Osteoarthritis in cats

Osteoarthritis is a common radiographic finding in older cats, with a prevalence of up to 90% in appendicular joints. Many cats experience impaired mobility from osteoarthritis; however, there are more and more treatment options available, including diet modification, environmental modification, medical therapy, and physical rehabilitation. Continuing challenges involve accurate diagnosis and outcome assessment of treatment, but considerable progress has been made in the last decade.     

A pilot study examining a proprietary herbal blend for the treatment of canine osteoarthritis pain

Osteoarthritis is the most common joint disease in dogs. Despite the use of nonsteroidal anti-inflammatory drugs (NSAIDs), many owners seek natural therapies; either to augment the response to NSAIDs, or as a replacement. Substantial research has been directed to investigation of novel therapies. A randomized, double-blinded, controlled study was conducted to assess the efficacy of a herbal remedy for treatment of canine osteoarthritis pain. Client-owned dogs (N = 24) with osteoarthritis were enrolled between 2 veterinary hospitals. Each dog underwent veterinary and owner assessment at 0, 4, and 8 weeks, using the Canine Brief Pain Inventory and Hudson activity scale. Blood was collected for a complete blood (cell) count (CBC) and serum chemistry analysis. The product was deemed to be safe and well-tolerated at the manufacturer recommended dosage, with no significant changes seen in the CBC or serum biochemical analyses. Aside from1 dog that developed gastrointestinal upset, all other dogs tolerated the supplement without complication. The supplement did not statistically improve clinical signs in dogs based on veterinary or owner assessments of lameness. There was a treatment/time effect when assessing veterinary pain scores; however, post-hoc analysis suggests no observable benefit of treatment compared with the placebo group at any time point.     

Advances in total joint replacement in small animals

Total joint replacement is now considered a routine surgical option for small animals with advanced joint disease. This review highlights the current state of the art in total hip, elbow and knee replacement in small animals, as well as the potential for application to other joints such as the intervertebral discs, hock and shoulder. Advances in cementless fixation, the use of less-invasive, bone-sparing procedures, and the development of custom implant options for revision surgery and oncologic reconstruction will be discussed. As growth in this field continues, it is important that future developments in total joint replacement are built on a foundation of detailed laboratory evaluation of new implant designs and surgical techniques, objective assessment of clinical outcomes, and a comprehensive, coordinated retrieval program that evaluates both well-functioning and failed joint replacements.     

Treatment of osteoarthritis of the femoro-tibial joint of the dog by synovectomy and debridement, and repair of the ruptured anterior cruciate ligament

Surgical treatment of fourteen cases of acute degenerative joint disease (osteoarthritis) of the femorotibial joint of dogs is described. In nine cases the arthritic disease was accompanied by a ruptured cruciate ligament. Surgery consisted of synovectomy and debridement of the stifle joint and, where appropriate, replacement of the anterior cruciate ligament. During a follow-up period varying from 3 months to three and a half years excellent results were recorded in ten of the fourteen cases.     

Surgical osteochondral defect repair in the horse—a matter of form or function?

Focal cartilaginous and osteochondral lesions can have traumatic or chondropathic degenerative origin. The fibrocartilaginous repair tissue that forms naturally, eventually undergoes fibrillation and degeneration leading to further disruption of joint homeostasis. Both types of lesion will therefore eventually lead to activity-related pain, swelling and decreased mobility and will frequently progress to osteoarthritis. Most attempts at realising cartilage regeneration have so far resulted in cartilage repair (and not regeneration). The aim of this article was to review experimental research on surgical cartilage restoration techniques performed so far in equine models. Currently available surgical options for treatment of osteochondral lesions in the horse are summarised. The experimental validity of equine experimental models is addressed and finally possible avenues for further research are discussed.     

Semen collection techniques.

Semen collection techniques in the stallion have evolved considerably over the last 70 to 80 years and are used today primarily for artificial insemination. Semen can be collected from stallions that are otherwise unable to breed, allowing continued use of valuable animals. There are many options for collection of semen from stallions that present with ejaculatory dysfunction (see the article by McDonnell elsewhere in this issue.) Although there are many advantages to the use of artificial breeding, the collector must understand each step of the collection procedure as well as stallion preferences and proper use of an artificial vagina and mount source so that a representative semen sample is collected.     

