Neck Ostectomy Research Articles

Generation and characterization of mesenchymal stem cells from the affected femoral heads of dogs with Legg Calvé Perthes disease

Background: Canine Legg Calvé Perthes disease (LCPD) occurs during the growth period, and the cause of ischemic necrosis of the femoral head during growth remains unclear. If LCPD-affected femoral head-derived mesenchymal stem cells (LCPD-MSCs) can be generated, they can be used as a new tool for the pathophysiological analysis of canine LCPD. Aim: To generate affected femoral head-derived MSCs from dogs with LCPD and investigate the mRNA expression levels of angiogenesis-related factors and osteogenic differentiation potency of LCPD-MSCs. Methods: This study was performed using affected femoral heads from dogs diagnosed with LCPD and underwent femoral head and neck ostectomy. The necrotic tissue was harvested from the LCPD-affected femoral head and cultured statically (LCPD group, n=6). Canine bone marrow-derived MSCs (BM-MSCs) were used as controls (control group, n=6). First, the morphology of the cultured cells was observed, and the expression of CD29, CD34, CD44, CD45, CD90, and major histocompatibility complex class II was analyzed using flow cytometry. Additionally, the trilineage differentiation potency of the LCPD-affected head-derived adherent cells was examined. Furthermore, the expression levels of HIF1A, VEGFA, VEGFB, and PDGFB mRNAs and the bone differentiation potency of LCPD-affected head-derived adherent cells were investigated. Results: LCPD-affected femoral head-derived adherent cells showed a fibroblast-like morphology, and the expression of cell surface antigens was similar to that of BM-MSCs. In addition, LCPD-affected femoral head-derived adherent cells showed the same trilineage differentiation potency as BM-MSCs and were consistent with MSC characteristics. Furthermore, the mRNA expression levels of angiogenesis-related factors could be objectively measured in LCPD-MSCs and those MSCs had bone differentiation potency. Conclusion: In the present study, canine LCPD-MSCs were successfully generated, suggesting their usefulness as a tool for pathological analysis of LCPD in dogs.

Traumatic hip luxation in an orange‐spined hairy dwarf porcupine (Sphiggurus villosus)

AbstractA free‐ranging adult, 1.59‐kg, female orange‐spined hairy dwarf porcupine (Sphiggurus villosus) was presented due to inability to locomotion. Ventrodorsal and lateral radiographs of the pelvis showed craniodorsal luxation of the right hip joint, and ischial fracture on the left side. Femoral head and neck ostectomy was performed, but the lesser trochanter was preserved. At the final evaluation, 2 months after the surgery, the porcupine showed full weight‐bearing on the right hindlimb, with no signs of lameness. Range of motion of the hip joints showed a decrease in the right hip joint, but crepitation was not observed in palpation. On radiographs, no bony proliferation was seen along the osteotomy line or in the area of the lesser trochanter, and the right and left trochanter were on the same level. The animal was released back into its natural habitat.

Complications and Long-Term Outcomes After Prosthetic Capsule Replacement in 15 Dogs with Traumatic Hip Luxation.

Complications and long-term clinical outcomes for 15 dogs surgically treated for traumatic craniodorsal hip luxation by prosthetic capsule replacement (PCR) with a prosthetic ligament were retrospectively reviewed. A PCR technique with capsulorrhaphy was performed in all dogs using acetabular screws with washers and a femoral tunnel as anchor points for the polyester prosthetic ligament. A non-weight-bearing sling was not placed. Minimum 1 yr follow-up period was required for study inclusion. Two major complications (13.3%) consisting of craniodorsal hip reluxation (n = 1) and capital physeal fracture (n = 1) were observed. Minor complications (superficial skin necrosis) occurred in one case (6.7 %). The patient with craniodorsal hip reluxation underwent femoral head and neck ostectomy and was excluded from long-term analysis. In the 11 cases that returned for long-term (median, 3.8 yr; range, 19-75 mo) evaluation at the authors' institution, 10/11 of the dogs were clinically sound. Three dogs did not return for long-term evaluation. However, telephone interview with owners minimum1 yr after surgery indicated normal limb function and absence of complications in all three cases. These results suggest that PCR with polyester prosthetic ligament can be successful in maintaining hip reduction in dogs with craniodorsal hip luxation.

