COXOFEMORAL JOINT RADIOGRAPHY IN STANDING CATTLE

BEATRICE WENZINGER, REGINE HAGEN, TANJA SCHMID, KARL NUSS

The objective of this study was to establish a technique for radiographic examination of the coxofemoral joint
and adjacent bony structures in standing cattle. Left (or right) 30◦ dorsal–right (or left) ventral radiographic
views of the coxofemoral joint region of standing cattle (n = 10) with hind limb lameness were evaluated
retrospectively. In addition, an experimental study of oblique laterolateral views of the coxofemoral joint region
of a bovine skeleton at angles of 15–45◦ was carried out to determine the optimal position for visualization of
the hip region. In the 10 clinical patients, the bodies of the ilium and ischium, the acetabulum and proximal third
of the femur could be assessed. Six of these cattle had fractures of the body of the ilium and body of the ischium,
five with and one without involvement of the acetabulum, two had craniodorsal and one caudoventral luxation
of the femur and one had a femoral neck fracture. The described laterodorsal–lateroventral radiographs of
the hip region in standing cattle were suitable for assessing the coxofemoral joint, the proximal aspect of the
femur and parts of the ischium, ilium and pubis. After testing the optimal angle on the skeleton, it was seen
that distortion and superimposition were minimized by positioning the X-ray beam at an angle of 25◦ to the
horizontal plane. It can be concluded that the described technique improves the evaluation of injuries of the
coxofemoral region in cattle. With the appropriate angle, the technique can also be applied in recumbent cattle.
C 2012 Veterinary Radiology & Ultrasound.

Key words: cattle, distortion, hip radiography, superimposition, x-ray beam angle.

Introduction and the coxofemoral joint space could be seen, sedation

was not required in the majority of horses and the cox-

D ISEASES OF THE bovine coxofemoral joint are a diag-

nostic challenge. Clinical signs range from moderate
and usually mixed hind limb lameness to inability to stand.1
ofemoral joint could be evaluated during weight bearing.
A disadvantage was poor visualization of the caudal parts
of the acetabular rim and the coxofemoral joint space. Set-
Sedation or general anaesthesia is required to make pelvic tings of 150 kV and 400–500 mAs are required to ob-
radiographs of cattle and the required doses of radiation tain images of this region,5 which means that portable
are very high with settings of 100 kV and 200 mAs.1–5 Fur- X-ray machines are not suitable. The long exposure time
thermore, the procedure is time consuming and there is a resulted in blurred images because of movement of the pa-
risk of exacerbating existing fractures during the recovery tient. This technique was not feasible in small horses and
phase. There are also drug withdrawal times to consider ponies because of limited space for the X-ray tube under the
when sedating or anaesthetising cattle. abdomen.
In 1991, a technique for obtaining standing equine pelvic In 2006, another technique for obtaining pelvic radio-
radiographs was described.6 The X-ray tube was positioned graphs in the standing horse was described.7 Laterodorsal–
ventrally under the abdomen of the horse and cranial to lateroventral views were made with the X-ray beam at a 30◦
the pelvic limbs, and the cassette was placed dorsally on angle to the horizontal plane. There was slight superimposi-
the sacrum. Good images of the iliac bodies were achieved tion and only minimal distortion of the imaged structures of
with the X-ray beam at an angle of 20–25◦ to the verti- the coxofemoral joint farthest from the beam, the proximal
cal plane. With an angle of 30–35◦ , good images of the third of the femur and the ilium and ischium. Thus, a vari-
acetabulum and caudal pelvic region were obtained. The ety of lesions involving these structures could be diagnosed,
advantages of this technique compared with conventional although many parts of the pelvis were not accessible.
methods were that the cranial parts of the acetabular rim This same technique has been used in our clinic for di-
agnosing diseases of the coxofemoral region in cattle since
From the Department of Farm Animals (Wenzinger, Schmid, Nuss),
Section for Diagnostic Imaging (Hagen), Vetsuisse Faculty, University of 2007. The goal of this retrospective study was to evaluate
Zurich , Winterthurerstrasse 260, 8057 Zurich Switzerland. the quality of radiographs obtained using this technique
Address correspondence and reprint requests to Beatrice Wenzinger, with respect to location of the lesion and age of the cattle.
at the above address. E-mail: [email protected]
The radiographic method was also assessed using a bovine
Received September 27, 2011; accepted for publication January 22,
2012. skeleton to determine whether the technique could be stan-
doi: 10.1111/j.1740-8261.2012.01927.x dardized and/or improved.
Vet Radio & Ultrasound, Vol. 00, No. 0, 2012, pp 1–6.

