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

Joint laxity in canine hip dysplasia assessed using the hip flexed not distracted ventrodorsal view

OBJECTIVES

The ventrodorsal hip extended standard view is conventionally used for radiographic screening of canine hip dysplasia. However, because the ventrodorsal hip extended standard view minimises hip joint laxity, several alternative views have been proposed. Our aim was to evaluate a new ventrodorsal hip flexed and not distracted view to assess joint laxity, by comparing it with the ventrodorsal hip extended standard and ventrodorsal hip flexed and distracted views.

MATERIALS AND METHODS

Between April 2013 and March 2017, all dogs referred to the University of Naples "Federico II" for the diagnosis of canine hip dysplasia were studied using the ventrodorsal hip extended standard, ventrodorsal hip flexed and not distracted and ventrodorsal hip flexed and distracted views. The Norberg angle and the laxity index were measured for each view.

RESULTS

Overall, 102 dogs, 67 males and 35 females, mean age 15 months, were included. The mean (±standard deviation) Norberg angles were 99.77° (±10.42°), 89.29° (±14.32°) and 91.80° (±13.50°) for the ventrodorsal hip extended standard, ventrodorsal hip flexed and not distracted and ventrodorsal hip flexed and distracted views, respectively. The mean (± standard deviation) laxity indices were 0.19 (± 0.14), 0.39 (± 0.25) and 0.36 (± 0.21), respectively. The ventrodorsal hip flexed and distracted and ventrodorsal hip flexed and not distracted views had lower Norberg angle and higher laxity index values compared with the ventrodorsal hip extended standard view. The ventrodorsal hip flexed and distracted and ventrodorsal hip extended standard views are in strong agreement for the measurement of both Norberg angle and laxity index, as confirmed by Bland-Altman analysis and the intraclass correlation coefficient.

CLINICAL SIGNIFICANCE

The ventrodorsal hip flexed and distracted and ventrodorsal hip flexed and not distracted views obtained with the hip in a neutral position reveal joint laxity better than the ventrodorsal hip extended standard view. Unlike the ventrodorsal hip flexed and distracted view, the ventrodorsal hip flexed and not distracted view does not require human operators or special devices for positioning the dog. The wide age range of the dogs enrolled might have influenced the laxity index measurements, since capsular fibrosis in older dogs reduces laxity.

Three-dimensional assessment of the influence of juvenile pubic symphysiodesis on the pelvic geometry of dogs

OBJECTIVE To evaluate the 3-D geometry of canine pelves and to characterize the long-term effects of juvenile pubic symphysiodesis (JPS) on pelvic geometry by comparing the pelvic configuration between littermates that did and did not undergo the procedure. ANIMALS 24 Labrador Retriever, Golden Retriever, or Labrador Retriever-Golden Retriever crossbred service dogs from 13 litters. PROCEDURES At 16 weeks old, puppies with a hip joint distraction index ≥ 0.5 were randomly assigned to undergo thermal JPS (n = 9), mechanical JPS (7), or a sham (control) surgical procedure (8). Ten years later, each dog underwent a CT scan of the pelvic region. Modeling software was used to create 3-D reconstructions from the CT scans, and various pelvic measurements were made and compared among the 3 treatments. RESULTS Compared with the control treatment, thermal and mechanical JPS increased the hemipelvis acetabular angle by 4°, the acetabular angle of lateral opening by 5°, and the orientation of the medial acetabular wall in a transverse plane by 6°, which indicated that JPS increased dorsal femoral head coverage by the acetabulum. Both JPS procedures decreased the pelvic canal area by approximately 20% and acetabular inclination by 6° but did not alter acetabular retroversion. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that thermal and mechanical JPS were equally effective in altering the 3-D pelvic geometry of dogs. These findings may help guide future studies of alternatives for optimizing canine pelvic anatomy to minimize the risk of hip dysplasia and associated osteoarthritis.

