DOCSLIB.ORG

Total Hip Arthroplasty in the Horse: Overview, Technical Considerations and Case Report N

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Total Hip Arthroplasty in the Horse: Overview, Technical Considerations and Case Report N EQUINE VETERINARY EDUCATION / AE / November 2010 547 Case Reporteve_118 547..553 Total hip arthroplasty in the horse: Overview, technical considerations and case report N. Huggons*, R. Andrea†, B. Grant‡ and C. Duncan§ WR Pritchard Veterinary Medical Teaching Hospital, University of California Davis; †Chaparral Veterinary Medical Center, Arizona; ‡31624 Wrightwood, California, USA; §Gordon & Leslie Diamond Health Care Centre, Vancouver, Canada. Keywords: horse; total hip arthroplasty; hip replacement; coxofemoral joint; acetabulum Summary Hance 1998; Loesch et al. 2003; Smith et al. 2004), disruption of intra-articular ligaments (Trotter et al. 1986; A total hip arthroplasty was performed in a small Nixon 1994), fractures (Turner et al. 1979; Embertson equine patient with a history of traumatic subluxation of et al. 1986; Hunt et al. 1990a) and dysplasia (Jogi and the coxofemoral joint during infancy resulting in severe Norberg 1962; Speirs and Wrigley 1979) have also been degenerative changes to the femoral head and described. acetabulum. The transtrochanteric surgical approach Few treatment options exist for hip disease, with used to expose the joint, as well as the technique and limitations primarily due to the large muscle mass technology to replace the joint, is described. The patient covering the joint, difficulty with surgical access to the was weightbearing within 24 h of surgery and walking joint and implant failure associated with post operative successfully without sling support 4 days post operatively. weightbearing. Surgical fixation of femoral capital On the fifth post operative day, the patient abruptly epiphyseal fractures in foals has included excision deteriorated and succumbed to multiple pulmonary arthroplasty, Steinmann or Knowles pin fixation, multiple thromboemboli and a jejunal infarction. Despite the intramedullary pins, femoral head ostectomy and an systemic complications in this case, the initial short-term interfragmentary compression system (Hunt et al. success of this treatment option indicate its potential to be 1990a,b; Squire et al. 1991). Conservative therapy considered in the management of equine coxofemoral carries a poor to guarded prognosis (Hunt et al. 1990a). joint disease/lesions. Closed reduction under general anaesthesia is indicated in acute cases of coxofemoral luxation Introduction (Clegg and Comerford 2007) and closed reduction in combination with an Ehmer sling has resulted in short-term success in a miniature pony (Clegg and Coxofemoral disease in the equine species is infrequently Butson 1996). Chronic coxofemoral luxation has been reported and rarely a primary source of pain causing treated with open reduction and a variety of surgical lameness (Hendrickson 2002; Dyson 2003). Diagnosis is stabilisation techniques. Excision arthroplasty of the based on physical examination, ultrasound and/or femoral head, joint capsule imbrication, open surgical radiographs of the coxofemoral region. Various aetiologies reduction, transarticular Steinmann pin, an ischio-ilial of coxofemoral disease have been reported including (DeVita) pin, total hip arthroplasty and toggle-pin coxofemoral luxation (Rothenbacher and Hokanson technique with capsullorrhaphy have all been reported 1965; Nyack et al. 1982; Field et al. 1992; Malark et al. 1992; with variable success rates (Trotter et al. 1986; Platt et al. Clegg and Butson 1996; Garcia-Lopez et al. 2001; Portier 1990; Malark et al. 1992; Garcia-Lopez et al. 2001; Toth and Walsh 2006), acetabular osteochondrosis dissecans et al. 2007). (Rose et al. 1981; Miller and Todhunter 1987; Nixon 1994), In human hip disease, total hip arthroplasty (THA) has femoral head osteochondrosis (Nixon et al. 1988; Nixon become one of the most effective and reliable surgical 1994) and degenerative joint disease (Trent and Krook interventions for improving quality of life. It has been 1985; Lamb and Morris 1987; Nixon 1994; Clegg and Butson found to provide considerable improvement in functional 1996). Pathologies such as septic arthritis (Clegg 1995; mobility and range of motion and permanently relieves *Corresponding author email: [email protected] pain in the majority of patients (Roder et al. 2003). The © 2010 EVJ Ltd 548 EQUINE VETERINARY EDUCATION / AE / November 2010 success in man has resulted in total hip arthroplasty being a routinely performed treatment measure in small animal orthopaedics (Cook 2007). To date, there are only 3 reports of THA for use in large animals. Two successful case reports of total hip replacements in alpacas have been recently published (Ortved et al. 2009; Schulz et al. 2009). In the horse, a