Orthopedic surgery

Osteochondrosis dissecans is a developmental disease that sometimes occurs in fast-growing dogs when the rapid development of cartilage can outstrip its blood supply, causing abnormal cartilage development that results in lameness, pain, and subsequent osteoarthritis. In some cases, the changed parts of the cartilage are separated from the remaining part of the cartilage surface.

Genetic factors are the most important causes of OCD, mainly breed predisposition, most often in giant breeds. Diet or dietary restrictions in the first few months of life, hormonal imbalance, or joint trauma also increase the risk of OCD. Most dogs with OCD show clinical symptoms before the age of one year. However, sometimes, especially in the case of shoulder OCD, clinical signs can also appear in older dogs. Clinical signs are variable and depend on the type of joint affected and the size of the cartilage defect. The most common clinical signs are limping, stiffness, swelling and pain in the joint, decreased activity, or a generally "depressed" behavior.

Diagnostics

The first in the series is an orthopedic examination, followed by X-ray imaging of suspicious joints from multiple projections, usually under sedation. OCD can appear simultaneously with other developmental diseases (e.g., elbow dysplasia). Then the patient may need advanced diagnostic methods (CT, MRI).

As OCD begins to develop in a certain joint, then osteoarthritis (inflammation of the joint) begins to develop in that joint. Once osteoarthritis develops, it cannot be cured, but it can be successfully managed in most patients. There are several treatment options for OCD of the shoulder, depending on the patient's clinical and X-ray picture. Conservative treatment is usually appropriate for patients with a minor cartilage defect and minimal discomfort, but most patients require a surgical solution:

• Surgical removal of the cartilage flap
• Implants

There are several forms of shoulder instability: 

• low-grade shoulder ligament sprains (limping worsens after activity) 
• high-grade shoulder ligament sprains (extremity hanging limply) 
• stretching of the rotator cuff muscles. 

The diagnosis of shoulder instability is based on tests usually performed under sedation or general anesthesia (X-ray imaging of the shoulder to check for osteoarthritis and/or MRI). Treatment for shoulder instability depends on the degree of sprain and strain and the degree of instability. Low-grade injuries are most often treated conservatively, with anti-inflammatory drugs, reduction of activity, physical therapy, and hydrotherapy. The physical therapy plan, which is carried out at home, is created for each patient individually. 

High-grade injuries require surgical treatment. 

• Protective Stabilization: The surgical technique of shoulder stabilization is based on a method used to repair rotator cuff muscle injuries in human medicine. 
• Arthrodesis: For the most severe cases, such as high instability, dislocation, joint fracture, and arthritis, arthrodesis may be the best option. This is called a "rescue operation" because it is used in those cases where all other options would not be successful.

Proximal ulnar osteotomy (PUO)

In some joints, stress fractures of the coronoid process of the ulna occur because of a short radius, and such a discrepancy is permanent.

With such elbows the goal is to reduce pain and prevent further progression of osteoarthritis. This is done by making an incision on the ulna below the elbow joint. This technique can be used when there is a conflict between the humerus and the ulna.

Osteochondrosis dissecans is a developmental disease that occurs within the normal differentiation of cartilage cells, resulting in failed endochondral ossification. (Basic processes in the fetal development of the skeletal system and bone formation). In fast-growing dogs, the rapid development of cartilage can outstrip its own blood supply, causing abnormal cartilage development that leads to lameness, pain, and subsequent osteoarthritis.

In some cases, there is a separation of the changed parts of the cartilage from the remaining part of the OCD cartilage surface. Genetic factors are the most important cause - so there is a breed predisposition. Labradors, golden retrievers, and most giant breeds have it most often. Poor or excessive nutrition in the first few months of life, hormonal imbalance, or joint trauma also increase the risk of OCD. Most dogs with OCD show clinical symptoms before the age of one year, although sometimes, especially in the case of shoulder OCD, clinical signs can also appear in older dogs. Clinical signs are variable and depend on the type of joint affected and the size of the cartilage defect.

