Coxofemoral Luxation Research Articles

Aspects of coxofemoral luxations in the horse

Aspects of coxofemoral luxations in the horse

Hip Toggle Stabilization Using the TightRope® System in 17 Dogs: Technique and Long‐Term Outcome

To describe the technique for, and long-term clinical outcome of, a modified hip toggle stabilization using the TightRope® system for coxofemoral luxation repair. Retrospective case series. Medical records (July 2008-July 2010) including radiographs (17 limbs) of dogs that had coxofemoral luxation repaired with the TightRope system were reviewed. Follow-up (≥12 months) was obtained by telephone interview of owners. Six dogs were available for re-evaluation, radiographs, and objective gait analysis. Follow-up (mean, 24 months; range, 12-43 months) by telephone interview was available for 17 dogs. Of these, 6 dogs were re-evaluated (mean, 7.5 months; median 12.5 months: range, 4-24 months) and had gait analysis. Mean duration of luxation before surgical intervention was 7.5 days (median, 7 days; range, 2-44 days). There was a single case of relaxation 27 months postoperatively. One dog died from non-surgical related circumstances. Objective gait analysis showed equal pelvic limb use in all 6 dogs available for re-evaluation. All owners of living dogs reported limb function as being good to excellent, and perceived that their dogs were pain free. Radiographs (mean, 7.5 months; median, 12.5 months; range, 4-24 months post surgery) of 6 dogs showed no progression of osteoarthritis in comparison to immediate postoperative radiographs. Hip toggle with the TightRope system as a prosthetic ligament of the head of the femur produces a favorable clinical outcome with high owner acceptance.

Radiographic diagnosis of craniodorsal coxofemoral luxation in standing equids

SummaryRadiographic evaluation of the pelvis in standing horses has been used to diagnose fractures of the pelvis, head and greater trochanter of the femur, and luxations of the coxofemoral joint. Coxofemoral luxation injuries are more common in smaller horse breeds and donkeys, but, due to their size, the standing ventrodorsal projection is not possible, as there is insufficient space to place the radiography equipment under the animal's abdomen. The objective of the study was to report the advantages and limitations of the use of an oblique radiographic projection to diagnose unilateral craniodorsal coxofemoral luxation in 3 ponies and a donkey performed with the animals standing under light sedation. All cases had severe unilateral hindlimb lameness and asymmetry of the gluteal region; 2 also had concurrent intermittent upward fixation of the patella. A standing dorsolateral 20–30° ventral oblique radiograph of the affected coxofemoral joint was performed in all cases to obtain a definitive diagnosis. Radiography of the coxofemoral joint in standing ponies and donkeys can be carried out to identify craniodorsal coxofemoral luxation avoiding the need for general anaesthesia.

Köpeklerde Kalça Eklemi Çıkığının Modifiye Sentetik Kapsül Tekniği ile Sağaltımı: 6 Olgu

In this study, it was aimed to investigate that long-term clinical efficacy of modified synthetic capsule technique in treatment of coxofemoral luxation in dogs. As animal materials, six dogs which different breeds, sex and ages that detected coxofemoral luxation in clinical and radiological examination were subjected. As different from modified synthetic capsule technique, two cortical screws were inserted into the dorsal rim about 5 mm away from the acetabular edge at the 10and 12-o’clock positions for the left hip and the 12and 2-o’clock positions for the right hip. Also, the transverse hole was created in greater trochanter. Non-absorbable monofilament suture material was tied to the screw heads previously and then the suture ends were passed as crosswise through the transverse tunnel in the trochanter major. Subsequently, the suture material was tied on the greater trochanter by stretching following that the femoral head was placed into the acetabulum. It was seen that there was no complication related with the reduction or screws in clinical and radiological examinations of the dogs at fourth week. We determined that five dogs recovered “perfect” and one dog “good” end of sixth months.

FEMORAL HEAD AND NECK EXCISION ARTHROPLASTY IN A LEOPARD TORTOISE (STIGMOCHELYS PARDALIS)

Cases of femoral head and neck excision arthroplasty are infrequently reported in reptiles, and details of surgical technique and clinical outcome in chelonia are lacking. An adult female leopard tortoise (Stigmochelys pardalis) was presented with chronic non-weight-bearing lameness of the left hind limb. Examination and radiography were consistent with coxofemoral luxation, and as a result of the chronic presentation, surgical intervention was recommended. A cranial approach to the joint via the prefemoral fossa afforded good surgical exposure. A depressed lytic acetabular lesion was noted during the procedure, postulated to be a result of abnormal wear from the luxated femoral head. A fiberglass prop was used during recovery to allow extension of the limb without full weight-bearing. Lameness persisted postoperatively, but limb usage significantly improved.