Complementary and alternative veterinary medicine and gastrointestinal disease

Gastrointestinal, hepatic, and pancreatic diseases provide a significant challenge to the veterinary practitioner. Specific causes and effective therapies can be elusive and sometimes frustrate both the animal caretaker and the veterinarian. The therapeutic options of a conventional veterinary practice are frequently limited and may come down to a decision of which is worse: the disease or the side effects of the treatment. This article provides information for the veterinary practitioner to consider for expanding his/her options. Acupuncture, herbal remedies, and homeopathy are not newly discovered modalities. They are old practices that are getting a fresh look from Western medicine as we seek new ways to better serve our patients and clients. The goal of this article is to provide the reader with many ideas and sufficient solid information to consider the use of these options. Specific therapies are suggested for numerous gastrointestinal and liver problems. Many of these may be used in conjunction with conventional therapies to aid in the healing process.     

The canine stifle

Cranial cruciate ligament (CCL) injury is a leading cause of lameness in dogs. Recent advances in diagnostic visualization and surgical treatments for CCL injury have stimulated an increased emphasis on early clinical recognition and an early return to function. Many surgical treatments have been described that aim to restore stifle joint stability and minimize the progression of osteoarthritis. Major advances have occurred not only in the treatment of CCL injury, but also in postoperative recovery, specifically, rehabilitation therapy. The benefits of rehabilitation therapy following CCL surgery are multifaceted including pain relief, decreased inflammation and swelling, increased tissue flexibility, strengthening, improved proprioception, improved limb and joint biomechanics, and improved weight-bearing. In this article, we introduce a variety of rehabilitation therapy options for postoperative CCL patients including modalities, manual therapy, therapeutic exercise, and the benchmarks for a full return to function.     

What is the Evidence of Hyaluronic Acid and Polyacrylamide Hydrogel in Intra-articular Therapy in Equines? Systematic Literature Review

A systematic review was conducted to investigate evidence to support or refute the use of hyaluronic acid and polyacrylamide hydrogel as intra-articular therapy in equines, which are frequent treatment options in the routine of veterinarians of equines in cases of osteoarthritis. In total, 19 studies were included, among clinical and in vitro studies, as well as a retrospective series of cases. The outcomes of the included studies provided fragile evidence supporting the recommendation for intra-articular use of hyaluronic acid. No study was included showing any clinical outcome in diseased synovial tissues of the polyacrylamide hydrogel. There is no concrete evidence of benefits, treatment protocols, and mechanisms of action of hyaluronic acid in the joint therapy in equines.     

Meloxicam and surgical denervation of the coxofemoral joint for the treatment of degenerative osteoarthritis in a Bengal tiger (Panthera tigris tigris).

An adult male white Bengal tiger (Panthera tigris tigris) with pronounced atrophy of the pelvic musculature was diagnosed with degenerative osteoarthritis of the coxofemoral joints. Initial management with the nonsteroidal anti-inflammatory drug meloxicam and a semisynthetic sodium pentosan polysulfate resulted in clinical improvement and radiographic stabilization of the arthritic condition over several months. However, because pain was still evident, bilateral denervation of the coxofemoral joints was performed, successfully ameliorating the signs of osteoarthritic pain in the tiger. Meloxicam has shown good clinical efficacy for the treatment of osteoarthritis and other painful conditions in large felids. Coxofemoral joint denervation offers many advantages for the treatment of osteoarthritis in exotic carnivore species, and should be considered a viable treatment modality.     

Genetic and economic analyses of female replacement rates in the dam-daughter pathway of a hierarchical swine breeding structure.