The most common clinical signs are limping, stiffness, swelling, pain in the joint, reduced activity, or generally "depressed" behavior that points to the so-called silent pain.

Diagnostics

OCD diagnosis is a multimodal process. An orthopedic examination was performed, followed by X-ray imaging of suspicious joints from multiple projections, under sedation. OCD can occur simultaneously with other developmental diseases (e.g., elbow dysplasia), and then CT or MRI scans may be necessary. As OCD begins to develop in a certain joint, osteoarthritis (inflammation of the joint and associated bones) also develops in that joint. Once osteoarthritis develops, it cannot be cured, but it can be successfully managed in most patients.

Treatment

Treatment of elbow dysplasia depends on the size of the cartilage defect:

• Surgical removal of the cartilage flap (for minor damage)
• SOR (Synthetic Osteochondral Resurfacing) for large damages

An unfused anconeal process is a condition in which the bony process in the elbow separates from the ulna. This detached bone fragment causes pain and lameness and contributes to damage to the elbow joint. It is most often diagnosed in German Shepherds and Bernese Mountain Dogs. It is the result of elbow misalignment (ulna malalignment or short ulna syndrome). In most dogs, this condition causes severe pain and obvious lameness. Achieving an optimal outcome depends on early diagnosis and treatment.

Diagnostics

X-ray recording from multiple projections, under sedation. In some cases, we have subtle changes when the anconeal growth remains slightly attached to the bone, so CT is required for diagnosis. In dogs with unfused anconeal shoots, the best outcome is achieved with early surgical intervention:

• reattachment of the anconeal outgrowth (only in dogs in which this disease was diagnosed early and in which the anconeal outgrowth has not changed shape)
• surgery to remove the anconeal spur is usually the best solution in chronic patients

Carpal hyperextension is the most common injury that occurs in large active dogs, but small dogs can also have it. Warning signs for this condition are limping, swelling of the carpal joint, visible paw contact on the ground, and excessive movement of the carpus (hyperextension). Three common carpal joint injuries cause hyperextension: improper development of the ligaments that support the carpal joint in puppies. Affected puppies walk with excessive extension of the carpus (that gait is more like a bear's than a dog's). Most often, both carpal joints are affected, and in some extreme cases, the tarsal joints are also affected. Puppies that have laxity of the ligaments and consequent hyperextension of the carpus because of long-term immobilization only have a problem with the bandaged leg.

Trauma

There are different degrees of carpal sprain. The degree of limping and joint swelling depends on the severity of the trauma. Some dogs will have an obvious malposition with an inadequate deviation of the injured joint.

Degenerative joint hyperextension

This most often happens in older dogs and is typical for, for example, collies. The tendency of one or both carpal joints is gradual loosening until complete collapse. Such and similar complaints can occur in several joints, and then we talk about polyarthritis. Such is, for example, rheumatoid arthritis, which occurs in both dogs and cats and can appear in all joints.

Diagnostics

Diagnostics of carpal hyperextension consists of several steps. The first in the series is an orthopedic examination, followed by an X-ray, potentially under sedation or general anesthesia. As part of the radiographic study, "stress projections" are made, which include an X-ray projection of the carpus in a position that fully reflects the degree of hyperextension. This allows the orthopedist to see which ligaments are damaged and makes treatment decisions more straightforward.

Your dog's case may require advanced CT or MRI diagnostic methods.

Based on the complete diagnosis, we decide whether conservative treatment is sufficient for the patient or whether a surgical solution is necessary. An orthopedic examination gives us an idea of the nature of the problem. Special X-ray tests provide information about which ligaments are damaged.

In patients in whom there is a suspicion of a fracture, but it is not visible on an X-ray, CT is recommended. MRI can also provide helpful information. Which treatment is appropriate for carpal hyperextension depends on the underlying cause. Conservative treatment includes splints or bandages and physical therapy. This is an option for developmental hyperextension and mild hyperextension. Carpal bandages are made to measure. If the cause of hyperextension is a fracture, then surgical repair of the fracture and complete stabilization of the joint is performed.

