Coxofemoral Luxation Research Articles

Haemato-biochemical evaluation of toggle pin technique in dogs for the repair of coxofemoral luxation

Haemato-biochemical evaluation of toggle pin technique in dogs for the repair of coxofemoral luxation

Comparison of intraoperative outcomes in excision arthroplasty with or without partial tenotomy of deep gluteal muscle in dogs

Background: Excision arthroplasty is a commonly performed surgical technique for treating coxofemoral luxation in dogs. Favourable outcomes have been reported in dogs up to 15 kg. Aim: This study aimed to compare the intraoperative findings of two surgical approaches i.e., with or without partial deep gluteal muscle tenotomy in the excision arthroplasty in dogs. Methods: A total of 15 dogs having average body weight 15.6 kg (3.5-26) and 29.5 months (6-72) of age were brought to the Veterinary Surgery Clinics at University Veterinary Hospital, Samsun, Turkey with traumatic coxofemoral luxation or femur head/neck fracture. Craniolateral incision was used to approach the craniodorsal aspect of the hip joint in all cases. Myotomy of the superficial gluteal muscle and partial tenotomy of the deep gluteal was performed in one group. While blunt dissection approach was performed for elevation of gluteal muscles in another group. Results: Fifteen dogs (myotomy and tenotomy in 8 dogs and without tenotomy in 7 dogs) were diagnosed having lesions along with coxofemoral luxation in 9 cases, femoral neck fracture in 5 cases and caput femur fracture in 1 case. Partial tenotomy improved the exposure of joint capsule and femur neck. Discussion and Conclusion: The remnants of femoral neck after excision arthroplasty may contact the acetabulum and cause pain in the postoperative period. By applying the partial deep gluteal muscle tenotomy technique, surgeons can readily expose joint capsule, femoral head, femoral neck, and great and lesser trochanter.

A case report of a cementless total hip replacement performed in a pelvic limb amputee after a failed surgical reduction of a traumatic coxo-femoral luxation with a toggle rod.

Coxo-femoral luxation is the most common luxation seen in dogs after road traffic accidents. There are multiple surgical techniques to repair the luxation. These range from a capsular reconstruction to a total hip replacement. This case report describes a total hip replacement to repair a failed toggle rod repair of a coxo-femoral luxation in a Greyhound pelvic limb amputee. The dog returned to normal activity as a household pet three months post-surgery and at the last follow-up consultation at 12 months post-surgery the dog was able to maintain an acceptable activity level as an amputee with no radiographic signs of complications.

Efficacy of Modified Toggle Splint with Nylon Suture for ‎‎Stabilization of Coxofemoral ‎Luxation in Dogs

Coxofemoral luxation is a common orthopedic lesion in dogs. This study aimed to evaluate ‎the effectiveness of a modified toggle splint with nylon suture as a prosthetic teres ligament ‎for reducing and fixing coxofemoral luxation in dogs. Five adult mongrel dogs weighing ‎‎15±2 kg were used in this experimental study. The toggle splint was fabricated from a ‎Steinmann pin (1cm length, 2mm diameter) by drilling 0.5 mm hole in the center. ‎Stabilization of coxofemoral joint was performed by a modified Toggle splint technique. A ‎tunnel, from the major trochanter through the fovea capitis to the acetabulum, was ‎performed in which the toggle splint was passed through, and nylon suture was used for ‎fixation. Dogs were scored for lameness severity at 0-, 14-and 42-day post-operation using a ‎numerical rating scale (NRS) with 5 levels, and reductions were assessed radiographically ‎at three-time points the day of operation, day 28th, and day 42nd. The results showed that the ‎treatment splint was effective in achieving good reduction and fixation in four out of five ‎‎(80%) dogs at all time points. Reluxation was observed only in one dog (20%) up to week 6 ‎post-operation. The mean lameness score on day 14 (2.0±0.87) and 42 (0.60±0.60) were ‎significantly lower (P<0.001) compared to day 0. These results indicate that the modified ‎toggle splint with nylon suture is a promising treatment option for canine coxofemoral ‎luxation.

Computer-assisted surgery for placing toggle constructs across the coxofemoral joints of small equids using a minimally invasive approach-A proof-of-concept cadaveric study.

