dental disease or bladder infection), other debilitating con- Treatment Options for Mature ditions, cruciate ligament damage or neurological disorders. Complications are reported in approximately 15% of cases Dogs or Th ose With Arthritis at and include luxation, premature implant loosening (due to the Time of Diagnosis infection or bone resorption), and nerve damage. Some com- plications are treatable but others may require removal of Femoral Head and Neck Excision the implants (resulting in a procedure similar to the femoral head and neck excision). Because most of these complica- Th e femoral head and neck excision (FHO) is a com- tions are related to the use of bone cement, a BFXTM (bio- monly performed procedure. Th is procedure is best suited logical fi xation) cementless hip replacement system has been for small to medium-sized dogs (under 40-50 lbs), with less Oakland Veterinary developed by BioMedtrix and has been used in many referral than favorable results in larger dogs. Th e FHO is performed clinics in the past with a higher success rate. Not all dogs are by removing the femoral head (ball portion of the joint), candidates for this cementless system and each will need to Referral Services which eliminates bone-on-bone contact. Over 2-4 weeks a be assessed intra-operatively for bone quality. Dogs that are false joint develops with scar tissue, which, along with the not candidates will receive a cemented implant instead. surrounding pelvic muscles, mimics joint function that is Proper home care after surgery is very important to the similar to the function of the forelimbs. Th is allows near success of the procedure. Strict confi nement and close super- normal range of motion and signifi cantly relieves the pain vision is required for the fi rst eight weeks after surgery and of arthritis, making the leg more functional and comfort- yearly x-rays are required able. Most dogs become much more active following sur- to monitor for implant gery but physiotherapy is loosening. Most dogs often required for the fi rst (80%) achieve a level of 6 weeks. Th e advantage of comfort and activity that this procedure is that it is will not require bilateral a relatively quick and in- hip replacement; however, expensive procedure with working dogs or dogs in few complications, can high activity sports may be performed at any age, need both hips replaced. Post-operative radiograph of a FHO and has good results in the majority of dogs. Post-operative exercise restrictions are usually limited to two weeks. Post-operative radiograph of a Total Hip Replacement cementless THR & cemented THR Th e total hip replacement (THR) procedure is very sim- ilar to that used in human medicine. It is the treatment of Have you been referred? choice for medium to large-breed dogs used for working or Th ings to bring at the time of your SURGERY sporting activities or when optimal hip function is desired. consultation: Th e success rate with this procedure is 85%, and dogs with successful implants are able to perform almost any task per- • Recent radiographs and blood work formed by dogs with normal hips. In this procedure, both • Medications your pet is being given the ball and socket portions of the hip joint are removed and replaced with cobalt chrome and polyethylene implants. Candidates for total hip replacement are typically large- 1400 Telegraph Road breed dogs with irreparable disease or injury to the hip joint. Canine Hip Th e dogs must be fully grown, over 40 lbs, and ideally not Bloomfi eld Hills, MI 48302 overweight. An extensive pre-operative evaluation is re- quired to minimize post-operative complications. Candi- (248) 334-6877 Dysplasia dates must be cleared for sub-clinical infections (including www.OVRS.com Canine Hip Dysplasia (CHD) is a developmen- tal disorder of the hip that begins with joint laxity and pro- Diagnosis Treatment Options for gresses to arthritis over a period of several months to years. Th e diagnosis of hip dysplasia is based on history, physi- Immature Dogs It is one of the most common skeletal diseases seen by vet- cal examination, and radiographic evaluation. A typical his- erinarians. Th e condition is more common in large breed tory may include any or all of the following: Juvenile Pubic Symphysiodesis dogs, but can be seen in any breed. • Diffi culty or stiff ness upon rising Juvenile pubic symphysiodesis (JPS) is a procedure per- • Rising using front legs only and dragging rear formed in dogs less than 20 weeks of age with increased joint • “Bunny hopping” gait laxity (assessed by PennHIP scoring), or with dogs with a • Short stride in rear legs strong genetic predisposition to hip dysplasia (e.g., an acci- • Reluctance to exercise or climb stairs dental