single case is reported in the literature and was performed in a 9-year-old miniature horse with early complications due to implant failure following discharge from the hospital (Malark et al. 1992). Recum et al. (1980) reported the results of experimental coxofemoral hemiarthroplasty in 7 ponies, concluding that coxofemoral surgery can be performed in the adult pony and a total artificial hip joint may provide better results than a partial hip replacement. The purpose of this paper is to describe the transtrochanteric surgical technique employed to fit a small equid with a total hip arthroplasty, along with the post operative management and outcome of a single case. Clinical report An 8-week-old Dwarf Friesian filly presented with a history of trauma at age 6 weeks sustained by falling into a hole at pasture. At that time, a severe left hindlimb lameness (grade 4/5) was present. Diagnostic work-up localised the injury to the pelvic region. Neutral and stressed Fig 1: Ventral-dorsal radiographs including a neutral view on the left (a) and a stressed view on the right with the left hip subluxated radiographic views were obtained, demonstrating left (b). coxofemoral subluxation (Fig 1). Diagnostic arthroscopy of the left coxofemoral joint was performed and showed rupture of the round ligament. Conservative treatment was attempted and the patient re-presented with difficulty weightbearing of 3 months’ duration. Examination of the limb revealed muscle atrophy around the hip and proximal displacement of the greater trochanter. A ventral-dorsal radiograph revealed subluxation of the left coxofemoral joint, flattening and excessive anteversion of the femoral head, and severe degenerative changes to the acetabulum and femoral head (Fig 2). The diagnosis was traumatic coxofemoral subluxation at infancy with secondary femoral head flattening and severe osteoarthritis. Arthrocentesis and laboratory evaluation ruled out infection. The foal was again managed conservatively with stall rest for a period of 4 months. During this time the left hindlimb suffered severe disuse atrophy Fig 2: Ventral-dorsal radiograph 4 months after Figure 1 and the foal developed external rotation demonstrating a normal right hip joint, while on the left there is of the left hindlimb with intermittent weightbearing on subluxation of the coxofemoral joint, severe degenerative the dorsum of the fetlock. The patient also displayed a changes to the acetabulum and femoral head, excessive femoral number of congenital abnormalities, including phenotypic neck anteversion and a flattened femoral head. dwarfism, scoliosis and a heart murmur. The long-term prognosis for this foal was considered to be guarded due Preoperative planning for a total hip arthroplasty to the chronic duration and associated degenerative included consulting with a human orthopaedic specialist changes to the left hindlimb. (C.D.). Measurements of the opposite normal Case management included analgesics and anti- coxofemoral size suggested that total hip replacement inflammatory medication in addition to sling training would be feasible, using components similar in size and (Anderson Pony Sling)1, while the surgical choices were shape to those used in man, but at the larger end of considered. the scale. © 2010 EVJ Ltd EQUINE VETERINARY EDUCATION / AE / November 2010 549 Surgical technique A 14 gauge catheter was placed in the left jugular vein and ceftiofur (2.2 mg/kg bwt i.v.), amikacin (6.6 mg/kg bwt i.v.) and phenylbutazone (1.1 mg/kg bwt i.v.) were administered. The patient was premedicated with xylazine (0.5 mg/kg bwt i.v.) and induced with diazepam (0.1 mg/kg bwt i.v.) and ketamine (2.2 mg/kg bwt i.v.). Anaesthesia was maintained with isoflurane in oxygen delivered by a semiclosed rebreathing circuit. The foal was placed in right lateral recumbency with the left limb suspended in partial extension. The hair was clipped and proximal limb and hip aseptically prepared. An antimicrobial surgical incise drape (Ioban)2 was placed over the proposed surgical site, centred over the greater trochanter. An impervious sterile abdominal drape (Steri-Drape)2 was placed over the left hindlimb centred over the greater trochanter and the remaining areas covered with sterile half drapes (Steri-Drape). A 25 cm curvilinear skin incision was made, centred Fig 3: Intraoperative image demonstrating the reflected greater trochanter (white arrow) and attached gluteal muscles on the right, over the greater trochanter, extending 10 cm proximally the wide surgical exposure that this afforded and the implanted towards dorsal midline and 15 cm distally towards acetabular shell (black arrow) within the newly reamed acetabular mid-diaphysis of the femur. A combination of sharp and cavity in the centre. The asterisk is located over the caudal pelvis blunt dissection was used along the cranial border of and semitendinosus musculature.
