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80 Aseptic Necrosis of the Femoral Head

• Abdominal radiographs: limited utility due Acute General Treatment PEARLS & CONSIDERATIONS
to lack of serosal detail If abdominal distention due to fluid accumula- Comments
VetBooks.ir Advanced or Confirmatory Testing therapeutic abdominocentesis or adominal • Excessive fluid drainage may promote further
tion is severe enough to compromise respiration,
• Abdominal ultrasonography: evaluate hepatic
and renal parenchyma
effusion and dehydration.
drainage may be indicated (p. 1056).
unless due to heart failure.
Guided by initial findings Chronic Treatment • Lasix has no role in management of ascites
• If evidence of hypoalbuminemia and concur- Treatment aimed at underlying disorder
rent hyperglobulinemia, intestinal biopsies Prevention
may be indicated to determine cause of Nutrition/Diet Ectoparasite and endoparasite prophylaxis
protein-losing enteropathy (p. 600). Protein-losing enteropathy, protein-losing
• If hypoalbuminemia and proteinuria, nephropathy, and cardiac disease have unique Technician Tips
urine protein: creatinine ratio (p. 1391) nutritional requirements. • Animals with severe ascites may have diffi-
indicated culty breathing, especially when restrained
• If murmur, jugular pulses, or cardiovascular Recommended Monitoring while lying on their side or back (e.g., during
abnormalities detected, echocardiogram (p. Resting respiratory rate, body weight; abdomi- abdominal ultrasound).
1094) and heartworm antigen test (p. 1350) nal circumference can be used to estimate • Avoid blind cystocentesis in animals with
indicated change in volume of ascites fluid. ascites.
TREATMENT PROGNOSIS & OUTCOME SUGGESTED READING
Chambers G: Abdominal enlargement. In Ettinger
Treatment Overview Variable depending on cause SJ, et al, editors: Textbook of veterinary internal
Depends on underlying cause medicine, ed 8, St. Louis. 2017, Elsevier, pp
144–148.
AUTHOR: Aida I. Vientós-Plotts, DVM
EDITOR: Leah A. Cohn, DVM, PhD, DACVIM

Aseptic Necrosis of the Femoral Head Client Education
Sheet

BASIC INFORMATION • Other causes of rear limb lameness (e.g.,
PHYSICAL EXAM FINDINGS patellar luxation, stifle injury)
Definition • Pain on extension and flexion of the affected
A painful hip condition caused by interruption of hip joint(s) Initial Database
blood supply to the proximal femoral epiphysis, • Affected limb may be non–weight-bearing • Physical examination of affected and unaf-
producing bone necrosis and collapse of the • Muscle atrophy in the affected limb(s) fected hind limb, with special emphasis on
articular cartilage and eventually hip osteoarthritis. • Crepitus unusual but may be present in dogs the hip joints
The problem is unilateral in about 80% of cases. that have developed degenerative joint disease • Hip radiographs (lateral and ventrodorsal
projections)
Synonyms Etiology and Pathophysiology ○ Early stage: femoral head lucency
Legg-Calvé-Perthes (LCP) disease, Legg-Perthes • Cause and pathogenesis are unknown. ○ Later stages: femoral head deformity and
disease, Perthes disease, avascular or aseptic • The primary lesion appears to be ischemic degenerative changes in the hip
necrosis of the femoral head injury causing necrosis of the bone of the
femoral capital epiphysis. Advanced or Confirmatory Testing
Epidemiology • Dead bone trabeculae collapse, forming Computed tomography, magnetic resonance
SPECIES, AGE, SEX hollow spaces that cause loss of support to imaging, nuclear scintigraphy: not routinely
• Small-breed dogs overlying articular cartilage. Trabeculae that required but could be useful when radiographic
• Mean age of onset of clinical signs is 7 form in their place are abnormally thin and changes are not yet apparent
months, with a range of 3-11 months. unable to support normal loads.
• This disease has not been reported in cats. • Subsequent weight bearing causes collapse TREATMENT
of the femoral head and deformation of
GENETICS, BREED PREDISPOSITION the cartilage, leading to development of Treatment Overview
• Autosomal recessive trait in West Highland osteoarthritis. Treatment is aimed at restoration of normal,
white and Manchester terriers, miniature pain-free activity.
poodles DIAGNOSIS
• Other commonly affected breeds include Acute General Treatment
Yorkshire, Lakeland, and cairn terriers; Diagnostic Overview • Medical management (analgesics, exercise
miniature pinschers; toy poodles; Australian Signalment, physical findings, and radiographic modification; one report of successful use
shepherds; Chihuahuas; dachshunds; Lhasa confirmation make the diagnosis. of an Ehmer sling): return to pain-free
apsos; pugs. function in about 25% of cases
Differential Diagnosis • Surgical intervention
Clinical Presentation • Capital physeal or femoral neck fractures ○ Femoral head and neck excision (FHNE)
HISTORY, CHIEF COMPLAINT • Hip dysplasia or femoral head ostectomy (FHO) is the
Slowly progressing or acute onset of hip pain/ • Coxofemoral luxation most common treatment.
lameness during the first year of life • Septic arthritis of the hip ○ Total hip replacement (THR)

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