Excision arthroplasty of the femoral head and neck

An abnormality of the coxofemoral joint is recognized when the articular cartilage sliding interface between the femoral head and the acetabulum is interrupted. The article considers the pathologic conditions that may affect the normal coxofemoral articulation and are responsive to excision arthroplasty. Techniques of excision arthroplasty and the biceps femoris muscle sling technique are described.     

Internal fixation of femoral head and neck fractures in the cat

A quick surgical approach for internal reduction and fixation of femoral head and neck fractures is described. The results and reasons for preferring this technique to femoral head and neck excision are discussed.     

Effects of postoperative administration of ketoprofen or carprofen on short- and long-term results of femoral head and neck excision in dogs

OBJECTIVE: To determine whether postoperative administration of ketoprofen or carprofen had any effects on short- or long-term results of femoral head and neck excision (FHNE) in dogs. DESIGN: Prospective randomized controlled trial. ANIMALS: 40 client-owned, large-breed dogs undergoing FHNE and 15 healthy large-breed dogs used as controls for hip joint angle measurements and force plate analyses. PROCEDURE: Dogs undergoing FHNE were treated with ketoprofen, carprofen, or a placebo for 21 days after surgery. Hip joint abduction and extension angles were measured at the end of surgery and 120 days later. Lameness scores were assigned, and force plate analyses were performed on days 3, 15, and 120. RESULTS: There were no significant differences among treatment groups in regard to hip joint angles or lameness scores. Force plate analysis revealed that dogs in all 3 treatment groups bore consistently less weight on the operated limb than did control dogs for the duration of the study. Dogs receiving ketoprofen had greater peak propulsive force at a walk on day 3 and greater peak vertical force at a walk on day 15 than did dogs receiving the placebo. Treatment of an acute condition and preservation of the lesser trochanter, but not postoperative analgesic administration, were positively associated with ground reaction forces on day 120. Owners of 12 of 31 dogs indicated that the dog's gait worsened for a few days after discontinuation of analgesic administration. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of ketoprofen or carprofen after surgery was not associated with long-term results of FHNE, probably because of the impact of other factors. Because some owners noticed worsening of the lameness following cessation of analgesic administration in the present study, it is possible that longer administration would have improved long-term results.     

Simultaneous bilateral femoral head and neck ostectomy for the treatment of canine hip dysplasia

Simultaneous bilateral femoral head and neck ostectomy (FHO) was performed on 15 dogs for severe bilateral hip dysplasia. A follow-up survey was performed 6 to 48 months after surgery to assess the postoperative recovery and activity levels of the operated dogs. All dogs had normal activity levels and were pain free according to their owners. Owner satisfaction regarding the outcome of the surgery was high. Simultaneous bilateral FHO was a viable surgical option for the treatment of painful bilateral hip disease in dogs, especially when other surgical options were not indicated or were cost prohibitive.     

Influence of femoral head and neck conformation on hip dysplasia in the German Shepherd dog.

We investigated the prevalence of an anatomic variant of the proximal femur, termed the broomstick-like femoral head and neck formation, and its influence on the Féderation Cynologique Internationale (FCI) hip dysplasia score in 294 German Shepherd dogs. One-hundred and eighty (61%) of the 294 dogs in our study had this anatomic variant. The calculated area of the femoral heads in dogs with a broomstick-like conformation was 4.5 +/- 0.6 cm2 on the hip-extended view. In dogs with a normal femoral head, the calculated area of the femoral head was significantly larger at 4.8 +/- 0.6 cm2 (P < 0.05). In the frog-leg view, there was no significant difference in femoral head area between dogs with the broomstick-like conformation and normal dogs. There was no difference in the antetorsion angle between dogs with broomstick-like conformation and normal dogs. There was also no difference in the distraction ratio between the two phenotypes. The official FCI hip score was similar in dogs with and without the broomstick-like conformation. The average heritability of the broomstick-like conformation was 0.3 +/- 0.1, suggesting heritable influence. We conclude that the broomstick-like conformation is a common finding in the German shepherd dog and has genetic base. The broomstick-like conformation does not appear to be associated with the presence of canine hip dysplasia and it can therefore be assumed to be a normal anatomic variant.     

Brown bear (Ursus arctos arctos) femoral head and neck excision.

