A technique for pelvic radiography in the standing horse

REASONS FOR PERFORMING STUDY: An alternative technique of radiographing the pelvis in the standing horse is required, to avoid the risks associated with general anaesthesia. HYPOTHESIS: That lateral oblique radiography in the standing horse would be a useful technique in the investigation of pelvic injury. OBJECTIVES: To describe the technique of lateral oblique pelvic radiography in the standing horse and demonstrate the feasibility and usefulness of this technique. METHODS: A technique for lateral oblique radiography in the standing horse was devised and retrospective review made of radiographic findings in 18 clinical cases. RESULTS: The caudal iliac shaft, greater trochanter of the femur, femoral head, acetabulum and coxofemoral articulation on the side under investigation were visualised consistently using this technique. Of the 18 cases, 3 iliac shaft fractures, 1 acetabular fracture, 2 coxofemoral luxations and 4 horses with new bone formation around the coxofemoral joint and/or proximal femur were identified. CONCLUSIONS: Lateral oblique radiography in the standing, conscious horse can be used to investigate conditions affecting the caudal iliac shaft, coxofemoral articulation and proximal femur in the horse. POTENTIAL RELEVANCE: The technique is straightforward, noninvasive and useful in the investigation of horses with suspected pelvic injury. However, not all pelvic injuries would be identified, and normal radiographic findings do not rule out injury or fractures elsewhere in the pelvis.     

ULTRASOUND EVALUATION OF THE COXOFEMORAL JOINTS OF THE CANINE NEONATE

The effectiveness of ultrasound in depicting the normal anatomy of the coxofemoral joint in puppies was evaluated. Ultrasound images were obtained from twenty Springer Spaniel puppies ranging from one day to twelve weeks of age. The anatomy of the hip joint could be identified up to eight weeks of age. By twelve weeks of age the degree of ossification prevented complete hip joint evaluation. Three different views were utilized. The longitudinal and dorsolateral views were the most useful. Motion of the femoral head within the acetabulum could be observed. Measurements of the acetabulum, femoral head and joint space could be obtained however these measurements were inconsistent. The technique appears to be useful for depicting the anatomy of the neonatal coxofemoral joint however, additional studies utilizing both normal and dysplastic puppies are recommended to determine if this examination will be useful in discriminating between normal and dysplastic puppies.     

RADIOGRAPHIC ANATOMY OF THE CANINE COXOFEMORAL JOINT USING THE DORSAL ACETABULAR RIM (DAR) VIEW

A radiographic study of the anatomy of the canine acetabulum was performed. The relationship between the area of dorsal acetabular rim that is subject to early damage in dogs with coxofemoral joint laxity, and the "DAR point" identified on dorsal acetabular rim (DAR) radiographic views was examined. Radiographs and digital photographs were made of the pelvis harvested from each of six skeletally mature dogs. Through analysis of these images, it was determined that in the standing animal, the DAR point is located 4–6 mm (or approximately 37°) caudal to the dorsal acetabular rim area that is prone to early damage in dogs with coxofemoral joint laxity. This study suggests that the DAR radiographic view may under-represent changes to the dorsal acetabular rim in dogs with coxofemoral laxity.     

Radiographic diagnosis of craniodorsal coxofemoral luxation in standing equids

Radiographic evaluation of the pelvis in standing horses has been used to diagnose fractures of the pelvis, head and greater trochanter of the femur, and luxations of the coxofemoral joint. Coxofemoral luxation injuries are more common in smaller horse breeds and donkeys, but, due to their size, the standing ventrodorsal projection is not possible, as there is insufficient space to place the radiography equipment under the animal's abdomen. The objective of the study was to report the advantages and limitations of the use of an oblique radiographic projection to diagnose unilateral craniodorsal coxofemoral luxation in 3 ponies and a donkey performed with the animals standing under light sedation. All cases had severe unilateral hindlimb lameness and asymmetry of the gluteal region; 2 also had concurrent intermittent upward fixation of the patella. A standing dorsolateral 20–30° ventral oblique radiograph of the affected coxofemoral joint was performed in all cases to obtain a definitive diagnosis. Radiography of the coxofemoral joint in standing ponies and donkeys can be carried out to identify craniodorsal coxofemoral luxation avoiding the need for general anaesthesia.     

