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Orthopaedics > Hip and elbow dysplasia > Flashcards

Hip and elbow dysplasia Flashcards

1
Q

What is the difference between hip dysplasia and laxity

A

Hip dysplasia is a developmental hereditary condition but these puppies are normal at birth

Laxity in hips can be common in puppies and doesn’t predict later dysplastic changes

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2
Q

What breeds are assocaited with hip dysplasia

A

Labradors, GSDs, Rottweilers, Golden retrivers
+ crosses of thisW

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3
Q

What is a typical age of presentation for hip dysplasia

A

6-7 months

+ there is a second group that presents later on due to secondary degenerative joint disease as a result of hip dysplasia

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4
Q

What do we see on ortho exam of an animal with hip dysplasia

A

Asymmetric muscle mass over quads and glueals
Sensitivity over hind quarters
Pain on hip extension and abduction
Reduced range of motion
If crepitus is present, suggests DJD secondary to hip dysplasia
Asymmetric pad wear

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5
Q

Gait changes with hip dysplasia

A

Shortened low stride on (more) affected limb
Lateral sway
Bunny hopping if bilaterally affected

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6
Q

What is a psoas injury

A

Soft tissue injury of ileo-psoas muscle on medial side of the hip

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7
Q

Which dogs typically get avascular necrosis of the femoral head (Ddx for hip dyspasia)

A

Young small breed dogs

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8
Q

What are the two hip specific ortho tests

A

Ortolani test
Barden hip lift

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9
Q

What is a positive barlow sign

A

Subluxation in the Ortolani test

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10
Q

What is a positive ortolani sign

A

Reduction on abduction of the hip in Ortolani test

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11
Q

How does the ortalani test work

A

Dog heavily sedated/GI in dorsal recumbency
Push down on femur and feel it subluxate if loose in socket
Then abduct the femur until it reduces back into place (+ve ortalani sign)

Can then adduct hip to detect sublixation (positive Barlow)

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12
Q

What position is a dog in for the Barden test

A

Lateral recumbency
move femur up and down to detect movement (laxity)

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13
Q

What views is done for BVA hip scoring

A

VD extended view

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14
Q

What direction do subluxations of the hip tend to go and how can we tell

A

Cranio-dorsally or caudo-ventrally
Can tell using 2 radiographic views

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15
Q

What dorsal acetabular cover is normal

A

At least 50% of the femoral head being covered by the dorsal acetabular rim

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16
Q

What is the Norberg angle and what is normal

A

THe angle formed between the centre of the femoral head and the dorsal acetabular ring
Should be >105*; less suggests subluxation

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17
Q

What is Pennhip distraction index

A

Measuring of assessing risk of hip dysplasia by taking two radiographs with calibrated force applied to distract the hip between
- The less it moves, the tighter in the socker

> 0.7 distraction index associated with poor prognosis (0.3 good)

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18
Q

What is the painful part of hip dysplasia

A

Hip arthritis that develops later

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19
Q

What forms part of the conservative management of a dog with hip dysplasia

A

Rest, diet control esp if overweight
Controlled exercise; consistent small amounts of exercise
Rehab
Neutraceuticals/chondroprotectants in early stages
NSAIDs e.g meloxicam
Analgesia e.g paracetamol
Anti-NGF i.e librela

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20
Q

Quick summary of surgical options for hip dysplasia

A

Pectineal myectomy
Juveline pubic symphiolyss
Triple pelvic osteotomy
Intertrochanteric osteotomy
femoral head/neck excision
Joint replacement (arthroplasty)

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21
Q

How does a triple pelvic osteotomy work

A

Make a triple fracture in the pelvis; cut through wing of ileum, pubis and isceum
Then can rotate the acetabular segment to increase dorsal rim cover of femur head
- Plate it and allow to heal

22
Q

What are the indications for triple pelvic osteotomy

A

Young dog with hip dysplasia (4-8months)
+ve ortolani sign
No osteoarthritis present

23
Q

What is an intertrochanteric osteotomy

A

Reorientation of the proximal femur to improve seating of head in acetabulum

24
Q

What is a femoral head-neck excision

A

Salvage procedure to remove the hip joint and leave a pseudarthrosis
Gives suboptimal range of motion etc; not pain free

