Conservative and medical management of hip dysplasia

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.

Evaluation of the dorsal acetabular coverage obtained by a modified triple pelvic osteotomy (2.5 pelvic osteotomy): an ex vivo study on a cadaveric canine codel

OBJECTIVES

To evaluate the acetabular ventroversion obtained with a modified triple pelvic osteotomy (2.5 PO) compared with that resulting from standard double pelvic osteo-tomy (DPO).

STUDY DESIGN

Ex vivo study.

ANIMALS

Seven pelves obtained from skeletally mature dogs with a total body weight ranging from 26-41 kg were used.

METHODS

Unilateral DPO technique and dorsal ischial mono-cortical osteotomy were performed on every right hemipelvis. Angular ventral rotation was measured by determining the relative orientation of two Kirschner wires placed in the ilial wing and in the dorsal acetabular rim.

RESULTS

The mean angle of ventroversion was 9.5 ± 5.2 degrees for the DPO group (range 2.1-18.1) and 10.9 ± 4.8 degrees for the 2.5 PO group (range 4.1-19.5). The mean difference between the 2.5 PO and DPO was 1.5 ± 0.6 degrees (range 0.5-2.1).

CONCLUSIONS

The 2.5 PO technique increased acetabular ventroversion versus DPO.

Canine hip dysplasia: reviewing the evidence for nonsurgical management

OBJECTIVE

To systematically review the evidence available for nonsurgical management of hip dysplasia (HD).

STUDY DESIGN

Literature review.

METHODS

Databases (Pubmed, Veterinary Information Network) were searched for clinical studies on nonsurgical management of HD in dogs. The evidence in each study was reviewed and assigned a score (I-IV) based on previously reported levels of evidence.

RESULTS

Fourteen articles were identified that met the inclusion criteria, including 3 Level IV, 4 Level III, and 7 Level II studies. Methods of nonsurgical management reviewed included: activity restrictions, weight management, acupuncture, modulation of joint disease by polysulfated glycosaminoglycans, mesenchymal stem cell therapy, and extra corporeal shock wave therapy.

CONCLUSION

Weight management is an effective and important component of managing dogs with HD and associated osteoarthritis. Techniques that modulate the progression of joint disease may also be beneficial for treating dogs with HD. Further studies are needed to investigate other methods of managing HD such as hydrotherapy and physical rehabilitation.

Early hip laxity examination in predicting moderate and severe hip dysplasia in Estrela mountain dog

OBJECTIVES

To determine the reliability of early passive hip laxity examination in predicting moderate and severe hip dysplasia.

METHODS

The passive hip laxity of 104 Estrela Mountain dogs was evaluated using the Ortolani method, conventional hip-extended radiography and the PennHIP method, when the animals were between four and 12 months of age. After the age of one, dogs were re-examined for hip dysplasia using the Fédération Cynologique Internationale scoring system. The passive hip laxity results were subsequently compared with the Fédération Cynologique Internationale scores for sensitivity, specificity, positive predictive value, negative predictive value and accuracy.

RESULTS

The PennHIP method achieved the best results in specificity (93 per cent), positive predictive value (91 per cent) and accuracy (88 per cent), and the Ortolani method was the best in sensitivity (92 per cent) and negative predictive value (92 per cent).

CLINICAL SIGNIFICANCE

The Fédération Cynologique Internationale grades D and E can be predicted with confidence even before animals are one year old.

Effect of carprofen on hemostatic variables in dogs

OBJECTIVE

To evaluate the effect of carprofen on hemostatic variables in clinically normal dogs.

ANIMALS

12 clinically normal Labrador Retrievers.

PROCEDURE

10 dogs (6 females, 4 males) received carprofen (2.2 mg/kg of body weight, PO, q 12 h) for 5 days. Two dogs (untreated control group; 1 female, 1 male) did not receive carprofen. Hemostatic variables (platelet count, activated partial thromboplastin time, prothrombin time, fibrinogen, platelet aggregation, and bleeding time) were assessed for all dogs prior to treatment, on day 5 of treatment, and 2 and 7 days after discontinuation of the drug (days 7 and 12). Serum biochemical variables and Hct were assessed prior to treatment and on days 5 and 12.

RESULTS

In dogs receiving carprofen, platelet aggregation was significantly decreased, and onset of aggregation was significantly delayed on days 5, 7, and 12, compared with pretreatment values. Activated partial thromboplastin time was significantly increased on days 5, 7, and 12 over pretreatment values in treated dogs, but values remained within reference ranges. Significant differences were not detected in buccal mucosal bleeding time, other serum biochemical and hemostatic variables, or Hct, compared with pretreatment values and the internal control group.

CONCLUSIONS AND CLINICAL RELEVANCE

Administration of carprofen for 5 days causes minor but not clinically important alterations in hemostatic and serum biochemical variables in clinically normal Labrador Retrievers. Carprofen is commonly used to treat osteoarthritis and chronic pain in dogs, but prior to this study, its effect on platelet aggregation and hemostatic variables was unknown.

Effect of public symphysiodesis on pelvic development in the skeletally immature greyhound

OBJECTIVE

To evaluate the effect of pubic symphysiodesis (PS) on pelvic development in skeletally immature dogs.

STUDY DESIGN

Prospective randomized clinical trial.

ANIMALS

Eight 4 month-old, sexually intact female Greyhounds.

METHODS

Initial PS was performed at 4 months of age using a powered stapling device. Because of failure of the initial surgery, a second PS was performed 1 month later by resecting the pubic symphysis with a rongeur followed by placement of handmade bone staples in four dogs. Sham PS was performed in four control dogs at 4 months of age. Pubic growth rate and pelvic development were evaluated using standard plane radiography and computed tomography. Specific measurements included acetabular ventroversion, Norberg angle, lateral center-edge angle, and pelvic inlet dimensions. Hip distraction indices were determined as well.

RESULTS

PS at 4 months of age using a stapling device failed. Pubic symphysiodesis using hand made staples was successful at 5 months of age and did not result in any clinically significant intraoperative or postoperative complications. Pubic symphysiodesis markedly decreased pubic symphysis growth in the treatment group. Hip distraction indices and pelvic inlet circumference, area, and width significantly decreased in treated dogs compared to those in the control group. Acetabular ventroversion was significantly increased in treated dogs compared to those in the control group.

CONCLUSIONS

PS decreases pelvic canal size, increases acetabular ventroversion, and does not appear to have any clinically significant complications.

CLINICAL RELEVANCE

PS performed in skeletally immature dogs with hip dysplasia may provide an effect similar to a triple pelvic osteotomy and warrants further investigation.

Pharmacological management of pain and infection in the surgical oncology patient

Surgical oncology patients are often high-risk patients that require careful perioperative management for a successful outcome. Prophylactic antibiotics are needed to prevent infection in tissues compromised by disease, radiation, or chemotherapy. Pain control is needed to prevent the stress response to surgery from worsening the outcome and to aid in the maintenance of patient comfort.