MSK 6 Hips cruciate MPLs Flashcards
1
Q
What is the primary difference in age between young and old hip dysplasia?
A
5-12 months for young hip dysplasia; variable onset in mature dogs (3 years+).
2
Q
What are the common clinical signs of both young and old hip dysplasia? (5)
A
- Pain with hip extension
- Reduced range of motion (ROM)
- Reluctance to walk, run, jump, climb
- Exercise intolerance
- Reduced muscle mass
3
Q
What is a key radiographic difference between young and old hip dysplasia?
A
No OA changes have developed yet in young; moderate to severe OA changes on radiographs in old.
4
Q
What is Juvenile Pubic Symphysiodesis? and when is it best performed?
A
A procedure involving thermal necrosis of the pubic physis to rotate acetabuli over the femoral heads, best done at 14-22 weeks.
5
Q
What are the ideal candidates for Triple or Double Pelvic Osteotomy?
A
- Patients with clinical signs of hip dysplasia
- Confirmed laxity with no OA changes
- Less than 10 months to 1 year old
6
Q
What are common complications of Total Hip Replacement?
A
- Luxation
- Femur fracture
- Fractured acetabulum
- Cup avulsion
- Aseptic loosening
7
Q
What is the primary goal of Femoral Head and Neck Excision?
A
To eliminate pain from bone-on-bone contact.
8
Q
What is the radiographic feature known as ‘Morgan’s line’?
A
Caudolateral curvilinear osteophyte (CCO) seen on the femoral neck in dogs 18 months or older.
9
Q
Define Hip Dysplasia.
A
A developmental disorder of increased laxity in the hip joint causing pain and injury to periarticular structures, leading to eventual degenerative joint disease.
10
Q
What are the two most common types of meniscal injuries?
A
- Bucket handle of medial caudal meniscus
- Radial tears of lateral meniscus
11
Q
What predisposes immature animals to Cranial Cruciate Ligament (CCL) injuries?
A
Avulsion of the ligament from femoral or tibial attachment sites due to trauma.
12
Q
What are the pros of Extracapsular repair for a 35kg overweight lab?
A
- Cheaper
- More accessible for general practitioners
- Something is better than nothing
13
Q
What is the purpose of Tibial Plateau Leveling Osteotomy (TPLO)?
A
To reduce the tibial plateau angle so that there is no forward tibial thrust when weight is placed.
14
Q
What are the complications associated with Tibial Tuberosity Advancement (TTA)?
A
Higher risk of complications compared to other techniques, relies on the body forming fibrous scar for ongoing stability.
15
Q
What are the characteristics of Grade 4 luxating patella?
A
- Marked femoral varus
- Proximal tibial valgus
- Severe bony/ligamentous deformities
16
Q
What is the significance of the ‘puppy line’ in radiographic studies?
A
An indistinct radiodense line on the femoral neck in dogs younger than 18 months, self-limiting and not clinically significant.
17
Q
What factors contribute to the pathogenesis of Hip Dysplasia? (4)
A
Complex mix of many genes and environmental factors, including rapid growth, obesity, and hormonal influences.
18
Q
List the grading system for MPLs (4)
A
- Grade 1: Mild laxity, relocates spontaneously
- Grade 2: Spontaneously luxates and relocates
- Grade 3: Permanently luxated but can be relocated
- Grade 4: Permanently luxated, unable to relocate
19
Q
What are common surgical procedures for patellar luxation? (4)
A
- Tibial crest transposition
- Wedge or block sulcoplasty
- Medial desmotomy (soft tissue)
- Lateral fabella tie (soft tissue)
20
Q
What is the primary risk when performing a medial desmotomy?
A
Not being effective or causing overtightening, leading to lateral luxation.
