|
View Previous Case of the
Month Reports- click here
Lucy is a beautiful, 3 year
old Golden Retriever who came to us last month after sustaining an
injury of unknown origin. Her owners had left Lucy in the
yard for the day, and when they got home, the found she could not use
her back left leg. Lucy was obviously in pain when they found her, so
they took her to the emergency clinic (we were closed at the time). The
emergency veterinarian isolated the pain to her hip joint. She sedated
Lucy and took radiographs and found that she had dislocated her hip.
Fortunately, the bones were
not broken, the thigh bone had simply slipped out of the socket formed
by the pelvic bones. The radiographs revealed that Lucy has poorly
formed, shallow hips
(hip dysplasia) and so it took less force to dislocate her hips than a
normal dog.
The owners brought Lucy and
her x-rays to us in the morning to
see if we could salvage her hip and let her walk again. Upon
examination, Lucy was walking only 3 legs and was very painful in the
left hip. In order to allow Lucy to walk normally, the femur had to be
replaced in the joint. Unfortunately, when we attempted this under
sedation, the hip continued to pop back out. This happens most of the
time after a luxation because the joint capsule; which had to rip in
order for the femur to pop out of the joint, falls back into the
acetabulum and interferes with the femoral head sitting properly in the
joint.
Since we couldn't make the
femur stay in the joint naturally, we had to turn to surgical
intervention to help Lucy. Our choices were to try and save the hip
joint by replacing the femur into the acetabulum and stabilizing it
surgically, or to remove the head of the femur (the ball on the end) so
that the bones would not be stuck on each other. The first surgery has
a potential 20% failure rate and tends to be more expensive than the
latter, however, it has the best chance of gaining normal function of
the joint. The second procedure, called a femoral head excision
arthroplasty, is sometimes necessary and tends to leave the dog with a
comfortable hip and very reasonable gait.
We decided to try surgical
reduction using a technique known as the "Toggle Rod Coxofemoral
Reduction Surgery". In this surgery we recreate the round ligament
which helps hold the femur in the acetabulum. The surgical technique is
illustrated on the following page:
Toggle Rod Coxofemoral Reduction Surgery"
Lucy was taken to surgery
that morning and 2 hours later we had the hip properly reduced. The
x-ray below shows the hip in place and you can see the "metal toggle"
that is inside the pelvis holding the synthetic round ligament. (click
on the x-rays for larger views).
Lucy was sent home a few days
later with antibiotics and pain medication. She was kept in a crate for
two weeks and by the time she came in for suture removal, she was
walking on the leg with minimal pain. She will be kept on restricted
activity for 4 more weeks and then she should be able to resume normal
activity.
|
