Coxofemoral Luxation Research Articles

Reduction and stabilization of hip luxation by the transposition of the ligamentum sacrotuberale in dogs: an in vivo study.

To evaluate the effectiveness of transposition of the sacrotuberous ligament (LST) for the treatment of coxofemoral luxation in the dog. In vivo experimental study. Ten mixed-breed dogs (weighing 12 to 26 kg). After general anesthesia, the LST was exposed and released from the sacrum with a sacral bone fragment. Coxofemoral luxation was created by capsulotomy and transection of the ligament of the head of the femur. Suture was passed through 2 small holes in the bone fragment to guide transposition of the LST through a tunnel drilled through the acetabulum and femoral head and neck. The suture material was pulled tight and an interference screw was placed into the femoral tunnel to lock the sacral bone fragment and LST securely in the tunnel. Butorphanol was administered for pain relief and dogs were allowed unrestricted activity. Coxofemoral radiographs were obtained at 15-day intervals. Two dogs were euthanatized for macroscopic and histopathologic examinations at 3 months. Release of the sacral bone was moderately difficult. The transposed ligament and bone fragment were of an appropriate length and were easily and securely fixed by a interference screw method. Visible severe lameness, during the first 7 to 10 days improved to mild lameness within 10 to 21 days. Gait was subjectively normal after 5 weeks. No radiographic abnormalities were observed at any time point. Grossly, the LST was intact and apparently viable and functional. On histopathology, the space in the bone tunnel was filled with new tissue and a hyaline-like layer surrounded the LST. The sacral bone fragment attached to the LST was united with the femoral bone. Transposition of the LST reduced and stabilized experimentally induced coxofemoral luxation in 10 dogs. Survival of the LST up to 3 months and its adaptation to transposition suggest that this surgical technique could be considered as a permanent treatment option for hip luxations. Transposition and fixation of the LST was easy, but releasing the sacral edge of the LST was difficult because of its deep location and division of the origin into 2 branches in some dogs. Results of this experimental study suggest that the technique may be satisfactorily used in dogs with coxofemoral luxation.

Transposition of the sacrotuberous ligament for the treatment of coxofemoral luxation in dogs.

A surgical technique is described for transposition of the sacrotuberous ligament to replace the teres ligament in the treatment of coxofemoral luxation in dogs. Ten dogs with coxofemoral luxation were treated using this technique and all animals regained full limb function within two months of surgery. It is suggested that the technique could be employed in dogs suffering from all types of hip luxations.

Treatment of traumatic coxofemoral luxation with triple pelvic osteotomy in 19 dogs (1987-1999)

SummaryThe objective of our study was to investigate, retrospectively, the role of triple pelvic osteotomy in the management of traumatic coxofemoral luxation. Nineteen patients were identified from medical record data and four dogs returned for long-term physical, goniometric and radiographic evaluation. Seventeen of nineteen dogs had maintenance of reduction of the hip. Due to poor outcome, two of these seventeen dogs required salvage procedures. Three of four dogs that returned for long-term follow-up, owner evaluation, radiographic scoring, and physical examination had satisfactory results. These four dogs had manual goniometric evaluations performed on the affected side, and the contralateral hip. A paired student t-test was used for statistical analysis, and internal rotation was the only value which was significantly (p d0.05) different between the two sides. Reduction alone is not a representation of success when evaluating open management of coxofemoral luxation, because two dogs with poor limb function necessitated femoral head and neck excision for limb salvage. The TPO does have a role in the treatment of traumatic coxofemoral luxation, but may not be sufficient in cases involving congenital dysplasia and/or intraarticular fractures.Triple pelvic osteotomy is a successful means of mitigating the sequela of congenital hip subluxation. This surgical technique can be used to manage dogs with traumatic coxofemoral luxation. There was an indication in this study that reduction alone is not a satisfactory means of evaluating management of traumatic coxofemoral luxation. Dogs with congenital dysplasia or intra-articular fractures associated with traumatic luxation may require alternate methods of reduction.

Kirschner-Ehmer創外固定器を用いて関節可動型整復術を行った犬の外傷性股関節脱臼2例

Movable extra-articular arthrodesis using a Kirschner-Ehmer external fixation system was applied as a new method for treating traumatic coxofemoral luxation in 2 dogs. After manipulative reduction of the hip under anesthesia, a Kirschner wire was orthodromically inserted into the femur from the fossa trochanterica. Then two half pins were inserted into the ilium and the ischiadic tuber and connected with two external parallel bars using two single and two double clamps so that the intramedullary pin lay between the two externalbars. Both animals were able to walk within a few days, and all external fixators were removed 13 and 23 days after surgery. Since the pin inserted into the femur is not fixed to the external bar, this method allows an extensive range of hip-joint motion during treatment.