21
Q
What are the radiographic characteristics of Grade 4 luxating patella? (x7)
A
- Marked femoral varus, femoral torsion (<27 degrees),
- Proximal tibial valgus, tibia rotated 60-90 degrees relative to the sagittal plane,
- Severe bony/ligamentous deformities (OA/DJD),
- Likely concurrent cranial cruciate ligament signs (fat pad compression, osteophytes, joint effusion),
- Shallow trochlear groove with poorly developed or absent medial ridge,
- Poorly developed medial femoral condyle,
- Patella on the medial aspect
22
Q
What surgical procedures are indicated for Grade 4 luxating patella? (4)
A
- Corrective osteotomies of femur (various types)
- Tibial leveling plateau osteotomy with internal tibial torsion correction
- +/- derotational proximal tibial osteotomy
- Tibial tuberosity transposition/advancement
These procedures aim to correct the underlying bone deformities contributing to the luxation.
23
Q
What factors affect the prognosis for luxating patella cases treated surgically?
A
1) Grade of luxation: good for 2-3, fair to good for 4
2) Severe grade 4 with DJD, cartilage loss, muscle atrophy, and rotational deformity: grave to poor prognosis
3) Bigger dogs (20kg +) had higher rates of complications/reluxations
4) Needing both tibial
rates
* Poor If distal femoral varus is NOT addressed
These factors highlight the importance of thorough preoperative assessment.
24
Q
What are the primary stabilizers of the coxofemoral joint? (3)
A
- Femoral head ligament (capital ligament)
- Joint capsule
- Dorsal acetabular rim
These structures help maintain the integrity and stability of the hip joint.
25
List the secondary stabilizers of the coxofemoral joint. (3)
* Acetabular labrum and transverse acetabular ligament
* Hydrostatic pressure created by joint fluid
* Periarticular muscles (deep, middle, and superficial gluteal muscles)
## Footnote
Secondary stabilizers provide additional support but are not the primary means of stabilization.
26
What are the physical exam findings for craniodorsal hip luxations? (8)
1. * Pain in hip region
1. * Non-weight bearing lameness
1. * External rotation and adduction of the affected limb
1. * Asymmetry of hips
1. * Increased distance between the greater trochanter and ischiatic tuberosity
1. * Greater trochanter is equidistant between ischiatic tuberosity and cranial dorsal iliac spine
1. * Apparent shortening of affected limb
1. * Crepitus in hip joint
## Footnote
These findings help differentiate craniodorsal luxations from other types of luxations.
27
What are the steps for closed reduction of a craniodorsal luxation?
* General anesthesia
* X-rays to confirm and rule out fractures
* Lateral recumbency affected side up
* Use a towel or rope through inguinal area to stabilize the pelvis
* Disengage femoral head from dorsal acetabular rim by holding hock and stifle and externally rotating the limb
* Apply traction in a distocaudal direction to align femoral head over acetabulum
* Rotate the limb internally and abduct to seat the femoral head into the acetabulum
* Press on the greater trochanter to keep it in place and take the leg through full ROM
* X-rays at the end to confirm position
* +/- Use EHMER sling to stabilise in joint after replacement
28
When is surgical intervention indicated over closed reduction for luxation? (8)
* Acetabular or femoral head fractures present
* If reluxation occurs after closed reduction
* Concurrent injuries require immediate return of hip function
* Chronic luxation
* Visual inspection of cartilage is advised if it has been weeks
* Muscle contracture and unable to reduce
* Changes or hematoma within acetabulum
* Dysplastic changes in the joint on radiographs
## Footnote
Surgical options may provide better outcomes in complex cases.
29
What are the potential complications of hip toggle surgery? (6)
* Too loose or too tight
* Infection
* Implant failure, premature suture failure
* Injury to rectum
* Sciatic nerve damage
* Articular cartilage damage, OA/DJD
## Footnote
Awareness of these complications is crucial for postoperative management.
30
What are the differentials for hip-related issues? (5)
* Femoral neck fracture
* Hip luxation
* Acetabular fracture
* Iliopsoas strain
* Femoral neck necrosis
## Footnote
These differentials help guide diagnostic and treatment strategies.
