1. ADVERSITY “ I am not afraid of storms for I am learning how to sail my ship.” -Louisa May Alcott

2. DISEASES OF THE MUSCULOSKELETAL SYSTEM PART 3

3. POOR CONFORMATION: LUXATING PATELLA

6. PATELLA IN GROOVE PATELLA OUT OF GROOVE

7. POOR CONFORMATION KNOCK-KNEED/PIGEON-TOED, OR COW-HOCKED STANCE MAY OCCUR IN LATERAL LUXATIONS BOW-LEGGED STANCE MAY OCCUR IN MEDIAL LUXATIONS

8. POOR CONFORMATION: TREATMENT OF PATELLAR LUXATION TROCHLEAR WEDGE RESECTION

9. POOR CONFORMATION: TROCHLEAR WEDGE RESECTION

10. POOR CONFORMATION: TIBIAL CREST TRANSPOSITION

12. POOR CONFORMATION: HIP DYSPLASIA YOUNG DOGS 5-8 mos AND MATURE ANIMALS WITH CHRONIC DISEASE

13. POOR CONFORMATION: HIP YSPLASIA

14. POOR CONFORMATION: HIP DYSPLASIA Poor conformation combined with genetic, environmental and nutritional factors Acetabular vs. Femoral hip dysplasia

15. POOR CONFORMATION: HIP DYSPLASIA PHYSICAL EXAM FINDINGS  Pain on palpation of hips  Joint laxity (positive ortolani sign) – early disease – subluxation of hip  Crepitus  Decreased ROM of hip joints  Atrophy of thigh muscles  Hypertrophy of shoulder muscles

16. POOR CONFORMATION: HIP DYSPLASIA http://www.youtube.com/watch?v=2rRKDheDrLs&NR=1 http://www.youtube.com/watch?v=SHCIT87jY0M&feature=related

17. Hip Dysplasia: Radiographic view For standard Orthopedic Foundation for Animals–type radiographs to evaluate hip conformation, extend the hips and internally rotate the tibias until the patella lies directly over the trochlear grooves. Be sure the pelvis is straight, with symmetric obturator foramina. ventrodorsal view of the pelvis with rear limbs extended symmetrically and rotated inward to center the patellae over the trochlear grooves

18. POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION "normal" radiographically may be further classified as excellent, good, fair, or near normal

19. POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION

20. HIP DYSPLASIA and OFA CERTIFICATION dysplasia are categorized as mild, moderate, or severe

21. PennHip Evaluation Distraction View Compression view Extended View

22. HIP DYSPLASIA TREATMENT NSAIDs NEUTRICEUTICALS/CHONDROPROTECTIVE AGENTS

23. HIP DYSPLASIA TREATMENT: MEDICAL MANAGEMENT Aspirin or buffered aspirin: 10-25 mg/kg q 8-12 hr or as needed: Discontinue if vomiting occurs. Carprofen (Rimadyl): 2 mg/kg PO q 24 hr Deracoxib (Deramaxx): For chronic dosing use 1-2 mg/kg PO q 24 hr as needed. Etodolac (EtoGesic): 10-15 mg/kg PO q 24 hr Firocoxib (Previcox): 5 mg/kg PO q 24 hr. Do not use in puppies less than 7 months of age or in dogs weighing less than 7 pounds. Meloxicam(Metacam): 0.2 mg/kg first dose; then 0.1 mg/kg thereafter q 24 hr PO. Tepoxalin (Zubrin): 20 mg/kg PO q 24 hr x 1 treatment; then 10 mg/kg PO q 24 h. This is similar to carprofen and ketoprofen.

24. HIP DYSPLASIA TREATMENT: MEDICAL MANAGEMENT Polysulfated glycosaminoglycan (Adequan): Polysulfated glycosaminoglycans prevent cartilage breakdown by inhibiting the enzymes of cartilage degradation during inflammation.  Discontinue use if there is no improvement after the third week. Caution, may increase bleeding time. Cosequin: Note that dose is based primarily on empiricism and manufacturer's recommendations.  Adverse effects have not been reported although hypersensitivity is possible.  Cosequin is a brand name for glucosamine HCL combined with chondroitin sulfate which may stimulate synthesis of synovial fluid, inhibit degradation, and improve healing of articular cartilage.

25. Hip Dysplasia – Treatment Surgical  Total hip replacement  Salvage procedure in mature dogs with severed DJD unresponsive to medical Tx  Pain free in 90% of cases  Unilateral replacement provides acceptable function in 80% of cases  Excision Arthroplasty or Femoral Head Ostectomy  Forms “false” joint  Removal of femoral head and neck to prevent joint pain  Salvage procedure when medical treatment not working and other sx too expensive  Best - < 20#; good musculature  Abnormal gait  Triple Pelvic Osteotomy

26. Arthroscopy – Juvenile patients A, Ventrodorsal radiograph of an immature dog with subluxation of the femoral heads and minimal evidence of DJD, typifying a candidate for triple pelvic osteotomy. B, Ventrodorsal radiograph of a dog with advanced hip dysplasia and osteophyte formation. This dog may be a candidate for total hip replacement or femoral head ostectomy if clinical signs cannot be managed medically. Arthroscopic view of a normal hip joint

27. HIP DYSPLASIA TREATMENT TRIPLE PELVIC OSTEOTOMY

28. HIP DYSPLASIA TREATMENT FEMORAL HEAD OSTECTOMY “False joint” forms from scar/fibrous tissue

29. HIP DYSPLASIA TREATMENT www.kahalapethospital.com/yahoo_sit e_admin/as... artreality.com

30. JUVENILE PUBIC SYMPHYSIODESIS Juvenile pubic symphysiodesis (JPS) surgery is a prophylactic procedure performed in puppies 10 to 20 weeks of age that have been diagnosed with hip dysplasia causes premature closure of the cranial pubic symphysis PennHip distraction view of a Labrador puppy at 14 weeks. The DI is 0.55. The same dog at 50 weeks (36 weeks post-JPS).

31. Hip Dysplasia – Client Info Weight control important to decrease load on painful joint Swimming excellent activity Lameness may occur due to surgical shortening of the affected limb Physiotherapy – decreases joint stiffness, helps maintain muscle integrity Joint degeneration progressive May be heritable – do not breed Special diets designed for fast growing dogs may decrease severity