the most commonly luxated joint in dog and cat

A

Coxofemoral

25
Q

What is the cause of coxofemoral luxations?

A

Motor vehicle accidents

Associated with contralateral pelvic or long bone fracture

Associated with thoracic injury

Silent trauma — eg fell down stairs

26
Q

T/F: coxofemoral luxation causes an acute, unilateral weight bearing lameness

A

False

Acute unilateral NONweightbaring lameness

27
Q

What are your DDX for coxofemoral luxation?

A

Fracture of femoral head or neck

Slipped capital physis or avulsion fracture

Fracture of acetabulum

Hip dysplasia and degenerative joint disease (DJD)

28
Q

What are the 3 stabilizers of the hip joint?

A

Ligament of head of femur
Joint capsule
Dorsal acetablular rim

29
Q

What muscles attach to the greater trochanter of the femur, which requires a tension band when repairing with osteotomy

A

Middle and deep gluteals

30
Q

T/F: most coxofemoral luxations are in the craniodorsal direction

A

True

31
Q

This this consisted with a (craniodorsal or caduoventral) coxofemoral luxation?

Non-weight bearing lameness 
Greater trochanter difficult to palpate 
Hold leg out and flexed 
Stifle internally rotated 
Affected limb longer on extension
A

Caudoventral luxation

32
Q

This this consisted with a (craniodorsal or caduoventral) coxofemoral luxation?

Affected leg held in relaxed extension with foot beneath the body and stifle externally rotated

Affected leg is shorter on extension of hip
Pain and crepitus on palpation

A

Craniodorsal

33
Q

T/F: Ehmer slings should be used to stabilize reduced caudoventral coxofemeral luxation

A

True

Place in hobbles

34
Q

T/F: Ehmer sling should be used to stabilize a reduced craniodorsal coxofemeral luxation

A

True

7-10days post reduction

35
Q

How do you do a closed reduction of a craniodorsal coxofemoral luxation?

A

Grap tarsus and externally rotate the limb

Apply distal traction to bring head of femur below the acetabular rim

When head clears acetablulum, internally rotate limb

Place thumb of opposite hand on ventral rim acetabulum and index finger on trochanter
Apply pressure while putting joint through ROM to clear out debris from joint

36
Q

When is open reduction indicated for coxofemoral luxation?

A

Avulsion of fovea capitis

Closed reduction unsuccessful

Unable to maintain closed reduction

37
Q

What are the two possible approaches to open reduction of coxofemoral luxation?

A

Cranial -lateral

Dorsal approach by osteotomy of greater trochanter

38
Q

What are the types of repair can you do on coxofemoral luxations

A

Reconstructions
— capsulorrhahy
—translocation of greater trochanter

Prosthetic implant
— prosthetic capsule made of suture
—toggle pin (only procedure that does not required coaptation)

Total hip replacement
Femoral head and neck osteotomy

39
Q

How s a prosthetic capsule made?

A

Hole drilled transversely across neck of femur

Bone screws and washers are inserted into dorsal acetabulum

Non absorbable suture material is placed through hole and around screws in figure 8 pattern

40
Q

How is a toggle pin/rod made?

A

Toggle with non-absorbable suture attached into acetabular fossa

Suture material is drawn through tunnel drilled in femoral neck

Suture is secured on lateral side of femur

41
Q

What is the prognosis for closed and open coxofemoral luxation reductions?

A

Closed - 50%
Lower with dysplasia or previous trauma

Open - 85-50% with good to excellent limb function

42
Q

What is legg-perthes disease?

A

Aseptic necrosis of the femoral head

43
Q

Possible causes of legg-perthes disease?

A

Hereditary

Infraction of femoral head

44
Q

Pathogenesis of legg-perthes disease?

A

Blood supply to femoral head is occluded

Aseptic necrosis of subchondral bone followed by cartilage collapse

Incongruity resulting in DJD and lameness

45
Q

Signalment associated with legg-perthes disease?

A

Young (prior to capital physis closure)
Toy and small breed
6-7months

46
Q

Diagnosis of legg-perthes disease?

A

Pain on manipulation of hip

Chronic — muscle atrophy and creptius, decreased ROM

Rads
—deformity of femoral head
—shortening and thickening of femoral neck
—foci of bone opacity in epiphysis

47
Q

Treatment for legg-perthes disease?

A

Femoral head and neck excision

Surgery as early as possible
Need pain management and physical therapy

Prognosis - good

RUSVM Small Animal Surgery 1 (39 decks)

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