Long-term outcome of juvenile pubic symphysiodesis and triple pelvic osteotomy in dogs with hip dysplasia

OBJECTIVE: To compare long-term outcomes of juvenile pubic symphysiodesis (JPS) and triple pelvic osteotomy (TPO) in dogs with hip dysplasia. DESIGN: Prospective clinical trial. ANIMALS: 18 dogs with hip dysplasia (ie, distraction index > or = 0.5 in at least 1 hip joint and no, mild, or moderate radiographic evidence of degenerative joint disease [DJD]). PROCEDURES: Dogs between 4 and 5.5 months old at enrollment were assigned to undergo JPS, and dogs between 5 and 12 months old were assigned to undergo TPO. All dogs were reexamined at 2 years of age. RESULTS: At 2 years of age, there were no significant differences between groups in regard to lameness scores, angle of extension of the hip joints, distraction index, peak vertical force, acetabular angle, radiographic DJD score, or owner-assigned scores of clinical function. Dorsal acetabular rim angle was significantly higher in dogs that underwent JPS than in dogs that underwent TPO. For dogs that underwent TPO, dorsal acetabular rim angle was significantly decreased and acetabular angle was significantly increased at 2 years of age, compared with values obtained prior to surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that JPS and TPO have similar effects on hip joint conformation in dogs with moderate to severe hip dysplasia but that neither procedure eliminates the hip joint laxity characteristic of hip dysplasia or the progression of degenerative changes.     

Total hip arthroplasty for treatment of canine hip dysplasia.

Cemented THA is an established procedure for treating arthropathies of the hip in large, healthy mature dogs. CHD with secondary osteoarthritis is the most common indication. Although comparative studies between THA and excision arthroplasty have not been reported, our experience with both procedures and studies in the literature support THA as the best available treatment for crippling degenerative joint disease secondary to CHD in large, mature dogs. Negative aspects of the procedure include high cost, the potential of significant complications, and the sophisticated surgical technique required. Improvements in patient selection, design of implants, surgical technique, and postoperative care have decreased the incidence of complications and improved the success rate to over 90%. However, concerns in human applications about cement disease and the desire to increase the functional life of the prosthesis have renewed interest in cementless systems. Advantages of cementless THA are fixation via bony ingrowth and avoidance of problems associated with PMMA. Important technical aspects of cementless THA relate to optimal fit and fill so that the prosthesis is stable, bone ingrowth is promoted, and weight-bearing forces are transferred to the proximal femur physiologically. Problems recognized with cementless systems include fissure fracture, bone resorption, and excessive motion between the implant and bone. Currently, investigations are being conducted to develop prosthetic materials that more closely match the stiffness of bone, stem designs that provide optimal fit and maintain normal strain patterns in the bone, and coating materials that promote permanent fixation by bone ingrowth. Early clinical results in humans and research results in dogs have been encouraging but have not withstood the test of time. Results of cementless techniques must be compared to the standards set by cemented THA over the last 20 years in humans and the last 10 years in dogs.     

Effects of pubic symphysiodesis in dysplastic puppies

OBJECTIVE--To determine the long-term effects of juvenile pubic symphysiodesis (JPS) in dysplastic puppies. STUDY DESIGN--Prospective, randomized, clinical trial. ANIMALS--Seven dysplastic Chesapeake Bay retrievers and 2 beagle-crosses (BX1 and 2). METHODS--Five puppies had JPS performed with electrocauterization at 12, 16, 20, 22, and 24 weeks of age, respectively. Two puppies served as controls. BX1 and BX2 were used to obtain biopsies of the symphysis. Hips were evaluated for: pelvic development (transverse computerized tomography for acetabular angle [AA] and dorsal acetabular rim angle [DARA]); laxity [hip extended and stress radiography [distraction index (DI)]); Ortolani maneuver with reduction angles; acetabular coverage (Norberg angles); and function (coxofemoral range of motion, hip pain, and gait analysis by force-plate technique at 44 and 137 weeks of age). RESULTS--The pubis fused prematurely in every puppy that was operated on with the JPS technique. Greater acetabular responses were related to younger ages at surgery. The final mean AA in dogs that had JPS was 25 degrees greater than preoperative values; 40% increased over control. The DARA final mean was 10 degrees, 52% less than preoperative values and 46% less than control. The final mean DI in dogs having JPS was 0.28, 47% improved over preoperative values and 58% better than control. Mean pelvic dimensions in dogs that had JPS were 18% less than control. Gait analyses were normal for all dogs at 137 weeks. No urinary or bowel complications occurred. CONCLUSIONS--Significant ventrolateral acetabular rotation, increased hip coverage, diminished hip laxity, normal pain-free gait, and insignificantly reduced pelvic size occurred after JPS. CLINICAL SIGNIFICANCE--Dysplastic hips in young dogs were significantly improved by JPS.     

