Surgical methods for treating hip dysplasia in dogs. Prevention of hip dysplasia in dogs. Method of surgical treatment of hip dysplasia in dogs

• Date: 02/25/2015, 15:59
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Algorithm surgical tactics in conditions of chronic dislocation of the femoral head in dogs.
Samoshkin I.B., Slesarenko N.A.

Animal Traumatology Center
State Budgetary Institution "Mosvetobedinenie"
Federal State Educational Institution of Higher Professional Education Moscow State Academy of Veterinary Medicine and Applied Biotechnology named after. K.I. Scriabin

Elucidation of the clinical and morphological patterns of etiopathogenesis of post-traumatic pathology of the hip joint in dogs and the development on this basis of rational methods for its correction is one of the fundamental problems of modern veterinary surgery, arthralgia and morphology. Its solution is of particular relevance in connection with the progression of the incidence of arthropathy of the hip joint, which causes the loss of its functional suitability and the limb as a whole.
The literature of recent years provides data on new methods of reconstructive operations for pathological conditions art. coxae.
However, despite the successes in the development of methodological approaches to the surgical treatment of pathological conditions of the hip joint, at present, an analysis of risk factors in the development of arthropathy has not been carried out, and the morphofunctional basis of the pathological process of the joint as a whole, as well as osteo- and chondropathy of the femoral head, has not been shown. The issue of reparative transformations of bone tissue and the cartilage covering of the joint during surgery and the use of various implants requires further study. Of interest are the adaptive rearrangements that occur in intra- and para-articular tissues under normal conditions and in arthropathy of various origins, which have fundamentally important for veterinary traumatology, orthopedics and operative surgery.

General characteristics of the material.

This section is based on an analysis of the surgical treatment of 140 dogs admitted to the clinic for chronic post-traumatic dislocation of the hip joint.
A total of 143 reconstructive operations were performed on 140 patients. The total numbers of operations exceed the number of operated animals due to the fact that in three cases there was bilateral hip arthropathy.

Clinical and radiographic characteristics of patients with chronic post-traumatic dislocations of the hip joints.

At clinical examination sick animals, as a rule, noted lameness of the hanging or supporting limb of varying degrees, severe arthralgia, as well as a sharp limitation in the range of active movements in the joint.
The main symptom of a traumatic dislocation is the deformation of the area of ​​the damaged joint. Each dislocation corresponds to a certain position of the femoral head relative to the acetabulum. In this case, the pelvic limb itself takes on a characteristic position.
In case of iliac dislocation of the hip (luxatio femoris iliaca), displacement of the greater trochanter, significant shortening and external rotation of the limb were determined. The gluteal region on the side of the dislocation acquired greater roundness.
With supraacetabular dislocation (luxatio femoris supraacetabularis), there is also a significant shortening of the limb, which is in a state of adduction and moderate internal rotation.
Ischial dislocation (luxatio femoris ischiadica) is characterized by a sharp deformation of the limb, correlating with hyperflexion knee joint, located, as a rule, slightly above the level of the hip joint. A significant number of patients experience neurological disorders.
With obturator (luxatio femoris obturatoria) and pubic (luxatio femoris pubica) dislocations, there is usually hyperextension of the knee and hock joints, the affected limb is elongated, brought forward or retracted as much as possible.
When both hip joints are dislocated, immobility is pronounced, and the patient lies with the pelvic limbs widely spaced.
It is appropriate to note that with any dislocation, no matter how clear its diagnosis, it is required radiographic examination to determine the nature and extent of violations of articular relationships. In this case, radiography should be carried out, if possible, in two projections, which makes it possible to objectively judge the location of the head and the degree of its displacement relative to the glenoid cavity.

Total hip arthroplasty involves 4 stages of surgery on the hip joint.

At the first stage, we make a 4-7 cm long incision in the skin and subcutaneous tissue along the outer surface of the thigh, encircling the trochanter major. The fascia lata was dissected. Using a blunt and sharp method, we disconnect the deeper layers of muscles along the fibers (m. glutaeus superficialis, m. glutaeus medius, m. glutaeus profundus and m. piriformis), carrying out thorough hemostasis using an electrocoagulator. Then we dissect the joint capsule (if it is preserved). We pass the Gigli saw under the greater trochanter, encircling the femoral neck, and perform resection of the head. You can also use a chisel for this purpose. A prerequisite for this stage of reconstructive surgery is the treatment of the femoral neck stump with a rasp.
At the second stage, soft tissue growths on the glenoid cavity were excised and arthrosis was performed with a ball cutter or curette, thereby creating a “roof” for the proximal epiphysis.
The third stage is implantation of an artificial hip ligament. For this purpose, we use lavsan tape or (to avoid complications) catgut No. 1, three threads of which were woven into a pigtail and fixed transosseously to the greater trochanter and the upper arch of the acetabulum through pre-drilled channels in the bone. We give the implanted ligament optimal physiological tension, which is controlled by abduction-adduction, flexor-extensor, and rotational movements of the limb.
The fourth and final stage is myoplasty of the joint capsule. We place a purse-string suture on the capsule and the muscles adjacent to the joint, tightening it in the area of ​​the femoral neck stump. The surgical wound is sutured tightly in layers.
The duration of the operation is on average 100±10 minutes. All patients tolerate total arthroplasty surgery satisfactorily.
Awakening from anesthesia was noted 1.5-2 hours after the end of the operation. During the day, the animals remain in a state of low mobility, refusing to take food and water. On the second day, in the vast majority of cases, appetite was restored, patients began to move on to the operated limb, gradually increasing the load on it. Postoperative swelling subsided on days 6-9. Healing of sutures by primary intention. 1 month after surgery, all patients had a partial limitation of the range of motion in the operated joint, and there was pronounced hypotrophy of the soft tissues of the hip. There were no vascular or neurological disorders, except for patients in whom surgery was performed for chronic sciatic dislocation. Localization of the head in close proximity to n. ischiadicus contributes to its constant traumatization and provokes involvement in the scar-adhesive process. Without a doubt, neurological disorders in this group of patients, manifested in peroneal nerve palsy, were a consequence of the above reason. During the postoperative period, these animals were prescribed a course of injections of proserin and B vitamins. Restoration of innervation of the limb was noted after 3 months from the date of surgery.
A sharp improvement in general condition in the immediate postoperative period was recorded in a patient with a history of deforming right-sided coxarthrosis, aseptic necrosis head and neck of the femur, severely stiff mobility of the hip joint. Clinically, there is constant arthralgia, severe pain on moderate palpation, range of motion is severely limited. The results of the arthroplasty revealed a deformation of the head with a total thinning of the cartilaginous covering up to exposure of the subchondral bone. Along the surface of the articulation, micro- and macro-defects of the cartilage of the head and acetabulum were traced in the form of abnormalities, cracks and fiber dislocations. Osteophytic growths were recorded along the periphery of the head, as well as in the paraacetabular region.
Postoperative period proceeded without complications. On the third day after surgery, the patient began to include the affected limb in the load. Healing of sutures by primary intention. After 1.5 months of intensive rehabilitation period, the range of motion in the operated joint was completely restored. 3 months after arthroplasty, no signs of lameness, as well as vascular and neurological disorders were noted. In all other cases, complete restoration of the functional suitability of the operated limb was observed within 1.5-2 months after surgery. The joints with arthroplasty, as well as the distal parts of the diseased limb, were in a functionally physiological position. There were no vascular, neurological disorders, or cosmetic defects associated with the operation.
Radiologically, on stage radiographs, the greater trochanter and the neck stump were projected opposite the glenoid cavity. No signs of aseptic necrosis or osteoporosis were noted.

Clinical assessment of the condition of the operated limb.

When examining sick animals in the postoperative period clinically and assessing the condition of the operated limb, we took into account the degree of restoration of its axis, the functional setting and range of motion in the operated joint and the joints of the distal parts of the diseased limb, the integrity and trophism of soft tissues, anatomical shortening, as well as vascular and neurological disorders of the operated limb, infectious complications after surgery, cosmetic defects caused by treatment, functional suitability of the operated joint and the limb as a whole.
Observation of the animals showed that they all tolerated the total arthroplasty operation satisfactorily. Awakening from anesthesia in dogs began 1.5–3 hours after surgery. They begin to drink water on the first day and eat food 2-3 days after surgery. During the first 24 hours, the general condition was satisfactory, the animals slept most of the time. The operation on the operated limb begins 2-3 days after the operation, gradually including it in the stato-locomotor act. Temperature, pulse and respiration indicators in all animals normalize on days 5–7, postoperative swelling subsides, as a rule, on days 6–8.
In all animals, no visible inflammation was observed within the skin, subcutaneous tissue or bone tissue. The surgical wounds healed by primary intention without cosmetic defects. By the time the sutures were removed 2 weeks after surgery, in all operated patients, the hip joints, as well as the joints of the distal parts of the diseased limb, were installed in a functional physiological position. Upon examination, no atrophy of the soft tissues of the operated area was detected, no vascular or neurological disorders were detected, and there were no cosmetic defects caused by surgery. Anatomical continuity of soft tissues in the area of ​​arthroplasty was noted. During the study of the range of motion of the hip joint in extreme positions, severe pain was noted in all dogs.
1 month after total arthroplasty, in all experimental dogs, the hip joints and joints of the distal parts of the operated limb were installed in a functionally physiological position; no restrictions in the range of motion of the operated joint were observed. All operated animals had severe lameness of the leaning limb type; there were no vascular or neurological disorders in the area of ​​surgical intervention. A clinical study of animals with arthroplasty revealed the presence of hypotrophy of the soft tissues of the operated limb. Complete restoration of her functional fitness was noted within 1.5–3 months after surgery. At the end of this rehabilitation period, all operated dogs stood freely on their pelvic limbs, jumped and moved without any signs of lameness. There were no vascular neurological disorders, cosmetic defects, or atrophy of the soft tissues of the operated limb. All patients with arthroplasty had full range of motion in the joints.