Modified Ventral Femoral Head and Neck Ostectomy: A Canine Cadaver Study

The aim of this study was to assess the accuracy and efficiency of performing modified ventral femoral head and neck ostectomy (mFHNO) after measuring the ideal femoral head and neck ostectomy angle (iFHNOA) on preoperative radiographs of the hip joints. Our modification of the FHNO consisted of removal of the femoral head and neck in stages. The study included cadavers of 10 adult large breed dogs (5 mongrel dogs, 4 German shepherds and 1 Gordon setter), 5 males and 5 females, weighing between 25 and 45 kg (36.2 ± 6.8 kg). There were 18 femoral head and neck ostectomies: 8 left and 10 right. The mean difference (d) between the achieved postoperative ostectomy angle and iFHNOA (± standard deviation) was 1.9° ± 7.8° (95% confidence interval: –4.6°; 8.4°) in the left limb and 0° ± 6.8° (95% confidence interval: –4.9°; 4.9°) in the right limb. Both mean d value were not statistically significantly different from 0° (p = 0.518 in the left limb and p = 0.999 in the right limb), which means that the ostectomy angles obtained by the modified method were performed nearly ideally in each case.

Effects of orthopedic postoperative rehabilitation treatments in dogs

Rehabilitation treatments after orthopedic surgery promote postoperative healing in humans. In veterinary medicine, there is increased interest in rehabilitation treatments because they are potentially beneficial to animals in the post-operation period. This study examined the effectiveness of rehabilitation treatment in dogs that underwent orthopedic surgeries, including femoral head & neck ostectomy (FHNO) and medial patellar luxation treatment (MPLT). The group that received the rehabilitation treatment after FHNO showed a significantly shorter recovery length of 6.62 weeks compared to those that did not receive the treatment. The other group that received the rehabilitation treatment after MPLT showed a significantly shorter recovery length of 5.01 weeks compared to those that did not receive the treatment. For the qualitative evaluation, the types and frequencies of rehabilitation treatments were monitored. The rehabilitation programs used frequently were heat therapy, laser therapy, passive range of motion, exercise therapy, and aquatic therapy. A standard rehabilitation program after hindlimb surgery was suggested based on the quantitative and qualitative investigation. The results add additional evidence that showed the beneficial effects of rehabilitation treatments in dogs.

Are dogs with hip dysplasia in less pain after total hip replacement than femoral head ostectomy?

PICO question
 In large breed juvenile dogs with hip dysplasia and radiographic bilateral osteoarthritis, is a total hip replacement superior/inferior/or equivalent to bilateral femoral head ostectomy at reducing the severity of long-term hip pain?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Twelve papers were critically appraised. One paper was a systematic review. Six papers were prospective case series. Five papers were retrospective case series
 Strength of evidence
 Weak
 Outcomes reported
 Besides one systematic review, there are no other studies available that directly compare pain reduction with total hip replacement and femoral head ostectomy for the treatment of hip dysplasia in large breed juvenile dogs with radiographic evidence of secondary osteoarthritis. In one study, 12/12 (100%)of owners that responded to an owner outcome questionnaire reported no hip pain with femoral head and neck ostectomy. In this study, owners assessed pain based on activity level of the dog (running, playing, jumping, using stairs normally), gait abnormalities (only when running or after strenuous exercise), and duration of postoperative medications. In eight studies, 91–100% of cases had no hip pain with total hip replacement reported via clinical examination and/or owner outcome questionnaire
 Conclusion
 There is evidence suggesting that both total hip replacement and femoral head ostectomy may be capable of reducing long-term pain as a result of osteoarthritis, secondary to hip dysplasia, however, based on the current literature, it is challenging to say whether total hip replacement is superior to femoral head and neck ostectomy at reducing long-term hip pain. It is important to recognise that other factors considered as outcomes (i.e. range of motion, ground reaction forces, force-plate analysis, etc.) may contribute to differing outcomes overall for total hip replacement vs femoral head ostectomy, but this paper focused specifically on pain. While there is a systematic review that provides evidence supporting that total hip replacement is superior at returning dogs to normal function, evaluating return to normal function was not the focus of this Knowledge Summary
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