Load more

Recommended publications
  • Total Hip Replacement Part 1
    DIAGNOSIS AND SURGICAL APPROACHES: TOTAL HIP REPLACEMENT PART 1 Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. Abstract Arthritis, fractures, and repetitive strain can cause significant pain in the hip joint over time, but hip replacement surgery is an option for many patients each year in the United States. Plastic, ceramic, and metal components can be used to wholly replace the ball-and-socket hip joint and restore mobility in patients. Although most patients who undergo total hip replacement surgery are either retired or elderly, it can be useful for any patient who suffers pain that is not relieved by traditional methods.
    [Show full text]
  • AIS-Pennhip-Manual.Pdf
    Training Manual Table of Contents Chapter 1: Introduction and Overview ............................................................................................... 5 Brief History of PennHIP ........................................................................................................................................5 Current Status of CHD ...........................................................................................................................................5 Requirements for Improved Hip Screening ............................................................................................................6 PennHIP Strategies ................................................................................................................................................7 The AIS PennHIP Procedure .................................................................................................................................8 AIS PennHIP Certification ......................................................................................................................................8 Purchasing a Distractor ..........................................................................................................................................9 Antech Imaging Services........................................................................................................................................9 Summary ............................................................................................................................................................
    [Show full text]
  • The Orthopedic Examination in Dogs: a Fast and Effective Tool Denis Marcellin-Little, DEDV, DACVS, DACVSMR University of California, Davis
    The Orthopedic Examination in Dogs: A Fast and Effective Tool Denis Marcellin-Little, DEDV, DACVS, DACVSMR University of California, Davis Even if many lamenesses in dogs appear somewhat mysterious at first glance, they can be approached step by step, and their cause can, in most instances, be localized to specific bones or joints. The purpose of this presentation is to describe these diagnostic steps: know the most common orthopedic disorders, keep the signalment in mind, collect a thorough history, observe the dog standing, changing position, and walking, palpate the dog, prepare a short list of differential diagnoses, and confirm your suspicions with radiographs. STEP 1. KNOW THE MOST COMMON ORTHOPEDIC DISORDERS The majority of lamenesses are caused by a handful of diseases.9 In the forelimb, elbow dysplasia with or without fragmentation of the medial coronoid process and osteochondritis dissecans of the humeral head are most common. In the hind limb, hip dysplasia and cranial cruciate ligament injuries are most common (Table 1). Table 1. Orthopedic problems ranked by decreasing prevalence Problem Incidence Canine hip dysplasia 10% Pelvic fracture 8% Cruciate ligament injuries 8% Patellar luxation 7% Femoral fractures 7% Coxofemoral luxation 5% Radial and ulnar fractures 4% Other 51% If we extend the list to 20 diseases, we cover 99 percent of the lamenesses. Ideally, we should have in mind one or two statements about the 1) definition, 2) importance (prevalence and severity), 3) etiology, 4) pathogenesis, 5) heritability, 6) clinical signs, 7) diagnosis, 8) treatment, and 9) prognosis of each common orthopedic problem. For example, Table 2 lists the facts related to canine hip dysplasia.