Conclusion

The problem of eliminating instability of the hip joint due to various degenerative-dystrophic processes remains, despite the numerous methods proposed, relevant to the present day. The biological approach and the desire to restore the hip joint and its elements made it possible to penetrate deeper into the mystery of the pathological process.
In this regard, the method of total arthroplasty helps to stop the lesion and correct the anatomical components of the operated area.
Summarizing the presented data regarding the results of reconstructive surgery on the hip joint, it can be noted that within 5-6 weeks after arthroplasty, the strength characteristics of the hip joint are virtually completely restored.
Literature:

1. Guryev V.N. Coxarthrosis and its surgical treatment. - Tallinn: Valgus, 1984.- 344 p.
2. Diagnosis and treatment of degenerative-dystrophic joint lesions / Shumada I.V., Suslova O.Ya., Stetsula V.I. and others - Kyiv: Health, 1990.- 196 p.
3. Ezhov Yu.I. Corrective osteotomies of the femur in the treatment of degenerative-dystrophic diseases of the hip joint II-III stage. // Surg. methods of treating diseases and consequences of damage to large joints. - 1990. - pp. 3-6.
4. Study of a new method of arthroplasty according to the “rolling joint” type in an experiment / Markov Yu.A., Kaveshnikov A.I., Belenkiy V.E., Fedorov V.N. // Clinical and biomechanical assessment of results. - Saratov, 1990. - pp. 10-16.
5. Mitin V.N. Surgical methods for the treatment of hip dislocations in small animals: Abstract of thesis. dis... cand. vet. nauk.- M., 1984.- 16 p.
6. Samoshkin I.B. Total arthroplasty in conditions of dysplasia in dogs // Current veterinary problems: Materials of the international. conference. - Barnaul, 1995. - pp. 177-178.
7. Samoshkin I.B. Clinical and statistical assessment of the results of arthroplasty for dysplasia in dogs // Veterinary Medicine. 1995.- No. 8.- p.48-50.
8. Samoshkin I.B. Total arthroplasty of the hip joints in dogs with dysplasia // Bulletin of Traumatology and Orthopedics named after. N.N. Priorova. - 1996. - No. 2. - p. 55-56.
9. Samoshkin I.B. Biomechanical characteristics of the hip joint in dogs after total arthroplasty // Morphology: Proc. report III Congr. Intl. Assoc. morphologists. - St. Petersburg, 1996. - v. 109, no. 2. - p. 88.
10. Samoshkin I.B. Biomechanical rationale for total hip arthroplasty in dogs. // Scientific aspects of prevention and therapy of agricultural diseases. animals: Scientific materials. Conf. dedicated to the 70th anniversary of the veterinary faculty. honey. Voronezh. state agrarian Univ. K.D.Glinka: - Voronezh, 1996. - Part I. - P.25-26.
11. Samoshkin I.B. Reconstructive operations in conditions of dysplasia in dogs, // Scientific. aspects of prevention and therapy of agricultural diseases. animals: Scientific materials. Conf. dedicated to the 70th anniversary of the veterinary faculty. honey. Voronezh. state agrarian Univ. K.D.Glinka: - Voronezh, 1996. - Part I. - P.26.
12. Samoshkin I.B. Biomechanical substantiation of total hip arthroplasty in dogs // Vestn. problems of biology and medicine. - 1997. - No. 2. - P.83-88.
13. Samoshkin I.B. Algorithm of surgical tactics for arthropathy of various origins // Proc. report: Scientific - practical. conf. The present and future of bone pathology: - M., 1997. - P.124-125.
14. Samoshkin I.B., Slesarenko N.A. Method of surgical treatment of hip dysplasia in dogs: Patent No. 2043089. Patent holder: Moscow. State Academician vet. honey. and biotechnology named after K.I. Skryabin. - Registered in the State. register of inventions September 10, 1995
15. Baer W.S. Arthroplasty with the aid of an animal membrane // Amer. J. Orthop. Surg.- 1918.- V. 16.- P. 1-7.
16. Bowen J.M., Lewis R.E., Kneller S.K. Progression of hip dysplasia in German Shepherd dog after unilateral pectineal myotomy // J. Am. vet. med. Ass.- 1972.- V. 161.- N 8.- P. 899-904.
17. Charnley J. Arthroplasty of the hip. A new operation // Lancet.- 1961.- V. 1.- P. 1129.
18. Chwilczynski M. Resektion der Femurkopfes als Behandlungs - mentod einigen Krankheiten des Huftgelenk Eeim Hund // Bericht Tierkrankheiten R¢onferenz. Leipzig.- 1975.- S. 101-103.
19. Denny H.R. Pelvic osteotomy in the dog // Vet. annual.- 1987.- P. 214-220.
20. Hohn R.B. Pelvic osteotomy // Proc. Am. Anim. Hosp. Assoc.- 1982.- P. 302.
21. Leichti R. Hip arthrodesis and associated problems. - Berlin, Heldelberg, New York: Springer-Verlag, 1978. - 269 p.
22. Murphy J.B. Ankylosis-arthroplasty. Clinical and experimental // J.A.M.A.- May 20, 1905.- V.44.-P.1573.
23. Paatsama S., Rissanen P., Rokkanen P. Skin arthroplasty of the hip joint in the dog // Bull. Soc. Sci. Vet. Lyon.- 1965.- V. 67.- P. 561-563.
24. Paatsama S., Rissanen P., Rokkanen P. I Some aspects of hip dysplasia and coxa plana in dogs. II Arthroplasty of the dysplastic canine hip joint: an experimental study with special reference to histochemistry and oxytetracycline bone labeling // J. Small Animal Pract.- 1966.- V. 7.- P. 477-481; 483-488
25. Smith-Petersen M.N. Evolution of mold arthroplasty // J. Bone Joint Surg.- 1948.- V. 30 B.- P. 59.
26.Walker T.L., Prieur W.D. Intertrochanteric Femoral Osteotomy // Seminars in Veterinary Medicine and Surgery (Small Animal) .- 1987.- V. 2, No. 2.- (May).- P. 117-130. Wallace L.J. Pectineus tendon surgery for the management of canine hip dysplasia // Veterinary Clinics North America, Small Animal Practice.- 1992.- V. 22, No. 3.- P. 607-621; 18 ref.

Results of clinical examination, radiography and motion analysis. Department of Surgery, Faculty of Veterinary Medicine, Ludwig Maximilian University, Munich, Germany.

VetCompOrthopTraumatol 2010; 23: 297-305

Original source: Off W, Matis U. ResektionsarthroplastikdesHüftgelenkesbeiHundenundKatzen.

Klinische, röntgenologische und ganganalytische Erhebungen an der Chirurgischen Tierklinik der Ludwig-Maximilians-Universität München. Tierärztl Prax 1997; 25: 379–387.

Summary

From 1978 to 1989 At the Department of Veterinary Surgery of the Ludwig Maximilian University, Munich, Germany, 132 femoral head and neck osteotomies were performed in dogs and 51 in cats. Eighty-one (44%) animals underwent follow-up clinical examination and radiography at an average of 4 years postoperatively, with 17 animals also undergoing motion analysis. Functional results were rated as good in 38% of cases, satisfactory in 20% and unsatisfactory in 42% of cases. However, 96% of owners were satisfied with the results of the operation. As shown by kinetic and kinematic measurements, despite the relief of pain after resection of the head and neck of the femur, as a result of the operation appeared functional disorders both small and large dogs. These disturbances were not noticeable during fast gaits.

Introduction

Osteotomy of the femoral head and neck (FCH) – relatively simple procedure, which has become the subject of many studies (1, 2, 4–8, 10–12, 18–24). Techniques and surgical approach vary, as do the results of the procedure. Some researchers have relied solely on owner assessment of outcome by completing questionnaires.

This study was conducted to evaluate the effectiveness of OGBC according to clinical examination and radiography of patients after surgery, performed at the Department of Veterinary Surgery, Ludwig Maximilian University, Munich, Germany. Some dogs were also analyzed for kinetics and kinematics, since the human eye is not able to correctly evaluate the full movement of a four-legged animal.

