Hip (coxofemoral) joint conditions (Yr4)

Question 1

what are the ligaments that connect to the round head of the femur?

Answer 1

teres ligaments

Question 2

what are the main muscles around the hip joint?

Answer 2

gluteals

Question 3

what are the main developments conditions of the hip?

Answer 3

hip dysplasia
Legg-calve-perthes disease

Question 4

what type of joint is the hip?

Answer 4

diarthrodial (wide range of motion)

Question 5

how does the acetabulum of the dog and cat compare?

Answer 5

dogs is deep
cats is more shallow

Question 6

what is the primary stabiliser of the hip joint?

Answer 6

teres ligament (ligament of the round head of the femur)

Question 7

what helps to stabilise the hip joint?

Answer 7

teres ligament
joint capsule
gluteal muscles

Question 8

what does the sciatic nerve divide into?

Answer 8

tibial and perineal nerve

Question 9

where does the sciatic nerve divide into the tibial and perineal nerves?

Answer 9

level with the stifle

Question 10

what are the landmarks of the hip joint?

Answer 10

wing of ileum
ischiatic tuberosity
greater trochanter
(form a triangle)

Question 11

what should be done on a clinical exam of the hip joint?

Answer 11

flexion and extension
internal/external rotation in extension
abduction and adduction
(try do without stifle flexing)

Question 12

what are some predisposing factors of hip dysplasia?

Answer 12

genetics
bodyweight
nutrition (high protein)
growth rate (fast)

Question 13

what is the pathogenesis of hip dysplasia?

Answer 13

laxity due to poor tissue coverage then osteoarthritic changes due to this

Question 14

what does hip dysplasia lead to?

Answer 14

oesteoarthritis

Question 15

what causes the pain associated with hip dysplasia?

Answer 15

femoral head hitting dorsal acetabular rim

Question 16

what age dogs usually present with hip dysplasia?

Answer 16

8-12 months old

Question 17

what breeds are predisposed to hip dysplasia?

Answer 17

labradors
rottweilers
collies
setters

Question 18

what are the clinical signs immature dogs with hip dysplasia present with?

Answer 18

unilateral/bilateral hindlimb lameness
bunny hopping (back legs move together)
reluctance to exercise
pain upon flexion/extension
positive ortolani test

Question 19

what are the two groups of dogs that present with hip dysplasia?

Answer 19

young immature (<12 months)
older dogs with osteoarthritis

Question 20

what clinical signs do mature dogs with hip dysplasia present with?

Answer 20

stiffness after rest/exercise
bunny hopping
bilateral lameness
pain upon manipulation
reduced range of motion

Question 21

what static radiographic views should be taken for suspected hip dysplasia?

Answer 21

ventrodorsal extended/frog-legged
lateromedial view

Question 22

what are some early (primary) radiographic changes associated with hip dysplasia?

Answer 22

wide joint space with medial divergence
less than 50% of femoral head within the acetabulum

Question 23

what are some secondary radiographic changes associated with hip dysplasia?

Answer 23

new bone formation of femoral neck
remodelling of femoral head/neck
remodelling of acetabular rim

Question 24

what are the two options for treating mip dysplasia?

Answer 24

conservative
surgical

Question 25

when should conservative management of hip dysplasia be used?

Answer 25

always worth trying unless dog is very painful or if owners very keen for surgery

Question 26

how can hip dysplasia be conservatively/medically managed?

Answer 26

analgesia (NSAIDs and paracetamol) weight control exercise/environmental modification nutritional management (nutraceuticals) educate owners

Question 27

what surgical interventions are available for young dogs with hip dysplasia?

Answer 27

double/triple pelvic osteotomy juvenile pubic symphisiodesis

Question 28

what surgical interventions are available for all dogs with hip dysplasia?

Answer 28

femoral head and neck excision total hip replacement (>9 months)

Question 29

why should you exercise dogs after femoral head and neck excisions?

Answer 29

gluteal muscles give the main portion of the stability for the joint, hence they need to be strengthened

Question 30

what is the gold standard treatment of hip dysplasia?

Answer 30

total hip replacement

Question 31

when does JPS treatment of hip dysplasia have to be done?

Answer 31

before 20 weeks of age

Question 32

what is JPS treatment of hip dysplasia?

Answer 32

intermittent electrocautery of the pubic chondrocytes to shorten the pubic bones and cause ventrolateral rotation of the acetabulum

Question 33

what breeds is Legg-calve-perthes disease seen in?

Answer 33

small breeds (terriers, westies...)

Question 34

what is Legg-calve-perthes disease?

Answer 34

an ischaemia of the femoral head leading to deformities and collapse

Question 35

how should Legg-calve-perthes disease be treated?

Answer 35

surgery (femoral head and neck excision of total hip replacement)

Question 36

what disease is similar to Legg-calve-perthes disease, but seen in cats?

Answer 36

slipped femoral capital physis

Question 37

what age animals are capital physical fractures seen in?

Answer 37

immature (4-7 months old) secondary to trauma

Question 38

what is the first thing to do when presented with a pelvic fracture?

Answer 38

stables the animal

Question 39

what is a very poor prognostic indicator for pelvic fractures?

Answer 39

no movement or deep pain

Question 40

what should be assessed if you find one fracture of the pelvis?

Answer 40

look for the second one (will always be two as the pelvis is shaped like a box)

Question 41

what pelvic fractures are suitable for conservative management?

Answer 41

if they are non-weight bearing (pubis, ischium, wing of ilium)

Question 42

what conservative management should be given to pelvic fracture cases?

Answer 42

cage/small room rest for 4-6 weeks turning then and padded bedding (if non-ambulatory) check bladder qid if not urinating analgesia (opioids)

Question 43

what is the analgesia of choice for pelvic fractures?

Answer 43

opioids (full or partial agonists) - buprenorphine

Question 44

what pelvic fractures need surgery?

Answer 44

weight bearing - acetabulum, ipsilateral fractures of ilium/pubis/ischium, iliac shaft, sacroiliac joint severely painful neurological deficits

Question 45

what is the post-operative care for pelvic fractures?

Answer 45

cage/small room rest for 4-6 weeks short lead walks (10 minutes) see at 3 and 7 days, and 4-8 weeks analgesia and soft bedding physiotherapy/hydrotherapy