Ch 57 Hip luxation Flashcards

Question

transposition of the Sacrotuberous Ligament

Answer 1

another technique similar to toggle rod fixation. - The ischial insertion of the sacrotuberous ligament is cut using an osteotome (to include a piece of ischial bone) and the ligament is isolated, taking care to avoid injury to the sciatic nerve. - The ligament is then passed through the femoral tunnel (6-mm diameter) and is attached below the greater trochanter by placing a screw through the bone fragment and into the femur.

Answer 2

- A capsulorrhaphy is performed if possible. - hole is drilled just cranial to the acetabulum. A second hole through the femur just distal to the insertion of the gluteal muscles. - One or more strands of large, monofilament suture material - The joint is internally rotated and abducted, and the suture is tied. - report of 14 patients in which an iliofemoral suture was used to stabilize acute and chronic luxations described no reluxations and no complications. No reduction in range of motion was identified

Answer 3

- dorsal approach to the hip joint is recommended - A prosthetic capsule technique or toggle rod procedure is used to enhance joint stability, although neither technique entirely prevents ventral displacement of the femoral head. - If ventral instability persists, the ventral acetabular ligament can be sutured - ventral augmentation > iliac crest shelf graft; extracapsular sling; an internal fixator plate can be used to augment the ventral acetabular rim.

Answer 4

indication: recurrent luxations, significant fractures or OA, if cost is a concern - biomechanics of the hind limb change following FHNE because the femoral head no longer articulates with the acetabulum and a fibrous false joint is present. > This results in a mechanical lameness due to limb-shortening, dorsal displacement of femur and restricted extension of hip - Aggressive pain management and aggressive physical therapy are therefore critical in the early postoperative period to allow early use of the limb good-to-excellent long-term clinical outcomes with complete or near complete return to function by 1–2 months postoperatively in cats (Yap et al 2015) - Many studies cite better results in dogs weighing less than 18 to 20 kg - factors that can influence postoperative outcome include age, temperament, activity, surgical technique, postoperative physical therapy, and the severity of muscle atrophy at the time of surgery - The bone-on-bone contact is thought to be a significant cause of pain, discomfort, and an unwillingness to use the operated limb, particularly during the early postoperative period,7,18 especially in large and giant breeds of dogs Generally, outcomes are difficult to compare between studies due to several confounding factors

Answer 5

- provides stability by rotating the acetabulum ventrolaterally to provide greater coverage of the femoral head. - This technique has been used primarily for recurrent luxations, for dogs with hip dysplasia, and for femoral head luxation after total hip replacement

Answer 6

- Hip replacement arthroplasty may be used in cases of chronic luxation, reluxation, severe osteoarthritis, or damage to the femoral head - Pozzi 2004: Treatment of traumatic coxofemoral luxation by cemented total hip

Answer 7

Left: 10 and 1 o’clock position on DAR Right: 11 and 2 o’clock position on DAR

Answer 8

Autogenous iliac crest graft Extracapsular sling Internal fixator plate to augment ventral acetabular rim

Answer 9

- confinement and restricted activity for 4 to 6 weeks to allow soft tissue healing - monitored closely for clinical signs of reluxation - - Management of osteoarthritis is most effective when started early in the disease process - - Physical rehabilitation has been shown to improve joint range of motion and to enhance comfort in patients with joint injury. Once healing is complete and the joint is stable, rehabilitative techniques such as sit-to-stand exercises, inclined walking, hydrotherapy,

Answer 10

fair to good if reduction and stability are achieved soon after injury - long-term study of 64 dogs treated using various techniques, including closed, extracapsular, transarticular pinning, toggle rod stabilization, DeVita and FHO found that 62% showed no lameness and 20% were severely lame - - Osteoarthritis of the hip joint progresses in 55% to 62% - - Closed reduction of coxofemoral joint luxation in cats had a 51% success rate. - It may be worth attempting closed coxofemoral joint reduction in cats prior to recommending surgery - - Placing a bandage (Ehmer or hobbles) after closed reduction may decrease the risk of the coxofemoral joint reluxating, but more studies are needed to evaluate this further - - Retroseptive on toggle outcomes in 128 dogs: The overall complication rate was 24.2%, and the reluxation rate was 14.8%. decreased risk of reluxation when the cause was traumatic in origin - Multiple surgical options reported, suggesting that there is no single ideal method: - No prospective studies compare the techniques **complication rate?** - overall: 15-43 (major -minor) - intraop <5% - reluxation 6-25% (10-15% dogs and cats) - OA: 60-100% in dogs an cats

Answer 11

retrospective case series, commercial toggle rod and nylon monofilament suture The overall complication rate was 24.2%, and the reluxation rate was 14.8%. median follow-up time was 151 days (range, 0-4440). dogs with polytrauma that had additional surgeries performed at the time of the open hip reduction surgery were not at an increased risk for reluxation Published recommendations on nylon monofilament suture test selection are based on bone tunnel size, which includes having a femoral tunnel ≤20% the width of the femoral neck or a tunnel of a maximum width of onethird the diameter of the bone.2,8 Suture size to body weight ratio only approached significance (P = .07) in our study. Increasing test size of the monofilament nylon suture would be expected to provide increasingly better resistance to cycling, abrasion, and fatigue.

Answer 12

Multi-institutional retrospective cohort study. Sample population Forty-eight client-owned cats Intraoperative and postoperative complications were recorded in two (4.2%) and 11 (24.4%) cats, respectively. The most common postoperative complication was reluxation (n = 5 [11.1%]). Outcome was classified as excellent in 81.1% and good in 16.2% of cats after a median of 445.5 days (range, 53-3720). No difference in rate of complications or outcomes was identified between UHMWPE and nylon.

