Hip dislocation in a dog: treatment and post-operative care. Method of surgical treatment of hip dysplasia in dogs

It is very important for dogs to get regular exercise, since active movement is the key to their good health. If for some reason the dog cannot walk, his condition quickly worsens. Many factors can lead to this, but one of the most difficult veterinary practice conditions is dislocation hip joint in dogs.

The hip joint is formed head femur and the acetabulum of the pelvis. Despite its rather simple structure, it has decent mobility, allowing the animal’s paw to move in several planes.

In this case, dislocation is understood as a pathology in which the head of the femur emerges from the acetabulum. As a rule, the “everted” bone takes a cranio-dorsal direction (moves forward and upward).

What anatomical features prevent hip dislocation in dogs? There are a range of anatomical features designed to maintain a close connection between the femoral head and the acetabulum. The most important are the following:

• Strong bond, emerging from the head of the femur and attached to the bottom of the acetabulum.

• The head itself and the recess for it perfectly match in shape, which eliminates the possibility of spontaneous “breakage” of the joint.

• Bursa provides protection against mechanical damage and serves as an additional fastener.

• The muscles and ligaments of the limb act as compression bandage.

The main problem with hip dislocation is that it the ligament is torn , connecting the head of the femur and the acetabulum. That's why drug treatment this pathology simply does not exist - the only way out is a difficult and not at all cheap surgical intervention.

It is important! It is possible to straighten the injured paw only in the mildest cases, when the integrity of the ligament is not broken and there are no muscle tears.

Predisposing factors of pathology

What circumstances lead to hip dislocation in dogs? If any of the above structures are damaged, dislocation will not take long to occur. Most often, serious mechanical injuries. In more in rare cases immediate cause is . Fortunately, both hips are affected extremely rarely (no more than 5-6% of cases with very serious injuries). But there are other predisposing factors that can lead to hip dislocation.

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The most common are improper feeding and impaired water-salt metabolism. The dog's diet should contain sufficient amounts protein, micro- and macroelements, as well as. In addition, with age, it is necessary to reduce the amount of protein the dog receives, since in older animals this causes problems with, promotes the deposition of salts in joints. If an animal lacks any of the above, its body cannot quickly grow new collagen fibers, causing the joints to weaken greatly and the likelihood of dislocation increases.

However, this is not the worst thing. It is much worse when the animal suffers from, and. In these diseases, the structure of both the bone itself and the joints is seriously damaged. They are greatly weakened, which is also common leads to dislocations, especially if the dog has suffered some kind of injury. Arthritis infectious etiology, accompanied severe inflammation(which is often purulent) and are fraught not only with dislocation, but also with septic phenomena: when the head of the femur comes out of the acetabulum, multiple microtraumas often occur, which are an excellent gateway for infection. The consequences are different, sometimes it ends in death.

Finally, one cannot fail to mention breed predisposition. If you are the owner large or giant breed dog, be careful - hip dislocation is most common in them. The reason is the huge mass of such dogs and joints, “designed” by nature for much less load. By the age of five or six, the head of the femur and acetabulum can be worn to the limit.

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Clinical picture and diagnosis

How can you tell if something is wrong with your dog? This is easy to do - if your pet is dislocated can't walk normally, even in a standing position he tries don't step on paws, since otherwise it causes him severe pain. IN severe cases the paw just dangles. The leg falls “inward”, so it’s hard not to notice this. The dog loses its appetite, becomes lethargic and apathetic.

Diagnosis is quite simple - correct diagnosis easy to put on the basis clinical signs, based on the results of a clinical examination. To know exactly the extent of the damage, your veterinarian will use x-ray. It is necessary to determine whether the round ligament is torn, whether there are deep mechanical damage directly to the head of the femur. Based on data obtained during x-ray examination, the veterinarian will draw up a plan for further surgery.

About treatment

As we have already said, in the simplest cases the “dropped out” hip can be realigned, but the chances of this are minimal. In addition, for a successful procedure one has to use general anesthesia. In addition, if the head of the femur has come out of the femoral socket at least once, the likelihood of recurrence is very high. The older the dog, the higher the chances. There are some factors that make relapse 100% possible:

• Dysplasia I hip joint.
• The dislocation occurred against the background of serious injuries.
• The dog has a serious excess excess weight .
• After realignment, the limb never regained its former mobility.

