Suspected femoral head necrosis in 7mo giant breed rabbit

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Martin Atkinson — Wed, 30 Dec 2015 17:21:45 GMT

[quote user="David Mills"]From the description, obviously the underlying pathology was present before castration but may have been exacerbated during GA by legs being moved etc.[/quote]I was going to suggest something similar. Clearly this couldn't have caused the problem even if the bunny had fallen off the table and was swinging from its leg, the pathology looks too old, but I have had cases of dogs with HD being worse after neutering or other surgery that required legs being tied out of the way.

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

David Mills — Wed, 30 Dec 2015 16:39:57 GMT

Yes we have done FHNE in rabbits with dislocations and fractures. They appear to do well, but there does appear to be a cut off at around 3.5-4kg - any bigger and the lameness can be fairly profound, though appears mechanical.

One of the main issues post-op is gentle physio. It works better in calm house bunnies, but those stuck outside with a profound flight reaction tend to take longer.

From the description, obviously the underlying pathology was present before castration but may have been exacerbated during GA by legs being moved etc.

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Martin Atkinson — Wed, 30 Dec 2015 14:01:35 GMT

Ashley, the actual owner of the rabbit in my case was quite sanguine about it, after all it had had it's teeth trimmed many times before with no incidents. Like your case I didn't necessarily examine the rabbit for lameness before because we took it straight out of its basket and wrapped it the towel then straight back again so it could have happened before. But spinal fractures displaced vertically by more than a centimetre don't happen gently wrapping rabbits in towels!. The mother was the one who kicked off so she seemed far too defensive that it happened on her watch for my liking when all she was asked was if there was a possibility the rabbit had been dropped or jumped/ fallen out of its cage.

I never bothered sending the bill for the X-ray or euthanasia as I didn't expect it to be paid, I just wrote it off as another experience with an unreasonable human being. I suspect your's won't be paid either.

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Ashley Sykes — Wed, 30 Dec 2015 11:32:04 GMT

Martin, my suspicions in this case are that of what Chris wrote: that perhaps the lameness was "noticed" after veterinary intervention and they wanted a freebie. They specifically said in no uncertain terms they would be suing the practice/my boss if we don't do it all free.

I specifically said in no uncertain terms on the result of the radiographs the next morning that this was not our fault and they will be paying for the rads and stay here, to which there was no answer.

I euthanased it later that afternoon and they actually left and said thank you to me - very odd. Bill unpaid currently while we await the return of my boss from holiday next week!

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Martin Atkinson — Wed, 30 Dec 2015 11:24:02 GMT

[quote user="Bob Russell"]If I were the owner, I would be blaming the surgery and expecting a hip replacement free of charge[/quote]I had an incident with a rabbit that came in for a routine incisor trim and we followed the procedure we had many times previously wrapping it in a towel gently to restrain it while I trimmed the teeth. Later that day came the call that the rabbit was off its back legs so we readmitted it for X-ray and it had a grossly displaced lumbar spinal fracture. The rabbit had been brought in my the owner's mother as she was on holiday and I asked mother if there was any possibility the rabbit had been dropped. She went mental accusing us of injuring it and of casting aspersions on her! My nurse and I are adamant the rabbit did not struggle and was handled carefully and even it it had wriggled there was no way if could have injured its spine so severely. The mother's reaction was suspiciously like self denial but we will never know. They very unfairly posted up a damning review on Google to which my work experience student posted a reply without prompting saying how unreasonable and ignorant this person was.

So sorry to hijack the thread but the moral is to tread carefully even though there is no way that degree of injury/necrosis could have been caused by whatever happened at castration. I'm no orthopod but I think I would be performing a total ablation on that side and sending bits for culture. However there is no way I'd do it for anything less than normal fees and expect payment in advance. If they refuse that give them the contact details for RCVS to make their unreasonable compliant and call VDS when the claim comes in!

PS I started this before your final post Ashley.

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Ashley Sykes — Wed, 30 Dec 2015 11:14:29 GMT

Thank you for the replie everyone - sorry for not replying sooner (it has been a mental 3 days being the only 24hr non-surcharge surgery in the area...) but later that afternoon the owner turned up, wanted to see the bunny, and then demanded euthanasia of it. I advised he should wait until we have a second opinion and review treatment options, he was not interested - it has been euthanased.

Difficult case. Septic arthritis is something I hadn't thought of, definitely a possibility.

For future reference if anyone has done an FHNE in a rabbit I would be interested to know, given Emily and Wynne's points.

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Chris Barker — Tue, 29 Dec 2015 22:34:29 GMT

It seems to me that there is loss of bone density extending beyond the femoral head and along the femoral neck; the acetabulum has lost definition too. Given that there appears to be pathology evident on both sides of the joint, the age and species... I just wonder whether this is a septic arthritis rather than avascular necrosis? And (cynic speaking here) owners do seem to 'notice' problems after veterinary intervention with consequent assumption of cause and effect.

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Bob Russell — Tue, 29 Dec 2015 13:12:39 GMT

Not sure how many options there are!

If I were the owner, I would be blaming the surgery and expecting a hip replacement free of charge!

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Hannah Wynne Richards — Tue, 29 Dec 2015 11:01:15 GMT

Again, not an orthopod, but hind legs are more important to rabbits than dogs, who bear > 50% of their weight on front legs.

Wynne

RE: Suspected femoral head necrosis in 7mo giant breed rabbit

Emily Rainbow — Mon, 28 Dec 2015 16:09:08 GMT

Not an orthopaedic person but I'd worry about whether the extreme pressures on the hind limbs in a giant rabbit would make everything too unstable after a FHNE? I guess on the other hand the large musculature may provide more support vs say a small dog?

sorry not much help at all!