Morphometric assessment of hip dysplasia in a cat treated by juvenile pubic symphysiodesis

Objective: To quantitatively evaluate the change of the coxofemoral joints using computed tomography and distraction index in a cat with hip dysplasia treated by juvenile pubic symphysiodesis.

Study Design: Case report.

Animal: Eighteen-week-old female entire Maine Coon cat.

Results: Juvenile pubic symphysiodesis resulted in changes in the distraction index, acetabular angle, dorsal acetabular rim angle, dorsal acetabular sector angle, and clinical improvement at the six month follow-up. No intra-operative or postoperative complications were recorded.

Conclusions: Juvenile pubic symphysiodesis performed at 18 weeks of age resulted in improvement in hip joint conformation and hip laxity in a dysplastic cat.

Clinical relevance: Juvenile pubic symphysiodesis may be a promising treatment for feline hip dysplasia and is a safe and technically simple procedure to perform. Further investigations are warranted.

Juvenile Pubic Symphysiodesis

In properly selected dogs, juvenile pubic symphysiodesis improves joint congruity, decreases hip laxity, and can reverse or prevent progression of degenerative joint disease in the hips. To be effective, surgery must be done at a young age and in hips that are only mildly to moderately lax. Juvenile pubic symphysiodesis is best viewed more as a preemptive procedure than as a strictly therapeutic one. Dogs considered to be at risk for hip dysplasia should be screened with Ortolani testing at 12 weeks of age, with further imaging and perhaps surgery to follow for those who have a positive Ortolani sign.

Evaluation of an overlapping pubic and ischiatic osteotomy for the improvement of acetabular ventroversion in dogs: an ex vivo study

OBJECTIVES

To assess the potential of a new single-session surgical procedure, the overlapping pubic and ischiatic osteotomy (OPIO) for modification of bilateral hip conformation. We hypothesized that OPIO would be simple to perform with currently available surgical equipment, through a single surgical approach, with minimal potential morbidity, and that it would allow adequate simultaneous bilateral improvement of coxofemoral joint conformation in patients at risk of canine hip dysplasia.

METHODS

The OPIO procedure was performed in the pelves of five large breed canine cadavers. Computed tomography images of each cadaver were compared by measurement of the dorsal acetabular rim angle (DARA), acetabular angle (AA), dorso-ventral sacroiliac ratio (SR), and pubic inlet area before and after OPIO.

RESULTS

Coxofemoral joint conformation was improved after OPIO. Postoperative DARA was significantly decreased (mean: -5.09°) and AA was significantly increased (mean: 3.54°) after OPIO. The SR was not significantly different after OPIO, indicating minimal impact on the sacro-illiac joints by the procedure. Pubic inlet dimensions and area were significantly decreased after OPIO, but the overall effect on pelvic inlet area was clinically insignificant.

CLINICAL SIGNIFICANCE

An OPIO allows some improvement of coxofemoral joint conformation in canine cadavers.

Effects of intertrochanteric varus osteotomy on Norberg angle and percent coverage of the femoral head in displastic dogs

This study was conducted to assess the effects of femoral varus osteotomy on joint congruency in dogs affected by early stage hip dysplasia. Preoperative planning to move the femoral head within the acetabulum was carried out. Varisation of the femoral inclination angle (fIA) was achieved by Intertrochanteric Osteotomy (ITO). Norberg angle (NA), percent coverage (PC) of the femoral head by the acetabulum and fIA was measured from preoperative, immediate postoperative and first and second recheck radiographs of seven dogs that underwent an ITO (joint n = 9). There was significant (p < 0.05) improvement of both NA and PC in all patients as indicated by a change in the mean ± standard deviation of 78.9° ± 7.5 and 36.9% ± 5.2 to 92.2° ± 6.7 and 50.6% ± 8.3, respectively. No significant difference (p < 0.05) was observed between the values of the planned femoral inclination angle (pfIA) of the femur and the effective femoral inclination angle (efIA) obtained after surgery (115.9° ± 2.5 and 111.3° ± 6.4, respectively). These findings could encourage the use of ITO in veterinary practice and indicate that intertrochanteric varus osteotomy should be re-considered for the treatment of early stage hip dysplasia in dogs with radiological signs of joint incongruency.

Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis: objective and subjective evaluation

OBJECTIVES

The hypothesis of this study was that juvenile pubic symphysiodesis (JPS) results in pelvic changes that can be identified radiographically in adult dogs.

METHODS

The medical records at the Clinica Veterinaria Vezzoni were searched for standard ventro-dorsal views of the pelvis of adult Labrador and Golden Retrievers that had undergone JPS or had not undergone surgery. The objective assessment of radiographs included the analysis of various pelvic measurements. Subjective evaluation of radiographs was undertaken by 18 specialists and 21 general practitioners and was based on five criteria relating to 1) the acetabular fossae, 2) the pubic symphysis, 3) the margin of the cranial pubic area, 4) the pubic rami, and 5) the obturator foramen.

RESULTS

The radiographs of 42 Labrador Retrievers and 16 Golden Retrievers were evaluated. The most useful criteria were the radiographic measurement of the shape of the obturator foramen and two different ratios of length to width of the pubic rami; these values were significantly smaller in dogs after JPS. The pelvic canal width was the same in both groups. All objective measurements were repeatable within and between evaluators. The most reliable subjective criterion was number 4, followed by number 5 in Golden Retrievers and by 2 in Labrador Retrievers.

CONCLUSION

Our objective and subjective evaluations were simple and yielded useful and repeatable results. There was no significant difference between general practitioners and specialists with regard to subjective evaluation, which indicates that these evaluation criteria can be used by small animal clinicians after minimal training.

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.

Treatment of hip dysplasia

Hip dysplasia is a common orthopaedic developmental disorder of dogs. This paper reviews the treatment options available for management of the condition in the skeletally immature and adult dog.

Avaliação radiográfica de cães com displasia coxofemoral tratados pela sinfisiodese púbica

Avaliou-se a progressão dos sinais radiográficos de cães com displasia coxofemoral ou potencialmente displásicos tratados pela técnica da sinfisiodese púbica. Foram utilizados 14 cães, seis machos e oito fêmeas, com idades entre quatro e seis meses. Após exame físico, procedeu-se ao exame radiográfico para avaliação da articulação coxofemoral, segundo padrão estabelecido pelo Colégio Brasileiro de Radiologia Veterinária. Três deles foram também avaliados pelo método PennHIP. Pelo histórico clínico, nove (64%) animais foram trazidos por manifestarem sinais de dificuldade locomotora com os membros pélvicos, manifestada especialmente por claudicação unilateral ou bilateral e dificuldade de se levantar. Cinco (36%) cães não tinham qualquer sinal clínico, e em quatro (29%) realizou-se o exame radiográfico como prevenção. O sinal físico mais evidente foi dor à palpação da articulação coxofemoral, e dois (14%) cães apresentaram sinal de Ortolani positivo. Com exceção de um cão que apresentou infecção nos pontos cutâneos, todos os demais evoluíram sem complicações no período pós-operatório. Radiograficamente houve progressão das lesões articulares em seis (43%) animais e oito (57%) mantiveram a classificação inicial. Concluiu-se que cães tratados pela sinfisiodese púbica não apresentam melhora dos sinais radiográficos iniciais.

Juvenile pubic symphysiodesis and juvenile pubic symphysiodesis associated with pectineus myotomy: short-term outcome in 56 dysplastic puppies

OBJECTIVES

(1) To compare short-term outcome of juvenile pubic symphysiodesis (JPS) in puppies aged 12-17 weeks with lax hips (group JPS1), in puppies aged 18-22 weeks (group JPS2), and control (group C) puppies; and (2) to document outcome of bilateral pectineus myotomy (PM) associated with JPS in 18-22-week-old puppies (group JPS-PM).

