Coxofemoral Joint 2022 PDF

The Coxofemoral (Hip) joint The Coxofemoral (Hip) joint Review of anatomy/clinical examination Conditions of hip joint Developmental conditions • Hip dysplasia • Legg-Perthes disease Traumatic conditions • Fractures • Luxation/Dislocation Objectives of lecture •Know normal anatomy of hip •Be abl...

The Coxofemoral (Hip) joint The Coxofemoral (Hip) joint Review of anatomy/clinical examination Conditions of hip joint Developmental conditions • Hip dysplasia • Legg-Perthes disease Traumatic conditions • Fractures • Luxation/Dislocation Objectives of lecture •Know normal anatomy of hip •Be able to identify most common hip conditions •Know how to primarily manage most common hip conditions Anatomy §Diarthrodial joint §Wide range of movement §Stability augmented by surrounding structure esp. teres ligament and joint capsule §Know how to identify joint capsule! Anatomy Review of clinical examination Review of clinical examination Conditions of hip Developmental • Hip dysplasia (HD) • Legg-Perthe’s disease Traumatic • Fractures of acetabulum • Fractures of femoral head and neck • Coxofemoral luxation Acquired • Hip OA • Neoplasia • Immune mediated arthropathy Hip dysplasia (HD) Aetiopathogenesis: • Laxity and instability of hip joint • Large breed dogs/Devon Rex cat • Genotype and then bodyweight, nutrition, growth rate Hip dysplasia (HD) Aetiopathogenesis: • Laxity due to poor soft tissue cover, then OA change as response • Pain as femoral head hits dorsal effective acetabular rim • Clinical signs “subside” 1218mo HD-History and clinical signs Two groups usually presented: • Immature dogs<12mo • Adult dogs with OA secondary to HD HD-Clinical signs Immature dogs • Less than 1 year old • Unilateral/bilateral HL lameness • “bunny-hopping” • Reluctance to exercise • Pain upon hip extension/flexion • Positive Ortolani test HD-Clinical signs Adult dogs • Mature dogs • Stiffness after rest/ exercise • “Bunny-hopping” • Usually bilateral • Pain upon joint manipulation and reduced ROM • Differentiate from bilateral stifle, hock and lumbosacral disease HD-Diagnosis HISTORY+CLINICAL+ RADIOLOGIC SIGNS- NB !!!!!!! Radiography • Static o o o o VD extended/frog-legged Lateromedial view Special views Important for BVA/KC scheme HD-Diagnosis HISTORY+CLINICAL+ RADIOLOGIC SIGNS- NB !!!!!!! Radiography • Dynamic-Distraction index (DI) (Not common in UK) o Penn Hip/ Can do accredited course here o DI: 0 (in) -1 (completely out) scale v <0.3 no risk v >0.7 has HD HD- Radiologic changes Early (primary) changes • Important to note for Double/Triple pelvic osteotomy (DPO/TPO) • Wide joint space with medial divergence • Centre of femoral head lateral to dorsal acetabular edge HD- Radiologic changes Secondary changes: • New bone formation of femoral neck (Morgan line) • Remodelling of femoral head/neck • Remodelling of cranial effective acetabular rim HD-Treatment • Conservative treatment o 75-80% success rate (Denny and Barr 1987) o Farrell 2007-50% on NSAIDs • Surgical treatment HD-Surgical treatment • Surgical treatment o Only if non-responsive to conservative management o Young dogs v (Double/Triple pelvic osteotomy) v Juvenile pubic symphisiodesis o All dogs v Femoral head and neck excision (FHNE) v (> 9 months) Total hip replacement (THR) TPO HD- Treatment: JPS Recent technique (Dueland, 2001, 2010a and b, Patricelli, 2002, Vezzoni 2008) • Causes thermal arrest of pubic chondrocytes by electrocautery/staples • Shortening of pubic bones and fixed in pelvis • Results in ventrolateral rotation of acetabulum and better congruity • Courtesy of J. Innes Similar to TPO HD- Treatment: JPS Identification of ideal cases challenging • Most changes to pelvis before 20 weeks • Need to diagnose @1416 weeks • DI used to diagnose reliable after 4 months • (0.3-0.5- moderate laxity) HD- Treatment: JPS Outcome •JPS dogs do better than conservative with mild/moderate HD •No effect if performed after 22 weeks HD-Surgical treatment- FHNE • Salvage procedure • Use to treat