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Excision Arthroplasty of the Hip Joint in Dogs and Cats

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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°. Osteotomy of the femoral neck was achieved using an osteotome or oscillating Correspondence to: Vet Comp Orthop Traumatol 2010; 23: 297-305 saw. Sometimes the lesser trochanter was Prof. Dr. Ulrike Matis Vorstand der Chirurgischen und Gynäkologischen also resected. In order to completely re- This article was originally published in 1997 in the move the caudal edge of the femoral neck, Kleintierklinik der Ludwig-Maximilians- journal Tierärztliche Praxis. Both authors have ap- Universität München proved the re-publication of this article in English, for the osteotome or saw was directed in a Lehrstuhl für Allgemeine und Spezielle Chirurgie which they have provided the translation of as well. caudolateral direction (ǠFig. 3) rather einschließlich Augenkrankheiten Original citation: Off W, Matis U. Resektionsarthro- Veterinärstr. 13 than perpendicular to the long axis of the plastik des Hüftgelenkes bei Hunden und Katzen. 80539 München femoral neck. The goal was to create a Germany Klinische, röntgenologische und ganganalytische Er- smooth resection plane with no bony pro- hebungen an der Chirurgischen Tierklinik der Lud- Phone: +49 89 2180 2628 tuberances. In the majority of cases, the Fax: +49 89 39 53 41 wig-Maximilians-Universität München. Tierärztl Prax E-mail: [email protected] 1997; 25: 379–387. joint capsule was closed to provide a layer of tissue between the acetabulum and cut surface of the femur after removal of the femoral head and neck (ǠFig. 4) (17). An additional procedure used in some pa- Introduction nations of patients in the Department of tients near the end of the study period was Veterinary Surgery, Ludwig-Maximilians- placement of one or two heavy, slowly-ab- Femoral head and neck ostectomy (FHO) University, Munich, Germany. Kinetic and sorbable sutures to attach the gluteal ten- is a relatively straightforward procedure kinematic evaluations were also under- dons to the insertion of the rectus femoris and has been the topic of many studies (1, taken in some dogs because the human eye muscle to prevent caudodorsal malposi- 2, 4–8, 10–12, 18–24). The techniques and cannot fully and accurately assess quad- tion of the femur. Wound closure was rou- surgical approaches used as well as the re- ruped motion. tine. Ventrodorsal radiographs were ob- sults of the procedure vary. In some studies, tained immediately after surgery to deter- the findings have been based solely on the mine the orientation of the osteotomy outcome of owner questionnaires. Materials and methods plane. The aim of this study was to investigate Follow-up examinations of 81 patients the efficacy of FHO using the results of From 1978 to 1989, FHO was carried out (66 dogs and 15 cats) were carried out clinical and radiographic follow-up exami- in 132 dogs and 51 cats. The procedure seven months to 10 years after surgery Vet Comp Orthop Traumatol 5/2010 298 W. Off, U. Matis: Excision arthroplasty of the hip joint The evaluations were scored as follows: ● Good: no lameness, complete weight bearing at all gaits. ● Satisfactory: slight lameness, occasional stiffness, occasional non-weight-bear- ing lameness. Fig. 1 ● Unsatisfactory: permanent mild to se- Indications for femo- vere lameness, frequent non-weight- ral head and neck bearing lameness, lameness after exer- ostectomy in 132 cise, lameness at a trot and/or gallop, dogs and 51 cats. weather-associated lameness. Radiographs taken immediately postoper- atively were available in 67 patients (55 dogs and 12 cats) for assessment of com- plete resection of the femoral neck with or without removal of the lesser trochanter Fig. 2 and the presence of sharp bony edges along Body weight dis- the osteotomy line. tribution of 132 dogs Seventeen dogs were also evaluated in and 51 cats that the gait laboratory (18, 19). The following underwent femoral head and neck ost- kinetic data were evaluated using a tread- ectomy (Body