Triple Pelvic Osteotomy and Double Pelvic Osteotomy

Osteoarthritis, adipokines and the translational research potential in small animal patients

Osteoartritis (OA) is a debilitating disease affecting both humans and animals. In the early stages, OA is characterized by damage to the extracellular matrix (ECM) and apoptosis and depletion of chondrocytes. OA progression is characterized by hyaline cartilage loss, chondrophyte and osteophyte formation, thickening of the joint capsule and function loss in the later stages. As the regenerative potential of cartilage is very limited and osteoarthritic changes are irreversible, prevention of OA, modulation of existing osteoarthritic joint inflammation, reducing joint pain and supporting joint function are the only options. Progression of OA and pain may necessitate surgical intervention with joint replacement or arthrodesis as end-stage procedures. In human medicine, the role of adipokines in the development and progression of OA has received increasing interest. At present, the known adipokines include leptin, adiponectin, visfatin, resistin, progranulin, chemerin, lipocalin-2, vaspin, omentin-1 and nesfatin. Adipokines have been demonstrated to play a pivotal role in joint homeostasis by modulating anabolic and catabolic balance, autophagy, apoptosis and inflammatory responses. In small animals, in terms of dogs and cats, naturally occurring OA has been clearly demonstrated as a clinical problem. Similar to humans, the etiology of OA is multifactorial and has not been fully elucidated. Humans, dogs and cats share many joint related degenerative diseases leading to OA. In this review, joint homeostasis, OA, adipokines and the most common joint diseases in small animals leading to naturally occurring OA and their relation with adipokines are discussed. The purpose of this review is highlighting the translational potential of OA and adipokines research in small animal patients.

Kinetic and Radiographic Outcomes of Unilateral Double Pelvic Osteotomy in Six Dogs

OBJECTIVE

 The aim of this study was to assess the kinetic and radiographic outcome of unilateral double pelvic osteotomy (DPO) using a temporospatial pressure walkway, preoperative and postoperative radiographs.

STUDY DESIGN

 Retrospective case series of six dogs that underwent unilateral DPO for canine hip dysplasia. The untreated limb was unfit for DPO due to radiographic evidence of osteoarthritis and was therefore managed non-surgically. Preoperative and postoperative radiographs and kinetic data were compared between untreated and DPO-treated hips using a Wilcoxon signed-rank test.

RESULTS

 There was no significant difference in British Veterinary Association Hip Dysplasia Scheme (BVA-HD) scores between untreated and DPO-treated hips preoperatively (p-value = 0.09) and postoperatively (p-value = 0.06). The median postoperative GAIT4 Dog Lameness Score was lower in untreated hips than DPO-treated hips but was not statistically different (p-value = 0.18).

CONCLUSIONS

 All dogs in this case series achieved a total pressure index and GAIT4 Dog Lameness Score on the DPO-treated hip comparable to normal limbs. All untreated hips in this series had increased BVA-HD scores at follow-up, whereas all DPO-treated hips had reduced BVA-HD scores. This difference was not significant and warrants further studies. We conclude total pressure index may be preserved in hips treated with unilateral DPO, while the contralateral hip is managed non-surgically.

Acetabular rim extension using a personalized titanium implant for treatment of hip dysplasia in dogs: short-term results