To develop a minimally invasive technique for placing a toggle construct across the coxofemoral joint of small equids using computer-assisted surgery. Experimental cadaveric study. Three pilot specimens: One donkey, one Shetland pony and one Warmblood foal. Six main study specimens: Three Shetland ponies, one American Miniature Horse, one Warmblood foal and one donkey. Experimental surgeries were performed on both coxofemoral joints of each cadaver. Using a minimally invasive surgical approach, 5.5 mm bone canals were drilled through the femur and acetabulum, traversing the coxofemoral joint. Intraoperative guidance was provided by a cone-beam computed tomography (CBCT)-coupled surgical navigation system. A toggle construct was introduced through the bone canals. Surgical accuracy aberrations (SAA) were measured at the femoral entry and exit points and at the acetabular entry point on merged pre- and postoperative CBCT scans. The coxofemoral joint was assessed for articular cartilage damage by gross dissection. A toggle construct was placed across all 18 coxofemoral joints. The overall median SAA in the main study was 2.8 mm (range: 0.4-8.0 mm). No cartilage damage was found in the cadaveric specimens of the main study. The described technique allowed for the placement of a toggle construct across the coxofemoral joint of small equid cadaveric specimens without prior coxofemoral luxation. This technique may serve as an option for surgical stabilization of coxofemoral joints in small equids. Further biomechanical investigations are required to assess optimal implant positioning and toggle constructs.

Surgical Stabilisation of a Coxofemoral Luxation in a Northern Goshawk (Accipter gentilis) with Transarticular Pinning

A 3-year-old male northern goshawk (Accipiter gentilis) used in falconry for hunting was diagnosed with a craniodorsal coxofemoral luxation of the left leg after an unsuccessful hunting flight. Closed reduction in the dislocation was unsuccessful and the hip joint reluxed again with slight abduction of the limb. An open surgical reduction with a transarticular stabilization using a normogradely inserted Kirschner wire was performed. The implant was removed surgically after five weeks. After about seven weeks, the owner saw no abnormalities in the loading of the limbs, and the goshawk was successfully used for hunting after nine months in the next hunting season.

Arthroscopic-assisted hip toggle stabilization in cats: An ex vivo feasibility study.

To describe arthroscopic-assisted hip toggle stabilization (AA-HTS) in cats, evaluate its feasibility and associated rate of iatrogenic injury, and assess deviations from planned surgical technique. Ex vivo study. Skeletally mature cat cadavers (n=7). Preoperative pelvic computed tomography (CT) was performed for surgical planning and to identify the ideal femoral bone tunnel projection. Ultrasound-guided transection of ligament of head of femur was performed. Following exploratory arthroscopy, AA-HTS was performed using a commercially available aiming device. Surgical time, intraoperative complications, and feasibility of technique were recorded. Iatrogenic injury and technique deviations were assessed by postoperative CT and gross dissection. Diagnostic arthroscopy and AA-HTS were successfully performed in all 14joints. Median (range) surgical time was 46.5 (29-144) min, including 7 (3-12) min for diagnostic arthroscopy and 40 (26-134) min for AA-HTS. Intraoperative complications occurred in 5 hips, related to bone tunnel creation (4) and toggle dislodgment (1). Toggle passage through the femoral tunnel was the most challenging component of technique, recorded as mildly difficult in 6 joints. No damage to periarticular/intrapelvic structures was identified. Minor articular cartilage damage (<10% total cartilage area) was identified in 10 joints. Thirteen deviations (8 major, 5 minor) in surgical technique from preoperative planning were identified in 7 joints. In feline cadavers AA-HTS was feasible but was associated with a high rate of minor cartilage injury, intraoperative complications, and technique deviations. Hip toggle stabilization using an arthroscopic-assisted approach may be an effective technique for management of coxofemoral luxation in cats.

Diagnostic Procedures and Surgical Treatment of Craniodorsal Coxofemoral Luxation in a dwarf rabbit

To our knowledge, there are no sufficient reports on the full management of hip luxation in rabbits, including descriptions of the diagnostics procedure with the use of computed tomography, surgical procedure, and postoperative management with a measurable assessment of the results. The objective of this study was to report on a computed tomography examination of a coxofemoral joint in a rabbit, a surgical technique for the repair of craniodorsal coxofemoral dislocation, as well as short- and long-term postoperative outcomes. Craniodorsal coxofemoral luxation was diagnosed by physical examination and radiographic examination. A craniodorsal luxation of the femoral head and the presence of an intact femoral neck were confirmed by computed tomography. An ostectomy of the femoral head and neck was performed using a craniolateral open approach. The coxofemoral luxation was successfully reduced, and reluxation did not occur. At short- and long-term follow-ups, in parallel with clinical examination, an extensive pain assessment protocol was applied. CT proved to be a simple and effective technique and should be considered as an alternative to radiographic examination for diagnosis of coxofemoral luxation in rabbits. An immediate surgical intervention in hip dislocation in rabbits is necessary to alleviate pain associated with the movement of the injured joint and to avoid development of degenerative changes. In follow-up examinations after the procedure, a reliable assessment of postoperative pain and the effectiveness of perioperative analgesia should be made by introducing a postoperative pain assessment protocol. It could simplify an objective comparison between outcomes of different orthopaedic procedures in rabbits.

