dislocated hip - how long to wait before starting rehab

[jenrehab]

Does anyone have experience on how long a dog should remain in an Ehmer sling following hip dislocation? And....once the dog is out of the sling, what is the protocol for starting with PROM? I definitely have a fear of causing a repeat luxation even with gentle PROM. But my suspicion is, if careful PROM is likely to cause a reluxation, that there is far too much joint capsule damage and it was going to happen regardless.
Thoughts?
Jennifer Stelfox

[lehughes]

Hey Jennifer,

So text books will say to maintain the sling for 3 - 10 days or 10 - 14 days (2 different sources). I'd go with the longer. Then restricted activity for 6 - 8 weeks.
To be honest, it's a bit of a garbage procedure when compared to a toggle pin repair, but you go with what's been presented, and what the owner opted for.

So, I'd say that rehab needs to start ASAP after removal of the sling. They are so so so stiff everywhere when it comes off. Gentle ROM within tolerance should be okay, but I'd limit motions to flex / ext / abduction. The stifle and tarsus will need attention as well.

These poor kiddos are going to need glutes glutes and more glutes, so the sooner you can safely start working glutes the better. Even if just e-stim and weight shifting.

I'd agree with you that if PROM luxates the hip, then it didn't have a chance to begin with.

And of course, put nutraceuticals / chondroprotectants on board ASAP.

Best of luck!

Laurie

[David Lane]

FWIW, I always went the 10-14d route for bandaging. If it is a closed reduction, then I am looking to determine stability right away by applying as much non-painful PROM as I can. If the reduction is going to fail and we need to progress to an open reduction, we best learn that right away. If it is an open reduction, then we are dealing with a far less fragile situation and I would treat it more like a THR in general rehab terms. Does that help?

[jenrehab]

Hi David and Laurie:
Yes, this helps alot.
If this was an open reduction, I am assuming that we should immediately start the hip PROM within limits (avoid adduction?) with stifle/hock PROM too and gentle weight shifting exercises. I'm assuming that walking would be reserved to just slow on leash walking out to the toilet for the first 2 weeks and then start slow 5 min walks TID-QID? How soon can you start on the glute strengthening exercises?
Thanks so much for your help
Jen

[lehughes]

Hey Jen,

Sorry... just getting back to the Forum now. (I have way too many hamster wheels that I run on!)

So, yes, I think adduction is one of the main ranges to avoid, along with passive external rotation. I think biomechanically, what ranged could pop it out again.

If it's an open reduction... then have they not surgically held it in place (i.e. a toggle pin technique)? I hope I'M not missing something.

But I'm going to go with my assumption of such, and in which case your thoughts below are bang-on. I think you could do some easy glute strengthening right away - i.e. e-stim with weight shifting (umm... I guess incisions would be your only hang-up). Then when they are starting to use the leg, you can incorporate backing up, side stepping, 3-leg stands, low cavalettis, then sit to stands, and various other options as well. Just think progression (i.e. flat land first, then introduce hills around 4 weeks.

Just back it up and think about what is your goal at this stage? Then combine that with 'What will target that goal but not compromise anything else' (i.e. by creating pain or swelling)? And sprinkle in your knowledge of primary healing & rehab principles...

'New to you' conditions are always a bit scary at first... but typically you can fall back on the basics to sort out the details of what to do for just about anything that walks through the door.

Cheers!

Laurie