Pectineus tendon surgery for the management of canine hip dysplasia.

Pectineus tendonectomy is a useful procedure for relieving pain and rehabilitating the dysplastic dog in select cases. Relief of pain is believed to come from a combination of releasing tension on the hip joint capsule and providing a better loading contact surface on the articular cartilage owing to the increased abduction of the hind legs after surgery. Some pain relief also may come from the release of tension on the pectineus muscle. The modified procedure described in this article results in less seroma formation and less reattachment of the severed ends of the pectineus tendon of origin than the procedure originally described by the author.     

Femoral head and neck excision in the management of canine hip dysplasia.

Degenerative joint disease as a sequela to pathology of the coxofemoral joint can cause considerable pain. In dogs weighing less than 20 km, excision of the femoral head and neck is sufficient to control this pain. A pseudoarthrosis functions effectively as a salvage hip joint. In dogs weighing more than 20 km, additional surgery is required to ensure painfree use of the hip. Postoperatively, the weight of these larger animals appears to cause striking of the proximally excised femoral shaft with the pelvis during exercise. This contact causes pain that limits the use of the joint. The inclusion of a biceps femoris muscle sling to prevent this striking and the resultant pain is outlined.     

Comparison of three distraction methods and conventional radiography for early diagnosis of canine hip dysplasia

Two radiographic distraction techniques (one employing a wooden lath and, the other, a PennHip distractor), an ultrasonographic distraction method and conventional radiographic Fédération Cynologique Internationale (FCI) hip score were evaluated in eight-month-old Labrador retrievers to determine the most reliable method for predicting radiographic FCI hip score at the age of one year. With reference to the FCI hip score, sensitivity and specificity of the PennHip method were 100 per cent and 54 per cent; sensitivity and specificity of the lath technique were 85 per cent and 71 per cent; whereas they were 62 per cent and 67 per cent for the ultrasonographic method. For all distraction methods, the positive predictive value (PPV) was moderate and the negative predictive value (NPV) was high. Sensitivity, specificity, PPV and NPV were 100 per cent for the FCI hip score. It is concluded that, at the age of eight months, FCI hip score is the most reliable method for predicting FCI hip score at the age of one year in the colony of dogs investigated. Both the PennHip and lath method were also clinically reliable techniques in predicting true negatives. The ultrasonographic distraction method was moderately reliable.     

Controlling canine hip dysplasia in Finland.

The aim of the study was to evaluate the Finnish Kennel Club's hip-dysplasia screening and control programs. As a retrospective study, records of hip-dysplasia screening of 69,349 dogs in 22 breeds that were born in 1988-1995 were analyzed and compared to data from prior to 1988. In most breeds, no significant changes in dysplasia prevalence could be found. In English cocker spaniels, golden and Labrador retrievers and Rottweilers a significant decrease - but in boxers, Dobermans, German Shepherd dogs and rough collies a significant increase - in prevalence was detected. In flat-coated retrievers overall prevalence increased - but the prevalence of severe hip-dysplasia decreased significantly during the study period. The present control program has not resulted in fast progress. Selecting against hip-dysplasia cannot be expected to be very effective, when based only on mass selection on phenotypic observations. Predicted breeding values based on progeny testing would probably give better results. Also, breeders' compliance and commitment to programs is not always high and other selection criteria in breeding are thought to be more important. Modern society has high demands for animal welfare and consumer issues, and breeders and kennel societies should pay more attention to health issues in breeding pedigreed dogs.     

Static and dynamic ultrasonography for the early diagnosis of canine hip dysplasia

Objective : To determine the feasibility of sonographical examination of hip joints in non-sedated puppies and to assess the value of static and dynamic ultrasonography for the early diagnosis of canine hip dysplasia (CHD). Methods : Prospective study was carried out. Five hundred and sixty-six puppies between the ages of 16 and 49 days underwent sonographical determination of the α-angle, joint laxity and distraction value (DV). Sonographical parameters were correlated to conventional radiographic CHD classification in the adult dogs. Results : α-Angles between 74° and 89° (X ±sd=82·8°±2·31°) were measured. Despite the feasibility of sonographical hip assessment in puppies, no statistically significant correlation was found between sonographical determinations of the α-angle, joint laxity, DV and conventional radiographic hip joint classification at the age of 12 to 24 months. Clinical Significance : Results of our study suggest that static and dynamic ultrasonography of hip joints in puppies between 16 and 49 days of age is technically feasible but cannot be recommended for detecting puppies that will develop CHD between the ages of 12 and 24 months.     

Radiographic development of canine hip dysplasia.

