Conservative Management of Hip Dysplasia

Comparison of the distraction index and Norberg angle with radiographic grading of canine hip dysplasia

The Orthopedic Foundation for Animals (OFA) radiographic grading system stands as a well-established benchmark for categorizing hip dysplasia in canines. Although more objective techniques to quantify early hip laxity in young dogs, such as the Norberg angle (NA) and distraction index (DI), have been documented, there is a scarcity of published studies that directly compare these radiographic measures. The primary objectives of this prospective, analytical study were to assess and compare the NA and DI measures with OFA grades within a cohort of dogs. Thirty dogs (57 hip joints) were evaluated, with a mean age of 5.4 ± 2.9 years and a mean body weight of 34.3 ± 7.1 kg. The discriminative power of hip dysplasia for DI and NA used OFA as a reference were compared by multivariate discriminant analysis test. Using the DI (≤0.3) 12 joints were classified as normal, using NA (≥105°) 24 joints and using OFA (≤3) 29. When comparing the discriminant power of NA with OFA resulting similar (P = .8324) with correct classifications of 81% using cross validation, however, the discriminant power of dysplasia of the DI resulted significantly greater (P = .0034) than OFA with correct classifications of only 59% using cross-validation, consequently it was possible determined that of 29 patients with OFA ≤ 3, 20 had DI > 0.3. These findings demonstrated that phenotypic healthy dogs according to OFA grading can present passive hip joint laxity, as demonstrated by radiographic evaluation with distraction. Furthermore, DI can contribute to the screening of CHD when evaluated in conjunction with OFA grading.

Long-Term Effects of Whole-Body Vibration on Hind Limb Muscles, Gait and Pain in Lame Dogs with Borderline-to-Severe Hip Dysplasia-A Pilot Study

This pilot study aimed to evaluate the long-term effects of Whole-Body Vibration (WBV) on hind limb muscles, gait and pain in lame dogs with borderline-to-severe hip dysplasia. Ten lame client-owned dogs with borderline-to-severe hip dysplasia, aged from 1.5 to 9.0 years and weighing 14.5 to 53.0 kg, were enrolled. The WBV training program consisted of 15 min sessions three times weekly for 16 weeks. Muscles of the hind limbs were evaluated using measurements of thigh circumference, the cross-sectional thickness of selected hind limb muscles by ultrasound assessment, and vastus lateralis muscle activity determined by surface electromyography (EMG). Lameness and clinical signs of pain were assessed by visual lameness scoring, orthopedic examination and an owner-based questionnaire. Kinetic analysis was performed by using a pressure-sensitive walkway. Manual thigh circumference measurements of both hind limbs showed significant increases over the trial period with a greater degree of change observed after week 8. Ultrasound measurements of the left gluteal muscles and the quadriceps femoris muscles of both hind limbs showed significant increases in the cross-section thickness post WBV. Owner's perception of pain also showed a decrease in signs of pain at week 12 and week 16 compared to baseline. Based on graphs of the EMG activity patterns of the vastus lateralis muscle, 65% of the hind limbs had an improvement after 48 WBV sessions when compared to pre-session patterns. However, no significant differences were observed in visual lameness evaluation and kinetic analysis. Therefore, further studies will help to better clarify the role of WBV in canine rehabilitation protocols.

Mechanical osteoarthritis of the hip in a one medicine concept: a narrative review