Materials and methods

Between 1978 and 1989, 132 dogs and 51 cats underwent OGBC surgery. This procedure was used in cases where joint preservation was not feasible or practical (Fig. 1). The most common indication in dogs was avascular necrosis of the femoral head due to Legg-Calvé-Perthes disease; most animals suffering from this disease weighed

In all cases, a craniolateral approach to the hip joint was used. After bending the joint capsule and cutting the round ligament, the limb was rotated 90° outward. An osteotome or vibrating saw was used to perform osteotomy of the femoral head. Sometimes the lesser trochanter was also cut off. To completely remove the caudal edge of the femoral neck, the osteotome or saw was held perpendicular to the long axis of the femoral neck (Fig. 3). The goal of this intervention was to create a smooth resection plane without bony protrusions. In most cases, the joint capsule was closed to create a layer of tissue between the acetabulum and the cutting surface of the femur after removal of the head and neck (Fig. 4) (17). Toward the end of the study, some animals received two additional sutures of durable, slowly absorbable material to secure the gluteal tendons to the insertion of the rectus femoris muscle to prevent caudodorsal displacement of the femur. The wound was sutured in the usual way. Immediately after surgery, photographs were taken in the ventrodorsal projection to determine the osteotomy plane.

Follow-up examinations of 81 animals (66 dogs and 15 cats) were carried out 7 months to 10 years after surgery (average 4 years) in our clinic.

Rice. 1. Indications for osteotomy of the femoral head and neck in 132 dogs and 51 cats.

Rice. 2. Weight distribution of 132 dogs and 51 cats who underwent osteotomy of the femoral head and neck (the weight of 5 dogs is unknown).

Rice. 3. Orientation of the osteotome during femoral neck osteotomy.

Rice. 4. The joint capsule was positioned between the osteotomy site and the acetabulum to avoid pain due to contact of the two bony surfaces.

a) view of the hip joint in the transverse plane before resection;

b) view after removal of the head and neck of the femur;

c) closing the joint capsule;

d) ventral view of the acetabulum after closure of the joint capsule.

Clinical parameters such as lameness, muscle atrophy, pain with passive movements, crepitus, caudodorsal displacement of the femur and range of motion. These objective variables were supplemented by the owners' assessment of the following indicators:

1. duration of postoperative symptoms;
2. duration of the postoperative recovery period;
3. support on the affected limb during a slow gait, fast gait, after strenuous activities physical activity and in cold or damp weather;
4. subjective assessment of the success of surgical intervention.

Scores were assigned as follows:

1. good: no lameness, the animal fully relies on the limb at all gaits;
2. satisfactory: slight lameness, sometimes stiffness, sometimes lameness without support of the limb;
3. unsatisfactory: mild to severe persistent lameness, the animal often does not support the limb, lameness after exercise, lameness when trotting and/or galloping, lameness associated with weather.

In 67 cases (55 dogs and 12 cats), radiographs were taken immediately after surgery to assess the completeness of resection of the femoral neck with or without removal of the lesser trochanter and to ensure that there were no sharp bone edges along the osteotomy line. 17 dogs were also studied in a movement assessment laboratory (18, 19). Using a treadmill with four built-in load plates, the following kinetic parameters were assessed:

1. duration of the support phase (ms);
2. peak vertical support load (% of body weight);
3. slope of the support load curve (% of body weight/sec);
4. integral (% of body weight x sec).

Kinematic data were obtained using reflective markers placed on the iliac crest, greater trochanter, lateral femoral condyle, malleolus of the fibula, and tarsus during movement.

results

Postoperative assessment showed shortening of the limb in 68 animals (84%) (caudodorsal displacement of the femur), muscle atrophy in 61 (75%) animals, a decrease in the range of motion during extension and abduction of the pelvic limb in 60 (74%), symptoms of lameness in 45 ( 60%), symptoms or pain with passive movement of the limb in 26 (32%) and crepitus in 8 (10%) animals (Table 1). The proportion of dogs weighing more than 15 kg was small, but this group tended to have worse outcomes than smaller patients. Subjective assessment showed that least amount postoperative problems have been observed in cats. Although clinical lameness was not detected in any cat, owners of 5 of 15 cats reported a shortened stride after physical activity, when the weather changes, fast or slow gait or after long periods peace. According to the owners' observations, when the operated limb was loaded with a slow gait, 69 (85%) animals looked normal, and normal function with a fast gait was preserved in 52 animals (64%). Lameness after strenuous physical activity was observed in 19 patients (23%), and in cold weather - in 20 (24%) (Table 2).

However, 78 of 81 (96%) owners considered the outcome of the operation to be successful.

Average duration recovery period ranged from 4 to 6 weeks in cats and small dogs and 7 to 9 weeks in dogs weighing more than 15 kg, although the period of postoperative lameness in the latter group was on average shorter than in smaller patients. Based on information obtained from owner questionnaires and the results of repeated clinical examination, functional results were assessed as good in 38% of cases, satisfactory in 20% and unsatisfactory in 42%. There was no correlation between body weight and functional outcome (Table 3). Symptoms present before surgery persisted for an average of 5 weeks in animals with good results and an average of 7 weeks in animals with worse surgical results (Table 4).

Postoperative radiographs showed complete osteotomy of the femoral head and neck in 40 animals (60%), half of which also underwent resection of the lesser trochanter (Table 5).

Table 1. Clinical signs in 66 dogs and 15 cats 7 months to 10 years (average 4 years) after osteotomy of the femoral head and neck.

Table 2. Subjective information obtained from owners of 66 dogs and 15 cats after osteotomy of the femoral head and neck.

Table 3. Functional outcome depending on body weight.

Table 4. Functional outcome depending on the duration of postoperative symptoms.

The proportion of animals with satisfactory functional outcome was slightly greater after incomplete resection than after complete resection. X-rays, made during the follow-up period, showed proliferation of bone tissue in the area of ​​the lesser trochanter in 34 animals (51%); 13 of these animals underwent resection of the lesser trochanter, while 21 did not (Fig. 5). Ossification in this area was noted in all cats (Fig. 6), while in dogs the incidence of osteophyte formation after complete and incomplete resection of the femoral head and neck was similar. There was no correlation between osteophyte formation and functional outcome.

On average, analysis of the movements of all dogs studied using kinetic data showed a shortening of the stance phase on the operated limb compared to the opposite limb (Table 6). In dogs weighing less than 15 kg, the peak vertical support load was slightly increased at the walk, but increased to 13% of body weight at the trot, while in dogs weighing more than 25 kg the load on the operated limb was lower by an average of 6% from body weight at both gaits. However, only one large dog has been tested on a treadmill while trotting. The slope of the ground load curve was used as a measure of force transfer, which was steeper in small dogs than in large dogs. The integral (total area under the curve), which is a measure of load impulse, was increased only in trot and decreased in other gaits due to a reduction in the duration of the stance phase (Fig. 7). The kinematic amplitudes of the hip, knee and tarsal joints varied significantly, but the graphs showed a characteristic pattern for each joint. The hip joint angle was slightly reduced in small dogs and markedly reduced in large dogs, indicating resistance to joint extension (Fig. 8).

The decrease in the angle of the hip joint was compensated mainly by extension of the tarsal joint.

Discussion

The pioneers who pioneered the use of OGHA in veterinary medicine (21, 24) were pleased to find a promising, simple, and inexpensive method for the treatment of complex hip disorders. However, the use of OGBC as a panacea requires critical consideration. In our study, the effectiveness of OGBC was examined in a population limited to dogs and cats with predominantly chronic (weeks-long) symptoms (14, 16). Our results are consistent with those of Duff and Campbell, who found that progressive muscle atrophy and contractures associated with claudication were detrimental to surgical outcome (4). In contrast to total hip replacement, complete muscle recovery does not usually occur after OHHA (9, 15). The age of the animals did not correlate with the outcome, which is consistent with the data of Gendreau and Cawley (6).

Table 5. Radiographic and functional outcomes in 55 dogs and 12 cats immediately after femoral head and neck osteotomy surgery and at an average of 4 years after surgery.

*Follow-up examination was performed an average of 4 years after femoral head and neck osteotomy.

It was not possible to determine the effect of changes in surgical technique, in particular, interposition of the joint capsule or fixation of the greater trochanter with sutures, on the outcome retrospectively, since the medical records were incomplete. Grade x-rays showed that removal of the lesser trochanter to eliminate pain due to contact of the femoral and pelvic bones does not affect the outcome; Bone proliferation in the area of ​​the resected or retained lesser trochanter did not correlate with functional outcome. The rate of unsatisfactory results after incomplete resection of the femoral neck was slightly higher than after complete resection, which is consistent with the results of Lee and Fry (10). However, the correlation between clinical picture and radiographic findings were nonsignificant, consistent with Duff and Campbell (5).

Of the 81 dogs and cats, 38% had limb function assessed as good on average 4 years after surgery, 20% as satisfactory, and 42% as unsatisfactory. These results may seem poor compared to other studies, but it should be noted that most of these studies were based on owner opinion (1, 2, 4, 7, 8, 10–12, 20–22, 24). The vast majority (96%) of our patient owners also rated the outcome as favorable.