1
2 WENZINGER ET AL 2012

FIG. 1. Caudal schematic view of the right 30◦ dorsal–left ventral radiographic view used to image the left coxofemoral joint.

Materials and Methods laterodorsal–lateroventral views at an angle of about 30◦ to

the horizontal plane (Figs. 1 and 2).
Ten cattle, including five mature cows (four Brown Swiss
Radiographs were centered over the affected region,
and one Red Holstein 560–630 kg) and five heifers (two
which was the left hip in seven animals and the right hip
Brown Swiss, two Holstein Friesian and one Red Hol-
in three. Radiographs of the contralateral hip region were
stein 300–350 kg) were evaluated between June 2007 and
made for comparative purposes in three patients. Radio-
March 2011 because of pelvic limb lameness. Three animals
graphs were evaluated by various radiologists, but all were
were acutely lame and seven had been lame for more than
assessed again by the same radiologist (RH) for this study.
1 week. A mixed lameness was diagnosed in seven animals,
A complete articulated bovine skeleton was used to de-
supporting leg lameness in two and swinging limb lameness
termine whether the technique for pelvic radiography could
in one. Radiographs of the pelvis were made in standing
be standardized and to establish the optimal angle for the
animals with a movable overhead Siemens Polydoros 80 X-
X-ray beam in relation to the horizontal plane. A portable
ray machine∗ and CR cassettes† with a linear grid, fixed in
X-ray machine‡ and a CR cassette were used with settings
a cassette holder. The radiographs were made by various
of 56 kV and 2.5 mAs. The cassette was positioned in a
trained personnel using settings of 70–80 kV and 40–80
holding device with the cranial edge at the level of the coxal
mAs. All radiographic views of the coxofemoral joint were
tuber. The angle of the X-ray tube and vertical placement
of the cassette were the only variables. The X-ray tube was
∗ Siemens Schweiz AG, Dietikon, Switzerland.
† ST5, Fujifilm AG, Dielsdorf, Switzerland. ‡ Gierth HF 200, Gierth X-ray international GmbH, Riesa, Germany.
VOL. 00, NO. 0 HIP RADIOGRAPHY IN STANDING CATTLE 3

FIG. 2. Dorsal schematic view of the right 30◦ dorsal–left ventral radiographic view used to image the left coxofemoral joint. The X-ray beam (arrow) passes
immediately cranial to the right greater trochanter and is aimed at the left acetabulum.