breeding of two dysplastic dogs). It involves thermal • Rear limb lameness destruction of the pubic growth plate, causing rotation of • Soreness in hips the pelvis and improved coverage of the hip as the puppy • Waddling rear limb gait grows. Th is procedure is minimally invasive and most dogs Th e clinical signs may begin between fi ve and eight can be spayed or neutered at the same time. Initial results months of age or may develop after skeletal maturity. Some from this procedure are encouraging but long-term results dogs don’t have noticeable problems until eight to ten years are not yet available. of age or older. Th e onset of clinical signs may appear sud- denly or gradually. Th is variability is due to the individual Triple Pelvic Osteotomy severity of the disease as well as pain tolerance of the pet. Th e ideal candidate for the triple pelvic osteotomy Young dog with hip dysplasia Normal hips Most dogs with CHD are most painful when the hips are (TPO) procedure is a young dog (5-10 months of age) with extended by pulling the rear legs back behind the body. clinical signs caused by hip dysplasia (including pain and Multiple genes are involved in the inheritance of hip Palpation of the hips usually reveals joint laxity, al- hip laxity) but without radiographic signs of arthritis. In dysplasia, and many other factors infl uence its development, though anesthesia may be required to detect it in some this procedure, the pelvis is cut in 3 locations to allow rota- including body type, size, growth rate, and nutrition. Over- cases. In young dogs or in very mild cases, joint laxity tion of the acetabulum (hip socket) into a normal position. feeding and dietary supplementation for maximal growth may be the only detectable abnormality. Later in the dis- Th is seats the femoral head more deeply into the socket and ease arthritic changes are seen. Radiographs are necessary have been shown to increase the incidence of hip dysplasia improves stability. Th e pelvis is stabilized in this new posi- to confi rm the diagnosis and evaluate the severity of CHD. in young, growing, large-breed dogs. Conversely, the de- tion with a specially designed bone plate. Th e hip is now Th e standard radiographic position is with the dog lying on velopment of hip dysplasia can be delayed, and its severity able to remodel in the new position without developing ar- its back with both rear legs pulled straight back and paral- thritis. With proper case selection, approximately 90% of diminished when the growth rate of pups is restricted. lel to each other. Most dogs with CHD are too painful dogs achieve good to excellent results and return to athletic At OVRS we off er one of the most comprehensive to tolerate this position awake, so sedation or anesthesia is endeavors. Owner satisfaction is high and they had no reluc- programs for the diagnosis and surgical management of usually necessary. Proper radiographic positioning is very tance recommending the procedure to others. If a TPO is hip dysplasia. Medical and/or surgical treatment may be important to accurately evaluate the hips and to determine needed on the opposite leg, it is performed 3-6 weeks later. recommended, depending on the individual circumstances. the best treatment. When arthritis devel- Medical management usually consists of moderate consis- Th e Orthopedic Foundation of America (OFA) has ops in a dog with hip dyspla- tent exercise, weight loss and anti-infl ammatory medica- been the standard for certifi cation of dogs’ hips as being free sia, the damage is irreversible. tions for pain management. Low impact activity like swim- of CHD. Th e radiograph is taken after the dog is 2 years of A triple pelvic osteotomy will ming is ideal to maintain muscle age and requires the hip-extended position. Unfortunately, not restore normal hip func- progress has been disappointing in reducing the frequency mass with minimal joint stress. tion or eliminate pain in these of CHD using OFA alone. Recently the PennHIP program Several surgical options are dogs. Two procedures available has emerged as a new scientifi c method for the early diag- available for treating hip dyspla- for these patients include the nosis of CHD. It measures the passive hip joint laxity or femoral head and neck excision sia. Th ey include: juvenile pubic “looseness” of the hip ball in the hip socket under sedation and the total hip replacement. symphysiodesis, triple pelvic oste- or anesthesia. PennHIP is more reliable and has the ad- otomy, total hip replacement and vantage of being accurate on puppies as young as 16 weeks femoral head and neck excision. of age. Dr. Henney is trained and certifi ed to perform the At left, post-operative radiograph PennHIP procedure. of TPO