Canine diffuse idiopathic skeletal hyperostosis

The radiographic and necropsy findings in a case of canine diffuse idiopathic skeletal hyperostosis are reported. Radiographically, the disease was characterized by progressive development of para-articular mineral densities along joint surfaces of the appendicular skeleton; progressive osseous fusion of the ilium, pubis, femur, and ischium; and progressive flowing ossification of the dorsal spinous processes of cervical and thoracic vertebrae. The para-articular lesions were considered to develop as a consequence of fibrocartilaginous proliferation followed by endochondral ossification. Progression of the ossification process led to para-articular joint fusion and almost complete ossification of the metaplastic cartilage. A distinguishing feature was the sparing of intra-articular structures.     

Radiographic appearance and clinical progress after excision arthroplasty of the canine hip

This paper describes the radiographic appearance of the proximal femur and acetabulum after excision arthroplasty for chronic hip lameness in the dog. An attempt has been made to correlate the various radiographic appearances with the clinical findings. The fate of spurs of bone left at the site of resection has been investigated. A constant finding was remodelling of the acetabulum and proximal femur; the results of this remodelling are described.     

Ultrasound-guided coxofemoral arthrocentesis in horses

REASON FOR PERFORMING STUDY: Coxofemoral joint pain is probably underestimated due to difficulties in identifying hip pain. The deep location of the joint and proximity of the sciatic nerve make arthrocentesis based on external landmarks a difficult and potentially risky procedure in mature horses. OBJECTIVES: To describe an ultrasound-guided injection technique of the coxofemoral joint in standing horses and to evaluate its accuracy and potential difficulties/complications. METHODS: Nine mature horses had both pelvic areas prepared for sterile ultrasound examination (3.5 MHz curvilinear probe). Coxofemoral joints were located and penetrated at their craniodorsolateral aspect under ultrasonographic guidance and injected with sterile contrast medium. A standing ventrodorsal radiographic view of each hemipelvis centred on the hip was obtained for each horse to assess the injection site. Horses were evaluated for 10 days following injection for possible complications. RESULTS: Intra-articular injection was successful in all 18 joints. The procedure was well tolerated by horses under minimal restraint. Mean +/- s.d. needle repositionings required before accurate placement was 1.5 +/- 1.3 per joint. Once the needle was in the joint, synovial fluid was obtained in 7/18 joints. Minimal periarticular contrast medium was detected in 2/18 joints. Mean +/- s.d. ultrasonographic examination time required for coxofemoral localisation, accurate needle positioning and injection was 4.3 +/- 2.1 min. No complications were observed in the 10 days following injection. CONCLUSION: The ultrasound-guided coxofemoral arthrocentesis is an accurate, reliable and safe technique that offers a real time evaluation of needle introduction into the deep and narrow coxofemoral joint space. POTENTIAL RELEVANCE: Although this technique remains to be tested on clinical cases, it is a promising tool to facilitate diagnosis of coxofemoral pain, septic arthritis or administration of intra-articular medication.     

Coxofemoral luxations in cats

In a retrospective study, 79 untreated luxations of the coxofemoral joint in cats were recorded over a 12-year period. Twenty-nine of these cases were available for follow-up, of which 13 were re-examined clinically and radiologically. It was found that the maximum incidence of the injury occurred from one to three years of age. Follow-up radiographs showed that the cats had developed nearthroses of various degrees located dorsally on the ilium. The degree of nearthrosis formation was not consistently correlated with the length of the observation time. Radiological signs of decreased bone density of the proximal femur may be caused by reduced weightbearing related to changes in biomechanical function and altered blood supply in the luxated limb. Almost two-thirds of the re-examined animals presented some kind of locomotor dysfunction on clinical examination. Limb function improved with time. The best clinical results appeared to be in cats that were immature at the time of injury and developed nearthrosis similar to a normal coxofemoral joint. All the cats available to this study showed acceptable functional results and had a normal level of activity according to the owners.     