Depending on the degree of injury, the carpus can be partially or completely fused.

• Pancarpal arthrodesis (for serious injuries, high-grade sprains, and degenerative hyperextensions) - a complete fusion of the carpal joint) 

Pancarpal arthrodesis joins the antebrachium to the metacarpal bones via the carpal joint using a combination of plates and screws.

• When diagnosed with immune-mediated polyarthritis, the treatment is usually medication. Pancarpal arthrodesis is rarely performed in dogs and cats with severe polyarthritis.

Hip dysplasia is a genetic disease in dogs that tends to develop "loose" hips during the dog's early development. Future patients are usually born with morphologically normal hips, but the tissues (ligaments and joint capsule) that generally stabilize the hip joint become flaccid in the first few weeks of life. The consequence of this laxity is that an ordinarily compliant joint becomes misaligned – so the femoral head and acetabulum eventually become too flattened and no longer fit properly.

Dogs with hip dysplasia eventually develop osteoarthritis in the affected joint. In most dogs with dysplasia, both hips are affected.

Dysplasia primarily has a genetic etiology, although obesity in the first months of life can affect the development of clinical manifestations in dogs that have genes for dysplasia.

Current research indicates that more than 100 genes are involved in developing hip dysplasia. It is essential to know that environmental influences cannot cause hip dysplasia but can lead to clinical manifestations in animals that carry genes for hip dysplasia. There is no evidence that excessive activity in puppyhood leads to the development of hip dysplasia. Hip dysplasia is the most common orthopedic condition in dogs. Large dogs are most affected, although small dogs and cats can also be affected. There are numerous clinical signs of hip dysplasia, and it is most often diagnosed between 6 and 12 months of age.

Clinical signs

Stiffness of extremities, avoidance of activity, difficulty standing up and lying down, difficulty climbing and descending stairs, irregular gait, and limping on one or both hind legs. Dogs at home rarely show pain in a way that most owners can detect (panting, whining), although this condition is excruciating during an orthopedic exam that involves stretching the hips. The pain is caused by repetitive strain due to loose hip stabilizers and microfractures of the bone and cartilage surfaces rubbing against each other. Cartilage erosions increase and worsen over time, and the pain is the result of an overall joint process called osteoarthritis.

Diagnostics

Clinical signs that the owner may notice at home: stiffness of the limbs, avoidance of activity, difficulty getting up and lying down, difficulty climbing and descending stairs, irregular gait and limping on one or both hind legs, rare panting or whining (in a very advanced stage).

It is problematic that osteoarthritis (OA) occurs at an advanced age, so the owners believe that the animal moves less because of age and not because of a problem (if there is no obvious limping). If dysplasia is suspected, it is necessary to make an X-ray of the hips under sedation. In some cases, advanced diagnostic methods such as CT or MRI and the ORTOLANI test, a specific test to assess hip laxity, are also required. Once the diagnosis is complete, we will suggest the best therapy for the patient.

The best way to treat hip dysplasia depends on many factors, but the most important is the severity of the clinical picture. In some dogs, the clinical picture is mild; in some, the diagnosis of dysplasia is an accidental finding discovered during developmental imaging for hip dysplasia. In some dogs, clinical symptoms are apparent, and therapy should not only treat the current problem but also potential problems in the future.

Conservative treatment of hip dysplasia is recommended in patients in whom hip dysplasia is an incidental finding. In dogs with clinical symptoms, the response to conservative treatment depends on the severity of the pain originating from the dysplastic hip. Conservative treatment includes weight control, activity control, physical therapy, and anti-inflammatory pain medications. In the short term, most dogs respond to this treatment. Unfortunately, progress is rarely long-term. As time passes, most dogs require increasing activity restriction and ongoing support with anti-inflammatory pain medications.