Despite the lameness and lack of weight bearing on the limb, some dogs did not show any pain or limitation in range of motion that may be responsible for the lameness.

Passive movement of the operated limb caused pain in only about 33% of animals, while lameness was observed in 56% of cases, and more animals had other signs of dysfunction, such as muscle atrophy (Table 1). Consequently, the cause of lameness is not always obvious. In the absence of pain, the lameness may be mechanical due to scarring. The results of the movement analysis showed functional impairment in all 17 dogs after OHA. These animals showed a reduction in support contact time regardless of body weight, even if lameness was not noticeable on clinical examination. In small dogs, the vertical support force during stride was almost equal on both pelvic limbs, while in (a relatively small number of) large dogs this force was reduced on the operated limb, presumably due to the animal's desire to spare it.

Rice. 5. X-rays of an 8-month-old, 5-kg Jack Russell Terrier with Legg-Calvé-Perthes disease. Ventrodorsal view of the pelvis:

a) before surgery;

b) immediately after surgery with complete resection, including the lesser trochanter;

c) 8 months after surgery, slight proliferation of bone tissue without deterioration of function.

Rice. 6. X-rays of a two-year-old cat weighing 3.5 kg with repeated dislocation of the hip joint. Ventrodorsal view of the pelvis:

a) before surgery;

b) immediately after surgery with incomplete resection of the lesser trochanter; pronounced proliferation of bone tissue in the area of ​​the lesser trochanter without deterioration in function.

With the exception of one dog, kinetic studies at trotting have only been performed in small dogs; the results showed increased load on the operated limb. This phenomenon was noted by Dueland et al in a comparative study of total hip replacement and OGHA, which led the authors to question the superiority of hip replacement over OGHA in quadrupeds (3). However, gait analysis in people with shortened limbs suggests that the increased load is caused by a shift in the center of gravity toward the shortened side (13).

In our study, owners often noted that dogs avoided trotting. During trotting, pairs of limbs move diagonally towards each other, and at some point one of the pelvic limbs bears approximately 60–80% of the body weight. It is unknown whether avoidance of the trot is associated with the occurrence of this short-term severe loading or with a decrease in the ability to extend the hip joint. Based on our kinematic data, dogs with a reduced range of motion in the hip joint after OHA compensate for this mainly due to greater extension at the tarsal joint.

In conclusion, the present study revealed discrepancies between the results of objective clinical assessment and subjective observations of owners of animals who have undergone OHBI. This clearly shows that the effectiveness of surgical treatment should not be determined using questionnaires. The currently accepted view that small dogs compensate better than large dogs for the effects of OHCA should be reconsidered in light of our results from the movement analysis. Reduction of pain after OHHA comes at the expense of some impairment of limb function, even in small dogs, where lameness may be difficult to detect with the naked eye due to their rapid movements. Thus, OHA should be limited to exceptional circumstances when joint preservation is not possible or infection or other contraindications preclude joint replacement, even in small dogs (16).

Table 6. Results of motion analysis of 17 dogs after osteotomy of the femoral head and neck.

Rice. 7. Ground force curve, 5.8 kg Yorkshire terrier 6 years after right femoral head and neck osteotomy during a) walking and b) trotting. Y axis: N = Newtons; X-axis: time in seconds; F1 = right thoracic limb; F4 = left thoracic limb; F2 = right pelvic limb; F3 = left pelvic limb.

Rice. 8. Schematic illustration the angle of the hip and knee joints of a St. Bernard weighing 44.5 kg 6 years and 7 months after osteotomy of the head and neck of the right femur; a) right pelvic limb, b) left pelvic limb.

Green: hip angle; red: knee joint angle; y-axis: angle (degrees); x-axis: time (sec).

Literature:

1. Berzon JL, Howard PE, Covell SJ, et al. A retrospective study of the efficacy of femoral head and neck excisions in 94 dogs and cats. Vet Surg 1980; 9:88–92.
2. Bonneau NH, Breton L. Excision arthroplasty of the femoral head. Canine Pract 1981; 8, 2: 13–25.
3. Dueland R, Bartel DL, Antonson E. Force-plate technique for canine gait analysis of total hip and excision arthroplasty. J Am Anim Hosp Assoc 1977; 13, 5: 547–552.
4. Duff R, Campbell JR. Long term results of excisional arthroplasty of the canine hip. Vet Rec 1977; 101: 181–184.
5. Duff R, Campbell JR. Radiographic appearance and clinical progress after excision arthroplasty of the canine hip. J Small Anim Pract 1978; 19, 8: 439–449.
6. Gendreau C, Cawley AJ. Excision of the femoral head and neck: The long-term results of 35 operations. J Am Anim Hosp Assoc 1977; 13, 5: 605–608.
7. Hofmeyr CFB. Excision arthroplasty for canine hip lesions. Mod Vet Pract 1966; 47, 2: 56–58.
8. Junggren G.L. A comparative study of conservative and surgical treatment of Legg-Perthes disease in the dog. Anim Hosp 1966; 2: 6–10.
9. Kosfeld HU. Der totale Hüftgelenkersatz beim Hund. Klinische, röntgenologische und ganganalytische Erhebungen in den Jahren 1983 bis 1993. Diss med vet, München 1996.
10. Lee R, Fry PD. Some observations on the occurrence of Legg-Calvé-Perthes" disease (Coxaplana) in the dog, and an evaluation of excision arthroplasty as a method of treatment. J Small Anim Pract 1969; 5: 309–317.
11. Lippincott C.L. Excision arthroplasty of the femoral head and neck utilizing a biceps femoris muscle sling. Part Two: The caudal pass. J Am Anim Hosp Assoc 1984; 20: 377–384.
12. Lippincott C.L. A summary of 300 surgical cases performed over an 8 year period: excision arthroplasty of the femoral head and neck with a caudal pass of the biceps femoris muscle sling (Scientific Meeting Abstract). Vet Surg 1987; 16, 1: 96.
13. Lüttschwager P. Zum Einfluä statischer und muskulärer Dysbalancen auf die Bewegungsasymmetrie beim Laufen mit unterschiedlichen Geschwindigkeiten. Dipl.-Arbeit 1992, Sporthochschule Köln.
14. Matis U, Waibl H. ProximaIe Femurfrakturen bei Katze und Hund. Tierärztl Prax 1985; Suppl.1: 159–178.
15. Matis U, Knobloch S, Off W. Der Hüftgelenkersatz beim Hund. 9 Jahre Erfahrung an der Chirurgischen Tierklinik der Ludwig-Maximilians-Universitat München. 1. Seminar des AMC New York, Tegernsee, 1992 (Abstract).
16. Matis U. Operationsverfahren bei Hüftgelenkdysplasie. Tierärztl Prax 1995; 23:426–431.
17. Matis U, Schebitz H, Waibl H. Zugang zum Hüftgelenk von kraniolateral. In: Operationen an Hund und Katze, 2. Aufl. Schebitz H, Brass W (Hrsg.) Berlin: Blackwell.
18. Off W. Klinische und ganganalytische Erhebungen zur Resektionsarthroplastik des Hüftgelenks bei Hund und Katze in den Jahren 1978 bis 1989. Diss med vet München 1993.
19. Off W, Matis U. Ganganalyse beim Hund. Teil 2: Aufbau eines Ganglabors und bewegungsanalytische Untersuchungen. Tierärztl Prax 1997; 25: 303–311.
20. Olsson SE, Figarola F, Suzuki K. Femoral head excision arthroplasty. Clin Orthop Rel Res 1969; 62: 104–112.
21. Ormrod AN. Treatment of hip lamenesses in the dog by excision of the femoral head. Vet Rec 1961; 73:576–577.
22. Piermattei DL. Femoral head ostectomy in the dog: Indications, technique and results in ten cases. Anim Hosp 1965; 1: 180–188.
23. Seer G, Hurov L. Simultaneous bilateral coxofemoral excision arthroplasty in the dog. Can Vet J 1968; 9: 70–73.
24. Spreull JSA. Excision arthroplasty as a method of treatment of hip joint diseases in the dog. Vet Rec1961; 73:573–576.

Sudden lameness is a common problem faced by dog ​​owners, which often leads them to suspect a sprain or dislocation. At the same time, not all owners correctly understand the essence of these pathologies and do not always attach due importance to this. Meanwhile, a dislocated joint is a fairly serious injury that can lead to severe complications and the consequences if the animal is not diagnosed in a timely manner and is not provided with qualified assistance.

A joint dislocation is a disruption of function and anatomy due to displacement of the articular surfaces forming a joint relative to each other, without violating their integrity.

Joint dislocations can be congenital or acquired (traumatic), complete or partial (subluxation).

When a dislocation occurs, damage to the soft tissues and intra-articular structures surrounding the joint is inevitable: capsule, ligaments, blood vessels, articular cartilage and nerves.

Among joint dislocations, the hip joint occupies a leading position.