Comparison of the Diagnostic Value of Ultrasonography and Standing Radiography for Pelvic–Femoral Disorders in Horses

Objective— To assess agreement between ultrasonography (transcutaneous and transrectal) and standing radiography in horses with fractures in the pelvic region and disorders of the coxofemoral joint.
Study Design— Case series.
Animals— Warmblood horses (n=23) and 2 ponies.
Methods— Medical records (1999–2008) of equids with pelvic or coxofemoral disorders that had pelvic radiography and ultrasonography were retrieved and results of both techniques compared.
Results— Radiography and ultrasonography each identified equal numbers of fractures of the tuber coxa (n=4), ilial shaft (2), ischium (3), femoral neck (2), and osteoarthritis/osis of the coxofemoral joint (6). Fractures of the ilial wing (4) were only identified by ultrasonography not by standing radiography. Of 9 acetabular fractures, 3 were identified on radiographs only, 5 were identified with both modalities. One pubic fracture was identified using ultrasonography and radiography. One acetabular and 1 pubic fracture were only diagnosed on necropsy.
Conclusions— We found reasonable agreement (73%; 24/33) between ultrasonography and standing radiography for diagnosis of pelvic–femoral disorders. Ultrasonography was more useful for ilial wing fractures and radiography for acetabular fractures.
Clinical Relevance— Ultrasonography is a rapid, safe imaging technique for detecting disorders of the pelvic region with a high diagnostic yield and is a preferred initial approach in horses with severe hindlimb lameness.     

Changes in the Proximal Femur and Coxofemoral Joint Following Intramedullary Pinning of Diaphyseal Fractures in Young Dogs

We report radiographic changes and clinical results seen in the proximal femur and coxofemoral joint of 7 young dogs following intramedullary pinning. Changes seen radiographically included coxa valga, a small malformed femoral head, a short thin femoral neck, and coxofemoral subluxation. Epiphyseal trauma, ischemia, and mechanical impairment of normal femoral neck growth due to presence of the intramedullary pin are discussed as possible etiologic factors.     

Pelvic osteotomy for axial rotation of the acetabular segment in dogs with hip dysplasia.

Pelvic osteotomy has provided normal function and activity to dogs with hip dysplasia. Physical and radiographic examination and palpation under anesthesia permit evaluation of the degenerative process and provide the specific amount of axial rotation of the pelvis necessary for each dog. The technique consists of an osteotomy of the pubis, ischium, and ilium to reestablish acetabular support of the femoral head.     

Lameness Associated with Coxofemoral Soft Tissue Masses in Six Dogs

Six cases of mechanical lameness involving the coxofemoral joint are presented. All dogs had a history of chronic rear leg pain and lameness, and decreased range of motion of the hip. On physical examination, ventral subluxation of the coxofemoral joint during extension was present in three dogs. A radiographic diagnosis of subluxation was made in five dogs. In each dog, surgical exploration of the area caudal to the coxofemoral joint revealed a fibrous mass between the lesser or third trochanters and the ischium, diagnosed as a nonneoplastic fibrous reaction by microscopic examination. The clinical, radiographic, and histopathologic signs were similar to previously described cases of myositis ossificans. Five dogs returned to normal function after excision of the soft tissue mass, and one dog was normal when lost to follow-up 4 weeks postoperatively.     

Diagnostic procedures and surgical treatment of craniodorsal coxofemoral luxation in calves

OBJECTIVE: To report use of ultrasonographic examination of the coxofemoral joint, a surgical technique for repair of craniodorsal coxofemoral dislocation, and outcome. STUDY DESIGN: Clinical case reports. ANIMALS: Calves (n=4) with coxofemoral luxation. METHODS: Craniodorsal coxofemoral luxation was diagnosed by physical examination, radiographic, and ultrasonographic findings. Open surgical reduction of the femoral head was performed using a modified caudal approach. RESULTS: Craniodorsal luxation of the femoral head and the presence of an intact femoral neck were confirmed by ultrasonography. All luxations were successfully reduced and reluxation did not occur. At follow-up, 1 heifer had calved and 1 was 5 months pregnant. One calf died of bronchopneumonia 6 days after surgery. One calf had severe coxofemoral degenerative joint disease diagnosed (ultrasonography, radiography, and arthrocentesis) 3 months after surgery and confirmed by necropsy. CONCLUSION: Ultrasonography proved to be a simple and effective non-invasive technique for diagnosis of coxofemoral luxation. Immediate surgical intervention in hip dislocation in calves is necessary to avoid unnecessary trauma to subchondral structures. In calves, open instead of closed surgical reduction appears preferable because it allows access to the acetabular cavity for removal of debris. CLINICAL RELEVANCE: Ultrasonography should be considered a supplementary but not an alternative to radiographic examination for diagnosis of coxofemoral luxation and for follow-up examinations after reduction.     

