B-mode ultrasonography and ARFI elastography of articular and peri-articular structures of the hip joint in non-dysplastic and dysplastic dogs as confirmed by radiographic examination.

BACKGROUND: Canine hip dysplasia is a common orthopedic disease in veterinary practice. The diagnosis is made by radiographic examinations that evaluate bone alterations associated with hip dysplasia. Although radiographic examination is the gold standard for diagnosis, it does not allow a detailed evaluation of soft tissues such as the joint capsule and periarticular muscles. This study aimed to evaluate the accuracy of B-mode ultrasonography and acoustic radiation force impulse (ARFI) elastography in assessing the joint capsule and periarticular muscles of dogs using the Orthopedic Foundation of Animals (OFA) classification and the distraction index (DI) in the early and late diagnosis of hip dysplasia. This study sought to propose a protocol for the ultrasonographic evaluation of the structures involved in canine hip dysplasia. METHODS: Radiographic and ultrasonographic evaluations were performed on 108 hip joints of 54 dogs. Thirty dogs were older than 2 years and 24 were aged between 4 and 10 months. RESULTS: It was verified that an increase in pectineus muscle stiffness (cutoff value > 2.77 m/s) by elastography in some dysplastic dogs and an increase in the thickness of the joint capsule (cutoff value > 0.9 mm) in B-mode ultrasonography, were associated with a distraction index > 0.5, with both having a positive correlation. In B-mode ultrasonographic evaluation, the presence of signs of degenerative joint disease, such as irregularities of the cranial edge of the acetabulum and femoral head, were associated with a distraction index > 0.5 in canines, with a specificity of 94%. In adult dogs, the findings of degenerative joint disease on ultrasound were associated with a diseased OFA classification (P < 0.05). Measurement of the joint capsule > 1.10 mm was diagnostic for dysplasia in unhealthy dogs by OFA. CONCLUSIONS: ARFI elastography has shown that the pectineus muscle may experience changes in stiffness in dysplastic animals. Additionally, changes in joint capsule thickness can be identified in B-mode in young and adult dogs with dysplastic joints, which contributes to the diagnosis of hip dysplasia.

Intra-articular botulinum toxin A (BoNT/A) for pain management in dogs with osteoarthritis secondary to hip dysplasia: A randomized controlled clinical trial.

The aim of this study was to evaluate the efficacy and safety of the intra-articular (IA) injection of botulinum toxin type A (BoNT/A) to the management of chronic pain in dogs. In a randomized, controlled, double-blinded study sixteen dogs with osteoarthritis secondary to hip dysplasia were distributed into two groups: 25 IU BoNT/A (BoNT) or saline solution (Control) was administered IA in each affected joint. All dogs received oral supplements (90 days) and carprofen (15 days). The dogs were assessed by a veterinarian on five occasions and the owner completed an assessment form at the same time (baseline to 90 days). The data were analyzed using unpaired-t test, Fisher's exact test, analysis of variance and the Tukey's test (P<0.05). There were no differences between groups in the veterinarian and owner assessments. Lower scores were observed in both groups during 90 days after IA therapy in the owner assessments (P<0.001). Compared with baseline, the Vet score was lower from 15-90 days after IA injection in the BoNT group, and at 15 and 30 days in the Control group (P<0.001). Both treatments were safe and reduced the clinical signs associated with hip osteoarthritis. However, IA BoNT/A (25 IU) did not provide better pain relief than the control treatment.

Canine Hip Dysplasia: Diagnostic Imaging.

Diagnostic imaging is the principal method used to screen for and diagnose hip dysplasia in the canine patient. Multiple techniques are available, each having advantages, disadvantages, and limitations. Hip-extended radiography is the most used method and is best used as a screening tool and for assessment for osteoarthritis. Distraction radiographic methods such as the PennHip method allow for improved detection of laxity and improved ability to predict future osteoarthritis development. More advanced techniques such as MRI, although expensive and not widely available, may improve patient screening and allow for improved assessment of cartilage health.

Triple Pelvic Osteotomy and Double Pelvic Osteotomy.

Triple and double pelvic osteotomy (TPO, DPO) are performed with the goal of increasing acetabular ventro-version, increasing femoral head coverage, and decreasing femoral head subluxation. Since the first descriptions of TPO, there have been modifications in technique, most notably omission of the ischial osteotomy for DPO, and improvements in the implants, including availability of locking TPO/DPO bone plates. Associated complication rates seem to have declined accordingly. The most salient questions regarding these procedures remain what selection criteria should be used to identify candidates and whether halting or preventing osteoarthritis is necessary to consider these surgeries clinically beneficial.

Etiopathogenesis of Canine Hip Dysplasia, Prevalence, and Genetics.

