Canine hip dysplasia treated by juvenile pubic symphysiodesis

Summary

Objectives: To measure one and two year effects of juvenile pubic symphysiodesis (JPS) in puppies defined as ‘at-risk’ for canine hip dysplasia (CHD) using the following objective hip conformation criteria: Acetabular angle (AA), dorsal acetabular rim angle (DARA) and hip laxity (PennHIP© distraction index (DI).

Design: Controlled clinical case study. Animals: Thirty-nine dysplastic puppies (six controls).

Procedures: The dogs were anaesthetised and acetabular angle, DARA, and DI values were obtained by computed tomography and radiography preoperatively. Electro-cautery fusion of the pubic symphysis was performed between 12 – 24 weeks of age. The imaging was repeated at one and two years of age.

Results: Significant hip improvements were seen at the two-year follow-up appointments for: AA (JPS dogs 31% increase, control 3%), DARA (JPS 38% decrease, control 15%) and DI (JPS 41% decrease in laxity, controls 20%) for all postoperative versus preoperative values. Pubic fusion occurred with minor morbidity.

Conclusion: Juvenile pubic symphysiodesis resulted in significant improvements in hip conformation (AA and DARA), especially in mild to moderately lax hips (DI = 0.40–0.69). Most dogs with DI ≥0.70 increased in osteoarthritis grade by two years of age.

Clinical relevance: Juvenile pubic symphysiodesis surgery at 12–24 weeks of age significantly improved hip conformation and decreased laxity in at-risk CHD dogs. Early-age (12 to 16 week) recognition of hip laxity offered greater JPS benefits than surgery performed at 19- to 24-weeks-old. Dogs with severe laxity (DI ≥0.70) continued to increase in osteoarthritis. An early (12–16 weeks) positive laxity test (Ortolani) should alert one to obtain objective laxity determinations (Penn-HIP^© DI).

Keywords

Canine - hip dysplasia - juvenile pubic symphysiodesis

*Errors stated in the Corrigendum published with issue 6/2010 have been corrected in this version of the article (address listed for 3rd author and Reference 10).