Iatrogenic Iliopsoas Tendon Injury May Occur during Femoral Head and Neck Ostectomy—An Ex-Vivo Study in Dogs

AbstractObjective The aim of this study was to determine if inadvertent iatrogenic damage to the iliopsoas tendon can occur during routine femoral head and neck ostectomy (FHO), using a cadaveric dog model.Study Design Four cadaveric specimens (eight hindlimbs total) of dogs that were humanely euthanatized for reasons unrelated to this study. Pre-experimental radiography confirmed absence of pelvic or femoral comorbidities. Each limb of each paired sample was randomly assigned as either dissection-only control or FHO. The simulated FHO procedures were performed by an American College of Veterinary Surgeons diplomate, and post-procedure radiography confirmed appropriate ostectomy. The FHO limbs underwent pre- and postoperative ultrasonographic investigation by an American College of Veterinary Radiology diplomate. Finally, the FHO limbs were grossly dissected, and abnormalities were documented.Results Gross visual damage was seen on all postoperative FHO limbs. The damage was most apparent in extreme external rotation of the limb at dissection. Yet, ultrasound investigation did not reveal changes associated with these gross lesions.Conclusion Iatrogenic inadvertent damage to the iliopsoas tendon may occur during routine FHO, as demonstrated in this ex vivo model; however, this result is not evidence for clinical relevance. A prospective clinical study is needed to assess if iliopsoas injury secondary to FHO has any clinical impact on recovery and limb function.

Ventral femoral head and neck ostectomy: Standard versus novel K-wire guided technique using a premeasured ostectomy angle in canine cadavers.

To assess the accuracy and efficiency of performing ventral FHO (vFHO) after measuring the ideal femoral head and neck ostectomy angle (iFHOA), with and without guidance of a K-wire. To compare the iFHOA to the previously accepted 45° angle to guide vFHOs. Randomized, controlled, ex vivo study. Ten mixed-breed canine cadavers. A routine un-guided and guided vFHO was performed on each cadaver. A single unmodified ostectomy was performed on all hips. The pre- and postoperative iFHOA and postoperative residual femoral neck were radiographically assessed. Subjective intraoperative palpation and postoperative radiographic ostectomy completeness (OC) scores were assigned. Subjective OC scores (p > .63) did not differ between techniques, and guided vFHOs were as good or better for 7/10 dogs assessed via intraoperative palpation, and 9/10 dogs assessed radiographically. Residual femoral neck measurements were similar in both groups (p > .75). The average iFHOA in this study was 38.5°, with no significant difference between limbs of the same cadaver (p=.34). Guided vFHO took longer (294.5s, p=.002) than unguided vFHO (166.7s). The mean iFHOA of 38.5° was less than the previously published 45° angulation for vFHOs. Subjectively, use of a K-wire guide improved soft tissue retraction, neck visualization, and confidence in cut angulation. Preoperative iFHOA measurement may minimize the risk of inappropriate vFHO angles.

Measurement of ground reaction forces in cats 1 year after femoral head and neck ostectomy.

