Ortho 3

Question 1

what does hip dysplasia inevitably lead to

Answer 1

OA, osteoarthritis, in all breeds
[it is a primary risk factor for OA in all breeds. note, sighthounds don’t get hip dysplasia]

Question 2

what is bimodal presentation of hip dysplasia

Answer 2

young dogs: lame due to laxity of joint, have wide stance
older dogs: fibrosis occurs, mostly normal walk
even older dogs: lame again due to OA, take short strides with hip sway

Question 3

what is hip dysplasia

Answer 3

interaction of multiple genes and environmental influences; varying degree of hip developmental abnormalities (shallow acetabulum flattening of femoral head) due to hip laxity. subluxation in early life then OA as older

Question 4

basic etiology of hip dysplasia

Answer 4

• genetic susceptibility: multiple genes, breed specific possibly, interactions possibly
• environment
• hip laxity: all breeds, get joint laxity due to excessive joint fluid, low pelvic muscle mass, hormones, Ca and fit D excess, IM injected polysulfulated glycosaminoglycans (reduce the laxity), increased BW

Question 5

every abnormal ortho dog should be _____.
there is a 50% reduction in morbidity of OA by ________

Answer 5

feed restricted;
restricting caloric intake

Question 6

hip dysplasia: when the hip joint is incongruent and the centre of the joint (femur contacting acetabulum) is lateralized, the forces crossing the joint ________ and the area of force transmission (contact area) _____, leading to cartilage damage, joint inflammation, and ultimately OA

Answer 6

increases; decreases

Question 7

with hip dysplasia are hips normal or abnormal at birth

Answer 7

normal (developmental not congenital disease)

Question 8

with hip dysplasia earliest dysplastic changed can be seen by ____ weeks and radiographic signs may be apparent by ___ weeks of age

Answer 8

4; 7

Question 9

which occurs first in hip dysplasia: evidence of palpable or radiographic laxity, or degenerative structural changes

Answer 9

evidence of palpable or radiographic laxity

Question 10

OA is a ______ disease, so with increasing age pain and disability _________

Answer 10

progressive; increase

Question 11

hip dysplasia leads to joint laxity which in turn leads to OA. what do both joint laxity and OA cause (in terms of patient QOL)

Answer 11

PAIN and DYSFUNCTION

Question 12

signalment of hip dysplasia patients please

Answer 12

anyone
typically large and giant breed dogs (German shep, Rotties, Golden retrievers, Saint Bernards, etc.)
but NOT sighthounds (Greyhounds, Borzoi)

Question 13

describe C/S for juvenile (severe form) hip dysplasia

Answer 13

a “well behaved quiet puppy”
5-12 months age of sudden onset, uni or bilateral lameness, bunny hopping, difficulty rising, etc.
severe hip joint laxity
may improve with time [remember bimodal presentation, periarticular fibrosis]

Question 14

describe C/S for chronic form hip dysplasia

Answer 14

a “quiet old dog”
variable onset in mature animal, typically insidious or chronic presentation
uni or bilateral lameness, difficulty rising, stiff pelvic limbs, exercise intolerance, and other C/S related to pain from DJD

Question 15

a puppy has a positive Ortolani test. does this mean it will get clinical OA?

Answer 15

dog has hip laxity and is more likely to get, but is not condemned to, clinical OA

Question 16

a puppy has a negative Ortolani test. does this mean it will get clinical OA?

Answer 16

this is a normal Ortolani test result, but normal hips are not guaranteed, could get clinical OA anyway

Question 17

PE findings/process for hip dysplasia

Answer 17

first localize to hip joint and rule out neuro disease
stance: wide based stance progressing to narrow based
gait: hip/spinal sway, bunny hop, weight shifting
hands on: painful ROM, decreased extension, crepitation
and for puppies: Ortolani test

Question 18

what radiographs can you take to examine hip dysplasia

Answer 18

hip extended view: OFA [this has variable results but can help to diagnose hip laxity and OA]
neutral position radiography: PennHIP [this is the one you must be certified for and needs anesthesia/sedation]

Question 19

3 views of PennHIP for hip dysplasia

Answer 19

VD: hip extended, compression view, distraction view [these views are anylyzed for relative degree of laxity then compared as a ratio]

Question 20

describe medical management for hip dysplasia

Answer 20

treatment not a cure: palliative, to reduce pain and improve function
nutritional (not fat)
exercise modification/exercise therapy: low impact, high resistance, eg. long slow walks and swimming
pharmacologic: NSAIDs or monoclonal antibodies, potentially glucosamine too

Question 21

which dogs can get prophylactic surgery for hip dysplasia

Answer 21

for skeletally immature dogs WITHOUT secondary OA (goal is to prevent secondary OA)
must be 12-20 weeks (for juvenile pubic symphisiodesis) or 10-12 months (for pelvic osteotomy)

Question 22

what are the two prophylactic surgery options for hip dysplasia

Answer 22

juvenile pubic symphisiodesis (JPS): for dogs 12-20 weeks
pelvic osteotomy (double or triple) for dogs 10-12 months

Question 23

who can get hip dysplasia salvage procedures and what is the purpose of them

Answer 23

dogs >1 year old with OA
to eliminate source of pain. from secondary OA

Question 24

compare the two types of salvage procedures for hip dysplasia. which is the gold standard

Answer 24

femoral head and neck excision, FHO: eliminate source of pain but the functionality is not normal, 42% unsatisfactory outcome, needs rehab therapy. note it is IRREVERSIBLE

total hip arthroplasty, THR: can restore functionality, but is a specialist procedure, 90% success rate, rehab rarely needed, gold standard for salvage treatment

Question 25

90% of all joint laxations occur at which joint

Answer 25

hip

Question 26

the cause of hip luxation is usually _______

Answer 26

traumatic

Question 27

with hip laxations caused by trauma, there are injuries to other body systems in ____ of cases

Answer 27

55%

Question 28

what do you see

Answer 28

sclerotic, wide acetabulum and fat femoral neck… hip dysplasia dog

Question 29

are most hip luxations craniodorsal, ventral, or caudal

Answer 29

75% are craniodorsal

Question 30

clinical findings for CRANIODORSAL hip luxations

Answer 30

EXTERNAL rotation and ADDUCTION and apparent SHORTENING of limb
pain, lameness (initially non-weight bearing)

Question 31

clinical findings for VENTRAL hip luxations

Answer 31

INTERNAL rotation and ABDUCTION and apparent LENGTHENING of limb
pain, lameness (initially non-weight bearing)

Question 32

how can you confirm diagnosis of hip luxation

Answer 32

radiography VD and lateral views to confirm luxation, determine direction, and evaluate for other abnormalities
(look for pelvic fractures, femoral head/neck fractures, physical fractures if immature, and hip dysplasia)

Question 33

how to treat hip luxation

Answer 33

reduction ASAP
ideally within 3 days, closed or open techniques

Question 34

which has a better outcome long term, craniodorsal or ventral hip luxation

Answer 34

ventral

Question 35

even if you perform a successful open or closed reduction for hip luxation, you can expect that _______ will develop

Answer 35

OA