STUDY DESIGN

Prospective study.

METHODS

Puppies (12-22 weeks) from large and giant breed dogs with a combination of a positive Ortolani sign, poor acetabular coverage (Norberg angle [NA]<or=100 degrees ), and a subluxation index (SI) >0.5 for one or both hips were selected. Puppies aged <18 weeks were randomly assigned to group JPS1 or C. Puppies aged 18-22 weeks were randomly assigned to group JPS2, JPS-PM, or C. Three to 4 months later, surgery was considered successful in pain-free dogs with negative Ortolani sign, normalized acetabular coverage (NA>or=105 degrees ), and SI>0.5. Success rates were compared using Fisher's exact tests: JPS1 versus JPS2 versus C; JPS2 versus JPS-PM. Significance was set at P<.05.

RESULTS

All dysplastic hips from nonoperated (C) groups were dysplastic at follow-up, meaning that our criteria for case selection were accurate. JPS1 had significantly better success rate than JPS2 (85 versus 17.8%, respectively). JPS-PM dysplastic hips failed to demonstrate a better outcome than JPS2 hips.

CLINICAL RELEVANCE

This study confirms, on a large series of dysplastic hips, the age-dependent effects of JPS, with better results if performed before 18 weeks of age. There is no benefit of adding PM to the procedure in candidates >18 weeks at surgery.

Developmental orthopedic disease

Developmental orthopedic diseases are a common cause of pain and lameness in young dogs. Most occur in large-breed dogs with rapid growth rates. This article reviews the signalment, etiology and pathogenesis, clinical signs, diagnosis, treatment, and prognosis for many of the common developmental orthopedic diseases, including hypertrophic osteodystrophy, panosteitis, osteochondrosis, Legg-Calve-Perthes disease, hip dysplasia, elbow dysplasia, and pes verus.

Simultaneous Bilateral Femoral Head and Neck Ostectomy for the Treatment of Canine Hip Dysplasia

Simultaneous bilateral femoral head and neck ostectomy (FHO) was performed on 15 dogs for severe bilateral hip dysplasia. A follow-up survey was performed 6 to 48 months after surgery to assess the postoperative recovery and activity levels of the operated dogs. All dogs had normal activity levels and were pain free according to their owners. Owner satisfaction regarding the outcome of the surgery was high. Simultaneous bilateral FHO was a viable surgical option for the treatment of painful bilateral hip disease in dogs, especially when other surgical options were not indicated or were cost prohibitive.

THE EFFECTS OF PATIENT POSITIONING AND SLICE SELECTION ON CANINE ACETABULAR ANGLE ASSESSMENT WITH COMPUTED TOMOGRAPHY

Acetabular angles (AAs) and dorsal acetabular rim angles acquired by computed tomographic (CT) imaging have been used to assess patient response to juvenile pubic symphysiodesis surgery. The purpose of this study was to evaluate the effects of patient positioning and slice selection on these angles, and an attempt was made to devise a repeatable method of measuring these angles that would eliminate positioning effects. We found significant variation in AAs with small differences in pelvic tilt and slice selection. Dorsal acetabular rim angles were not affected. As a result of positioning differences from one CT study to the next, every attempt should be made to standardize pelvic tilt, or eliminate its effect on AAs by standardizing gantry angle in relation to an anatomic landmark that will not change over time. The floor of the sacral vertebral canal may be a reasonable landmark for this purpose and deserves further study.

Changes of hip joint congruity after triple pelvic osteotomy in the dog with hip dysplasia

Changes in hip joint congruity was evaluated in dogs with hip dysplasia before and after triple pelvic osteotomy by computed tomography examination in the standing position. Lateral center edge angle significantly increased, and center distance (CD) significantly decreased after surgery compared to the values before surgery, respectively. There was an inverse proportion between the postoperative period and the change in the ratio of CD. These results suggested that joint laxity was improved with time after surgery, providing evidence of the clinical usefulness of this surgery.

