Coxofemoral Hip Luxation in Dogs

Coxofemoral Hip Luxation in Dogs

By: Dr. Nicholas Trout

Section: Veterinary Care In-depth

Veterinary care should include diagnostic tests and subsequent treatment recommendations.

Diagnosis In-depth

  • Physical examination. This is important to ensure that your dog is not in shock because of the trauma or associated blood loss. It is also important to make certain that no other injuries are present.

  • Chest radiographs. Chest trauma such as pulmonary contusions (bruising) or pneumothorax, which is a collapsed lung, can be identified on chest radiographs. It is particularly important to identify these lesions if your dog is to undergo anesthesia.

  • A complete orthopedic examination to look for the cause of the lameness and to determine if other injuries are present. Fractures, especially of the pelvis and femur, are frequently found after a trauma that causes coxofemoral luxations. The examination involves palpation of all of the bones and joints of each leg for signs of pain or abnormal motion within a bone or joint.
    The neurologic or nerve status of each leg will also be determined. Specific palpation of the hip joint can be highly suggestive of coxofemoral luxation when animals are not excessively painful and there is minimal swelling around the joint. A thorough orthopedic examination is essential to direct appropriate radiographic examination and to allow your veterinarian to discuss the benefits of potential treatments, prognoses, and costs with you.
  • Radiographs of the pelvis. Two X-ray views of your dog's pelvis are used to confirm the diagnosis of hip luxation and will also show pelvic fractures if they are present.

  • Laboratory tests. None are required to make the diagnosis, but they may be needed to determine whether concurrent problems exist that might influence anesthesia.
            
    Treatment In-depth

  • Emergency care for concurrent problems may be required. Your veterinarian may need to treat your dog for shock by administering intravenous fluids to maintain blood pressure and improving oxygen delivery to the body.

  • Wound care may be necessary if lacerations or other wounds are present. These wounds must be cleaned of debris and covered or closed to minimize infections.

  • If there are concurrent fractures your veterinarian may wish to stabilize them with splints. Pain medications may be needed to keep your dog comfortable until the fracture can be properly treated.

    Closed reduction (non-surgical replacement of joint)

    The outcome for this procedure is best when the procedure is performed early after trauma. General anesthesia is needed to replace the femur into the socket.

    After the procedure, the limb is placed in a sling to prevent use of the leg and maintain the position of the joint.

    Open reduction (surgical replacement of joint)

    This technique is used when closed reduction fails, an avulsion fracture is present at the attachment of the round ligament of the femoral head on the femur, or if concurrent orthopedic problems preclude the use of a sling after closed reduction. It too requires general anesthesia.

    Open reduction requires that a surgical approach to the hip joint is made to allow direct visualization of the bones and joint capsule. The torn round ligament of the femoral head is removed and the head of the femur is replaced into the acetabulum.

    The surgeon may use one of the following methods for maintaining the position and preventing reluxation:

  • Joint capsule reconstruction, which is repair of the torn joint capsule

  • Prosthetic joint capsule, which is the use of suture material between acetabular rim and femur to prevent the femoral head from moving out of joint

  • Toggle pin, which is the placement of a piece of large suture material within the joint to mimic the function of the damaged round ligament

  • Greater trochanter translocation, which consists of redirecting the pull of the large hip muscles to force the head of the femur into the acetabulum

  • De Vita pin, which is the placement of a metal bar across the rim of the acetabulum to prevent the femoral head from moving out. The pin needs to be removed in several weeks through a small incision behind the animal's thigh. This technique may also be employed in a "closed" fashion, without the need for an incision.

    After surgery, the limb may be placed in a sling.

     
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