Prótese total de anca para resolução de displasia coxo-femoral
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2015-11-30
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A displasia da anca é uma patologia do desenvolvimento, não congénita, poligénica e o
mais comum problema ortopédico hereditário em cães, sobretudo de raças grandes ou gigantes.
De um modo geral é uma malformação na qual, em cachorros, provoca instabilidade
articular que por alterar a concentração de forças sobre o fémur e acetábulo afeta o crescimento e
conformação do osso resultando numa má anatomia articular e doença articular degenerativa
secundária. Na sua patogenia estão implicados tanto fatores ambientais como influência genética.
Não há um tratamento efetivo para restaurar uma articulação displásica, sendo, no
entanto, o objetivo do tratamento aliviar a dor, impedir alterações degenerativas secundárias e
maximizar a função da articulação. Deste modo, a prótese total de anca é hoje a solução mais
completa para a resolução da maioria destas complicações. Esta técnica consiste na
implementação de um cálice de polietileno como substituição do acetábulo e uma nova cabeça e
haste femoral permanentemente unidas ao osso por cimento ósseo de polimetilmetacrilato. É
recomendada em animais com mais de 18 kg que atingiram a maturidade no que diz respeito ao
crescimento ósseo e, por isso, em animais no mínimo com 9 meses, não geriátricos e sem
excesso de peso. A prótese total de anca tem, no entanto, ainda algumas complicações
associadas, como por exemplo, luxações, infeções e fraturas.
O objetivo deste estudo consistiu no acompanhamento de 6 casos clínicos que surgiram
no Hospital Ars Veterinaria em Barcelona, durante o meu período de estágio. Surgiram em
diferentes fases de manifestação da doença ou recuperação da cirurgia, mas todos inicialmente
apareceram à consulta com o sinal clinico de claudicação. Os métodos de diagnóstico utilizados
foram o exame físico e radiográfico completo, após os quais foi recomendada a cirurgia de
prótese de anca. Dos 6 animais operados, 4 apresentaram melhorias e 2 complicações. Desses 2 animais, 1 melhorou após nova intervenção.
Hip dysplasia is a developmental, not congenital, polygenic disease and the most common inherited orthopedic problem in dogs, especially in big or giant breeds. Generally it is a malformation that causes, especially in puppies, joint instability which will change the concentration of forces on the femur and acetabulum and this way affect the growth and shaping of the bone resulting in poor joint anatomy and secondary degenerative joint disease. In its pathogenesis are implicated both environmental factors and genetic influence. There is no effective treatment to restore a dysplastic joint. However, the goal of treatment is to relieve pain, prevent secondary degenerative changes and maximize joint function. Thus, the total hip replacement is now the most complete solution for the resolution of most of these complications. This technique consists in the implementation of a polyethylene cup as a replacement for the acetabulum and a new head and femoral stem permanently united to the bone by polymethylmethacrylate bone cement. It is recommended for animals over 18 kg which have reached maturity in respect to bone growth and therefore, in animals with at least 9 months, not geriatric and without excessive weight. A total hip replacement is, however, still associated with some complications, such as dislocations, fractures and infections. The goal of this study was to follow and report 6 clinical cases that appeared at the Hospital Ars Veterinaria, in Barcelona during my training period. They appeared in different stages of the disease’s development or surgical recovery, but they all initially showed the same clinical sign of lameness. The diagnostic methods used were a complete physical and radiographic examination, after which a total hip replacement surgery was suggested. Out of the 6 operated animals, 4 showed improvements and complications appeared in 2 of them. 1 of those 2 animals improved after another surgery.
Hip dysplasia is a developmental, not congenital, polygenic disease and the most common inherited orthopedic problem in dogs, especially in big or giant breeds. Generally it is a malformation that causes, especially in puppies, joint instability which will change the concentration of forces on the femur and acetabulum and this way affect the growth and shaping of the bone resulting in poor joint anatomy and secondary degenerative joint disease. In its pathogenesis are implicated both environmental factors and genetic influence. There is no effective treatment to restore a dysplastic joint. However, the goal of treatment is to relieve pain, prevent secondary degenerative changes and maximize joint function. Thus, the total hip replacement is now the most complete solution for the resolution of most of these complications. This technique consists in the implementation of a polyethylene cup as a replacement for the acetabulum and a new head and femoral stem permanently united to the bone by polymethylmethacrylate bone cement. It is recommended for animals over 18 kg which have reached maturity in respect to bone growth and therefore, in animals with at least 9 months, not geriatric and without excessive weight. A total hip replacement is, however, still associated with some complications, such as dislocations, fractures and infections. The goal of this study was to follow and report 6 clinical cases that appeared at the Hospital Ars Veterinaria, in Barcelona during my training period. They appeared in different stages of the disease’s development or surgical recovery, but they all initially showed the same clinical sign of lameness. The diagnostic methods used were a complete physical and radiographic examination, after which a total hip replacement surgery was suggested. Out of the 6 operated animals, 4 showed improvements and complications appeared in 2 of them. 1 of those 2 animals improved after another surgery.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, Ciências Veterinárias
Palavras-chave
Cão , Displasia da anca , Prótese total da anca