Ortho 3 Flashcards
what does hip dysplasia inevitably lead to
OA, osteoarthritis, in all breeds
[it is a primary risk factor for OA in all breeds. note, sighthounds don’t get hip dysplasia]
what is bimodal presentation of hip dysplasia
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
what is hip dysplasia
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
basic etiology of hip dysplasia
- 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
every abnormal ortho dog should be _____.
there is a 50% reduction in morbidity of OA by ________
feed restricted;
restricting caloric intake
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
increases; decreases
with hip dysplasia are hips normal or abnormal at birth
normal (developmental not congenital disease)
with hip dysplasia earliest dysplastic changed can be seen by ____ weeks and radiographic signs may be apparent by ___ weeks of age
4; 7
which occurs first in hip dysplasia: evidence of palpable or radiographic laxity, or degenerative structural changes
evidence of palpable or radiographic laxity
OA is a ______ disease, so with increasing age pain and disability _________
progressive; increase
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)
PAIN and DYSFUNCTION
signalment of hip dysplasia patients please
anyone
typically large and giant breed dogs (German shep, Rotties, Golden retrievers, Saint Bernards, etc.)
but NOT sighthounds (Greyhounds, Borzoi)
describe C/S for juvenile (severe form) hip dysplasia
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]
describe C/S for chronic form hip dysplasia
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
a puppy has a positive Ortolani test. does this mean it will get clinical OA?
dog has hip laxity and is more likely to get, but is not condemned to, clinical OA
a puppy has a negative Ortolani test. does this mean it will get clinical OA?
this is a normal Ortolani test result, but normal hips are not guaranteed, could get clinical OA anyway
PE findings/process for hip dysplasia
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
what radiographs can you take to examine hip dysplasia
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]
3 views of PennHIP for hip dysplasia
VD: hip extended, compression view, distraction view [these views are anylyzed for relative degree of laxity then compared as a ratio]
describe medical management for hip dysplasia
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
which dogs can get prophylactic surgery for hip dysplasia
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)
what are the two prophylactic surgery options for hip dysplasia
juvenile pubic symphisiodesis (JPS): for dogs 12-20 weeks
pelvic osteotomy (double or triple) for dogs 10-12 months
who can get hip dysplasia salvage procedures and what is the purpose of them
dogs >1 year old with OA
to eliminate source of pain. from secondary OA
compare the two types of salvage procedures for hip dysplasia. which is the gold standard
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
90% of all joint laxations occur at which joint
hip
the cause of hip luxation is usually _______
traumatic
with hip laxations caused by trauma, there are injuries to other body systems in ____ of cases
55%
what do you see
sclerotic, wide acetabulum and fat femoral neck… hip dysplasia dog
are most hip luxations craniodorsal, ventral, or caudal
75% are craniodorsal
clinical findings for CRANIODORSAL hip luxations
EXTERNAL rotation and ADDUCTION and apparent SHORTENING of limb
pain, lameness (initially non-weight bearing)
clinical findings for VENTRAL hip luxations
INTERNAL rotation and ABDUCTION and apparent LENGTHENING of limb
pain, lameness (initially non-weight bearing)
how can you confirm diagnosis of hip luxation
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)
how to treat hip luxation
reduction ASAP
ideally within 3 days, closed or open techniques
which has a better outcome long term, craniodorsal or ventral hip luxation
ventral
even if you perform a successful open or closed reduction for hip luxation, you can expect that _______ will develop
OA