The hip joint is complex in its structure, multi-axial, i.e. moves freely like a hinge in several planes. The femoral head is securely located in the acetabulum, where stability is provided by the joint capsule and round ligament.

In dogs, complete traumatic dislocation of the head of the hip joint mainly occurs in the craniodorsal position (94% of cases) and caudoventrally towards the obturator foramen. Incomplete dislocation (subluxation) occurs in dogs with joint dysplasia.

Clinical signs and diagnosis

With traumatic dislocation of the hip joint, a complete lack of support for the injured limb, swelling in the joint area and asymmetry of the pelvic limbs are most often observed.

Palpation reveals pain, instability and symptoms of crepitus.

The final diagnosis is made based on radiographic examination (Figure 1).

Treatment of hip dislocation

The sooner the dislocated joint is reduced, the better the long-term clinical result will be with a decrease in the likelihood of developing secondary arthrosis.

The optimal time for reduction is in the first hours after the injury.

If 12 to 24 hours have passed since the dislocation, the doctor may try to reduce the dislocation without surgery. Unfortunately, reduction of a dislocated hip joint using the closed reduction method most often does not bring positive result As a rule, a relapse occurs, the femoral head comes out of the acetabulum again.

After reposition, the joint needs immobilization, which is difficult to achieve in an animal due to its anatomical structure and the inability to provide adequate rest.

The most reliable and effective treatment choice is surgery.

There are several methods that make it possible to ensure a complete recovery for the animal with a high degree of probability. The specialist chooses which method to perform reposition and fixation based on several factors, such as: the animal’s age, breed, body weight, chronic diseases, the nature and severity of the dislocation, and associated injuries.

Method of suturing the joint capsule (capsulorrhaphy)

The joint capsule is the main anatomical structure stabilizing the hip joint. When dislocations occur, a tear or rupture of the elements of the joint capsule occurs. After open reduction of the hip joint, the joint capsule is tightly sutured, and this serves as a stabilizing element (Fig. 1). After this operation, the animal must rest for 14 days.

Round ligament replacement method

The method consists of replacing the round ligament with a biocompatible implant (Fig. 2). This technique is similar to transarticular stabilization, but instead of a wire, a graft is inserted into the anatomical position of the round ligament. The remains of the round ligament are removed. The capsule is sutured and movements are limited for 7-10 days.

Transarticular stabilization method

The essence of this technique is to fix the hip joint in its correct anatomical position using a metal pin passed through the joint and fixing it to the bottom of the acetabulum (photo 2). During the postoperative period, the animal is limited in movement (short-term walks on a short leash, keeping in a limited space). After 2-3 weeks, the wire is removed, and the joint is stabilized due to the periarticular fibrous tissue formed during this period, and the functions of the limb are gradually restored.

Resection arthroplasty method

It consists of removing the head of the femur, after which the joint is stabilized due to the formation of fibrous tissue in the joint cavity (photo 3). It can be difficult for owners to understand how it is possible to restore the functions of a limb by removing a joint. In order to understand this, let’s pay attention to how the attachment of the thoracic limb to the skeleton is ensured; there is no joint between the scapula and the axial part of the skeleton and the connection is carried out exclusively through soft tissues (synsarcosis), the same thing happens with the pelvic limb after surgery. This surgical intervention is indicated for patients with dislocations due to hip dysplasia and a body weight of up to 15 kg. An undoubted advantage This operation is the absence of any implants inside the joint. The recovery time depends mainly on the animal’s body weight; the smaller it is, the faster the restoration of limb functions occurs.

During the rehabilitation period in animals with dislocations of the hip joints, physiotherapy and swimming are recommended.

If you suspect a dislocated hip joint in an animal, remember the following:

1) Do not try to correct the dislocation yourself, this is very painful for the animal and can aggravate the damage to the surrounding and intra-articular structures.

2) To examine the animal and reposition the dislocation, relaxation and anesthesia will be necessary, so the animal should not be fed for 10-12 hours before visiting the doctor.

3) When transporting, it is better to lay the animal on a flat surface on the side opposite to the injured limb.

4) Do not delay your visit to the clinic if you do not spend the first 2-3 days therapeutic measures Irreversible changes in the joint may occur.

Resection arthroplasty, or resection of the femoral head, is the only operation of choice for Perthes disease.

Legg-Calvé-Perthes disease, or simply Perthes disease or aseptic necrosis of the femoral head, is a pathology manifested in the form of impaired blood supply to the femoral head, which gradually leads to its necrosis and destruction. As the disease progresses, the pain increases and the dog completely stops using the injured limb. To relieve pain and restore the ability to use the paw, resection of the femoral head is performed.

The pathology has a pronounced breed predisposition- dwarf and decorative dog breeds.

As Perthes disease progresses, the condition of the femoral head worsens. These are irreversible changes, return the joint to its original state, make it smooth and healthy again. this level development of medicine is impossible. Therefore, a visit to a veterinary orthopedic surgeon and rehabilitation specialist, and a decision on surgery, must be made as early as possible, before the joint is completely deformed.

Preparing for surgery

After the diagnosis is made, but before the date of surgery is scheduled, it is recommended to show the pet to a rehabilitation specialist. Often Perthes disease is accompanied by atrophy of the gluteal and thigh muscles. This, firstly, greatly complicates the surgeon’s work and increases the risk of possible complications, and secondly, it will slow down the restoration of weight-bearing ability after surgery (in some cases, without the help of a rehabilitation specialist, the dog may not begin to fully use the limb). The rehabilitologist will develop a program of preoperative preparation and postoperative recovery for you. After achieving your goals (usually a set of muscle mass, improving the elasticity of the ligaments and the range of motion in the joint), you can plan the day of the operation together with the rehabilitator.

Operation

The operation is carried out by appointment only, under general anesthesia. Before surgery, you must undergo a 12-hour fast and do not give water for 4-6 hours. Before surgery, your dog must be examined by an anesthesiologist. It is advisable to make an appointment with an anesthesiologist for elderly animals or animals with chronic diseases 5-7 days before the planned day of surgery, in order to have time to do the required tests if necessary.

The name of the operation contains a brief description of its meaning - resection (resectio, translated from Latin - cutting off) arthroplasty (from the Greek árthron - joint and plastike - sculpting, plastic). The essence of the operation is to cut off the deformed femoral head and create a gap of scar tissue between the articular cavity and the surface of the femur, which will not allow the bone surfaces to come into contact, thereby completely preventing the recurrence of pain.

There are two options for resection - complete or with preservation of the femoral neck. However, the second option has been abandoned in modern veterinary practice, since with incomplete osteotomy of the femoral head, contact of bone surfaces often occurs, and a relapse of the pain syndrome. The figure shows a dotted line along which the resection is carried out.

There are no contraindications to surgery for Perthes disease; there may be contraindications to anesthesia.

After complete recovery from anesthesia under observation in a hospital, you will be contacted, and in the evening of the same day you will be able to take the dog home. It will be necessary to treat the stitches and perform the exercises prescribed by the rehabilitator.

Complications after surgery

Complications after surgery may appear in the form of gray in the suture area. In the absence of rehabilitation exercises, the return of weight bearing may not occur or will take a long time, and lameness may persist. It is recommended to remove sutures 10-14 days after surgery. To protect the seam from being licked by a dog, we recommend purchasing a protective collar.

Postoperative period

Immediately after the operation (during the first 24 hours), it is necessary to continue the rehabilitation program. In the first days, cryotherapy and PROM are necessary, gradually the exercises will become more difficult.

The goal of postoperative rehabilitation is to restore the ability to support the injured limb and restore muscle mass. The dog loses the habit of using the paw, the support on which caused pain, and this habit remains even after the pain disappears. The duration of recovery can take from several days to several months - depending on the degree of neglect of the problem before surgery, the degree of muscle development, the preservation of the elasticity of the ligaments, and the possibility of completing a rehabilitation program. The prognosis for recovery is given by a rehabilitation specialist during the initial examination.

After a competently performed operation for Perthes disease, following all the recommendations of a rehabilitator and performing exercises in a timely manner, the operated hip joint will be practically no different from a healthy one, except for a slightly reduced range of motion.

Cost of surgery for Perthes disease

You can purchase subscriptions to classes at the rehabilitation center.

Treatment of hip dysplasia in dogs

S.A. Yagnikov

Peoples' Friendship University of Russia

Department of Veterinary Pathology

Moscow 2006 UDC 6196617.3.57

Yagnikov S.A. Doctor of Veterinary Sciences.

Treatment of hip dysplasia in dogs.

Moscow, RUDN, 2005, 37 p., 2 tables.

The methodological recommendations give the modern concept of hip dysplasia in dogs and describe the clinical symptoms of the disease. Are given general recommendations To reduce the pain symptom in this group of animals, the concept of drug treatment of secondary osteoarthritis developing against the background of hip dysplasia in dogs is shown.

Modern methods of surgical treatment of hip dysplasia, indications for these methods, surgical technique, and long-term results of treatment are described.

Reviewer – Doctor of Veterinary Sciences, Professor Porfiryev I.A.

