Surgery of the Hip II (5) Flashcards
Dr. Gilley
What is a triple or double pelvic osteotomy?
A. position of osteotomies for completion of TPO
B. stabilization with bone plate
What is the difference between a DPO and TPO?
DPO: no ischial cut
What is an FHO?
femoral head and neck excision
What are the types of devices for a total hip replacement?
cemented canine THR implants
cementless canine THR implants
Kyon THR
What procedure is this? Type of implant?
total hip replacement
BFX biological fixation - uncemented
What procedure is this? Type of implant?
total hip replacement
cemented prosthesis - see cement in here
What is a juvenile pubic symphysiodesis?
expose public symphysis with ventral midline incision over pubis
What is the purpose of a juvenile pubic symphysiodesis?
fuses the pubic symphysis - locks down the growth plate and causes ventroversion by bicautery (burn growth plate and close it)
What does this depict?
coxofemoral (CF) or hip luxation
What is a coxofemoral or hip luxation?
traumatic displacement of femoral head from acetabulum
What are the most common effects of a coxofemoral luxation?
results in craniodorsal displacement of femoral head from the acetabulum
What are the types of displacements of coxofemoral luxation?
craniodorsal
ventrocaudal
What anatomical changes happen with coxofemoral luxation?
round ligament of femoral head always fails completely
fibrous joint capsule completely torn for dislocation of femoral head
How do you treat coxofemoral laxations?
treat as quickly as possible! - prevents continued damage of soft tissue surrounding hip joint and degeneration of articular cartilage
Coxofemoral laxations are usually associated with ____
trauma - up to half of patients
perform a physical exam!
Which stance is pathognomonic for craniodorsal coxofemoral luxation?
paw beneath body and external rotation of stifle
What is the thumb test?
thumb in space caudal to greater trochanter and externally rotate femur
What happens if the coxofemoral joint is intact regarding the Thumb test?
greater trochanter displaces the thumb
What happens if the coxofemoral joint is luxated regarding the Thumb test?
greater trochanter rolls over thumb
How can you diagnose coxofemoral luxation?
by the position of the greater trochanter related to ilial crest and tuber ischii
Before treatment method is chosen for coxofemoral luxation, how do you evaluate the radiographs?
- avulsion of fovea capitis
- associated hip joint fractures
- degenerative changes secondary to hip dysplasia
What makes coxofemoral luxation a poor prognosis?
if there is spontaneous luxation secondary to hip dysplasia
What are differential diagnoses of coxofemoral luxation?
- acute subluxation or luxation of hip joint secondary to hip dysplasia
- femoral capital physeal fracture
- femoral neck fracture
- acetabular fracture
What is medical management for a coxofemoral luxation?
managed with closed manipulation to replace femoral head within acetabulum
- closed reduction
- open reduction
What should you always attempt when trying to manage coxofemoral luxation?
attempted before open reduction
How do you perform closed reduction of craniodorsal luxation?
How do you perform closed hip reduction?
Go review closed hip reduction
What is this?
Ehmer femur - used to prevent pelvic limb weight bearing
What is the technique for closed reduction of caudoventral luxation?
A. patient in lateral recumbency
B. place traction on limb while simultaneously abducting the leg
place in hobbles
What are reconstructive procedures for the hip?
- synthetic capsular reconstruction with suture and bone screws or suture anchors
- toggle pin placement
- additional stability gained by translocation of greater trochanter
What does reconstruction of the joint capsule as sole means of stabilization require?
- dorsal joint capsule identifiable
- normal conformation of hip joint
Procedures?
capsulorrhaphy - interrupted sutures to appose joint capsule
Procedure?
placement of a prosthetic capsule - bone screws in dorsolateral acetabulum
Procedure?
“Toggle-Rod Fixation”
- drill hole centered through femoral neck
- though acetabular fossa
Procedure?
stabilization with toggle pin suture - attach multiple strands of nonabsorbable suture to toggle pin
How do you pass sutures?
though hole drilled in femoral neck
Procedure?
stabilization by translocating greater trochanter
prepare site distal & slightly caudal to normal anatomical position
stabilize greater trochanter in position with small pins & orthopedic wire
Procedure?
tension band wiring - placement and mechanical principle of tension band
- wire exerts force that counters force of muscle contraction
- compresses fracture surface
What is postoperative care and assessment for treating coxofemoral issues?
Ehmer sling then very controlled physical rehabilitation exercises
What are the prognoses for coxofemoral laxations?
closed reduction - 50% chance regaining good to excellent limb function and maintaining reduction
open reduction: 85-90%
poor prognosis - patients with poor confirmation of hip joint
T/F: You should always attempt closed reduction in patients with hip luxation
TRUE
What is the timeline of Legg-Calve-Perthes Disease?
occurs in young patients before closure of capital femoral physis
“noninflammatory aseptic necrosis of femoral head”
What is management of Legg-Perthes Disease?
- femoral head and neck excision
- total hip replacement