Closed Toggle Pinning for Canine Traumatic Coxofemoral Luxation

SummaryA method of closed implantation of a toggle pin bone anchor and prosthetic ligament was developed for the treatment of traumatic canine coxofemoral luxation. Radiographic and anatomical evaluation of the canine femur and acetabulum were performed in order to develop an imaging and instrumentation technique that would allow closed placement of a toggle pin bone anchor under fluoroscopic guidance, while at the same time minimizing, or eliminating, damage to the articular cartilage. The surgical technique was then performed in 14 canine cadaver coxofemoral joints, followed by gross evaluation of implant placement, and potential cartilage or soft tissue damage. The cervical canal radiographic view of the proximal femur allowed placement of the drill hole through the fovea capitis of the femoral head without damaging the articular cartilage. The acetabular fossa was readily distinguishable from the acetabular articular cartilage on both of the lateral and ventrodorsal radiographic views of the pelvis. The toggle pin apparatus was inserted without damage to the articular cartilage in nine out of the fourteen hips and the bone tunnels were situated within the cancellous bone of the femoral neck in each of the nine specimens evaluated. Complications encountered during the procedure included bending and/or breakage of the guide wire in three hips and damage to the articular cartilage in two hips. The success of technique modifications designed to diminish the incidence of these complications awaits investigation in a clinical trial. Closed toggle pinning for canine traumatic coxofemoral luxation has the potential advantage of achieving rapid stabilization of the coxofemoral joint without damage to the articular cartilage and the need for an open approach to the joint. The clinical application of the technique is reported in one patient.The equipment and methodology for closed implantation of a toggle pin bone anchor and prosthetic ligament was developed for the treatment of traumatic coxofemoral luxation. A cadaver study was performed to assess the viability of the technique. Clinical application in one case is described.

Traumatic Coxofemoral Luxation in Dysplastic Dogs Managed with a Triple Pelvic Osteotomy: Results in four Dogs

SummaryTriple pelvic osteotomy (TPO) was used in the treatment for traumatic coxofemoral luxations in four adult, large breed dogs with hip dysplasia. Initial closed reductions failed in three and one dog had an initial closed reduction and subsequent open reduction of the coxofemoral luxation that failed. Hip dysplasia was thought to be a prominent factor contributing to the reluxation. TPO successfully maintained reduction of the coxofemoral luxation in all of the dogs. An increase in dorsal acetabular coverage of the femoral head following TPO was demonstrated by an increased Norberg angle. The improved congruency was thought to maintain reduction of the femoral head in the acetabulum and decrease stresses on the joint capsule, allowing healing to occur. Long-term (median: 343, mean ± SD: 406 ± 226 days follow-up) function of the affected limb was comparable to the contralateral limb. Three of the four dogs did not have radiographic progression of coxofemoral degenerative joint disease of the affected joint and differences in the progression of degenerative joint disease were not evident between the affected and the contralateral coxofemoral joint. A decrease in abduction and external rotation and an increase in internal rotation following TPO was noted in the affected coxofemoral joint. Our results establish the utility of this procedure in dysplastic dogs with traumatic coxofemoral luxations.Triple pelvic osteotomy used in the treatment for traumatic coxofemoral luxation in four adult, large breed dogs with hip dysplasia successfully maintained reduction and resulted in satisfactory limb function in all patients.

Open reduction and stabilisation of coxofemoral joint luxation in dogs and cats, using a stainless steel rope inserted via a ventral approach to the hip joint.

Open reduction and stabilisation of coxofemoral joint luxation was made via a ventral approach to the hip joint in dogs and cats, using a transarticular stainless steel rope. A feature of the procedure is transarticular penetration of the rope from the pelvic cavity to the femoral neck by guidance with a guide wire which was previously inserted from the femoral neck into the pelvic cavity and by detection of the guide wire in the pelvic cavity by use of forceps connected to an alarm-ohmmeter. Forty-seven animals (37 dogs and 10 cats) with acute and simple coxofemoral luxation were treated and postoperatively maintained in cage rest without external fixation. Most of the animals regained an almost normal gait within several days.

Abstract of Current Literature

Use of a Modified Toggle Pin for Repair of Coxofemoral Luxation in Dogs With Multiple Orthopedic Injuries: 14 cases (1986–1994) by Beckham HP Jr, et al

Reduction of dislocated hips

Most veterinarians in dairy practice will have been presented with a cow with a coxofemoral luxation (commonly known as dislocated hip) usually either over the calving period, related to calving paralysis, milk fever etc., or more commonly, during the mating period when cows riding each other on the cow yard slip, spread their legs abnormally and dislocate their hip joints.
 During my time in dairy practice, I have developed methods of diagnosis, prognosis and reduction of the dislocated hip. I have had as many reduction failures as I have had successes, but all cases help my understanding and knowledge of hip dislocation and the successes make me keep trying.