positioned at 15◦ , 22.5◦ , 25◦ , 30◦ , 37.5◦ , and 45◦ to the hor- femoral metaphysis and the proximal part of the femoral
izontal plane. The X-ray beam was directed from dorsal on diaphysis were seen readily and evaluated in all 10 patients.
the healthy side toward the affected coxofemoral joint ven- However, the neck of the femur could only be seen in the
trally (Figs. 1 and 2). The focus-to-film distance was 1 m. patient with a femoral fracture and in the two patients
with craniodorsal femoral luxation because of slight rota-
tion of the femur. In the remainder of patients, the greater
Results
trochanter and the neck of the femur were always superim-
A fracture of the body of the ilium and body of the posed. In addition, in the patient with a femoral fracture the
ischium with involvement of the acetabulum was diagnosed distance between the femoral head and greater trochanter
in five patients (Figs. 3 and 4), a fracture of the body of the was reduced.
ischium and ilium with no acetabular involvement in one Eight of the 10 animals were slaughtered without treat-
other. Craniodorsal luxation of the femur was diagnosed ment and one pregnant cow near term and in good general
in two cattle, caudoventral luxation in one. In one cow, condition with only mild lameness of the affected limb was
fracture of the femoral neck (collum ossis femoris) was discharged with the recommendation to slaughter her after
suspected, but the radiographic findings were inconclusive. calving. One heifer with femoral luxation was operated us-
In all radiographs, the body of the ilium and body of the ing open reduction followed by stabilisation of the dorsal
ischium had minimal overlapping and were assessed easily. joint capsule with a mesh.8
The cranial branch of the pubis and the body of the ischium In laterodorsal–lateroventral radiographs of the pelvis
were seen adequately for evaluation in only three patients. of the bovine skeleton, there were various degrees of super-
The cranial branch of the pubis with the pectineal line was imposition or distortion of the contralateral coxofemoral
seen in only one patient. Assessment of the acetabulum was joint, proximal third of the contralateral femur and
possible in seven patients; it could be differentiated easily contralateral ilium and ischium, depending on the angle
from the surrounding bone mainly because of good visual- of the X-ray beam (Table 1). To position the coxofemoral
ization of the joint space. In contrast to the caudoventral joint centrally on the film, when an angle of 45◦ was used,
luxation in one patient (Fig. 5) the acetabulum could not the upper edge of the cassette had to be placed at the level
be identified clearly in the two patients with craniodorsal of the palpable projection of the greater trochanter. It was
femoral head luxation. This precluded visualization of the necessary to increase the height at which the cassette was
joint space, which is critical for identification of the ac- positioned as the angle of the X-ray beam decreased. Thus,
etabulum. The greater trochanter, femoral head, proximal to have the coxofemoral joint positioned centrally on the
4 WENZINGER ET AL 2012

FIG. 3. Right 30◦ dorsal–left ventral radiograph of the left coxofemoral joint area of a 1-year-old Holstein Friesian heifer. The arrows indicate an acetabular
fracture. The fracture line runs from the ischial spine (spina ischiadica; arrow 1) into the acetabulum, from where it branches toward the body of the ilium
(arrow 2) and the pubis (arrow 3). There is rounding of the fracture edges and mild dislocation.

film when an angle of 15◦ was used, the upper edge of the distortion were minimal with an X-ray beam angle of 25◦
cassette had to be placed approximately 5 cm ventral to the or 30◦ (Fig. 6). Using an angle of 15◦ or 22.5◦ , there was
coxal tuber. With angles of 45◦ and 37.5◦ (Fig. 6), there was superimposition of parts of the contralateral coxofemoral
marked dorsoventral distortion and superimposition of the joint, body and acetabular branch of the ischium, with
greater trochanter, ilium and sacrum. Superimposition and the ischial spine closest to the X-ray machine (Fig. 6).

FIG. 4. Postmortem specimen of the left acetabulum from the patient in Fig. 3. The directions of the fracture lines in the acetabulum are confirmed. Arrows
point to the same anatomic structures described in Fig. 3.
VOL. 00, NO. 0 HIP RADIOGRAPHY IN STANDING CATTLE 5

FIG. 5. Left 30◦ dorsal–right ventral radiograph of the right coxofemoral

joint area of a recumbent 6-year-old Red Holstein cow. There is a right
caudoventral coxofemoral luxation. The acetabulum (arrowheads) is clearly
visible. The femoral neck, head and body of ischium are superimposed and
cannot be defined clearly.

However, with an angle of 30◦ , the ischial spine was only

partially visible and superimposition of the structures on
the contralateral side was minimal. The least amount of
distortion was achieved using an angle of 25◦ ; at the same
angle, the dorsal margin of the ischial spine closest to the
X-ray machine was fully visible and not superimposed on
the coxofemoral joint and bony structures dorsal to the
joint on the contralateral side (Fig. 6).

