ADVERSITY“I am not afraid of storms for I am learning how to sail my ship.”

-Louisa May Alcott

DISEASES OF THE MUSCULOSKELETAL

SYSTEMPART 3

POOR CONFORMATION: LUXATING PATELLA

POOR CONFORMATION: LUXATING PATELLA

POOR CONFORMATION: LUXATING PATELLA

POOR CONFORMATION: LUXATING PATELLA

PATELLA INGROOVE

PATELLAOUT OFGROOVE

POOR CONFORMATION

KNOCK-KNEED/PIGEON-TOED, ORCOW-HOCKED STANCE MAY OCCURIN LATERAL LUXATIONS

BOW-LEGGED STANCE MAY OCCURIN MEDIAL LUXATIONS

POOR CONFORMATION: TREATMENT OF PATELLAR LUXATION

TROCHLEAR WEDGE RESECTION

POOR CONFORMATION: TROCHLEAR WEDGE RESECTION

POOR CONFORMATION: TIBIAL CREST TRANSPOSITION

POOR CONFORMATION: TIBIAL CREST TRANSPOSITION

POOR CONFORMATION: HIP DYSPLASIA

YOUNG DOGS 5-8 mos AND MATUREANIMALS WITH CHRONIC DISEASE

POOR CONFORMATION: HIP YSPLASIA

POOR CONFORMATION: HIP DYSPLASIA

Poor conformation combined with genetic, environmental and nutritional factors

Acetabular vs. Femoral hip dysplasia

POOR CONFORMATION: HIP DYSPLASIA

• PHYSICAL EXAM FINDINGS Pain on palpation of hips Joint laxity (positive ortolani sign) – early disease – subluxation of hip

Crepitus Decreased ROM of hip joints Atrophy of thigh muscles Hypertrophy of shoulder muscles

POOR CONFORMATION: HIP DYSPLASIA

http://www.youtube.com/watch?v=2rRKDheDrLs&NR=1

http://www.youtube.com/watch?v=SHCIT87jY0M&feature=related

Hip Dysplasia: Radiographic view

For standard Orthopedic Foundation for Animals–type radiographs to evaluate hip conformation, extend the hips and internally rotate the tibias until the patella lies directly over the trochlear grooves. Be sure the pelvis is straight, with symmetric obturator foramina.

ventrodorsal view of the pelvis with rear limbs extended symmetrically and rotated inward to center the patellae over the trochlear grooves

POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION

"normal" radiographically may be further classified as excellent, good, fair, or near normal

POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION

HIP DYSPLASIA and OFA CERTIFICATION

dysplasia are categorized as mild, moderate, or severe

PennHip Evaluation

Distraction View

Compression view

Extended View

HIP DYSPLASIA TREATMENT

NSAIDs

NEUTRICEUTICALS/CHONDROPROTECTIVE AGENTS

HIP DYSPLASIA TREATMENT: MEDICAL MANAGEMENT• Aspirin or buffered aspirin: 10-25 mg/kg q 8-12 hr or as

needed: Discontinue if vomiting occurs. • Carprofen (Rimadyl): 2 mg/kg PO q 24 hr • Deracoxib (Deramaxx): For chronic dosing use 1-2 mg/kg PO q

24 hr as needed.• Etodolac (EtoGesic): 10-15 mg/kg PO q 24 hr • Firocoxib (Previcox): 5 mg/kg PO q 24 hr. Do not use in puppies

less than 7 months of age or in dogs weighing less than 7 pounds.

• Meloxicam(Metacam): 0.2 mg/kg first dose; then 0.1 mg/kg thereafter q 24 hr PO.

• Tepoxalin (Zubrin): 20 mg/kg PO q 24 hr x 1 treatment; then 10 mg/kg PO q 24 h. This is similar to carprofen and ketoprofen.

HIP DYSPLASIA TREATMENT: MEDICAL MANAGEMENT• Polysulfated glycosaminoglycan (Adequan): • Polysulfated glycosaminoglycans prevent cartilage breakdown by inhibiting

the enzymes of cartilage degradation during inflammation. Discontinue use if there is no improvement after the third week. Caution,

may increase bleeding time.

• Cosequin: Note that dose is based primarily on empiricism and manufacturer's recommendations. Adverse effects have not been reported although hypersensitivity is

possible. Cosequin is a brand name for glucosamine HCL combined with chondroitin

sulfate which may stimulate synthesis of synovial fluid, inhibit degradation, and improve healing of articular cartilage.

Hip Dysplasia – Treatment• Surgical

Total hip replacement Salvage procedure in mature dogs with severed DJD

unresponsive to medical Tx Pain free in 90% of cases Unilateral replacement provides acceptable function in 80% of

cases Excision Arthroplasty or Femoral Head Ostectomy

Forms “false” joint Removal of femoral head and neck to prevent joint pain Salvage procedure when medical treatment not working and

other sx too expensive Best - < 20#; good musculature Abnormal gait

Triple Pelvic Osteotomy

Arthroscopy – Juvenile patientsA, Ventrodorsal radiograph of an immature dog with subluxation of the femoral heads and minimal evidence of DJD, typifying a candidate for triple pelvic osteotomy. B, Ventrodorsal radiograph of a dog with advanced hip dysplasia and osteophyte formation. This dog may be a candidate for total hip replacement or femoral head ostectomy if clinical signs cannot be managed medically.

Arthroscopic view of a normal hip joint

HIP DYSPLASIA TREATMENTTRIPLE PELVIC OSTEOTOMY

HIP DYSPLASIA TREATMENT

FEMORAL HEAD OSTECTOMY

“False joint” forms from scar/fibrous tissue

HIP DYSPLASIA TREATMENT

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JUVENILE PUBIC SYMPHYSIODESIS• Juvenile pubic symphysiodesis (JPS) surgery is a prophylactic procedure performed in puppies 10 to 20 weeks of age that have been diagnosed with hip dysplasia

• causes premature closure of the cranial pubic symphysis

PennHip distraction view of a Labrador puppy at 14 weeks. The DI is 0.55.

The same dog at 50 weeks (36 weeks post-JPS).

Hip Dysplasia – Client Info• Weight control important to decrease load on painful joint• Swimming excellent activity• Lameness may occur due to surgical shortening of the affected

limb• Physiotherapy – decreases joint stiffness, helps maintain muscle

integrity• Joint degeneration progressive• May be heritable – do not breed• Special diets designed for fast growing dogs may decrease

severity