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Joint Diseases of the Hindlimb > Hip Joint > Flashcards

Hip Joint Flashcards

1
Q

What type of joint is the coxofemoral joint?

A

Diarthrodial

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2
Q

what is the coxofemoral joint composed of? (2)

A

-Acetabulum
- Femoral head.

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3
Q

What can the acetabulum be divided into? (2)

A

Lunate surface
Acetabular fossa.

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4
Q

Where does the ligament of the head of the femur originate?

A

Fossa

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5
Q

Normal femoral head/neck are:
A) Inclined by what angle to the femoral long anxis?
B) Anteverted by what angle?

A

A) 130-145
B) 12-40

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6
Q

Define anteverted.

A

Inclined forwards

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7
Q

Are gluteal muscles primary or secondary stabilizers of the hip joint?

A

2ry

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8
Q

Are adductor muscles primary or secondary stabilizers of the hip joint?

A

2ry

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9
Q

Are abductor muscles primary or secondary stabilizers of the hip joint?

A

2ry

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10
Q

Is the ligament of the head of the femur primary or secondary stabilizers of the hip joint?

A

1ry

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11
Q

Is the joint capsule a primary or secondary stabilizers of the hip joint?

A

1ry

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12
Q

Is the acetabular labrum a primary or secondary stabilizers of the hip joint?

A

2ry

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13
Q

Where does the blood supply to the femoral head come from? (2)

A

Intraosseous supply from the metaphysis
Epiphyseal system

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14
Q

What does the femoral head blood supply cross from the metaphysis?

A

Physeal scar

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15
Q

The blood supply to the femoral head and neck comes from the intraosseous supply from the metaphysis, which crosses the physeal scar into the femoral head in what age animals?

A

Mature animals

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16
Q

The epiphyseal system which enters the femoral head through the joint capsule via?

A

Cranial and caudal circumflex femoral arteries.

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17
Q

When retracting the biceps femoris - what lies underneath which needs extra care?

A

Sciatic nerve

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18
Q

On the craniodorsal approach to the hip:
A triangle can be identified bounded by what:
A) Dorsally (2)
B) Laterally
C) Medially

A

A) Middle and deep gluteal muscles
B) Vastrus lateralis muscle
C) Rectus fem

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19
Q

What is the normal range of inclination of the femoral neck of the dog?

A

135 – 145 degrees

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20
Q

craniodorsal approach to the hip:
Where is the skin incision

A

A skin incision is centred on the greater trochanter extending distally to one third of the length of the femur. Proximally the incision curves slightly cranially and extends approximately halfway between the greater trochanter and the dorsal midline.

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21
Q

craniodorsal approach to the hip:
The superficial leaf of the fascia lata is incised where?

A

Along the cranial border of the biceps femoris muscle.

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22
Q

craniodorsal approach to the hip:
The biceps femoris muscle is retracted A) and the deep leaf of the fascia lata is incised to free the insertion of the B)

A

A) caudally
B) the tensor fasciae latae muscle

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23
Q

craniodorsal approach to the hip:
The incision continues proximally through the intermuscular septum between the ? border of the superficial gluteal muscle and the tensor fasciae latae muscle.

A

cranial

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24
Q

craniodorsal approach to the hip:
What are retracted cranially (2) and the biceps caudally. Blunt dissection and separation along the neck of the femur allows visualization of a triangle bounded

A

Fasia lata
And attach tensor fasciae latae

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25
Q

craniodorsal approach to the hip:
An incision is then made in the joint capsule and continued A) along the femoral neck through the origin of the B) muscle on the neck and lesser trochanter.

A

A) laterally
B) vastus lateralis

26
Q

craniodorsal approach to the hip:
What can increase exposure, leaving enough tendon on the bone to allow suturing.

A

Tenotomy of a portion of the deep gluteal tendon close to the trochanter

27
Q

craniodorsal approach to the hip:
The origin of the ? muscle is elevated from the femoral neck and reflected distally. Hohmann retractors are placed ventral and caudal to the femoral neck to allow visualization of the femoral head.

A

vastus lateralis

28
Q

craniodorsal approach to the hip:
Closure if the deep gluteal tendon incision (2)

A

For closure, one or two mattress sutures or a pulley suture

29
Q

craniodorsal approach to the hip:
What 2 muscles are sutured together during closure?

A

origin of the vastus lateralis muscle is sutured to the cranial edge of the deep gluteal muscle.

30
Q

craniodorsal approach to the hip:
What sutures are placed in the insertion of the tensor fasciae latae muscle distally and are continued proximally along the cranial border of the superficial gluteal muscle.?

A

Continuous

31
Q

craniodorsal approach to the hip:
The superficial leaf of the fascia lata distally and the ? proximally are closed to the cranial border of the biceps femoris with a continuous pattern.

A

gluteal fascia

32
Q

Craniodorsal and Caudodorsal Aspect of the Hip Joint by Osteotomy of the Greater Trochanter:
How is the skin incision made?

A

The skin incision is centred on the cranial aspect of the greater trochanter of the femur, curving craniomedially to near the midline and following the cranial border of the femur distally to near midshaft. The alternative, a curved flap incision is preferred by some surgeons.

33
Q

Craniodorsal and Caudodorsal Aspect of the Hip Joint by Osteotomy of the Greater Trochanter:

Subcutaneous tissues are reflected with the skin. An incision is made in the superficial leaf of the fascia latae along the cranial border of ?? muscle for the entire length of the exposure.

