Canine hip dysplasia treated by juvenile pubic symphysiodesis. Part II: two year clinical results.

OBJECTIVES: To determine the clinical effects of juvenile pubic symphysiodesis (JPS) treatment in hip dysplasia-prone puppies with comparison to similar untreated control puppies. DESIGN: Controlled clinical case study. ANIMALS: Thirty-nine dysplastic puppies, of which six were part of the control group, with a positive Ortolani or hip distraction index (DI)≥0.40. PROCEDURES: The following eight clinical tests were evaluated preoperatively, and at one and two years postoperatively: Ortolani, hip reduction angle (HRA), gait evaluation, osteoarthritis, hip pain, and three Norberg angles (angle-extended mode [N-OFA], angle-compression mode [N-COM], and angle-distracted mode [N-DIS]). Juvenile pubic fusion (JPS) was performed by unipolar electro-cautery at 12 to 24 weeks of age; the control puppies received a sham operation. RESULTS: For the JPS puppies, the mean osteoarthritis level did not significantly increase (11%). There was a 74% reversal of preoperative positive Ortolani signs. Hip reduction angle, DI and N-DIS also improved significantly. Only N-DIS fully detected Norberg angle laxity. Within the control group, osteoarthritis increased significantly (55%) with no improvement in Ortolani incidence, N-OFA or N-COM angles. A decrease in HRA and DI was associated with increased osteoarthritis levels. Signs of hip pain increased by 33%, which was not significant. Dogs with initial severe hip laxity (DI≥0.70) experienced progressive osteoarthritis. CONCLUSIONS AND CLINICAL RELEVANCE: In JPS dogs with preoperative mild to moderate hip laxity (DI = 0.40-0.69), insignificant osteoarthritis occurred at two years. Juvenile pubic symphysiodesis surgery also improved other clinical criteria (Ortolani, HRA, hip pain, N-DIS). Osteoarthritis was generally not prevented by JPS in dogs with initial severely lax hips (DI≥0.70). Juvenile pubic symphysiodesis surgery at 12 to 24 weeks of age was an effective and safe pre-emptive bilateral treatment for mild to moderate hip dysplasia.

Canine hip dysplasia treated by juvenile pubic symphysiodesis. Part I: two year results of computed tomography and distraction index.

OBJECTIVES: To measure one and two year effects of juvenile pubic symphysiodesis (JPS) in puppies defined as 'at-risk' for canine hip dysplasia (CHD) using the following objective hip conformation criteria: Acetabular angle (AA), dorsal acetabular rim angle (DARA) and hip laxity (PennHIP© distraction index (DI). DESIGN: Controlled clinical case study. ANIMALS: Thirty-nine dysplastic puppies (six controls). PROCEDURES: The dogs were anaesthetised and acetabular angle, DARA, and DI values were obtained by computed tomography and radiography preoperatively. Electro-cautery fusion of the pubic symphysis was performed between 12 - 24 weeks of age. The imaging was repeated at one and two years of age. RESULTS: Significant hip improvements were seen at the two-year follow-up appointments for: AA (JPS dogs 31% increase, control 3%), DARA (JPS 38% decrease, control 15%) and DI (JPS 41% decrease in laxity, controls 20%) for all postoperative versus preoperative values. Pubic fusion occurred with minor morbidity. CONCLUSION: Juvenile pubic symphysiodesis resulted in significant improvements in hip conformation (AA and DARA), especially in mild to moderately lax hips (DI = 0.40-0.69). Most dogs with DI≥0.70 increased in osteoarthritis grade by two years of age. CLINICAL RELEVANCE: Juvenile pubic symphysiodesis surgery at 12-24 weeks of age significantly improved hip conformation and decreased laxity in at-risk CHD dogs. Early-age (12 to 16 week) recognition of hip laxity offered greater JPS benefits than surgery performed at 19- to 24-weeks-old. Dogs with severe laxity (DI≥0.70) continued to increase in osteoarthritis. An early (12-16 weeks) positive laxity test (Ortolani) should alert one to obtain objective laxity determinations (PennHIP© DI).

