SA: Hip Injuries

Question 1

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Question 4

What are the stabilizers of the hip joint?

Answer 4

Normal congruency (femoral head and acetabulum)
Joint capsule and joint fluid (hydrostatic pressure)
Round ligament
Surrounding musculature

Question 5

What are the most important muscles for hip stability?

Answer 5

Gluteals: superficial, middle, deep
- extension, abduction, medial rotation of hip joint
Pectineus: adduction of thigh

Question 6

What are the general clinical signs of hip dysplasia?

Answer 6

‘Tight skirt’ gait
Bunny hopping
Rehab helps build muscle = hip benefits!!

Question 7

In general, what is the pathophysiology of hip dysplasia?

Answer 7

Question 8

What is the etiology of hip dysplasia?

Answer 8

Genetic predisposition + environmental

Question 9

What are the 3 components of hip dysplasia?

Answer 9

Hip laxity
Hip subluxation
Hip arthritis

Question 10

History: Hip Dysplasia

Answer 10

Not as active
Not jumping into car anymore

Question 11

What is the linear biphasic progression of hip dysplasia?

Answer 11

Juvenile: with severe HD, will have signs of joint laxity (synovitis, mm tearing, microfx of acetabulum)
Adult: joint inflammation –> periarticular fibrosis
(transient improvement in symptoms)

Question 12

Palpation: Hip Dysplasia

Answer 12

‘Ball and socket joint’
Sagittal plane ROM (extension/flexion)
Frontal plane ROM (abduction)
PAIN ON BOTH

Question 13

What are the differential diagnoses for pain on hip extension/flexion?

Answer 13

Hip dysplasia
Cranial cruciate ligament disease (pain on stifle hyperextension)
Neurologic disease (pain on LS palpation)
Hip flexor disease (pain on stretching hip flexor)

Question 14

What HD palpation tests should be used for juveniles?

Answer 14

Ortolani
Dorsal or lateral recumbency –> subluxate hip –> abduct
Reduction = positive

Question 15

What does the sit test look like with HD?

Answer 15

Positive
Similar to CCLD
See bunny hopping (try going upstairs)

Question 16

What is normal femoral head coverage?

Answer 16

> 50%

Question 17

Answer 17

Fully subluxated

Question 18

Answer 18

Degenerative joint disease

Question 19

Answer 19

Top = osteophytes
Bottom = subchondral bone sclerosis

Question 20

What is the significance of normal OFA due to wind-up?

Answer 20

Joint capsule is tighter when hip is extended so it makes hips look better than they actually are

Question 21

When are OFA views best?

Answer 21

Always a good start for juvenile HD diagnostic, but not always diagnostic –> PennHIP is better

Question 22

What is required for PennHIP view radiographs?

Answer 22

Distraction view

Question 23

What do PennHIP radiographs measure?

Answer 23

“Passive (not functional) laxity” with distraction index

Question 24

What is indicative of different DI values?

Answer 24

<0.3 = no OA
>0.7 = OA

Question 25

How is distraction index measured?

Answer 25

*PennHIP* DI = d/r

Question 26

What does DI correlate with?

Answer 26

DJD probability at >2 years

Question 27

What information does PennHIP provide?

Answer 27

Patient DI OA risk category Breed average DI Central 90% range of the breed DI's

Question 28

What is the PennHIP breeding recommendation?

Answer 28

Any dog with a DI tighter than the breed average and not showing radiographic hip OA

Question 29

How is hip dysplasia diagnosed in juveniles (less than 5m)?

Answer 29

Gait difficult to assess Ortolani if positive Radiographs: OFA may not be sufficient, so PennHIP

Question 30

How is hip dysplasia diagnosed in immature animals (5-14m)?

Answer 30

Gait abnormalities Ortolani to specify how it palpates Radiogaphs: OFA likely sufficient, PennHIP is no obvious subluxation

Question 31

How is hip dysplasia diagnosed in adult animals (>14m)?

Answer 31

Abnormal gait Ortolani usually not present Radiographs: OFA like always sufficient

Question 32

What is the treatment for HD in patients <5m old?

Answer 32

Juvenile pubic sympysiodesis

Question 33

What is the treatment for HD in patient 5-14m?

Answer 33

Triple pelvic osteotomy *Increases coverage of femoral head*

Question 34

What are indications for a TPO?

Answer 34

6-12m Clinical symptoms No significant DJD Adequate dorsal acetabular rim (DAR)

Question 35

What is the progression of diagnosis and treatment with immature HD?

Answer 35

Question 36

Compare JPS and TPO

Answer 36

Question 37

What are the treatments for adults with HD?

Answer 37

Medical management Total hip replacement Femoral head and neck Ex

Question 38

What are options for medical management in adults with HD?

Answer 38

**Omega 3 fatty acids** **Weight loss/control** NSAIDs Exercise modification/rehadbilitation Glucosamine CS

Question 39

What are complications of total hip replacements?

Answer 39

Short term: femur fracture, luxation Long-term: aseptic loosening, implant failure

Question 40

Femoral Head and Neck Excision

Answer 40

Eliminates bony contact (= source of pain) between acetabulum and femoral head Creates fibrous pseudoarthrosis *Results are variable*

Question 41

Femoral Head Osteotomy

Answer 41

*Not advised in juvenile patients due to risk of bone regrowth* **Can always FHO, Cannot THR after FHO**

Question 42

Gait: Hip Luxation

Answer 42

Adducted with externally rotated stifle Limb length discrepancy

Question 43

What is the most common direction of hip luxation?

Answer 43

Craniodorsal

Question 44

Answer 44

Hip luxation

Question 45

Treatment: Hip Luxation

Answer 45

*Usually traumatic, so treat the patient first* Then, ASAP closed reduction

Question 46

What are the subsequent steps after a successful hip luxation closed reduction?

Answer 46

Dorsal: sling for 10-14d Ventral: hobbles for 14d (prevents abduction)

Question 47

What are the treatments for hip luxation if closed reduction is unsuccessful?

Answer 47

Open reduction and stabilization (if good hip conformation, best chance for normal hip) FHO (salvage procedure) THR (if poor hip conformation, esp larger dogs)

Question 48

What are the options for open reduction of hip luxation treatment?

Answer 48

Hip joint: trochanteric osteotomy, craniolateral approach Sx stabilization: capsulorrhapy, capsular augmentation, toggle pin or tightrope

Question 49

Legg Calve Perthes Disease

Answer 49

Non- inflammatory, aseptic necrosis of the femoral head Commonly 5-8m old toy and terrier breeds *FHO*