Surgical treatment of hip dysplasia:

Juvenile Pubic Symphysiodesis (JPS)

The operation involves an induced premature fusion of the pelvis to alter the growth so that the connection between the "ball and cups" (femoral head and acetabulum) is improved. This is a simple procedure that involves electrical cauterization of the pubic area (on the underside of the pelvis). For this procedure to be effective, the patient must not be older than five months, and the degree of hip laxity must be mild to moderate. JPS is considered a prophylactic method. All dogs undergoing this procedure must be castrated.

Triple Pelvic Osteotomy (TPO)

Surgical method that involves surgical modification of the existing hip joint with the aim of improving the adhesion of the head of the femur to the existing hip socket.

Three incisions are made on the bone around the cup, and the segment thus created is rotated to a point to allow optimal fit. The bone segments are fixed in the new position with the help of a plate and screws. The appointment lasts between 4 and 6 weeks. TPO is only effective in dogs that have loose hips but not other features of dysplasia or osteoarthritis. Evaluation for TPO involves a series of specific tests and the use of advanced diagnostic procedures. In suitable dogs, arthroscopy is recommended to assess the condition of the cartilage.

DPO (Double Pelvic Osteotomy)

THR (artificial hip implantation) (picture)

A very complex operation that involves cutting off the entire diseased joint. The head of the femur is replaced with a metal implant, and the articular cup is replaced with a plastic or metal implant. Implants are attached to the bone with the help of a bone implant or have a spongy sheath through which the bone can penetrate. The artificial hip is most often implanted in large dogs, but it can also be implanted in small dogs and cats. In patients who require intervention on both hips, the interventions are never performed at the same time due to the higher risk of complications. The success rate of this intervention is 90-95%, and after a few days, the patients walk normally. It restores full activity to most dogs.

Excision of the femoral head and neck FHO (Femoral Head Excision)

If an artificial hip cannot be implanted (for financial reasons or when individual anatomy precludes THR), this is the only choice. With this operation, the head and neck of the femur are completely removed, creating a "false" joint. The pain disappears because contact with the bones is eliminated, but the formation of a "false" joint limits its function, so recovery in large dogs can be unpredictable. After this procedure, physical therapy is extremely important, which greatly affects the outcome, as well as maintaining an ideal body weight.

The anterior cruciate ligament is a band of fibrous tissue that connects the thigh bone (femur) to the lower leg (tibia), preventing the tibia from moving forward relative to the femur. It also prevents excessive extension and rotation of the knee. In humans, trauma to this ligament is a common occurrence, usually as a sports injury. The nature of the disease in dogs is completely different - the ligament rarely breaks due to trauma; more often, it is a degenerative process that occurs over time when the ligament is "worn".

In most dogs, the rupture is the result of a long-term degenerative process, as the threads that make up the ligament weaken over time.

The cause of this is still unknown, but it is believed that genetic factors have the greatest influence, with a significant breed predisposition (Labrador, Rottweiler, Boxer, Golden Retriever, Westie, Newfoundlander). A genetic cause is ruled out by evaluating family lines (usually, the ancestors had ruptured ligaments on both knees, but you will hardly find this out from irresponsible breeders). Obesity, inflammatory conditions of the joints, hormonal imbalance, and individual conformations also play a role in the cause of the disease.

Clinical picture

Limping is the most common clinical symptom of anterior cruciate ligaments. In some dogs, it can happen suddenly, during, or after an activity. Some dogs get ruptures in both knees - in this case, they have problems standing. In severe cases, dogs cannot stand up and may look like a neurological case. Ligament rupture causes a cascade of reactions that leads to knee pain and lameness. Osteoarthritis is already present in its earliest stages. At the critical point of rupture, the ligament loses its mechanical function, after which a painful limp is followed by a mechanical limp.

