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Veterinary Nursing > Hips and Stifles > Flashcards

Hips and Stifles Flashcards

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1
Q

Describe how hip dysplasia occurs.

A

Developmental - dogs born with normal hips, laxity develops in joint capsule
Can be due to genetics / size / diet / exercise

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2
Q

What is the typical signalment for hip dysplasia patients?

A

Mainly large/giant breed dogs but also small breeds/cats

Biphasic clinical signs - at 6-7 months (development of laxity) / adult (onset of osteoarthritis

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3
Q

What are the gait-related clinical signs of hip dysplasia?

A

Short stride, stiffness, clunking of hips
Lateral sway
Bunny hopping
Adducted hindlimbs

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4
Q

What clinical signs of hip dysplasia can we see on orthopaedic examination?

A

Pain on hip extension
Clunking
Hindlimb muscle atrophy
Crepitus

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5
Q

How can we use radiography to diagnose hip dysplasia?

A

Ventrodorsal extended X-rays
Looking for hip subluxation/acetabular remodelling/osteophytes
Orthogonal views

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6
Q

What other test for hip dysplasia can be done?

A

Ortolani test
Dog in dorsal/lateral recumbency
Test of hip laxity

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7
Q

How can we non-surgically treat hip dysplasia?

A

Management of osteoarthritis

NSAIDs, rest, hydrotherapy, diet

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8
Q

How can we surgically manage hip dysplasia?

A

Young dogs < 6 months = growth plate fusion (juvenile pubic symphysiodesis) / osteomies (triple/double pelvic osteotomy)
Total hip replacement
Femoral head and neck excision

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9
Q

What are the alternative names for avascular necrosis of the femoral head?

A

Ischaemic necrosis

Legg Calve Perthes

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10
Q

Why does avascular necrosis of the femoral head occur?

A

Trauma, ischaemia
Small breed disposition
Genetic basis - should not be bred from

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11
Q

What are the clinical signs of avascular necrosis of the femoral head?

A

Small breeds from 5 months
Unilateral hindlimb lameness
Pain on hip extension and flexion
Muscle wastage

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12
Q

How can we diagnose avascular necrosis of the femoral head?

A

Radiography

Lucent areas initially, then collapse and mushrooming

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13
Q

How can we treat avascular necrosis of the femoral head?

A

Surgery - femoral head and neck excision / total hip replacement
Conservative - cage rest

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14
Q

What is the prognosis for avascular necrosis of the femoral head?

A

Guarded - usually require salvage surgery

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15
Q

What are the other names for slipped capital femoral epiphysis?

A

Femoral neck metaphyseal osteopathy

Physeal dysplasia

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16
Q

What are the clinical signs/signalment for slipped capital femoral epiphysis?

A

Lameness and hip pain

Young, male, castrated

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17
Q

How can we diagnose slipped capital femoral epiphysis?

A

Radiography
Radiolucent line at capital physis
Separation/movement between femoral head and femoral neck
Resorption of femoral neck

18
Q

How can we treat slipped capital femoral epiphysis?

A

Salvage surgery - femoral head and neck excision / total hip replacement / parallel pin

19
Q

What is the prognosis for slipped capital femoral epiphysis?

A

Guarded for healing - usually do not heal

20
Q

Why can hip luxation occur?

A

Usually traumatic e.g. RTA, fall

Can be seen spontaneously in dogs with hip dysplasia

21
Q

What are the clinical signs of hip luxation?

A

Sudden onset lame post-trauma
Gait - stifle out, hock in and leg adducted
Luxation usually in craniodorsal direction
Variable lameness (moderate to non-weightbearing)
Variable pain and crepitus

22
Q

How can we diagnose hip luxation?

A

Leg length comparison
Thumb displacement test
Palpation of landmarks
Radiography - two orthogonal views, check carefully for concurrent fractures/hip dysplasia that may alter prognosis

23
Q

What does treatment for hip luxation depend on?

A

Presence of pre-existing disease e.g. hip dysplasia
Duration of luxation
Concomitant orthopaedic injuries

24
Q

How can we treat hip luxation?