Human and veterinary medicine have historically presented many medical areas of potential synergy and convergence. Mechanical osteoarthritis (MOA) is characterized by a gradual complex imbalance between cartilage production, loss, and derangement. Any joint instability that results in an abnormal overload of the joint surface can trigger MOA. As MOA has a prevailing mechanical aetiology, treatment effectiveness can only be accomplished if altered joint mechanics and mechanosensitive pathways are normalized and restored. Otherwise, the inflammatory cascade of osteoarthritis will be initiated, and the changes may become irreversible. The management of the disease using non-steroidal anti-inflammatory drugs, analgesics, physical therapy, diet changes, or nutraceuticals is conservative and less effective. MOA is a determinant factor for the development of hip dysplasia in both humans and dogs. Hip dysplasia is a hereditary disease with a high incidence and, therefore, of great clinical importance due to the associated discomfort and significant functional limitations. Furthermore, on account of analogous human and canine hip dysplasia disease and under the One Medicine concept, unifying veterinary and human research could improve the well-being and health of both species, increasing the acknowledgement of shared diseases. Great success has been accomplished in humans regarding preventive conservative management of hip dysplasia and following One Medicine concept, similar measures would benefit dogs. Moreover, animal models have long been used to better understand the different diseases' mechanisms. Current research in animal models was addressed and the role of rabbit models in pathophysiologic studies and of the dog as a spontaneous animal model were highlighted, denoting the inexistence of rabbit functional models to investigate therapeutic approaches in hip MOA.

Center of pressure and ground reaction forces in Labrador and Golden Retrievers with and without hip dysplasia at 4, 8, and 12 months of age

Canine hip dysplasia (CHD) is a common orthopedic disease. Owing to the importance of CHD in affected dogs, both clinically and for their use in breeding or work, increasing attention is being given to early diagnosis. Therefore, early clinical and radiological examination of young animals is increasingly in demand, whereas common CHD screening according to the Fédération Cynologique Internationale (FCI) is usually performed at the age of 12 months or even older in Europe. One way to objectively evaluate gait pattern is to measure the ground reaction forces (GRFs) and center of pressure (COP). In this study, we used a pressure plate to evaluate the GRF and COP parameters for 32 Labrador Retrievers and 17 Golden Retrievers at 4, 8, and 12 months of age. The dogs also underwent radiological examination of the hip joints following the FCI rules at the age of at least 12 months, which were grouped as sound (FCI grade A or B) and diseased (FCI grade C or worse). The results revealed significantly higher COP values in both breeds in the diseased limb groups at any measurement point during walking, with the most pronounced results obtained at 8 months of age. Furthermore, COP values during walking were significantly higher at 4 months than at 8 and 12 months in both the sound and diseased limb groups, indicating an increased stability of the gait pattern. Except for COP-Speed, the values of all COP parameters were higher during walking than during trotting at 4 months of age (i.e., COP-Speed was higher when trotting), indicating that the 4-beat gait in walk is more difficult to control for puppies than the 2-beat gait in trot. Overall, our results support the early evaluation of CHD in growing animals using non-invasive methods.

Psychometric properties of the Brazilian version of the Canine Brief Pain Inventory (CBPI) for dogs with clinical signs of osteoarthritis and preliminary evidence of its clinical utility

ABSTRACT This study aimed to determine the psychometric properties and clinical use of the Brazilian version of the Canine Brief Pain Inventory (CBPI) in dogs with hip dysplasia (HD). Forty-three dogs with HD and 16 clinically normal dogs were enrolled. The HD dogs were treated daily with 4.4mg/kg carprofen (GT = 21) or placebo (GP = 19), for four weeks. Owners completed the CBPI at two weeks (W-2) and immediately before the start of the treatment (W0), two (W2) and four (W4) weeks during treatment, and two weeks (W6) after the end of treatment. The internal structure was accessed, and the Cronbach’s alpha coefficient was 0.97, indicating the high internal consistency of the instrument. Principal Component Analysis (PCA) suggested the retention of one component, which accounted for 78% of the variability. The ROC curve analysis concluded that the score 3 has an excellent performance to discriminate between normal and possible HD dogs (AUC of 0.973). There was no difference between dogs treated with carprofen versus placebo. The instrument in Portuguese showed construct and criterion validity and reliability to be used in dogs with HD.

Complications associated with total hip arthroplasty in four large nondomestic felids

CASE DESCRIPTION

A 9-year-old 37-kg sexually intact male snow leopard (Panthera uncia) with no history of lameness but radiographic evidence of right femoral subluxation and flattening of both femoral heads, 2 juvenile (< 1 year old) 25-kg sexually intact male cheetahs (Acinoynx jubatus) with unilateral hind limb lameness resulting from trauma, and an 11-year-old 110-kg sexually intact female Amur tiger (Panthera tigris altaica) with a 2-year history of left hip joint osteoarthritis were examined.