A stochastic life-cycle swine production model was used to study the effect of female replacement rates in the dam-daughter pathway for a tiered breeding structure on genetic change and returns to the breeder. Genetic, environmental, and economic parameters were used to simulate characteristics of individual pigs in a system producing F1 female replacements. Evaluated were maximum culling ages for nucleus and multiplier tier sows. System combinations included one- and five-parity alternatives for both levels and 10-parity options for the multiplier tier. Yearly changes and average phenotypic levels were computed for performance and economic measures. Generally, at the nucleus level, responses to 10 yr of selection for sow and pig performance in five-parity herds were 70 to 85% of response in one-parity herds. Similarly, the highest selection responses in multiplier herds were from systems with one-parity nucleus tiers. Responses in these were typically greater than 115% of the response for systems with the smallest yearly change, namely, the five-parity nucleus and five- and 10-parity multiplier levels. In contrast, the most profitable multiplier tiers (10-parity) had the lowest replacement costs. Within a multiplier culling strategy, rapid genetic change was desirable. Differences between systems that culled after five or 10 parities were smaller than differences between five- and one-parity multiplier options. To recover production costs, systems with the lowest returns required 140% of market hog value for gilts available to commercial tiers, whereas more economically efficient systems required no premium.     

Identification of interleukin-1 in equine osteoarthritic joint effusions

Interleukin-1 (IL-1) is a protein secreted by stimulated cells of the monocyte-macrophage line, which has a number of important biologic activities. Interleukin-1 has been implicated in the induction and augmentation of the pathologic processes involved in arthritis and articular cartilage destruction. Horses develop osteoarthritis with a frequency and degree of severity similar to human beings. To further document the similarity of the osteoarthritic process in people and horses, the synovial fluid from 5 horses with clinical osteoarthritis was tested for IL-1 bioactivity. Interleukin-1 activity was found in all tested synovial fluids. Upon column chromatography, the synovial fluid-derived factor had a molecular weight consistent with that of IL-1 in other mammalian species. Ion exchange chromatography of osteoarthritic synovial fluid revealed the principal peaks of bioactivity to be in the fractions with isoelectric points of 7.2, 5.4, and 4.7, which are characteristic of IL-1. A considerable degree of homology between human and equine IL-1 was demonstrated by the cross hybridization of human IL-1 beta cDNA probe with RNA derived from IL-1-producing equine adherent monocytes. These results indicate that equine IL-1 is in all of the osteoarthritic equine joints tested and that equine IL-1 has many of the characteristics of IL-1 isolated from other species.     

Inherited Disorders of Hemostasis in Dogs and Cats

Inherited disorders of hemostasis encompass abnormalities in primary hemostasis, coagulation, and fibrinolysis resulting from genetic mutations. There is significant variation in the phenotype expressed ranging from life limiting to the absence of overt clinical signs. Von Willebrand disease is the most common primary hemostatic disorder in dogs, and hemophilia A is the most common coagulation factor disorder. The diagnosis of inherited bleeding disorders is made by functional and/or quantitative evaluation. Genetic testing has added to the knowledge base, allowing prevention through targeted breeding. Avoidance of trauma and injury is paramount in the prevention of bleeding in animals diagnosed with inherited hemostatic disorders. Current therapeutic options include platelet transfusions, broad replacement of coagulation factors (e.g., plasma), targeted factor replacement (e.g., cryoprecipitate), antifibrinolytic agents and specific factor replacement, and treatment of the symptoms (i.e., bleeding) with blood transfusions.     

Principles of treatment for osteosarcoma

Canine osteosarcoma accounts for 5% to 6% of all canine malignancies. A thorough workup is recommended to help clients make an educated decision about treatment options. Patients should be screened for concurrent diseases and early metastasis, as part of the diagnostic workup. Diagnostic techniques have improved to allow for more biopsy options. Once osteosarcoma is confirmed, there are many treatment options, both definitive and palliative, which can be offered to an owner. Amputation is no longer the only option that we can offer as treatment. Limb-sparing surgeries have become more common, and techniques in chemotherapy have significantly improved the median survival time in patients. Even if surgery is not an option, there are alternatives available to provide pain control and good quality of life. It is important to be versed in all the options to provide clients with the best possible recommendations.     

Non-pharmacological treatment options for refractory epilepsy: An overview of human treatment modalities and their potential utility in dogs

Refractory epilepsy is a common disorder both in humans and dogs and treatment protocols are difficult to optimise. In humans, different non-pharmacological treatment modalities currently available include surgery, the ketogenic diet and neurostimulation. Surgery leads to freedom from seizures in 50–75% of patients, but requires strict patient selection. The ketogenic diet is indicated in severe childhood epilepsies, but efficacy is limited and long-term compliance can be problematic. In the past decade, various types of neurostimulation have emerged as promising treatment modalities for humans with refractory epilepsy. Currently, none of these treatment options are used in routine daily clinical practice to treat dogs with the condition. Since many dogs with poorly controlled seizures do not survive, the search for alternative treatment options for canine refractory epilepsy should be prioritised. This review provides an overview of non-pharmacological treatment options for human refractory epilepsy. The current knowledge and limitations of these treatments in canine refractory epilepsy is also discussed.     