Evaluation of the treatment of traumatic coxofemoral luxations in dogs using toggle pin technique

This study was performed on 11 dogs diagnosed with traumatic coxofemoral luxation. The direction of the luxations, the operation details, postoperative complications, and radiographic evaluation were recorded during the study. The study utilized the toggle pin technique, which provided open-reduction techniques for the treatment of coxofemoral luxations. Polyester multifilament braided sutures with commercial toggle pins were employed in three cases, whereas toggle pins obtained from Kirschner wire and monofilament nylon suture material were performed in eight patients. Clinical and radiographic monitoring of postoperative lameness, complications, pain, and infection were assessed and recorded for comparison. Postoperative reluxation was observed in two cases in which multifilament braided polyester suture material was performed without other complications. In the cases without reluxation, it was noted that the animals used their limbs comfortably on the 1st postoperative day, and their lameness scores were 0 on the 7th postoperative day. As a result of the findings, the toggle pin technique using monofilament nylon suture could effectively treat coxofemoral luxations in dogs.

Prognostic indicators for survival of downer cattle treated using a flotation tank in a referral hospital: 190 cases (2000-2020).

Nonambulatory cattle present therapeutic challenges in addition to animal welfare concerns. Flotation therapy is a treatment option, but more information regarding prognostic indicators for survival is needed to guide use of this modality. Evaluate historical and clinical variables assessed during hospitalization as prognostic indicators for survival in recumbent cattle undergoing flotation treatment in a referral hospital. A total of 190 nonambulatory dairy cattle. Retrospective case series. Medical records were analyzed from cattle undergoing flotation between 2000 and 2020. Univariable and multivariable logistic regression analyses were performed to assess the association of clinical variables with survival to discharge. Eighty-nine of 190 (47%) recumbent cattle survived to discharge. For each additional day of hospitalization, cattle were 1.10 (95% confidence interval [CI], 1.02, 1.21) times more likely to survive. Cattle unable to walk out of the tank after their first float session were 0.11 (95% CI, 0.04, 0.28) times less likely to survive compared to cattle that could and inappetent cattle were 0.22 (95% CI, 0.07, 0.63) times less likely to survive compared to cattle with normal appetites. Cattle diagnosed with coxofemoral luxation or toxemia were 0.11 (95% CI, 0.02, 0.65) and 0.16 (95% CI, 0.02, 0.90) times less likely to survive, respectively, compared to cattle with causes of recumbency that were undetermined. Walking out of the tank after the first float session, appetite, diagnosis, and days of hospitalization are associated with outcome in nonambulatory dairy cattle treated by flotation. These findings can be used to determine likely outcome and guide treatment, referral, or euthanasia decisions.

Clinical outcomes of canine total hip replacement utilizing a BFX lateral bolt femoral stem: 195 consecutive cases (2013-2019).

To evaluate the clinical outcomes of total hip replacements (THR) utilizing a BFX lateral bolt stem in dogs with coxofemoral joint disease. Retrospective study. A total of 149 dogs representing 195 THR. Consecutive THRs utilizing a BFX lateral bolt stem were studied. Preoperative, immediate postoperative, 1-, 2-, 3-, 4-, and 12-month postoperative radiographs were performed. All major and minor complications, revisions, outcomes, subsidence, canal flare index (CFI) were recorded. An intraoperative complication rate of 11.8% was observed. The postoperative complication rate was 13.6%, with 9.2% major and 4.4% minor complications. Complications included: postoperative femur fractures (3.6%), coxofemoral luxation (3.6%), stem failure (0.5%), septic loosening (0.5%), aseptic loosening (0.5%), and acetabular fracture (0.5%). Three dogs underwent prophylactic plating after subjective assessment of cortical thickness. Five of 195 (2.6%) cases underwent explant of their prostheses (median=3months). Mean stem subsidence at 1 month postoperatively was 1.22 ± 0.16 mm. An increased CFI was associated with postoperative femur fractures (p < .05). A total of 190 of 195 (97.4%) cases returned to normal function in the long-term follow-up period. Use of the BFX lateral bolt stem resulted in minimal postoperative subsidence, a low femoral stem complication rate, and a high rate of achieving normal limb function. The BFX lateral bolt stem should be considered in canine THR as the femoral failure rate is low and the long-term success rate is high.