First identified in 1935, canine hip dysplasia is thought to be the most common orthopedic condition diagnosed in the dog. It is most prevalent in large and giant breed dogs, with a complex polygenic mode of inheritance, and relatively low heritability. External factors including caloric intake when growing have a significant effect on phenotypic expression. Initial joint laxity progresses to osteoarthritis due to subluxation and abnormal wearing. Selective breeding programs to attempt to decrease prevalence have shown modest results so far.

[Use of gold implants as a treatment of pain related to canine hip dysplasia--a review. Part 2: Clinical trials and case reports]. / Anwendung von Goldimplantaten zur Schmerztherapie bei kaniner Hüftgelenkdysplasie--eine Literaturübersicht. Teil 2: Klinische Studien und Fallberichte.

Gold bead implantation/gold acupuncture is becoming increasingly used in veterinary medicine as a method of pain treatment in cases of osteoarthritic diseases. Part one of the overview dealing with the use of gold implants as a treatment of canine hip joint dysplasia (cHD) introduced the method of implanting gold in tissue and publications which investigated the subsequent effects of implantation. This article focuses on publications concerning the clinical effectiveness of gold implantation within the scope of pain therapy in cHD. Due to the study design, a classification using evidence-based levels (EbL) was carried out. Three double-blind, placebo-controlled randomised studies (EbL II) were considered together with three retrospective studies on own patients (EbL IV) and five case studies (EbL IV). While the case and retrospective studies reported impressive therapeutic success in treating cHD-incurred pain with gold implantation, a pain-reducing effect through gold implantation was only demonstrated in one of the three double-blind studies. The two remaining EbL II studies found no differences between the placebo-group and the group of dogs treated with gold implantation. In one of these two studies, kinematic and kinetic gait analyses were used for objective evaluation of the effects of the treatment. Thus, the only study that carried out an objective evaluation of the therapeutic result of gold implantation came to the conclusion that the method is ineffective. For a concluding assessment of gold implantation in the case of cHD, gait analysis studies investigating the effects of gold implantation in comparison to a standard treatment with nonsteroidal anti-inflammatory drugs are currently lacking.

Associations among exercise duration, lameness severity, and hip joint range of motion in Labrador Retrievers with hip dysplasia.

OBJECTIVE: To evaluate factors associated with lameness severity and hip joint range of motion in dogs with hip dysplasia and to assess the association between hip joint range of motion and degree of lameness. DESIGN: Prospective case series. ANIMALS: 60 client-owned Labrador Retrievers with hip dysplasia. PROCEDURES: Owners completed a questionnaire regarding their dogs' daily exercise duration and type (i.e., low impact vs high impact) and lifestyle. Range of motion of affected hip joints was measured with a transparent plastic goniometer. The presence of subluxation or luxation of hip joints as a consequence of hip dysplasia and the size of the largest osteophytes or enthesophytes of hip joints on ventrodorsal radiographic images of the pelvis were recorded. Multivariate analyses were performed to identify factors associated with lameness, loss of hip joint flexion, and loss of hip joint extension and to identify factors associated with the presence of large osteophytes. RESULTS: Exercise was associated with a decrease in the severity of lameness in dogs with hip dysplasia. The strength of this inverse relationship increased with longer exercise duration. Lameness was more severe in dogs with hip joint luxation than in dogs without luxation. Hip joint extension was 1° lower for each year of age, and osteophyte or enthesophyte size was 1 mm larger with each 3-year increase in age. CONCLUSIONS AND CLINICAL RELEVANCE: Longer daily exercise duration was associated with lower lameness scores in dogs with hip dysplasia. Dogs with hip joint luxation secondary to hip dysplasia had higher lameness scores than did dogs without hip joint luxation.

[Use of gold implants as a treatment of pain related to canine hip dysplasia--a review. Part 1: Background and current state of research regarding the effects of implanting gold in tissue]. / Anwendung von Goldimplantaten zur Schmerztherapie bei kaniner Hüftgelenkdysplasie--eine Literaturübersicht. Teil 1: Hintergründe und Stand der Forschung zu Effekten nach Implantation von Gold in Gewebe.

Gold-bead implantation as a method of pain treatment in dogs suffering from osteoarthritic disease is receiving increasing attention in veterinary medicine. For the present article, publications from veterinary books and journals were collected and evaluated, together with related articles in human medicine. After providing an overview of the historical use of gold and gold compounds, the technique of implanting this noble metal is introduced. The reasons for establishing the terms gold acupuncture and gold (bead) implantation are described, considering the question whether and what kind of methodological differences exist behind these terms. Next, previous publications concerning the effects of gold implantation in tissue are summarised. In 2002 it was proven that gold ions are released from the surface of gold implants by a process termed dissolucytosis. Subsequent publications further investigated details about the interaction between gold ions and tissue as well as the distribution pattern of bio-released ions. Gold compounds were previously used for chrysotherapy in human medicine until medication with fewer side effects became established. The anti-inflammatory and immuno-modulatory properties of gold compounds were used to treat rheumatoid arthritis. Current research aims to ascertain whether the anti-inflammatory and immuno-modulating effects of gold compounds are imitated by gold ions released from gold implants at a local level. In conclusion, the present review summarises important findings about the effects of gold implanted in tissue. However, further research is necessary to estimate the limitations and benefits of this auromedication.

