Small Ani. Sx- Ortho- Conditions of the Hip Joint 1

wilsbach's version from 2015-12-02 03:11

Legg - Calvé - Perthes Disease

Question Answer
what IS Legg - Calvé - Perthes Disease?Non inflammatory aseptic femoral head and neck necrosis
WHO tends to get LCP dz and what what age?Small breed of dogs, 4-11 Months (young!). The Manchester Terrier has a genetic predisposition
2 ways to dx LCPdz?CS + rads
what are the clinical signs of LCP dz?Pain, Crepitus, Muscle atrophy, Non weight bearing lameness (hold back legs underneath and dont put weight on them)
explain the pathogenesis of LCP dz (uni or bilateral?)Cause unknown, but it happens bc of Vascular ischemia-- could be from a bone infarct, or 􀀁Necrosis, Deformation, collapse. Unilateral or bilateral can happen (he said in class bilateral more common)
why are younger dogs more prone to LCP dz?bc they have a growth plate in the neck of the femur which is impermeable to BVs, so there is a higher chance of not getting enough blood supply to the head of the femur
what does radiographs look like for LCP dzIncreased joint space, Coxa plana (flattening of the head of the femur), Osteophytes, subluxation
how do you tx LCP dz?cant save- just do FHO- (femoral head ostectomy) (no bandages or slings- doesnt fix prob and just causes loss of ROM)
what is the prog of LCP dz?Good with FHO-- also physiotherapy and Mini/Nano THR (total hip replacements)

Coxofemoral luxation

Question Answer
**what is the most common direction for Coxofemoral luxation to occur in?Craniodorsal (90%) (possible to go caudodorsal or ventral)
what damage occurs when there is a coxofemoral luxation?Joint capsule and lig. Capitis femoris torn
what does a dog usually look like with a coxofemoral luxation?leg looks like this and looks a bit shorter than nornal, and external rotation bc touches bone to bone, so painful, rotate out to minimize bone to bone contact
how can you dx coxofemoral luxation?Usually if the hip is un-luxated, the landmarks of the ilial crest, tuber ischii, and greater trochanter make a triangle. However, if the hip is luxated, they are in a line.
this is your standard radiograph to dx hip luxation. however, why might you wanna take a DV also?need to take DV view too to see how good acetabulum or not, if dysplastic animal, see if there are fx in hip joint. (yes...this is a cat. they can get it too)
So...what's going on here? What does it mean?This is actually a pseudarthrosis-- the blackish hole beneath where the head of the femur is was the acetabulum. However, this is a CHRONIC case, so there is bone formation to make a "new" acetabulum bc it's been unstable for so long
what are the three treatment options for hipluxation?(1) Closed reduction/ conservative treatment (splint/sling) (2) Open reduction / internal sling (3) FHO
when would it be appropriate to perform a CLOSED reduction to fix a luxated hip?You can do this if it is an acute luxation with no arthrosis /HD (hip dysplasia), No fractures, and is stable after reduction
how do you perform the closed reduction?first external rotation, then pull ventrally, and internal rotation to hook femoral head into acetabulum
Once you have done the closed reduction, what do you do to give it time to heal?Ehmer sling for 10 days, which positions the leg to keep femoral head inside acetabulum. Doing this allows some time to heal joint capsule and prevent re-luxation. Can also do box confinement. (When properly applied, induces an internal rotation of the limb) **CAUTION OF COMPLICATIONS OF SLINGS-- pressure necrosis etc
when do you want to do Surgical reduction/ stabilization to tx hip luxation?Other limbs affected (can't sling both back legs, lol), Not enough stability, Reluxation continues, Articular fractures, large dogs
what is the most commonly used surgical procedure to tx hip luxation? explain what is going onIliofemoral suture! Have piece of suture (biggest one you have, like size 6), 1-2 holes in trochanter and one in ventral cranial acetabulum--- and suture is pulling femoral head inside acetabulum. This is the approach:
what might you be able to add to the iliofemoral suture technique to make it more stable?bone anchor
when do you know you've tightened the suture enough with the iliofemoral suture technque?should be some internal rotation.
post-op management after sx iliofemoral suture technique? (And times for various things youre doing)Lateral radiograph, Box confinement 10 days, Activity restriction 4-6 weeks
what is the prognosis for hip luxation-- closed reduction? open reduction? how often does FHO cause probs?(dont have to memorize #s but get the jist) 50% of the time, re-luxation after closed reduction. 20% reluxation in closed. FHO lameness in about 30 % (for life- not pain, just mechanical lameness 80% of the time),