A

the biceps femoris

34
Q

Craniodorsal and Caudodorsal Aspect of the Hip Joint by Osteotomy of the Greater Trochanter:

The biceps femoris muscle is retracted caudally and the A) nerve identified. An incision is made in the deep leaf of the fascia lata to free B)

A

A) sciatic
B) the insertion of the tensor fasciae muscle.

35
Q

Craniodorsal and Caudodorsal Aspect of the Hip Joint by Osteotomy of the Greater Trochanter:

This incision is continued proximally along the cranial border of the superficial gluteal muscle. The tendon of insertion of this muscle is transected close to ? leaving enough tissue on the bone to allow suturing.

A

the third trochanter,

36
Q

Craniodorsal and Caudodorsal Aspect of the Hip Joint by Osteotomy of the Greater Trochanter:

The superficial gluteal muscle is retracted In which direction? (a)

. The greater trochanter is osteotomised by placing using an B) . Alternatively, an osteotome can be placed on the lateral surface of the greater trochanter, just proximal to the superficial gluteal muscle insertion on the third trochanter.

A

A) craniodorsally
B) oscillating saw

37
Q

Craniodorsal and Caudodorsal Aspect of the Hip Joint by Osteotomy of the Greater Trochanter:

The cut is directed to form a A) degree angle with the long axis of the femur so as to cut the trochanter flush with the B) , beneath the insertions of the middle and deep gluteal muscles. Alternatively, oscillating saw or a Gigli wire saw can be used for the osteotomy.

A

A) 45
B) femoral neck

38
Q

Craniodorsal and Caudodorsal Aspect of the Hip Joint by Osteotomy of the Greater Trochanter:

The middle and deep gluteal muscles are reflected A) as a unit with the greater trochanter. Prior to closure of the surgical wound, the greater trochanter is reduced and stabilised with a B) fixation.

A

A) dorsomedially
B) tension band wire

39
Q

What is the intent of a FHNE?

A

Form a fibrous false joint

40
Q

What weight of dog has a better outcome with an FHNE?

A

<15kg

41
Q

What age patient has a better outcome with FHNE?

A

Younger

42
Q

Other than age, weight; what else improves outcome of an FHNE? (4)

A

Consistent limb use has been maintained pre-op;
Extensive muscle atrophy has been avoided;
Correct surgical technique has been used;
An intensive post-op rehabilitation programme has been implemented.

43
Q

When debating whether to perform a FHNE, why should a patient NOT be a good candidate for JPS/DPO/TPO or THR?

A

The reason patients shouldn’t be a good candidate for these other procedures is that these procedures give potentially better and more consistent outcomes

44
Q

Which of the following statements is correct?
- Return to maximal function following femoral head and neck excision occurs within a few weeks.
- Early activity following femoral head and neck excision is contraindicated.
- Muscle mass is expected to return to normal following femoral head and neck excision.
- Dogs and cats of all ages and sizes experience changes in their gait following femoral head and neck excision.

A

Dogs and cats of all ages and sizes experience changes in their gait following femoral head and neck excision.

45
Q

Perform a craniolateral approach to hip joint:
- A Partial tenotomy of which muscle is performed?

A

Deep gluteal muscle

46
Q

Perform a craniolateral approach to hip joint:
On the approach transect what ligament?

A

Head of the femur

47
Q

Which rotation direction is needed for FHNE?

A

External

48
Q

Femoral head is luxated by 90° external rotation of the femur:
A) What can be used to luxate if cannot perform manually? (2)
B) Femur rotated in which direction?
C) Patella pointing
D) Femur ? to table

A

A) Hip disarticulator or Hatt spoon
B) External
C) skyward
D) parallel

49
Q

Which retractors for FHNE?

A

Hohmann

50
Q

FHNE:
Clear enough ? (3) from the femur for necessary exposure.

A

joint capsule, periosteum and vastus lateralis muscle

51
Q

Which direction is the femoral neck transected for FHNE?

A

Caudal aspect of intertrochanteric: fossa to the lesser trochanter.

52
Q

Why is a surgical saw preferred to osteome in FHNE? (2)

A

Saw results in smoother cut

Saw less likely to cause iatrogenic femoral fracture.

53
Q

Closure of FHNE:
Joint capsule closure over acetabulum to include what muscle?

A

vastus lateralis

54
Q

FHNE closure:
Suturing of partially transected deep gluteal muscle using what (2) pattern

A

modified locking loop
running suture

55
Q

FHNE closure:
Reappose vastus lateralis muscle to which muscle

A

deep gluteal

56
Q

FHNE closure:
Reappose superficial gluteal muscle to A) continuous to deep fascia using B) suture pattern

A

A) tensor fasciae latae muscle
B) continuous

57
Q

FHNE closure:
Reappose superficial leaf of fascia latae to ? muscle using continuous suture pattern

A

biceps femoris

58
Q

What is the post op advice for a FHNE with regards to exercise?

A

Following FHNO complete rest is contraindicated and exercise should be encouraged asap after the procedure combined with aggressive analgesia to minimise pain and enhance physiotherapy

59
Q

Complications of FHNE? (4)

A

Continued lameness
Decreased ROM
Muscle atrophy
Limb shortening

60
Q

Why are the biomechanical effected with FHNE? (4)

A

lack of a femoral head acetabular articulation and the presence of a fibrous pseudoarthrosis, the result is a dorsal displacement of the remaining femur and limb shortening.

61
Q

How long can it take for normal limb function to return after FHNE?

A

6mo

Joint Diseases of the Hindlimb (10 decks)

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