Hip and Stifle Disease Flashcards Preview

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Flashcards in Hip and Stifle Disease Deck (172)
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1
Q

what type of disease is hip displasia?

A

developmental

2
Q

how does hip displasia develop?

A

dogs are born with normal hips and laxity develops in joint capsule which allows hip to subluxate

3
Q

what is the aetiology of hip displasia?

A

genetic (breed predisposition)
size
diet
exercise

4
Q

how can diet and exercise contribute to hip displasia?

A

excessive / fast growth or exercise

makes presentation of hip dysplasia more likely

5
Q

what species does hip dysplasia mainly affect?

A

mainly large and giant dog breeds

can affect small breeds and cats though

6
Q

when may hip dysplasia signs present?

A

biphasic - present at 2 different stages of life

7
Q

what are the biphasic clinical signs of hip dysplasia?

A

6-7 months present with laxity

adult dogs present with osteoarthritis

8
Q

what are the clinical signs of hip dysplasia on gait analysis?

A
short stride
lameness
stiffness
clunking of hips
lateral sway of spine
bunny hopping of both back legs
adducted hindlimbs at walking and standing
9
Q

what are the clinical signs of hip dysplasia on orthopedic examination?

A

pain on hip extension
clunking of hip
hindlimb muscle atrophy
crepitus on manupulation

10
Q

what muscle in the hindlimbs atrophies most with hip dysplasia?

A

gluteals

11
Q

what is used to confirm the diagnosis of hip dysplasia following suspicion from exam?

A

imaging

12
Q

what is the common x-ray view for diagnosis of hip dysplasia?

A

ventrodorsal extended x-rays

13
Q

what are you looking for on hip x-rays when diagnosing hip dysplasia?

A

hip subluxation
acetabular remodelling
osteophytes

14
Q

when looking at hip dysplasia x rays what are you looking for to show some subluxation?

A

acetabulum should sit half way within the dorsal acetabular rim - if it is less than this there is laxity

15
Q

what views should be taken to confirm hip dysplasia?

A

orthogonal

16
Q

what is the Ortolani test used for?

A

testing hip laxity

17
Q

how is the dog positioned for the ortolani test?

A

dorsal or lateral recumbacy

18
Q

when will you get a negative result on the Ortolani test?

A

if hip is normal or dislocated

19
Q

how is the ortolani test performed?

A

pressure applied to knee

hip is subluxated then abducted until reduced to give the angle of subluxation

20
Q

what are the main treatment options for hip dysplasia?

A

non-surgical

surgical

21
Q

what are the non-surgical management methods of hip dysplasia?

A

management as for OA

22
Q

when will non-surgical hip dysplasia management be used?

A

milder cases

financial issues

23
Q

what are the surgical methods of hip dysplasia management?

A

growth plate function
osteotomies
total hip replacement
femoral neck and head excision

24
Q

what is a growth plate fusion also known as?

A

juvenile pubic symphysiodesis

25
Q

on what dogs can growth plate fusion be performed to treat hip dysplasia?

A

young dog 4-5 months

26
Q

what are the osteotomies performed to treat hip dysplasia?

A

triple / double pelvic osteotomy

27
Q

what age of dog can a triple/pelvic osteotomy be performed?

A

less than 6-7 months

28
Q

what is the role of growth plate fusion or osteotomy surgeries to treat hip dysplasia?

A

improves dorsal cover of the femoral head

29
Q

what is avascular necrosis of the femoral head also known as?

A

ischaemic necrosis

Legg Calve Perthes

30
Q

what is the cause of avascular necrosis of the femoral head?

A

trauma

ischemia to femoral head

31
Q

what breeds are predisposed to avascular necrosis of the femoral head?

A

small breeds

32
Q

why should avascular necrosis of the femoral head affected animals not be bred from?

A

the disease has an inherited basis consistent with an autosomal recessive gene

33
Q

in what animals is avascular necrosis of the femoral head seen?

A

small breeds form 5 months

34
Q

what are the signs of avascular necrosis of the femoral head?