    [Show full text]
  • Excision Arthroplasty of the Hip Joint in Dogs and Cats
    Pearls from the Past © Schattauer 2010 297 Excision arthroplasty of the hip joint in dogs and cats Clinical, radiographic, and gait analysis findings from the Department of Surgery, Veterinary Faculty of the Ludwig-Maximilians-University of Munich, Germany W. Off; U. Matis Department of Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany was used when preservation of the joint Keywords years postoperatively in 81 (44%) of the ani- was not feasible or practical (ǠFig. 1). Dog, cat, hip joint, femoral head and neck mals, and gait analysis was also done in 17. The most frequent indication in dogs was ostectomy, clinical and radiographic findings, The functional results were rated good in 38% avascular necrosis of the femoral head gait analysis of patients, satisfactory in 20%, and poor in caused by Legg-Calvé-Perthes disease; 42%. However 96% of the owners were satis- most patients suffering from this disease Summary fied with the results. Kinetic and kinematic weighed <15 kg (ǠFig. 2). Seventy-five From 1978 to 1989, 132 dogs and 51 cats measurements showed that although femoral percent of the patients were less than two- underwent femoral head and neck ostectomy head and neck resection alleviated pain, it re- years-old. at the Department of Veterinary Surgery, Lud- sulted in functional deficits in small as well as A craniolateral approach to the hip was wig-Maximilians University, Munich, Ger- large breed dogs. These deficits were not vi- used in all cases. After reflection of the many. Clinical and radiographic re-evalu- sible during rapid movement. ations were carried out an average of four joint capsule and transection of the round ligament, the limb was rotated outwards 90°.
    [Show full text]
  • Learn About Total Hip Replacement
    Learn about Total Hip Replacement Many factors enter into the decision to have a total hip replacement performed on your pet and you may have many questions about the procedure. The answers to the most commonly asked questions about total hip replacement follow. We hope you find this information helpful. What is total hip replacement? Total hip replacement - or total hip arthroplasty - involves removal of a painful or damaged “ball and socket” hip joint and replacement with an artificial hip or prosthesis. The new ball is made from a cobalt-chromium metal alloy and the new socket from high molecular weight polyethylene plastic. The joint prosthesis eliminates the cause of pain and stiffness and dogs can return to most of the activities they enjoy. When compared to femoral head and neck ostectomy (FHO), total hip replacement provides the best return to normal function in the limb. Why might total hip replacement be necessary? The most frequent reason for performing a total hip replacement is relief of pain caused by severe degenerative joint disease secondary to hip dysplasia or fracture and to improve mobility. Other reasons include chronic dislocation of the hip and acute dislocation of the hip that cannot be reduced because of hip dysplasia or soft tissue damage. Many dogs with arthritic hip joints seem to function normally or cope with their disability. When a painful joint is replaced with an artificial joint, there is often a dramatic change in the dog's personality as well as a change in activity levels. Are there reasons why my dog should not have a total hip replacement? Yes.
    [Show full text]
  • PART G Lower Extremity Treatment Guidelines.Fm
    TITLE 19 LABOR 1 DELAWARE ADMINISTRATIVE CODE 1000 DEPARTMENT OF LABOR 1300 Division of Industrial Affairs 1340 The Office of Workers’ Compensation 1342 Health Care Practice Guidelines PART G Lower Extremity Treatment Guidelines 1.0 Introduction Pursuant to 19 Del.C. §2322C, health care practice guidelines have been adopted and recommended by the Health Care Advisory Panel to guide utilization of health care treatments in workers' compensation including, but not limited to, care provided for the treatment of employees by or under the supervision of a licensed health care provider, prescription drug utilization, inpatient hospitalization and length of stay, diagnostic testing, physical therapy, chiropractic care and palliative care. The health care practice guidelines apply to all treatments provided after the effective date of the regulation adopted by the Department of Labor, May 23, 2008, and regardless of the date of injury. Lower Extremity was added to the list of treatment guidelines, effective 6/13/2011. The guidelines are, to the extent permitted by the most current medical science or applicable science, based on well-documented scientific research concerning efficacious treatment for injuries and occupational disease. To the extent that well-documented scientific research regarding the above is not available at the time of adoption of the guidelines, or is not available at the time of any revision to the guidelines, the guidelines have been and will be based upon the best available information concerning national consensus regarding best health care practices in the relevant health care community. The guidelines, to the extent practical and consistent with the Act, address treatment of those physical conditions which occur with the greatest frequency, or which require the most expensive treatments, for work-related injuries based upon currently available Delaware data.
    [Show full text]
  • Should We Offer Total Hip Replacement to Our Feline Patients?