Usually, repeated dislocation develops no later than two weeks after the first case. Over time, the frequency of this phenomenon will inevitably increase, and surgery will be required. If at least one repeated dislocation occurs, or, moreover, the reduction of the hip is impossible for some reason, a decision on surgical intervention must be made. Today more than 12 have been developed in various ways operations, but many of them are only the development of ideas proposed back in the 60s of the last century; since then, nothing more perfect has been invented. Here are a few methods that are used most often:

• Recovery round ligament(the same one that connects the head of the femur and the bottom of the acetabulum).
• Reparation (restoration) of the joint capsule.
• Transarticular fastening.
• Replacement of the joint capsule with a synthetic prosthesis.

Lameness is the main symptom with which pet owners turn to an orthopedist. Lameness hind limbs more often associated with pathology of the hip (HJ) or knee joints. Let's look at the two most common congenital pathologies development of hip joints: aseptic necrosis femoral head and hip dysplasia (TJD).

Legg-Calvé-Perthes disease (aseptic or ischemic necrosis of the femoral head, juvenile osteochondrosis), affects representatives dwarf breeds dogs, develops into at a young age 5-10 months The trigger point for the development of pathology is circulatory disorders bone tissue femoral head, which leads to necrosis of the femoral head and its deformation. The development of lameness occurs gradually or suddenly after a jump or fall due to injury to the affected area of ​​the bone.

The pattern of development of Perthes disease corresponds to 5-8 months. age when the animal develops lameness, which gets worse after physical activity. Physically and radiologically, aseptic necrosis of the femoral head should be differentiated from arthritis (typical of older dogs), dislocation kneecap(reduction is possible with restoration of limb function, displacement of the patella is clearly visible in the image) and hip dysplasia(typical for large breeds, has certain radiographic characteristics). Over time, the dog completely ceases to rely on the affected limb and muscle atrophy develops. With bilateral damage to the joints, the animal exhibits immobility and pain when attempting to forcefully move.

Radiographically, the affected femoral head has an irregular, often almost triangular shape with uneven bone density.

On early stages diseases, pain and lameness can be controlled by the use of painkillers and anti-inflammatory drugs, as well as the regular use of chondroprotectors (glucosamine, chondroitin), but this is a short-term and ineffective effect. The most common way to solve the problem is to remove the femoral head, after which the animal’s painful sensations, motor ability is restored, and sometimes lameness disappears.

Sick dogs must be excluded from breeding, since the disease is inherited. At the age of 5-6 months. It is advisable to do an X-ray of the hip joint for early detection pathology.

Dysplasia is a disorder in the formation of an organ or tissue. With dysplastic syndrome in orthopedics, the development of connective tissue is disrupted, which can manifest itself as increased mobility joints in combination with connective tissue weakness. Dysplasia of the hip joints in dogs was first described in 1935 by G.B.Schnelh. Since then it has been proven that the disease is genetic in nature and is characteristic of large and giant breeds.

Clinical signs of dysplastic syndrome appear from 4-10 months. in the form of joint stiffness, lameness, soreness and muscle weakness pelvic limbs. X-ray reveals: dorsal displacement of the central part of the femoral head relative to the acetabulum; expansion of the joint space; flattening of the acetabulum; increase more than 150g. the angle between the neck and the axis of the femur; Bone formations appear secondarily in the acetabulum and on the head of the bone. Based on these changes, five degrees of DTHD are divided into five degrees (an interpretative and prognostic approach to determining the degree of dysplasia in different countries different): A – healthy joint; B – predisposition to dysplasia; C – predysplastic stage; D – initial destructive changes; E – Pronounced destructive changes. In Russia, dogs with degrees D and E are not allowed for breeding.

DTHS should be differentiated from: osteochondrosis, Perthes disease, osteomyelitis, fractures of the growth zone of the femoral head.

The main methods used to treat pathology of the hip joints:

Conservative treatment is the most common and least effective approach.

Triple pelvic osteotomy – complex surgery to change the geometry of the dog’s pelvis to increase the area of ​​support of the femoral head on the acetabulum.