A 30-yr-old untamed European female brown bear (Ursus arctos arctos) with a craniodorsal luxation of the right femoral head and bilateral degenerative joint disease of the coxofemoral joint had a femoral head and neck excision following unsatisfactory conservative medical therapy. The bear was injected with zolazepam-tiletamine, and anesthesia was induced with i.v. thiopental and maintained with isoflurane in oxygen via endotracheal tube. A lumbosacral epidural injection of medetomidine-bupivacaine provided additional analgesia. Slight initial cardiorespiratory depression was counteracted with fluid and inotropic drug administration and ventilatory assistance. The bear's gluteal muscle anatomy differs from that of the dog. Recovery was uneventful. The bear was confined indoors for 6 wk and was able to ambulate normally within 6 mo.     

Talar neck fractures in five cats

Five cats with fracture of the talar neck were treated using external skeletal fixation (ESF). In four of the cases, ESF was the only fixation technique used and this was applied in a closed manner coupled with traction. In the remaining cat, ESF was used in combination with a lag screw. All the fractures eventually healed, demonstrating that ESF provided a simple and effective method of treatment for these cases.     

Use of sedation and ropivacaine‐morphine epidural for femoral head and neck ostectomy in a dog

A five‐year‐old male German shepherd dog presented with traumatic craniodorsal luxation of the right coxofemoral joint with pre‐existing moderate hip dysplasia. A femoral head and neck ostectomy was performed. The patient was sedated with acepromazine and morphine administered intramuscularly. A lumbosacral epidural was performed using a combination of morphine and ropivacaine. Intraoperatively, an infusion of medetomidine, morphine, lidocaine, and ketamine was administered intravenously, and oxygen was administered via facemask. Heart rate, respiratory rate and oscillometric arterial blood pressures were monitored. Postoperatively, carprofen was administered once subcutaneously. On the day of hospital discharge, carprofen and tramadol were administered orally every 12 hours. Twenty‐one days later, the dog was doing well and the surgical staples were removed. Sedation with acepromazine and morphine, administration of an epidural containing morphine and ropivacaine, and intraoperative sedation with medetomidine, morphine, lidocaine and ketamine were suitable for femoral head and neck ostectomy .     

Effects of high fat diets or prednisolone treatment on femoral head separation in chickens

1. The effects of high fat diets and prednisolone treatment were studied to understand the etiology of femoral head separation (FHS) in fast growing broiler chickens. Dietary effects on production parameters such as growth, feed conversion ratio (FCR) and blood chemistry were also measured.

2. Three groups of chickens, consisting of 30 birds each, in two replicate pens, were fed isonitrogenous diets containing 40 (control), 60, or 80?g poultry fat supplements per kg feed. The birds were fed a starter diet containing the fat supplements for the first three weeks, then switched to a grower diet containing the same supplements for the rest of the experimental period. Two groups of birds were also raised with the control diets, but were administered either cholesterol or prednisolone intramuscularly at 30 and 32 days of age to evaluate their effects on FHS incidences.

3. The chickens were euthanised and necropsied at 37?d of age. The presence of femoral head weakness was determined by applying mild pressure on the pelvic joint to cause the growth plate to become detached from its articular cartilage in affected cases.

4. High fat diets did not change FHS incidences, but increased 28?d body weights (BW) and FCR. At 37?d of age the BW differences were not significant but the FCR (gain: feed ratio) remained higher in high fat fed groups. Prednisolone treatment, by contrast, resulted in decreased BW, decreased feed efficiency, increased FHS index, and elevated blood lipid levels.

5. The results suggest that high dietary fats do not affect FHS incidence in broilers. Prednisolone treatment causes hyperlipidaemia and increases FHS index, and may therefore provide a suitable experimental model of FHS pathogenesis in growing chickens.     

Femoral neck fractures and capital epiphyseal separations in cats

In a retrospective study, 47 fractures of the femoral neck and 17 capital epiphyseal separations were recorded in a total of 62 animals over a 12-year period. It was found that cats sustain femoral neck fractures more often than capital epiphyseal separations. Until cats are six months old the vast majority of lesions in the proximal femur are fractures of the neck. Between the ages of six and 12 months both lesions are equally represented. After 12 months of age no capital epiphyseal separations occur and the incidence of femoral neck fractures diminishes appreciably. If left untreated, an acceptable clinical result can be obtained in both femoral neck fractures and capital epiphyseal separations, although the best functional result is achieved in femoral neck fractures. In the present study, spontaneous healing was seen only in femoral neck fractures in cats younger than three months. All cats with capital epiphyseal separations developed hypertrophic pseudoarthrosis.     