31
What is the most common injury of the physes of the proximal femur?
Type 1 Salter Harris 'Slipped cap'
## Footnote
This type of fracture often requires urgent surgical stabilization.
32
What are the open approaches for capital physeal fractures? (3)
* Craniolateral approach
* Dorsal approach via osteotomy of greater trochanter (<5 months)
* Dorsal approach via tenotomy of gluteal muscles (<3-5 months)
## Footnote
The choice of approach depends on the age of the animal and the specifics of the injury.
33
What are the characteristics of the complex arterial network around the femoral neck?
* The blood supply to the femoral head is derived solely from blood vessels that course along the surface of the femoral neck, cross the growth plate and then penetrate the bone to supply nutrients to the femoral head
* Single extracapsular vascular ring is highly susceptible to vascular insult
## Footnote
Understanding the vascular supply is important for surgical planning.
34
Classic presentation for capital physeal fractures?
Young, overweight, castrated male cats are overrepresented.
35
What are the outcomes of a conservative approach to treating capital physeal fractures? (6)
1. Poor functional outcomes;
2. chronic discomfort,
3. lameness,
4. disuse atrophy,
5. secondary DJD,
6. pseudarthrosis with progressive cervical resorption
## Footnote
These outcomes underscore the need for timely surgical intervention.
36
What are the preferred fixation methods for primary repair of capital physeal fractures?
Multiple Kirschner pins or small diameter Steinman pins
## Footnote
These methods avoid compression of the physis and allow for continued growth.
37
What are the potential consequences of premature closure of the capital physis? (3)
1. * Shortened femur by 25%
1. * Abnormal development of femoral head and neck
1. * Development of DJD
## Footnote
These complications highlight the importance of careful surgical technique.
38
What is capital physeal dysplasia?
Spontaneous separation of physis after physeal closure, occurring more in cats than dogs
39
What is the recommended approach for salvage in cases of capital physeal dysplasia? (2)
* FHNE
* Total Hip Arthroplasty
## Footnote
The choice depends on the specific case and financial considerations.
40
Avascular necrosis femoral head underlying cause?
Dont know what causes it
blood supply to developing femoral head fragile- intracapsular blood supply, so very susceptible to damage, injury, disease
41
Signalment and presentation for femoral head necrosis in dogs (5)
1. 5-10mths age
1. certain breeds - poodles, terriers, westies, mini pins,
1. unlateral, sometimes bilateral
1. hip pain/lameness
1. mostly insidious onset, occasionally sudden onset
42
Standard hip xray views (3)
VD extended
Frogleg
Lateral
43
Pathophysiology FH necrosis
Not sure of what initially causes it
Results in necrosis and collapse of subchondral bone
Joint surface eventually collapses under weight bearing
Articular cartilage collapses, remodelling of femoral neck
44
Radiographic signs FH Necrosis (4)
1. Femoral neck sclerosis/thickening
1. Early - joint space looks a bit wider earlier
1. then moth eaten appearance,
1. then femoral head collapses
## Footnote
changes can be very subtle
45
Treatment options FH necrosis (LCPdz): Gold standard and other
1. Total hip replacement = gold standard
2. FHNO
46
Potential complications Capital Physeal surgery (4)
1. Infection
1. Loosening pins/K wires
1. Iatrogenic fracture
2. Damage to blood supply femoral physis
47
True or False: Medial luxation is more common in small breed dogs.
True
48
What are common clinical signs of a medially luxating patella?
Lameness, skipping, or holding up the affected leg.
49
Which breeds are most commonly affected by medial patellar luxation?
Toy breeds such as Chihuahuas, Poodles, and Yorkshire Terriers.
50
What grading scale is used to classify the severity of patellar luxation?
A 1 to 4 grading scale.
51
What is Grade 1 in the patellar luxation grading scale?
The patella is luxated only with manipulation and spontaneously returns to its normal position.