The objective of this study was to compare ground reaction forces (GRFs) of a group of cats after femoral head and neck ostectomy (FHO) with those of a historical control group. We searched the database of the Small Animal Clinic of the Veterinary University in Vienna for cats that had undergone unilateral FHO at least 1 year previously. Owners were telephoned and invited to the clinic with their cats for a re-examination. An in-house owner questionnaire-based evaluation, complete orthopaedic examination, hip radiography and gait analysis with a pressure-sensitive plate were performed, and results were compared within and between groups (FHO group and control group [CG]). Seventeen cats that had undergone FHO (FHO group) at least 1 year previously and 15 healthy cats (CG) from a previous study were included. Measured GRFs (peak vertical force and vertical impulse [IFz] normalised to total force [%TF]) of the FHO legs were lower than those of the other legs of the FHO group and the legs of the CG. Results of the owner questionnaire were generally good and did not match the results of the GRF comparison. Furthermore, the gaits evaluated during the orthopaedic examination did not correlate with the measured GRFs where we identified a certain degree of lameness (reduced IFz, %TF) in all cats. Cats with limb shortening (dorsally displaced major trochanter major) were not revealed to have different GRF measurements. This is the first study to assess GRFs in a large group of cats that had undergone FHO, comparing findings with those in healthy cats. Even if the differences are statistically significant, but rather small, our findings point to a long-term residual gait abnormality that could be detected using a pressure-sensitive plate but not always with an orthopaedic examination, in cats 1 year after FHO.

Colocephalectomy for the Treatment of Capital Physeal Fracture of the Femoral Head in Pony

Background: Femoral capital physeal fractures occur in young animals and are generally associated with trauma. They have a poor prognosis and surgical therapy is the most indicated. There are few studies describing surgical treatment and postoperative results, so the objective of the present report was to present the first case in Brazil of a colocefalectomy for the treatment of femoral capital physeal fracture in a young pony, the post-surgical and the results obtained with the technique employed.Case: An 18-month-old pony, male, not castrated, , weighing 136 kg was referred to the Veterinary Hospital of the Federal University of Paraná (HV-UFPR) with a history of trauma for 4 days. On physical examination, the animal presented lameness grade 5 of the right pelvic limb, shortening and lateral deviation of the limb, crackling and painful sensation on abduction, and slight atrophy of the gluteal muscles on the affected side. In the radiographic examination, a femoral capital physeal fracture was found in the oblique ventro-dorsal projection. Once the diagnosis was performed, a colocefalectomy was realized, as the patient is a light and short horse. The patient underwent general anesthesia and was placed in the left lateral position. The access to the coxofemoral joint was made through the lateral face of the right hindlimb. The muscles of the region were incised and deviated, so a partial myotomy was performed in the deep gluteal and vastus lateralis. This procedure allowed to visualize the fracture, where the head of the femur remained congruent to the acetabulum. A hammer and a curved osteotome were used to section the round ligament, allowing the dislocation of the femoral head and with the aid of an oscillating orthopedic saw was performed the femoral neck ostectomy. Previously to the synthesis of the muscular planes and the skin, a passive tubular drain was fixed, in order to avoid the accumulation of exudate and consequent dehiscence of stitches, which was removed on the 6th postoperative day. For postoperative analgesia, epidural morphine was administered for 6 days and intravenous phenylbutazone for 3 days. Antibiotic therapy was performed with Ceftiofur and Metronidazole. The stitches were removed on the 15th postoperative day, after the correct healing of the surgical wound. The patient’s return to activity was gradual and he was pasture sound on the 42nd postoperative day. After medical discharge, contact with the owner was kept until the fifth postoperative month, and he related that the animal remained walking well and maintaining his reproductive function.Discussion: Femoral capital physeal fractures can occur in young animals, and are not common in clinical surgical care. Clinical signs are crackle of the joint on manipulation and presence of swelling in the affected region. The patient in question, in addition to evident lameness, had crackling and painful sensation during the abduction of the limb, but there was no local swelling, but an atrophy of the musculature of the limb, that occurs in cases of chronic femoral injury. Surgical intervention is the indicated method of treatment and should be performed as soon as possible after the injury has occurred, avoiding the worsening of bone and joint degeneration. Femoral head ostectomy is more suitable for animals less than 12 months old and weighing up to 100 kg. The technique has as a postoperative complication the contamination of the surgical wound, however the implantation of the passive tubular drain allowed rapid evolution of healing. Physical rehabilitation in the postoperative period is variable according to the progress of the animal’s locomotion. Therefore, the colocefalectomy technique aims to maintain the patient’s quality of life, even as in the case reported, it allowed the animal to maintain the reproductive function.