Infections with helminths and/or protozoa in cats in animal shelters in the Netherlands

To determine the prevalence of infections with helminths and protozoa in cats in animal shelters, faecal samples from 305 cats from 22 animal shelters in the Netherlands were examined, using a centrifugation-sedimentation-flotation-technique. The association between potential risk factors and the occurrence of an infection was also tested. Infections with helminths and/or protozoa were found in 160 samples (52.5%). Toxocara cati was found in 86 cats (28.2%), Cystoisospora felis in 59 cats (19.3%), Cysto?sospora rivolta in 43 cats (14.1%), Capillaria spp. in 34 cats (11.2%), Ancylostoma tubaeforma in 9 cats (3.0%), Taenia taeniaeformis in 9 cats (3.0%), Aelurostrongylus abstrusus in 8 cats (2.6%), Giardia intestinalis in 3 cats (1.0%), Dipylidium caninum in 2 cats (0.7%) and Toxoplasma gondii in 1 cat (0.3%). The highest prevalence was seen in kittens and stray cats. The main preventive factor against infection was a short stay in a shelter.     

Effects of femur position on radiographic assessment of completeness of femoral head and neck excision in medium- to large-breed dogs

OBJECTIVE: To determine the effect of femur positioning on radiographic assessment of completeness of excision after femoral head and neck excision (FHNE) in medium to large breed dogs. SAMPLE POPULATION: 10 femurs from canine cadavers (body weight > 20 kg). PROCEDURE: Complete FHNE was performed on 5 canine femurs. Excision consisting of inadequate removal of the medial distal aspect of the femoral neck was performed on the remaining 5 femurs. Each femur was positioned with predetermined amounts of internal and external rotation about the long axis and radiographed. Investigators evaluated a set of 8 radiographic views of each femur. Sensitivity (SE), specificity (SP), positive predictive value, negative predictive value, and completeness of excision assessment accuracy were estimated for each of the femur positions. RESULTS: Craniocaudal radiographic views of the femur positioned with external rotation of 15 degrees, 30 degrees, and 45 degrees as a group had the highest SE, SP, and completeness of excision assessment accuracy relative to other radiographic views. The SE, SP, and accuracy of assessment were higher when the degree of external rotation was increased from 15 degrees to 30 degrees or 45 degrees. CONCLUSIONS AND CLINICAL RELEVANCE: Craniocaudal radiographic views of the femur positioned in external rotation (15 degrees, 30 degrees, and 45 degrees) improved the ability to detect adequacy of excision relative to standard craniocaudal and lateromedial radiographic views. Evaluation of craniocaudal radiographic views of the femur positioned in external rotation may increase the ability to assess FHNE adequacy in medium- to large-breed dogs.     

Multimodal therapeutic approach and interdisciplinary challenge for the treatment of unresectable head and neck squamous cell carcinoma in six cats: a pilot study

Feline head and neck squamous cell carcinoma (SCC) is a loco‐regional disease harbouring a poor prognosis. The complex anatomic location precludes aggressive surgical resection and tumours recur within weeks to few months. Response to chemotherapy and local control after radiation therapy has been disappointing. In this study, a multimodal approach including medical treatment (thalidomide, piroxicam and bleomycin), radiation therapy (accelerated, hypofractionated protocol) and surgery was attempted in six cats. Treatment was well tolerated. Three cats with sublingual SCC were alive and in complete remission at data analysis closure after 759, 458 and 362 days. One cat with laryngeal SCC died of renal lymphoma after 51 days and the other with maxillary SCC died of a primary lung tumour 82 days after diagnosis. In both cats, the SCC was in complete remission. Only one cat developed metastases after 144 days. These encouraging preliminary results merit further evaluation in future trials.     

Omentalisation of the head in cats: a cadaver study

The involvement of the greater omentum in reconstructive, abdominal and thoracic surgery is based on its manifold qualities, which include immunological support, lymphatic drainage, angiogenesis, adhesion, haemostasis and fat storage. The purpose of this study was to determine whether the greater omentum could be extended to the head. In addition, we evaluated the surgical procedures necessary for this extension. Our study reveals that specific surgical lengthening techniques of the greater omentum, such as dorsal extension and inverted L-shape elongation, are necessary to successfully transpose the omentum to the head in cats. As the survival of the omentum after transposition procedures is still unknown, its application in chronic non-healing wounds of the head in cats warrants further investigation.