Distraction index as a risk factor for osteoarthritis associated with hip dysplasia in four large dog breeds.

OBJECTIVE: To determine if age, breed, gender, weight or distraction index (DI) influenced the risk of radiographic osteoarthritis (OA) of canine hip dysplasia (CHD) in four common dog breeds; the American bulldog, Bernese mountain dog, Newfoundland and standard poodle. MATERIALS AND METHODS: This was a cross sectional prevalence study with 4349 dogs. Canine hips were evaluated using 3 radiographic projections: the hip-extended view, the compression view and the distraction view. The hip-extended view was examined for the presence of OA. The PennHIP distraction view was utilized to calculate the DI. For all breeds, a multiple logistic regression model incorporating age, weight, gender, and DI was created. For each breed, disease-susceptibility curves grouping dogs on the basis of age were constructed. Receiver-operating characteristic (ROC) curves were developed for each breed regardless of age. RESULTS: For all breeds, DI was the most significant risk factor for the development of OA associated with CHD. Weight and age were also significant risk factors in all four breeds, but gender was not. CLINICAL SIGNIFICANCE: Results from this study support previous findings, that irrespective of breed, the probability of radiographic OA increases with hip joint laxity as measured by the DI. Breed-specific differences in this relationship, however, warrant investigation of all breeds affected by CHD to determine inherent dependency of hip OA on joint laxity. Such findings guide veterinarians in helping dog breeders to make evidence-based breeding decisions and in informing dog owners to implement preventative treatments for CHD for dogs found to be at risk.

Freqüência da displasia coxofemoral em cães da raça Pastor Alemão / Frequency of hip dysplasia in German Shepherd dogs

One hundred twenty-three radiographs of German Shepherd dogs (47 females and 76 males) from Military Police of Minas Gerais State were studied from April 2001 to july 2004, with the purpose of establishing the frequency and asymmetry of hip displasia. The radiographs were taken with the animals in the ventrodorsal position, with the limbs parallel and the pelvis symmetric. The average age of the dogs was 33.8±23.5 months-old. The study indicated that 89.4 percent of them had hip dysplasia (91.5 percent of females and 88.2 percent of males), being 6.3 percent unilateral, 17.3 percent bilateral asymmetric, and 76.4 percent bilateral symmetric. The frequency of hip displasia in the studied population was high, indicating the necessity of an efficient control program of the disease.

Bacterial infective arthritis of the coxofemoral joint in dogs with hip dysplasia.

The objective of this study was to describe seven cases of unilateral bacterial infective coxarthritis from a total of 19 cases of bacterial infective arthritis (BIA), presenting over a two year period. We recorded the history, clinical signs, diagnostic process, treatment and clinical outcome in these cases. The data were obtained from medical records, review of the radiographs, and telephone follow-up with the owners. All of the dogs in this study had severe chronic osteoarthritis secondary to hip dysplasia, which caused periodic hind limb lameness. They were all admitted with severe acute hind-limb lameness. Pelvic radiographs were performed under general anaesthesia shortly after presentation, followed immediately by arthrocentesis of the affected joint. The synovial fluid was evaluated microscopically by direct smear and a sample was sent for culture and sensitivity. An attempt was not made to drain or lavage the affected joint during the course of treatment. The initial choice of antibiotics was empiric and subsequently modified, as required, based on the sensitivity results. Four of the dogs showed a rapid return to weight-bearing after the initiation of antibiotic treatment, and all of the patients returned to their pre-BIA level of function. Neither recurrent infections nor any adverse sequela requiring further intervention were reported by the owners on telephone follow-up.

Assessment of the hip reduction angle for predicting osteoarthritis of the hip in the Labrador Retriever.

