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The hip joint and pelvis

image of The hip joint and pelvis
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Abstract

The hip joint comprises the femoral head and he acetabulum, which is part of the hip bone. The hip bone is constructed of four parts: the ilium, ischium, pubis and the acetabular bone or bones. Indications for diagnostic imaging of the hip joints and pelvis include: pelvic limb lameness; pelvic region trauma; pain or instability of the hip joint or pelvis; and HD control problems. This chapter looks at the standard views and special views of radiography; normal anatomy; alternative imaging techniques and abnormal image findings.

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Figures

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14.1 VD view of the pelvis of a skeletally mature normal large-breed dog.
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14.2 Patient positioning for the lateral view of the pelvis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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14.3 VD extended hip joint view. (a) Illustration of proper radiographic positioning of the pelvis, hips and femurs. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (b) Radiograph of normal hips with proper positioning of pelvis and femurs for HD evaluation. Note the pelvic symmetry and position of the patellae over the centre of the distal femurs.
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14.4 Patient positioning for the VD extended hip joint view for HD evaluation. (a) Sandbags and a foam trough are used for symmetrical positioning of the thorax. (b) The pelvic limbs are fixed in an extended position with the aid of bandages and screw clamps on the table. (c) Final positioning includes a bandage around the stifles to keep the limbs pronated.
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14.5 VD extended hip joint view for HD evaluation collimated to the pelvis. No abnormality is seen but the pelvis is tilted to the left, as evidenced by the wider left ilial wing and smaller left obturator foramen.
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14.6 VD extended hip joint views of normal dogs collimated to the left hip joint. (a) German Shepherd Dog (FCI grade A2). (b) Lhasa Apso (FCI grade A1). (c) Dachshund (FCI grade A1).
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14.7 VD extended hip joint view collimated to the caudal pelvis illustrating over-rotation of the pelvis along its short axis, resulting in foreshortened obturator foramina.
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14.8 VD flexed (‘frog-legged’) view of the hip joints of a skeletally mature large-breed normal dog. The femoral shafts are at an angle of 80 degrees to the lumbar spine.
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14.9 (a) VD extended and (b) VD flexed views of the hip joint of a 5-year-old Labrador Retriever with moderate arthrosis. A CFHO is identified with black arrowheads and a CCO with white arrowheads on both views. Note how the former is seen as a spur on the articular surface edge (joint capsule insertion) and the latter superimposes on the trochanteric fossa (compare with Figure 14.8 ).
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14.10 Patient positioning for the inlet (V20°Cr-DCd) and outlet (V20°Cd-DCr) views of the pelvis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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14.11 Patient positioning for the ML view of the right hip joint. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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14.12 (a) Standard VD extended and (b) Flückiger technique views of the hip joints of a skeletally mature large-breed dog with moderate dysplasia. The marked increased joint space width in (b) indicates hip joint laxity, which was masked on the standard extended view. There is incidental bilateral lumbarization of S1.
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14.13 PennHIP scheme. (a) Schematic diagram of positioning for distraction and compression views. (b) The DI is determined by measuring the separation distance (d) of the femoral head centre (FHC) from the acetabular centre (AC) and dividing by the radius ® of the femoral head. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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14.14 PennHIP radiographs. (a) Standard VD extended hip joint view of the hips of a 2-year-old dog that had a subjective diagnosis of excellent hips. (b) Compression view of the hips of the same dog. (c) Distraction view of the hips of the same dog. Both hips have increased laxity (looseness), more so in the right hip. Breeding from this dog was not recommended because the DI of the right hip indicated a greater laxity than the mean for the breed.
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14.15 (a) Annotated VD extended hip joint view of the pelvis of a skeletally mature large-breed dog. (b) Annotated lateral view of the pelvis of a skeletally mature large-breed dog.
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14.16 Illustration of an ossicle on the dorsal acetabular rim. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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14.17 VD extended hip joint view of a dog with bilateral gas-filled anal glands (arrowed) superimposed as ovoid radiolucencies on the ischium.
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14.18 Dog with pelvic trauma. (a) VD flexed pelvis radiograph (unsedated patient): assessment is limited by superimposition of the pelvic structures and faecal material, as well as obliquity. The left hemipelvis, together with a portion of the associated sacral wing, which has a sagittal fracture, is displaced cranially in relation to the right. Fractures of the left cranial pubis and ischium are suspected. (b) CT using a maximum intensity projection delineates the pubic fractures as well as an additional left ilial shaft fracture and a luxated left coxofemoral joint. (c) Transverse CT image in a bone window at the level of the sacrum. The sacral wing fracture is obvious but there is an additional incomplete fracture of the mid-sacral body and step formation at the dorsal aspect of the left sacroiliac junction (arrowheads).