Mammary gland uptake of sodium Tc-pertechnetate in a cat with a drug-induced gynecomastia.

Sodium Tc-pertechnetate accumulated in the mammary glands of a male cat. It was determined that the uptake was attributable to gynecomastia induced by medroxyprogesterone acetate injections. Gynecomastia and pertechnetate uptake resolved following cessation of medroxyprogesterone acetate treatment.

Canine pubic symphysiodesis: investigation of electrocautery dose response by histologic examination and temperature measurement.

OBJECTIVES: To determine thermal necrosis zone and the maximal temperature achieved with various electrocautery doses applied to the pubic symphysis of immature dogs, and to establish the minimal electrocautery dose needed to affect thermal necrosis of the germinal chondrocytes of the immature canine pubis. STUDY DESIGN: A randomized, controlled, prospective study. ANIMALS: Twelve puppies, 15 to 17 weeks of age. METHODS: Each treated puppy was randomly selected to receive 3 of 33 possible doses of electrical current applied at uniform intervals along the pelvic symphysis. Three treatment sites were sham-operated controls. All treatment zones were biopsied 7 days after application of electrocautery. Confocal laser microscopy with calcein green and ethidium homodimer red stains were used to determine cell type and viability within treatment and control zones. The physeal diameter and thermal necrosis zone were measured. Thermal necrosis zone and dose, and temperature and dose were compared using regression analysis. Prediction equation analysis was used to establish dose recommendations. RESULTS: Doses of 40 W produced a highly significant linear relationship (R(2) =.88, P <.01) with thermal necrosis zone, and a significant linear relationship (R(2) =.76, P <.02) with maximal temperature. CONCLUSIONS: The thermal necrosis zone within the pelvic symphysis and maximal temperature achieved can be reliably predicted using electrocautery doses of 40 W. For application of electrocautery to induce pubic symphysiodesis, doses should be chosen based on measured or estimated physeal size. Using prediction equation analysis, the surgeon can plan mean thermal necrosis zone with acceptable variance. CLINICAL RELEVANCE: Unipolar needle electrocautery can be used to reliably achieve symphyseal necrosis. Prediction equation analysis can be used to determine 40-W doses.

Effects of pubic symphysiodesis in dysplastic puppies.

OBJECTIVE: To determine the long-term effects of juvenile pubic symphysiodesis (JPS) in dysplastic puppies. STUDY DESIGN: Prospective, randomized, clinical trial. ANIMALS: Seven dysplastic Chesapeake Bay retrievers and 2 beagle-crosses (BX1 and 2). METHODS: Five puppies had JPS performed with electrocauterization at 12, 16, 20, 22, and 24 weeks of age, respectively. Two puppies served as controls. BX1 and BX2 were used to obtain biopsies of the symphysis. Hips were evaluated for: pelvic development (transverse computerized tomography for acetabular angle [AA] and dorsal acetabular rim angle [DARA]); laxity [hip extended and stress radiography [distraction index (DI)]); Ortolani maneuver with reduction angles; acetabular coverage (Norberg angles); and function (coxofemoral range of motion, hip pain, and gait analysis by force-plate technique at 44 and 137 weeks of age). RESULTS: The pubis fused prematurely in every puppy that was operated on with the JPS technique. Greater acetabular responses were related to younger ages at surgery. The final mean AA in dogs that had JPS was 25 degrees greater than preoperative values; 40% increased over control. The DARA final mean was 10 degrees, 52% less than preoperative values and 46% less than control. The final mean DI in dogs having JPS was 0.28, 47% improved over preoperative values and 58% better than control. Mean pelvic dimensions in dogs that had JPS were 18% less than control. Gait analyses were normal for all dogs at 137 weeks. No urinary or bowel complications occurred. CONCLUSIONS: Significant ventrolateral acetabular rotation, increased hip coverage, diminished hip laxity, normal pain-free gait, and insignificantly reduced pelvic size occurred after JPS. CLINICAL SIGNIFICANCE: Dysplastic hips in young dogs were significantly improved by JPS.