Discussion
We have used a technique analogous to the one described
for radiography of the pelvis in standing horses7 in cattle for
a number of years. The ventrodorsal technique6 in standing
animals is of limited use in lactating cows because insuf-
ficient penetration of the X-rays through the mammary
tissue results in markedly reduced radiographic detail.
The technique used in mature cows in this study re-
quired less radiation (70–80 kV and 40–80 mAs) than a
ventrodorsal view in dorsal recumbency in a horse (100 kV
and 200 mAs) or a ventrodorsal view in a standing horse

TABLE 1. Radiographic Assessment of Bony Structures in Oblique

Laterolateral Radiographs with the X-ray Beam at Different Angles

Angle of X-ray Beam 15◦ 22.5◦ 25◦ 30◦ 37.5◦ 45◦

Body of the ilium 3 3 3 3 3 0
Ischial spine 3 3 3 1 0 0
Body of ischium 3 3 3 3 3 3
Branch and body of ischium 1 1 1 1 1 1 FIG. 6. (A–C) Right dorsal–left ventral laterolateral oblique radiographs
Body with pecten pubis 0 1 1 1 0 0 of the left coxofemoral joint region of a bovine skeleton with the X-ray beam
Acetabulum 3 3 3 3 2 2 aimed at the acetabulum at various angles to the horizontal plane: (A) 45◦ ;
Proximal femoral metaphysis 3 3 3 3 3 3 there is marked dorsoventral distortion and superimposition of the greater
Femoral diaphysis 0 0 0 0 0 0 trochanter, ilium and sacrum. The metal devices visible in the sacrum were
Femoral head 3 3 3 3 2 2 used to hold the skeleton together (B) 25◦ ; superimposition and distortion of
Greater Trochanter 3 3 3 3 2 2 the coxofemoral area are minimal. In addition, a large portion of the femur
is visible, including the lesser trochanter and proximal part of the diaphysis.
0 not assessable, 1 partially assessable, 2 assessable but distorted, 3 assess- (C) 15◦ ; there is superimposition of parts of the contralateral coxofemoral
able. joint, body and acetabular branch of the ischium and ischial spine.
6 WENZINGER ET AL 2012