Hip dysplasia/ Coxarthrosis (part one)

Question Answer
what is the definition of Hip dysplasia/ Coxarthrosis?Abnormal development of the coxofemoral joint--- the hips are sound at birth, this is a DEVELOPMENTAL PROBLEM
is HD uni or bilateral?can be either
WHO tends to get hip dysplasia?breed related- super muscular dogs like greyhounds tend not to get it at all, whereas dogs like St. bernard, almost half of them have it! Cats can also have it, but they often don't show the pain.
what is the pathophysiology of HD?some Genetic / Environmental factors... hips are normal at birth! Then there is Rapid skeletal growth with slow muscle development, bc of relative lack of soft tissue support, Failure of soft tissue to keep hips in acetabulum.
according to how the pathophysiology of HD works, what can you do to help prevent HD?Growth restriction helps
explain the pathogenesis of how the problems occur(first start with pathophysiology which basically means there is a failure of soft tissue to provide support and keep femoral head in the acetabulum) Instability--> Synovitis + subluxation--> Osteoarthrosis (specifically coxarthrosis)
this is the progression of normal to horrible-- how much you describe the horrible looking one? very big head= coxa mangum bc big, Very flat head= coxa planum bc flat
what are the chronic/degenerative changes you see with HD?Thickening of joint capsule (bodies attempt to add stability), New bone formation, Osteophytes, Fovea capitis can be filled in with bone/distorted, Lig capitis femoris torn, Cartilage damage (then bone to bone contact-- super painful and if running can get heat necrosis from friction etc)
one of the chronic progressive changes caused by HD is new bone formation... what is a radiographic sign you can see bc of this?MORGAN LINES-- look like radiopaque lines due to new bone formation
what is another area which can get problems 2* to HD, and why?can get Secondary Lumbosacral stenosis bc hurt to move hips, so swing pelvis from the lower back to move.
when are the most common times for you to see clinical signs?Bimodal distribution! Often see lots of CS from 4-12mo, then it stops for a while, and then you see progressively more and more older than 15mo (DJD)
what will you find upon orthopedic exam of a HD dog?Joint capsule laxity, Range of Motion (ROM), pain, creptius
how do you test for Joint Capsule Laxity? (name of test and way you do it)Ortolani - test-- adduct femur (bring closer to body) to try to subluxate femoral head. Then pull femur back away from body (abduct) and feel for a "pop" as the femoral head goes back into place
what ROM are you really testing for to see if painful?abduction and extension
when doing ROM tests for HD what must you keep in mind can be a ddx?make sure its not lower back pain, but actually hip pain
what radiographic position do you take to try to dx HD? When are these rads usually taken? what are you looking for?VD view, extended limbs, take these rads at > 2 years of age (traditionally, but far beyond the point where we can help them with preventative medicine, but can prevent from breeding), looking for congruency. Then you GRADE them Normal (4 grades), Dysplasic (3 grades)
when do you take stress rads and what are you trying to figure out?take Stress radiographs early in life if you wanna preventatively tx pt-- can do this to figure out the "distraction index"
Explain How you take stress radiographs, and what the distraction index islooking for laxity in hips of young dog. Stress with tools (pic) and then take radiographs- from the rads you calc the distraction index where the red dot is the center of the acetabulum, and the yellow dot is the center of the femoral head. Ideally they should be overlapping each other. to get DI, you measure the distance from red dot to yellow dot, and then divide by radius of femoral head to get your DI. 0 is perfect hips and 1 is really really bad.
what is the conservative tx of HD?Pain relief, look for Clinical improvement, trying to Slow down progression of disease (not all need sx)--> there is short term and long term management. SHORT TERM: Rest (2 weeks), Physiotherapy, NSAIDs (think young dogs, open growth plates, lots of pain and inflammation.) LONG TERM: **Weight reduction!, Glucosamine/ chondroitin, Exercise (swimming/ walks) (low impact like swimming is great), NSAIDs when needed, Physical rehabilitation
so this dog has these AWFUL radiographs, but then you go into the room to talk to the owner and the dog is happy and jumping around and doesnt seem to feel any pain! what should you do?Clinical signs may not correlate with radiographic findings--- TREAT THE PT NOT THE RADS