Hip dysplasia (HD) is a common orthopedic problem in young dogs. To decrease the laxity of the hip joint related to HD, the surgical treatments are recommended to increase femoral head coverage. ACEtabular rim eXtension (ACE-X) using a personalized 3-dimensional printed titanium shelf implant is a new surgical treatment to increase femoral head coverage and decrease laxity of the dysplastic hip joint, however, the efficacy is less know. Client-owned dogs older than 6 months with clinical signs of coxofemoral joint subluxation and radiographic evidence of HD with no or mild osteoarthritis (OA) were included. The Norberg angle (NA), linear percentage of femoral head overlap (LFO), and percentage of femoral head coverage (PC) were investigated radiographically and with computed tomography (CT) before and after surgery. OA was graded (scores 0-3) according to the maximum osteophyte size measured on CT. In addition, joint laxity (Ortolani) test results, gait analysis, and the Helsinki chronic pain index (HCPI) questionnaire were obtained at preoperative, immediately postoperative and at 1.5- and 3-month evaluations. Acetabular rim extension was performed in 61 hips of 34 dogs; NA, LFO, and PC were significantly higher immediately postoperatively and at the 1.5- and 3-month follow-up examinations compared with preoperative values (p < 0.05). Osteophyte size gradually increased over time (p < 0.05). The OA score significantly increased between preoperatively and directly postoperatively, and between preoperatively and at 3-month follow-up (p < 0.05). The laxity test normalized in 59 out of 61 hips after surgery, and the HCPI questionnaire showed that the pain score decreased significantly at 1.5 and 3 months, postoperatively. The force plate showed no significant improvement during the 3 months follow-up. Although pain reduction by the implant was unclear in short-term results, a personalized shelf implant significantly increased femoral head coverage and eliminated subluxation of the dysplastic hip joint. Further studies are required to study the long-term efficacy of gait, chronic pain, and progression of osteoarthritis.

Evaluation of the Iatrogenic Sciatic Nerve Injury following Double Pelvic Osteotomy Performed with Piezoelectric Cutting Tool in Dogs

(1) Background: The double pelvic osteotomy (DPO) is a prophylactic surgical procedure associated with 0.4% incidence of sciatic nerve injury. The piezoelectric cutting tool is a surgical device able to involve only mineralized tissue avoiding neurovascular tissue and other soft tissue. This study aimed to evaluate the sciatic nerve injury observed in dogs underwent iliac osteotomy performed using the piezoelectric cutting tool. (2) Methods: Dogs underwent DPO performed with piezoelectric cutting tool were included. Neurological assessment was performed 6 and 24 h after surgery and then repeated 12 days, 4 and 8 weeks after surgery. Temporary and or permanent sciatic nerve injury were recorded. (3) Results: 84 DPOs performed in fifty dogs were included. No temporary/permanent neurological disease associated with iatrogenic damage of the sciatic nerve were observed. (4) Conclusions: The iliac osteotomy performed with piezoelectric cutting tool was not associated to iatrogenic sciatic nerve injury.

Clinical outcomes of double pelvic osteotomies in eight dogs with hip dysplasia aged 10-28 months

OBJECTIVE

To report the short-term outcome of double pelvic osteotomy (DPO) in dogs with canine hip dysplasia ≥10 months of age.

STUDY DESIGN

Case series.

ANIMALS OR SAMPLE POPULATION

Eleven hips in eight dogs aged between 10 to 28 months.

METHODS

Dogs clinically affected by hip dysplasia with a hip reduction angle <40°, subluxation angle <25°, dorsal acetabular rim angle between 7.5-25°, and minimal osteoarthritic changes were considered as candidates for DPO. The clinical outcome was subjectively assessed using a lameness score and pain scale upon hip extension. Norberg angle, percentage of the area of the femoral head coverage, percentage of linear femoral head coverage, pelvic width dimensions were measured on pre and postoperative radiographs.

RESULTS

At the 8-week follow-up examination, all the dogs had no lameness with no pain upon hip extension. Median Norberg angle increased by 21.8% (p < .01), median percentage of the area of the femoral head coverage increased by 66.7% (p < .01) and percentage of linear femoral head coverage increased by 162.5% (p < .01) 1 year after DPO. No changes to pelvic canal width after DPO were detected.

CONCLUSION

Double pelvic osteotomy improved joint congruity and clinical signs in dogs affected by hip dysplasia without osteoarthritis that were ≥10 months of age.

CLINICAL SIGNIFICANCE (OR IMPACT)

Double pelvic osteotomy may be a treatment option for dogs with hip dysplasia ≥10 months of age. A large study assessing long-term outcomes is indicated.

Triple pelvic osteotomy with a 12.5° and a 20° Slocum-type plate: A short-term prospective clinical pilot study in 38 dogs

OBJECTIVE

To determine whether using 12.5° Slocum-like triple pelvic osteotomy (TPO) plates would create sufficient femoral head coverage and lower the occurrence of overrotation compared with using 20° TPO plates in dogs with hip dysplasia.

