Discussion related to the musculoskeletal system - injuries, post-op, lameness, extremity issues (joint, muscle, tenon, fascia...), axial skeleton issues, etc., as it relates to canine rehabilitation.
Hi Laurie
I've been trying to post this on the forum, even though I refreshed my password and did all the registration, it wont let me, I'm computer clumsy, so probably it's me
I have this patient, the xrays are attached, their vet wants to do surgery, just asking if you think there is anything to do instead.. she is mix breed one year old, and she is limping... you'll see the xrays... very clear. Ideas!
I was going to ask you how is the cold and I just realized that it was eight years ago, around this time that I was there with you... wow... where does time go????
Thanks
cheers
Y.
DOG-Pelvis VD-02_02_2017-11_37_34-168.JPEG (299.15 KiB) Viewed 7659 times
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DOG-Pelvis VD-02_02_2017-11_37_42-512.JPEG (356.22 KiB) Viewed 7659 times
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So, there are a few different variables.
1) If there was no limp and no pain or minimal pain, then just work to muscle, address pain management, and add in some manual therapy and nutraceuticals for joint health.
2) Even in your case of lameness, you could do the same as a trial. See how the dog does and how it manages, then decide from there.
3) Because she’s little, she would likely do just fine with a femoral head and neck excision. And given that she’s so young and has so much life ahead of her… I think that would be my option given the look the x-rays and the fact that she’s limping.
Sometimes option 2 (a trial of conservative management) simply helps owners ‘get to’ the decision to do surgery.
And, Wow, 8 years! That’s amazing! You would not like it here today… I’ll try and post a photo to the e-blast for tomorrow. There are some amazing snow drifts… because the wind is blowing like crazy!!!
I suspect that this dog given the age and being a small breed has asceptic necrosis of the femoral head.
This is a very painful condition, because the cartilage is often displaced exposing underlying subchondral bone.
This can be genetic or due to trauma causing disruption of blood supply to the femoral head- a very different process than hip dysplasia
I recommend femoral head and neck excision ASAP and not just because I'm a surgeon.
Then rehab aggressively afterwards!
Caroline
I just want to jump in to discuss the concerns of doing an FHO on a still growing dog.
But I have seen two dogs over my years (both just under the 1-year mark) where the FHO surgery resulted in regrowing of abnormal bone... presumably since the dog was still in a 'growing phase'. Both dogs had a repeat surgery to clean it up, and both dogs had it regrow a second time. Followed by both dogs being euthanized. It has made me leery to recommend an FHO until growing has stopped.
Have our surgeons seen this?
(In my 24 years, I've only seen 2... but they sure did stick in my memory!)
Great question Laurie.
Most dogs young or old will undergo some remodeling at the osteotomy site over time.
Almost all of the dogs that I've done are young (< 1 year) small dogs. Of course many of the toy breeds do stop growing by about 9 months of age.
I have not had a problem with this regrowth causing a problem and I am sad to hear they were euthanized (because of the regrowth?).
It may be that not enough bone was taken off to start with. You need to take ALL of the neck off between the greater trochanter and lesser trochanter (sometimes even including the lesser trochanter even though that is where the iliopsoas inserts!).
In very young dogs < 5 months of age, there is a concern about doing femoral head and neck ostectomy because of disruption of the growth plate in the greater trochanter, either causing displacement or angular limb deformity so maybe that is what occurred in your patients?
Reported complications of the procedure include limb shortening, muscle atrophy, decreased range of motion and patella luxation.
Just a quick comment on the positioning of this dog for X ray. Not great because of femoral and pelvic rotation and obliquity. If I was trying to measure a hip migration percentage in a child with these it would not be possible or at least not accurate.
So these two cases were quite some time ago. From best I can remember, one was a Jack Russel about 9 months old and the other was an Old English Sheepdog that was just about a year old. I remember seeing the x-rays and they were astounding! It looked like someone had tried to replace the femoral head with a cauliflower!