    Should we offer total hip replacement to our feline patients? A Knowledge Summary by Katie Smithers BVSC CertAVP MRCVS 1* 1 University of Liverpool, Leahurst Campus, Neston, CH64 7TE * Corresponding Author ([email protected]) ISSN: 2396-9776 Published: 16 Dec 2020 in: The Veterinary Evidence journal Vol 5, Issue 4 DOI: 10.18849/VE.V5I4.347 Reviewed by: Jacqueline Cole (BSc BVetMed MRCVS) and Eithne Comerford (MVB PhD CertVR CertSAS PGCertHE DipECVS FHEA FRCVS RCVS) Next Review Date: 11 Jan 2022 KNOWLEDGE SUMMARY PICO question In cats with traumatic coxofemoral injury, does total hip replacement (THR) offer improved outcome when compared with femoral head and neck excision (FHNE) arthroplasty? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed One paper was critically reviewed. It was a non-randomised retrospective observational study Strength of evidence Moderate evidence Outcomes reported THR results in superior clinical outcome and owner satisfaction compared to FHNE in cats Conclusion In cats with traumatic coxofemoral injury, although the evidence is not conclusive and somewhat limited, the literature reviewed here suggests that THR offers a superior outcome in feline patients. There is currently insufficient evidence to determine if there is a difference in long-term outcome, complications or osteoarthritis (OA) development following THR or FHNE in feline patients 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.
    [Show full text]
  • Development of New Implant System for Correction of Coxofemoral Luxation in Canines
    Project Number: GRG-0901 DEVELOPMENT OF NEW IMPLANT SYSTEM FOR CORRECTION OF COXOFEMORAL LUXATION IN CANINES A Major Qualifying Report Submitted to the Faculty Of the WORCESTER POLYTECHNIC INSTITUTE In partial fulfillment of the requirements for the Degree of Bachelor of Science by Meghan Pasquali ________________________ Nicholas Pelletier ________________________ Jennifer Richards ________________________ Jonathan Shoemaker ________________________ Date: April 23, 2009 Approved: Prof. Glenn Gaudette, Advisor 1. Toggle rod _________________________ 2. Coxofemoral luxation 3. Novel implants Table of Contents Authorship .................................................................................................................................................... 5 Table of Figures ............................................................................................................................................ 6 Acknowledgements ....................................................................................................................................... 8 1 Abstract ................................................................................................................................................. 9 2 Introduction ......................................................................................................................................... 10 3 Background ......................................................................................................................................... 12
    [Show full text]
  • Diagnosing and Treating Rear Limb Disorders in Dogs Don Hulse, DVM, DACVS Austin Veterinary Sports Medicine College Station, TX
    Diagnosing and Treating Rear Limb Disorders in Dogs Don Hulse, DVM, DACVS Austin Veterinary Sports Medicine College Station, TX Hip dysplasia is an abnormal development of the coxofemoral joint. The syndrome is characterized by subluxation or complete luxation of the femoral head in the younger patient while in the older patient mild to severe degenerative joint disease is present. Laxity in the hip joint is responsible for the early clinical signs and joint changes. Subluxation stretches the fibrous joint capsule, producing pain and lameness. When the surface area of articulation is decreased, this concentrates the stress of weight bearing over a small area through the hip joint. Subsequently, fractures of the trabecular cancellous bone of the acetabulum can occur, causing pain and lameness. The cancellous bone of the acetabulum is easily deformed by the continual dorsal subluxation of the femoral head. This piston-like action causes a wearing of the acetabular articular surface from a horizontal plane to a more vertical plane causing subluxation to worsen. The physiologic response to joint laxity is proliferative fibroplasia of the joint capsule and increased thickness of the trabecular bone. This relieves the pain associated with capsular sprain and trabecular fractures. However, the surface area of articulation is still decreased causing premature wear of articular cartilage, exposure of subchondral pain fibers and lameness. This may occur early in the pathologic process or later in life. There are two general recognizable clinical syndromes associated with hip dysplasia: (1) patients 5 to 16 months of age, (2) patients with chronic degenerative joint disease. Patients in group 1 present with lameness between 5 to 8 months of age.