Traumatic Coxofemoral Luxation in Cats Treated with Hip-Toggle Stabilization Using the Mini Tightrope® Fixation System

Abstract The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of 21 cats that underwent coxofemoral toggle stabilization using the Mini TightRope® Fixation System (mTR®). Data were compiled from client-owned cats with traumatic hip luxation. Each cat underwent the same protocol including orthopedic assessment, preoperative radiographic evaluation, surgical procedure, postoperative management and clinical re-examination at 14 days, 8 weeks and 12 months following surgery. Age, body weight, implants and osteoarthritis progression were recorded. A lameness score 0-4 was assigned to each cat. Pain upon hip extension was not quantified but as pain reaction or no pain reaction. Major complications and osteoarthritic (OA) changes were recorded. Osteoarthritic changes were classified on a 0-4 scale. Twenty-one cats were included in the study. Coxofemoral luxations were stabilized using a mTR®. At 8 weeks, weight bearing was considered normal (grade 0) in all cats and no pain reaction was elicited during hip extension. One year after surgery, orthopedic examination was within the normal limits and according to the owners, all animals exhibited a normal physical activity. No complications were recorded. Evidence of slight OA changes were observed in 5 out of 21 cats. The final outcome was considered excellent in 16/21 patients and good in 5/21 cats. The application of the mTR® system can be considered a suitable surgical treatment in cats affected by traumatic hip luxation.

A rare lysosomal storage disorder: Feline mucopolysaccharidosis VII

AbstractA 9‐week‐old, male domestic shorthair presented with a 2‐week history of progressive hindlimb weakness and reduction in normal play behaviour. At 17 weeks of age, the patient exhibited progressive hindlimb paresis and ataxia and had developed facial dysmorphia and bilateral corneal clouding, prompting investigation into a mucopolysaccharidosis disorder. Peripheral blood cytology, increased urinary glycosaminoglycan excretion and radiographic findings (generalised epiphyseal dysplasia, coxofemoral luxation and vertebral fusion) suggested mucopolysaccharidosis. Definitive diagnosis was obtained through serum enzymatic testing, which yielded a complete deficiency in β‐glucuronidase and increased compensatory activity in α‐L‐iduronidase and B‐arylsulfatase. This pattern was consistent with a diagnosis of feline mucopolysaccharidosis VII, and palliative therapy was initially implemented. The patient ultimately died at 21 months of age.

Use of bone anchors for the treatment of partial and complete traumatic elbow luxations: A retrospective case series of three dogs

AbstractThree dogs presented with traumatic lateral elbow luxation following road traffic accidents. Concurrent injuries included skin abrasions and coxofemoral luxation. All luxations were reduced and stabilised with bone anchors through a lateral approach to the elbow joint and had an augmented or prosthetic lateral collateral ligament placed. One elbow joint was stabilised with FASTak anchor (Arthrex, Karsfeld, Germany) and two with suture anchors by IMEX bone anchor (Veterinary, Longview, TX). Reluxation occurred in one case 24 hours after discharge requiring revision surgery. Median follow‐up time for the three cases was 180 days (range: 49–2920) and the functional outcome was considered excellent in all cases as determined by veterinary assessment, clinical record reviews, owner communication and Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. In conclusion, placement of bone anchors with augmentation of the lateral collateral ligament for management of traumatic elbow luxation in dogs is a good alternative to previously reported surgical techniques.

Extracapsular sling technique for treatment of three canine caudoventral hip luxation cases

AbstractThe objective of this study was to report surgical stabilisation of caudoventral coxofemoral luxation by an extra‐articular technique in dogs. Medical records from caudoventral coxofemoral luxations in dogs and cats presented at our institution between January 2012 and December 2020 were reviewed. Caudoventral luxations were relatively rare and were found in one cat and in 13 dogs. Three cases of surgical stabilisation using a ventral coxofemoral approach were reviewed, replacing function of the transverse acetabular ligament using a figure of eight braided suture passed around two pelvic screws and one femoral screw. Functional recovery was obtained in all three cases, without complication or re‐luxation. Extra‐articular stabilisation using a sling implant is a simple, effective method for treatment of caudoventral coxofemoral luxation in dogs.

