Sinfisiodese púbica juvenil associada à miectomia do pectíneo para tratamento de displasia coxofemoral em cão / Juvenile pubic symphysiodesis associated with pectineus myectomy for treatment of hip dysplasia in dog

Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery. Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development. Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life.

Uso de Termografia na identificação da Flacidez coxofemoral em Cães Jovens

A termografia tem sido avaliada como método de diagnóstico em diversas enfermidades na veterinária. A displasia coxofemoral é doença poligênica e multifatorial de difícil controle, sendo o índice de distração método capaz de identificar cães displásicos precocemente. A sinfisiodese púbica juvenil é método de tratamento aplicado em animais em fase de crescimento, até quatro meses de idade, que pode modificar a conformação da pelve e diminuir as alterações tardias decorrentes da flacidez articular e incongruência. O objetivo deste trabalho foi avaliar termografia no diagnóstico de frouxidão articular coxofemoral. Foram avaliados 34 cães, ambos os sexos, grande porte e saudáveis. Foram submetidos à avaliação termográfica e radiográfica. Os animais foram distribuídos de acordo com o índice de distração em: grupo controle (ID<0.5, n= 12) e flácido (ID0.5, n=22), avaliados em dois momentos. Aos 3-4 meses de idade (M0) e ao atingir um ano de idade (M1). Os animais com ID0.5 foram submetidos a sinfisiodese púbica juvenil. No exame termográfico dos grupos controle e flácido, houve diferença estatística significativa para as vistas dorsal, lateral e ventral no momento M0 entre os grupos. Os animais do grupo flácido apresentaram temperatura da articulação significativamente menores em relação ao grupo controle. A termografia mostrou ser eficiente ferramenta de triagem no diagnostico precoce da frouxidão articular coxofemoral em cães jovens.

Thermography has been studied as a diagnostic method for several diseases in veterinary medicine. Hip dysplasia is a polygenic and multifactorial disease of difficult control and PennHIP is the method capable of identifying dysplastic dogs early. Juvenile pubic sinfisiodesis is a treatment method applied to growing animals that can modify pelvic conformation and decrease late damage of joint flaccidity and incongruity resulting from hip dysplasia. The aim of this experiment was to evaluate the use of thermography as method for identification of hip joint laxity in young dogs. Thirty-four healthy dogs of large breeds and both sexes were submitted to thermographic and radiographic evaluation. The animals were distributed in two groups according to the distraction index by the PennHip method: control group (ID <0.5, n = 12); and flaccid (ID0.5, n = 22). The dogs were evaluated two times: M0, at 3-4 Months of age and M1 when reaching one year of life. Animals with ID0.5 were submitted to juvenile pubic sinfisiodesis. The mean temperature in termographic exam were significant higher in the control group in all views: dorsal (31.8 ± 0.22 and 30.2 ± 0.23), lateral (32.3 ± 0.23 and 31.2 ± 0.2) and ventral 37.7 ± 014 and 37 ± 015) at M0. Animals in the flaccid group had significantly lower joint temperatures than the control group. The thermography demonstred to be an efficient method for the early diagnosis of hip joint laxity in young dogs.

Avaliação radiográfica de cães com displasia coxofemoral tratados pela sinfisiodese púbica / Radiographic evaluation in dogs with hip dysplasia treated by pubic symphysiodesis

Avaliou-se a progressão dos sinais radiográficos de cães com displasia coxofemoral ou potencialmente displásicos tratados pela técnica da sinfisiodese púbica. Foram utilizados 14 cães, seis machos e oito fêmeas, com idades entre quatro e seis meses. Após exame físico, procedeu-se ao exame radiográfico para avaliação da articulação coxofemoral, segundo padrão estabelecido pelo Colégio Brasileiro de Radiologia Veterinária. Três deles foram também avaliados pelo método PennHIP. Pelo histórico clínico, nove (64 por cento) animais foram trazidos por manifestarem sinais de dificuldade locomotora com os membros pélvicos, manifestada especialmente por claudicação unilateral ou bilateral e dificuldade de se levantar. Cinco (36 por cento) cães não tinham qualquer sinal clínico, e em quatro (29 por cento) realizou-se o exame radiográfico como prevenção. O sinal físico mais evidente foi dor à palpação da articulação coxofemoral, e dois (14 por cento) cães apresentaram sinal de Ortolani positivo. Com exceção de um cão que apresentou infecção nos pontos cutâneos, todos os demais evoluíram sem complicações no período pós-operatório. Radiograficamente houve progressão das lesões articulares em seis (43 por cento) animais e oito (57 por cento) mantiveram a classificação inicial. Concluiu-se que cães tratados pela sinfisiodese púbica não apresentam melhora dos sinais radiográficos iniciais.(AU)