Physical therapy treatment in the functional recovery of dogs submitted to head and femoral neck ostectomy: 20 cases

ABSTRACT: Patients who undergo excisional surgical procedures such as femoral head and neck ostectomy (FHO) require a postoperative rehabilitation plan which includes different physical therapy modalities. Therefore, this retrospective study was done to demonstrate the different physical therapy modalities utilized in 20 dogs who were subjected to FHO, and to provide data on the frequency of physical therapy modalities, the protocol duration and time interval from the commencement of physiotherapy and surgery and the patient’s functional recovery. All the protocols included the modalities of thermotherapy (heat), massage, passive stretching and passive joint movement. In the initial phase, electrotherapy and therapeutic ultrasound were most often used, while the water treadmill was continued until the treatment was completed. Physiotherapy sessions varied from 3 to 50 in number, and physiotherapy was commenced from day 5 until day 214 post the surgical procedure. The functional recovery of the limb was in the following range: 65% (13/20) satisfactory, 25% (5/20) partially satisfactory and 10% (2/20) unsatisfactory. Physical therapy treatment was thus concluded to be most influential in the functional recovery of the limb, even if was started late.

Effective Medical Management and Physiotherapy Program of Femoral Head and Neck Ostectomy (FHO) in 24 Dogs and Cats; Clinical Report

Case Description- Twenty four cases of dogs and cats were presented for inability to move and/or getting up one of the legs while walking and leaning on the other.Clinical Findings-Physical and radiographic examinations revealed that the patients had coxofemoral luxation, hip dysplasia, comminuted acetabular fracture, avascular necrosis of femoral head and/or femur head fracture.Treatment and Outcome- The patients went under routine femoral head and neck ostectomy (FHO) surgery. A 3-4 weeks full postoperative management was applied. Serial follow up suggested that all patients were in excellent condition with no or insignificant and non-problematic lameness. Younger and small sized patients had better outcome. However immature patients are in risk of limb shortening due to excision of physis.Clinical Relevance- Although many studies have been published in FHO, anyone cannot found the applicable information and full postoperative management in an individual published paper. Hence, the purpose of this report was to provide applicable clinical information and offering a full medical and physiotherapy program. The authors’ offer, special aftercare table and seriously believe that this program will deliver a better outcome. The table includes antibiotic and analgesic therapy, physiotherapy program and other considerations.

