Transcript POOR CONFORMATION: HIP DYSPLASIA

POOR CONFORMATION: HIP DYSPLASIA
YOUNG DOGS 5-8 mos AND MATURE
ANIMALS WITH CHRONIC
DISEASE
POOR CONFORMATION: HIP DYSPLASIA
POOR CONFORMATION: HIP DYSPLASIA
Acetabular vs.
Femoral hip
dysplasia
Poor conformation combined with genetic, environmental and nutritional factors
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
ventrodorsal view of the pelvis with rear limbs extended symmetrically and
rotated inward to center the patellae over the trochlear grooves
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.
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 24 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 patients
A, 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 TREATMENT
TRIPLE PELVIC OSTEOTOMY
HIP DYSPLASIA TREATMENT
FEMORAL HEAD OSTECTOMY
“False joint” forms from scar/fibrous tissue
HIP DYSPLASIA TREATMENT
artreality.com
www.kahalapethospital.com/yahoo_site_
admin/as...
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
YOUNG, SMALL BREEED DOGS
http://www.youtube.com/watch?v=_vvtprqhyoI
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 INTO
BONE RESULTS IN THICKENED CARTILAGE THAT IS PRONE TO INJURY
OSTEOCHONDRITIS DISSECANS
CARTILAGE FLAP OF THE SCAPULOHUMERAL
JOINT 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
PANOSTEITIS
1. PELVIS
2. LESIONS OF PANOSTEITIS
3. FEMUR
INFLAMMATION IN THE MARROW
CAVITIES OF LONG BONES THAT LEADS
TO PAIN, LAMENESS, AND FEVER
PANOSTEITIS
INCREASED MEDULLARY OPACITY
PANOSTEITIS
TREATMENT OF PANOSTEITIS INCLUDES
NSAIDS AND CAGE REST
THIS DISEASE IS SELF-LIMITING AND HAS A GOOD PROGNOSIS!
LUXATIONS
HX OF TRAUMA, ACUTE LAMENESS, NON WEIGHT BEARING, POSSIBLE
SWELLING OVER THE HIP
LUXATIONS
CRANIODORSAL LUXATION IS THE
MOST COMMON TYPE
LUXATIONS
THE EHMER SLING IS USED AFTER CLOSED REDUCTION OF THE LUXATED
HIP JOINT; THE DOG SHOULD BE CONFINED FOR 7-10 DAYS
LUXATIONS
TUMORS OF THE BONE
MOST COMMON IN LARGE BREED
MALE DOGS OLDER THAN 7 YRS OF
AGE
THE DISTAL RADIUS IS THE MOST
COMMON LOCATION
TUMORS OF THE BONE
85%-90% OF BONE CANCER IN DOGS IS OSTEOSARCOMA
TUMORS OF THE BONE
OSTEOSARCOMA TENDS TO OCCUR AWAY FROM
THE 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 LIMB
ALONG 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