History
1.A 4 years, 45 kg female Labrador “Gepsy” was presented to our clinic in New Cairo (DrPaws Veterinary Hospital) with chronic progressive hind limbs lameness and stiffness.
2.Owner reported exercise intolerance and difficult rising during dog’s activity.
3.Swinging and bunny-hopping gait was evident
Orthopedic Examination
1.Orthopedic examination revealed bilateral hip arthritis & crepitation with some degree of outward positioning of both femoral heads.
2.Pain reaction during hip extension, flexion, adduction and abduction.
Radiographic examination
1.Bilateral canine hip dysplasia (CHD) graded as 4th degree with severe hip arthritits.
2.Femoral head deformation and flattening, subchondral sclerosis and osteophyes accumulation over the femoral neck, acetabular rims and acetabular articular surfaces.
Recommendations
1.Decrease of dog body weight as it was over-weight
2.Bilateral Total hip replacement (THR) of femoral head and neck ostectomy (FHO) procedure
3.FHO was selected to be performed for “Gepsy” for both hips with interval 1.5 months at least (according to the degree of recovery and back to normal function following physiotherapy programs postoperatively).
4.Photos shown here are a collection of two of our FHO procedures.
Surgery
1.Surgery was performed on the lateral recumbency position
2.Skin incision is craniolateral to the greater trochanter
3.Layers as the following: Skin, s/c, separation between the tensor fascia lata muscle cranially and biceps femoris muscle caudally. Following that, reflection of superficial gluteal, middle gluteal muscle proximaly. Partial tenotomy is performed to the deep gluteal muscle and vastus lateralis muscle. Muscles retraction is facilitated by the use of Gelpi retractors.
4.Outward rotation of the stifle and hip joints away from the body to facilitate the extraction of the femoral head out of the socket (acetabulum).
5.Cutting of the round ligament (connects the femoral head and acetabulum) with a curved scissor.
6.Outlining of the osteotomy line by the help of monopolar electrocautery.
7.By the use of microsagittal saw, femoral head and neck was ostectomized.
8.Intraoperative x. ray was taken to ensure the correct line osteotomy.
9.Full range of movement is performed to ensure no crepitation or bone-to-bone contact.
10.Closure of joint capsule, suturing of vastus lateralis and appositioning to gluteal muscles, appositioning of biceps femoris to tensor-fascia lata muscle and finally the s/c and skin were closed separately by Z-shape interrupted pattern and intradermal subcuticular suture.
Postoperative Care
1.After FHO procedure, it is highly recommended to ensure the integrity of sciatic nerve after the retraction caused by muscle retractors used during the operation. Withdrawal reflex is performed and the animal should walk in toes after FHO not on the dorsum of the metatarsal and phalanges.
2.Wound care includes washing by saline followed by the use of antibiotic spray with/without healosol sray for enhancement of wound healing.
3.Systemic antibiotic and NSAID are prescribed for 1-14 days postoperatively.
4.During the first 3-4 days following operation, it is beneficial to keep the dog at rest. Cold fomentation is recommended to decrease postoperative swelling and edema. Beginning from the 4th day, slow and steady walking for 5 minutes per day is advisable in addition to PROM and leg massage.
5. Starting from the 2nd week, animal should go with increased leash walking gradually and certain proprioception exercises. Physiotherapy is fully described as following.
6.Slight hip bandage could be placed for the first 3 days following operation.
Postoperative Follow up gait (Available)
Physiotherapy
Postoperative function/ patient selection
1.Body size
2.Temperament active more than overweight and sedentary dogs
3.Age (Younger more than older)
4.Obesity (Overweight dogs has longer duration of recovery)
5.Chronicity , disuse muscle atrophy has poor prognosis
6.Concurrent skeletal muscle problems (Muscle or bone affections)
Day after surgery
-Extension-flexion-abduction-adduction PROM (VIP) for 15-20 times daily to avoid loss of motion and muscle wastage
-The goal is to maximize the bearing weight ability / gain ROM and muscle extensibility/ address proprioception deficits/ strengthen affected limb and stimulate soft tissue healing
Types of Exercises;
1.Cross leg standing
2.Booties/ plastic bag/ hair elastic / syringe cap/ pen cap exercise
3.Hill walking , improves weight bearing and extension
4.Dancing (Wheel barrowing)
5.Slow leash walks
6.Standing on stairs / wheel barrowing (Improve hip extension)
6.PROM
For strengthening
1.Underwater treadmill (Slow speeds)
2.Uphill walking
3.Cross standing
4.Sit and stand exercises
Later postoperatively
1.Jumping (Bed or platform)
2.Pulling exercises
3.Walking and trotting
For improving proprioception
1.Walking over obstacles (Muscle coordination, timing and body awareness)
2.Wobble board
3.Walking on different surfaces
4.Standing on or walking across a narrow plank of wood raised slightly off the ground
First week
1.Leash walking (Short, slow, for 5-10 minutes /2-3 T per day
2.Pain relief medications and cool compresses 5-10 minutes/ 3-4 T/D/7 days
3.Massaging for quadriceps and hamstring before (Cranial and caudal muscle group) and after PROM
Second/ Third Week
1.Continue PROM
2.Massaging
3.Exercises
-Sit/Stand (3-4 T/D) for 5-7 repetitions
-Figure “8” walking 3-4 T/D for 10 repetitions (Begin with wide circles around 15 feets for 3 days then 5 feets circles for 3 days) followed by hot fomentations
Fourth / Fifth Week
1.PROM
2.Leash walks
3.Sit/Stand Exercises
4.Unstaring
5.Eight figure walking (Walking and trotting)
Sixth week
1.20 minutes leash walks (3T/D)
2.Exercises
-Sit/Stand (20 repetitions/3-4 T/D
-Eight figure exercises
-Uphill slow walking or Standing over stairs
