POOR CONFORMATION: HIP DYSPLASIA

YOUNG DOGS 5-8 mos AND MATUREANIMALS WITH CHRONICDISEASE

POOR CONFORMATION: HIP DYSPLASIA

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

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: 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): 5 mg/kg IM every 3-5 days for 8 injections, followed by an injection every 1-2 months for maintenance: – 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: 1-2 regular strength capsules PO q 24 hr for smaller dogs and 2-4 capsules of double strength for larger dogs: – 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 – Juvenille 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

LEGG-CALVE-PERTHES DISEASE

http://www.youtube.com/watch?v=_vvtprqhyoI

YOUNG, SMALL BREEED DOGS

LEGG-CALVE-PERTHES DISEASE

May also be considered a Developmental disorder

LEGG-CALVE-PERTHES DISEASE: TREATMENT

FEMORAL HEAD AND NECK EXCISION

FHNE

DEGENERATIVE DISORDERS: OSTEOCHONDRITIS DISSECANS

OSTEOCHONDRITIS DISSECANS

FAILURE OF THE LOWER LAYERS OF ARTICULAR CARTILAGE TO MATURE INTOBONE RESULTS IN THICKENED CARTILAGE THAT IS PRONE TO INJURY

OSTEOCHONDRITIS DISSECANS

CARTILAGE FLAP OF THE SCAPULOHUMERALJOINT WHICH IS THE MOST COMMON LOCATION

OSTEOCHONDRITIS DISSECANS

OSTEOCHONDRITIS DISSECANS

CARTILAGE FLAP IN THE STIFLE JOINT

OSTEOCHONDRITIS DISSECANS

http://www.youtube.com/watch?v=_bJqjqh5a2A

INFLAMMATORY CONDITIONS: PANOSTEITIS

LARGE, MEDIUM BREEDS AT A YOUNG AGE 6-18 MONTHS

CAUSE: UNKNOWN, BUT THERE ARE MANY SUSPECTED CONTRIBUTORS

PANOSTEITIS1. PELVIS2. LESIONS OF PANOSTEITIS3. FEMUR

INFLAMMATION IN THE MARROW CAVITIES OF LONG BONES THAT LEADSTO PAIN, LAMENESS, AND FEVER

PANOSTEITISINCREASED MEDULLARY OPACITY

PANOSTEITIS

TREATMENT OF PANOSTEITIS INCLUDESNSAIDS AND CAGE REST

THIS DISEASE IS SELF-LIMITING AND HAS A GOOD PROGNOSIS!

LUXATIONS

HX OF TRAUMA, ACUTE LAMENESS, NON WEIGHT BEARING, POSSIBLESWELLING OVER THE HIP

LUXATIONS

CRANIODORSAL LUXATION IS THEMOST COMMON TYPE

LUXATIONS

THE EHMER SLING IS USED AFTER CLOSED REDUCTION OF THE LUXATEDHIP JOINT; THE DOG SHOULD BE CONFINED FOR 7-10 DAYS

LUXATIONS

TUMORS OF THE BONE

MOST COMMON IN LARGE BREEDMALE DOGS OLDER THAN 7 YRS OFAGE

THE DISTAL RADIUS IS THE MOSTCOMMON LOCATION

TUMORS OF THE BONE

85%-90% OF BONE CANCER IN DOGS IS OSTEOSARCOMA

TUMORS OF THE BONE

OSTEOSARCOMA TENDS TO OCCUR AWAY FROMTHE ELBOW AND TOWARDS THE KNEE

TUMORS OF THE BONE

TUMORS OF THE BONE

METASTASIS OF OSTEOSARCOMA TO THE LUNGS; THERE IS USUALLY ALREADY SOME MICROSCOPIC SREAD OF TUMOR BY THE TIME IT IS DIAGNOSED

TUMORS OF THE BONE

AMPUTATION OF THE AFFECTED LIMBALONG WITH CHEMOTHERAPY IS A COMMON TREATMENT PLAN

SURVIVAL TIME IS ~12 MONTHS EVEN WITH AGGRESSIVE THERAPY

MYOPATHIES: POLYMYOSITIS

MYOPATHIES: POLYMYOSITIS

MYOPATHIES: MASTICATORY MUSCLE MYOSITIS (aka atrophic myositis, eosinophilic myositis)

CLINICAL SIGNS INCLUDE ELEVATED 3RD EYELIDS, ATROPHY OF THE JAW MUSCLES, AND INABILITY TO OPEN THE MOUTH (TRISMUS)

MYOPATHIES: FELINE POLYMYOPATHY

CERVICAL VENTROFLEXION OF THE NECK 2° TO HYPOKALEMIA