Fractures and Luxations of the Pelvis and Proximal Femur

Although lameness caused by fractures and luxations of the pelvis and proximal femur are rare, they are serious and often end an animal's productive life unless properly diagnosed and promptly treated. Diagnosis of these injuries is difficult without special radiographic equipment; however, careful physical examination will often lead to a tentative diagnosis. Coxofemoral luxations and slipped capital epiphysis are two of these life-threatening injuries. This article discusses their diagnosis and possible options for treatment, which can lead to a useful, productive life. The diagnosis of other pelvic injuries is discussed, although these injuries are often not as amenable to treatment.

Use of a modified toggle pin for repair of coxofemoral luxation in dogs with multiple orthopedic injuries: 14 cases (1986-1994)

Objective To develop modifications of the toggle pin procedure for use as a ligament of the head of the femur (LHF) prosthesis and to assess outcomes when used for coxofemoral luxation (CFL) in dogs with multiple orthopedic injuries. Design Retrospective case series. Sample Population 14 dogs with CFL as a component of orthopedic polytrauma. Procedure Modifications to previous descriptions of the technique for use of a toggle pin for LHF prosthesis included deletion of the osteotomy of the greater trochanter in 12 of 16 joints with CFL, drilling of the femoral tunnel from a distal-to-proximal direction, deletion of a second femoral bone tunnel for suture placement, and use of a 2-hole polypropylene button to secure the LHF prosthetic suture. Results Mean age at time of injury, weight, and duration between injury and definitive surgery was 4.1 ± 1.1 years, 19.7 ± 2.8 kg, and 5.8 ± 2.7 days, respectively. Weightbearing began 3.0 ± 0.4 days after surgery. Mean postoperative follow-up period for dogs with maintained coxofemoral reduction of longer than 1 month (n = 13) was 19.5 ± 6.1 months. Owners reported good or excellent clinical results, which were confirmed by semi-quantitative assessment methods. Radiographic signs of degenerative joint disease were minimal. There was no significant difference between hind limbs when comparing mid-thigh limb circumference at the time of follow-up examination. Clinical Implications A modified toggle pin procedure for LHF prosthesis can maintain coxofemoral reduction and allow early weightbearing in dogs with coxofemoral luxation as a component of multiple orthopedic injuries.

Treatment of Chronic Coxofemoral Luxation by Femoral Head and Neck Excision Arthroplasty in a White Throated Monitor, Varanus albigularis.

Treatment of Chronic Coxofemoral Luxation by Femoral Head and Neck Excision Arthroplasty in a White Throated Monitor, Varanus albigularis.

Flexible external fixation for craniodorsal coxofemoral luxations in dogs.

An external fixator consisting of two Ellis pins connected by a flexible band was developed and evaluated as a treatment for craniodorsal coxofemoral luxations in dogs. The technique for closed application of the fixator without injury to the coxofemoral joint or sciatic nerve was developed in six dog cadavers. The coxofemoral joints were then surgically destabilized and the limbs were manipulated through a full range of motion to assess the efficacy of the fixator in maintaining joint reduction. The fixator maintained joint reduction and stability after a surgically created craniodorsal luxation except when the femur was externally rotated 90 degrees. A flexible external fixator was then applied unilaterally in four healthy dogs. The dogs tolerated the fixator well and were bearing weight on the limb within 2 days after surgery; the range of motion was not limited by the fixator. The efficacy of a flexible external fixator in maintaining joint reduction after craniodorsal coxofemoral luxation was then evaluated in eight large dogs. The right coxofemoral joint in each dog was luxated surgically by removal of the dorsal joint capsule and transection of the ligament of the head of the femur and deep gluteal muscle. The joint was reduced and the fixator pins were applied in a closed fashion. In four dogs, a flexible external band was applied to the pins. Luxation did not reccur in these four dogs. The bands were not applied initially in four control dogs. Luxation occurred in three of the four control dogs within 24 hours of surgery. The joints that luxated were reduced and the flexible bands applied. Luxation did not recur after the bands were in place. The dogs tolerated the external fixators well, were bearing weight within 2 days of surgery, and walking with only minimal lameness 5 days after surgery. Luxation of the coxofemoral joints did not occur during the 2-week period in which the fixators were in place. The joints remained stable 1 week after removal of the fixators, at which time the dogs were euthanatized. Necropsy evaluation identified inflammation surrounding the pins and fibrous thickening of the dorsal joint capsule. The flexible external fixators were applied closed, maintained reduction of the coxofemoral joint after replacement of a craniodorsal luxation, and allowed weight bearing and limb usage soon after surgery. The flexible external fixator has several advantages over other methods of treating craniodorsal coxofemoral luxations. Complications noted in this study included pin tract drainage, pin loosening, and disruption of the flexible bands.