A

unilateral hindlimb lameness
pain on hip extension and flexion
marked muscle wastage

35
Q

how is avascular necrosis of the femoral head diagnosed?

A

imaging

36
Q

what will be seen on radiographs of a patient with avascular necrosis of the femoral head?

A

lucent areas initially

collapse of femoral head and mushrooming when advanced

37
Q

how is avascular necrosis of the femoral head treated surgically?

A

femoral head and neck excision

total hip replacement

38
Q

how is avascular necrosis of the femoral head treated conservatively?

A

cage rest

39
Q

when will conservative treatment of avascular necrosis of the femoral head only be used?

A

is mild case or an incidental finding

40
Q

what is the prognosis of avascular necrosis of the femoral head?

A

guarded

most require salvage surgery

41
Q

what is slipped capital femoral epiphysis (SFCE) also known as?

A

femoral neck metaphyseal osteopathy

physeal dysplasia

42
Q

what are the clinical signs of slipped capital femoral epiphysis?

A

lameness

hip pain

43
Q

what are the animals who are mainly affected by slipped capital femoral epiphysis?

A

young cats
male
castrated
overweight or large breed

44
Q

why does castration influence slipped capital femoral epiphysis?

A

stops or delays the fusion of the growth plate

45
Q

what radiographic view is prefurrable when diagnosing slipped capital femoral epiphysis?

A

frog legs so femoral head can be seen

46
Q

is slipped capital femoral epiphysis traumatic?

A

no - atraumtic

47
Q

what radiographic changes are seen in patients with slipped capital femoral epiphysis?

A

radiolucent line at capital physis
separation / movement between femoral head and femoral neck
resorption of femoral neck

48
Q

what is the treatment for slipped capital femoral epiphysis?

A

femoral head and neck excision
total hip replacement
parallel pin
may spontaneously heal

49
Q

why is a parallel pin no so effective at treating slipped capital femoral epiphysis?

A

bone resorption leaves little to pin

50
Q

what is the prognosis of slipped capital femoral epiphysis?

A

guarded for healing - many will not heal

51
Q

what is the mechanism of the cause (pathogenesis) of hip luxation?

A

traumatic

52
Q

what is another cause of hip luxation?

A

spontaneously in dogs with hip dysplasia

53
Q

what are the clinical signs of hip luxation?

A

sudden onset lameness pot trauma
altered gait
luxated leg often shorter

54
Q

what direction does the hip luxation usually take?

A

craniodorsal

55
Q

what is the gait of an animal with hip luxation?

A

stifle out, hock in and leg adducted

56
Q

what radiographs can be used to diagnose hip luxation?

A

2 orthogonal radiographs (VD and Lat)

check for concurrent fractures or hip dysplasia

57
Q

why should you check for concurrent fractures or hip dysplasia on orthogonal radiographs of a patient with luxation?

A

may alter prognosis

58
Q

how may hip luxation be diagnosed on exam?

A
assessment of lameness
assessment of pain and crepitus
palpation of bilateral landmarks to feel for normal and abnormal)
limb length
thumb displacement test
59
Q

what is the thumb displacement test for hip luxation?

A

manipulate hip with thumb between tuber ischii and greater trochanter
if dislocated with thumb will remain in the notch while hip is manipulated

60
Q

how will landmarks often line up in a hip luxation?

A

tuber ischii, crest of ileum and greater trochanter will line up rather than forming a triangle

61
Q

what is essential for diagnosing hip luxation?

A

radiographs and CT

62
Q

what can the physical exam and clinical signs of hip luxation be complicated by?

A

presence of fractures of the pelvis and proximal femur

63
Q

what must be provided to hip luxation as soon as possible?

A

analgesia - opioid (full alpha agonist) and/or NSAID

64
Q

what should patients with hip luxation be checked for?

A

concurrent injuries (e.g. RTA)

65
Q

what does treatment of hip luxation depend on?

A

presence of pre-exisiting disease (e.g. hip dysplasia)
duration of luxation
concomitant orthopedic injuries

66
Q

what are the management options for hip luxation?

