Hip

Question 1

The hip is a diarthrodial joint. What does this mean?

Answer 1

Articulating bones separated by a fluid-containing joint cavity
(Most common joint)

Question 2

What are 2 developmental conditions of the hip?

Answer 2

Hip dysplasia

Legg-Calve-Perthe’s disease

Question 3

What are some acquired conditions of the hip joint?

Answer 3

Osteoarthritis
Neoplasia
Immune mediated arthropathy

Question 4

What are some traumatic conditions of the hip?

Answer 4

Coxofemoral luxation
Fractures of femoral head and neck
Fractures of acetabulum

Question 5

What causes hip dysplasia?

Answer 5

Laxity and instability of hip joint
Causes osteoarthritis
Results in pain as femoral head hits acetabular rim

Question 6

What are the risk factors for hip dysplasia?

Answer 6

Large breed dogs
Devon Rex Cat
Genotype
Bodyweight
Nutrition 
Growth rate

Question 7

What breed cat is predisposed to hip dysplasia?

Answer 7

Devon Rex

Question 8

At what age do the clinical signs of hip dysplasia subside?

Answer 8

12-18 months

Dogs present young (<12 months)

Question 9

What two ages of dogs usually present with hip dysplasia?

Answer 9

Young dogs - <12 months

Adult dogs with osteoarthritis secondary to HD

Question 10

What are the clinical signs of young dogs (<1) with hip dysplasia?

Answer 10

Unilateral/bilateral HL lameness
Bunny hopping
Reluctance to exercise
Pain upon hip/extension flexion 
Positive Ortalani test

Question 11

What is the Ortolani test?

Answer 11

Used to diagnose hip dysplasia

Under sedation, hip manipulation will cause subluxation and popping

Question 12

What are the clinical signs of hip dysplasia in adult dogs?

Answer 12

Stiffness after rest/exercise
Bunny hopping
Usually bilateral lameness
Pain upon joint manipulation 
Reduced ROM

Question 13

How is hip dysplasia diagnosed?

Answer 13

History
Clinical signs
Radiography

Question 14

What EARLY radiologic changes are seen with hip dysplasia?

Answer 14

Wide joint space with medial divergence

centre of femoral head lateral to dorsal acetabular edge

Question 15

What secondary radiologic changes are seen with hip dysplasia?

Answer 15

New bone formation of femoral neck (Morgan line)

Remodelling of femoral head/neck and cranial acetabular rim

Question 16

What are the treatment options for hip dysplasia?

Answer 16

Conservative - exercise restriction, NSAIDs

Surgery (if non-responsive to conservative management)

Question 17

What surgery can be performed to treat hip dysplasia?

Answer 17

Total hip replacement (all ages- Tx of choice)
Femoral head and neck excision (all ages)
(Triple pelvic osteotomy, juvenile pubic symphisiodesis - young dogs only)

Question 18

What are the indications for femoral head and neck excision surgery?

Answer 18

Legg-Calve-Perthe’s disease
Unreducible fractures
Hip dysplasia

Question 19

What are contraindications for a total hip replacement?

Answer 19

Chronic systemic illnesses

E.g. skin problems

Question 20

What are the disadvantages of a total hip replacement?

Answer 20

Expensive!

Cannot be done if chronic systemic illness (e.g. skin problems)

Question 21

What breeds are prone to Legg-Calve-Perthe’s disease?

Answer 21

Small breeds

WHWT, Manchester terriers

Question 22

What is the pathogenesis of Legg-Calve-Perthe’s disease?

Answer 22

Ischaemia of femoral head bone

Leads to deformity and collapse

Question 23

What age dogs are usually seen with Legg-Calve-Perthe’s disease?

Answer 23

Young (5 months old)

Question 24

What are the clinical signs of Legg-Calve-Perthe’s disease?

Answer 24

Unilateral lameness (usually) 
Young dog (5 months)
Pain and crepitus upon hip manipulation

Question 25

How is Legg-Calve-Perthe's disease diagnosed?

Answer 25

Radiography (frog leg and VD extended)

Question 26

What is the treatment for Legg-Calve-Perthe's disease?

Answer 26

Surgery > conservative Femoral head and neck excision (Tx of choice) Total hip replacement (Post-op rehab very important)

Question 27

What fractures can be seen in the proximal femur?

Answer 27

Capital and capital physical fractures Femoral neck fractures Greater trochanter fractures

Question 28

In what age animals are capital physeal fractures usually seen?

Answer 28

Young - 4-7 m/o

Question 29

What are the clinical signs of capital physeal fractures?

Answer 29

Young animal (4-7 months) Pain upon hip maniuplation History - secondary to trauma

Question 30

What is the treatment for capital physeal fractures?

Answer 30

Surgery | 3 divering/parallel K or arthrodesis wires

Question 31

What is the most common luxation in small animals?

Answer 31

Coxofemoral (hip)

Question 32

What animals are usually affected by coxofemoral lunation?

Answer 32

Animals >12 months | Following major trauma e.g. RTA

Question 33

Coxofemoral lunation can occur in any direction, but which is most common?

Answer 33

Craniodorsal

Question 34

What are the clinical signs of coxofemoral lunation?

Answer 34

Leg carried in flexion - stifle out, hock in | Greater trochanter more prominent - look for asymmetry

Question 35

How is coxofemoral lunation diagnosed?

Answer 35

History and clinical signs | Radiography (2 views - rule out other problems such as capital fractures and hip dysplasia)

Question 36

What is the treatment for coxofemoral lunation?

Answer 36

``` Closed reduction (manipulation of the joint without incising) unless hip dysplasia, or avulsion fracture If re-luxation occurs then open reduction and stabilisation ```

Question 37

Within what timeframe of a coxofemoral lunation should a closed reduction be performed? How is this done?

Answer 37

Within 48 hrs (if over this time = surgery) Under GA - tie dog to table (Radiograph after to ensure reduction)

Question 38

What may cause reluxation of the coxofemoral joint after closed reduction?

Answer 38

Haematoma | Fragments in acetabulum