Juvenile pubic symphysiodesis in dysplastic puppies at 15 and 20 weeks of age

OBJECTIVE

To examine the effects of juvenile pubic symphysiodesis (JPS) on hip joint conformation, hip laxity, gait, and the development of degenerative joint disease (DJD) in dysplastic puppies operated at 15 and 20 weeks of age.

STUDY DESIGN

Randomized controlled prospective study. ANIMALS-Eighteen female hound puppies with increased hip laxity.

METHODS

Puppies were randomized to 1 of 4 treatment groups: JPS at 15 weeks of age (n = 6), sham-operated control at 15 weeks of age (n = 3), JPS at 20 weeks of age (n = 6), and sham-operated control at 20 weeks of age (n = 3). Hip extension with pain scoring, Ortolani palpation, hip reduction angle measurement (HRA), PennHIP radiography (University of Pennsylvania) with measurement of distraction index, Norberg angle measurement, and transverse computed tomographic imaging to measure acetabular angle (AA) and dorsal acetabular rim angle (DARA), were tested preoperatively, and at 1 and 2 years of age.

RESULTS

JPS resulted in significant changes in AA, HRA, DARA, and conversion to Ortolani negative status. Larger and more rapid changes in hip conformation were seen when surgery was performed at 15 weeks of age. No significant changes were identified in control dogs. Twenty-five percent of JPS dogs developed DJD whereas 83% of control dogs developed DJD.

CONCLUSIONS

JPS resulted in significant improvements in hip joint conformation and hip laxity in dysplastic puppies treated at 15 and 20 weeks of age. Improvements in conformation were significantly greater when surgery was performed at 15 weeks of age.

CLINICAL RELEVANCE

JPS appears to be a promising treatment for hip dysplasia and is a safe and technically simple procedure to perform.

Effects of pubic symphysiodesis in dysplastic puppies

OBJECTIVE

To determine the long-term effects of juvenile pubic symphysiodesis (JPS) in dysplastic puppies.

STUDY DESIGN

Prospective, randomized, clinical trial.

ANIMALS

Seven dysplastic Chesapeake Bay retrievers and 2 beagle-crosses (BX1 and 2).

METHODS

Five puppies had JPS performed with electrocauterization at 12, 16, 20, 22, and 24 weeks of age, respectively. Two puppies served as controls. BX1 and BX2 were used to obtain biopsies of the symphysis. Hips were evaluated for: pelvic development (transverse computerized tomography for acetabular angle [AA] and dorsal acetabular rim angle [DARA]); laxity [hip extended and stress radiography [distraction index (DI)]); Ortolani maneuver with reduction angles; acetabular coverage (Norberg angles); and function (coxofemoral range of motion, hip pain, and gait analysis by force-plate technique at 44 and 137 weeks of age).

RESULTS

The pubis fused prematurely in every puppy that was operated on with the JPS technique. Greater acetabular responses were related to younger ages at surgery. The final mean AA in dogs that had JPS was 25 degrees greater than preoperative values; 40% increased over control. The DARA final mean was 10 degrees, 52% less than preoperative values and 46% less than control. The final mean DI in dogs having JPS was 0.28, 47% improved over preoperative values and 58% better than control. Mean pelvic dimensions in dogs that had JPS were 18% less than control. Gait analyses were normal for all dogs at 137 weeks. No urinary or bowel complications occurred.

CONCLUSIONS

Significant ventrolateral acetabular rotation, increased hip coverage, diminished hip laxity, normal pain-free gait, and insignificantly reduced pelvic size occurred after JPS.

CLINICAL SIGNIFICANCE

Dysplastic hips in young dogs were significantly improved by JPS.