Avascular Necrosis of the Femoral Head in Dogs - Retrospective Study

Background: The avascular necrosis of the femoral head is a development disease caused by ischemic necrosis, which is mainly observed in young dogs. The etiology of the disease remains controversial. The diagnosis requires imaging exams such as MRI and radiographs. Thus, the aim of the current study was to retrospectively assess a population of dogs with avascular necrosis of the femoral head in order to feature the disease, as well as to analyze the radiographic appearance of the lesion at the moment of patient consultation.Materials, Methods & Results: The signalment factors of dogs (breed, gender, age and body mass), the affected hind limb, the radiographic appearance of the lesion, the clinical signs at the moment of patient consultation, the time of occurrence and the type of treatment were evaluated. The disease was radiographically classified according to the previously described items. Forty-three cases of avascular necrosis of the femoral head were identified, 97.67% presented lameness and pain during palpation of the hip joint; and 54.34%, were 1 week to 4 months old. Females represented 58.13% of the sample, and 65.11% of them weighed from 2.6 to 4.9 kg. Based on the radiographic classification, 4.34% were Grade 1; 32.60%, Grade 2; 8.69%, Grade 3; 19.56%, Grade 4; and 34.78%, Grade 5. The femoral head and neck ostectomy was performed in 42 hind limbs (91.30%); 42.85% of the dogs reached total functional recovery and 26.19% required physiotherapy and rehabilitation.Discussion: The present sample was composed of 25 dogs, which were 6-to-11-month old at the moment of patient consultation, but 17 dogs were 12-to-36-month old at this time; only one dog was older than 36 months. It may be associated with the non-recognition of clinical signs by the owners, rather than with the late-onset form of the disease. With respect to the breed, pinscher, Yorkshire, poodle, Lhasa apso, pug were most frequently observed. However, 7 dogs were crossbreed. Such group differed from that of a review involving 188 cases encompassing West Highland white terrier, Cairn terrier and poodle as the most commonly affected breeds. No sex predilection was found in a study comprising 188 cases, but in another study comprising 14 dogs, female predilection was observed. Likewise, the females represented 58.13% of cases in the present study; and 41.86% of the participants were male. The mean body mass of the dogs in the current study was 4.33 kg, which matches the small breed dogs, which are most affected by the disease. Clinical signs of non-weightbearing lameness or an intermittent subtle lameness are common in the avascular necrosis of the femoral head. Lameness of the affected hind limb was observed in 69.76% of the cases in the present study, but 2.32% showed no lameness. Occasionally, the avascular necrosis of the femoral head is bilaterally found in 12% to 16.5% of the cases. Only 3 out of the 43 cases assessed in the present study were bilateral. Since the lesions were more frequent in Grades 2 and 5, there is less chance of success through the conservative treatment. Thus, the femoral head and neck ostectomy was the surgical procedure performed in 42 hind limbs. The procedure is used to provide pain relief and to reduce the signs of lameness. In conclusion, the population assessed in the present study was composed of small size dogs, mean body mass 4.33 kg, no sex predilection, mostly presenting unilateral lesions and higher Grade 2 and Grade 5 radiographic lesion frequency.Keywords: radiographic, joint, canine, hip.