Patellar fractures in cats

The results of a survey on patellar fractures in cats were published in 2009 (Langley-Hobbs 2009) following a request for cases in a letter in Veterinary Record (VR, March 19, 2005, vol 156, p 392). A concurrent study in North America is ongoing. From having access to information on over 150 patellar fractures some interesting findings have been discovered about this unusual condition. Transverse patellar fractures (Fig 1) most commonly occur in young cats (one to three years old) with over 50 per cent of cats subsequently fracturing the contralateral patella, usually within three months of the first fracture. Up to 75 per cent of these affected cats have deciduous teeth (cheek and/or canine) (Fig 2) persisting beyond six months of age. This syndrome is suspected to be a variation of osteogenesis imperfecta. Other concurrent pathologic atraumatic bony lesions include pelvic, humeral, femoral, tibial and fibular fractures, as well as coxofemoral luxations (Langley-Hobbs and others 2009). While surgical correction would seem appropriate for these patellar fractures, failure after pin and tension band was reported in 86 per cent of patients in a retrospective report (Langley-Hobbs and others 2009). FIG 1 Transverse patellar fractures in a cat FIG 2 Deciduous teeth in a cat older than six months Together with Steven Bailey, in the USA, I (Sorrel J. Langley-Hobbs) am currently in the process of collecting cheek swabs and/or blood samples (if blood is already being collected as part of the clinical investigation) from affected cats. DNA will then be stored at the University of Pennsylvania by Margret Casal. As soon as a sufficient number of samples have been obtained, Leslie Lyons will conduct a genome-wide association study. If any colleagues have seen a cat with patellar fractures and retained deciduous teeth they can e-mail me at the address below. I can supply swabs, a short form to complete with details about the cat, and will then arrange for the samples to be shipped to the USA.

Mechanical Analysis of Twelve Toggle Suture Constructs for Stabilization of Coxofemoral Luxations

To compare the mechanical performance of 12 commonly used toggle suture constructs (TSCs). In vitro biomechanical study. Toggle suture constructs (n = 136). TSC evaluated included #5 OrthoFiber, double strand of 5 Ethibond sutures (polyethylene terephthalate suture), 80 lb monofilament nylon, or #5 FiberWire, combined with Piermattei toggle (3/32" Steinmann pin), modified Piermattei toggle (0.045" Kirschner wire), and 1/8" Securos toggle rod for a total of 12 test groups. Acute and cyclic testing were performed using a servohydraulic testing machine and load at failure and cycles to failure were determined. In acute testing, modified Piermattei TSCs failed by toggle deformation and Piermattei and Securos TSCs failed by suture breakage at the eyelet. Mean failure load of Piermattei-#5 OrthoFiber TSC (1416 ± 74 N) was significantly greater than that of Piermattei-#5 Ethibond (883 ± 38 N); both were significantly greater than all other TSCs. Only the Piermattei TSC with #5 OrthoFiber, #5 Ethibond, and 80 lb monofilament nylon did not fail during cyclic testing. A combination of the Piermattei toggle and #5 OrthoFiber or #5 Ethibond achieved a higher load at failure than all other groups, and resisted the greatest number of cycles to failure. Long-term mechanical testing of these TSCs are warranted to further define their durability.

Computed tomography of coxofemoral injury in five mute swans (Cygnus olor)

Five mute swans (Cygnus olor) were presented with inability to stand or with abnormal positioning of a leg. Clinical examinations indicated the possibility of femoral fractures or coxofemoral luxations. The suspected diagnosis was proven by means of computed tomography (CT), while superimposition of gastrointestinal contents or other artefacts limited radiographic diagnosis in three birds. A typical CT sign for lesions of the coxofemoral joint apart from femoral displacement was haemorrhage within the pelvic bones (especially around the acetabulum), found in four of the five birds. Small femoral head avulsion fractures could be detected only with CT.