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14.19 Transverse MR images of a skeletally mature dog with myositis of the gemelli, internal and external obturator and quadratus femoris muscles. (a) T2W, (b) T1W plain and (c) T1W post-contrast images. Note the heterogeneous hyperintensity of the muscles (arrowed) in (a) and contrast enhancement of the same muscles in (c).
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14.20 Collimated VD extended view of the right hip joint of a cat with an avulsion fracture of the round ligament (confirmed at surgery) and dorsocranial luxation of the femoral head. The arrows indicate the fracture bed and arrowheads the avulsed fragment.
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14.21 (a) VD and (b) lateral views of the pelvis of a dog with pseudoarthosis formation after chronic luxation of the right femoral head. Note the malformed femoral head, new bone on the ilial body and filling up of the acetabulum with new bone formation.
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14.23 VD extended hip joint view of a 2-year-old German Shepherd Dog with a transitional L7 vertebra type 3. Note the asymmetrical fusion of the transverse process of L7 on the right side (black arrows) while the contralateral transverse process is thinner than normal (white arrows). Mild bilateral coxarthrosis secondary to HD is present.
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14.24 Sketch of mineralized bodies (bursitis calcarea) in the tendon of the iliopsoas muscle (white arrow) and in the tendon of the psoas minor adjacent to the iliopectineal eminence (black arrow). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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14.25 VD extended hip joint view of a dog with bilateral mineralization of the gluteal tendons (bursitis calcarea) (arrowed).
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14.26 VD extended hip joint view of a toy-breed dog with advanced left-sided avascular femoral head necrosis. Note the severe deformation and heterogeneous osteolytic areas of the left femoral head, secondary remodelling of the acetabulum and disuse muscle atrophy. Secondary coxa vara and a widened joint space are also present.
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14.27 VD extended view of the pelvis and femurs of a cat with severe metaphyseal osteopathy. There is bilateral extensive irregular lysis of the proximal femoral metaphyses.
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14.28 (a) VD extended and (b) flexed views of the hips of an 11-month-old Bull Terrier with progressive non-weight-bearing lameness of the right limb over 3 weeks. There is bilateral metaphyseal sclerosis and femoral neck lysis. Diagnosis was bilateral SCFE with pathological fracture of the right femoral neck.
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14.29 Examples of HD changes. (a) Normal hip joints (FCI grade A). (b) Mild divergence of the joint space with no signs of osteoarthrosis (FCI grade B). (c) Moderate femoral head subluxation, flattening of the craniolateral acetabular rim and mild osteoarthrosis (note CFHO and CCO) (FCI grade C). (d) Moderate subluxation and slightly more advanced osteoarthrosis than in (c) (FCI grade D). (e) Marked subluxation with moderate femoral head osteophytic changes but advanced capsular enthesophyte formation (lipping) cranial to the acetabulum (FCI grade E).
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14.30 Measurement of the Norberg angle. On the VD extended hip joint view, it is the angle between a line connecting the femoral head centres and a line from the centre of the femoral head to the craniolateral acetabular rim. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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14.31 Collimated ventrodorsal extended view of the normal right hip of a Shih Tzu. The Norberg angle (between the black lines) is less than 105 degrees (white line).
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14.34 PennHIP assessment in a 20-week-old dog. (a) The hips were considered normal for the dog’s age on the standard VD extended hip view. (b) The distraction view showed moderate subluxation. The DI of both hips indicated much greater laxity than the mean for the breed.
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14.36 VD extended hip view of normal variants. (a) Hip of a normal German Shepherd Dog with ‘broomstick-like’ femoral neck conformation. Note the lack of distinction between the femoral head and neck. (b) Hip of a normal Rottweiler with plump femoral head conformation.
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14.37 VD extended hip joint view of a normal hip in a 4-year-old Domestic Shorthair cat. The Norberg angle was 96 degrees.
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14.38 VD extended hip joint view of a 12-year-old Domestic Shorthair cat with severe bilateral hip dysplasia and osteoarthrosis (arrowed). The Norberg angle was <80 degrees.
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14.39 (a) VD extended and (b) mediolateral view of the hips of an 8-year-old Labrador Retriever that had a total hip replacement followed by a femoral fracture. This was reduced with a plate and screws; the procedure was followed by repeated femoral shaft implant and plate loosening.
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14.40 VD extended hip view of a puppy with bacterial septic arthritis of the left hip, osteomyelitis of the left ilium and acetabulum with associated extensive irregular periosteal new bone. There is overlying soft tissue swelling with gas opacities following the course of the fascial planes.
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14.41 Malignant neoplasms of the pelvis. (a) Metastasis of prostatic carcinoma to the sacrum as evidenced by lysis of the right side of the sacrum. (b) Chondrosarcoma of the caudal pubis and ischium.
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14.42 VD extended hip view of a 4-month-old Persian kitten with mucopolysaccharidosis. Characteristic radiographic findings are dysplastic changes of all epiphyses, irregularly widened acetabula and bilateral coxofemoral subluxation (mimicking HD) with radiolucencies in the femoral necks. The caudal lumbar vertebrae are widened as a result of caudal beaking and foreshortening.

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