Changing the neck-diaphyseal angle of the femur - this operation is intended to increase the index of insertion of the head, performed when weak degree dysplasia and prevention of hip dislocation.

Resection of the femoral head and neck is an operation in which the head and neck of the femur are removed and the integrity of the hip joint is completely destroyed. In place of the destroyed joint, after some time a false joint is formed, which in most cases functions adequately and allows the animal to fully move without experiencing pain.

Resection of the neck and head of the femur in a veterinary clinic is carried out quite often; indications for its implementation are various pathological conditions of the hip joint, in which the animal experiences significant pain and its ability to move is impaired. Examples of such diseases include the following pathologies: recurrent or chronic dislocation of the hip joint; degenerative joint diseases secondary to hip dysplasia or Leg-Perthes disease (avascular necrosis of the femoral head and neck); various traumatic injuries of the hip joint. Most often, surgery in a veterinary clinic is performed when traumatic injury hip joint (femoral head and neck, acetabulum) and Leg-Perthes disease. Employees veterinary clinic have accumulated sufficient experience in conducting this type of intervention.

An alternative to resection of the femoral neck and head is total hip replacement, but this type of operation is characterized by high cost and poor availability. In recent years, specialists certified in hip replacement have appeared in our country; if the owner wishes, the staff of the veterinary clinic can provide guidance in choosing a specialist.

Postoperative care

Before the operation, the staff of the veterinary clinic conducts, if possible, full examination animal, after which the owner is informed about possible options treatment and postoperative prognoses. The operation itself in a veterinary clinic takes about an hour and a half, from the moment the animal is put under anesthesia ( total time). The animal can be taken away immediately after the operation; if there are difficulties in caring for it, it can be left in the veterinary clinic for some time.

After surgery, the animal is given short-term antibiotic therapy, pain relief and monitoring of the postoperative wound. During the first two to three days, repeat visits to the veterinary clinic may be required; the need and frequency of repeat visits should be discussed with the staff of the veterinary clinic.

Postoperative sutures are removed 2 weeks after the operation; during this time they must be protected from licking by the animal itself either with a collar or blanket. Options for protecting sutures should be discussed with your veterinary clinic. During the healing period of the sutures, they are treated 2 times a day with 3% hydrogen peroxide to remove crusts and then an antibiotic ointment (eg levomekol) is applied. Removal of sutures should be carried out by a veterinary doctor.

Early physical therapy can accelerate the rate of pseudarthrosis formation and restoration of supporting function of the hind limbs. In dogs, this is accomplished by walking on a leash and passive flexion of the affected limb; in cats, encouragement to move and passive flexion of the limbs are used. In dogs, swimming is the best option postoperative physiotherapy, if possible, use this type of treatment - do not neglect it.

Forecasts

The results of resection of the femoral head and neck depend on many factors, including the animal’s body size, general condition muscular system, temperament, physician experience and postoperative physical therapy. The main factor influencing the outcome of the operation is the weight of the animal. In cats and dogs of small breeds it occurs more often full recovery function of the hind limbs, and it can be difficult to visually determine the absence of the hip joint. In dogs with a body weight of more than 25 kg, the results of joint replacement will be better, but this type of operation is characterized by high cost and poor availability. In principle, even in dogs weighing up to 50 kg without excess weight, satisfactory results can be expected and a return to normal locomotion with mild lameness. In large animals with overweight body - surgery may be contraindicated.

Photo 1. Intraoperative X-ray dogs after arthroplasty (resection of the head and neck of the femur). A husky-type dog, weight 20 kg, the reason for treatment was long-term lameness of the non-supporting type, a radiographic examination revealed a dislocation of the hip joint. During the operation - old dislocation, with dystrophic changes the femoral head itself and the formation of a significant amount of scar tissue.

Veterinary clinic of Dr. Shubin,

• Date: 02/25/2015, 15:59
• Category:

Algorithm of surgical tactics in conditions of chronic dislocation of the femoral head in dogs.
Samoshkin I.B., Slesarenko N.A.

