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Orthopedic Diseases of the Hip - Coggle Diagram
Orthopedic Diseases of the Hip
Leggs-Calves-Perthes like disease (LCP)
aka avascular necrosis of the hip
hereditary
may be trauma induced
may be vascular
signalment
less than 1yi
terrier, small dog
CS
irritable
chewing hip
progressive lameness
mottled irregular femoral head
treatment
definition
abnormal amount of passive hip laxity (subluxation)
presence of idiopathic degenerative joint disease in coxofemoral joint
cartiledge damage
osteophyte formation
subchondral schlerosis
prevalence and etiology
prevalence very high
multifactorial etiology
genetics
environment
diet
restricted diet decreases
anion gap
decreasing decreases HD
decreased osmolality = decreased synovial fluid
pathogenesis
passive hip laxity
degenerative joint disease
cartiledge erosin
osteophytes
sclerosis
periarticular fibrosis
diagnosis
radiographs
imperfect
confirmation of clinical findings
hip extended view
easy to perform
poor reproducibility
excellent for diagnosis of DJD
modest ability to diagnose laxity
many with abnormal hips appear abnormal on this view
norberg angle measurement
7 grade OFA
osteoarthritis
sclerosis "Morgan's Line"
ostephytes
caudolateral curvilinear osteophyte (CCO)
enthesophytes
lysis
compression/distraction view
more complex technique
moderate ability to diagnose DJD
excellent ability to diagnose passive hip laxity
excellent repeatability
need to be 4mo
history
difficulty...
jumping
climbing stairs
bunny hopping
progressive
worse after rest or exercise
signalemnt
large and giant purebreds
some breeds protective
8-12mo or >5yo, but any age possible
PE
hip pain
extension or abduction
crepitus and decreased ROM with DJD
usually bilateral
ortolani sign
simple measure of passive laxity
weak correlation to DI
negative finding could be normal or DJD
hip dysplasia
treatment
nonsurgical
50-80% have good clinical fxn
NSAIDs
previcox
dermaxx
rimadyl
:forbidden: naproxen
exercise management
swimming
daily leash walks
dietary management
reduction in BCS increases vertical forces
prescription diets
injectable glycosaminoglycans
:forbidden: nutraceuticals
femoral head and neck extension
triple pelvic osteotomy
technique
osteoomy o pubis, ischium, ilium
rotation and stabilization of segment to increase ventroversion
pros
90% satisfactory at 12mo, maybe 5y
may slow osteophytosis
cons
sciatic nerve paralysis ~!%
expensive due to amt of equipment and expertise needed
controversies
what are the indications?
hip pain
mild laxity
under 2yi
no evidencce for "window of opportunity"
how much to rotate the hip
20 degress
does is change progression of disease
can you do bilateral procedure
yeah
prophylactic?
nah
total hip replacement
indications
skeletally mature
ineffective nonsurgical management
end stage osteoarthritis
10% major complications
pubic symphysiodesis
prophylactic sx
technique
fuse caudal 1/2 of pubic symphysis at 4-5mo of age
continued growth from ilium and ischium ventrovert acetabulum
pros
cons
controversies
remember efficacy does not imply safety
ineffective treatment options
denervation of hip joint capsule
pectineal myectomy
BOP/shelf arthroplasty
varus or derotational osteotomy
femoral neck lengthening
sacroiliac wege rotation
acupuncture
personally stopped at slide 28
really struggle-bussin' in general