• References

• 1 Smith RN. The pelvis of the young dog. Vet Rec 1964; 76: 975-979.
• 2 Riser WH. The dog as a model for the study of hip dysplasia. Vet Pathol 1975; 12: 235-334.
• 3 Mathews KG, Stover SM, Kass PH. Effect of pubic symphysiodesis on acetabular rotation and pelvic development in guinea pigs. Am J Vet Res 1996; 57: 1427-1433.
• 4 Dueland RT, Adams WM, Fialkowski JP. et al. Effects of pubic symphysiodesis in dysplastic puppies. Vet Surg 2001; 30: 201-217.
• 5 Patricelli AJ, Dueland RT, Lu Y. et al. Canine pubic symphysiodesis: Investigation of electrocautery dose response by histologic examination and temperature measurement. Vet Surg 2001; 30: 261-268.
• 6 Patricelli AJ, Dueland RT, Adams WM. et al. Juvenile pubic symphysiodesis in dysplastic puppies at 15 and 20 weeks of age. Vet Surg 2002; 31: 435-444.
• 7 Swainson SW, Conzemius MG, Riedsel EA. et al. Effect of pubic symphysiodesis on pelvic development in the skeletally immature golden retriever. Proceedings from the 26th Veterinary Orthopedoc Society Meetings; 1999. Sun Valley; Idaho: 13.
• 8 Swainson SW, Conzemius MG, Riedsel EA. et al. Effect of pubic symphysiodesis on pelvic development in the skeletally immature greyhound. Vet Surg 2000; 29: 178-190.
• 9 Vezzoni A, Dravelli G, Vezzoni L. et al. Comparison of conservative management and juvenile pubic symphysiodesis in the early treatment of canine hip dysplasia. Vet Comp Orthop Traumatol 2008; 21: 267-279.
• 10 O'Brien RT, Dueland RT, Adams WC. et al. Dynamic ultrasonographic measurement of passive coxofe-moral joint laxity in puppies. J Am Anim Hosp Assoc 1997; 33: 275-280.
• 11 Adams WA, Dueland RT, Meinen J. et al. Early detection of canine hip dysplasia: comparison of two palpation and five radiographic methods. J Am Anim Hosp Assoc 1998; 34: 339-347.
• 12 Adams WA, Dueland RT, Daniels R. et al. Comparison of two palpation, four radiographic and three ultrasound methods for early detection of mild to moderate canine hip dysplasia. Vet Rad Ultrasound; 41 484-490.
• 13 Risler A, Klauer JM, Keuler NS. et al. Puppy line, metaphyseal sclerosis, and caudolateral curvilinear and circumferential femoral head osteophytes in early detection of canine hip dysplasia. Vet Rad Ultrasound 2009; 50: 157-166.
• 14 Slocum B, Slocum TD. Pelvic osteotomy. In Bojrab MJ. editor. Current Techniques in Small Animal Surgery. Baltimore, MD: Williams and Wilkins; 1998 pgs 1159-1165.
• 15 Berzon JL, Howard PE, Covell SJ. et al. A retrospective study of the efficacy of femoral head and neck excision in 94 dogs and cats. Vet Surg; 1980; 9: 88-92.
• 16 Slocum B, Slocum TD. DARthroplasty. In Bojrab MJ. editor. Current Techniques in Small Animal Surgery. 4^th edition. Baltimore, MD: Williams & Wilkens; 1998. pgs 1168-1170.
• 17 Prieur WD. Intertrochanteric osteotomy. In Bojrab MJ. editor. Current Techniques in Small Animal Surgery. 4th ed. Baltimore, MD: Williams & Wilkens; 1998. pgs 1165-1168.
• 18 Slocum B, Slocum TD. Femoral neck lengthening. In Bojrab MJ. editor. Current Techniques in Small Animal Surgery. 4th ed. Baltimore, MD: Williams & Wilkens; 1998: 1154-1159.
• 19 Fitch RB, Kerwin S, Hosgood G. et al. Radiographic evaluation and comparison of triple pelvic osteotomy with and without additional ventral plate stabilization in forty dogs-part 1. Vet Comp Orthop Traumatol 2002; 3: 164-171.
• 20 Fitch RB, Kerwin S, Hosgood G. et al. Treatment of mechanically failed triple pelvic osteotomies in four dogs-part 2. Vet Comp Orthop Traumatol 2002; 3: 172-176.
• 21 Hasegawa Y, Iwase T, Kitamura S. et al. Eccentric rotational acetabular osteotomy for acetabular dysplasia. J Bone Jt Surg 2002; 84A: 404-410.
• 22 Chalman JA, Butler HC. Coxofemoral joint laxity and the Ortolani sign. J Am Anim Hosp Assoc 1985; 21: 671-676.
• 23 Smith GK, Biery DN, Gregor TP. New concepts of coxofemoral joint stability and the development of a clinical stress-radiographic method for quantitating hip joint laxity in the dog. J Am Vet Med Assoc 1990; 196: 59-70.
• 24 Dueland RT, Adams WM, Patricelli AJ. et al. AAACanine hip dysplasia treated by juvenile pubic symphysiodesis - Part II: Two year clinical results. Vet Comp Orthop Traumatol 2010; 23: 318-325.