A

closed reduction +/- sling
open reduction
salvage optons - FHNE or THR

67
Q

what is the aim of a salvage surgery?

A

maintain normal function but not anatomy

68
Q

when should closed reduction be attempted?

A

early

69
Q

why should closed reduction be attempted early?

A

the longer the luxation has been present the more difficult to reduce it is
there will also be more cartilage damage

70
Q

when should a closed reduction never be attempted?

A
acetabular or femoral head fractures
chronic luxations
other injuries such as pelvic fractures that prevent reduction
if cartilage evaluation is needed
if hip dysplasia
71
Q

how is closed reduction performed?

A
  • Animal anaesthetised
    – Assistant needed to hold on to dog or may be pulled off table
    – Extend, adduct and externally rotate limb to lift femoral head over dorsal acetabular rim
    – Then abduct and internally rotate to sit femoral head into the acetabulum
    – Confirm reduction with two orthogonal xrays
    – Ehmer sling or cage rest post reduction
72
Q

what is needed post closed hip luxation reduction?

A

Ehmer sling or cage rest

73
Q

what are the options for open (surgical) reduction of hip luxation?

A
toggle - replaces round ligament
transarticular pin
prosthetic capsular repair
iliofemoral suture
priamry capsular repair
74
Q

how long does surgical repair of hip luxation by transarticular pin and
iliofemoral suture last?

A

temporary until joint capsule and ligament of the femoral head heal

75
Q

what is the prognosis with treatment of hip luxation?

A

good in 75% of cases

76
Q

what are the complications associated with hip luxation?

A

OA will form

recurrent dislocation is possible

77
Q

what is patella luxation?

A

displacement of the patella from the groove in distal femur

78
Q

what direction can the patella luxate?

A

medial or lateral

79
Q

what direction does patella luxation occur mostly?

A

medial

80
Q

in how many limbs does patella luxation often occur?

A

often bilateral

81
Q

in what breeds is patella luxation common?

A

small breed

82
Q

what is medial patella luxation common in?

A

large and small dogs

cats

83
Q

what animals is lateral patella luxation common in?

A

large breed dogs

84
Q

what direction does patella luxation occur in, in cats?

A

medially most commonly

85
Q

what age are most patella luxation patients?

A

young as usually developmental and may be heraditory

86
Q

what is traumatic patella luxation more common in?

A

cats

87
Q

what are the predisposing developmental abnormalities to patella luxation?

A

femoral torsion
lateral bowing of distal femur
medially positioned tibial tuberosity
hypoplasia of medial femoral condyle

88
Q

what is characteristic of patella luxation?

A

giat

89
Q

what will animals with patella luxation avoid doing?

A

flexing or extending the stifle as quads don’t function

90
Q

how do animals walk with bilateral medial patella luxation?

A

cowboy stance
stifles flexed
wide based stance

91
Q

what is found on clinical exam of a patient with patella luxation?

A

stifle discomfort
patella clicks on the manipulation of the stifle
laxity of patella on stifle extension

92
Q

what is the gait like of an animal with bilateral lateral patella luxation?

A

knock knees

93
Q

how is patella luxation graded?

A

I - IV

94
Q

describe grade I patella luxation

A

patella normally within groove

returns spontaneously when luxated manually

95
Q

describe grade II patella luxation

A

patella normally within groove

can be luxated and will remain so when released

96
Q

describe grade III patella luxation

A

patella normally outside groove

can be manipulated back into groove

97
Q

describe grade IV patella luxation

A

patella normally outside groove

cannot be reduced by manipulation

98
Q

what does the prognosis of patella luxation depenf on?

A

severity

99
Q

what is the grade of most patella luxation cases?

A

II

100
Q

is imaing usually necessary for patella luxation?

A

no - may well be normal unless patella actually luxated

101
Q

what can imaging of patella luxation be used for?

A

checking for concurrent disease

102
Q

how can patella luxation be treated?

A

tibial tuberosity transposition
deepening of trochlear groove
soft tissue repairs

103
Q

what is the aim of tibial tuberosity transposition surgery?

