Questions for CE Credits - Femoral Head Ostectomies

1) Which of the following is NOT an indication for an FHO:

a) Legge Calve Perthes
b) Acetabular fractures
c) Osteosarcoma of the femoral head
d) Coxofemoral luxations
e) Capital physeal fractures

2) Which of the following statements regarding hip luxations is TRUE:

a) The FHO should be the first treatment option selected for hip luxations in cats.
b) An open reduction may be a better choice for small and medium breed dogs.
c) The closed reduction should always be considered first.
d) Large/giant breed dogs should have the FHO considered before the closed reduction.
e) A cat should always be placed in an Ehmer sling after a closed reduction.

3) Which of the following statements in NOT true regarding Spontaneous/Idiopathic Hip Luxations:

a) No history of trauma is associated with it.
b) It can occur bilaterally, although often at separate times.
c) It appears to be more common in Spaniels.
d) It occurs in adult dogs.
e) Spontaneous hip luxation is not an actual thing.

4) Which of the following statements regarding FHOs for hip dysplasia (HD) is FALSE:

a) FHO for larger dogs with chronic HD (osteoarthritis-OA) is not for the inexperienced surgeon.
b) The post-operative care for the dog with chronic HD and OA can be very difficult.
c) Larger breed dogs with chronic HD/OA should consider a total hip replacement surgery.
d) All young dogs clinically affected by their HD should have an FHO.
e) Young dogs diagnosed with HD can have their OA be well managed as they mature.

5) When preparing to do an FHO (Choose the FALSE statement):

a) Shave the limb circumferentially.
b) Shave all the way to the hock.
c) Shave beyond the dorsal midline.
d) Be sure to Free drape the limb.
e) You do not need to review the surgical anatomy because you took this course.

6) When making the skin incision (Choose the TRUE statement):

a) Make the skin curvilinear incision just behind the greater trochanter.
b) Identify the tuber ischium and the greater trochanter before incising.
c) Incise from the wing of the ilium to the femoral condyle.
d) Incise the skin directly over the femur.
e) Make a straight incision just behind the greater trochanter.

7) It is important to properly locate the femoral head throughout the surgery in order to stay “on target”. Which of the following statements is FALSE:

a) The femoral head is located below the apex of the angle created by the deep gluteal and the vastus lateralis.
b) The femoral head can be palpated to move within the acetabulum while the femur is internally and externally rotated.
c) Once the Vastus lateralis muscle is cleared from the femoral neck, the head can sometimes be visible, at least palpable, at the proximal most aspect of the neck.
d) The femoral head is located just cranial to the greater trochanter which is a readily palpable landmark.
e) The femoral head is located just cranial to the tuber ischium.

8) When creating the ostectomy cut in the femur; which of the following statements is FALSE:

a) The femur should be internally rotated in order to expose the femoral head.
b) The patella should be pointing to the ceiling.
c) The cutting line is from inside the greater trochanter to just above/proximal the lesser trochanter.
d) The osteotome should be positioned perpendicular to the cranial surface of the femur.
e) It is helpful to have an assistant hold the femur in the correct position.

9) Instruments that can be used to make the cut in the femur include (select the statement that is NOT true):

a) A chisel and mallet
b) A gigli wire
c) An osteotome and mallet
d) A power oscillating or saggital saw
e) A cleaver

10) Which of the following statements regarding the approach is FALSE:

a) An incision is made in the fascia (TFL) just cranial to the biceps femoris muscle.
b) The fascial incision should include both the superficial and deep leaves.
c) The fascial incision should take a slight cranially directed turn at the level of the greater trochanter and continue between the TFL muscle and superficial gluteal.
d) A partial tenotomy of the middle gluteal will help with the exposure.
e) Elevating the medial aspect of the vastus muscle from the proximal femur will help with the exposure.

11) With respect to the osteotomy itself. Which of the following statements is FALSE:

a) Palpating the cut in the femoral neck will help identify excess neck left behind.
b) It is important to palpate the deep mediocaudal border as that is often where excess bone is left behind.
c) Excess bone can be trimmed using rongeurs.
d) Excess bone can trimmed using a rasp.
e) If the femoral neck cut is not perfect, then the patient will not do well.

