Hips! part 2, Palmer

Question 1

CHD is a _____ etiology (genetic, diet, activity, etc). Its a ______ dz that develops during ____-natal growth. Functional hip hyperlaxity –> altered coxofemoral modeling (shaping) –> DJD

Answer 1

Multifactorial

Progressive

Post-natal

Question 2

What is the difference between passive and functional hip laxity?

Answer 2

Passive
- laxity demonstrated by means of some external vet manipulations (Ortolani, PennHip distraction views, etc)

Functional:

• dynamic, spontaneous subluxation that occurs during natural patient activities
• relatively DIFFICULT to identify; significant!

Question 3

What is DAR slope?

Answer 3

Dorsal Acetabular Rim slope

DAR slope –> subluxation –> capsular stretching

Question 4

What is TPO? When should it be performed? What age of animal?

Answer 4

Triple Pelvic Osteotomy - bone cuts made in pelvis and acetabulum is rotated to fit over the femoral head, secured with bone plate

Indication: symptomatic, functional hip hyperlaxity with minimal DJD

This is STAGE dependent!
Performed BEFORE joint degenerates (usually 5-8 mo)

Question 5

What is JPS? When should it be performed? Age of animal?

Answer 5

Juvenile Pubic Symphysiodesis - electrocautery used to stop pubic symphysis growth. This leads to rotation in acetabular growth so that the fem head is more covered

This is AGE-DEPENDENT (< 20wks)

Question 6

Dog with “Tight Skirt” gait

Answer 6

CHD

Question 7

What is the ‘book-end’ test?

Answer 7

put pressure on lateral rear-limbs and feel reduction

Question 8

Should we do the Ortolani test in awake puppies?

Answer 8

Nope! Use sedation or anesthesia

Question 9

1. ________
   - may underestimate subluxation due to ‘wind-up’ of joint capsule
2. ________ (“Frog Leg”)
   - allows assessment of acetabular depth
3. _________ (“DAR”)
   - to visualize condition and slope of DAR
4. ___________ (______)
   - a stress view using a device to force hip distraction to measure PASSIVE hip joint laxity

Answer 9

1. Hips extended (OFA style)
2. Hips abducted
3. Dorsal Acetabular Rim View
4. Distraction Views (PennHIP)

Question 10

When assessing rads in “Hips Extended” position… “thin is ___ and ___”

Answer 10

Thin is UP and IN (thinner ilial body is raised up from the table causing the femoral head to artifactually appear further in the acetabulum)

Question 11

PennHIP - Distraction Index (DI)

0 =
1 =
DI < 0.3 =
DI > 0.7=

Laxity is a risk factor ____ < DI < 0.7

Answer 11

0 = no distraction
1 = complete luxation
DI < 0.3 = osteoarthritis unsusceptible
DI > 0.7 = high probability for OA

Question 12

OA in adult dogs… Continued subluxation –>: degrades ______ –> progressive OA

Answer 12

Articular cartilage

Question 13

Dog presents (1.5+ years old), with progressive chronic lamenness/stiffness, slow to rise or climb stairs. Dog has poor hind limb mm mass, hyperextended hindlimbs, and shifts weight forward. On PE there is dec hip extension and ABduction, crepitus, hamstring mm atrophy, and NO ortolani sign!

Answer 13

CHD !

Question 14

Tx options for Degenerative (adult) CHD?

Answer 14

Medical:
- weight loss, diet/lifestyle, physical therapy, NSAIDs, Nutraceuticals, Adequan

if that doesnt work…

Sx:

• THR is the best sx option
• FHNE, but cant do THR if this fails! warn owner