Total Hip Replacement in small breed dogs and cats

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1 Total Hip Replacement in small breed dogs and cats Fredrik Danielsson DVM, Dipl ECVS vetaid.se

2 Indications Hip dysplasia Osteoarthritis Coxofemoral luxations Avascular necrosis of the femoral head (Legg- Calvé-Perthes Disease) Slipped capital femoral epiphysis Commonly missed Clinical vs nonclinical Cats - Main coon

3 Indications Femoral head/neck fractures Femoral neck metaphyseal osteopathy Unsatisfactory outcome of femoral head/neck excision (FHNE) Pelvis fx malunion

4 Femoral Head and Neck Excision (FHNE) Salvage treatment option in different severe hip conditions Fully informed owners often ready to afford optimal treatment Pain relief of variable success Leg length discrepancies to be anticipated Prolonged, often incomplete rehabilitation

5 Excision arthroplasty of the hip joint in dogs and cats. Clinical, radiographic, and gait analysis findings U. Matis VCOT 1997 Clinical and radiographic re-evaluations avrg 4y years postoperatively Good in 38% Satisfactory in 20% Poor in 42% 96% owners satisfaction Kinetic and kinematic measurements showed that although femoral head and neck resection alleviated pain, it resulted in functional deficits in small breed dogs and cats These deficits were not visible during rapid movement.

6 Resolve pain, restore function & quality of life - regardless of size!

7 Procedure Micro implants: small dogs and cats Nano implants: miniature dogs < 2-3 kg Miniature breeds: safe from 6 months (Jankovits et al., 2012) Nano Breeds Stem Cup CFX CFX #1 +0 #1 +2 #1 +4 One piece stem/head Maximum patient weight: 20 lbs (9.0 kgs) Stem #2 #3 Cup CFX Maximum patient weight: 40 lbs (18.2 kgs) 8mm +0 8mm +2 6mm I.D. 10mm Head CFX 8mm Micro Breeds Micro/Nano Hip Instrument Set BFX / CFX THR Implant Selection Chart 12mm 14mm 16mm 8mm I.D.

8 Procedure Patient position critical - vaccum bed Power reaming? Start with acetabelum - high speed burr/ reamer Femoral canal - no power reaming? Test extreme ROM before closure

9 Procedure Micro/Nano always cementing technique Same principle as CFX Cement technique at surgeons preference - thin mantle is recommended to reduce thermal necrosis Acetabulum - Finger pack or inject

10 Procedure Burr instead of acetabular reamer (Liska)? Prudent hand preparation of femoral shaft Fluoroscopic control in deformed bone

11 Outcome 91% success rate (Liska 2010) Small report 7 dogs with unilateral avascular necrosis, ground reaction forces did not differ between normal hips and hips receiving the Micro THR (Jankovits et al. 2012)

12 Outcome Luxation is the most common complication Luxation occurred in 9 of 66 consecutive cases in one study (Liska 2010) Five luxations were managed with revision Four dogs had dorsal and ventral luxations for reasons not well understood

13 Outcome No detectable correlation between luxation and the angle of lateral cup opening Oversizing as well as undersizing the components can predispose to luxation in dogs or cats weighing <2.5 kg Smaller implants (Nano) are now manufactured to eliminate the risk of oversizing in small cats and dogs weighing 2 4 kg

14 My experiences Faster procedure than in large breeds Less precise, but more forgiving Very low complication rate (1/15 (7%) major complication) Very satisfied owners Long term complications not known Excellent outcome - pressure mattress

15 Pressure mattress

16 Pressure mattress

17 Post operative care Hospitalized one night Pain management Urinary catheter Helping hand 6 wks of leash walk at increasing length No jumping, playing etc (cats a problem) Cats allowed free activity after 6 weeks Rehab varies with preop condition

18 Summary THR represents excellent procedure to replace FHNE in many conditions Shorter recovery time Overall better performance Allows faster rehabilitation in multiple limb disease Outcomes justify increased recommendation of THR in cases previously treated with FHNE or even euthanasia