    [Show full text]
  • Case Report Femoral Head Ostectomy to Treat a Donkey for Coxofemoral Luxation F
    478 EQUINE VETERINARY EDUCATION / AE / October 2007 Case Report Femoral head ostectomy to treat a donkey for coxofemoral luxation F. T ÓTH*, H. S. ADAIR, T. E. C. HOLDER AND J. SCHUMACHER The University of Tennessee, College of Veterinary Medicine, Large Animal Clinical Sciences, 2407 River Drive, Knoxville, Tennessee 37996, USA. Keywords: horse; donkey; coxofemoral luxation; femoral ostectomy Introduction condition was 7/9 (Henneke et al. 1983). Its right hind foot was rotated outward, and the right calcaneal tuberosity and Coxofemoral luxation occurs uncommonly in horses and right greater trochanter were positioned more proximally than donkeys (Malark et al. 1992). Young equids are most their left counterparts. While standing, the donkey rested the commonly affected, and the most common cause is trauma toe of the affected limb on the ground, but when walked, it (Garcia-Lopez et al. 2001). Several techniques have been was a grade 5 out of 5 lame (Anon 1991). It violently resisted advocated for the treatment of horses with the condition. In manipulation of its right hindlimb. Crepitus was not palpated one study, reluxation after closed reduction occurred in 4 out in the region of the right coxofemoral joint. of 5 horses (Malark et al. 1992). Accounts of femoral head and neck ostectomy performed in cattle report a good prognosis Radiographic examination for growing to full adult weight (Squire et al. 1991), whereas accounts of femoral head and neck ostectomy performed in The donkey’s pelvis was radiographically examined, using a horses and ponies describe multiple complications, such as lateromedial radiographic projection obtained with the upward fixation of the patella and osteoarthritis of the donkey standing and sedated with xylazine HCl (0.5 mg/kg coxofemoral joint (Platt et al.
    [Show full text]
  • Code of Colorado Regulations 1 Patient Compliance, As Well As Availability of Services
    DEPARTMENT OF LABOR AND EMPLOYMENT Division of Workers’ Compensation WORKERS’ COMPENSATION RULES OF PROCEDURE WITH TREATMENT GUIDELINES RULE 17, EXHIBIT 6 LOWER EXTREMITY INJURY MEDICAL TREATMENT GUIDELINES 7 CCR 1101-3 Rule 17 - Exhibit 6 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________ A. INTRODUCTION This document has been prepared by the Colorado Department of Labor and Employment, Division of Workers’ Compensation (Division) and should be interpreted within the context of guidelines for physicians/providers treating individuals qualifying under Colorado Workers’ Compensation Act as injured workers with lower extremity injuries. Although the primary purpose of this document is advisory and educational, these guidelines are enforceable under the Workers’ Compensation Rules of Procedure, 7 CCR 1101-3. The Division recognizes that acceptable medical practice may include deviations from these guidelines, as individual cases dictate. Therefore, these guidelines are not relevant as evidence of a provider’s legal standard of professional care. To properly utilize this document, the reader should not skip nor overlook any sections. B. GENERAL GUIDELINES PRINCIPLES The principles summarized in this section are key to the intended implementation of all Division of Workers’ Compensation guidelines and critical to the reader’s application of the guidelines in this document. 1. APPLICATION OF THE GUIDELINES The Division provides procedures to implement medical treatment guidelines and to foster communication to resolve disputes among the provider, payer, and patient through the Workers’ Compensation Rules of Procedure. In lieu of more costly litigation, parties may wish to seek administrative dispute resolution services through the Division or the Office of Administrative Courts.
    [Show full text]
  • Hip Dysplasia (CHD) Is Adult Weight Slower
    Two Harbors Veterinary Clinic 1333 Fairgrounds Rd. • Two Harbors, MN 55616 • (218) 834-1333 C ANINE HIP D YSPLASIA Canine hip dysplasia (CHD) is adult weight slower. Penn Hip involves the taking of disadvantage to this procedure a malformation of the hip joint several x-rays using several hip is cost, running $8000 per hip. that results in painful arthritis if How do We Screen for CHD? positions. Your dog gets a left untreated over a long While any dog can have CHD, measured laxity of its hips. Medical Treatment Options period of time. The time it takes certain breeds are more prone This procedure can be While surgical therapy is the to develop arthritis depends on to developing it. German performed at six months of preferred treatment of CHD, a number of factors, including Shepherds and Labrador age, expanding the number of the one-time cost of these the severity of the dysplasia Retrievers in particular seem treatment options available. procedures can certainly be and the size of the dog. The very prone. Any dog with an blinding. Arthritis from CHD purpose of this handout is to adult body weight of over 60 The Penn Hip is probably a can be managed medically as discuss this disease and what pounds warrants a screening x- better procedure for predicting well, but it is important to treatment options are available. ray around 6 months of age. arthritis, but at this point in time understand that this therapy is OFA remains the breeders' palliative only, not curative. How Do Dogs get CHD? Certification is necessary for standard.
    [Show full text]