Cat dislocated hip

Re: Cat dislocated hip

Malcolm Ness — Tue, 10 Jul 2012 13:42:21 GMT

[quote user="Tim Browning"]There's never any evidence[/quote]

"Never" "Any"

!!!

Re: Cat dislocated hip

Tim Browning — Tue, 10 Jul 2012 13:16:23 GMT

There's never any evidence for these sorts of clinical issues one way or the other, we will have to wait until accurate clinical coding of procedures is widespread to catch data. Anecdotally I have had no failures but then I have never done an open reduction without a stitch , it only takes a couple of minutes extra op time and I don't trust my capsular/soft tissue repair. But I agree with the principle of KISS

Re: Cat dislocated hip

Malcolm Ness — Mon, 09 Jul 2012 15:36:41 GMT

[quote user="Julian Earl"]does it work in small dogs the same way?[/quote]

Yes.

re Imbrication techniques discussed above - loads and loads of them chatted about but no convincing evidence that any of them add to a well executed open reduction and soft tissue reconstruction. Keep it simple!

Re: Cat dislocated hip

Utlendigur — Mon, 09 Jul 2012 14:11:23 GMT

[quote user="Tim Browning"]What I do is an open reduction (only if a well formed, non arthritic hip on X-ray) and sew the soft tissue and then a PDS figure of eight suture from the knobbly bit on the outside of the femoral head where everything inserts (greater trochanter?) to the insertion of the ileo/psaos (I think - its quite obvious as has shiny tendon of insertion) on the pelvis anterior medial.[/quote]

I do the same sort of technique except for using a bone tunnel in the iliac shaft and nylon rather than pds. Iliofemoral suture? Not that we'd count as polite society

Re: Cat dislocated hip

Tim Browning — Mon, 09 Jul 2012 12:41:49 GMT

What I do is an open reduction (only if a well formed, non arthritic hip on X-ray) and sew the soft tissue and then a PDS figure of eight suture from the knobbly bit on the outside of the femoral head where everything inserts (greater trochanter?) to the insertion of the ileo/psaos (I think - its quite obvious as has shiny tendon of insertion) on the pelvis anterior medial.

This stabilises the joint nicely and you don't have to remove a pin or let it break with a pointy bit in the pelvis. This operation is called a 'hip stitch' here and possibly has another more technical name in politer society - it doesn't seem a widely used technique but is very useful. I also don't like toggling due to implant failure of a moving part and never have to do it.

Re: Cat dislocated hip

Julian Earl — Mon, 09 Jul 2012 12:19:03 GMT

Thanks Malcolm. Okay, next question: does it work in small dogs the same way?

T.I.A.

Re: Cat dislocated hip

Malcolm Ness — Sun, 08 Jul 2012 22:11:20 GMT

[quote user="Julian Earl"]Malcolm: am I understanding correctly? The short length of pin is left with a graspable end protruding laterally (sufficient for removal) but the pointy end is though the head into the acetabulum in the position of the teres ligament? Not "fixed" but presumably of sufficient length to hold the head in position until healing is complete?[/quote]

Yes.

[quote user="Julian Earl"]Re. EA: on the basis they are walking within a week or ten days, that seems a good result to me.[/quote]

They are LIMPING after a week to ten days ( or the day after surgery if you do a good cranio-lateral approach!) and limping is all they will ever do - probably limping proficiently enough that most vets and most owners will be happy but lame all the same. Cut the leg off and they will be walking on the day of surgery!! Evelyn says it all - why salvage when you can repair?

re the question about OA - difficult to know in cats considering how crap we are, as vets, at detecting even severe OA in cats. However, I have operated a number of working dogs with hip luxations and generally, following successful surgical reduction, they live their lives out normally.

Re: Cat dislocated hip

Evelyn Barbour-Hill — Sun, 08 Jul 2012 20:59:59 GMT

It does seem a bit odd to cut off the femoral head, when the hip can be fixed with an easier operation.

