The Coxofemoral (hip) joint

Question 1

What are developmental conditions of the hip?

Answer 1

• Hip dysplasia
• Legg-Perthes disease

Question 2

What should be checked on clinical exam of the hip?

Answer 2

• Landmarks
• Walking / trotting
• Muscle atrophy
• Specific tests = Barlow / Ortolani / Bardens

Question 3

What are traumatic conditions of the hip?

Answer 3

• Coxofemoral luxation

Question 4

What occurs in hip dysplasia? What animals are predisposed?

Answer 4

• Laxity / instability of hip joint - due to poor soft tissue cover + then OA
• Pain from bone on bone action
• CS at 12-18months
• Large breed dogs / devon rex cat
• Genotype = Bodyweight = Nutrition = Growth rate

Question 5

CS of hip dysplasia?

Answer 5

• Early presentation =
  -Less than 1y/o
  -Uni / bilateral HL lameness
  -Bunny- hopping
  -Pai upon hip flexion/extension
  -+ve Ortolani test
  -Reluctance to exercise
• Later presentations =
  -Mature dogs
  -Stiffness after rest/exercise
  -Bunny hopping
  -Usually bilateral
  -Pain on joint manipulation

Question 6

How do you diagnose hip dysplasia?

Answer 6

• History + Clinical signs
• Radiographs

Question 7

What are radiograph changes with hip dysplasia?

Answer 7

• Early changes =
  -Important to note for Double/Triple pelvic osteotomy (DPO/TPO)
  -Wide joint space with medial divergence
  -Centre of femoral head lateral to dorsal acetabular edge
  -“luxoid” dogs
• Secondary changes =
  -New bone formation of femoral neck (Morgan line)
  -Remodelling of femoral head/neck
  -Remodelling of cranial effective acetabular rim

Question 8

What is conservative treatment of hip dysplasia?

Answer 8

• Restricted exercise
• Weight loss
• Analgesia
• Adjunctive therapies - physio

Question 9

When would you use surgical tx for hip dysplasia?
What is surgical treatment of hip dysplasia?

Answer 9

• Only if non-responsive to conservative management
• Luxoid dogs
• Young dogs = double/triple pelvic osteotomy / juvenile pubic symphisiodesis
• All dogs = femoral head + neck excision
  ->9m/o = total hip replacement

Question 10

What breeds get legg-calve-perthes disease? What is the condition?

Answer 10

• WHWT
• Manchester terriers
• Ischaemia of femoral head bone = deformity + collapse

Question 11

Dx of legg-calve-perthes disease?

Answer 11

• Hx + CS
• Pain / crepitus upon hip manipulation
• Radiography frog-leg + VD extended-mottle/misshapen appearance to femoral head

Question 12

Tx of legg-calve-perthes disease?

Answer 12

• Surgical > conservative
  -femoral head + neck excision
  -Total hip replacement

Question 13

What can cause coxofemoral luxation? CS? Dx?

Answer 13

• Major Trauma - RTA
• Animals >12m/o
• CS =
  -severely lame
  -leg carried in flexion, stifle out, hock in
  -greater trochanter more prominent
  -asymmetry
• Dx = Hx + CS + Radiography

Question 14

What is treatment of coxofemoral luxation?

Answer 14

• Closed reduction - put it in and sling
• If re-luxation = open reduction + stabilise