One of the factors that influence mechanical lameness is the shape of the top of the tibia, which has a very pronounced backward slope. The consequence of this slope in dogs with ACL damage is that the femur can slide down the slope every time weight is transferred to that leg. In dogs with preserved ligaments, the hill is only a problem if it is very steep, and then we have predisposing factors for this disease. In some dogs, mechanical deficiencies result in trauma to other structures in the joint, such as the meniscus (shock-absorbing cartilage). When the femur slides down the slope of the tibia, it can damage that cartilage, especially the medial side.

The diagnosis of anterior cruciate ligament rupture is usually made during an orthopedic examination or specific tests for the knee. In dogs with partial rupture or early degeneration of the ligament, X-ray imaging or magnetic resonance imaging (under sedation) is required. In most dogs, exploratory arthroscopy is also used to confirm the diagnosis and assess the condition of the cartilage.

Conservative treatment of this disease is rarely recommended except in cases of risky general anesthesia. Key points of conservative treatment are weight control, physical therapy, activity control, and nonsteroidal anti-inflammatory pain medications.

All of this is very important in the short-term management of surgically treated dogs, although the primary goal of surgery is to minimize the need for long-term activity control and medication. Dogs weighing more than 15 kg have very little chance of becoming clinically normal without surgery. Dogs lighter than 15 kg and cats have a better chance, although recovery takes months and is rarely complete.

Surgical treatment consists of techniques that aim to replace the damaged ligament and those that involve the full removal of the torn ligament and making an incision on the tibia, which changes the forces acting on the knee joint.

Ligament replacement techniques

Various surgical techniques have been performed in veterinary medicine for a very long time, which are analogous to the methods of implanting artificial ligaments used in human medicine. Techniques using local tissue transfer have the slightest chance of stabilizing the joint and allowing it to function as a typical joint or near-normal joint because the amniotic tissue is not as muscular as the ligament and is in the same biomechanical environment that caused the rupture of the true ligament.

Ligament prosthetic techniques have been used for many years. These are simple techniques that have allowed patients to return to almost normal activities. The primary disadvantages of these techniques are their unpredictability in the early stages of recovery and mechanical limitations in heavy and athletic dogs. Some dogs limp a little longer until there is improvement. Some take several weeks to recover but may also have constant knee instability and pain. Variations of these techniques are most often recommended in dogs with traumatic anterior cruciate ligament tears and in patients who have damaged several stabilizing factors in the knee. Over the decades, materials such as nylon and many others have been placed between the bone at the back of the femur (fabella) and the tunnel at the top of the tibia. This is called a side seam, and success depends on the type of material and technique.

Osteotomies as a treatment for cruciate ligament rupture

These techniques change the geometry of the knee in such a way that the ligaments are no longer needed to maintain knee stability. Several techniques involve changing the shape of the tip of the tibia by making an incision in the bone and thus placing it in a new position:

TPLO (Tibial Plateau Leveling Osteotomy)

This operation involves making a semicircular incision at the top of the tibia and rotating the tibial plateau until the previous tilt of the bone no longer disappears. The bone is subsequently fixed with a suitable plate and screws.

TTA (Tibial Tuberosity Advancement)

This operation involves the same principles as TPLO, with an incision on the tibia to allow for a change in geometry. The mathematical principles behind TTA are much more complex than those behind TPLO. The basic principle is that the altered direction of stretching of the quadriceps muscle group produces forces across the knee joint that counteract the tendency of the femur to slide down the slope of the tibial plateau.

Both TTA and TPLO aim to create a right-angle angle between the tibial plateau and the patellar tendon, thereby counteracting the tendency of the femur to slide down the slope of the tibial plateau. Because bone heals more efficiently than ligaments, these methods provide much greater strength than ligament repair methods. Recovery is much better; dogs walk on the operated leg 1-3 days after surgery. A quick return to normal activities is significant for heavy dogs, athletic dogs, dogs with mild lameness, and patients who have bilateral ruptures.

