Advanced Procedures for Common
Orthopedic Problems in the Dog
by Bob Gruda, D.V.M.
There are many bones, muscles, tendons, ligaments, and joints in a dog’s body, but only a few of these structures make up the majority of the problems seen at my clinic.
Recently problems of the stifle joint or knee have been coming through my practice in greater numbers. The knee joint is located on the hind limb below the hip joint and above the ankle joint. In medium- to large-breed dogs the cruciate ligament within the knee joint is our biggest concern. The problem centers on the slope or steepness at the very top or plateau of the tibia (the bottom bone that makes up the knee joint). If a dog has an overly steep tibial plateau, excessive sheer force is placed on the cranial cruciate ligament, known as the ACL in humans. From a very young age, this sheer force causes the ACL to wear out and weaken, resulting in premature osteoarthrosis or arthritis. Eventually, the stress on the weakened ligament leads to partial or complete rupture, with the dog experiencing varying degrees of lameness or not using the back leg at all. Usually both knees are affected, although one knee will always have more progressive degeneration than the opposite knee. This condition can become debilitating very quickly. Prevention or elimination of cruciate ligament strain before the ligament begins to tear starts with recognizing that any medium- to large-breed and even some small-breed dogs can experience a cruciate ligament rupture. During routine examinations, ask your vet to evaluate your dog’s knee joints for any swelling or pain on extension. Also, look for your dog to get up slowly or to be hesitant to jump on the couch or in the car. Any type of gait change could indicate a back leg that is hurting. If you notice any of these signs, it’s time for your vet to examine the dog and take appropriate x-rays.
Once a diagnosis of early cruciate ligament degeneration is made, surgery can be considered. The advantage of early surgery is eliminating further degradation and tearing of the ligament. There are two established surgical techniques that can accomplish this task, Tibial Plateau Leveling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA). TPLO has been established for the past 6-7 years; TTA is newer, with high numbers being performed for the past 2-3 years. TPLO works by reducing the slope of the tibial plateau and TTA alters the relationship between the straight patellar tendon and the tibial plateau. I have been performing TTA surgeries for about a year, and it is becoming clear that patients with excessive cruciate ligament strain can lead active lives. The major disadvantage of these two surgeries is costbetween $2500 and $3500.
Regarding the hip joint, all of you know the two words that mean pain and discomfort for medium- to large-breed dogs: hip dysplasia. Simply put, dysplasia is an inherited condition that results in the hip’s ball and socket joint fitting together poorly because the smooth cartilage in the joint rubs together abnormally, leading to damage. The inevitable result is osteoarthrosis (arthritis) that progresses at different rates, depending on the dog.
The best way to deal with dysplasia is to alter the anatomy before the degenerative arthritis begins, as early as 10-14 weeks of age. Since most puppies do not show any outward signs this soon, during routine examination the vet can perform a simple test that demonstrates laxity, or subluxation, of the hip joint. Special x-rays can be taken to measure hip joint laxity to help diagnose at-risk puppies. Puppies that are breed-specific for dysplasia and are also experiencing subluxation of the hip joint are strong candidates for early intervention surgery.
If the puppy is younger than 16-18 weeks of age, a Juvenile Pubic Symphysidiosis (JPS) can be considered. JPS surgery involves forcing the pubic growth plate on the floor of the pelvis to close or fuse earlier than normal. Because this growth plate will no longer widen the floor of the pelvis, changes in the angle of the ball portion (acetabulum) of the hip joint result in improvement in the relationship between the ball and the socket of the hip joint, reducing or eliminating any abnormal wear on the cartilage. This simple procedure can be life changing for a dog destined to have arthritis and daily pain. I have been performing JPS surgery for the past two years with mixed results. For some puppies, a more invasive surgery is indicated. A Triple Pelvic Osteotomy (TPO) involves cutting parts of the pelvis so that the socket part of the hip joint can be rotated to better fit with the ball component of the hip joint. Certain requirements must be met before this surgery can be implemented, such as cartilage health, appropriate age, and typical radiographic changes. These two procedures result in fewer of the more invasive and expensive Total Hip Replacements having to be done.
Elbow joint problems also benefit from early diagnosis. The two most common congenital conditions that I see are referred to as Fragmented Coronoid Processes (FPC) and Ununited Anconeal Processes (UAP). If diagnosed early, and appropriate procedures to remove the offending FPC or UAP are performed either invasively or through an arthroscope, devastating degenerative changes in the elbow can be reduced or eliminated altogether. Arthroscopy is less harmful to the joint and easier to recover from. If early intervention cannot be achieved and severe osteoarthrosis develops, and if financially possible, Total Elbow Replacement is now available for dogs that meet all the requirements.
All these conditions and any other degenerative joint problem are improved by administering daily a high-quality and very absorbable nutraceutical with glucosamine and chondroitin, such as Cosequin. These two supplements help cartilage cells stay alive and thus slow down progressive osteoarthrosis.
Your trusted veterinarian can address these congenital joint diseases and other joint problems properly through access to the most current and up-to-date information on procedures, medications, supplements, and alternative methods that can lead to a much-improved quality of life for your beloved dog.
Robert A. Gruda, D.V.M. owns and operates Gruda Veterinary Hospital, a small animal and equine veterinary practice at the Turquoise Trail Business Park on Highway 14 in Santa Fe (505-471-4400).
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