© S.A. Yagnikov

List of abbreviations and symbols

AT(antetorsion angle) – the angle of rotation of the head of the femur cranially in relation to the diaphysis of the femur.

GAG– glycosaminoglycans.

GEP CITO– state experimental enterprise of the Central Institute of Traumatology and Orthopedics named after. N.N. Priorova.

Dysplasia– developmental disorder.

DCP- dynamic, compression plate.

LC DCP- dynamic, limited contact compression plate.

Gastrointestinal tract– gastrointestinal tract.

KG– corticosteroid hormones.

MO(intertrochanteric osteotomy) is a reconstructive operation that includes a wedge-shaped ostotomy of the femur in the intertrochanteric region, followed by fixation with a hook-shaped, dynamic, compression plate.

NLC- essential fatty acids.

NSAIDs– non-steroidal anti-inflammatory drugs.

OA- osteoarthritis.

PIN(pectin myectomy, iliopsoasthenotomy and neurotomy) - palliative surgery, including myectomy m. pectineus, tenotomy m. iliopsoas and intersection (destruction) of nerves and nerve endings innervating the capsule of the hip joint.

RA(resection arthroplasty) – osteotomy of the head and neck of the femur with interposition between the femur and the glenoid cavity of autologous tissue.

HS– chondroethin sulfate.

THAT(triple pelvic osteotomy) is a reconstructive operation that includes segmental osteotomy of the pubic bone, osteotomy of the ischium and ilium, followed by lateral rotation of the ostotomized pelvic segment, followed by fixation of the body of the ilium with a plate and screws.

TBS– hip joint.

TETS (total endoprosthetics hip joint) - replacement of the hip joint with an artificial joint (prosthesis).

?SHDU(cervical-diaphyseal angle) - the angle formed by the axis of the femoral neck and the axis of the diaphyseal segment of this bone.

EA- epidural anesthesia.

Conservative treatment of hip dysplasia

Hip dysplasia in dogs is considered an incurable disease. All methods of conservative and surgical treatment are aimed at relieving or reducing pain symptoms and slowing the progression of secondary osteoarthritis. The choice of treatment tactics depends on the manifestation of clinical symptoms and radiological parameters of dysplasia, the age and body weight of the animal, the degree of muscle mass atrophy, the purpose of the animal and the presence of concomitant diseases in the patient.

Loss of body weight. Overweight leads to a caudal shift in the center of gravity, which increases the load on the pelvic limbs and contributes to the progression of secondary osteoarthritis in the hip joint. You can control the animal’s body weight based on the following signs: the animal’s ribs are easily determined by palpation, and in short-haired dogs they are noticeable when moving. For chronic pain caused by secondary osteoarthritis, only with a decrease in body weight can a clear clinical improvement be obtained. After losing weight, many dogs do not need daily anti-inflammatory therapy.

Table 1. Body condition assessment in dogs

Limitation of movements. Dogs during the growth period with excessive joint instability and adult animals with developed hip dysplasia should avoid prolonged exercise, as this leads to the development and progression of dysplastic osteoarthritis. Animals suffering from hip dysplasia should not experience weakness or lameness of the pelvic limbs after a walk. If after a walk the animal exhibits a disorder motor function pelvic limbs in the form of lameness or weakness, then the load is excessive and should be reduced.

In dogs with hip dysplasia that were walked on lawns, exacerbation of dysplastic coxarthrosis was observed much less frequently than in dogs walked on asphalt. Swimming is recommended for animals with hip dysplasia, since movements are performed in water with minimal load on the articular surfaces and a fairly large load on the periarticular muscles, which helps strengthen them.

Owners should avoid moving the animal on smooth and slippery floors, as spreading of the pelvic limbs can lead to increased damage to the joint.

Cold and humidity. Cold and wet weather often leads to exacerbation of dysplastic osteoarthritis, increased lameness, and night pain. Dogs suffering from hip dysplasia should be kept in a warm and dry room.

Table 2. Doses, frequency of use and route of administration of NSAIDs approved in veterinary medicine.

Recently, NSAIDs have been widely used in postoperative period to relieve pain and reduce postoperative swelling and inflammation. NSAIDs are prescribed in the indicated doses, but not more than 2-3 days. With a longer course of treatment, “suture dehiscence” is noted, which leads to wound healing by secondary intention. This is due to a decrease in the number of fibroblasts that synthesize collagen and proteoglycan, necessary for tissue fusion by primary intention 36.

Corticosteroid hormones

Corticosteroid hormones for dysplastic OA are reserve drugs and are used in cases of ineffectiveness and/or complications after the use of NSAIDs 18,25,28,37. CG is used systemically or locally via intra-articular injection. Intra-articular steroid injection has always been criticized due to the high percentage of infectious complications 70. The opinions of different authors regarding the effect of steroids on the articular surface of cartilage are contradictory. They are more pessimistic when assessing effects on articular cartilage in rodents and more optimistic when assessing effects on the joints of dogs and monkeys 4,5, 13,32,33,34,59,62,72.

Assessing the results of the injection of CG into the affected joint, based on literature data, we can conclude that intra-articular injections of CG reduce the erosion of articular cartilage, slow down the production of osteophytes, and inhibit the activity of stromelysin and the proliferation of chondrocytes. This supports the idea that corticosteroids may slow the progression of OA. However, the literature does not indicate the duration of CG therapy, and all work was carried out at the early stage of OA. In addition, the authors of the works point out that it is very difficult to select

a dose of CG that would suppress catabolism in the cartilage tissue of the joint and at the same time not suppress the regeneration of cartilage tissue 41,52.

Most effective drug, which has a prolonged effect, is diprospan (a preparation of betamethasone salts), triamcinolone and kenalog in a dose of up to 5 mg per injection, diluted in 1-2 ml of a 2% lidocaine solution 11. The drug is administered at intervals of 14-40 days. The injection site is prepared as a surgical field: the hair is trimmed at the site where the needle is inserted into the joint cavity, and the skin is treated with Lavasept solution, or 0.5% alcohol solution chlorhexidine. After inserting a needle into the joint cavity, the synovial fluid is first aspirated, and then a syringe with the drug is connected to the needle and injected.

U small breeds of dogs and cats arthrocentesis (insertion of a needle into the joint cavity) and intra-articular administration of corticosteroid hormones are difficult. Therefore, we recommend that small animals receive a subcutaneous injection of prolonged corticosteroid hormones (Dexafort, once every 10-14 days, subcutaneously, 2-3 injections).

Most common complication– polydipsia (increased thirst) and polyuria (increased urine volume and frequency of urination) in an animal after administration of the drug for 5-12 days. Polydipsia and polyuria gradually decrease and stop. In this case, the animal cannot be limited in water.

Contraindications for intra-articular injection of CG are infectious arthritis, planned joint surgery, hyperglycemia.

Anabolic steroid

In large joint OA, the use of drugs that increase muscle mass may lead to functional improvement 56,59,71. This occurs due to an increase in joint stability and the enrichment of articular cartilage with mucopolysaccharides 71. Anabolic steroids are recommended for use in dogs after bone growth has completed, since drugs in this group contribute to the “closure” of the epiphyseal growth zones and prevent continued bone growth 50,71. The use of anabolic drugs is recommended to be combined with dosed training 56,59,71.

Unfortunately, drugs of this group are prohibited in veterinary medicine. But we will give the doses and frequency of use of drugs of this group in small domestic animals.

Table 3. Doses, frequency of use and method of administration of anabolic steroids approved in veterinary medicine.

Antioxidants

Antioxidants include vitamins C, E, and the trace element selenium. The mechanism of action of antioxidants is to reduce the level of free radicals in the joint cavity, which are promoters of inflammation and contribute to the degradation of proteoglycans.

The concentration of vitamin C in blood plasma in healthy dogs large breeds is 7.02 mg/l. With pain caused by osteoarthritis, the concentration of vitamin C drops sharply 48. The level of vitamin C is regulated by its production in the animal's body. To provide positive influence on OA, high concentrations of the vitamin in tissues are required. A dose of 90 mg/kg was required to produce clinical improvement in canine OA, but the results of this study have not been validated 16,18. The pathogenesis of pain reduction in OA is due to the decisive role of vitamin C in the synthesis of collagen 65. The likelihood of obtaining a positive effect in the treatment of OA using large doses of vitamin C borders on more likely get side effects from the gastrointestinal tract 18.48. The effectiveness of other antioxidants in the treatment of OA has not been evaluated in veterinary medicine 16.

Viscoelastic drugs

Synovial fluid in a diseased joint loses its lubricating function, and also loses its damping (shock-absorbing) and attracting ability. All these properties are due to viscoelasticity synovial fluid. Preparations designed to replenish viscoelasticity are synthesized on the basis of hyaluron, and the raw materials for their production are rooster scallops. The increase in viscosity of drugs in this group is due to the presence of cross-links between hyaluron molecules, which provide a high molecular weight of the drug 7. The therapeutic effect of the drugs applies only to the affected joint. It is due solely to their rheological properties and is not associated with pharmacological, immunological or metabolic effects. Therefore, it is customary in the world to call the drugs Gialgan and Synvisc a device. In terms of effectiveness in relieving pain symptoms in OA, drugs in this group compete with NSAIDs 3. However, they have one significant drawback that limits their widespread use in veterinary medicine - high cost. One course of treatment for OA consists of three to five intra-articular injections of 1-2.0 ml of the drug for each injection with an interval of one week 7.

