Oh, My Aching Back, Knees, and Joints
By Nancy Marano
If a human experiences severe arthritis in his hips or knees, or ruptures a disk in her back, an orthopedic surgeon can replace the joint or repair the ruptured disk. But what about dogs? Are there similar procedures available to help them?
“What we do for humans we usually can do for dogs,” says Dr. Terry Schukei, D.V.M. of the TLC Canine Clinic Albuquerque, New Mexico. “But the owner’s willingness to make the emotional and financial commitment pet surgery requires is still the determining factor in whether surgery is performed.”
According to the Worldwide Pet Supply Association, $10 billion was spent on the pet industry in 1997. While these figures are impressive, U.S. Census numbers show $402 billion was spent on recreation in 1995. Obviously, considerable disposable income is available. It is a matter of where a pet’s health falls on its owner’s priority list.
COMMON ORTHOPEDIC PROBLEMS
Anterior Cruciate Ligament (ACL)
A tear in any of the ligaments of the stifle (knee) joint causes instability in the knee. Each time an afflicted dog walks or runs, its knee sustains more damage until degenerative joint disease occurs. If left untreated, the strain on the opposite limb often results in ligament ruptures there as well. ACL injuries are the most common cause of hind limb lameness. Ligament rupture can occur from traumatic injury in younger dogs, but it usually occurs in dogs seven years old and up.
Many surgical techniques are available to correct this problem, but whatever procedure is used the goal is to stabilize the stifle joint. ACL surgery, which can cost anywhere from $250 to $800, has an 85%-95% success rate. Dogs that undergo the procedure must be confined for six to twelve weeks following the surgery, while exercise is gradually increased to strengthen the joint.
Canine Hip Dysplasia (CHD)
Hip dysplasia is the most common inherited disease in large breed dogs. The acetabulum, a cup-shaped hollow in the hip bone into which the head of the femur (the thigh bone) fits to form the ball-and-socket joint, is too shallow or malformed. This causes hip laxity, which leads to degenerative disease, pain, and lameness.
The only way to diagnose CHD is to x-ray the hips. Until recently these x-rays followed protocols set by the Orthopedic Foundation for Animals (OFA), the world’s largest all-breed hip registry, whose database contains information on 475,000 dogs. There are two major drawbacks to this method: first, x-rays aren’t taken until the dog is two years old, and second, the evaluation of the appearance of the hips for the presence of dysplasia is subjective.
Now a second method for earlier diagnosis is available. Known as PENNHip, it was created in 1983 by Dr. Gail Smith, University of Pennsylvania School of Veterinary Medicine. This method scientifically measures passive hip laxity with the patient sedated during the x-rays to allow total muscle relaxation. The test is accurate on dogs at 16 weeks of age with reevaluation suggested at two years. The tighter the hips are on the PENNHip Distraction Index the less likely the dog is to develop CHD. Veterinarians need special training for certification in this method.
Dr. James Tomlinson, D.VM., Department of Veterinary Medicine, University of Missouri, a recognized authority on CHD says that total hip replacement and triple pelvic osteotomy are the best surgical procedures to treat CHD.
Total Hip Replacement (THR)
This procedure, like that used in humans, uses a plastic and metal prosthesis that forms a new ball and socket joint. This procedure is 90% successful, allowing most dogs normal, pain-free function of their limb. As in ACL surgery, the problem may affect both hips so a second surgery is not uncommon.
Immediately following surgery, x-rays are taken to be sure the prosthesis is positioned correctly. Recovery takes 6-12 weeks, again with a gradual increase in exercise. Problems, if they occur, might result from infection, implant loosening, fracture, or dislocation.
Triple Pelvic Osteotomy (TPO)
Instead of replacing the joint, this procedure reorients the acetabulum over the femoral head. The surgeon cuts three bones in the pelvis, thereby allowing rotation of the acetabulum to the proper angle for reduction of hip laxity and a tighter fit of the femoral head into the acetabulum. Once repositioned, the acetabulum is secured by using a bone plate and screws.
TPO is effective when done on young dogs, ideally before 10 months of age, to regain joint stability and help provide normal joint development before osteoarthritis starts. Once the degenerative process begins, this procedure is not a good choice.