A

realigns tibial tuberosity and pull of the quadriceps with teh groove

104
Q

how can the trochlear groove be deepened?

A

wedge or block

105
Q

how is deepening of the trochlear groove performed?

A

block or wedge is removed from femur at the trochlear groove
this is removed and bone from beneath is cut away
the block or wedge is then replaced to maintain the articular cartilage

106
Q

what are the 2 soft tissue patella luxation surgeries?

A

release - side of normal luxation has tissues cut to reduce pull
imbrication

107
Q

what is the post op care for a patient who has had patella luxation repair?

A

consider a support dressing if severe
multimodal analgesia
gradual increase in exercise after 3-6 weeks strict rest

108
Q

how much strict rest is needed following patella luxation surgery?

A

3-6 weeks

109
Q

what is the prognosis of patella luxation repair?

A

deteriorates with increasing grade of luxation

110
Q

what is the prognosis of patella luxation for small dogs?

A

90-95%

111
Q

what is the prognosis for dogs over 20kg with patella luxation?

A

significantly higher risk of complications or repair failure

112
Q

what is the most common cause of hindlimb lameness in dogs?

A

cranial cruciate ligament disease

113
Q

what is the disease process of cranial cruciate ligament disease?

A

poorly understood

114
Q

what are the functions of the cranial cruciate ligament?

A

limit cranial drawer
limit hyperextension of stifle
limit internal rotation of stifle

115
Q

what is cranial drawer?

A

movement of tibia tibia in relation to femur

116
Q

what are the causes of cranial cruciate ligament disease?

A

major trauma
degeneration
inflammatory arthropathy
tibial plateau angled by growth abnormality

117
Q

is cranial cruciate ligament disease often caused by major trauma?

A

no

118
Q

what trauma can case cranial cruciate ligament disease?

A

hyperextension

119
Q

what dogs is degenerative cranial cruciate ligament disease most common?

A

middle aged

female

120
Q

what is the most common cause of cranial cruciate ligament disease?

A

degeneration

121
Q

what is acute presentation of cranial cruciate ligament disease due to?

A

ligament rupture

122
Q

what is the most common presentation of degenerative cranial cruciate ligament disease?

A

low grade lameness

123
Q

what breeds are predisposed to cranial cruciate ligament disease?

A

retriever
lab
westie

124
Q

why may some breeds be predisposed to cranial cruciate ligament disease?

A

proteolytic changes weaken ligament

125
Q

what condition is already present in degenerative cranial cruciate ligament disease cases?

A

degenerative joint disease

126
Q

what percentage of degenerative cranial cruciate ligament disease occurs bilaterally?

A

30-50%

127
Q

what conditions in young, large breed dogs often lead to cranial cruciate ligament disease?

A

inflammatory arthropathy

tibial plateau angled by growth abnormaility

128
Q

at what age will dogs with inflammatory arthropathy and tibial plateau angled by growth abnormality present with cranial cruciate ligament disease?

A

6m - 6 years

129
Q

why may patients with cranial cruciate ligament disease not always have a positive cranial drawer?

A

there are 2 bands to the ligament and only one may have ruptured

130
Q

what are the 2 bands of the cranial cruciate ligament?

A

caudolateral

craniomedial

131
Q

when are the caudolateral bands of the cranial cruciate ligament tight?

A

only in extension

132
Q

when are the craniomedial bands of the cranial cruciate ligament tight

A

always

133
Q

what band of the cranial cruciate ligament is usually affect by partial tears?

A

craniomedial band

134
Q

why must the cranial drawer jest be performed in extension and flexion?

A

partial tears or different band rupture

135
Q

how is cranial cruciate ligament disease diagnosed?

A

gait analysis

physical exam

136
Q

what is found in the physical exam that suggests cranial cruciate ligament disease?

A
stifle pain especially on extension
effusion
crepitus
media buttress
instability on cranial drawer and tibial thrust tests
137
Q

what is assessed on the cranial drawer test?

A

abnormal movement between the femur and tibia

138
Q

how should the cranial drawer test performed?

