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Hawksmoor News

November 2015 Case Study – Flo

flo1Name:            Flo

Age:               3 Years Old

Breed:           Lurcher

Condition:    Excision Arthroplasty to the Left Hind.

 

Flo has been attending the centre since early 2013 following surgery for an Excision Arthroplasty in her Left Hind limb and subsequent muscle atrophy. An Excision Arthroplasty or Femoral Head Ostectomy is a surgical procedure that removes the head and neck of the femur bone. This surgery is performed to alleviate pain and is a salvage procedure used when pain cannot be alleviated in any other way. It is a common procedure seen in Veterinary Practices.

The procedure exposes the head section of the femur bone (the ball and socket joint) and then the head is removed using either a saw or a bone hammer and chisel. Unlike most other hip surgeries, the head of the femur is not replaced, but is allowed to heal and develop its own fibrous scar tissue to that the joint is no longer bone-to-bone, it becomes a false joint. The neck of the femur is usually removed at the same time as the head. This prevents the post operative complication of bone rubbing on bone and continued pain.

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This diagram demonstrates how the hip joint will appear post excision arthroplasty surgery.

 

Following this type of surgery, due to the reduced use and weight bearing of the limb, marked muscle atrophy is usually noted and rehabilitation may take some time. The ultimate aim is for the dog to use the leg appropriately and build adequate muscle mass. Due to the change in the joint, this limb will usually exhibit reduced function compared to the other limb.

When Flo first attended the centre she was completely non weight bearing in the left hind limb and severe muscle atrophy was present. She preferred to keep her left hind limb tucked up into her body and she had not used the limb for some time prior to attending the centre. Flo was a rescue dog so her history was not known by the owner.

On this initial session, Flo was assessed and her muscle mass measurements were as below –

 

Limb Measurements
Left Fore 19.5cm
Right Fore 19.5cm
Left Hind 27cm
Right Hind 36.5cm

 

As you can see from the above measurements, Flo had 9.5cm difference in her hind limb muscle mass which was also visibly noticeable as well as during palpation of the limb. The aquatic treadmill was the preferred choice of treatment to re-educate Flo’s gait pattern, encourage adequate weight bearing with the assistance of the water taking some of the weight of her limbs and also assisting with building adequate muscle mass in the hind limbs.

Flo during a session in the treadmill.

Flo during a session in the treadmill.

 

On the first session, the water level was filled to 17 inches and the speed was start at 17 meters per minute. She carried out 2 walks of 1 minute 30 seconds with a good rest between. During the first few sessions, Flo was reluctant to place the left hind limb but with stimulation she started to toe touch on the belt as it was moving.

After 5 or 6 sessions, Flo started to weight bear on the left hind limb and the water level was increased by 1 inch in order to provide further support to Flo during her sessions. The speed of the belt was also slowly increased in order to encourage a greater range of motion through all her limbs and especially the left hind limb. We were also carrying out re-balancing exercises in the treadmill to ensure correct loading through the hind limbs on her rest periods.

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After 10 sessions, Flo was re-measured as follows –

 

Limb Measurement
Left Fore 22.5cm
Right Fore 22.5cm
Left Hind 32.5cm
Right Hind 38cm

 

These measurements showed an increase in overall muscle mass especially in the left hind which was a great result for Flo. Following on from this Flo continued for a few more sessions at twice a week and progressed steadily.

Flo now attends the centre once every 2 weeks and now uses the affected limb with minimal problems. She is unable to use the limb completely normally due to the surgery she had but this does not stop her running around and chasing small furry thing!

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Flo’s favourite part of the session – The towel rub!!

 

Flo’s measurements were taken through her sessions as follows –

Limb Measurement
Left Fore 35cm
Right Fore 34cm
Left Hind 35cm
Right Hind 39cm

 

 

Limb Measurement
Left Fore 36cm
Right Fore 36cm
Left Hind 36cm
Right Hind 40cm

 

 

Limb Measurement
Left Fore 37cm
Right Fore 37cm
Left Hind 37cm
Right Hind 41cm

 

The most recent measurements are below –

Limb Measurement
Left Fore 37cm
Right Fore 37cm
Left Hind 38cm
Right Hind 39cm

 

These demonstrate that Flo has built up her muscle mass well and is now almost even on the hind limbs. Her movement within the treadmill has also improved and she is confident to carry out her sessions in the treadmill alone being assisted from the outside of the tank. Flo copes really well with her sessions and now uses the incline in the treadmill to encourage greater weight bearing and range of motion through the hind limbs which she copes extremely well with.

Overall we are really pleased with Flo’s rehabilitation and she will continue to attend the centre every 2 weeks for maintenance.

Well done Miss Flo, always a pleasure to treat and absolutely LOVES her gravy bones!

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