Approach to femoral head and neck excision

Re: Approach to femoral head and neck excision

Hannah Wynne Richards — Fri, 20 Feb 2015 08:31:04 GMT

I hadn't even heard of the ventral approach before reading this thread, but being a bit of a timid surgeon, I don't think I'll try it next time. My attitude is "First, do no harm"

Cross ref to thread on dinovets. I don't know if this makes me one - for being reluctant to try something new - or not a dinovet - for being hesitant to jumo in to any surgery!!!!!!!!!!!!!!!!!

I'm a lot more willing (in fact eager) to try new medical treatments - if things go wrong, there's usually more time to rescue the situation.

Wynne

Re: Approach to femoral head and neck excision

Andrew Mellor — Thu, 19 Feb 2015 18:34:39 GMT

[quote user="Gerry Henry"]

; outcomes - as in return to normalish ambulation - vary hugely but recovery after doing the second hip is generally quicker;

[/quote]

I find this with bilateral cruciate too but am convinced it is out of necessity- as in no good leg to stand on rather than second one not being as sore!

Re: Approach to femoral head and neck excision

Gerry Henry — Thu, 19 Feb 2015 18:20:36 GMT

I like it because there is no cutting of muscles, remove the pectineus and bluntly dissect onto the joint; I use a blue line oscillating saw to remove the head and an air burr to smooth; flush with warm saline and close; outcomes - as in return to normalish ambulation - vary hugely but recovery after doing the second hip is generally quicker; you will need a scrubbed assistant to abduct and rotate the limb during cutting/smoothing.

Re: Approach to femoral head and neck excision

Andrew Mellor — Thu, 19 Feb 2015 16:12:12 GMT

I have done maybe a dozen of these in dogs and maybe a couple of dozen in cats , I would say my technique has improved with each one and my pain management has definitely improved but I cannot say there has been any consistency in outcomes, some do better than others in the short term all generally do well longer term. whether sacrificing a small amount of muscle which I guess eventually necroses whilst some level of remodelling and fibrocartilage formation occurs would improve comfort in the short term I don't know and unless you did a bilateral surgery and compared one leg against the other I don't see how you could definitely say as each animal has such a different pain perception.

Re: Approach to femoral head and neck excision

John Flynn — Thu, 19 Feb 2015 14:44:57 GMT

[quote user="Andrew Mellor"]do you interpose soft tissue - either section of deep gluteal or pedicle of biceps femoris? how much difference does this make ?[/quote]

i close the joint capsule, but dont like idea of sticking other soft tissues there to get traumatised - ithink=more morbidity in my head

Re: Approach to femoral head and neck excision

Andrew Mellor — Thu, 19 Feb 2015 13:49:08 GMT

to the people that do this relatively frequently - do you interpose soft tissue - either section of deep gluteal or pedicle of biceps femoris? how much difference does this make ?

Re: Approach to femoral head and neck excision

Robin Grimmer — Thu, 19 Feb 2015 13:27:32 GMT

[quote user="John Flynn"]

I do them by a craniolateral apporach with partial tenotomy of tendon of origin of deep gluteal. In my experience, there are a great many variations on a "traditional" approach - those cutting all the gluteal muscles in half probably can't be lumped in with a technique relying on decent retraction and a scrubbed assistant to separate muscles.

I've only ever considered ventral approach for caudo-ventral hip luxations, so interesting to know that this is an alternative for FHNE - I'd need more convincing of the benefits though before changing habits.

[/quote]

+1 for this. The only time I did a different approach was a caudal approach for a hip toggle.

Re: Approach to femoral head and neck excision

Charlotte Marshall — Thu, 19 Feb 2015 12:08:02 GMT

But do you get a quicker time to walking on the leg?

Re: Approach to femoral head and neck excision

Gerry Henry — Wed, 18 Feb 2015 19:00:08 GMT

I've used the ventral approach for the last 10 years; scary until you get used to it; use lots of moist swabs as packing; don't be dogmatic about exactly where you open the joint capsule, manipulate the hip, you can feel the femoral head nicely.

Re: Approach to femoral head and neck excision

John Flynn — Tue, 17 Feb 2015 19:42:53 GMT

Re: Approach to femoral head and neck excision

Charlotte Marshall — Tue, 17 Feb 2015 18:40:13 GMT

Afraid this is what I had already found! I thought at first she had misunderstood till I looked it up there. Don't like the sound of it myself but then my boss does all the orthopaedics anyway.

Re: Approach to femoral head and neck excision

Andrew Mellor — Tue, 17 Feb 2015 17:16:55 GMT

from Piermattei an atlas of surgical approaches to the bones and joints of the dog and cat-

approach to the ventral aspect of the hip joint - ( very scary in my opinion as so many extremely vital structures- femoral artery and vein and saphenous nerve, then medial circumflex femoral artery and vein- need to free these vessels from facia-often get vessel disruption, but less deep muscles dissection needed)-

Piermattei says "exposure of the joint by this approach is quite sparseand its use is therefore quite limited, although some consider it the approach of choice for femoral head and neck excision because the integrity of the structures dorsal to the joint is maintained."

hope that helps

Re: Approach to femoral head and neck excision

Hannah Wynne Richards — Tue, 17 Feb 2015 16:57:02 GMT

If I was doing it ventrally, I'd be scared of nicking the femoral artery! Are you sure this isn't a case of Chinese whispers?

Wynne