weight mill with four integrated force plates: of 5 dogs unknown). ● Stance time (msec) ● Peak vertical ground reaction force (% BW) ● Slope of ground reaction curve (% BW/sec) ● Integral (% BW x sec) Kinematic data were collected using reflec- tive markers over the iliac crest, greater trochanter, lateral femoral condyle, fibular malleolus, and the fifth metatarsal bone to provide joint angles of the hip, stifle, and tarsal during motion. Results Fig. 3 Postoperative re-evaluation showed that 68 Direction of the patients (84%) had limb shortening (cau- osteotome during dodorsal malposition of the femur), 61 osteotomy of the (75%) had muscle atrophy, 60 (74%) had femoral neck. reduced range-of-motion during extension and abduction of the hip hindlimb, 45 (56%) had signs of lameness, 26 (32%) (mean 4 years) at our clinic. The clinical ● Duration of preoperative signs showed signs of pain during passive move- variables evaluated included lameness, ● Duration of postoperative convales- ment of the limb, and eight (10%) patients muscle atrophy, pain with passive move- cence had crepitus (ǠTable 1). There was a small ment, crepitus, caudodorsal malposition of ● Weight bearing on the affected limb at a number of dogs that weighed more than 15 the femur, and range-of-motion. These slow gait, fast gait, after strenuous exer- kg, but this group tended to have worse re- objective variables were supplemented by cise and during cold or wet weather sults than smaller patients. Subjective the owners’ evaluations of: ● Subjective assessment of overall surgical evaluation indicated that cats had the fe- success west postoperative problems. Although Vet Comp Orthop Traumatol 5/2010 © Schattauer 2010 W. Off, U. Matis: Excision arthroplasty of the hip joint 299 Fig. 4 The joint capsule was interposed be- tween the osteotomy site and acetabulum to prevent pain from bone-to-bone con- tact. a) Transverse view through the hip joint before resec- tion; b) appearance after removal of the femoral head and neck; c) closure of the joint capsule; and d) ventral view of the acetabulum after closure of the joint capsule. clinical lameness was not detected in any of Table 1 Clinical signs in 66 dogs and 15 cats seven months to 10 years (mean 4 years) after the cats, owners of five of the 15 cats re- femoral head and neck ostectomy. ported a shortened stride after exercise, Clinical Total Dogs Cats during weather changes, at a fast or slow parameters n = 81 n = 15 gait, or after long periods of rest. <15 kg BW 15 - 25 kg BW >25 kg BW Based on the owners’ observations, the n = 51 n = 4 n = 11 load placed on the operated leg at a slow Caudodorsal mal- 68 (84%) 41 4 10 13 gait was normal in 69 patients (85%) and position of the femur it remained normal at a fast gait in 52 Muscle atrophy 61 (75%) 39 4 11 7 (64%). Lameness was seen in 19 patients (23%) after strenuous exercise and in 20 Restricted range-of- 60 (74%) 34 4 11 11 motion patients (24%) during cold weather (ǠTable 2). However, 78 of 81 (96%) Lameness 45 (56%) 35 1 9 - owners felt that the procedure had a suc- Pain on passive 26 (32%) 17 1 4 4 cessful outcome. The mean duration of movement convalescence was four to six weeks in cats Crepitus 8 (10%) 4 1 3 - and small dogs, and seven to nine weeks in dogs over 15 kg even though the duration BW = Body weight of preoperative lameness in the latter group was on average shorter than that of smaller patients. Based on information in 20% and unsatisfactory in 42%. There and a mean of seven weeks in patients from the client questionnaire combined was no correlation between body weight with poorer outcomes (ǠTable 4). with the results of clinical re-evaluations, and functional outcome (ǠTable 3). Pre- Postoperative radiographs showed com- the functional results were considered operative signs were seen for a mean of plete ostectomy of the femoral head and neck good in 38% of the patients, satisfactory five weeks in patients with good results in 40 animals (60%), half of which had also © Schattauer 2010 Vet Comp Orthop Traumatol 5/2010 300 W.
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