• 25 Piermattei DL. An Atlas of Surgical Approaches to the Bone and Joints of the Dog and Cat. Philadelphia, PA: Saunders 1993; pgs 258-261.
• 26 Morgan JP. Canine hip dysplasia: Significance of early bone spurring. Vet Rad 1987; 28: 2-5.
• 27 Mayhew PD, McKelvie PJ, Biery DN. et al. Evaluation of a radiographic caudolateral curvilinear osteophyte on the femoral neck and its relationship to degenerative joint disease and distraction index in dogs. J Am Vet Med Assoc 2002; 220: 472-476.
• 28 Adams WM. Radiographic diagnosis of hip dysplasia in the young dog. Vet Clin North Am 2000; 30: 267-280.
• 29 Dejardin LM, Perry RL, Arnoczky SP. et al. The effect of triple pelvic osteotomy on hip force in dys-plastic dogs: A theoretical analysis. Vet Surg 1996; 25: 114-120.
• 30 Dejardin LM, Perry RL, Arnoczky SP. The effect of triple pelvic osteotomy on the articular contact area of the hip joint in dysplastic dogs: An in vitro experimental study. Vet Surg 1998; 27: 194-202.
• 31 Millis MB, Kim Y-J. Rationale of osteotomy and related procedures for hip preservation: A review. Clin Orthop Relat Res 2002; 405: 108-121.
• 32 Johnson AL, Smith CW, Pijanowski GJ. et al. Triple pelvic osteotomy: Effect of limb function and progression of degenerative joint disease. J Am Anim Hosp Assoc 1998; 34: 260-264.
• 33 Borostyankoi F, Rooks RL, Kobluk CN. et al. Results of single-session bilateral triple pelvic osteotomy with an eight-hole iliac bone plate in dogs: 95 cases (1996–1999). J Am Vet Med Assoc 2003; 222: 54-59.
• 34 Holsworth IG, Schulz KS, Beale B. et al. Arthroscopic correlation to radiographic findings in canine juvenile hip arthroscopy. 29th Veterinary Orthopedic Society Meeting 2002. The Canyons; Utah, USA.: Pg. 62.
• 35 Slocum B, Devine T. Dorsal acetabular rim radio-graphic view for evaluation of the canine hip. J Am Anim Hosp Assoc 1990; 26: 289-296.
• 36 Trumpatori BJ, Mathews KG, Roe SR. et al. Radio-graphic anatomy of the canine coxofemoral joint using the dorsal acetabular rim (DAR) view. Vet Radiol Ultrasound 2003; 44: 526-532.
• 37 Wang SI, Mathews KG, Robertson ID. et al. The effects of patient positioning and slice selection on canine acetabular angle assessment with computed tomography. Vet Radiol Ultrasound 2005; 46: 39-43.
• 38 Fujiki M, Kurima Y, Yamanokuchi K. et al. Computed tomographic evaluation of growth-related changes in the hip joints of young dogs. Am J Vet Res 2007; 68: 730-734.
• 39 Murray DW. The definition and measurement of acetabular orientation. J Bone Jt Surg 1993; 75B: 228-232.
• 40 Manley PA, Adams WM, Danielson K. et al. Canine hip dysplasia: Long-term outcome of juvenile pubic symphysiodesis and triple pelvic osteotomy in dogs with hip dysplasia. J Am Vet Med Assoc 2007; 230: 1-5.
• 41 Smith GK, Mayhew PD, Kapatkin AS. et al. Evaluation of risk factors for degenerative joint disease associated with hip dysplasia in German Shepherd Dogs, Golden Retrievers, Labrador Retrievers, and Rottweilers. J Am Vet Med Assoc 2001; 219: 1719-1724.
• 42 Farese JP, Lust G, Williams AJ. et al. Comparison of measurements of dorsolateral subluxation of the fe-moral head and maximal passive laxity for evaluation of the coxofemoral joint in dogs. Am J Vet Res 1999; 12: 1571-1576.
• 43 Fluckiger MA, Friedrich GA, Binder H. A radio-graphic stress technique for evaluation of coxofe-moral joint laxity in dogs. Vet Surg 1999; 28: 1-9.
• 44 Madsen JS, Svalastoga E. Early diagnosis of hip dysplasia-A stress radiographic study. Vet Comp Orthop Traumatol 1995; 8: 114-117.
• 45 Smith GK, Hill SM, Gregor P. et al. Reliability of the hip distraction index in two-month-old German Shepherd dogs. J Am Vet Med Assoc 1998; 212: 1560-1563.
• 46 Smith GK, Biery DN, Kealy RD. et al. Effect of restricted feeding and age on hip osteoarthritis and hip score: A life-long study in Labrador retrievers. Abstracts from The Purina Pet Institute Symposium 2002. September St. Louis MO; USA.: Pgs. 23-25.
• 47 Kapatkin AS, Gregor TP, Hearon K. et al. Comparison of two radiographic techniques for evaluation of hip joint laxity in 10 breeds of dogs. J Am Vet Med Assoc 2004; 224: 542-546.