由 mutong_85 » 2013-08-05, 09:25
各位前辈和狗友,受累帮我看看那有什么建议呢?
Hi Mr and Mrs Tong,
Dennis contacted me about Leo's hip; whilst I have not had time to review Leo's history in depth, as I had to fly to Shanghai for work, I did review the x-rays.
Leo's hip is dis-located and there is no doubt in my mind that he requires surgery.
I believe there is some discussion as to the surgery type required. The surgery options are:
1) Hip toggle replacement whereby the ball is tied back into the cup. Please note the prosthetic used to do this snaps after 4-8 wks but the tissue has healed sufficiently to keep the ball in place.
2) Femoral head and neck excision. The ball of the hip joint is cut off. These days this procedure is viewed as a salvage procedure however is indicated in certain instances. After removal of the ball the muscles of the leg hold the leg to the pelvis. With the ball removed the leg is alot more comfortable as when dis-located the ball is rubbing against the pelvis abnormally.
3) Total hip replacement. This is as it sounds: the ball and hip are placed with a titanium alloy joint. This procedure is expensive but is the latest procedure.
Now to anatomy of the joint:
The ball of the hip joint is kept in the cup of the hip joint by the shape of the bones, the ligaments around the joint and the muscle attaching the leg to the pelvis. All these points are important.
In breeds that have poor hip confirmation the poor confirmation will have helped lead to the dis-location because the shape of the ball and cup are bad.
Once the hip dis-locates the ligaments around the joint are damaged and will not help to keep the ball in the joint.
In certain breeds such as Golden retrievers the conformation of the hip is so bad that option 1) above is very likely to fail. Either option 2) or 3) are recommended.
In Samoyeds the hip confirmation is usually good and appears to be so in Leo. Hence option 1) appears to be worth trying.
I say ' worth trying' because repeat dis-location is always possible however on the information I have at this time it would be my recommended option.
Dennis did mention that there had been some discussion that the femoral head is degrading in some way; that the head has avascular necrosis. Whilst this is possible in my experience it would be unusual in this breed, though I would like to do some research concerning this and we would need to re-X-ray at the time if surgery to fully understand the internal structure of the femoral head.
One thing is certain regardless of whether surgery 1) or 2) is performed. A dislocated hip leads to reduced use of the leg. Recovery from the surgery is very much dependant upon the strength of the muscles of the upper thigh. Leaving this surgery for too long greatly extends the recovery period.
Obviously we have not spoken directly and I do not want to interfere, however if you would like to continue the dialogue please either email me your questions or we can schedule a time to talk Tuesday or Wednesday.
Considering all options is very sensible however if Leo was my dog I would be scheduling one or other surgery type for certain, and in this instance it might be sensible to decide whether to perform 1) or 2) at the time of surgery.
Warm regards
Dr Tony Beck