Equis ISSN 2398-2977

Coxofemoral joint: disease - overview

Synonym(s): Hip disease, hip luxation, round ligament rupture

Contributor(s): Helen Herinckx, Vetstream Ltd, Graham Munroe

Introduction

  • Incidence: coxofemoral joint disease is an uncommon cause of hindlimb lameness.
  • Cause: direct trauma is the most common cause.
  • Signs: usually sudden onset, moderate to severe hindlimb lameness.
  • Diagnosis: investigative techniques include intra-articular/synovial anesthesia Hindlimb: joint anesthesia, synoviocentesis Synovial fluid: collection, radiography Hindlimb: radiography, ultrasonography Ultrasonography: overview and bone scintigraphy Bone: scintigraphy. Diagnosis can be difficult, time consuming and expensive.
  • Treatment: depends on the specific condition as well as the size of the animal.
  • Prognosis: depends on the specific condition as well as the size of the animal but is often poor to hopeless.

Pathogenesis

Etiology

Trauma

  • Most common cause of acquired hip conditions.
  • Fractures: of the acetabulum Pelvis: fracture and femoral head and neck caused by slipping over, being cast, falls or severe abduction/adduction of the limb.
  • Luxation/subluxation of the hip joint requires excessive trauma; rarely a primary injury and usually secondary to fractures of the acetabulum, unstable fractures of the ilial shaft or rupture of the teres ligament; can result from application of a full-limb cast Musculoskeletal: external fixation - casts preventing the distal limb from flexing. Permanent upward fixation of the patella Patella: upward fixation may result as a consequence of displacement of the femur due to shortening of the limb; in addition primary upward fixation of the patella can lead to luxation by violent contractions of the quadriceps muscle when the stifle is locked in extension; the head of the femur usually luxates craniodorsally.
  • Teres ligament partial or complete rupture can occur when a horse tries to get up when limb is trapped, for instance post general anesthesia when the limbs are still hobbled. May be associated with luxation/subluxation of the hip joint.
  • Trochanteric bursitis.
  • Femoral head displacement is occasionally seen in young animals.
  • Fracture and enthesopathy of the greater and third trochanter are often of traumatic origin and are covered elsewhere.

Congenital and perinatal conditions

  • Dysplasia: rare; can occur bilaterally; predisposes to early onset OA Musculoskeletal: osteoarthritis (joint disease); heritable in the Norwegain Dole pony and possibly other breeds. Malformation of the acetabulum and the head/neck of the femur leads to instability of the joint.

Infectious

Multifactorial

  • Osteoarthritis Musculoskeletal: osteoarthritis (joint disease) is uncommon in the coxofemoral joint; usually unilateral but occasionally bilateral following dysplasia; usually secondary to dysplasia, rupture of the teres ligament, luxation, fractures or other trauma.
  • Osteochondrosis Bone: osteochondrosis is extremely rare in the coxofemoral joint.

Immune-mediated

Miscellaneous

  • Tumors are extremely rare.
  • Osseous cyst-like lesions of the hip joint are uncommon, but have been reported in young horses associated with lameness, which may become chronic Bone: osseous cyst-like lesions.

Predisposing factors

General

Specific

  • Norwegian Dole ponies in hip dysplasia.

Pathophysiology

  • The hip joint is the articulation between the acetabulum of the pelvis and the head of the femur.
  • The three bones comprising the pelvis (the ilium (cranial), ischium (caudal) and the pubis (medial)) meet at the acetabulum.
  • The teres ligament (accessory, round) is part of the prepubic tendon on the pelvis which passes through the prepubic notch and inserts on the humeral head, providing the primary stability of the hip joint.
  • The acetabulum is surrounded by a fibrocartilage ligament which also serves to stabilize the joint.
  • The mass of muscles and ligaments surrounding the hip joint ensure that injury to the joint from external trauma is uncommon, but also means that palpation and manipulation can be extremely difficult.
  • See also: Joint: synovial pathobiology Joint: synovial pathobiology.
  • Many conditions occur secondary to trauma.