Avascular Necrosis of the Femoral Head in Dogs - Retrospective Study

Background: The avascular necrosis of the femoral head is a development disease caused by ischemic necrosis, which is mainly observed in young dogs. The etiology of the disease remains controversial. The diagnosis requires imaging exams such as MRI and radiographs. Thus, the aim of the current study was to retrospectively assess a population of dogs with avascular necrosis of the femoral head in order to feature the disease, as well as to analyze the radiographic appearance of the lesion at the moment of patient consultation.Materials, Methods & Results: The signalment factors of dogs (breed, gender, age and body mass), the affected hind limb, the radiographic appearance of the lesion, the clinical signs at the moment of patient consultation, the time of occurrence and the type of treatment were evaluated. The disease was radiographically classified according to the previously described items. Forty-three cases of avascular necrosis of the femoral head were identified, 97.67% presented lameness and pain during palpation of the hip joint; and 54.34%, were 1 week to 4 months old. Females represented 58.13% of the sample, and 65.11% of them weighed from 2.6 to 4.9 kg. Based on the radiographic classification, 4.34% were Grade 1; 32.60%, Grade 2; 8.69%, Grade 3; 19.56%, Grade 4; and 34.78%, Grade 5. The femoral head and neck ostectomy was performed in 42 hind limbs (91.30%); 42.85% of the dogs reached total functional recovery and 26.19% required physiotherapy and rehabilitation.Discussion: The present sample was composed of 25 dogs, which were 6-to-11-month old at the moment of patient consultation, but 17 dogs were 12-to-36-month old at this time; only one dog was older than 36 months. It may be associated with the non-recognition of clinical signs by the owners, rather than with the late-onset form of the disease. With respect to the breed, pinscher, Yorkshire, poodle, Lhasa apso, pug were most frequently observed. However, 7 dogs were crossbreed. Such group differed from that of a review involving 188 cases encompassing West Highland white terrier, Cairn terrier and poodle as the most commonly affected breeds. No sex predilection was found in a study comprising 188 cases, but in another study comprising 14 dogs, female predilection was observed. Likewise, the females represented 58.13% of cases in the present study; and 41.86% of the participants were male. The mean body mass of the dogs in the current study was 4.33 kg, which matches the small breed dogs, which are most affected by the disease. Clinical signs of non-weightbearing lameness or an intermittent subtle lameness are common in the avascular necrosis of the femoral head. Lameness of the affected hind limb was observed in 69.76% of the cases in the present study, but 2.32% showed no lameness. Occasionally, the avascular necrosis of the femoral head is bilaterally found in 12% to 16.5% of the cases. Only 3 out of the 43 cases assessed in the present study were bilateral. Since the lesions were more frequent in Grades 2 and 5, there is less chance of success through the conservative treatment. Thus, the femoral head and neck ostectomy was the surgical procedure performed in 42 hind limbs. The procedure is used to provide pain relief and to reduce the signs of lameness. In conclusion, the population assessed in the present study was composed of small size dogs, mean body mass 4.33 kg, no sex predilection, mostly presenting unilateral lesions and higher Grade 2 and Grade 5 radiographic lesion frequency.

Femoral Head and Neck Ostectomy for Surgical Treatment of Acute Craniodorsal Coxofemoral Luxation in Rabbits

Craniodorsal coxofemoral luxation is a common orthopedic condition causing lameness in rabbits, which may be caused through iatrogenic, congenital, or traumatic means. Current treatment methods for coxofemoral luxation in rabbit patients typically begins with conservative management in the form of restricted activity and often results in the need for an open surgical approach to the affected hip for a femoral head and neck ostectomy (FHNO). However, this technique has never been described for domestic rabbits. Because an FHNO is often performed successfully, it should be considered by veterinarians in rabbits diagnosed with a coxofemoral luxation that cannot be reduced. This article describes and illustrates the FHNO surgical procedure for the domestic rabbit.

Total hip replacement in two dogs with unsuccessful femoral head ostectomy

An English setter (case 1) and a Tibetan mastiff (case 2) presented with intermittent weight-bearing lameness on the right hind limb when trotting. The dogs had a history of femoral head and neck ostectomy (FHNO). Orthopedic examination revealed pain and crepitus on the right hip joint. The dogs underwent total hip replacement (THR). At the 2-year (case 1) and 1-year (case 2) follow-up, both dogs had resumed normal activity without lameness. The muscle mass and range of motion were significantly improved in the affected hind limb. In conclusion, FHNO with poor functional outcomes can be successfully ameliorated with THR.

Use of sedation and ropivacaine‐morphine epidural for femoral head and neck ostectomy in a dog

A five-year-old male German shepherd dog presented with traumatic craniodorsal luxation of the right coxofemoral joint with pre-existing moderate hip dysplasia. A femoral head and neck ostectomy was performed. The patient was sedated with acepromazine and morphine administered intramuscularly. A lumbosacral epidural was performed using a combination of morphine and ropivacaine. Intraoperatively, an infusion of medetomidine, morphine, lidocaine, and ketamine was administered intravenously, and oxygen was administered via facemask. Heart rate, respiratory rate and oscillometric arterial blood pressures were monitored. Postoperatively, carprofen was administered once subcutaneously. On the day of hospital discharge, carprofen and tramadol were administered orally every 12 hours. Twenty-one days later, the dog was doing well and the surgical staples were removed. Sedation with acepromazine and morphine, administration of an epidural containing morphine and ropivacaine, and intraoperative sedation with medetomidine, morphine, lidocaine and ketamine were suitable for femoral head and neck ostectomy.