In such cases, TPLO can be performed on both knees simultaneously. Which method is more suitable depends on the individual anatomical characteristics of the animal. In most cases, both methods are appropriate. An arthroscopy is recommended to examine other structures in the joint. In cases where the meniscus is damaged, meniscectomy is performed, i.e., removal of part of the meniscus. Meniscus recovery occurs under special circumstances. 90% of dogs treated with TTA or TPLO return to normal activities. This means that owners no longer notice any signs of limping at home. Working dogs can return to service after these interventions. The success rate of these two interventions is almost the same. Complications are less than when an intervention is performed with a side seam. The two most common complications are infection and mechanical complications. The infection is treated with antibiotics. In the worst case, the bacteria is on the implant, and then the implant has to be removed when the bone heals. In most patients, the implant remains for life; it does not have to be removed. Mechanical complications arise in dogs that are too active in the period until the bone heals (6 weeks). Such complications usually resolve with rest, and sometimes, a revision must be done. Rare complications of sprains or dislocations in the knee joint are successfully solved by physical therapy.

The patella (kneecap) is a small bone located just below the tendon of the insertion part of the quadriceps muscle at the top of the tibia. The patella acts as a fulcrum during normal extension of the knee joint. It slides up and down along the groove located in the front part of the knee joint. In some dogs, the patella luxates (dislocates) from its normal groove. The consequence of this luxation is the inability to adequately extend the knee joint. Since limping is caused by mechanical defects in the affected knee, the degrees of pain and osteoarthritis are different.

Patellar luxation is a very common condition. Small breeds of dogs are most often affected, although cats can also be affected. Clinical signs appear at different ages. Most dogs show symptoms when they are puppies, but symptoms can also appear in old dogs. Dogs with "cow hocks" have a greater predisposition to luxation of the patella. Most often, a characteristic "hopping" gait is observed: the animal raises the affected hind leg every few steps and then returns to its normal gait. Some animals constantly limp, and some animals with patellar luxation on both knees have a stiff, clumsy gait because normal knee extension is not possible. This condition is primarily genetic and is the result of selection in dog breeding, which favors the wrong position of the legs. The animal is born with normal knees, but the bones and muscles of the hind legs develop irregularly. The most common direction of movement of the patella is inwards (medially). The powerful mechanism of the quadriceps tends to luxate the patella. The groove in which the patella is normally located does not develop properly, and the limb is deformed. As the patella moves up and down, damage to the cartilage of the patella itself and the tip it touches during luxation can occur. This causes pain and later osteoarthritis. Also, abnormal quadriceps pull causes an internal rotation of the tibia relative to the femur, which puts pressure on other structures in the joint, such as the anterior cruciate ligament. The further the patella is outside the groove, the shallower the groove.

Diagnostics

Patellar luxation is diagnosed by a multimodal assessment by a specialist - orthopedist. Luxation can also be diagnosed during a routine veterinary examination or with very frequent "skipping" of the gait during activity. In our polyclinic, along with the orthopedic examination, it is recommended to do X-ray diagnostics under sedation. Depending on the extent of the condition, corrective surgery may be required. The grading system for patellar luxation is based on the position of the patella in relation to the groove on the femur in four stages:

I: The patella can only be pushed out of the groove by manual repositioning; otherwise, it is permanently in the groove.

II: The patella spontaneously luxates and returns to the groove.

III: The patella is permanently luxated but can be manually returned to the groove.

IV: The patella is consistently luxated and cannot be manually returned to the groove.

Patellar luxation is most often diagnosed spontaneously during a clinical examination. When it is an incidental finding in adult dogs, conservative treatment is the best option. In young dogs, surgery is the best option due to certain limb deformities that occur if the luxation is not treated. III and IV-degree luxation of the patella is an absolute indication for surgery. When dogs with grade II patellar luxation have severe clinical symptoms, then surgery is recommended. Surgery is never recommended for grade I luxation.