Type II collagen

Hyaline cartilage primarily consists of type II collagen and, to a lesser extent, types IX and XI. The disordered structure of type II collagen is the essence of the normal functioning of hyaline cartilage. Damage to the hyaline cartilage surface is considered to be a motivating factor and cause of OA progression 4,43. Two studies conducted in dogs with naturally occurring joint disease identified autoantibodies directed against type II collagen. These facts indicate that autoimmunity is at least a component in the progression of joint disease in humans and animals 17,58. The potential of collagen in the treatment of joint diseases is still unknown. A number of studies are required before collagen can be recommended for the treatment of joint diseases 17,58.

Gene therapy

An approach gene therapy to the treatment of OA consists of the introduction of genes for inhibitors of cytokines, interleukin (IL-1) and tumor necrosis factor (TNF), such as IL-RAP, and the soluble ETA receptor, as well as the introduction of genes for tissue inhibitors of metalloproteinases (TIMP-1, TIMP- 2) and genes for transforming growth factor (TGF-?). These genes, once activated, will produce large quantity inhibitors of interleukin-1 and tumor necrosis factor, inhibiting the damaging effects of cytokines. The production of inhibitors increases and suppresses the destructive effect of metalloproteinases on articular cartilage. The transforming growth factor gene stimulates the production of growth factor, which promotes the regeneration and restoration of cartilage tissue 22,31,69.

Conclusion

Drug treatment of OA should consist of drugs taking into account the following priorities: 1) relief of pain symptoms; 2) synovitis; 3) disturbances in the trophism of articular cartilage and subchondral bone; 4) muscle wasting. When using the above groups of drugs, the doctor must know which pathogenetic link of OA he affects, and be sure of the advisability of prescribing certain veterinary or medical supplies and food additives.

Myectomy m.pectineus15

Today, myectomy of the pectineus muscle in dogs during the growth period is not considered as a prevention of the development of hip dysplasia in dogs. But clinical observations have shown that excision of this muscle leads to a reduction in lameness (pain) and helps restore the motor function of the pelvic limb in case of hip dysplasia.

The reduction in pain after this operation is due to a decrease in subluxation of the femoral head, tension in the joint capsule and irritation of the nerve endings of the obturator nerve innervating the dorsal part of the joint capsule, as well as the absence of pain symptoms emanating from the tense pectineus muscle. The operation does not affect the development and progression of secondary osteoarthritis, is symptomatic in nature and has temporary success in relieving pain symptoms. The result of the operation in the form of reduction or complete disappearance of lameness of the pelvic limb can last from several months to 5-6 years. The main factors influencing the effectiveness of the operation are the patient’s age and the degree of dysplastic coxarthrosis.

Indications for surgery are cases of ineffective drug treatment or the presence of complications during drug therapy for dysplastic osteoarthritis, as well as patients who have contraindications to triple pelvic osteotomy, intertrochanteric osteotomy or hip replacement. However, surgery is only indicated if the goal is only to reduce pain. Surgery is most effective for relieving pain at the end of the growth phase in young dogs between 6 and 12 months of age. Other authors recommend pectin myectomy in older dogs with worsening dysplastic coxarthrosis and severe lameness. But there is an opinion that the operation is indicated for animals of all ages. The effect of the operation can only be expected in dogs with unstable joints and mild coxarthrosis. The advantage is that if there is no effect from this operation, more radical operations can be performed.

The operation does not restore normal gait. Only in young dogs aged 5-6 months, surgery can change the gait, bringing it back to normal, but this cannot be accurately predicted.

Several surgical techniques are described in the literature, but the most promising is complete excision of the pectineal muscle. The operation is performed bilaterally, even if only one hip joint is affected by dysplasia. On the day of surgery, the animal is allowed to go home; movement restrictions are recommended for up to 10-12 days.

Resection arthroplasty

Resection of the head and neck of the femur is also called resection (RA) or excisional arthroplasty, the purpose of which is to eliminate painful contact between the head and the glenoid cavity in dysplastic coxarthrosis. After the operation, the femur and the socket are not in contact. A connective tissue layer develops between them. The operated limb bears part of the dog's body weight. Resection arthroplasty is indicated in cases where reconstructive operations or hip replacement cannot be performed on the patient for one reason or another. Resection of the femoral head and neck is performed as a “rescue” measure in dogs with severe dysplasia accompanied by severe pain. Other authors consider the presence of clinically detectable lameness in dogs due to hip dysplasia to be a sufficient argument for performing RA. After RA, hip replacement is possible, although the prospects for restoring adequate biomechanics of the limb are questionable. RA is indicated for adult dogs, but can be performed successfully at any age.

The operation is most effective in small breeds of dogs weighing up to 15-22 kg. In dogs weighing more than 20 kg, surgery does not reduce pain, and most owners report little or no improvement in the function of the operated limb. RA results in large breed dogs can be improved by maintaining proper body shape (ribs should be easily palpable). Recent work shows that even in dogs weighing more than 22 kg, good to excellent functional results can be obtained after performing RA. To increase the effectiveness of the operation, modified techniques are used with transposition between the femur and the articular cavity of muscle flaps or the joint capsule, which play a damping function. You should also remove severe osteophytes on the glenoid cavity and perform an osteotomy of the lesser trochanter.

Drawing. Radiographs of the dog's pelvis in the first position. Dysplasia of both hip joints. Resection arthroplasty of the right hip joint according to W.OFF.

After RA, the operated pelvic limb shortens and the range of movements decreases due to the formation of a connective tissue movable joint at the site of the hip joint, which leads to limited movement of the pelvic limb and muscle atrophy, which is not amenable to therapy. When under load, the operated limb gets tired earlier, and after a short rest it quickly restores motor function. RA is contraindicated in dogs with neurological symptoms.

Operation technique.

Lippincott method. The craniolateral Archibald approach was performed to the hip joint. A transverse arthrotomy was performed on the cranial part of the joint capsule from the site of attachment to the pelvic bones to the femoral neck. An osteotomy of the head and neck of the femur was performed using a chisel or an oscillating saw. Then a muscle flap was formed from m. biceps femoris and through the formed hole in the caudal part of the joint capsule, it was passed into the joint cavity for interposition between the femur and the glenoid cavity. The free end of the muscle flap was sutured to the cranial part of the joint capsule and m. vastus lateralis with nylon, interrupted sutures.

Berzon method. The craniolateral Archibald approach was performed to the hip joint. An osteotomy of the head and neck of the femur was performed using a chisel or an oscillating saw along the line connecting the trochanter major and trochanter minor. To reduce pain from friction between the bones and speed up the rehabilitation period, a muscle flap formed from m. gluteus profundus. Two holes were drilled in the femur at the site of the neck osteotomy. The muscle flap was sutured to the site of osteotomy of the femoral neck, passing the threads through the formed holes.

Method according to Off. The craniolateral Archibald approach was performed to the hip joint. An arthrotomy of the hip joint was performed at the level of the neck. The head was dislocated from the glenoid cavity and joint capsule. An osteotomy of the head and neck of the femur was performed using a chisel or an oscillating saw along the line connecting the trochanter major and trochanter minor. To prevent painful contact between the femur and the glenoid cavity, the hypertrophied capsule of the hip joint was interposed, suturing the dorsal and ventral parts of the capsule with interrupted sutures.

Own way(Yagnikov S.A. ). The craniolateral Archibald approach was performed to the hip joint. A transverse arthrotomy was performed on the cranial part of the joint capsule from the place of attachment of the capsule to the pelvic bones to the femoral neck. An osteotomy of the head and neck of the femur was performed using a chisel or an oscillating saw. Then the proximal part of m. was separated with a raspatory. vastus lateralis from the underlying femur for 2-5 cm. Then the proximal part of the m. vastus lateralis dorsocaudally into the cavity of the joint capsule (between the pelvic bones and the femur) and sutured to the caudal part of the joint capsule, U-shaped sutures, nylon.

Postoperative treatment. The animal can be sent home on the day of surgery. For the formation of elastic connective tissue at the level of the hip joint after RA, the animal must begin to lean on the operated limb as early as possible. The owner of the animal must perform from 50 to 120 passive movements daily, performing flexion, extension, abduction and adduction of the pelvic limb. If there is pain, in the first 10-14 days after surgery, analgesics are indicated an hour before the procedure. Two weeks after surgery, the pain should subside. Before removing the sutures, it is necessary to limit the animal’s movements (walking on a leash or free movement in a limited area. After 14 days motor activity can be increased, recommend fast running, swimming, walking in deep snow, climbing stairs.

