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Preeti: SA Surgery > Sx Diseases of the Hip Objectives > Flashcards

Sx Diseases of the Hip Objectives Flashcards

1
Q

What is the definition of hip dysplasia?

A

Abnormal development of the coxofemoral joint resulting in

hip laxity

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2
Q

What factors contribute to the expression of hip dysplasia?

A

Etiology is multifactorial (genetic and non-genetic necessary)

Genetic component = polygenic and epigenetic (gene expression not DNA)

Environmental component = decreased pelvic muscle mass (Greyhound, GSD), rapid weight gain, and/or high dietary energy, Ca/Vit D

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3
Q

What is the typical presenting signalment of hip dysplasia?

A

Large breed dogs, male OR female (equal sex distribution!)

biphasic age presentation (5-12 months, or old animals)

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4
Q

What are the physical exam and historical findings associated with hip dysplasia in a young dog? In an old dog?

A

Young dog- hip laxity palpable (can subluxate femoral head), + ortolani sign

Old dog- chronic/recurring signs, decreased ROM in extension, crepitus, NO palpable laxity

  • Exercise intolerance*
  • Bunny hopping* gait at trot
  • Difficulty rising/stiff after rest*
  • Reluctant* to climb stairs or jump

Sits “to the side” = avoiding hip flexion = SPECIFIC to hip dysplasia

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5
Q

What gait abnormality is associated with hip dysplasia?

A

Bunny Hopping!

(instead of alternating back legs, transfers weight to the spine)

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6
Q

What is the ortolani sign? How is it elicited?

A

Palpable/audible clunk heard

when pushing stifle proximally while abducting stifle

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7
Q

Why is the ortolani sign absent in older animals with hip dysplasia?

A

Due to remodeling in a chronic process

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8
Q

which radiographic view is considered diagnostic for hip dysplasia?

A

Hip EXTENDED view with internal rotation of distal limbs

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9
Q

How do you judge proper positioning on a hip extended radiograph

for hip dysplasia diagnosis?

A

To ensure straight view of pelvis, obturator foramen should be same size

(alien eyes)

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10
Q

What is Morgan’s line on a radiograph?

A

Represents a caudal curvilinear early osteophyte

and is a well-defined linear density between femoral head and

greater trochanter

DO NOT confuse with a “puppy line”- which is self-limiting, not significant, but is indistinct and at a similar location

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11
Q

What are the typical radiographic findings of hip dysplasia?

A

Early: Morgan’s line

Later: Increased joint space, less than 50% acetabular coverage, femoral neck thickening or coxa valga, femoral head flattening or sclerosis

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12
Q

A change in the angle or shape between the femur and femoral neck

as an adapted response to abnormal stresses is known as

A

Coxa Valga

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13
Q

T/F:

expression of hip dysplasia can be very different in littermates

A

TRUE

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14
Q

What are the two most common methods of screening for hip dysplasia?

A

OFA: Cannot certify hip dysplasia before 2 years!

Single VD pelvis view- underestimates subluxation

PennHip: Distraction under anesthesia and measurement (distraction index)

Does not change after 16 weeks!

Estimate of probability of OA only, not clinical signs

DI < 0.3 is ideal (lower the better=less laxity)

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15
Q

What is the “ideal” value for acetabular coverage?

For distraction index?

A

>50% acetabular coverage is ideal (means no hip dysplasia)

<0.3 DI (means no hip laxity)

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16
Q

What are medical/conservative treatment options for hip dysplasia?

A

Anything used to treat arthritis works

Puppy: Decrease Ca/Vit D/Energy intake in diet

Adult: Weight management is the most important!

Exercise moderation

Physical therapy

NSAIDs

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17
Q

What are surgical treatment options for hip dysplasia?

A
  1. Corrective Procedures:
    1. To reverse laxity
      1. JPS (Juvenile Pubic Symphodesis)
      2. TPO (Triple Pelvic Osteotomy)
  2. Salvage Procedures
    1. To preserve function
      1. FHO (Femoral Head Ostectomy)
      2. THR (Total Hip Replacement)
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18
Q

In regards to corrective procedures for hip dysplasia, what are the

indications for JPS and TPO?

A

JPS: If less than 20 weeks old and

risk is high according to PennHIP at 16 weeks

TPO: if clinical signs of hip dysplasia are present, positive ortolani sign, angle of reduction is < 30°, and there is no rad evidence of DJD or remodeling

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19
Q

In regards to corrective procedures for hip dysplasia, how do JPS and TPO help fix the mechanics of hip dysplasia?

A

JPS: Fuses pubic symphasis which tethers growth of pelvis at midline and rolls the acetabulum ventrally to catch the femoral head

TPO: Osteotomy of the pubis, ischium, and ilium and fixation of ilium with angled plate rolls the acetabulum dorsally to catch the hip (preventing subluxation)

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20
Q

In regards to corrective procedures for hip dysplasia, what is the prognosis for future problems associated with hip dysplasia for JPS and TPO?

A

JPS: Reduces incidence of OA

TPO: DJD is usually progressive, but long term function excellent

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21
Q

In regards to salvage procedures for hip dysplasia, what are the

indications for THR and FHO?

A

THR: For large, active dogs after have exhausted other options

FHO: Smaller patients, and first line for salvage

Do both AFTER skeletal maturity (7 - 8 months of age)

22
Q

In regards to salvage procedures for hip dysplasia, what are the

differences between THR and FHO?

