Ch 57-59: Hips Flashcards
Liska VCOT 2018
Morbidity & mortality following THR in dogs
Most common cause of death?
mortality immediate post-op? Causes?
Most common pathophysiological process leading to death was neoplasia (31.2% of all causes)
Mortality during 1st 10d post-op – 0.32% (all occurred w/I first 72 hr)
6 deaths related to THR – femoral osteopenia w/ fx 2nd to decompensated renal failure
- contralateral hip pain w/ refusal to do sx
- 2 aseptic loosening w/ o refusal for sx revision
- 1 unresolvable MRSP
- unmanageable dorsal/ventral prosthesis luxation in a large dog prior to availability of proper implant
Bayer VCOT 2019
Complications and long-term outcome in 16 canine cementless hybrid hip arthroplasties
% complications? What were they?
how were complications managed?
Complications occurred in 3 arthroplasties (19%) including: luxation (1), aseptic cup loosening (1), implant failure w/ screw breakage followed by stem subsidence (1)
2 underwent revision, 1 treated conservatively after failure with acceptable outcome
Jones Vet Sx 2019
Total hip arthroplasty to address chronic hip luxation with pseudoacetabulum formation in 7 dogs
Complications?
Long-term outcome?
One intraoperative complication & 2 minor postop complications occurred in group 1 dogs
- Fissure of craniomedial femoral cortex intraop & occurred during hip reduction & repaired via cerclage
- 1 dog subsidence (6 mm) & retroversion of femoral stem into normoverted position on 11 wk post-op rads & had a grade II MPL
All dogs had good long-term outcomes
Liska Vet Sx 2019
Polar gap after cementless total hip replacement in dogs
what is a polar gap?
% ID on post-op films?
More common zones?
gaps ID on follow-up rads?
Polar gap = radiolucent zone on postop rads of THR interposed between host bone & metal shell of acetabular cup
Polar gap ID in at least 1 zone in 136 (68%) of VD rads and in 80 (40%) of lateral rads obtained immediately post-op
Gaps were more common in zones 2 & 5, measuring < 1 mm in depth
No gaps seen on rads after 5 wks post-op
Mitchell VCOT 2020
Comparison of femoral stem subsidence between 3 types of press-fit cementless THR in dogs
CFI = canal flare index; CF = canal fill
- which 3 systems?
- difference in complications?
- conclusions re: subsidence, CF, CFI, stem orientation?
traditional BFX, collared BFX, and BFX lateral bolt
No differences in complication rates (intraop postop or total)
Conclusion: BFX lateral bolt femoral stem associated with less postop subsidence compared w/ BFX collared & traditional BFX stems; No consistent changes in CF, CFI, or stem orientation or complication rates ID in association w/ increased subsidence in this study
Burneko Vet Sx 2020
Evaluation of cementless femoral stem level on mediolateral projection radiographs
alterations to measurements with axial rotation vs. frontal plane angulation?
No differences were detected between radiographically measured and actual stem level relative to the greater trochanter at 0, 15, 30, and − 30 axial rotation with 0 frontal plane angulation
Adduction consistently decreased the radiographic measured femoral stem level
Abduction consistently increased
Gifford Vet Sx 2020
Total hip replacement in dogs with contralateral pelvic limb amputation: A retrospective evaluation of 13 cases
- THR system?
- Mean ALO, version angle, angle of inclination?
- Follow-up? Luxation?
All dogs had BioMedtrix system
- Mean ALO: 40
- Mean version angle: 10
- Mean angle of inclination: 29
All 13 dogs had satisfactory clinical results at follow-up a median of 3 months (range, 2-36) after THR.
No postoperative luxation was recorded
Conclusion: Absence of postoperative luxation supports ALO of 35-45, mild retro version, and moderate declination as recommendations for amputees
Alvarez-Sanchez Vet Sx 2021(& Pierre!)
Zurich cementless total hip arthroplasty as a treatment option for capital physeal fractures in dogs: Outcome in 53 cases
Two groups?
What remodeling rate different in which group?
Intraop op comp rate?
Post op comp rate?
Overall outcome?
Conclusion?
dogs that underwent Zürich cementless total hip arthroplasty (Z-THA) for the repair of acute and chronic capital physeal fractures (CPF)
Dogs divided into 2 groups on the basis of the days elapsed between CPF diagnosis and Z-THA, acute (≤30 days) and chronic (>30 days). Hip remodeling variables were determined from preoperative radiographs or intraoperatively.
(23/53 (~45%) cases were acute, and 30 of 53 (~55%) cases were chronic)
There was no difference in the femoral remodeling rates between the acute and chronic groups (P = .184), whereas acetabular remodeling was more prevalent in the chronic group (P < .001).
Intraoperative complications occurred in 4/53 (7.5% [1/23 acute, 3/30 chronic]) cases
Postoperative complications occurred in 6/53 (11.3% [2/23 acute, 4/30 chronic]) cases.