52
What is the primary method of diagnosing a medially luxating patella?
Physical examination and palpation of the knee.
53
True or False: Surgery is always required for dogs with a medially luxating patella.
False
54
What is the main goal of surgical intervention for a medially luxating patella?
1. To stabilize the patella and prevent future dislocations.
1. Improve QOL/Reduce pain
1. Reduce severity of future OA
55
What is a common surgical technique for correcting medial patellar luxation?
Tibial tuberosity transposition.
56
What are potential complications of surgery for a medially luxating patella? (5)
1) Infection,
2) recurrence of luxation
3) implant loosening or breaking
4) Tibial tuberosity avulsion
5) Patella ligament rupture
57
What is a non-surgical treatment option for mild cases of medial patellar luxation?
Weight management and physical therapy.
58
True or False: Medially luxating patellas can cause arthritis over time.
True
59
What is the typical age of onset for symptoms of medial patellar luxation?
Usually between 4 to 6 months of age.
60
What diagnostic imaging can be used to assess patellar luxation severity?
X-rays.
61
What is the role of the femoral groove in patellar stability?
It helps guide the patella in its normal range of motion.
62
What is one potential genetic factor contributing to medial patellar luxation?
Conformation abnormalities in certain breeds.
63
True or False: All dogs with patellar luxation will show obvious symptoms.
False
64
What is the long-term prognosis for dogs after surgical correction of patellar luxation? (grade 1-2/3)
Generally good, with many dogs returning to normal activity.
65
What should be monitored in dogs with a history of patellar luxation?
Signs of lameness or discomfort in the affected leg.
66
What is the importance of early diagnosis and treatment of medial patellar luxation?
To prevent joint damage and improve the quality of life
Can consider early interventions: soft tissue surgeries if < 4mths
67
What is a common sign that a dog may be experiencing pain from a luxating patella?
Reluctance to jump or climb stairs.
68
What is the Lateral Fabellotibial suture used for in young dogs <4mths
To help reduce the amount of tibial crest rotation in young animals
## Footnote
It developmentally relies on patella rubbing on the distal femur to form a deeper groove.
69
What are the risks associated with the Lateral Fabellotibial suture?
Risk of break down and over correcting.
70
What is the purpose of desmotomy/Capsulectomy?
Performed on the side to which the patella is luxated to augment patella realignment.
71
What is the purpose of soft tissue/joint capsule imbrication opposite side of luxation?
To augment correction of luxation
72
What is the risk of partial capsulectomy on the opposite side?
Risk of overtightening, causing lateral luxation and breakdown.
73
When is fasciectomy performed?
If redundant fascia is present (cruciate and patella surgeries).
74
What are the risks associated with fasciectomy? (3)
Risk of over tightening
Lateral luxation
Breakdown
75
What is a Trochleoplasty? 2 types =
Trochlear deepening:
Wedge or block resection
76
What is Trochlear chondroplasty?
Chondroplasty is a surgical procedure that smooths or removes damaged cartilage in a joint.
77
What does wedge resection refer to? (and another name)
A type of bone reconstructive procedure, also known as block recession sulcoplasty.
Deepening of distal femoral trochlear groove
78
What is the purpose of quadriceps realignment?
To bring the insertion of the patella tendon more laterally in line with the femur.
79
What are the complications associated with tibial tuberosity transposition? (4)
1) K-wires and pin direction issues.
2) Fracturing tibial crest
3) Pin loosening
4) Infection
80
What is the recommended pin direction for tibial tuberosity transposition?
Horizontal to slightly down to counteract the pull of the quadriceps.
81
What is the minimum number of pins recommended for tibial tuberosity transposition?
2 pins as a minimum.
82
What is the diagnosis for the 16-week-old Labrador with a bunny-hopping gait?
Severe bilateral hip dysplasia
## Footnote
The diagnosis is based on radiographic findings showing limited femoral head coverage.