Animal Traumatology Center
State Budgetary Institution "Mosvetobedinenie"
Federal State Educational Institution of Higher Professional Education Moscow state academy veterinary medicine and applied biotechnology named after. K.I. Scriabin

Elucidation of the clinical and morphological patterns of etiopathogenesis of post-traumatic pathology of the hip joint in dogs and the development on this basis of rational methods for its correction is one of the fundamental problems of modern veterinary surgery, arthralgia and morphology. Its solution is of particular relevance in connection with the progression of the incidence of arthropathy of the hip joint, which causes the loss of its functional suitability and the limb as a whole.
In literature recent years provides data on new methods of reconstructive operations for pathological conditions art. coxae.
However, despite advances in the development of methodological approaches to surgical treatment pathological conditions hip joint, currently no analysis of risk factors in the development of arthropathy has been carried out, morphofunctional basis has not been shown pathological process joint as a whole, as well as osteo- and chondropathy of the femoral head. The issue of reparative transformations of bone tissue and the cartilage covering of the joint during surgery and the use of various implants requires further study. Of interest are the adaptive rearrangements that occur in intra- and para-articular tissues under normal conditions and in arthropathy. of various origins, having fundamentally important for veterinary traumatology, orthopedics and operative surgery.

General characteristics of the material.

This section is based on the analysis surgical treatment 140 dogs admitted to the clinic for chronic post-traumatic dislocation of the hip joint.
A total of 143 reconstructive operations were performed on 140 patients. The total numbers of operations exceed the number of operated animals due to the fact that in three cases there was bilateral hip arthropathy.

Clinical and radiographic characteristics of patients with chronic post-traumatic dislocations of the hip joints.

At clinical examination sick animals, as a rule, noted lameness of the hanging or supporting limb varying degrees, severe arthralgia, as well as a sharp limitation in the range of active movements in the joint.
The main symptom of a traumatic dislocation is the deformation of the area of ​​the damaged joint. Each dislocation corresponds to a certain position of the femoral head relative to the acetabulum. In this case, the pelvic limb itself takes on a characteristic position.
In case of iliac dislocation of the hip (luxatio femoris iliaca), displacement of the greater trochanter, significant shortening and external rotation of the limb were determined. The gluteal region on the side of the dislocation acquired greater roundness.
With supraacetabular dislocation (luxatio femoris supraacetabularis), there is also a significant shortening of the limb, which is in a state of adduction and moderate internal rotation.
Ischial dislocation (luxatio femoris ischiadica) is characterized by a sharp deformation of the limb, correlating with hyperflexion of the knee joint, which is usually located slightly above the level of the hip joint. U significant amount patients experience neurological disorders.
With obturator (luxatio femoris obturatoria) and pubic (luxatio femoris pubica) dislocations, there is usually hyperextension of the knee and hock joints, the affected limb is elongated, brought forward or retracted as much as possible.
When both hip joints are dislocated, immobility is pronounced, and the patient lies with the pelvic limbs widely spaced.
It is appropriate to note that with any dislocation, no matter how clear its diagnosis, an X-ray examination is required to determine the nature and extent of violations of the articular relationships. In this case, radiography should be carried out, if possible, in two projections, which makes it possible to objectively judge the location of the head and the degree of its displacement relative to the glenoid cavity.

Total hip arthroplasty involves 4 stages of surgery on the hip joint.

