Hip Disease Flashcards
what is the best prevention for juvenile hip disease
selective breeding
(hip laxity is highly heritable)
what disease does juvenile hip laxity predispose to
osteoarthritis
clinical signs of juvenile hip disease
varies from mild to severe depending on if laxity is functional or passive
requirement for surgery depends on level of pain/lameness
functional laxity
pathologic laxity that occurs during normal weight-bearing
caused by:
- thickening of femoral head ligament
- high joint fluid volume
- low pelvic muscle mass
- obesity/rapid growth
- early spay/neuter
causes clinical signs and progressive OA
passive laxity
laxity that only occurs during manual manipulation of the hips (ex. evaluated during pennhip rads)
presence of passive hip laxity is the NUMBER 1 risk factor for development of OA later in life
is hip disease expressed throughout life or only in certain stages
continuous expression throughout life
diagnosis for juvenile hip laxity
physical exam and radiographs (VD hip extended + pennHIP)
PE for juvenile hip laxity
typically done under sedation
barlow: subluxing the joint
ortolani: reducing the jointback into place
laxity can still be present even if not palpated
radiographs for juvenile hip laxity
VD hip extended: can ID subluxations and secondary DJD changes
pennHip: evaluates VDHE, compression view, and distraction view
- best for diagnosing PASSIVE hip laxity by calculating distraction index
what is the best diagnostic method for breeders to use
pennHip radiographs - measure distraction index and recommend breeding the top 50% of “tightest” dogs
at what age are pennHip radiographs most diagnostic
6 months or older
treatment of juvenile hip disease
palliative care ONLY - cannot surgically prevent OA from chronic hip disease
some surgical options (JPS and TPO)
juvenile pubic symphysiodesis (JPS)
only used in dogs <4 months
goal: early fusion of the pelvic symphysis to cause ventroversion of the pelvis
triple pelvic osteotomy (TPO)
osteotomies of the ischium, pubis, and ilium to rotate the acetabulum
controversial; has high complication rates
diagnosis of adult hip disease
- clinical signs
- PE
- radiographs
clinical signs of adult hip disease
mild to severe lameness
usually chronic and insidious
stiffness
bunny hopping gate (hind limbs)
exercise intolerance
PE for adult hip disease
muscle atrophy (bilateral)
dorso-lateral protrusion of the greater trochanter
pain on hip extension
decreased hip ROM
crepitus (crackling)
ortolani sign
radiographs for adult hip disease
VD hip extended view
1. joint conformation: <50% coverage of femoral head by the dorsal acetabulum
2. joint incongruity: non-parallel margins of dorsal femoral head and acetabulum
3. joint instability: subluxation
4. secondary DJD changes: thickening of femoral head/neck, osteo and enthesiophytes, flattened femoral head
treatment for adult hip disease
conservative and surgical
conservative adult hip disease management
weight loss/management
pain contol (NSAIDs)
supplements (EFAs)
exercise modificaiton - need to still be moving the joint
surgical options for adult hip disease repair
- THR
- FHNE/FHO
total hip replacement (THR) candidates
- clinical signs of OA
- unable to achieve desired level of activity
- unresponsive to conservative management
- no signs of infection
THR outcomes
return to normal function BUT has higher risk of complications than FHNE
cemented vs non-cemented vs hybrid THR
cemented: implants are held in by bone cement; easier but less precise
non-cemented: implants are held in by bony ingrowths that develop over time
- most common
- lower risk of infection, immune reaction, breakage, etc
- lateral bolts hold implant in place until bony ingrowth take place
hybrid: cemented stem + non-cemented cap
femoral head and neck excision (FHNE) outcomes
same as FHO (femoral head osteotomy)
removal of the femoral head and neck to provide pain relief
eliminates pain but does NOT restore normal function - hip joint will fill in with scar tissue so gait will still be abnormal
FHNE/FHO candidates
- previous failed repair of femoral head/neck fractures
- aseptic necrosis of femoral head
- pain from hip OA
- non-repairable acetabular fractures
- luxations that do not stay reduced
- failed THR implants
aseptic necrosis of the femoral head
vascular trauma to the circumflex femoral vein leading to anoxia in the epiphysis –> osteoclast/blast remodelling –> revascularization
unable to catch inciting cause of vascular trauma
signalment of ANFH
mild trauma at 4-12 months old
usually small breed dogs
clinical signs of ANFH
unilateral NWB or partial WB
what is the biggest risk factor for hip dysplasia in cats
hip laxity
uncommon but can occur