The radiographic findings in hip dysplastic or potentially hip dysplastic dogs treated by the pubic symphysiodesis were evaluated using 14 dogs - six males and eight females -, aging from four to six-month-old. After physical examination, the hip joint was evaluated by radiographic examination according to pattern established by the Colegio Brasileiro de Radiologia Veterinária. In addition, three dogs were evaluated by PennHIP method. According to medical history, nine (64 percent) dogs were admitted due to signs of locomotor difficulty in pelvic limbs, especially characterized by uni or bilateral lameness and stiffness on rising. Five (36 percent) dogs had no clinical signs. Radiographic examination was performed in four (29 percent) dogs as prevention. The most evident physical sign was pain on manipulation of the hip with Ortolani-positive in two (14 percent) dogs. Except for one dog that presented infection signs in the skin suture, no other postoperative complication was observed. The follow-up radiographic examination revealed progression of the degenerative articular changes in six (43 percent) dogs, and eight (54 percent) had no progression. In conclusion, the dogs treated by pubic symphysiodesis did not have improvement of the preoperative radiographic signs.(AU)

A sinfisiodese pública juvenil como alternativa no tratamento da displasia coxofemoral canina / Juvenile pubic symphysiodesis as alternative in canine hip dysplasia treatment

A displasia coxofemural canina é uma doença do desenvolvimento em cães de raças de grande e gigante porte, cuja complexa etiopatogenia dificulta o controle e exige a aplicação de técnicas diagnósticas precoces e precisas. Vários métodos terapêuticos têm sido desenvolvidos para interromper o progresso da afecção ou aliviar os sintomas de dor e incapacidade físico-funcional. Dentre os primeiros, a sinfisiodese pública juvenil consiste de uma técnica cirúrgica, minimamente invasiva, que permite melhorar a cobertura acetabular e evitar o desenvolvimento da doença articular degenerativa em animais predispostos. Através da lesão da porção cranial da cartilagem de crescimento da sínfise pública, pela utilização da pinça goiva e eletrobisturi, obtém-se correção bilateral das principais malformações articulares que acompanham a displasia coxofemoral. Esta técnica inovadora deve ser realizada antes dos quatro meses e meio de idade, para que sejam promovidas as modificações articulares necessárias á interrupção do processo da afecção. Em decorrência disto, torna-se necessário a precisa orientação dos proprietários já nas primeiras consultas de aconselhamento e vacinas(AU)

The canine hip dysplasia is a development disease, serious and highly frequent in dogs large and giant breeds. Its complex etipopathogeny makes it difficult to control and demands precocious and precise diagnosis techniques. A variety of therapeutic methods has been developed to interrupt the progress of this affection or to alleviate its symptoms of pain and physical-functionary incapacity. Amongst the first ones, the juvenile pubic Symphysiodesis consists a surgical technique, minimally invasive, which allows to improve the acetabular covering and to prevent development of degenerative joint disease in animals with this predisposition. This innovate technique must be applied before the dog complete four months and half of age, in order to promote the necessary modifications to interrupt the progress of this affection. Due to this, it is necessary to provide a precise orientation to the owner, even in the first consultations and vaccines(AU)

A sinfisiodese pública juvenil como alternativa no tratamento da displasia coxofemoral canina / Juvenile pubic symphysiodesis as alternative in canine hip dysplasia treatment

A displasia coxofemural canina é uma doença do desenvolvimento em cães de raças de grande e gigante porte, cuja complexa etiopatogenia dificulta o controle e exige a aplicação de técnicas diagnósticas precoces e precisas. Vários métodos terapêuticos têm sido desenvolvidos para interromper o progresso da afecção ou aliviar os sintomas de dor e incapacidade físico-funcional. Dentre os primeiros, a sinfisiodese pública juvenil consiste de uma técnica cirúrgica, minimamente invasiva, que permite melhorar a cobertura acetabular e evitar o desenvolvimento da doença articular degenerativa em animais predispostos. Através da lesão da porção cranial da cartilagem de crescimento da sínfise pública, pela utilização da pinça goiva e eletrobisturi, obtém-se correção bilateral das principais malformações articulares que acompanham a displasia coxofemoral. Esta técnica inovadora deve ser realizada antes dos quatro meses e meio de idade, para que sejam promovidas as modificações articulares necessárias á interrupção do processo da afecção. Em decorrência disto, torna-se necessário a precisa orientação dos proprietários já nas primeiras consultas de aconselhamento e vacinas

The canine hip dysplasia is a development disease, serious and highly frequent in dogs large and giant breeds. Its complex etipopathogeny makes it difficult to control and demands precocious and precise diagnosis techniques. A variety of therapeutic methods has been developed to interrupt the progress of this affection or to alleviate its symptoms of pain and physical-functionary incapacity. Amongst the first ones, the juvenile pubic Symphysiodesis consists a surgical technique, minimally invasive, which allows to improve the acetabular covering and to prevent development of degenerative joint disease in animals with this predisposition. This innovate technique must be applied before the dog complete four months and half of age, in order to promote the necessary modifications to interrupt the progress of this affection. Due to this, it is necessary to provide a precise orientation to the owner, even in the first consultations and vaccines