Answer 13

58 dogs stabilized using a 4.0 or 3.2 mm commercial toggle rod and either one or two strands of OrthoFiber, FiberWire, or monofilament nylon suture. Postoperative complications developed in 25 of the 58 (43%) dogs, with major complications in 9 cases (15.5%). The most common major complication was reluxation, which occurred in 6 dogs (10%). Five of the 6 cases of reluxation received monofilament suture good to excellent results for satisfaction with the procedure in 90%

Answer 14

40 of 92 (43.5%) dogs had reluxation of the affected hip joint at or near the time of sling removal Forty-six (50%) dogs had soft tissue injuries secondary to sling use; 17 of these dogs had injuries classified as severe, including 1 dog that required limb amputa¬tion. Odds of severe sling injury for dogs that had poor owner compliance with home care instructions noted in the record Placement of an Ehmer sling following closed reduction of a craniodorsal hip luxation had a low success rate and high complication rate. This study did not compare sling to no sling groups, so the finds should be interpreted with caution. Ultimately > clinitian prefence – recommend choosing owners with high compliance or potentially keeping the patient in hospital for close monitoring.

Answer 15

Results Closed reduction of coxofemoral joint luxation in cats had a 51% success rate. The only risk factor demonstrating a statistically significant benefit to the success of closed coxofemoral joint reduction was the application of a bandage (P = 0.02). Conclusions and relevance It may be worth attempting closed coxofemoral joint reduction in cats prior to recommending surgery. Placing a bandage (Ehmer or hobbles) after closed reduction may decrease the risk of the coxofemoral joint reluxating, but more studies are needed to evaluate this further

Answer 16

A total of 1140 hip ultrasounds were accuracy (median, 90.8%; sensitivity (89.5%), and specificity (80.0%) for diagnosing the presence of hip luxation. study supported the use of ultrasound for diagnosing the presence of hip luxation but did not support replacing radiographs for diagnosing 24 client-owned 84.2% to 100% for detecting the presence of luxation and 80.6% to 98.1% for diagnosing the direction accurately diagnosed the presence of osteoarthrosis and the presence of fractures of the femoral head/neck

Answer 17

single private practice, Long-term (>2 years) follow-up data transarticular suture technique – suture through acetabular wall, exited ventral to acetabulum, under rectus femoris and tied to other end at third trochanter - 25% reluxation, 75% excellent outcome, 66% no lameness small sample size, the retrospective nature of this study, variability in case management, the lack of biomechanical studies that have been used to test the strength of the nylon suture used, and the inability to perform gait analysis on the dogs included in this study.

Answer 18

Eighteen hip joints, randomly assigned either to group A (hip joints stabilised with an extra-articular (UHMWPE) implant secured by an interference screw [n = 8]) or to group B (hip joints stabilised with a UHMWPE iliofemoral suture [n = 8]). No difference was found between groups A and B for yield and failure load. However, the reoccurrence of craniodorsal hip luxation was higher in group B than in group A failure mode between group A (caudodorsal hip luxation in 7/8 cases) and group B (craniodorsal hip luxation in 5/8 cases) UHMWPE implant tends to approximate the physiological ligament stiffness and capsular stabilisation of intact hip joints in feline cadavers. | load applied to the hip likely to be lower than the force measured.

Answer 19

retrospective study.32. toggle with single- or double-loop mini-TightRope in 32 cats - complications: reluxation 5/32 (15.6%), 2/5 bone cut-out at femoral head-acetabulum - outcomes: excellent clinical outcome, 14/27 (51.8%) moderate-severe OA. A 2.0mm tunnel can exceed tunnel-femoral neck diameter ratio of 20% > no complications Suboptimal drilling of the femoral tunnel in terms of isometric position of the holes in the cis- and transfemoral cortices may lead to the persistence of joint instability and OA progression.

Answer 20

Retrospective. Caudoventral hip luxation in 160 dogs Low-trauma accidents 82.9% Over-represented breeds poodles (38.1%) success rates of closed reduction alone 10% closed reduction/Ehmer sling, 18% (60% complication) closed reduction/hobbles were 62% (32% complications, with repeated attempts) Success rate for toggle rod stabilization was 88.2%. Reluxation (11.8%) A ventral approach> preserves the dorsal hip stabilizers while allowing assessment and repair of ventral structures dogs suffering CvH are not predisposed to hip dysplasia

Answer 21

Retrospective. 7 pseudoacetabulum/chronic luxation tx with THR cementless (BioMedtrix BFX) Exposing the native acetabulum and reducing the prosthesis were surgically challenging. Cup position similar to normal THR cases. 1 intraoperative and 2 minor postoperative complications All dogs had good long-term outcomes. Low complications rate > dt high-volume surgeon (>120 THA/year drag their foot during the swing phase of gait > was transient concentric dorsal heterotopic ossification around a luxated femoral head > discriminate from luxoid case HUMAN: acute limb lengthening (relocating the chronically luxated femur distally) increases the risk of peroneal nerve palsy HUMAN: prosthesis at pseudoacetabulum associated with higher rates of complications Strategies such as placing the acetabular cup more dorsally or medially, creating a more distal femoral osteotomy, and/or distalization of the femoral component can be employed to assist in overcoming tension and thus facilitating reduction of the prosthesis

Ch 57 Hip luxation Flashcards

(45 cards)