Hip Dysplasia - advanced nursing

Question 1

What is hip dysplasia?

Answer 1

a common inherited, developmental disease of the hip joint

Question 2

How is hip dysplasia characterised?

Answer 2

hip laxity or instabilty and development of osetoarthritis

Question 3

What breeds are clinical signs more apparent in?

Answer 3

large breeds such as labradors, german shpeherds and golden retrievers

Question 4

When does laxity become apparent?

Answer 4

4-5 months old

Question 5

What does laxity allow the hip to do?

Answer 5

subluxate

Question 6

What is axity influenced by?

Answer 6

size of dog, rate of growth, diet, and exercise

Question 7

What does laxity of the hip result in?

Answer 7

inflammation and pain

Question 8

What does inflammation of the joint lead to?

Answer 8

increase in joint fluid and thickening of the joint capsule

Question 9

What ligament can become stretched or ruptured allowing subluxation or laxity?

Answer 9

round or teres ligament

Question 10

What happens to the femoral headdue to laxity?

Answer 10

it becomes flattened with new bone produced at the margins of the head and around the femoral neck

Question 11

What are common presenting complaints with a hip dysplasia?

Answer 11

bunny hopping, difficulty rising, pelvic limb lameness or stiffness, exercise interolerance, clicking or clunking of the hips

Question 12

What is crepitus?

Answer 12

hip grinding as hip taken through range of motion, felt with hand over hip joint

Question 12

What might you see on orthopaedic examination?

Answer 12

muscle atrophy, pain on hip extension and abduction, crepitus, clunking, lateral sway, instability

Question 13

Why might a hip ‘clunk’?

Answer 13

it is the hip popping back into place

Question 14

What is a lateral sway?

Answer 14

When the dog tries to protect the hips and uses the spine to propel the pelvic limbs forward

Question 15

What radiography views would you do to diagnose hip dysplasia?

Answer 15

orthogonol, ventrodorsal extended leg and frog leg

Question 16

How is hipdysplasia diagnosed using radiographs?

Answer 16

identifying hip subluxation and secondary osteoarthritis

Question 17

What severity of hip dysplasia can ultrasound diagnose?

Answer 17

early detection of dogs with mild to moderate dysplasia

Question 18

What is an example of palpation tests for diagnosis?

Answer 18

ortolani test

Question 19

What does the ortolani test mimic?

Answer 19

weight bearing

Question 20

What is the angle of reduction?

Answer 20

when the femur is taken away from midline and pops back in, the angle this occurs at is the angle of reduction

Question 21

What is the angle of subluxation?

Answer 21

when you bring the femur backto midline and the hip subluxates, the anglethis occurs at is the angle of subluxation

Question 22

What does a positive ortolani test suggest?

Answer 22

hip laxity

Question 23

What does a negative ortolani test suggets?

Answer 23

complete dislocation

Question 24

What is the bardens hip lift test?

Answer 24

when you try to lever the hip out of the acetabulum and see how much bounce there is

Question 25

What is abnormal with a bardens hip lift test?

Answer 25

more than half a cm of bounce

Question 26

What are the treatment options for hip dysplasia?

Answer 26

- non-surgical - myotomies - growth plate fusion - osteotomies - total hip replacement - femoral head and neck excision

Question 27

When is surgical treatment considered?

Answer 27

- significant clinical signs - failure to respond to conservative management

Question 28

What is involved in conservative treatment?

Answer 28

- restricting exercise to leash only - introducing hydrotherapy - controlling food intake to restrict weight gain and slow down growth - NSAIDs and other meds

Question 28

What is the first line of treatment?

Answer 28

conservative treatment

Question 29

What dogs might be considered for conservative management?

Answer 29

younger dogs

Question 30

What lifestyle adjustments can be made?

Answer 30

weightloss, exercise, hydrotherapy

Question 31

What surgical management options are there?

Answer 31

- growth plate fusion - osteotomies - total joint replacements - ostectomies`

Question 32

What is juvenile pubic symphysiodesis?

Answer 32

improves coxal joint congruecy in clinically affected immature dogs before secondary arthritic changes develop

Question 33

What does symphysiodesis imply?

Answer 33

fusion of a symphysis, which is achieved by the use off electrocautery

Question 34

What types of dogs is juvenile pubic symphysiodesis performed in?

Answer 34

skeletally immature dogs

Question 35

What does triple or double pelvic osteotomy iincrease?

Answer 35

dorsal coverage of the femoral head,corrects subluxation and restores the hips weight bearing surface area

Question 36

Who would be a suitable candidate for triple or double pelvic osteotomy?

Answer 36

dogs with moderate hip laxity with an angle of reduction of less than 35 degrees on an ortolani test, painful hips, no or minimal osteoarthritis and young (between 4 and 8 months)

Question 37

What happens during a triple or double pelvic osteotomy?

Answer 37

pelvis is cut in two or three places freeing the acetabulum which is rotated 20 degree

Question 38

Which 3 places are cut during a triple or double pelvic ostetomy?

Answer 38

pubis, ischium and ileum

Question 39

What type of procedure is a femoral neck and head excision?

Answer 39

salvage surgery

Question 40

What happens during a femoral head and neck excisional surgery?

Answer 40

femoralhead and neck removed to allow pseudoarthrosis to form

Question 41

What post-operative management is done after femoral head and neck excision surgery?

Answer 41

rapid return to exercise, physiotherapy after sutures removed

Question 42

What complications can occur after a triple or double pelvic osteotomy?

Answer 42

screw pullout or screw breakage

Question 43

What is the aim for total hip replacement?

Answer 43

pain relief and high levelfunction

Question 44

What are the indications for total hip replacement?

Answer 44

hip arthritis and hip dysplasia

Question 45

What is the success rate for cemented total hip replacement?

Answer 45

90-95%

Question 46

Why are cemented THR hard to revise?

Answer 46

cement has to be chipped away or osteotomsation of the femur to retrieve all foreign material

Question 47

What are examples of cemented systems for THR?

Answer 47

bardet,new generation devices

Question 48

What are examples of non-cemented systems for THR?

Answer 48

biomedtrix BFX, zurich, helica

Question 49

What happens in a non-cemented THR?

Answer 49

acetabulum is reamed out to fit a new femoral head

Question 50

What complications can arise from a non-cemented total hip replacement?

Answer 50

aspetic and septic loosening,fracture and neurological

Question 51

What is the zurich ceementless system? (KYON)

Answer 51

interlocking screws used

Question 52

What are the advantages of the kyon system?

Answer 52

easier to revise as no cement, less chance of subsidence due to locking system

Question 53

What is the helica hip?

Answer 53

femoral neck is preserved as the implant and is screwed into the bone

Question 54

What complciations can arise from total hip replacements?

Answer 54

fracture, loosening, dislocation, infection, subsidence, cement granuloma, neurlogical, luxation, osteomyelitis,implant failure, sciatic neuropraxia