A

Analgesia (opioid +/- NSAID)
Closed reduction +/- stabilisation (Ehmer sling/ESF)
Open reduction
Salvage options - femoral head and neck excision / total hip replacement

25
Q

When would we never attempt closed reduction of a hip luxation?

A 
Acetabular or femoral head fractures
Chronic luxations
Other injuries e.g. pelvic fractures preventing reduction
Evaluation of cartilage needed
Hip dysplasia
26
Q

How do we carry out a closed reduction on a hip luxation?

A

Animal anaesthetised
Assistant needed to hold on to dog to ensure is not pulled off table
Extend, adduct and externally rotate limb to lift femoral head over dorsal acetabular rim
Then abduct and internally rotate to sit femoral head into acetabulum
Confirm reduction with two orthogonal X-rays
Ehmer sling/cage rest post-reduction

27
Q

What options do we have for open reduction of hip luxation?

A 
Toggle
Transarticular pin
Prosthetic capsular repair
Iliofemoral suture
Primary capsular repair
28
Q

What is the prognosis for hip luxation patients?

A

Good in 75% of cases
Osteoarthritis will form
Recurrent dislocation possible

29
Q

How does patella luxation occur?

A

Displacement of patella from groove
Medial or lateral, often bilateral
Common in small breeds - usually medial luxation
Lateral luxation more common in large breeds
Can occur in cats
Most cases are developmental, possible hereditary
Occasionally traumatic

30
Q

How can we diagnose patella luxation?

A

Characteristic gait - nay avoid flexing/extending stifle
Clinical exam - stifle discomfort, patella clicks on manipulation of stifle, look for patella laxity with stifle in extension
Imaging - not usually necessary for diagnosis

31
Q

How is patella luxation graded?

A

I = least serious, IV = most serious

32
Q

How can we surgically treat patella luxation?

A

Tibial tuberosity transposition
Deepen trochlear groove - wedge / block
Soft tissue - release / imbrication

33
Q

How do we care for patella luxation patients post-op?

A

Consider support dressing
Analgesia - multimodal
Gradual increase in exercise after 6 weeks’ strict rest

34
Q

What is the prognosis for patella luxation patients?

A

Deteriorates with increasing grade of luxation
90-95% success rate in small dogs
> 20kgs significantly higher risk of complications/failure

35
Q

What is the function of the cranial cruciate ligament?

A

Limit cranial draw
Limit hyperextension
Limit internal rotation

36
Q

What are the causes of cranial cruciate ligament disease?

A

Major trauma - uncommon, usually hyperextension
Degeneration - common, can present acutely, certain breeds predisposed, degenerative joint disease already present, can occur bilaterally
Young large breed dogs - 6mth-3yrs, partial tearing, degenerative joint disease
Inflammatory arthropathy
Tibial plateau angled by growth abnormality

37
Q

How can we diagnose cranial cruciate ligament disease?

A

Gait analysis
Physical exam - stifle pain, effusion, crepitus, medial buttress
Instability tests - cranial draw / tibial thrust
Imaging - increased joint fluid, new bone formation

38
Q

How can we treat cranial cruciate ligament disease?

A

Conservative
Intra-/extra-articular replacements - intracapsular = over the top, extracapsular = fabello-tibial sutures
Corrective osteotomy

39
Q

How do we care for cranial cruciate ligament disease patients post-op?

A

Varies with procedure
NSAIDs for 10-14 days, opioids for 24-48rs
Surgery does not ‘cure’ dog, only slows progression of arthritis
Physiotherapy important

40
Q

What is the prognosis for cranial cruciate ligament disease?

A

Complication and success rates similar between techniques
Degenerative joint disease inevitably progresses in any dog
Full recovery can take several months
Likely to intermittent flare-ups of osteoarthritis in later life

41
Q

What injury can we often see alongside cranial cruciate ligament disease?

A

Meniscal tears - approx. 50% incidence in dogs with CCLD
Must perform arthrotomy at surgery to check for this
Usually medial meniscus that tears
Debride torn portion, leave unaffected meniscus

Veterinary Nursing (65 decks)

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