子牛の股関節脱臼の大転子移動術による1治験例

子牛の股関節脱臼の大転子移動術による1治験例

The Avian Coxofemoral Joint: A Review of Regional Anatomy and Report of an Open-Reduction Technique for Repair of a Coxofemoral Luxation

The Avian Coxofemoral Joint: A Review of Regional Anatomy and Report of an Open-Reduction Technique for Repair of a Coxofemoral Luxation

Clinical Case Applications of Mitek® Tissue Anchors in Veterinary Orthopaedics

SummaryThe Mitek®a tissue anchor is a new device designed for reattaching avulsed tendons, ligaments and joint capsule to bone. This device has proven useful in human orthopaedics. Initially approved for use in Bankart repair (reattachment of glenohumeral ligament to anterior glenoid rim) procedures (1-3), the Mitek® anchor is now utilized in ligamentous repairs and tenodesis of the foot, ankle (4, 5) and wrist (6, 7). These devices have the advantages of biocompatibility, small size, impressive pullout strength, versatility and ease of application (8). In this study Mitek® anchors were used to repair avulsed or ruptured tarsal and phalangeal collateral ligaments, coxofemoral luxations and to provide stability to cruciate deficient stifles.This paper describes the use of Metek® tissue anchors to repair tendinous, ligamentous, and joint capsule ruptures and avulsions.

Results of extra‐articular stabilisation following open reduction of coxofemoral luxation in dogs and cats

ABSTRACTThis report describes 14 dogs (mean age six years, mean bodyweight 25 kg) and three cats (mean age 9‐3 years, mean bodyweight 6–7 kg) with coxofemoral luxations of one to 91 days duration (median four days). In 47 per cent of the cases concomitant fractures or luxations (including three bilateral luxations) were present. Closed reduction was immediately unsuccessful in five cases and eventually unsuccessful in seven cases, whereas in five cases the nature of the additional trauma required surgical intervention. Via a craniolateral approach to the hip joint, combined with trochanter osteotomy in 24 per cent of the cases, the luxation was reduced and remnants of the capsule were sutured in 82 per cent of the cases. In all cases an extra‐articular iliofemoral suture band was applied to limit the range of motion of the femoral head. The technique is described and illustrated in detail. The success rate proved to be strongly related to the suture material and varied from excellent to poor. This extra‐articular stabilisation technique had excellent results in acute and chronic coxofemoral luxations in dogs when multifilamentous non‐absorbable material was used, even when no additional non‐weightbearing sling was used.

Treatment of recurrent coxofemoral luxation in a calf by use of open reduction and translocation of the greater trochanter

Treatment of recurrent coxofemoral luxation in a calf by use of open reduction and translocation of the greater trochanter

Femoral head ostectomy in horses and cattle.

Femoral head ostectomy was performed in six horses, three ponies, and four cattle for treatment of fractures of the femoral capital physis, coxofemoral luxation, fractured acetabulum, or severe degenerative joint disease. The procedures were performed via a cranial approach that did not involve osteotomy of the greater trochanter. A dorsal approach for femoral head ostectomy via osteotomy of the greater trochanter was evaluated in three healthy adult ponies. Three animals (2 ponies, 1 calf) were euthanatized within a month and one horse was euthanatized at year 2 due to postoperative complications. Nine animals were discharged to owners and six of them fulfilled their intended functions of breeding, milking, and being kept as companions. One horse was lost to follow-up and two horses died of causes unrelated to the surgery. All surviving animals had a residual lameness that was described by owners as mild to moderate. None of the horses were used as riding animals. The mean age and weight of 10 animals that regained weight-bearing locomotion was 3.1 months and 84 kg; for three unsuccessful cases it was 34 months and 174 kg. We concluded that femoral head ostectomy was a viable salvage procedure for large animals with capital femoral physeal fracture, chronic coxofemoral luxation, or acetabular fracture. Surgical prognosis appeared to be favorable in young cattle and fair in young horses or ponies weighing less than 100 kg. Osteotomy of the greater trochanter resulted in superior exposure of the intact coxofemoral joint and allowed easier, less traumatic surgical luxation of the joint to facilitate femoral head ostectomy.

Ischio-Ilial Pinning for Stabilization of Coxofemoral Luxations in Twenty-One Dogs: A Retrospective Evaluation

SummaryTwenty-one dogs with craniodorsal coxofemoral luxation were managed with placement of an ischio-ilial pin. The overall success rate in maintaining reduction was 73%, with pins placed at a central position resulting in the lowest incidence of reluxation (p = 0.095). Postoperative complications included pin migration (n = 2), septic arthritis (n = 1), pressure sores n = 3), and decubital ulcers (n = 1).