Coxofemoral Joint Luxation in Dogs Treated with Toggle Rod Stabilization: A Multi-Institutional Retrospective Review with Client Survey

Abstract

Coxofemoral luxation is the most common type of joint luxation observed clinically in dogs. This retrospective study determines the complications and outcomes of open reduction and internal fixation of coxofemoral luxations using a toggle rod stabilization in 58 dogs. The purpose of the study was to compare the results with previous studies to ascertain commonalities and differences. A majority of the canine luxations were stabilized using a 4.0 or 3.2 mm commercial toggle rod and either one or two strands of OrthoFiber, FiberWire, or monofilament nylon suture. Postoperative complications developed in 25 of the 58 (43%) dogs, with major complications in 9 cases (15.5%). The most common major complication was reluxation, which occurred in 6 dogs (10%). Five of the 6 cases of reluxation received monofilament suture, although there was not a statistically significant relationship between suture type and reluxation. Owner responses to a questionnaire reported good to excellent results for satisfaction with the procedure in 90% of cases. Results of the present study suggest that toggle rod stabilization remains an effective method for the treatment of coxofemoral joint luxation in dogs.

Risk factors for reluxation after toggle rod stabilization for treatment of coxofemoral luxation in 128 dogs

“…[1][2][3] Most (79%-83%) coxofemoral luxations result from vehicular trauma; however, other causes include falls, hip dysplasia, and spontaneous luxations. [1][2][3][4][5][6] Craniodorsal is the most common direction of displacement of the coxofemoral joint and occurs in 73% to 96% of cases. 1,2,4 Surgical and nonsurgical methods for treating hip luxation have been reported.…”

“…1,7 Surgical methods of coxofemoral luxation repair include capsulorrhaphy, extracapsular suture stabilization, trochanteric transposition, sacrotuberous ligament transposition, transarticular pinning, ischioilial pinning, deep gluteal muscle tenodesis, triple pelvic osteotomy, external skeletal fixation, and toggle rod stabilization 2,4,[8][9][10][11][12][13][14] The toggle rod construct has been used successfully in a variety of species including dogs, cats, a miniature horse, and an alpaca. 6,8,15,16 Researchers have evaluated toggle rod constructs in multiple biomechanical studies using hand-made toggles of a Steinmann pin or Kirschner-wire, commercial toggle rods, and different sutures including nylon monofilament and braided multifilaments. 3,17,18 These in vitro studies provide evidence that, although various toggle rod constructs can sustain 41% to 47% of the load of the ligament of the head of the femur in intact specimens, they are likely sufficient for normal physiologic forces in the postoperative recovery period.…”

“…2,[4][5][6]8,19 Other complications with toggle rod fixation are infrequent but may include seroma, fever, infection, subluxation, sciatic nerve damage, wound dehiscence, postoperative swelling, and injury to the articular cartilage. 2,5,6,8 Researchers evaluating 62 cases of toggle rod repairs in a previous study found that dogs in which surgery time was less than 2 hours were significantly less likely to have a reluxation. 5 Body weight, comorbidities, time from injury to correction, and previous reduction have not been shown to affect outcome.…”

“…5 Body weight, comorbidities, time from injury to correction, and previous reduction have not been shown to affect outcome. [4][5][6]19 Long-term follow-up of coxofemoral luxation repair has been assessed radiographically and via owner surveys. Radiographs have revealed varying levels of degenerative joint disease 1 year after successful reduction; however, changes observed on radiographs did not always correlate with clinical signs.…”

“…4 The survey instruments varied by study and investigated time to resolution of lameness, compliance with postoperative instructions, current limb function and activity levels, and overall satisfaction with the procedure. 2,5,6,20 Eighty-one percent to 88% of owners reported that their dog had good to excellent limb function postoperatively and were pleased with their dog's recovery. 2,5,6,20 The objective of this study was to determine risk factors for reluxation in a large population of dogs whose coxofemoral luxations were treated by a single surgical method, toggle rod stabilization with a nylon monofilament suture and a commercially available toggle rod.…”