At the first stage outer surface thighs we make a skin incision and subcutaneous tissue 4-7 cm long, encircling trochanter major. The fascia lata was dissected. Dumb and in a sharp way We separate the deeper layers of muscles along the fibers (m. glutaeus superficialis, m. glutaeus medius, m. glutaeus profundus and m. piriformis), carrying out thorough hemostasis using an electrocoagulator. Then we dissect the joint capsule (if it is preserved). We pass the Gigli saw under the greater trochanter, encircling the femoral neck, and perform resection of the head. You can also use a chisel for this purpose. Required condition This stage of the reconstructive operation is the treatment of the femoral neck stump with a rasp.
At the second stage, soft tissue growths on the glenoid cavity were excised and arthrosis was performed with a ball cutter or curette, thereby creating a “roof” for the proximal epiphysis.
The third stage is implantation of an artificial hip ligament. For this purpose, we use lavsan tape or (to avoid complications) catgut No. 1, three threads of which were woven into a pigtail and fixed transosseously to the greater trochanter and the upper arch of the acetabulum through pre-drilled channels in the bone. We give the implanted ligament optimal physiological tension, which is controlled by abduction-adduction, flexor-extensor, and rotational movements of the limb.
The fourth and final stage is myoplasty of the joint capsule. We place a purse-string suture on the capsule and the muscles adjacent to the joint, tightening it in the area of ​​the femoral neck stump. The surgical wound is sutured tightly in layers.
The duration of the operation is on average 100±10 minutes. All patients tolerate total arthroplasty surgery satisfactorily.
Awakening from anesthesia was noted 1.5-2 hours after the end of the operation. During the day, the animals remain in a state of low mobility, refusing to take food and water. On the second day, in the vast majority of cases, appetite was restored, patients began to move on to the operated limb, gradually increasing the load on it. Postoperative swelling subsided on days 6-9. Healing of sutures by primary intention. 1 month after surgical intervention All patients had a partial limitation of the range of motion in the operated joint, and there was pronounced hypotrophy of the soft tissues of the hip. There were no vascular or neurological disorders, except for patients in whom surgery was performed for chronic sciatic dislocation. Localization of the head in close proximity to n. ischiadicus contributes to its constant traumatization and provokes involvement in the scar-adhesive process. Without a doubt, neurological disorders in this group of patients, manifested in paralysis peroneal nerve, were a consequence of the above reasons. During the postoperative period, these animals were prescribed a course of injections of proserin and B vitamins. Restoration of innervation of the limb was noted after 3 months from the date of surgery.
A sharp improvement in the general condition in the immediate postoperative period was recorded in a patient whose history included deforming right-sided coxarthrosis, aseptic necrosis of the femoral head and neck, and severe stiffness of the hip joint. Clinically, there is constant arthralgia, severe pain on moderate palpation, range of motion is severely limited. The results of the arthroplasty revealed a deformation of the head with a total thinning of the cartilaginous covering up to exposure of the subchondral bone. On the surface of the articulation, micro- and macro-defects of the cartilage of the head and acetabulum were traced in the form of abnormalities, cracks and fibres. Osteophytic growths were recorded along the periphery of the head, as well as in the paraacetabular region.
The postoperative period proceeded without complications. On the third day after surgery, the patient began to include the affected limb in the load. Healing of sutures by primary intention. After 1.5 months of intensive rehabilitation period, the range of motion in the operated joint was completely restored. 3 months after arthroplasty, no signs of lameness, as well as vascular and neurological disorders were noted. In all other cases, complete restoration of the functional suitability of the operated limb was observed within 1.5-2 months after surgery. The joints with arthroplasty, as well as the distal parts of the diseased limb, were in a functionally physiological position. Any vascular, neurological disorders, as well as cosmetic defects There were no incidents associated with the operation.
Radiologically, on stage radiographs, the greater trochanter and the neck stump were projected opposite the glenoid cavity. No signs of aseptic necrosis or osteoporosis were noted.

Clinical assessment of the condition of the operated limb.

When examining sick animals in the postoperative period clinically and assessing the condition of the operated limb, we took into account the degree of restoration of its axis, the functional setting and range of motion in the operated joint and the joints of the distal parts of the diseased limb, the integrity and trophism of soft tissues, anatomical shortening, as well as vascular and neurological disorders of the operated limb, infectious complications after surgery, cosmetic defects caused by treatment, functional suitability of the operated joint and the limb as a whole.
Observation of the animals showed that they all tolerated the total arthroplasty operation satisfactorily. Awakening from anesthesia in dogs began 1.5–3 hours after surgery. They begin to drink water on the first day and eat food 2-3 days after surgery. During the first day general state was satisfactory, the animals slept most of the time. The operation on the operated limb begins 2-3 days after the operation, gradually including it in the stato-locomotor act. Temperature, pulse and respiration indicators in all animals return to normal on days 5–7, postoperative swelling subsides, as a rule, on days 6–8.
In all animals, no visible inflammation was observed within the skin, subcutaneous tissue or bone tissue. Surgical wounds healed by primary intention without cosmetic defects. By the time the sutures were removed 2 weeks after surgery, in all operated patients, the hip joints, as well as the joints of the distal parts of the diseased limb, were installed in a functional physiological position. Upon examination, no atrophy of the soft tissues of the operated area was detected, no vascular or neurological disorders were detected, and there were no cosmetic defects caused by surgery. Anatomical continuity of soft tissues in the area of ​​arthroplasty was noted. During the study of the range of motion of the hip joint in extreme positions, severe pain was noted in all dogs.
1 month after total arthroplasty, in all experimental dogs, the hip joints and joints of the distal parts of the operated limb were installed in a functionally physiological position; no restrictions in the range of motion of the operated joint were observed. All operated animals had severe lameness of the leaning limb type; there were no vascular or neurological disorders in the area of ​​surgical intervention. At clinical trial animals with arthroplasty, the presence of hypotrophy of the soft tissues of the operated limb was established. Complete restoration of her functional fitness was noted within 1.5–3 months after surgery. At the end of this rehabilitation period, all operated dogs stood freely on their pelvic limbs, jumped and moved without any signs of lameness. There were no vascular neurological disorders, cosmetic defects, or atrophy of the soft tissues of the operated limb. All patients with arthroplasty had full range of motion in the joints.