The radiographic changes observed in the development of CHD in the dog are complex and not fully understood despite years of research. Moderate to severe CHD is relatively easy to diagnose using standard radiographic views and evaluation techniques. However, early detection of mild or borderline CHD continues to be difficult to reliably detect radiographically. Efforts continue to be made to develop new views, techniques, and evaluation methods that will improve the radiographic evaluation of CHD. Until better methods are proven, the standard ventrodorsal leg extended view, evaluated by an experienced reviewer, will remain the method of choice for radiographic detection of CHD.     

The pathogenesis of canine hip dysplasia.

Dogs with CHD are born with normal hips that subsequently undergo varying degrees of subluxation of the coxofemoral joint. Although the etiology of CHD is multifactorial, the pathogenesis or stages of change within the affected coxofemoral joint(s) are similar regardless of cause. With the onset of the disease, there are progressive structural changes including joint laxity and femoral head subluxation; swelling, stretching, fraying, and eventual rupture of the teres ligament; a shallow, flattened acetabulum, deformity of the head; erosion of articular cartilage, eburnation of subchondral bone, DJD; and periarticular osteophyte formation.     

The pathology of canine hip dysplasia.

Although the complete pathogenesis of cartilage damage in canine hip dysplasia has not been completely worked out, it appears that joint laxity with resultant excessive stresses upon articular cartilage is the initiating factor. Grossly, this damage is characterized by cartilage thinning with potential exposure of subchondral bone, osteophyte formation, and pannus formation. Microscopically, there is a marked variation in chondrocyte cellularity, with focal regions of hypocellularity and chondrocyte clusters and synovial lining cell hyperplasia and hypertrophy as well as a decrease in proteoglycan content. This latter change has been substantiated biomechanically. Ultrastructural studies indicate that there is extensive alteration of collagen organization within the cartilage.     

Clinical hip dysplasia in growing dogs: the long-term results of conservative management

The long-term results of conservative management in 68 immature dogs with clinical and radiographic evidence of hip dysplasia are described. Seventy-six per cent of the dogs had minimal gait abnormalities despite radiological evidence of moderate or severe osteoarthrosis.     

Comparison of arthroscopic and radiographic abnormalities in the hip joints of juvenile dogs with hip dysplasia

OBJECTIVE: To compare radiographic and arthroscopic abnormalities in juvenile dogs with clinically apparent hip dysplasia. DESIGN: Case series. ANIMALS: 52 dogs (70 hip joints) with clinical signs of hip dysplasia scheduled to undergo triple pelvic osteotomy. PROCEDURE: A ventrodorsal radiographic projection of the pelvis was evaluated by a radiologist unaware of clinical and arthroscopic findings, and radiographic osteoarthritic abnormalities were judged and scored as absent (0), mild (1), moderate (2), or severe (3). Arthroscopy was performed by a surgeon unaware of clinical and radiographic findings, and arthroscopic abnormalities were graded from 0 (normal) to 5 (exposed, eburnated subchondral bone). RESULTS: In 30 of the 70 (43%) hip joints, no radiographic osteoarthritic abnormalities were seen. Severe, full-thickness articular cartilage lesions (grade 4) of the femoral head or acetabulum were seen arthroscopically in 14 (20%) joints. Lesions > or = grade 2 were seen in 60 (86%) joints. Partial tearing of the ligament of the femoral head was present in 57 (81%) joints, and complete rupture was seen in 5 (7%). Radiographic abnormalities were seen in 13 of the 14 (93%; 95% confidence interval, 66% to 99.8%) joints with grade 4 arthroscopic abnormalities but in only 23 of the 46 (50%; 95% confidence interval, 35% to 65%) joints with grade 2 or 3 arthroscopic abnormalities. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that radiography is not a sensitive method for identifying moderate cartilage lesions in juvenile dogs with hip dysplasia. If moderate cartilage lesions are an important prognostic indicator for the success of triple pelvic osteotomy, then methods other than radiography should be used to detect these lesions.     

犬髋关节发育异常的手术治疗进展

犬髋关节发育异常（Canine hip dysplasia,CHD）是遗传和环境应激因素所致的复合性疾病,也是最常发生的矫形外科疾病,其主要特征是髋臼变浅,股骨头变形,髋关节不同程度的松弛、半脱位或全脱位,最终发展为严重的退行性关节炎。通过触诊、临床症状及骨盆X-线摄片技术可进行诊断。犬髋关节发育异常的治疗包括保守的药物治疗及手术治疗。     

The role of nutrition in canine hip dysplasia.

The role of nutrition in canine hip dysplasia is a multifactorial as the disease itself. Large and giant breeds primarily are at risk for the disease. Rate of growth, feeding methods, feed consumption, specific nutrients, and electrolyte balances within the diet have all been shown to influence hip dysplasia. Known nutritional risk factors are rapid weight gain and excessive calcium supplementation. Nutritional factors with less secure roles in their influence on the disease process are vitamin C, protein, and carbohydrates. There exists a need to identify further and control the various nutritional factors in the diet that influence canine hip dysplasia.