Diagnostic and Operative Arthroscopy of the Coxofemoral Joint in Horses

Arthroscopic examination of the hip joint was performed in mature and juvenile horses, using a lateral approach and standard or long instruments depending on body weight. Nine hip joints were examined in three cadavers and four anesthetized horses. The lateral, cranial, and caudal regions of the femoral head and acetabulum were accessible, and, after distraction of the limb, the ligament of the head of the femur and the acetabular notch were also visible. In small horses, the medial regions of the hip joint were visible but were inaccessible in larger horses. Iatrogenic injury to the sciatic nerve or periarticular vasculature was not evident at necropsy examination. Six horses with lameness localized to the hip joint were examined arthroscopically. At surgery, two horses had tearing of the ligament of the head of the femur, two horses had osteochondrosis of the femoral head or acetabulum, and two horses had degenerative joint disease, one associated with a rim fracture of the caudal aspect of the acetabulum and the other of indeterminant origin. Improvement after debridement occurred in one of the horses with partial disruption of the ligament of the head of the femur and in both horses with osteochondrosis. Diagnostic and surgical arthroscopy of the hip can be accomplished in foals and weanlings using standard equipment, but, in adults weighing more than 300 kg, longer instruments are required and the ease of access and the visible extent of the hip joint is considerably reduced.     

Total hip arthroplasty in the horse: Overview,technical considerations and case report

A total hip arthroplasty was performed in a small equine patient with a history of traumatic subluxation of the coxofemoral joint during infancy resulting in severe degenerative changes to the femoral head and acetabulum. The transtrochanteric surgical approach used to expose the joint, as well as the technique and technology to replace the joint, is described. The patient was weightbearing within 24 h of surgery and walking successfully without sling support 4 days post operatively. On the fifth post operative day, the patient abruptly deteriorated and succumbed to multiple pulmonary thromboemboli and a jejunal infarction. Despite the systemic complications in this case, the initial short‐term success of this treatment option indicate its potential to be considered in the management of equine coxofemoral joint disease/lesions.     

Ultrasonographic examination of the hip joint region and bony pelvis in cattle

Transcutaneous and transrectal ultrasonographic examination of the hip joint region and the pelvis was carried out in 7 cadavers, transcutaneous ultrasonography in 17 healthy young and adult cattle, and transrectal sonography was performed in 12 healthy cows in order to study the normal ultrasonographic appearance of these regions. 7.5 MHz linear-, 5.0 MHz and 3.5 MHz convex transducers and a 7.5 MHz rectal probe were used. The bone surfaces of the greater trochanter, the femoral neck and head, the acetabulum and the other pelvic bones were visualised as hyperechoic contours. The coxofemoral joint space was identified in all cadavers and live cattle. The joint pouch could not be visualised, neither in cadavers nor in live cattle. After experimental filling of the coxofemoral joint pouch by injection of 35-45 ml eosin-solution it appeared as a large anechoic zone between the articular surface and the echogenic joint capsule. The inner contours of the pelvic girdle, both iliosacral joint spaces, the abdominal aorta and the external iliac arteries were depicted clearly by transrectal ultrasonography. The practical application of diagnostic ultrasound in these regions is demonstrated in clinical patients suffering from a septic coxarthritis and a sequestration of a part of the tuber coxae following an open fracture. These results serve as reference data for ultrasonographic investigation of disorders of the hip joint and the pelvic region in cattle.     