STUDY DESIGN

Prospective clinical study.

SAMPLE POPULATION

Thirty-five dogs with hip dysplasia (38 hips).

METHODS

Nineteen hips were surgically treated with a custom-made Slocum-type 12.5° TPO plate, and these were matched to 19 hips surgically treated with a 20° commercial Slocum TPO plate. Hips were case matched according to size and breed. Ortolani sign, angles of subluxation and reduction, distraction index, and femoral head coverage (FHC) were compared between groups. Excessive coverage was defined as >80%.

RESULTS

In the 12.5° group, FHC was ≥50% in all hips, with mean FHC (67%), gain (37%), and excessive coverage (11%) all significantly less than in the 20° group (79%, 54%, and 42%, respectively).

CONCLUSION

The 12.5° plate produced sufficient FHC compared with the 20° plate, with fewer hips with excessive coverage.

CLINICAL SIGNIFICANCE

The 12.5° TPO plate may result in sufficient FHC with a lower occurrence of excessive coverage compared with 20° plates.

Assessment of the medium- to long-term radiographically confirmed outcome for juvenile dogs with hip dysplasia treated with double pelvic osteotomy

OBJECTIVE

To assess the medium- to long-term radiographically confirmed outcomes in juvenile dogs with hip dysplasia (HD) that did and did not undergo double pelvic osteotomy (DPO).

STUDY DESIGN

Retrospective case-controlled.

ANIMALS

Twenty-six dogs with HD that were candidates for DPO; 22 dogs underwent DPO (16 bilateral, six unilateral); four dogs did not.

METHODS

Initial and follow-up radiographs of DPO candidates (2011-2017) that did and did not undergo surgery were reviewed, and the British Veterinary Association and Kennel Club Hip Dysplasia Scheme score (BVA-HD), osteoarthritis score (OAS) and laxity index score (LI) were determined. Baseline and follow-up BVA-HD, OAS, and change in radiographically confirmed scores were compared by using analysis of variance for correlated samples.

RESULTS

There was no significant difference in BVA-HD or OAS between surgically treated and nonsurgically treated cohorts at baseline. Follow-up radiographs (median, 49 months) revealed that most (34/38) hips had a BVA-HD ≤10 after DPO, while four of eight hips from the nonsurgical cohort had BVA-HD >10. Follow-up BVA-HD and OAS were lower in hips after surgery (BVA-HD median 2.15, interquartile range [Q1-Q3] 1.3-4.1; OAS median 1.9, Q1-Q3 1.1-4.1) compared with the nonsurgically treated cohort (BVA-HD median 11.4, Q1-Q3 8.1-17.5, P < .01; OAS median 7.0, Q1-Q3 5.1-13.4, P < .01). Seven hips with an LI >1 had no radiographically confirmed progression of osteoarthritis after DPO.

CONCLUSION

Double pelvic osteotomy prevented radiographically confirmed progression of osteoarthritis in the medium- to long-term. Laxity index score > 1 was not a contraindication for DPO in this study.

CLINICAL SIGNIFICANCE

Double pelvic osteotomy prevents progression of radiographically confirmed features of osteoarthritis in juvenile dogs with HD.

Antegrade and retrograde CT urethrography with virtual urethroscopy in a dog with urethral narrowing after bilateral triple pelvic osteotomy

An 8-month-old, castrated male Golden Retriever was unable to urinate without catheterization after a single-session bilateral triple pelvic osteotomy. To determine the cause, a retrograde urethrography was performed, but the results were equivocal. Antegrade (voiding by abdominal compression with heavy material) and retrograde CT urethrography were performed with virtual urethroscopy and revealed that the urethral diameter was narrowed near the pubic bone remnants due to pelvic canal narrowing. After corrective surgery, the patient was able to urinate normally. A combination of antegrade and retrograde CT urethrography with virtual urethroscopy was helpful for guiding surgical decision-making in this patient.