Orthopaedics: Common Conditions of the Hip Flashcards
(26 cards)
What is the name of the hip joint?
Coxofemoral joint
- What developmental conditions may affect the coxofemoral joint?
- What traumatic conditions may affect the hip joint?
- Developmental
* Hip dysplasia
* Legg-perthes disease - Traumatic
* Fractures- hip and pelvis
* Luxation/dislocation
What acquired conditions of the hip can develop?
- Hip OA
- Neoplasia
- Immune mediated arthropathy
What is the aetiopathogenesis of hip dysplasia?
- Laxity and instability of hip joint
- Large breed dogs/Devon rex cat
- Genotype and then BW, nutrition, growth rate
- Laxity due to poor soft tissue cover
- OA change as a response
- Pain as femoral head hits dorsal effective acetabular rim
- Clinical signs ‘subside’ 12-18mo
What are the two commonly presented groups with hip dysplasia?
- Immature dogs < 12 months
- Adult dogs with OA secondary to HD
What are the clinical signs of hip dysplasia in imature dogs?
- Less than 1 yo
- Unilateral/bilateral HL lameness
- ‘Bunny-hopping’
- Reluctance to excercise
- Pain upon hip extension/flexion
- Positice ortolani test
What are the clinical signs of hip dysplasia in adult dogs?
- Mature dogs
- Stiffness after rest/excercise
- Bunny hopping
- Usually bilateral
- Pain upon joint manipulation and reduced ROM
- Differentiate from bilateral stifle, hock and lumbosacral disease
How is hip dyplasia diagnosed?
- History and CS
- Radiographic signs: Static
VD extended/frog-legged
Lateromedial view
Special views - Dynamic-distraction index 0-1
- 1- joint out, 0 in
- What early (primary) changes occur in hip dysplasia?
- What secondary changes occur?
- Primary
* Important to note for double/triple pelvic osteotomy
* Wide joint space with medial divergence
* Centre of femoral head lateral to dorsal acetabular edge
2) Secondary
* New bone formation
* Remodelling of femoral head/neck
* Remodelling of cranial effective acetabular rim
What conservative treatment can be given for HD treatment?
- NSAIDs
- Weight control
- Excercise/environment modification
- Nutritional managment- nutraceuticals
- Adjunct medications
- Adjunct therapies
- Education
What surgical treatment can be given to young dogs and all dogs?
Young dogs
* Double/triple pelvic osteotomy
* Juvenile pubic symphisiodesis
All dogs
* Femoral head and neck excision
* > 9mo, total hip replacement
What are the pros and cons of juvenile pubic symphisiodesis?
- Risk over 20 weeks of age
- Not often done
What are the pros and cons of femoral head and neck excision?
- Salvage procedure
- Used to treat legg-perthes unreducible
- Craniolateral approach
- Removal all neck and bony spurs
What are the pros and cons of total hip replacement?
- Treatment of choice in dogs
- Contraindications- chronic systemic illness
- Maintained on analgesics
- Spenny
- What breeds are pedisposed to Legg-Calve-Perthes disease?
- What is the pathogenesis?
- What is the usual history and clinical signs?
- How is it diagnosed?
- How is it treated?
- Small breeds such as WHWT
- Ishaemia of femoral head bone leads to deformity and collapse
- Immature dogs, unilateral lameness
- Hx and CS, pain/crepitus upon hip manipulation, radiography-frog-leg and VD extended
- Surgical > Conservative- Femoral head and neck excision, total hip replacement
Where are femoral head and neck fractures more common?
- Capital and capital physeal
- Femoral neck
- Greater trochanter
- What age more commonly fracture their capital physeal?
- What is it secondary to?
- How is it diagnosed?
- How is it treated?
- Immature animals (4-7mo)
- Secondary to trauma
- HX, CS (pain upon manipulation), radiography
- Three diverging/parallel K or arthrodesis wires, craniolateral or dorsal approach to hip
What is assessed with suspected pelvic fracture?
- Assess urinary tract
- Neurological exam- sciatic with ilial fracture- assess CPS
- Assess function of pelvic nerve-anal/perineal reflex
- Palpate and feel for crepitus, assess for asymmetry
- May be shearing injuries
How should a pelvis be radiographically assessed for fractures?
- There is always two fractures- like a box
What are the treatment options for pelvic fractures?
What are the general considerations?
Conservative or Surgical
* 75% conservative would work
* Area of pelvis affected
* Small animals do better
* Surgery is needed within 5 days
* Use of animal
* Finance
When is conservative managment of pelvic fractures suitable?
Non weight bearing axes
* Pubis
* Ischium
* Wing of ilium
What does conservative managment of pelvic fractures entail?
- Cage rest/small room rest for 4-6 weeks
- If non-ambulatory- frequent turning and soft bedding
- Check bladder qid if not urintating consciously
- Analgesia- opioids- full or partial agonists, NSAIDs
When is surgical treatment of pelvic fractures indicated?
- Acetabulum- controversial
- Ipsilateral fractures of ilium, pubis, ischium
- Iliac shaft
- Sacroiliac joint
- Fractures causing marked stenosis of pelvic canal
- Pain
- Neurological defecits
- When are sacroiliac separations commonly seen?
- How can they present?
- When do they need surgical treatment?
- What are the methods of treatment?
- Commonly seen post RTAs
- If nerve root entrapment- pain++
- Painful, non-ambulatory, marked displacement, other contralateral fractures
- Lag screw fixation, transilial pin