Complications and Owner Assessment of Canine Total Hip Replacement: A Multicenter Internet Based Survey

To assess the variables associated with the complications of total hip replacement (THR) and report owner-assessed outcomes, through surgeon-based registration of cases via an online database, informed owner consent, and prospective outcomes assessment using a client-administered clinical metrology instrument. Prospective case series Dogs (n = 170) Entries into the British Veterinary Orthopaedic Association-Canine Hip Registry (BVOA-CHR) between January 2010 and August 2011 were reviewed. Variables evaluated included dog age, body weight, breed, and indication for THR and prosthesis. Associations between each variable and the incidence of complications were assessed using logistic regression. Additionally, an on-line, owner-administered outcomes assessment questionnaire (modified from the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire) was used to collect data from owners. One hundred and seventy cases met the inclusion criteria. Surgical indications included hip dysplasia and coxofemoral osteoarthritis (n = 150), Legg-Calves-Perthes disease (7), coxofemoral luxation (6), fracture (4), slipped capital physis (2), and femoral head and neck ostectomy revision (1). Surgical implants were from 4 systems. The incidence of surgeon-reported complication was 9.4%. No significant association was identified between weight, age, sex, breed, indication for THR, surgical technique and prosthesis, and the incidence of complications. In 82% of the cases, owners described their satisfaction with the outcome of THR as "very good" and a total of 20% complication rate was reported. There was a statistically significant improvement in owner-assessed questionnaire score before and after THR (P < .001). The BVOA-CHR offers a novel framework for the prospective studies on THR and on a national/international scale. Initial complication rates from the BVOA-CHR are similar to previous studies.

A care report of a feline sacroiliac and coxofemoral luxation following a road traffic accident

This article describes the nursing care provided to an elderly domestic short haired cat with a fractured pelvis following a road traffic accident. It is essential to consider the entire animal when presented with a fracture case owing to the high incidence of shock, pain and additional soft tissue injuries. Analgesia and shock therapy treatment commenced immediately and post surgery intense nursing care and physiotherapy began to allow the patient the best chance to make a full recovery.

Toggle rod stabilisation of coxofemoral luxation in 14 cats

To describe the surgical technique and to report outcomes in cats with coxofemoral luxation treated with open reduction and toggle rod stabilisation. Retrospective study of cats with coxofemoral luxation stabilised via the toggle rod method. Short-term follow-up included clinical examination and radiographs. Long-term follow-up was via owner questionnaire. Fourteen cats were included. All of the cats had reported unilateral craniodorsal hip luxation. Nine cats (64·3%) had additional orthopaedic injuries. Luxations were stabilised with a 3·2-mm toggle rod (2·7-mm toggle rod in one cat) and two loops of four-metric polydioxanone (five-metric polydioxanone in one cat and three loops of four-metric polydioxanone in two cats). Success rate, in terms of maintenance of reduction, was 86%. Reluxation occurred in two cats (14%), both of which had multiple limb injuries. Eleven owner questionnaires (mean follow-up time 15·5 months) reported a functional outcome of "very good" to "excellent". Although the diameter of the pelvic canal was reduced by the presence of the toggle rod (mean narrowing 16.2%), none of the cats had defaecatory issues. Toggle rod stabilisation is an effective method for the treatment of coxofemoral luxation in cats. Injuries to multiple limbs may be a risk factor for reluxation.

Stabilization of coxo-femoral luxation using tenodesis of the deep gluteal muscle

This retrospective study documents deep gluteal tenodesis (DGT) used to stabilize coxo- femoral luxation (CFL) in dogs and cats, and to report reluxation rate and clinical outcome after DGT. Medical records (1995-2008) of 65 dogs and cats with traumatic CFL treated by capsulorrhaphy and DGT were reviewed. Animals with radiographic evidence of pre-existing hip dysplasia or articular fractures had been excluded. Reluxation rate and outcome were assessed by clinical examination, performed two and ten weeks postoperatively. Surgical treatment was performed between one and 20 days after the initiating event. No perioperative complications occurred. All hip joints were correctly reduced and stabilized immediately after DGT completion. Except for five patients, placement of the screw was considered correct. In two of these patients, the screws were too long and were protruding into the pelvic canal. In two dogs, the screws were not tightened adequately, and in one dog the screw was too short. Twenty-six dogs and eight cats were re-examined between eight and 13 weeks postoperatively. Re- luxation did not occur in any of them. Outcomes were good in two cases and excellent in 32 cases; all but two had a normal range-of-motion of the reconstructed hip, and were free of lameness and did not show any signs of pain. Traumatic CFL can be stabilized safely and effectively by DGT in dogs and cats. This technique should be considered among other capsular reinforcement techniques in the presence of an intact deep gluteal muscle.