Patellar luxation can cause abnormalities in the skeleton, such as bending of the femur or tibia. In milder cases, we often see loss of cartilage in the patella and in the groove, as if the cartilage is mechanically crushed by both bones. A patient with medial luxation of the patella often ruptures the anterior cruciate ligament. In patients with clinical symptoms, it is best not to delay surgery. The basis of conservative treatment is weight control, physical therapy, activity correction, and nonsteroidal anti-inflammatory analgesics. This system is also valid in the postoperative course in operated patients, although the goal of the operation is to minimize the use of analgesics and enable regular activity.

Surgical treatment is recommended in patients with intermittent and constant limping as a result of patellar luxation.

The main goal of the operation is to create an average position of the quadriceps muscle in relation to the entire limb. This requires bone reshaping and soft tissue reconstruction.

TTA (Tibial Tuberosity Transposition)

The most important part of this procedure is the correct position of the patellar tendon. Considering that the bone heals faster than the tendon, the part of the bone to which the tendon is attached is cut and moved to the appropriate position and attached to the bone and gradually heals over the next 4-8 weeks. Often, a wire is placed next to the pins that pull on the quadriceps and create a balance between the wire sitting on the tibia in the opposite direction.

FVO (Femural Varus Osteotomy)

In dogs with a significant curvature of the femur, its correction is carried out. This is achieved by extracting the wedge-shaped part of the bone, sometimes three-dimensionally, and reconstructing the femur with a plate and screws. This is most often done in large breed dogs and dogs with a high degree of patellar luxation. For such corrections, it is necessary to make a CT scan. One such cut on the bone allows reangulation of the bone in all directions.

Trochleoplasty

When the groove in which the patella usually lies is shallow, an operation is performed to deepen the groove. This procedure involves cutting the wedge of bone, deepening the groove, and putting the wedge of bone back into place. Sometimes, when more deepening of the bone is needed, a bone incision is made instead of a wedge incision.

Reconstruction of soft tissues

In most dogs with patellar luxation, the soft tissues on the side of the patella are either too thick or too thin. Reconstruction implies the loosening of thickened fibers or the hardening of thin ones. For operated patients, the postoperative period lasts six weeks and includes rest and physical therapy. During this period, the patient comes for regular check-ups to monitor his condition, and after that, he gradually returns to the normal activity he had before the operation.

Osteochondrosis dissecans is a developmental disease that occurs within the normal differentiation of cartilage cells and results in failed endochondral ossification. (Basic processes in the fetal development of the skeletal system and bone formation). In fast-growing dogs, the rapid development of cartilage can outstrip its own blood supply, causing abnormal cartilage development that results in lameness, pain, and subsequent osteoarthritis. In some cases, there is a separation of the changed parts of the cartilage from the remaining part of the cartilage surface. This is called osteochondrosis dissecans (OCD).

Osteochondrosis can occur in any joint on the body but most often occurs in the shoulder, elbow, knee, and tarsus. Genetic factors are the most important causes of OCD, mainly breed predisposition (Labradors, golden retrievers, and giant breeds). Different breeds are predisposed to different joint conditions. For example, border collies, great Danes, and Irish wolfhounds often have shoulder problems, while bull terriers, rottweilers, and Labradors have ankle problems. Dietary restrictions or obesity in the first few months of life, hormonal imbalance, or trauma to the joint also increase the risk of OCD. Most dogs with OCD show clinical symptoms before the age of one year, although sometimes, especially in the case of shoulder OCD, clinical signs can also appear in older dogs.

Clinical signs

clinical signs are variable and depend on the type of joint affected and the size of the cartilage defect. The most common clinical signs are limping, stiffness, swelling and pain in the joint, decreased activity, or a generally "depressed" behavior.

Diagnostics

OCD diagnosis is a multimodal process. The first in the series is an orthopedic examination, followed by X-ray imaging of suspicious joints from multiple projections under sedation. OCD can occur simultaneously with other developmental diseases (e.g., elbow dysplasia), and then the patient may need advanced CT or MRI diagnostic methods.