Coxofemoral luxation as a complication of localised tetanus in a cat

Case summaryA 9-month-old male neutered domestic shorthair cat presented 2 weeks after castration with a 48 h history of acute-onset lateral recumbency and severe hindlimb rigidity. Physical examination findings included hyperthermia, tachypnoea, hindlimb rigidity and a healed orchidectomy site. Neurological examination of the head and forelimbs was normal; however, there was a spastic, non-ambulatory paraparesis of the hindlimbs, which was more severe on the left. Abnormal findings included mildly elevated serum creatine kinase levels and on electromyography there was bilateral pathological spontaneous activity of the biceps femoris muscles. A tentative diagnosis of tetanus was made based on clinical presentation. Treatment was initiated with tetanus antitoxin, diazepam, metronidazole, buprenorphine and physiotherapy of the hindlimbs. There was an improvement over the following 20 days. Twenty-five days later the cat presented with acute, painful, non-weightbearing lameness of the left hindlimb. Physical examination was suggestive of craniodorsal coxofemoral joint luxation, which was confirmed radiographically. This was treated with analgesia and rest. A marked clinical improvement was observed at the 3-month follow-up.Relevance and novel informationTo our knowledge, there have been no previously published reports of spontaneous coxofemoral joint luxation as a complication of hindlimb localised tetanus infection in cats. This report suggests that coxofemoral luxation should be considered as a possible complication in young cats with hindlimb localised tetanus.

Surgical treatment of coxo-femoral luxation by toggle pinning in a dog

Surgical treatment of coxo-femoral luxation by toggle pinning in a dog

Open hip reduction using a novel transarticular suture stabilisation technique in 24 dogs: a retrospective study of technique, outcome and complications

Case history: Medical records of a single private practice (Illinois, USA) were retrospectively reviewed to identify dogs (n=24) that had an open hip reduction with a transarticular suture stabilisation technique after presenting with a traumatic coxofemoral luxation between April 2003 and December 2018. Clinical findings: Dogs that met the inclusion criteria were of various breeds with a median body weight of 18.1 (min 4.2, max 54.5) kg and mean age at presentation of 6.5 (min 1, max 11) years. The surgical technique, short term outcome and complications were extracted from the medical records. Long-term (>2 years) follow-up data was obtained by a telephone interview with each owner. Treatment and outcome: All dogs underwent open hip reduction using a novel transarticular suture stabilisation technique. The outcome was reported by owners to be excellent in (18/24) 75% dogs with full return of limb function. Sixty-six percent (16/24) of owners reported that no lameness was observed 2 months after surgery. No minor complications were noted in this study. The hips of 6/24 (25%) dogs reluxated after surgery (defined as a major complication), which required femoral head and neck excision surgery. Clinical relevance: Open coxofemoral joint reduction using a novel transarticular suture technique is a viable surgical option to consider in dogs that present with a traumatic coxofemoral luxation.

Successful Treatment of Acute Craniodorsal Coxofemoral Luxation in a Scarlet Ibis (Eudocimus ruber) Using Closed Reduction and a Modified Ehmer Sling.

Whereas craniodorsal displacement of the coxofemoral joint is the most common luxation reported in small and large mammals, it occurs less often in avian species. Closed reduction and external coaptation with a modified Ehmer sling is the initial treatment, in most cases, for small animals (eg, dogs, cats) that present with a coxofemoral luxation. However, the Ehmer sling is reported to have a low success rate in treating coxofemoral luxations in these animals. Intractable coxofemoral luxations require an open surgical reduction. A few successful closed reductions of coxofemoral luxations have been reported in avian patients, as well as open reduction surgical techniques to repair avian coxofemoral luxations. The successful treatment of an acute craniodorsal coxofemoral luxation in a scarlet ibis (Eudocimus ruber) with a closed reduction and a modified Ehmer sling is described in this clinical report. The specific characteristics of both the patient and the injury are thought to have contributed to the success in this case.

Outcome of coxofemoral luxation treated with closed reduction in 51 cats.

The aim of this study was to describe the outcomes and determine the reluxation rate of cats undergoing closed coxofemoral joint reduction, and to investigate potential risk factors for reluxation of the affected coxofemoral joint. Case information was obtained from electronic medical records from Ocean State Veterinary Specialists and Bay State Veterinary Emergency and Specialty Services between January 2008 and May 2020. Data obtained from 51 cats with coxofemoral joint luxations included patient signalment, direction of coxofemoral joint luxation, concurrent injuries, ease of reduction, time of injury to closed reduction, bandage application and outcome. Data were analyzed for association with outcomes. Closed reduction of coxofemoral joint luxation in cats had a 51% success rate. The only risk factor demonstrating a statistically significant benefit to the success of closed coxofemoral joint reduction was the application of a bandage (P = 0.02). It may be worth attempting closed coxofemoral joint reduction in cats prior to recommending surgery. Placing a bandage (Ehmer or hobbles) after closed reduction may decrease the risk of the coxofemoral joint reluxating, but more studies are needed to evaluate this further. The outcome after closed reduction management for coxofemoral joint luxation in cats is similar to the previously reported success rate in dogs.