Correction of craniodorsal coxofemoral luxation in cats and small breed dogs using a modified Knowles technique with the braided polyblend TightRope™ systems

To report the surgical technique and short-term radiographic and functional outcome data for a series of client owned, small breed dogs and cats treated for traumatic craniodorsal coxofemoral luxation using open reduction and internal fixation with the Arthrex Mini TightRope (mTR) and TightRope (TR) systems. Data were collected retrospectively from the clinical case records, including the initial clinical and radiographic findings, surgical technique, and postoperative short-term clinical and radiographic data. Functional data collected after the six weeks reassessment were obtained via owner questionnaire. Four cats (mTR = 4) and five small breed dogs (mean weight 15 kg; TR = 4, mTR = 1) were included. Median time to postoperative weight bearing was one day. Median lameness score at six weeks postoperatively was 0 out of 5. Coxofemoral joint congruity was radiographically confirmed at the six weeks postoperative visit. Telephone follow-up (at a median of 16 weeks) revealed all animals had returned to their previous level of activity. Complications were minor, and limited to postoperative swelling (n = 1). Clinical use of the Arthrex Mini TightRope and TightRope systems can be recommended for traumatic craniodorsal coxofemoral luxation in this novel application as short-term results are at least comparable to existing surgical techniques. Long-term follow-up studies are needed.

Outcome and complications after dual mobility total hip replacement

To report the clinical and radiographic outcome of a canine total hip prosthesis with a dual mobility acetabular component, with a minimum of six months follow-up. The outcome of dogs that underwent primary cemented unilateral dual mobility hip prosthesis surgery by one of the authors for hip dysplasia or trauma, and which had a minimum of six months clinical and radiologic follow-up, was evaluated. Fifty dogs were included in the study. Follow-up ranged from six to 38 months (mean 14.4 months). Perioperative complications were acetabular collapse (n = 1) and greater trochanter fracture (n = 1), both of which were successfully managed perioperatively. Postoperative complications were aseptic loosening of the acetabular component (n = 2; both surgically revised), implant sepsis (n = 3; all explanted), acetabular fracture (n = 1; conservatively managed), greater trochanter fracture (n = 1; conservatively managed) and sciatic neurapraxia (n = 1). No cases of postoperative luxation or femoral implant aseptic loosening were encountered. Outcome was poor for three cases (3 implant sepsis), fair for three cases (including 1 acetabular component loosening and 1 acetabular fracture), and good or excellent for 44 cases (88%). There were not any cases of postoperative coxofemoral luxation observed in this series of 50 dogs with dual mobility hip prosthesis. Studies with more patients and longer follow-up are needed to confirm the satisfactory results observed to date with this implant.

Case Report: An ultrasound-assisted diagnosis of a coxofemoral luxation in a yearling

Case Report: An ultrasound-assisted diagnosis of a coxofemoral luxation in a yearling. Diagnosing coxofemoral luxations in the horse can be challenging. The presenting signs and physical examination may arouse suspicion of a luxated hip joint. Traditional methods of achieving a definitive diagnosis have relied upon taking a radiographic projection of the pelvis. Most mobile radiographic equipment have insufficient power to penetrate the deep pelvic musculature. This case report describes how the use of ultrasonography can be used to assist the diagnosis of such a condition in suitable patients, avoiding the necessity of transportation to a centre with suitable radiographic capabilities.

Femoral head excision after coxofemoral luxation in an Arab filly: Four years follow-up

Summary A foal with a cranio-dorsal coxofemoral luxation was treated with a prosthetic capsulorraphy technique after open reduction. After reluxation a femoral head ostectomy was performed for salvage purposes. The filly was discharged with minimal lameness and was using the limb properly after 51 days of hospitalisation. Four years later the filly is still doing well as a breeding mare, with an acceptable quality of life despite angular deformities in the contralateral limb.