Hip palpation has been used to provide semiquantitative information regarding passive joint laxity and susceptibility to hip dysplasia. The purpose of this study was to: (1) evaluate the intra- and inter-examiner repeatability of the hip reduction angle measured at 4 months of age by three examiners using manual goniometry and an electromagnetic tracking system; (2) compare the hip reduction angle measured with manual goniometry to the hip reduction angle measured with the electromagnetic tracking system; and (3) evaluate the hip reduction angle, distraction index and Ortolani manoeuvre at 4 months of age as predictors of the development of hip osteoarthritis at 12 months of age in 11 Labrador Retriever dogs. Intra- and inter-examiner repeatability was demonstrated for both the manual and electromagnetic goniometric measurement of the hip reduction angle (coefficient of variation < 4.3% and < 6.1%; and P = 0.163 and P = 0.836 respectively). The hip reduction angle measured by manual goniometry was moderately correlated to the hip reduction angle measured by the electromagnetic tracking system (r = 0.603, P < 0.0000). The hip reduction angle measured by manual and electromagnetic goniometry was a poor predictor of osteoarthritis at 12 months of age (r = 0.231, P < 0.062, and r = 0.321, P < 0.01). The distraction index was moderately correlated with the development of osteoarthritis by 12 months of age (r = 0.493, P < 0.0000). The Ortolani sign was sensitive (100%) but not specific (41%) for the development of osteoarthritis at 12 months of age. The hip reduction angle did not further quantify the Ortolani manoeuvre as a predictor of osteoarthritis in Labrador Retrievers.

Incidência de displasia coxofemoral em cães da raça Border Collie / Incidence of hip dysplasia in the Border Collie / Incidencia de displasia de cadera en caninos border collie

A Displasia Coxofemoral (DCF) é uma doença poligênica de natureza quantitativa, multifatorial e extremamente complexa, que comumente resulta em alterações degeneratiyas irreversíveis. O presente trabalho é um estudo radiográfico que avalia a freqüência e as lesões osteoarticulares da DCF em cães da raça Border Collie. Através do Ângulo de Norberg, classificou-se 52 pelves de cães da raça Border Collie, que foram submetidas ao exame radiográfico no Hospital Veterinário CESUMAR. Embora sejam cães de médio porte, mais da metade da população estudada (76%) tinha algum grau de displasia, mostrando incidência maior do que a referida pela Orthopedic Foundation for Animais.

Hip Dysplasia (HD) is a quantitative polygenic disease, multifactorial, and extremely complex, which commonly results in irreversible degenerative alterations. This article is a radiographic study which evaluates the frequency and the osteoarticular injuries of the HD in dogs from the Border Collie breed. Through the Norberg Angle, 52 pelvises of dogs from the Border Collie breed were submitted to radiographic exams on CESUMAR Veterinary Hospital. Although they are medium size dogs, more then half of the population studied (76%) had some degree of Dysplasia, presenting a larger incidence than that referred by the Orthopedic Foundation for Animals.

Two years follow-up study of the pain-relieving effect of gold bead implantation in dogs with hip-joint arthritis.

Seventy-eight dogs with pain from hip dysplasia participated in a six-month placebo-controlled, double-blinded clinical trial of gold bead implantation. In the present, non-blinded study, 73 of these dogs were followed for an additional 18 months to evaluate the long-term pain-relieving effect of gold bead implantation. The recently-published results of the six month period revealed that 30 of the 36 dogs (83%) in the gold implantation group showed significant improvement (p = 0.02), included improved mobility and reduction in the signs of pain, compared to the placebo group (60% improvement). In the long-term two-year follow-up study, 66 of the 73 dogs had gold implantation and seven dogs continued as a control group. The 32 dogs in the original placebo group had gold beads implanted and were followed for a further 18 months. A certified veterinary acupuncturist used the same procedure to insert the gold beads as in the blinded study, and the owners completed the same type of detailed questionnaires. As in the blinded study, one investigator was responsible for all the assessments of each dog. The present study revealed that the pain-relieving effect of gold bead implantation observed in the blinded study continued throughout the two-year follow-up period.

Double-blind, placebo-controlled trial of the pain-relieving effects of the implantation of gold beads into dogs with hip dysplasia.

Seventy-eight dogs with pain due to hip dysplasia were studied in a controlled, double-blind clinical trial to evaluate gold bead implantation as a pain-relieving treatment. The dogs were randomly assigned to two groups, 36 in the gold implantation group and 42 in the placebo group. Both groups were treated equally regarding anaesthesia, hair clipping and penetration of the skin with the same type of needle. The gold implantation group had small pieces of 24 carat gold inserted through needles at five different acupuncture points and the placebo group had the skin penetrated at five non-acupuncture points so as to avoid any possible effect of stimulating the acupuncture points. A certified veterinary acupuncturist marked the points, and two surgeons performed the implantations according to a randomisation code made in advance. After 14 days, three months and six months, the owners assessed the overall effect of the treatments by answering a questionnaire, and the same veterinarian examined each dog and evaluated its degree of lameness by examining videotaped footage of it walking and trotting. The treatment was blinded for both the owners and the veterinarian. There were significantly greater improvements in mobility and greater reductions in the signs of pain in the dogs treated with gold implantation than in the placebo group. The veterinarian's and the owners' assessments corresponded well.