Effect of anaesthesia and stress on the radiographic evaluation of the coxofemoral joint

A pelvic radiographic examination was performed on 15 large breed dogs without history and clinical sign of hip dysplasia. The effect of anaesthesia and of two stress-radiographic methods on the coxofemoral subluxation was evaluated. With anaesthesia a mild coxofemoral subluxation was seen in 31 per cent of the dogs, which all appeared radiographically normal when sedated. The Norberg angle was significantly decreased in anaesthetised dogs (P < 0–05). When dogs with a radiographically normal coxofemoral joint conformation were submitted to a stress-radiographic examination there was a shift towards an increased coxofemoral subluxation. Subluxation was seen in 70 per cent of the dogs when the knee fixation method of positioning was applied and in 100 per cent of the dogs when the wedge method was used. Correspondingly the Norberg angle decreased significantly when the coxofermoral joints were stressed (P_kneefix < 0–00003; P_wedge= 0–000008). The study concludes that the currently used procedure for evaluation of the hip joints does not necessarily disclose whether or not a dog has hip dysplasia.     

Additional kinematic variables to describe differences in the trot between clinically normal dogs and dogs with hip dysplasia

OBJECTIVE: To describe the abnormal gait of dogs with hip dysplasia by use of kinematic gait analysis. ANIMALS: 19 large-breed dogs with moderate to severe clinical and radiographic evidence of hip dysplasia and 10 clinically normal dogs (controls). PROCEDURE: Kinematic and force plate data were collected, and degree of coxofemoral joint abduction-adduction, mediolateral foot movement, distance between hind feet, maximum hind foot elevation, mediolateral pelvic movement, and coxofemoral joint angular acceleration were calculated. Essential Fourier coefficients were determined and used to reconstruct mean angular acceleration curves. Fourier coefficients and foot and pelvic movement data were compared between groups. RESULTS: Dogs with hip dysplasia had a greater degree of coxofemoral joint adduction and range of abduction-adduction and greater lateral pelvic movement, compared with controls. Foot movement variables did not differ significantly between groups. Coxofemoral joint angular acceleration was greater in the middle to end of the stance phase, whereas deceleration was greater in the late stance to early swing phase and middle to end of the swing phase in dogs with hip dysplasia, compared with controls. CONCLUSIONS AND CLINICAL RELEVANCE: Differences in degree of coxofemoral joint abduction-adduction, amount of mediolateral pelvic movement, and coxofemoral joint angular acceleration between clinically normal dogs and dogs with hip dysplasia may indicate a compensation in gait of affected dogs as a result of discomfort or biomechanical effects attributable to hip dysplasia and degenerative joint disease. Information gained from kinematic and kinetic gait analyses may be useful in evaluating treatments for hip dysplasia in dogs.     

Fascia lata loop stabilisation of the coxofemoral joint in the dog and cat

A transarticular loop of autogenous fascia lata was used to stabilise the coxofemoral joint following open reduction of recurrent and long standing hip luxation in 10 dogs and two cats. The caudolateral approach used proved to be simple and allowed good visualisation. Good results were obtained and only one of 12 cases reluxated in a follow-up period varying from three months to one year. The loop technique required little sophisticated equipment and is within the scope of the average surgeon.     

New concepts of coxofemoral joint stability and the development of a clinical stress-radiographic method for quantitating hip joint laxity in the dog

From mechanical principles and postmortem observations of coxofemoral joints of dogs, a hydrostatic mechanism influencing hip joint stability was discovered. This discovery led to the development of a stress-radiographic positioning method to quantitate hip joint laxity in dogs. The method incorporated 2 views with the dog in supine position and hips at neutral flexion/extension angle: a compression view, with the femoral heads fully seated in the acetabula; and a distraction view, with the femoral heads at maximal lateral displacement. An index measurement method was formulated to quantitate the relative degree of joint laxity appearing in either the compression or distraction view. Clinical evaluation of 6 dogs was done to compare the compression/distraction method with the standard hip-extended radiographic method. Also, the stress-radiographic method was performed on 16-week-old Borzoi and German Shepherd Dogs to compare the characteristics of inherent hip joint laxity in these breeds. In all dogs tested, hip joint laxity was masked by the standard hip-extended view as indicated by a 2.5-fold improvement in sensitivity to hip joint laxity of the new method (P less than 0.00001). Moreover, the mean hip joint laxity of 16-week-old German Shepherd Dogs exceeded the mean hip joint laxity of Borzois by 79% (P less than 0.00001). Reports in the literature document the incontrovertible association of hip joint laxity to the development of hip dysplasia in dogs. We believe the ability to accurately quantitate hip joint laxity will provide key diagnostic and prognostic criteria for the selection of pet dogs, and more importantly, breeding stock.