Good clinical outcomes were achieved in 51/53 (96% [21 acute, 30 chronic]) cases.
Conclusion: Complication rates of Z-THA for CPF repair were similar to the complication rates reported for Z-THA of dysplastic hips. Hip remodeling was common regardless of CPF chronicity.
Howser VCOT 2020
Effects of femur position on radiographic assessment of femoral head and neck excision completeness in cats
PQ (maybe) how to assess adequate cut?
Lesser trochanter maintained in all femurs
Craniocaudal views of femur in external rotation (30° and 45°) had highest SE, SP & accuracy (SE 97.5% and 97.5%; SP 92.5% and 95%; and accuracy 95% and 96%)
Next was external rotation of 15 (SE 92.5%, SP 87.5% and accuracy 90%)
Standard craniocaudal SE 57.5%, SP 72.5%, accuracy 65% and lateromedial SE 2.5%, SP 0%, accuracy 1%
- Conclusion: evaluation in external rotation can increase ability to assess adequacy of FHNE in cats *
PQ Some paper asking for modified approach what m is a landmark but is also in the way
Monotti VCOT 2020
Treatment outcomes for periprosthetic femoral fractures in cementless press-fit total hip replacement
Fx % intra op? Post op?
MC fx config? Location?
Major comp %? MC?
Overall incidence of fx?
28 dogs met inclusion criteria with femoral fracture repair associated with cementless press- fit total hip replacement were identified.
8 fractures occurred intraoperatively (~30%) and 20 occurred at a median of 2 days postoperatively (~70%)
An oblique or spiral configuration was noted in 19 cases
15 occurred at the distal end of the femoral stem (type B)
- 13 type B1 (stem stable)
Major complications occurred in 7/28 (25%) cases (five deep infection, two mechanical failures).
Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available.
Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases.
Overall incidence of fracture 8.6% is similar to previous reports
3 screws placed proximal to the stem is integral to the stability and success of the fracture repair
No differences seen between locking and non-locking plates
Israel Vet Sx 2022
Outcome of canine cementless collared stem total hip replacement with proximal femoral periprosthetic cerclage application: 184 consecutive cases
Rate proximal femoral fx?
Complications associated with use of wire?
Conclusion?
No proximal femoral fractures occurred
No complications associated with the use of cerclage wire
1 fissure and 2 fractures near the tip of the femoral stem → Required plate and screw fixation
Conclusion: A single full cerclage wire may minimize the risk of a proximal femur fracture following cementless collared stem total hip replacement in dogs. No complications were encountered with the cerclage wire.
Rodino Vet Sx 2022
Long-term follow up of 44 cats undergoing total hip replacement: cases from a feline hip registry (2010-2020)
MC breeds & sex?
MC indication?
Implants used?
Complication rate?
Associations with complications?
FMPI changes?
O satisfaction with results?
British shorthair and domestic shorthair were most frequent breeds
Neutered males most prevalent 33/44
slipped capital femoral epiphysis (SCFE) most common indication
All implants were cemented micro and nano hip implants
Complications 20%
9/11 major complications
Luxation
Femoral fracture
Implant failure
Medial patella luxation
No association between clinical variables and complications
Feline musculoskeletal pain index (FMPI) increased from 0.111 to 2.111
Very good owner satisfaction in 90.9%
Conc: most common indication for THR in cats was SCFE occurring in young male neutered cats. Complication rates were comparable to previous reports.
Lanz VCOT 2021
Zurich cementless dual mobility cup for canine total hip prosthesis: implant characteristics and surgical outcome in 105 cases
What does Zurich dual mobility cup allow?
The Zurich cementless dual mobility (DM) system allows impingement-free range of angulation of 80 to 132 degrees between the ceramic head and the polyether ether ketone (PEEK) cup when combined with the range of the PEEK cup in the outer metal cup.
1/105 dorsal luxation dislocation 27 months following surgery
Caudoventral subluxation on radiographs 9 months following surgery, but asymptomatic
Revised inserting new 25 mm DM head and a long neck
Israel VSURG 2023
Preclosure povidone-iodine lavage in total hip replacement surgery: Infection outcomes and cost–benefit analysis
Infection rate without PrePIL?
Infection rate with PrePIL?
Complications related to PrePIL?
Retrospective study, 1699 dogs, 17 cats
21/2111 THRs (0.99%) that did not have PrePIL developed infection.
Infection occurred in none of the 102 PrePIL cases (0%).
No complications were identified related to the use of PrePIL.
Conclusion: Preclosure povidone-iodine lavage appeared to be efficacious in lowering THR infection rates, and it appeared to be safe for this use based on our 102 consecutive cases.
The cost of the PrePIL was minimal compared to the overall cost to resolve THR infection and the potential effect on hip function prognosis. (Cost analysis revealed a PrePIL break-even cost at $49.74 and a break-even infection rate of 0.949%. )
Clinical significance: At current costs, PrePIL can be used in 2415 THR cases at a similar cost of a single revision surgery and resolution of a periprosthetic infection.