Timecourse

  • Acute onset traumatic cases are not always diagnosed early because of difficulties in examining this part of the horse.
  • Many cases therefore present with chronic and progressive lameness often related to the onset of osteoarthritis Musculoskeletal: osteoarthritis (joint disease).

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent reference from PubMed and VetMedResource.
  • Ludwig E K & Byron C R (2017) Femoral head ostectomy and medial patellar ligament desmotomy to treat a pregnant miniature horse with coxofemoral joint luxation and upward fixation of the patella. Can Vet J 58 (5), 498-502 PubMed.
  • Barcel√≥ Oliver F et al (2017) Treatment of septic arthritis of the coxofemoral joint in 12 foals. Vet Surg 46 (4), 530-538 PubMed.
  • Amitrano F N, Gutierrez-Nibeyro S D & Joslyn S K (2014) Radiographic diagnosis of craniodorsal coxofemoral luxation in standing equids. Equine Vet Educ 26 (5), 255-258 Wiley Online Library.
  • Barr A R S & Fairburn A J (2014) Aspects of coxofemoral luxations in the horse. Equine Vet Educ 26 (5), 259-261 Wiley Online Library.
  • Rottensteiner U et al (2012) Ultrasonographic evaluation of the coxofemoral joint region in young horses. Vet J 191 (2), 193-198 PubMed.
  • O'Neill H (2011) Case report: An ultrasound-assisted diagnosis of a coxofemoral luxation in a yearling. UK Vet 16, 5-7 VetMedResource.
  • Gracia L A et al (2011) Femoral head excision after coxofemoral luxation in an Arab filly: Four years follow-up. Equine Vet Educ 23 (7), 346-352 VetMedResource.
  • Garcia-Lopez J M (2010) Coxofemoral luxations in the horse: Surgical options and challenges. Equine Vet Educ 22 (11), 554-556 Wiley Online Library.
  • Geburek F, Rotting A K & Stadler P M (2009) Comparison of the diagnostic value of ultrasonography and standing radiography for pelvic femoral disorders in horses. Vet Surg 38 (3), 310-317 PubMed.
  • David F et al (2007) Ultrasound-guided coxofemoral arthrocentesis in horses. Equine Vet J 39 (1), 79-83 PubMed.
  • Garcia-Lopez J M, Boudrieau R J & Provost P J (2001) Surgical repair of coxofemoral luxation in a horse. JAVMA 219 (9), 1254-1258 PubMed.
  • Clegg P D & Butson R J (1996) Treatment of a coxofemoral luxation secondary to upward fixation of the patella in a Shetland pony. Vet Rec 138 (6), 134-137 PubMed.
  • Clegg P D (1995) Idiopathic infective arthritis of the coxofemoral joint in a mature horse. Vet Rec 137 (18), 460-464 PubMed.
  • Nixon A J (1994) Diagnostic and operative arthroscopy of the coxofemoral joint in horses. Vet Surg 23 (5), 377-385 PubMed.
  • Malark J A, Nixon A J, Haughland M A & Brown M P (1992) Equine coxofemoral luxations: 17 cases (1975-1990). Cornell Vet 82 (1), 79-90 PubMed.
  • Squire K R E et al (1991) Femoral head ostectomy in horses and cattle. Vet Surg 20 (6), 453-458 PubMed.

Other sources of information

  • Dyson S J (2011) The Coxofemoral Joint. In: Diagnosis & Management of Lameness in the Horse. 2nd end. Eds: Ross M W & Dyson S J. Saunders, USA. pp 581-582.
  • Hendrickson D A (2002) The Coxofemoral Joint. In: Adams Lameness in Horses. 5th edn. Lippincott, Williams & Wilkins. pp 1037-1043.


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