83
What are the management recommendations for the owners of the 16-week-old Labrador with severe hip dysplasia
* Strict diet management with appropriate/restricted diet
* Juvenile pubic symphysiodesis when young (16-20wks)
* Desex the dog at skeletal maturity
* Consider THR later if conservative management not working
## Footnote
Juvenile pubic symphysiodesis allows the pelvis to remodel over the femoral heads, potentially resolving laxity.
84
What physical examination findings in a 7-month-old golden retriever are suggestive of bilateral hip dysplasia? (6)
1) Reduced muscle mass
2) Prominent greater trochanters
3) Swaying hindlimb gait
4) Wide based stance
5) Ortolani or Bardens test laxity (under GA)
6) X-rays including extended VD view
## Footnote
These findings can help confirm the diagnosis of hip dysplasia.
85
What are the radiographic findings for the 7-month-old golden retriever? (3)
- Flattened femoral heads
- not fully seated within the acetabular rim, < 50% seated within the acetabulum
- no visible evidence of osteoarthritis
## Footnote
Regular monitoring and management are essential to prevent the progression of hip dysplasia.
86
Radiographic signs you would NOT see in a young dog with Hip dysplasia (2)
- OA
- Thickened neck
87
What long-term prognosis advice should be given to the owners of the golden retriever 7mths with Hip dysplasia
* Manage arthritis
* Keep lean
* Gentle low impact exercise
* Joint diet/supplements
* Cartrophen course
* Consider double or triple pelvic osteotomy (TPO)
* THR considerations
## Footnote
TPO helps manage hip dysplasia but does not stop arthritis development.
88
TPO/DPO can help manage Hip dysplasia, but don't alter....
OA development
89
What are the recommendations for the 1.5-year-old working Kelpie with hip manipulation discomfort diagnosed with severe hip dysplasia?
* Advise stopping work and becoming a companion dog
* Usual OA management tools
* Consider THR bilaterally if young to avoid OA changes
* FHO salvage procedure if THR is unsuitable
## Footnote
High levels of function can be expected after THR, but aggressive dogs may pose complication risks.
90
What is the gold standard surgery option for small dogs with identified CCL rupture? and other options-
1. TPLO (Tibial Plateau Leveling Osteotomy)
1. An extracapsular repair
91
What are the post-operative instructions for a patient undergoing stifle joint surgery?
* Good post-operative pain relief: NSAIDS, Panadol, Gabapentin, +/- opioids
* Strict rest for 2 weeks
* E collar usage
* Rechecks after one week
* Consider starting Cartrophen course after 1 week
* Graduated return to activity
92
What should be done if the dog returns with sudden lameness eight weeks post-cruciate surgery? (4)
* X-rays to assess implant integrity
* Consider arthrotomy to check for meniscal tear
* Assess for infection via joint warmness and blood tests
* Aseptic arthrocentesis can help evaluate for infection.
93
Cytology findings expected with septic arthritis
90% degenerate neutrophils with toxic changes
10% mononuclear cells
Turbid/cloudy
94
What is the diagnostic and treatment plan after finding a high neutrophil count in joint fluid cytology? (3)
* Culture the sample: blood culture medium, 3-10mls joint fluid,
* Start empirical antibiotics (amoxiclav or cephalexin) min 28days- until normal culture results- usually 4 weeks
* Perform joint irrigation with sterile saline (copious amts fluids, LRS/Saline, 3 way tap)
## Footnote
Antibiotics should be continued until two negative cultures are obtained.
95
% growth rate of septic fluid in plain culture medium vs. blood medium
30% vs. 70%
96
what tubes to collect in for septic joint testing and what tests (2)
1. Blood culture medium for culture
2. EDTA tube for cytology
97
If a dog presents with both hip and stifle issues what do you deal with first?
Stifle disease; hips have been a life long issue,
98
what bones are cut in a DPO vs. TPO
DPO = ilium and pubis, NOT the ischium
TPO= all three pelvic bones are cut: ischium, pubis, ilium