As OCD begins to develop in a certain joint, then osteoarthritis (inflammation of the joint and associated bones) begins to develop on that joint. Once osteoarthritis begins to develop, it cannot be cured, but it can generally be managed successfully. There are several options for the treatment of osteochondrosis of the ankle joint. The best option is determined for each patient after diagnostic tests. Conservative treatment may be recommended when lameness and pain are of short duration, although it is rarely recommended in dogs, except in cases where general anesthesia is contraindicated (severe heart disease, immunological conditions). Achieving an appropriate body weight, reducing activity, anti-inflammatory analgesics, supplements, and physical and hydrotherapy are recommended.

Surgical removal of the flap

Surgical removal of the cartilage flap leaves the possibility that the defect will be filled with a cartilage scar in the next few weeks. A fibrocartilogenic scar is less strong than a healthy joint. Although this allows the inflammation in the joint to be resolved in the short term, there is a possibility of developing osteoarthritis. Therefore, this surgical procedure is recommended for very small defects. Given where tarsal OCD occurs topographically, if left untreated, serious long-term weakening of the joint will occur.

• Osteochondral autograft
• Arthrodesis

Angular or rotational limb deformity is a pathological irregularity in the position and position of any limb. The consequences of angular deformities are functional spasticity as a result of improper posture and painful limping as a result of joint disharmony. The most common cause of angular deformities is asynchronous growth of bones that grow side by side, with the bone that stops growing early acting as an anchor, causing bending and rotation of the paired bone that continues to grow.

Breeders of some breeds, such as the Bulldog, Shih Tzu, and Lhasa Apso, tend to favor individuals with short legs, which can lead to this problem. In some cases, these deformities become excessive and cause functional lameness and pain. In other breeds, angular deformities can occur due to constant traumatic injuries in youth. If these injuries occur to one of the paired bones during active growth, premature growth arrest occurs, and an angular deformity of that limb develops. If your dog belongs to a breed that has short, crooked legs, it will not be easy to identify this problem. Regular consultations with an orthopedist during the dog's growth are of great importance.

Clinical signs

Limping on one or both front legs is the most common clinical sign of this problem. Angular deformities also occur on the hind legs, but much less often than on the front, except in dachshunds, where angular deformities develop equally on both the front and hind legs. If the puppy does not belong to breeds with short, crooked legs, and bending or rotation of limbs or limping is observed, it is urgent to take the dog to an orthopedic examination. Angular deformities are the most complex orthopedic problem in dogs.

DIGNOATICS (by a multimodal process):

An orthopedic examination determines whether an angular deformity is the cause of your pet's discomfort, X-rays should be taken of both the problem leg and the opposite leg under sedation.

CT provides a three-dimensional image that allows us to prepare the operation for each problem individually.

Severe osteoarthritis is often observed in dogs with a large osteochondral defect or in dogs with long-term osteochondrosis. In such circumstances, an artificial joint is implanted, or arthrodesis is performed - surgical joining of bones from all sides in order to prevent painful movement of the joint.

After severe trauma, an external fixation system is sometimes used to stabilize this joint. The priority in treatment is pain relief, which is achieved by quickly establishing the normal fit of the joints. Most often, the shorter bone, which behaves like an anchor, is cut close to the joint and allows the bone to return to its proper position. Correction of every angular and rotational position: it is achieved by cutting the deformed bones and regrouping them so that the adjacent joints fit perfectly spatially. The bones are fixed in the new position using internal (plates and screws) or external fixation. Prevention of further deformities with resumption of growth: in some young animals with significant growth potential, bone segments must be removed to prevent a re-anchoring effect after normal limb position is established.

Limb Shortening Treatment: In some dogs, early growth affects both bones in a pair. In these dogs, it is necessary to perform another operation where an external fixator is placed, which facilitates daily adaptation and allows the growth of the limb for several weeks after the operation.