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.

Bone Resorption Markers and Dual‐Energy X‐Ray Absorptiometry in Dogs with Avascular Necrosis, Degenerative Joint Disease, and Trauma of the Coxofemoral Joint

To compare the ability of N-terminal telopeptide (NTx) assays and dual-energy x-ray absorptiometry (DEXA) to detect bone resorption in dogs with nonneoplastic bone lysis and evaluate the correlation between these diagnostic tools. Prospective, cross-sectional clinical study. Dogs (n = 35; 39 femoral heads) that had femoral head and neck ostectomy and 6 cadaver specimens from healthy immature small dogs. Small dogs with avascular necrosis (n = 12), a reference group of small dogs (7), large dogs with degenerative joint disease (DJD; 10), and large dogs with trauma (10) were studied in addition to 6 femoral heads harvested from 6 small immature and healthy dogs euthanatized for reasons unrelated to this study. Densitometric measurements of femoral heads, urine NTx excretion, and serum NTx concentration were compared between groups. Avascular necrosis resulted in a decrease in bone mineral density (BMD) (0.18 ± 0.01 g/cm(2;) P < .01) of the femoral head and elevation of serum NTx (159.3 ± 59.4 nM; P = .03) compared to small dog controls (0.28 ± 0.02 g/cm(2) ; 18.7 ± 1.83 nM, respectively), but did not seem to affect urine NTx. DJD in large dogs did not seem to affect any of the densitometric parameters evaluated. BMD (P = .03) and serum NTx (P = .04) were lower in small compared to large dogs. Serum NTx and densitometric measurements correlate inversely with each other (P = .001) but neither test correlated with urine NTx (P = .8-.9). Serum NTx levels vary with dog size but seem to correlate better with BMD better than urine NTx excretion in dogs with nonneoplastic bone resorption.

Nano Total Hip Replacement in 12 Dogs

To determine the short-term clinical outcome of nano total hip replacement (NanoTHR) in dogs. Retrospective case series. Dogs (n = 12). Medical records (2009-2011) of dogs that had nano-THR were reviewed for signalment, weight, clinical signs, side, age, prosthesis sizes, concurrent surgeries performed, complications, operative time, 3-month postoperative pelvic radiograph results, and lameness scores. Breeds were Yorkshire Terriers (n = 6), Toy Poodles (2), with 1 each of Maltese, Pomeranian, Cavalier King Charles Spaniel, and Shih-Tzu. Median body was 4.87 kg (range, 2.5-5.90 kg) and median age, 35.75 months (range, 12-144 months). Radiographs were taken in 4 dogs at 12 days (n = 2), 14 days (1), and 30 days (1) after surgery because of presentation for an acute grade 5 lameness. Three dogs had femoral fractures distal to the femoral implant tip and 1 dog displaced the acetabular implant medially. After revision surgery, all femoral fractures were assessed as healed with intact plate fixation. The dog with the medially displaced acetabular component responded to conservative management including strict confinement and analgesic administration. Eight dogs (58%) were assigned a grade 1 lameness and 4 dogs were grade 2 (33%) at 12-week examination. The 3 dogs with grade 5 lameness scores found to have femoral fractures within 1 month after surgery, subsequently improved to grade 1 (n = 1) and 2 (2) 12 weeks after revision surgery. The dog with medial acetabular displacement improved to a grade 2 lameness 12 weeks after conservative management. Although all 12 dogs had good-to-excellent outcomes, 33% experienced significant complications associated with the technique. As improvements in instrumentation and refinements in the technique are developed, NanoTHR can be considered an alternative to the femoral head and neck ostectomy (FHO) or medical management of coxofemoral disease for toy breed dogs. Further studies with a larger number of dogs and longer follow-up times are required.