Conclusion

The problem of eliminating instability of the hip joint due to various degenerative-dystrophic processes remains, despite the numerous methods proposed, relevant to the present day. The biological approach and the desire to restore the hip joint and its elements made it possible to penetrate deeper into the mystery of the pathological process.
In this regard, the method of total arthroplasty helps to stop the lesion and correct the anatomical components of the operated area.
Summarizing the presented data regarding the results of reconstructive surgery on the hip joint, it can be noted that within 5-6 weeks after arthroplasty, the strength characteristics of the hip joint are virtually completely restored.
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Is it possible to do without it?

Only your attending physician can answer this question. Only you need an orthopedic surgeon, not a surgeon, not a veterinarian, but an operating orthopedist. There are dogs that are supported conservatively, there are dogs for which surgery is a question of whether to walk or lie down. We had exactly such a case. It all depends on the extent of your problems. Resection of the head of the joint is usually prescribed for grade E dysplasia, with severe flattening of the acetabulum, which includes the head of the joint, subluxation or dislocation of the hip joint, and secondary ostearthrosis - “corrosion” of the head of the joint and acetabulum. But not in all cases. Each image is a unique story, and treatment is chosen based on the principle of “what will be best.” There are two more types of operations that are performed for serious dysplasia. This is the so-called triple pelvic osteotomy, when the head of the joint is preserved. And hip replacement, when the diseased joint is replaced. These operations are not performed often due to specific restrictions and health indications, as well as the high cost of the operation. If you want to consult further on the advisability of the operation, I advise you to take the time and contact our Moscow veterinary orthopedists for advice. if this is difficult, you can consult about the image and the advisability of the operation remotely, on the V.B. advisory forum. Davydova www.vethospital.ru

How long does the postoperative period last?

It all depends on the operating doctor and the condition of the dog: weight, degree of problems, even its psychology. After the first operation, my dog ​​began to step on his paw on the second day, and by the time he was a month old he was limping. So we, already limping a little, went out for the second operation. With the second operation she had a very difficult time psychologically; she simply did not get up for three days, but after a month the slight lameness was no longer noticeable. In the first ten days, exercise is limited, walking on a leash, step by step, gradually increasing the walking time. We started from five meters - to the bench and back. For a week I supported her under her stomach with a scarf, insuring her so that she wouldn’t stumble. I carried her on a harness (thanks to Anya!) and gradually increased the load. In the first two weeks, it is better to protect the dog from sudden movements and jumps. And gradually exercise your paw. It must form a muscular corset, the key to its movement in the future.

Within a month, the so-called false joint. Maximum improvement is achieved between two and six months. After a month there are no restrictions in loads. The weight should be kept as light as possible.

What to expect next?

If the dog falls into the hands of an experienced operating orthopedist and there are no complications (which also largely depends on the orthopedist), then expect an active, cheerful dog that will not sit down like an old lady on every corner. If you have a problem with two paws, then wait for the next thing: a long and painful decision to undergo a second operation, struggling between acute pity for the dog and the need to cure it. The desire to go through the whole thing again rehabilitation period in the second round you definitely won’t have any problems. Therefore, if necessary, you will have to step over the “I don’t want to”. More severe reaction of the dog to the second operation. More rapid recovery second paw. If you have hocks that are close together, it will last a lifetime.