A

grip femur and tibia
move tibia cranially
should be resistance / no movement

139
Q

under what conditions should the cranial drawer be tested?

A

flexion and extension

140
Q

what are the issues are the cranial drawer test?

A

can be painful

can be resisted in the conscious animal

141
Q

how should the tibial thrust test be performed?

A

hand over stifle with finger on tibia
mimic weightbearing on hock with other hand (flex and extend foot)
finger on tibia will move forward if more mobile (should not be)

142
Q

what are the advantages of the tibial thrust test?

A

easier in conscious animals and those standing
harder to resist
more comfortable

143
Q

what is the disadvantage of the tibial thrust test?

A

more difficult

144
Q

what is seen in the joint with cranial cruciate ligament disease?

A

reduced infrapatellar fat pad due to compression by synovial fluid
increased synovial fluid
new bone formation

145
Q

what does new bone formation indicate?

A

DJD

146
Q

what does new bone formation indicate?

A

DJD

147
Q

when is diagnosis of cranial cruciate ligament disease not straightforward?

A

not clearly unstable
DJD on radiograph
effusion

148
Q

what is usually happening with problem cranial cruciate ligament disease cases where they do not heave clearly unstable joints but there is DJD and effusion?

A

usually cruciate disease with partial rupture
other arthropathies possible
consider arthrocentesis

149
Q

when is conservative treatment of cranial cruciate ligament disease used?

A

if unsure of rupture

150
Q

what are the 2 types of surgery to correct cranial cruciate ligament disease?

A

intra or extra articular replacements

corrective ostotomy

151
Q

what is the intracapsular surgical treatment for cranial cruciate ligament disease?

A

over the top

152
Q

what is the extracapsular surgical treatment for cranial cruciate ligament disease?

A

fabello-tibial sutures

153
Q

what is the purpose of extra or intracapsular surgical treatment for cranial cruciate ligament disease?

A

sutures used to mimic function of cranial cruciate ligament

154
Q

what is the corrective osteotomy surgical treatment for cranial cruciate ligament disease?

A

TPLO

155
Q

what happens during a TPLO?

A

tibial plateau angle is altered to stop tibial thrust

156
Q

what is the post-op care needed for cranial cruciate ligament disease treatment?

A

varies with procedure

157
Q

what analgesia is needed post op cranial cruciate ligament surgery?

A

NSAIDs for 10-14 days

opioids for 24-48 hours

158
Q

what are the post op instructions and guidance for owners following cranial cruciate ligament disease repair?

A

surgery will not cure the dog but can slow arthritis progression
limited exercise is essential to protect repair
physio and hydro are important and will benefit recovery
the joint will never be normal again

159
Q

what is the complication rate for cranial cruciate ligament disease surgeries?

A

10-15%

160
Q

what is the success rate for cranial cruciate ligament disease surgeries?

A

85-90%

161
Q

what procedures to repair cranial cruciate ligament disease give the best outcome?

A

osteotomy

162
Q

what is the least effective cranial cruciate ligament repair technique?

A

over the top (intraartiular repalcement) - fascia pulled into joint

163
Q

what does evidence suggest about weight-bearing following cranial cruciate ligament repair?

A

early is better with TPLO compared to Fabellotibial suture

164
Q

what is the risk with TPLO surgery?

A

higher infection rate than F-T suture

higher severe complication rate

165
Q

how long can full recovery from cranial cruciate ligament surgery take?

A

several months

166
Q

what cannot be prevented by cranial cruciate ligament disease surgery?

A

DJD progression eventually

intermittent OA flare up in later life

167
Q

how many patients with cranial cruciate ligament disease have meniscal tears?

A

50%

168
Q

what must be performed on cranial cruciate ligament disease surgery to assess meniscus?

A

arthrotomy

169
Q

what meniscus usually tears?

A

medial

170
Q

what should be done if a meniscal tear is found on arthrotomy?

A

debride torn portion

leave unaffected meniscus

171
Q

what are late meniscus tears?

A

those missed during surgery or those that happen after

172
Q

how many meniscal tears are late?

A

up to 20% of tears

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