Used in end stage degenerative joint disease

25
Q

In which dogs can femoral head/neck exicsion be a problem

A

Larger dogs since get one leg shorter than the other

26
Q

Which is the only surgery for hip dysplasia that requires early active mobilisation

A

Femoral head/neck excision
Otherwise get fibrosis and lack of mobility

27
Q

What are some possible complications of hip replacement

A

Luxation
Femoral fracture
ASeptic loosening
Sepsis

May need revision surgery
Can convert to excision arthroplasty

28
Q

What surgery gives most predictable and best clinical outcomes for hip dysplasia

A

Total hip replacement
Esp for large dogs since FHE less good

29
Q

How does a pectineal myectomy work

A

Theory is cutting through pectineum muscle which is a hip adductor will reduce tension on the joint capsule (of hip) and reduce pain

NB: doesn’t stabilise the hip

30
Q

What are the primary lesions of elbow dysplasia

A

Osteochondrosis of the humeral condyle
Ununited anconeal process
Fragmented medial coronoid process
Radio-ulnar incongruity

31
Q

Which animals are typically affected by elbow dysplaisa

A

Large and giant breed dogs e.g labs, rottweilers
Also smaller chondrodystrophic breeds
Males 2X more common
Generally diagnosed between 6-12 months (again secondary peak of presentation where there is secondary osteoarthritis)

32
Q

Clinical signs of elbow dysplaisa

A
  • Forelimb lameness
  • Shortened forelimb gait
  • Commonly bilateral, but often asymmetric
  • Effusion
  • Pain +/- crepitus, reduced ROM
33
Q

Which primary lesion of elbow dysplasia is radiography good at diagnosing and which view

A

ununited anconeal process; need flexed view

34
Q

Which animals do we tend to see ununited anconeal processes in

A

GSDs, bernese mountain dogs, wolfhounds

35
Q

How to deal with uninited anconeal process

A

If not much adaptive remodelling has happened yet can screw on to reattach

If there has been, remove the fragment

36
Q

What additional thing can be done in surgery for screwing on the anconeal process to protect the screw from forces acting on it

A

Ulnar ostectomy to remove a portion
Or osteotomy to cut it

37
Q

Why is the olecranon a tension site

A

Due to insertion of triceps

38
Q

When does the growth plate at the anconeal process close normally

A

by 5 months

39
Q

Which animals do we tend to see fragmented coronoid processes in

A

Labs, GSDs, bernese mountain dogs
Typically 6-14 months

40
Q

What is the theory between fragmented coronoid processes

A

Microfracture due to contact between coronoid process and proximal radius leads to remodelling with brittle bone which cleaves off eventually to leave. af ragment

41
Q

Treating fragmented coronoid processes

A

Can arthroscopically remove the fragment but it is not clearly better than conservative care

42
Q

What consequence do we get from fragmented coronoid processes

A

Elbow DJD

43
Q

When might fragment removal in fragmented coronoid process be more indicated

A

Where there is a clear separate body in the joint and the dog is variably lame i.e from the fragment moving

44
Q

How do osteochondrosis lesions in the elbow work

A

Get a failure of endochondral ossification causing divet in medial humeral condyle
This cartilage is not intact so subsurface failure occurs and the cartilage flap lifts up to make dissecans lesion

45
Q

What is an osteochondrosis dissecans lesion

A

Where abnormal cartilage lifts up to form a flap in the joint

46
Q

What are some surgical options for elbow osteochondrosis

A

Arthroscopic debridement +/- graft
Osteochondral transplant using healthy core of subchondral bone and artiluar cartilage from the femur
- Then core out lesion and replace

Elbow joint replacement for widespread disease

Elbow arthrodesis as a salvage procedure to relieve pain as alternative to amputation

47
Q

How does arthroscopic debridement in osteochondrosis lesion work

A

Lesion is hammered at to remove the diseased subchondral bone and cause bleeding from the bone marrow; this will form a clot which hardens into fibrocartilage

48
Q

What is generally the cause of radio-ulnar incongruity

A

Short radius
Better diagnosed on CT
Don’t worry in young dogs

49
Q

How is elbow incongruity treated

A

Ulnar osteotomy to allow ulnar to find a new posiiton

50
Q

What views are taken for elbow dysplasia scoring

A

2 x mediolateral views

Flexed view 45* (good for looking at anconeal process)
Extended view 110*

Grade = highest grade

51
Q
A

Orthopaedics (6 decks)

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