How NOT To Go Down Stairs

Elwood had a big "oops" last week-he fell down some stairs and came up lame on a hind leg. He wouldn't put any weight on it at all. His owners felt terrible seeing him like that, so brought him in to see us.
Now remember when I said that all hind limb lamenesses are due to injured cruciate ligaments until proven otherwise? In Elwood's case, we proved otherwise pretty quickly. He was so painful, that a good examination of his affected leg just wasn't possible with him awake, so we made sure he was stable, listened to his heart and lungs and checked the color of his gums and all. It appeared that all we were dealing with was that hurting leg. We quickly got some pain-relief and sedation medications into him and I proceeded to examine him more thoroughly. No thorn in his paw, no torn toe nail. I worked on up the leg, really concentrating on the stifle (knee) of course, but it was very stable and was not hot or swollen. None of the long bones felt unstable or were visibly poking through the skin-so no obvious fractures were evident. But when we got to his coxofemoral (hip) joint, it just wasn't as flexible as his opposite one was-we couldn't extend it completely. Hmmm, it was looking like that knee just wasn't the problem after all.

Next we decided to take some x-rays of his pelvis and knees to be complete and hopefully discover the cause of his coxofemoral joint decreased range of motion. The answer popped right out at us-Elwood had a luxated (dislocated) hip joint. Ouch! No wonder he wouldn't put weight on it. I was so glad we had given him a hefty dose of pain medication. He sure needed it. We called his owner and told him the story. Elwood would need to be anesthetised (sedation just wouldn't cut it) so we could reduce or replace the femoral head (ball) into the acetabulum (socket.) Of course they agreed and we proceeded to do that right away.

Elwood wasn't a large dog, thank goodness. He was a Cocker Spaniel, a little less than 30 pounds. In large dogs, reducing a hip luxation can be HARD work, and even in a 30 pound dog, I could expect to work up a little sweat. We anesthetised Elwood and placed him on a padded exam table. We then placed a cotton rope around his groin and had one of our assistants hold on to this for traction against me for when I started to pull. I didn't want him coming off the table! Another nurse held his head and endotracheal tube (breathing tube) in place.

There is a bit of an art to reducing a luxated joint. This is where the little bit of physics we learned so long ago comes in handy. It is also important to have both radiographic views of the hip to see just where the femoral head was in relation to the socket. Most luxations result in a dorsal and cranial position of the ball and this was the case with Elwood. I used one hand to put pressure on the ball (through the skin) and would attempt to guide it back where I wanted it-up and over the rim of the acetabulum (socket.) I used my other hand (and whole body, really) to rotate the femur outward and down-praying for that tell-tale "pop" when the ball happily returns to its normal position.

It took quite some time to get Elwood's muscles loosened up, but when we did, the "pop" came and the hip was back to normal. It instantly flexed and rotated normally-just like the opposite, healthy leg. We took a post-reduction x-ray just to confirm this and-nope-it wasn't in place. Rats! Sure enough, when I palpated the joint area, I could feel the ball out of the socket, plain as day. It either never went in completely and the "pop" was something else entirely, or the ball had re-luxated when we transported him to the x-ray room. Not good. This time when I made the motions to reduce the joint, I felt how easy it really did "pop" and how just as easily "popped" right back out. Double rats! This meant there was likely damage to the rim of the acetabulum, maybe even a congenital defect making the socket just too shallow to contain the femoral head with out the strong ligament attachment which had ruptured during Elwood's fall. So now what?

Elwood was going to need surgery to correct his dislocated hip. There is no wrap or sling that is strong enough or that offers enough support to keep a dog's hip joint stable for the time it would require to heal. If possible, it could be reduced and a band of heavy duty suture or wire could act as a sling internally, trapping the ball in the socket. Not all injuries can be repaired this way, especially if there is a congenital defect like a shallow acetabulum as I suspected was the case for Elwood. I recommended that Elwood have a procedure called an FHO-a femoral head and neck ostectomy. In this procedure, the femoral head and neck are actually removed, thus removing the object that is causing the bone-to-bone contact and thus the limitation of movement and the extreme pain.

Wow! That sure sounds dramatic, doesn't it? How would a dog be able to walk if his leg wasn't connected to his body? Well of course his leg is still connected-there are numerous very strong muscles in the thigh and buttocks that support the hip. The body will shortly form a sort-of false joint, one with no arthritis and no pain since there is no longer any bone-to-bone contact. My dog Verbal had this surgery done when she was quite young due to her terrible hip dysplasia in the affected limb. It is often considered a salvage procedure, but I really consider it to be a good choice for many dogs, especially young, active dogs. After recovering from the initial pain post-operatively, we encourage the clients to get those dogs moving-no cage confinement and strict rest as is the case with so many other orthopedic surgeries. We want the muscles to strengthen to support the hip, not atrophy from disuse. We will give instructions for physical therapy and get these patients started within a week or two after surgery.

I have done numerous FHO surgeries over the years and have always been happy with the outcome. A rare dog may need a second surgery if a portion of the neck remains and interferes with motion as the dog starts to bear more weight. Elwood's owners elected to have his surgery done at a veterinary surgical specialist facility since they could do the surgery that day and we would have had to schedule him for the next day. They just wanted him on the road to recovery as soon as possible. I received a report from the surgeon this morning and it sounds like Elwood's surgery went very well. He is home and his owners are pleased that he is already starting to touch his toes to the ground. What a trooper! I'll get the privilege of following up on his post-op care since the surgery facility is a much longer distance away. It is a shame this happened to poor Elwood, but he is fortunate to have devoted humans who are caring for him so well. He's already up and around, on good pain medication, and we'll have a discussion soon on how NOT to go down stairs in the future.

Peace,
DrReneigh