Hip: aseptic femoral headneck necrosis

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Sections available in full article Introduction, Presenting signs, Age predisposition, Breed predisposition, Pathogenesis, Etiology, Pathophysiology, Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Differential diagnosis, Treatment, Standard treatment, Subsequent management, Prevention, Control, Sequelae, Prognosis, Sources, Publications, Vetstream contributor(s),
Contributors Prof Walter Renberg DVM MS DipACVS
Prof Mark Rochat DVM MS DipACVS
Synonyms Avascular necrosis of the femoral head, Perthes disease, Legg Perthes disease, Legg-Calves-Perthes disease, coxa plana, coxa magna, osteochondrosis of the femoral head

Introduction

  • An aseptic necrosis of the femoral head of small breed juvenile dogs, particularly Terriers, Poodles, and Miniature Pinschers - associated with autosomal recessive gene. Males and females are equally affected.
  • Signs : gradually progressive unilateral or (less commonly -10-17%) bilateral hindlimb lameness, pain, restricted joint movement. Concurrent medial patellar luxation may be present.
  • Diagnosis : radiography.
  • Treatment : non-weight-bearing sling if identified prior to bony collapse; excision arthroplasty or total hip arthroplasty if identified after bony collapse.
  • Prognosis : good.

Diagnosis

Clinical signs

  • Pain on manipulation of hip joints, especially on abduction and extension.
  • Restricted joint movement.
  • Later: muscle atrophy - prominence of greater trochanter.
  • Crepitus.

Diagnosis

Differential diagnosis

  • Proximal physis separation/femoral neck fracture.
  • Infectious arthritis Hip: infective arthritis.
  • Hip dysplasia Hip: dysplasia.
  • Degenerative joint diseases from other causes.

Sequelae

Prognosis

  • Generally good with appropriate management.

Sources

Publications

Refereed papers

  • Recent references from PubMed.
  • Scott H (1999) Non-traumatic causes of lameness in the hindlimb of the growing dog. In Practice 2 , 176-195.
  • Gibson K L, Lewis D D, Pechman R D (1990) Use of external coaptation for the treatment of avascular necrosis of the femoral head in a dog. JAVMA 197 , 868-870.

Other sources of information

  • Cook W T, Smith M M (2003) Perthes' Disease. In: Slatter D H Textbook of Small Animal Surgery. 3rd edn, pp 2260-2264.

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