Postoperative care keeps the dog confined and inactive for four weeks. Running, jumping or climbing stairs are forbidden. After six weeks, the dog begins leash walks. These are gradually lengthened during the next month. X-rays are taken periodically to monitor the healing process and watch for the presence or progression of any degenerative disease.
Complications from this surgery may include injury to the sciatic nerve or narrowing of the pelvic canal, though these are unlikely. More common is loosening of the screws. If this happens, the dog is confined until union of the bones is complete.
Costs for THR or TPO typically range from $2000-3000.
This dislocation of the kneecap occurs when the kneecap migrates either to the inside or out side of the patellar groove, according to Dr. Schukei. It can be caused by traumatic injury, but usually is due to a congenital birth defect. It causes pain, gait abnormalities, and structural changes. If not treated, the joint instability can lead to the breakdown of supporting knee ligaments.
Patellar luxation is common in toy and miniature breeds. If the veterinarian thinks the dog is likely to experience continued debilitating effects from this problem, surgery can be done to reposition the kneecap and repair the stifle joint. This surgery, which costs between $1000 and $1500, has a 90%-95% success rate. Both stifle joints are commonly repaired at the same time.
The most common spinal problem in dogs is a ruptured disk, which can injure the spinal cord and cause paralysis. Laminectomy, a surgical procedure where the bony arches of one or more vertebrae are chipped away or removed to relieve pressure on the spinal cord, is the procedure of choice. Dr. Douglas Teague, D.V.M., and board certified surgeon, Wheat Ridge Animal Hospital, Wheat Ridge, Colorado, says veterinary surgeons are beginning to use a small incision, as they do in humans, to take out only the ruptured material, but that this technique is not yet widely used.
The surgeon relies on a myelogram, an x-ray procedure using special dye injected into the spinal canal to outline the lesion, in making the diagnosis. Fees for back surgery range between $1200-2000.
This appears in the front limbs and is usually the result of various bony abnormalities. It may be congenital or may occur during the puppy’s rapid growth period between four and twelve months. It commonly appears in large and giant breeds.
The three long bones of the forelimb meet at the elbow joint. When the bones don’t grow in unison, it causes abnormal development and loss of joint function and stability. Elbow dysplasia manifests itself in an abnormal gait, pain, decreased range of motion, and an intolerance for exercise. Eventually, this leads to arthritis.
Fractures are a common problem, but their frequency differs by location. Dr. Schukei says, “If there are strong leash laws, we aren’t going to see as many. But, in those areas where animals run free or they are unrestrained in the back of pick-up trucks, we see more.”
In canine orthopedic surgery, as in human surgery, the recovery period is lengthy. Owners must be prepared to follow the veterinarian’s postoperative care instructions conscientiously in order for the procedure to be successful. “The owner has to have an awareness of the type of situation they’re getting themselves into,” says Dr. Schukei. “We try to tell them ahead of time and instruct them on how to care for the animal. If they’re not prepared, or can’t make that commitment, then the procedure shouldn’t be done because it won’t work.”
The most common postoperative mistakes occur in the area of confining the animal. Owners will allow a dog to run in the back yard too soon after surgery. Another problem occurs when owners fail to have the cast checked frequently enough. The veterinarian needs to know whether there is infection under the cast, or if the cast is too tight or too loose. Any of these errors may cause a surgery to fail.
Is Surgery Always The Answer?
Given the cost of surgical procedures and most owners’ lack of pet insurance, whether or not to do a procedure becomes a serious decision. Dr. Schukei considers it his job, or any veterinarian’s job, to do his best to make the right diagnosis and give the client the best way to correct a problem. If surgery is the best solution, but the owner chooses against surgery, he tries to give them alternatives. But that is not always easy. Dr. Shukei told me, “If a dog comes in with a ruptured disk, he needs a myelogram and surgery. It’s not something I feel good about treating medically. Sometimes there is the right way or now way.”
Surgery can be expensive and putting a price on the bond between human and companion animal is difficult. But with the surgical techniques now available that successfully treat debilitating, degenerative conditions, opting for the surgery can give your pet the ability to live an enjoyable and fulfilling life, a gift beyond the measure of dollars and cents.
Copyright, National Pet & Health Care Network: PetView Magazine
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