Treatment of a Coxofemoral Luxation in a Pony Using a Prosthetic Capsule Technique

To report open reduction and joint stabilization using a prosthetic capsule technique for treatment of a craniodorsal coxofemoral luxation in a lightweight pony. Clinical report. Pony stallion (8 years old, 113 kg). A craniodorsal approach to the coxofemoral joint was performed under general anesthesia. After open reduction, a prosthetic capsule technique was used. Four 3.5 mm self-tapping cortical anchor screws were implanted: 2 screws were inserted above the cranial aspect of the dorsal acetabular rim, and 2 screws were inserted into the femoral neck. Subsequently, a #5 USP ultra-high molecular weight polyethylene suture was placed through these anchor screws in figure-8 fashion to serve as a prosthetic capsule. Routine closure and a medial patellar desmotomy completed the surgical procedure. Postoperatively, the pony was cross tied for 4 weeks to prevent it from lying down. Neither short-term nor long-term complications occurred and the pony was sound at the follow-up examination performed 15 months postoperatively. A prosthetic capsule technique can be used successfully to stabilize the coxofemoral joint after open reduction of a craniodorsal luxation in a lightweight pony.

Chronic Coxofemoral Luxation in a 13th Century Virginia Dog: Differentiation from Hip Dysplasia

The almost complete skeleton of a male dog with hypertrophic osteopathy and a chronically luxated right coxofemoral joint was one of over 100 canine skeletons excavated from Weyanoke Old Town, a Native American village site in what is now Virginia. Radiometric analysis indicated this dog lived between 1224 and 1296 AD. It was of medium size (46 cm tall, 12–13 kgs), and was an older individual. The right femoral head was dorsally luxated and articulated with an acetabular‐like structure composed of a rim of irregular osteophytes with eburnated bone at its center. The ventral aspect of the right femoral head was flattened and eburnated where it was in contact with the dorsal rim of the acetabulum. Hip dysplasia is common in modern dogs and is characterized by bilateral, gradual, post‐natal craniodorsal subluxation of the femoral heads, which results in erosion of the acetabulum and cranial flattening of the femoral head. This dog's hip lesions were most likely traumatic, as they were not bilateral, the dorsal acetabular rim was still intact, and there was ventral rather than cranial erosion of the femoral head. Animal paleopathology is not as well‐established as human paleopathology, but careful comparisons of lesions found in ancient animal remains with those in modern animals can provide important information about animal health both in the past and the present.

Ultrasonographic Appearance of Bovine Coxofemoral Luxation in Different Directions

Coxofemoral luxation is common in cattle and prognosis is very guarded or poor. Diagnosis is generally based on thorough physical examination by identifying the structure of the hip, but an accurate diagnosis can be challenging, especially in heavy and recumbent cows because large muscle mass covering the pelvis and hip makes palpation of the bony structures difficult. In cattle practice, ultrasound has been widely used as an important ancillary test for a more accurate diagnosis and avoidance of unnecessary treatment. The purpose of this report is to describe ultrasonographic features of twenty two dairy cows (3-7 years) with coxofemoral luxation in three different directions. Five cows with craniodorsal, six with caudodorsal, and eleven with caudoventral luxation were examined ultrasonographically. Only three cows were able to stand and eleven exhibited asymmetry of the hip upon external examination of the hindlimbs. Sonographic findings on the dorsolateral view of the hip in standing and laterally recumbent cows invariably included the ball-shaped femoral head outside the acetabulum in dorsal luxations and heterechoic empty joint cavity of the acetabulum in ventral luxation. On the ventrodorsal view for dorsal recumbency with the frog-leg position, either luxated femoral head or empty acetabular cavity was visible in fifteen examined cows in the three different directions of luxation, but the femoral head of the caudodorsal luxation was translated caudoventrally to the acetabulum owing to severe soft tissue damage around the acetabulum. Transrectal ultrasonography of the caudoventral luxation revealed the ball of the femoral head in or ventral to the obturator foramen with varying amounts of fibrin deposit on it. Ultrasonography can be used to make a definitive diagnosis of coxofemoral luxation in three different directions in recumbent cows, as well as standing cows.

Coxofemoral luxations in the horse: Surgical options and challenges

Coxofemoral luxations in the horse: Surgical options and challenges