CLINICAL FINDINGS

No clinically relevant clinical findings other than hip joint problems were identified. All 4 felids underwent staged bilateral (snow leopard) or unilateral (cheetahs and tiger [Panthera tigris]) total hip arthroplasty (THA).

TREATMENT AND OUTCOME

In the snow leopard, both femoral THA components were found to be luxated 1 year after surgery. Treatment consisted of autogenous corticocancellous rib graft augmentation of the dorsal acetabular rims and synthetic suture capsulorrhaphies. The snow leopard lived for an additional 4 years with no additional THA-related complications. In the other 3 animals, catastrophic complications (luxation in the cheetahs and femoral fracture in the tiger) occurred shortly after THA. The THA implants were removed, and excision arthroplasty was performed. Long-term outcomes were good in all 3.

CLINICAL RELEVANCE

Findings underscore the challenges associated with THA in large nondomestic felids. Given the high risk for early catastrophic failure as a result of luxation or fracture, plans must be made and resources must be available in case revision surgery or implant removal with excision arthroplasty becomes necessary.

Can Ultrasound Therapy Be an Environmental-Friendly Alternative to Non-Steroidal Anti-Inflammatory Drugs in Knee Osteoarthritis Treatment?

The non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs in knee OA (osteoarthritis) treatment. Despite their efficiency in pain and inflammation alleviation, NSAIDs accumulate in the environment as chemical pollutants and have numerous genetic, morphologic, and functional negative effects on plants and animals. Ultrasound (US) therapy can improve pain, inflammation, and function in knee OA, without impact on environment, and with supplementary metabolic beneficial effects on cartilage compared to NSAIDs. These features recommend US therapy as alternative for NSAIDs use in knee OA treatment.

Use of Reticulated Hyaluronic Acid Alone or Associated With Ozone Gas in the Treatment of Osteoarthritis Due to Hip Dysplasia in Dogs

This study aimed to evaluate reticulated hyaluronic acid alone or associated with ozone gas in the treatment of osteoarthritis due to hip dysplasia in dogs. Fourteen client-owned dogs were randomly assigned into two groups: Group 1—single intra-articular injection of hyaluronic acid; Group 2—single intra-articular infiltration injection of hyaluronic acid associated with ozone gas. Each hip joint received an average of 0.75 mL of reticulated hyaluronic acid ultrasound-guided. Ozone gas at a dose of 45 μg/mL was incorporated into hyaluronic acid by insufflation. Dogs were evaluated for body condition scoring, orthopedic examination and radiographic scores of the hip joints, goniometric measurements of the hip joints, visual gait score, and kinetic analysis. The evaluations were conducted immediately before treatments (M0), and at days 30 (M1), 60 (M2), and 90 (M3) after treatments. There were no significant differences in body mass and body condition scoring (5-point scale) in each group in all evaluation moments. The scores of orthopedic examination of the hip joints showed statistical differences in each group between moments (M0 > M3), but differences were not observed between groups. No statistical differences were found for radiographic scores in each group between moments, but differences were observed between groups immediately prior to treatments (G1 > G2) and 90 (G1 > G2) after treatments. Goniometric measurements of hip flexion and extension showed no significant differences in each group between moments or between groups. No statistical differences between groups were found concerning the lameness score. There were significant differences for lameness score among moments in Group 1, being M0 > M2 and M0 > M3, and Group 2 in which M0 > M1, M0 > M2, and M0 > M3. The mean percentage of change of PVF and VI between M3 and M0 in Group 1 was almost null and in Group 2 was positive, being 31.1 ± 29.4 and 10.6 ± 25.4, respectively. In conclusion, the intra-articular viscosupplementation alone or associated with ozone gas allowed improvement of lameness scores and orthopedic examination score. In Group 2 the association of ozone gas had better results on kinetic analysis.

Strategies for optimising musculoskeletal health in the 21st century

We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled "Musculoskeletal Health in the 21st Century" and held at the University of Surrey from 30th June-1st July 2015.The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.