A

THR: entire hip joint replaced with prosthesis

FHO: removal of entire head and neck of femur

Both have near normal function after sx

23
Q

In regards to salvage procedures for hip dysplasia, what are the

post- op recommendations for FHO?

A

IMMEDIATE post-op limb use is essential!

ROM and PT exercises encouraged!

24
Q

What are treatment options for hip dysplasia based on?

A

CLINICAL signs (not rad signs!)

25
Q

Why should medical management of hip dysplasia

precede sx treatment?

A

Sx treatment is very risky. Even though the prognosis is great, complications are CATASTROPHIC, so if you can use meds, do that.

26
Q

What is the most common etiology of coxofemoral luxation?

A

trauma

27
Q

What is the most commonly luxated joint?

A

coxofemoral luxation!

28
Q

What is the difference between craniodorsal and caudolateral luxation?

A

Craniodorsal: leg held in relaxed extension, stifle externally rotated with foot beneath body, affected leg is shorter, pain/crepitus on manipulation

Caudolateral: leg held abducted and flexed, stifle internally rotated,

affected leg is longer

29
Q

What type of coxofemoral luxation is most common and why?

A

Craniodorsal most common (>90% of luxations)

due to the pull of the gluteal muscles

30
Q

How is hip luxation diagnosed?

A

VD and Lateral rads

31
Q

When is closed reduction NOT indicated for coxofemoral hip luxation?

A

Contraindications = dysplastic hip, and/or presence of a fracture

32
Q

What maneuvers are required for closed reduction of

a coxofemoral hip luxation?

A

Grasp tarsus, externally rotate limb

Bring femoral head DISTAL to acetabulum

Internally rotate limb after femoral head clears acetabulum

33
Q

What type of coaptation is required for caudoventral coxofemoral luxation?

A

Apply Hobbles at level of stifle

in order to prevent abduction of limb

34
Q

What type of coaptation is required for craniodorsal coxofemoral luxation?

A

Ehmer sling in order to achieve abduction and internal rotation

to push femoral head away from damaged craniodorsal joint capsule

35
Q

What is anatomically happening in craniodorsal vs. caudoventral

hip luxation?

A

Caudoventral: Femoral head trapped ventral to ischium and the greater trochanter is recessed medially/difficult to palpate

Craniodorsal: Greater trochanter is displaced dorsally

36
Q

What are the indications for open reduction of the coxofemoral joint?

A

Pelvic/acetabular fracture

Femoral fracture

Hip dysplasia

Unstable closed reduction

Reccurrence after closed reduction

37
Q

What are the objectives for open reduction of the coxofemoral joint?

A

Reconstruct joint capsule and adjacent soft tissues

or

Maintain reduction temporarily with implant until soft tissues heal

38
Q

What are the three most commonly used procedures for correcting coxofemoral luxation?

A

Capsulorrhapy (closing joint capsule with heavy gauge suture- insufficient alone)

Prosthetic capsule (drill hole across femoral neck, screw in acetabulum, suture in figure 8 through tunnel and around screws)

Toggle pin/rod (Prosthetic capital ligament, suture “toggle” attached to pin placed through acetabulum, suture through femoral neck, secure to lateral femur)

39
Q

What are the salvage procedures that can be used in treating coxofemoral luxation?

A

FHO and THR

(I think salvage is indicated if you screw up the open reduction sx)

40
Q

What is the prognosis for coxofemoral luxation?

A

Better prognosis with open reduction, but expect DJD over time regardless

of corrective procedure (this DJD is clinically insignificant though)

41
Q

What is the likelihood of recurrence for closed vs. open reduction

of a coxofemoral luxation?

A

Closed = 50% recur

Open = 10 - 20% recur

42
Q

Aseptic necrosis of the femoral head is a condition known as

A

Legg-Perthes Disease

43
Q

What is the pathophysiology of Legg-Perthes Disease?

A

Ischemia to femoral head causes necrosis resulting in

epiphysis collapse with loading then fragmentation of the articular surface

Revascularization leads to new bone but with malunion of fractured femoral head

44
Q

What is the typical signalment of Legg-Perthes Disease?

A

Cats and SMALL/TOY breed dogs

4 - 11 months old

45
Q

What breeds are predisposed to Legg-Perthes Disease?

A

Mini Poodles and Westies predisposed

46
Q

___% of cases of Legg-Perthes Disease is bilateral

A

15%

47
Q

What do you see on Hx and PE for animals with Legg-Perthes Disease?

A

Signs of hip pain that is slow, progressive = necrosis

If pain acute, non-weightbearing = pathologic fracture

Chronic remodeling feels like hip dysplasia (mm atrophy, crepitus, decreased ROM)

48
Q

How is Legg-Perthes Disease diagnosed?

A

Radiographs!

Early: Radiopacity of lateral femoral head, focal bony lysis = moth eaten/ apple core sign

Later: Flattening/mottling of femoral head, collapse/thickening of neck

If have the clinical signs, but rads normal, repeat in 1 month (rad changes take time)

49
Q

What are the tx recommendations for Legg-Perthes Disease?

A

SURGERY is only option (med tx unhelpful)

FHO or THR

BUT *no need to delay procedure past skeletal maturity*

Post-op: Weight management, NSAIDs, and PT recommended

50
Q

What is the prognosis for Legg-Perthes Disease?

A

GOOD (but warn owner about 15% rate of contralateral dz)

Preeti: SA Surgery (10 decks)

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