(150kV and 400–500 mAs). The muscle layers that were coxal and ischial tuber, additional horizontal laterolateral,
penetrated by the X-rays were less dense in the standing an- tangential, ventrodorsal or dorsoventral views are required.
imal, especially in dairy cattle. Also, radiation exposure for In our study, the location of the injury, but not the age
personnel was minimal because a device was used to hold of the patient, determined whether radiographs were of
the cassette. Gas in the rectum created a contrast to the diagnostic value. However, the diagnosis of pelvic fractures
bony structures and increased the level of detail in latero- in young calves can be difficult because of open growth
lateral views. This can be achieved by manually removing plates, especially the three acetabular physes. Additional
faeces from the rectum just before radiography. Compared views, including those of the contralateral side of the pelvis
to conventional methods, obtaining oblique laterolateral are helpful for comparative purposes.
radiographic views of the pelvis in the standing animal has The radiographic diagnosis could be confirmed intraop-
a number of advantages. There is less input of time and eratively (femoral luxation) in one patient and at necropsy
decreased risk of exacerbating fractures or the clinical con- in four. The diagnosis based on clinical and radiographic
dition of the patient. In addition, sedation is not required findings could not be confirmed in the remaining five pa-
in the majority of patients, which means that withdrawal tients because they were slaughtered elsewhere with no op-
times are not a limiting factor in cattle destined for slaugh- portunity for a postmortem examination; however, in four
ter because of a poor prognosis. The described method can patients the fractures were palpable clinically and were vis-
also be used to obtain oblique laterolateral radiographs in ible on radiographs.
downer cows. Downer cows are positioned in lateral re- Positioning the X-ray beam at an angle of 22.5–30◦ pro-
cumbency with the cassette placed underneath the relevant duced the least distortion and least superimposition of the
acetabular area, and the beam is directed from dorsolateral structures of interest on the contralateral ischial spine; the
at a 25–30◦ angle to a imaginary line through both coxal best radiographs with respect to these two factors were
and ischial tubers. achieved using an angle of 25◦ to the horizontal plane.
Only the coxofemoral region closest to the X-ray cassette In a recent study a magnification technique was revisited
could be visualized on radiographs. Because most fractures and reapplied for radiography of various body parts us-
of one side of the pelvis are accompanied by a fracture of the ing state of the art equipment to minimize the effects of
other hemipelvis, it is recommended to make radiographs superimposition.9 It may be possible to apply these prin-
of both sides, especially when treatment is planned. ciples to blur out the bony structures of one coxofemoral
The radiographic technique used in this study is a rapid joint while obtaining images of diagnostic quality of the
method of evaluating diseases and fractures of the bony contralateral coxofemoral joint in cattle.
structures of the coxofemoral joint, body of the ilium, body To avoid superimposition of the contralateral side, we
of the ischium and proximal part of the femur. Fractures of recommend using an angle of 25◦ for evaluation of the
the greater trochanter and proximal third of the femur as coxofemoral joint and surrounding anatomic structures in
well as femoral luxations can be imaged optimally using an standing cattle. In patients that do not stand squarely be-
oblique view. The acetabulum could be readily assessed in cause of pain caused by a fracture, the pelvis may be skewed.
patients with the femoral head in situ; however, in two pa- In these patients, the correct angle of the X-ray beam is
tients with craniodorsal femoral luxation, superimposition achieved using an imaginary line drawn through both coxal
of the displaced femur made assessment of the acetabu- and ischial tubers for orientation and adjustment of the
lum difficult. Oblique views were inadequate for evaluating angle.
fractures of the pecten pubis, minimally displaced fractures
of the femoral neck or the femoral growth plate. For diag- ACKNOWLEDGMENTS
nosis of these injuries, dorsoventral or ventrodorsal views The authors thank the staff of the Division of Diagnostic Imaging and
may be indicated. For diagnosis of injuries of the sacrum, the Institute of Veterinary Pathology for their assistance and Matthias
Haab for the illustrations.

REFERENCES
1. Desrochers A. Coxofemoral luxation. In: Anderson DE, Rings M 6. May SA, Patterson LJ, Peacock PJ, Edwards GB. Radiographic tech-
(eds): Current veterinary therapy: food animal practice. Missouri: Saunders, nique for the pelvis in the standing horse. Equine Vet J 1991;23:312–4.
2009;268–270. 7. Barrett EL, Talbot AM, Driver AJ, Barr FJ, Barr ARS. A tech-
2. Lewis RE, Heinze CD. Radiographic examination of the equine pelvis: nique for pelvic radiography in the standing horse. Equine Vet J 2006;38:266
technique. J Am Vet Med Assoc 1971;159:1387–1390. –70.
3. Heinze CD, Lewis RE. Radiographic examination of the equine pelvis: 8. Keller AM, Nuss KM, Schmid T, Meyer SW, Nuss K. Surgical
case reports. J Am Vet Med Assoc 1971;159:1328–1334. treatment of coxofemoral luxation in two cattle. Schweiz Arch Tierheilkd
4. Bargai U, Pharr JW, Morgan JP. Bovine radiology 1. USA: Iowa State 2006;148:657–62.
University Press, 1989. 9. Drees R, Perrier M, Vetter JR, Brounts S, Schwarz T. Magnification
5. Butler JA, Colles CM, Dyson SJ, Kold SE, Poulos PW. Clinical radi- radiography in the horse to blur out superimposed structures. Wien Tierärztl
ology of the horse. 3rd ed. Oxford: Blackwell Scientific Publications, 2008. Mschr 2011;98:160–165.