In the first 10-14 days, the dog rests only on the tips of the phalanges, after 3 weeks the limb is partially loaded, and after 4 weeks it should be actively used. From the moment of surgery to maximum improvement in limb function, it takes from 2 to 5-6 months. The more pronounced the muscle atrophy, the longer the recovery period.

On the second hip joint, surgery should be performed only after the first limb can be used adequately when walking, most often after 2-3 months. Some publications recommend performing RA simultaneously on both sides, although this leads to a higher percentage of complications.

In the postoperative period no relationship was found between bone growths in the glenoid cavity and the functional state of the operated limb.

The main cause of pain after RA is the contact between the bony surfaces of the glenoid cavity and the femoral segment, which is a consequence of improperly performed osteotomy of the femoral head and neck.

U dwarf breeds In dogs in the postoperative period, dislocation of the kneecap may occur, in some cases on the opposite limb. Patella instability in these animals does not affect limb function.

Treatment results. A correctly performed operation will ensure the supporting function of the limb throughout the animal’s life. A number of authors believe that RA can relieve the animal from pain associated with hip joint OA. But in any case, this operation, due to its ease of implementation and relatively low cost, has a certain niche in the treatment of dogs with severe hip dysplasia. Patient owners should be aware that certain disturbances in the motor function of the pelvic limb are possible after surgery.

Drawing. Resection of the head and neck of the femur along with the lesser trochanter in dogs of large and giant breeds with an increase in the neck-diaphyseal angle and medialization of the lesser trochanter.

With all methods of surgical technique, resection arthroplasty reduces the pain symptom with an increase in the support reaction of the pelvic limb, but does not restore dynamic function limbs. The surgery is more effective in medium-sized dog breeds and less effective in large and giant breeds. Interposition of soft tissues between the femur and the glenoid cavity accelerates the recovery time of motor function of the limb, but does not affect the functional results of walking in long-term follow-up. In large and giant breeds of dogs, with an increase in the length of the limb, in order to maximize the restoration of the static function of the limb, it is necessary to perform an osteotomy of the lesser trochanter along with osteotomy of the head and neck of the femur.

At the glenoid–femur border, regardless of the method of performing RA, due to circulatory disturbances, autologous tissues are formed in the interposed between the femur and the glenoid cavity. connective tissue, covered with pseudosynoviocytes that produce a fluid similar in physical and biochemical characteristics to synovium.

Various retrospective studies have documented the long-term results of resection hip arthroplasty in dogs. After the end of the recovery phase, movement without signs of lameness was noted in 32-95% of dogs, periodic mild lameness - in 16.7-67.7%, constant lameness, worsening with exercise - in 4.2-51.5%, constant lameness severe - in 2.2-16.5%. 33.3-60.5% of dogs experienced pain during rotation and abduction of the pelvic limb, 97% had muscle atrophy after RA, and 69-87.9% had shortening of the limb. Lameness after RA is considered by some authors as a violation of the biomechanics of the pelvic limb, and not a manifestation of pain. About 90.0% of dog owners spoke positively about the results of the operation, with 71.2% being satisfied and 19.7% being very satisfied.

Triple pelvic osteotomy

After osteotomy of the pelvic bones at three levels and rotation of the osteotomized bone segment with the glenoid cavity, more adequate coverage of the femoral head is achieved, which leads to an even distribution of the load per unit area of ​​the articular surface and slows down the development of secondary dysplastic osteoarthritis. Increasing the stability of the hip joint reduces tension in the joint capsule and periarticular muscles, which reduces pain.

Indications. Moderate or severe lameness in the pelvic limbs, rapid fatigue of the animal, increasing atrophy of muscle mass, lordosis of the sternolumbar region spinal column, the presence of a positive Ortolani and Bardens sign, sacralization or lumbarization of the spinal column, subluxation of the femoral head, without signs of secondary osteoarthritis. Determining clinical symptom To carry out this operation, a clinical test was considered: the animal was under general anesthesia, in a lateral position with the affected limb up. Thumb The tester's left hand rests on the greater trochanter of the dog's femur. Right hand the doctor presses on the knee joint, trying to displace the femoral head from the socket. The presence of subluxation in the hip joint during abduction of the tested limb by 60-70? in relation to the sagittal plane of the body is a contraindication to TOT.

Contraindications are radiographs confirming the destruction of the dorsal and craniolateral edge of the glenoid cavity, signs of secondary OA and complete dislocation of the femoral head at the time of treatment. The animal should not have significant atrophy of the pelvic girdle muscles. In case of complete dislocation of the femoral head, TOT is contraindicated.

In dogs with increased neck-shaft angle and antetorsion angle, intertrochanteric osteotomy should be performed first, followed by TOT. Other authors believe that only TOT is sufficient.

Age limits possible holding operations. The operation is indicated for dogs of large and giant breeds aged 5 to 12 months, since at this age a certain restructuring of the femoral head and glenoid cavity is possible. The decisive factor for TOT surgery is not age, but the condition of the joint. Before the development of radiologically detectable OA, the prognosis for TOT is most favorable.

TOT should be performed only on animals with clinical manifestations of hip dysplasia. Some authors consider TOT as a preventive operation and recommend that it be performed in dogs with hip dysplasia before the onset of clinical symptoms.

Operation technique. The operation is based on the original Slocum technique (1986) and includes the following four stages: segmental osteotomy of the pubic bone; osteotomy of the ischium; transverse or oblique osteotomy of the body of the ilium, followed by rotation of the osteotomized pelvic segment and fixation of fragments of the ilium with a bone implant, and the ischial tuberosities with a wire suture. For stabilization, three types of implants were used: a reconstructive plate, a Numedic plate, a CPOP plate (Canine Pelvic Osteotomy Plate). To fix the plates to the bone, cortical screws Ø 3.5 mm and cancellous screws Ø 4.0 mm were used.

Drawing. Radiographs of the pelvis of a dog with hip dysplasia. Triple pelvic osteotomy on the right. Increased coverage of the right femoral head.

In the postoperative period, the animals were restricted in movement for 6-8 weeks, walking on a short leash until the consolidation of bone tissue at the level of osteotomies. Dogs can get up, stand and walk independently 2-3 days after surgery with abdominal support.

Full restoration of limb function should be expected by 12-16 weeks. The operation on the opposite half of the pelvis can be performed after 3-4 months, and when creating permanent rest after 3-4 weeks. To prevent the progression of osteoarthritis in the second hip joint, TOT in young animals is recommended to be performed simultaneously. Most dogs, according to the owners, could walk independently 3-4 days after surgery. The plates used for osteosynthesis are not removed, since they do not cause complications in the postoperative period, and the trauma during their removal is great.

Intertrochanteric osteotomy

Indications. The operation is recommended for dogs with enlarged femoral head and femoral head, which leads to subluxation of the femoral head from the glenoid cavity, reduces the area of ​​contact between articular surfaces hip joint and increases pressure per unit surface area of ​​articular cartilage, which leads to the development of secondary osteoarthritis, pain and lameness.

The operation is recommended to be performed during the growth period from 6 to 10 months, since young animals retain the ability to remodel the bones that form the hip joint, which determines a strong articular joint. However, each author has more precise age limits in this age range: 7 months, 6-8 months, 10-12 months. The upper age limit for intertrochanteric osteotomy is considered to be 12-16 months.

Intertrochanteric osteotomy (IO) is most effective in animals without radiographic signs of secondary osteoarthritis at the time of surgery. This criterion is combined with patients under 1 year of age. Contraindications to surgery are dislocation of the femoral head from the glenoid cavity, distinct changes in the shape of the femoral head and destruction of the craniolateral and dorsal edges of the glenoid cavity. But even in dogs with secondary OA, a decrease in pain symptoms, a decrease in lameness, and an increase in the animal’s activity were noted.

There is no consensus in the literature regarding the effect of this operation on the development of secondary osteoarthritis: secondary osteoarthritis progresses, MO inhibits the development of secondary OA, and a more optimistic opinion is that MO prevents the development of OA.

To obtain a stable articulation of the femoral head in the glenoid cavity, a correction of the NAS to 135 is necessary. To do this, it is necessary to perform a wedge osteotomy in the intertrochanteric region measuring 20-35?.

With a one-stage increase in AT, derotation of the proximal segment of the femur is simultaneously performed until the maximum congruent relationship between the head and the glenoid cavity is obtained. Fixation of osteotomized fragments is performed with a hook-shaped DCP plate.

On the first or second day after surgery, the dog should put weight on the operated limb. The animal is limited in its movements, walking on a leash for 4-5 weeks, 6-8 weeks.

The operation on the opposite hip joint is performed after fusion of bone fragments in 4-6 weeks.

The plates and screws used to fix osteotomized bone fragments are not removed unless clinically indicated, since such an operation is quite traumatic. Plates in young dogs may interfere with bone length growth and cause necrosis of the underlying bone due to pressure and poor circulation, which is an argument in favor of removal of the implants.

Complications when performing MO are rarely described. Lameness in the postoperative period may be a consequence of injury to the sciatic nerve or a fracture of the femoral neck due to uncontrolled activity of the animal.