12) With respect to closing the surgical site. Which of the following statements is FALSE:

a) The middle gluteal should be sutured back over the deep gluteal.
b) It is easiest to start the fascial closure from the distal aspect because the layers are so distinct there.
c) An interrupted subcutaneous suture pattern typically results in a more cosmetic closure than when a continuous pattern is used on a curvilinear incision.
d) The tenotomy in the deep the gluteal can sutured using a a mattress suture pattern.
e) The site should be lavaged before closing to help remove any bony debris as well as moisten the tissues.

13) Appropriate instruments for the FHO include (Choose the INCORRECT statement):

a) A Hatt spoon is very useful for cutting the teres ligament.
b) The osteotome should be sharpened on a regular basis as a dull osteotome has a greater chance of creating a femoral fracture.
c) Gelpi retractors should be placed from the greater trochanter/gluteal tendon area to TFL muscle to help maximize exposure.
d) A rongeur with an angled beak can allow the surgeon a slightly easier view into the surgical site.
e) A mallet with a heavier head tends to create more momentum on its own therefore requiring less effort on the part of the surgeon.

14) Which of the following statements regarding the post-operative care is FALSE:

a) It is best to start discussing the importance of the post-operative exercise BEFORE you do the surgery; if at all possible.
b) Long term (4weeks) NSAID (patient allowing) are very helpful in getting the patient to cooperate with the post-operative rehab program.
c) Long term (2weeks) post operative antibiotics are essential to the success of the surgery.
d) Follow-up examinations on a regular interval are highly recommended.
e) The fibrous tissue will align itself according to the exercises and movement applied to it.

15) These components are very helpful in the immediate post-operative period (first 14 days) : Choose the INCORRECT statement.

a) Active hip stretches
b) Slow controlled leash walks
c) Hip PROMs
d) Passive hip stretches
e) Good pain management

16) The following exercises can help contribute to strengthening the hip joint and are great to use in the FHO patient (choose the LEAST correct statement):

a) Walking up the stairs at a slow controlled pace.
b) Slow controlled walks on a leash.
c) Slow controlled walks up a hill.
d) Dancing.
e) Figures of 8 and circles.

17) Which of the following statements is FALSE:

a) Feline capital physeal dysplasia is always bilateral.
b) Legge Calve Perthes occurs in the young, small breed dogs and is associated with much pain in the hip.
c) Feline capital physeal dysplasia is a disease of large young cats.
d) Legge Calve Perthes is also referred to as Avascular necrosis of the femoral head.
e) Legge Calve Perthes can be unilateral.

18) Which of the following is NOT a complication seen with FHOs:

a) Sciatic nerve deficit
b) Persistent pain
c) Poor range of motion in the FHO hip
d) Fracture of the femur
e) Avascular necrosis of the femoral neck

19) Which of the following criteria is NOT an important key factor to your post-operative rehabilitation program:

a) A cooperative patient is important, he/she must be pain free to be cooperative.
b) Stretching of the hip so that the pet can achieve an “as close to normal” stride.
c) The slow, controlled Rehab walk to help strengthen the muscles, stretch the fibrous tissue and give confidence to the patient.
d) Follow up appointments to help encourage the client and adjust the rehab program as the patient progresses.
e) Ensuring that the patient gets enough time in the Underwater treadmill otherwise the surgery can not possibly succeed.

20) Which statement about the post-operative the Rehab walk is FALSE:

a) The amount of time that the pet is able to walk purposefully is important to keep in mind so that the owner can then slowly increase the duration.
b) The handler should use an extendable leash and give the dog some 'walking space'.
c) The pace should be a bit slower than “normal” so that the lame limb is engaged/working a bit more.
d) If the dog is walking quickly and very lame on a leg he/she may choose to simply hold it up off the ground completely.
e) The walk should be purposeful as opposed to a meander with lots of sniffing and chatting to the neighbours.

Questions for CE Credits – Femoral Head Ostectomies

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