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A closed reduction refers to a method of correcting a dislocated joint without recourse to surgery. By far, the joint most commonly dislocated in the cat is the hip joint. This usually happens as a result of trauma, such as a traffic accident, where a blow to the hip causes it to dislocate.
Dislocation refers to the displacement of the normal joint anatomy such that the head of the femur no longer sits in the cup of the pelvic acetabulum. This is associated with soft tissue damage and severe disruption of the ligaments which normally hold the joint in place.
Closed reduction is preferable to an open (surgical) reduction, as it causes less disruption to the surrounding tissue. However, even when a joint is successfully replaced using closed reduction, there is a high chance of it popping back out of joint, because the integrity of the securing ligaments has been damaged.
Closed reduction is performed in first opinion practice, and if unsuccessful, referral for an open reduction may be necessary.
The cat is first stabilized and treated for shock. Once stable, a full general anesthetic is required, as hip relocation is painful. At least two radiographs are taken in order to precisely pin down where the dislocated femur is sitting in relation to the pelvis.
The clinician works with an assistant. The cat lies with the dislocated leg uppermost. The assistant passes a loop of rope under the affected leg and holds it firmly in order to anchor the cat and provide a fulcrum for the clinician to pull against.
With one hand, the clinician grasps the hock of the dislocated leg and places the other hand over the femoral head in order to guide it back into the socket. Then with a twisting, pulling motion the clinician attempts to 'pop' the femoral head back into the acetabulum.
The clinician checks the relocation is successful by feeling the hip joint, and then presses down firmly to expel any blood clots from the joint.
If successful, the limb is then strapped in a non-weight bearing position for at least two weeks. This allows swelling to subside, the joint capsule to repair, and scar tissue stabilize the hip.
Closed reduction is most effective on a newly dislocated leg. Even then, the long term success rate is just 50%, with many legs re-dislocating at a later date. At this stage, a surgical option should be pursued.
Replacing the hip joint is just the beginning of a long recovery process. The cat must wear a bandage sling on the hind leg for at least 2 weeks. This prevents the cat putting weight on the leg and pushing it out of joint before adequate scar tissue has formed. After this initial two weeks, the cat should be cage rested for a further 6 weeks, to allow full healing to take place.
The cost involves a general anesthetic ($99 for each half hour), radiographs ($60 to $240 ), and the clinician's time (Expect a fee of around $100 plus per hour.) The cost of bandaging materials can be significant at around $50.
Closed hip reduction is only an option when no fractures of the hind leg or pelvis are present. Even when a hip is successfully relocated, the long-term results are disappointing and the recovery period protracted. Alternatively, cats do well with a procedure called a femoral head and neck excision, where the ball of the femur is trimmed back and a new muscular joint forms. The recovery time for this is around 2 weeks, and cats regain good, pain-free use of the hindlimb.
Outdoor cats should be supervised so as to minimize the risk of traumatic accidents. In addition, flooring in the home should be non-slip, as doing the 'splits' on laminate flooring is linked to hip dislocation.
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