Comparison of radiographic osteoarthritis scores in dogs less than 24 months or greater than 24 months following tibial plateau leveling osteotomy

Radiographic osteoarthritis scores were determined in 60 dogs up to 3 years following tibial plateau leveling osteotomy. Radiographs taken immediately following surgery and at long-term follow-up 1 to 3 years later were evaluated by 2 certified radiologists using a modified 32-point osteoarthritis scale. Changes in osteoarthritis scores were evaluated by paired t-tests and regression analysis. Sub-groups of dogs were formed to evaluate if osteoarthritis scores changed differently for follow-up periods of < 24 months compared with those > 24 months. There was a significant increase in osteoarthritis score from post-operative to follow-up evaluations for all dogs studied. Regression analysis of the relationship of months after surgery to change in osteoarthritis score was not significant. These results indicate that osteoarthritis did progress following tibial plateau leveling osteotomy, but not in a linear fashion over time.     

Cementless Total Hip Replacement in an Alpaca

Objective— To report management of a chronic slipped capital femoral epiphysis (SCFE) in an alpaca using cementless total hip replacement (THR).
Study Design— Case report.
Animal— An 18-month-old, 47 kg alpaca male.
Methods— Cementless THR was performed in an alpaca with a chronic, right SCFE, and secondary osteoarthritis. Force plate gait analysis was performed before and 8 weeks after surgery. Outcome was determined through clinical evaluation, radiography, and force plate gait analysis.
Results— Cementless THR resulted in marked improvement in the alpaca's comfort level, degree of lameness, and range of motion. On preoperative force plate gait analysis there was decreased contact time ( P =.01) and vertical impulse ( P <.01) of the affected limb, whereas at 8 weeks postoperatively significant differences in gait analysis between pelvic limbs were not apparent.
Conclusion— THR using a BioMedtrix^® canine cementless modular prosthesis restored hip function in an alpaca with coxofemoral osteoarthritis from chronic SCFE.
Clinical Relevance— THR may be an appropriate treatment for selected traumatic and degenerative conditions of the coxofemoral joint in alpacas.     

Canine total knee replacement performed due to osteoarthritis subsequent to distal femur fracture osteosynthesis. Two-year objective outcome

A 27-kg German Shorthaired Pointer was referred for evaluation due to the complaint of left pelvic limb lameness and signs of pain in the left stifle joint. Radiographs revealed signs of a healed supracondylar femoral fracture that had been previously repaired at another hospital with an intramedullary pin and two cross pins. In addition, there were signs of severe osteoarthritis (OA). The OA had been managed medically with administration of carprofen and nutraceuticals for nine months without any improvement. Left total knee replacement (TKR) surgery was performed to alleviate signs of pain. The patient was assessed preoperatively and at six months, one year, and two years after surgery using radiology, force platform analysis of gait, thigh circumference measures, goniometry, and lameness evaluation. Following surgery, the dog resumed normal activity without any signs of pain and a good quality of life at 3.5 months. Force plate analysis found that peak vertical force on the TKR limb was 85.7% of the normal contralateral limb after two years. Total knee replacement was a successful treatment to manage knee OA associated with a healed distal femoral fracture and internal fixation in this dog.     

New surgical treatments for osteochondritis dissecans and subchondral bone cysts.

Osteochondritis dissecans (OCD) and subchondral bone cysts (SBCs) occur commonly and at many different locations in equine limbs and can lead to secondary osteoarthritis when left untreated.Depending on the location and extent of the lesion, arthroscopic surgical debridement may be an effective treatment for returning a horse to athletic soundness. In many cases, however, additional techniques to improve the healing response in bone and cartilage are needed so as to preserve articular function. Methods for improving cartilage repair (ie, restoration of damaged cartilage)or regeneration (ie, reformation or recreation of new articular cartilage) in select cases of OCD and SBCs are discussed.