Management of Canine
Traumatic Hip Luxation (THL)
Luxation of the coxofemoral joint is responsible for approximately 64%
of all traumatic luxations. Most dogs with THL are older than 7
months because trauma in dogs under this age usually results in
fracture of the femoral head or neck. Management of THL is
complicated by several factors including hip dysplasia, avulsion
fracture of the femoral head at the attachment of the ligament of the
femoral head (5-10% of cases), coxofemoral joint cartilage damage,
severe disruption of the joint capsule, and other concurrent soft
tissue and orthopedic injuries secondary to the trauma that caused the
luxation (35-55% of cases). Information on the two major types of
luxation will be presented along with methods of treatment.
a)95.5% all luxations are craniodorsal and 83% of those are caused by automobile induced trauma.
b)Males and females are equally affected.
c)35-50% of THL cases have additional traumatic injuries.
d)5-10% have femoral head fractures.
e)3-6% of THL's are bilateral.
1.Affected limb may appear shorter.
2.Limb is held in adduction and external rotation with external stifle rotation and internal tarsal rotation.
3.Crepitus and pain are usually noted on flexion and extension of the hip.
1.Ventrodorsal and lateral radiographic projections will confirm the
diagnosis. Be sure the dog is well positioned and the films are
of excellent quality so you can adequately evaluate the hip for OA, hip
2.Look for other orthopedic injuries on the radiographs such as avulsion fractures, pelvic fractures, and spinal injuries.
3.Always take chest radiographs to rule out serious chest injuries and diaphragmatic hernia.
4.Confirm that the bladder and the cruciate ligaments are intact.
5.Perform a complete blood screen and complete physical examination.
h)Evaluation: The status of the coxofemoral joint is critical to
selecting the proper course of treatment. The following are
factors to be noted prior to selecting a treatment plan.
1.Evaluate the amount of hip subluxation and acetabular coverage of the
femoral head on the opposite limb to estimate how normal the luxated
hip was prior to injury.
2.How much remodeling and OA/DJD of the coxofemoral joint is present.
3.Are there injuries of the opposite limb that will force the dog to use the THL limb immediately after hip reduction?
1.If there is significant OA/DJD then femoral head and neck excision
(FHNE) or total hip replacement (THR) are probably necessary.
However, if the hip feels stable after closed reduction, then you may
want to evaluate the dog over a few weeks to see how it does prior to
performing surgery. Rarely a dog will surprise me and recover
well in spite of radiographic signs of OA-DJD.
2.If the hip looks normal but hip laxity is suspected then a triple
pelvic osteotomy (TPO) will probably be necessary to ensure adequate
reduction and minimize post reduction OA/DJD formation.
3.If the hip looks relatively normal then closed reduction should be
attempted because closed reduction is successful at least 50% of the
time in normal appearing hips. Always confirm reduction
radiographically. If the hip cannot be reduced, if it easily reluxates,
if there is an articular fracture or if closed reduction fails then
open reduction is necessary. Open procedures can be divided into
intercapular and extracapsular categories.
1.Joint capsule reconstruction (reluxation rate of 9.5% to 17.4%)
2.Prostatic Capsule technique (reluxation rate of 6%)
3.Single iliofemoral suture. Technique: A hole is drilled
transversely through the femur at the base of the greater
trochanter. An ileal tunnel is drilled as dorsoventrally as
possible near the origin of the rectus femoris muscle. A suture
(#3 Vicryl) is passed in figure-eight fashion through the tunnels and
over the femoral neck under the deep gluteal muscles (no reluxations in
4.Don't use De Vita Pin (sciatic nerve injury)
1.Toggle Pin: Allows dog to weight-bear immediately postoperatively (reluxation rate 18-25%).
2.Transarticular Pin: Usually best for dogs under 30 pounds. 80%
of smaller dogs in one study had good results. 7% reluxate. Pin
may break and must always be removed after 2-3 weeks. Dog kept in sling
while pin is in place.
1.If possible keep limb in an Elmer sling for 2 weeks postreduction.
2.Restrict activity to no running, jumping, climbing, or walking or slick surfaces for 3 to 8 weeks.
3.Return slowly to full activity with 2 weeks of leash walking only.
4.Expect some long-term postoperative lameness in about 30% of cases in spite of the closed or open technique used.
5.Failure rate reported to be between 8-20%.
6.Most dogs require 8-16 weeks to return to optimal function.
a)3.2% of all hip luxations.
b)Has much better prognosis than craniocaudal luxation.
c)Trauma is most common cause.
d)Closed reduction is almost always successful because the attachment
of the joint capsule to the dorsal acetabular rim is almost always
e)Activity restriction is the same as craniodorsal luxation but a sling is usually not indicated.