LeggPerthe's, unreducible #s • SUCCESS RATE Moderate to poor IN DOGS >15-20 KG • Craniolateral approach to hip • Remove all neck and bony spurs • REMEMBER POINT PATELLA TO THE SKY! HD-Surgical treatment- FHNE HD-Surgical treatment- THR THR • Treatment of choice in dogs (more recently can all dogs and cats (micro and nano) • Contraindicationso Chronic systemic illness e.g skin • Maintained on analgesics • Expensive- £4500-7000 + vat Conditions of hip Developmental • Hip dysplasia (HD) • Legg-Perthe’s disease Traumatic • Fractures of acetabulum • Fractures of femoral head and neck • Coxofemoral luxation Acquired • Hip OA • Neoplasia • Immune mediated arthropathy Legg-Calve-Perthe’s disease §Small breeds such as WHWT §Heritable in WHWT and Manchester terriers §Ischaemia of femoral head bone leads to deformity and collapse §Hx and CS: § Immature dogs(c. 5mo old) § Unilateral lamenessusually Legg-Calve-Perthe’s disease Diagnosis: • Hx and CS • Pain/crepitus upon hip manipulation • Radiography-frog-leg and VD extended Treatment: • Surgical > conservative • FHNE/THR • Post op rehabilitation-very important Slipped femoral capital physis in cats Slipped femoral capital physis in cats Conditions of hip Developmental • Hip dysplasia (HD) • Legg-Perthe’s disease Traumatic • Fractures of acetabulum • Fractures of femoral head and neck • Coxofemoral luxation Acquired • Hip OA • Neoplasia • Immune mediated arthropathy Femoral head and neck fractures §Capital and Capital physeal §Femoral neck §Greater trochanter Capital physeal fractures Immature animals (4-7mo) Secondary to trauma Pain upon hip manipulation Dx • HX, CS, Radiography Tx • • Three diverging/parallel K or arthrodesis wires Craniolateral or dorsal approach to hip Conditions of hip Developmental • Hip dysplasia (HD) • Legg-Perthe’s disease Traumatic • Fractures of acetabulum • Fractures of femoral head and neck • Coxofemoral luxation Acquired • Hip OA • Neoplasia • Immune mediated arthropathy Coxofemoral luxation §Commonest luxation in small animals §Following major trauma e.g. RTA §Animals usually >12mo §Can occur in may directions but usually craniodorsal Basil Morey, 4 yo Pointer RTA Coxofemoral luxation-Clinical signs §Leg carried in flexion, stifle out, hock in (CD luxn) §Greater trochantermore prominent- look for asymmetry §Assess triangle between TI, GT and iliac crest Coxofemoral luxation-Clinical signs Coxofemoral luxation-Clinical signs Coxofemoral luxation-Diagnosis History and CS Radiography • VD and lateral • Rule out other problems such as HD and capital fractures • 2 views! Coxofemoral luxation-Treatment §Closed reduction (initially) unless HD or avulsion fracture of femoral head. §If re-luxation occurs then open reduction and stabilisation Coxofemoral luxation-Treatment Closed reduction • Within 48 hours of injury • GA and tie dog to table • Take post-op rads to ensure reduction • Post reduction- NB- (place in Ehmer sling) and cage rest for 7-10 days • If worried- keep in surgery • Reluxation due to haematoma or fragments in acetabulum Coxofemoral luxation-Treatment Open reduction and stabilisation • Craniolateral approach to hip • Remove haematoma and bone fragments from acetabulum and lavage • Replace femoral head with caudal traction of femur • Suture joint capsule • Keep in place by augmenting joint capsule Coxofemoral luxation-Treatment §Suture joint capsule §Capsulorrhaphy §Toggle fixation §Transarticular pinning §Iliofemoral suture Hip- Summary §Conditions commonly seen in practice- HD, Hip OA, Legg-perthes, Coxofemoral luxations §HD and Hip OA can be treated conservatively > surgically (NB CS and Radiologic signs) §Coxofemoral luxations must be reduced within 48 hours or open reduction is required §FHNE is a technique which can be used to treat Legg- perthe’s disease Further reading §Barr and Denny, 1987, JSAP, 28, 243-252 §BSAVA Musculoskeletal and fracture manuals §Denny and Butterworth 2000 §Piermattei, Geeley, An Atlas of Surgical approaches to the bones of the dog and cat Any questions?