Re: Cat dislocated hip

Julian Earl — Sun, 08 Jul 2012 20:51:41 GMT

Malcolm: am I understanding correctly? The short length of pin is left with a graspable end protruding laterally (sufficient for removal) but the pointy end is though the head into the acetabulum in the position of the teres ligament? Not "fixed" but presumably of sufficient length to hold the head in position until healing is complete?

Re. EA: on the basis they are walking within a week or ten days, that seems a good result to me. I'm probably not as fussy as a specialist though.

Re: Cat dislocated hip

Mark Holmes — Sun, 08 Jul 2012 20:13:09 GMT

Malcolm, I had a discussion regarding hips with another orthopod recently and wondered what is the instance of post op arthritis following surgical reduction and stabalisation. It occurred to me that an excused hip whilst restricted maybe ultimately more comfortable than a reduced yet arthritic one. Just a thought, I wouldn't know either way.

Re: Cat dislocated hip

Malcolm Ness — Sun, 08 Jul 2012 19:49:07 GMT

We can do better than excision arthroplasty!

The vast majority of hip luxations in cats can be sorted sucessfully. Standard cranio-lateral approach to the joint which should be debrided of any torn remnants of teres ligament before the hip is carefully reduced. In most cases there is sufficient remaining joint capsule and other soft tissues remaining that can be sutured up providing your surgical approach was sufficiently sympathetic/competent. Don't be tempted to over-tighten or imbricate the periarticular tissues, just stitch them back where they are supposed to be. In the odd case where the hip remains unstable in spite of the previously described surgery, a transarticular pin can be placed. Dislocate the hip and twist the femur until you can see the origin of the teres ligament on the femoral head articular surface. Introduce the pin (1.6mm K wire is ideal) and drive it through the femoral neck and out through the lateral femoral cortex (remember to avoid the sciatic n). Pull the pin until it lies flush with the femoral head articular surface then reduce the hip and, with the femur in a normal standing position relative to the pelvis, drive the pin no more than 5 or 6 mm across the acetabulum. Bend and cut the XS length from the pin at the lateral femur before a routine closure.

Remove the pin (stab incision) after 3 or 4 weeks.

Contraindications are femoral head or acetabular fractures that significantly compromise stability or the very rare cases where the soft tissue damage is massive.

Salvage procedures (Excision arthroplasty or THR (which works well in cats) should be reserved for cases where better, easier options have failed). That said, I would encourage everyone contemplating excision arthroplasty to learn the cranio-lateral approach (practice on cadavers) - it is a little fiddly but allows a much nicer convalescence as there is minimal cutting of muscles.

Re: Cat dislocated hip

Julian Earl — Sun, 08 Jul 2012 18:53:42 GMT

I agree with Kate: they may "cope" but we can do better. I would simply excise the femoral head. It's relatively easy in a cat, especially with a femoral head that is already outside the acetabulum, and if the femoral contour is left fairly smooth and muscle damage is minimised, the cat should be walking on it by the time you remove the sutures.

Re: Cat dislocated hip

Kate Richardson — Sun, 08 Jul 2012 13:46:27 GMT

I guess it depends on finances at the end of the day- cat will be better with a hip than not! so if THR is an option or other surgical stabilisation technique (spot the non-orthopod) then I would advise going down that road. If not, then I would advise a femoral head excision- despite it appearing that cats do well with a permanently dislocated hip, I cannot truly in my heart believe that they do- the signs of chronic pain/discomfort are just more subtle. Yes it may 'cope', but is that truly acceptable? Absolutely need to ensure that the cat has otherwise recovered, but equally they recover better if all painful issues are resolved sooner rather than later - any clues as to why the bladder dysfunction? Could it be due to pain/mobility issues? I have to say my experience with cats and dislocated hips is that they rarely stay in place following manipulation unless replaced asap following luxation, so they tend to end up w FHE.