Surgical management of developmental joint dx Flashcards
Describe Capital physeal dysplasia?
- Physical separation without or with minimal trauma
- Signalment: young mature, cats > dogs, overweight, MC
- Unknown cause - early neutering?
Capital physeal dysplasia on histo?
wide physis – irregular clusters of chondrocytes in an abundant extracellular matrix and necrotic cartilage
Diagnostic for capital physeal dysplasia?
- VD pelvis Xray
- Frog leg view
- Apple core/ neck narrowing
Tx for capital physeal dysplasia?
- Repair -> screws & K wires
-> Also salvage procedures (THR)
What is Legg-Calve-Perthes?
-> Avascular necrosis of the femoral head (local ischaemia -> deformation)
-> Four stages: necrosis - fragmentation - reossification -healing
- Uknown cause
Signalment of Legg-Calve Perthes?
- Small & toy breeds - terriers & poodles
- 4-11 months old
- Bilat
What signs of Legg-Calve Perthes?
- Lameness - mild to NWB
- Hip exam: pain / crepitus
- Pelvic limb muscle atrophy
Diagnostics for Legg-Calve-Perthes?
- sig, history, exam, radiographs/ CT
TX for Legg-Calve-PErthes?
- Conservative
- FHNE
- THR
- Novel therapies * Bone marrow –
What is Osteochondrosis?
Disorder of Endochondral ossification
What is the anatomy of the growth plate?
Describe Articular cartilage in osteochondrosis
Thin outer layer → articular cartilage
Thick outer layer → similar to growth plate → epiphyseal enlargement
Vasculature: From perichondral plexus through cartilage canals
Pathogenesis of Osteochondrosis?
Grading of Osteochondrosis?
What are the most common locations of osteochondrosis in dogs?
- Humeral head
- Medial aspect of the humeral condyle
- Lateral or medial femoral condyle
- Medial or lateral trochlear ridge of the talus
What is the cycle of osteochondrosis?
OSteochondrosis signalment?
- LArge breed dogs
- 4-9 months old
- Lameness, exercise intolerance, joint effusion, joint pain
- Can be bilat
Tx goals - osteochondrosis?
- ↓pain and lameness
- restoration joint surface
- Normalisation joint biomechanics
- Prevention further joint degeneration
What non surgical tx?
- Non-steroidal anti-inflammatories
- Exercise restriction/modification
- Dietary supplements (eg. Omega-3 fatty acids)
- Weight control
What are indications for non-surgical tx of osteochondrosis?
- Young dogs (<6.5mo) mildly or asymptomatic, no joint mice or in
an area of little importance - Older dogs with advanced secondary OA
Surgical tx for osteochondrosis?
Arthrotomy vs arthroscopy
Flap excision + lesion periphery cartilage excision
Techniques: palliative, reparative or restorative
Palliative vs reparative techniques?
Palliative techniques → Debridement & lavage
Reparative techniques → vascular access
curettage, osteostixis, microfracture
restorative techniques?
- Fragment re-attachment
- Osteochondral transplants (OATS)
- Synthetic osteochondral resurfacing (SynACart)
what different abn in elbow dysplasia
- Fragmented medial coronoid process (>96%)
- Humeral trochlea osteochondrosis (2.7-25.4%)
- Ununited anconeal process
- Articular cartilage damage
- Joint incongruity (6-50.3%)
signalment for elbow dysplasia?
- Large and Giant breeds
- Bernese Mountain Dog, Golden Retrievers
- Young
- Smaller chondrodystrophic
Ununited anconeal process
- Large and Giant breeds
- Bilateral 20-35%
- Male>Female
- 5-12mo
- Associated MCP fragmentation & joint incongruence
- Secondary centre ossification – closing at 16-20w
What will we see on PE with UAP?
- Gradual onset & chronic lameness
- Marked joint effusion – caudal joint
- Pain – palpation & extension
- Limited elbow extension
UAP tx options?
- AP removal
- AP reattachment
- Ulnar osteotomy
- AP reattachment + Ulnar
osteotomy
what does Medial Compartement involve?
- Medial coronoid process disease
- Joint incongruence
- Osteochondritis dissecans
Signalment for medial compartement dx?
Young (6-18mo) Large and giant breeds
Chondrodystrophic breeds→ joint incongruence
Males>Females
Bilateral 25-80%
Medial coronoid process fissure / fragment - describe
- Genetic
- Overloading
-> joint instability
-> humeroulnar conflcit
-> joint incongruence (Radioulnar, Humeroradial, Humeroulcer)
tx for medial compartement dx
-Arthroscopy/arthrotomy
-Biceps ulnar release procedure
-Osteotomy of ulna or radius
-Load changing osteotomies
* PAUL
* SHO
-Partial elbow replacement
-Arthrodesis
-Conservative
Hip dysplasia PATHOGENESIS
WHAT ARE THE TWO MAIN FORMS OF HIP DYSPLASIA?
Juvenile (5-12mo) joint laxity
MAture (adults) progressive degen changes
Describe juvenile form ?
- Sudden onset lameness
- Bunny-hopping
- Difficulty rising after rest
- Reluctance to walk, run, jump, or climb stairs
- Exercise intolerance
- Pain
Describe mature form?
- Chronic progressive lameness
- stiffness
- Difficulty rising after rest
- Reluctance to walk, run, jump, or climb stairs
- Pain
Gait of hip dysplasia?
- Bunny hopping - young
- Hip or spinal sway
- Stiff and short-strided
- Shift weight to thoracic limbs
→ extension tarsus/stifles
Muscle mass shiting in hip dysplasia?
- ↑ Thoracic limbs
- ↓Pelvic limbs
Exam for hip dysplasia?
- Pain, crepitus, ↓ROM
- Ortolani test
- Barlow
- Bardens
Tx for hip dysplasia
- Juvenile Pubic Symphysiodesis
- Pelvic osteotomy
- Total hip arthoplasty
- Femoral head and neck excision
- Conservative
What does conservative tx involve?
- Weight management
- Modified exercise – on lead, not rough, short
and frequent walks - Physiotherapy, hydrotherapy
- Joint supplements
