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5 most common canine orthopaedic conditions

**Please note with all of these posts - you must seek veterinary advice and consent from both your veterinarian and veterinary physiotherapist before carrying out any of the exercises mentioned and must visit your veterinarian if your dog displays any of the signs mentioned**


There are various conditions that can affect our four legged friends, however, in this blog post, I cover the five most common orthopaedic conditions including a brief overview of what they are, common signs and how home management and complementary therapies can work to help. The five most common canine orthopaedic conditions are: hip dysplasia, elbow dysplasia, cranial cruciate ligament rupture, patella luxation and osteoarthritis.


HIP DYSPLASIA


What is hip dysplasia?


The term “dysplasia” is described as “abnormality of development” meaning hip dysplasia refers to the abnormal development of the hip joint(s). This is a genetic condition however factors such as excessive growth rate, improper weight and nutrition can influence the genetic predisposition. This is, however, not a congenital condition meaning puppies are not born with hip laxity and are born with “normal” hips. During the first few weeks of life, the soft tissue structures that surround and stabilise the hip joint become loose - leading to hip dysplasia.


The hip joint is a “ball and socket joint” meaning the femur sits within the hip socket, harmoniously. With hip dysplasia, the ball becomes flatter whilst the socket shallower. Once hip dysplasia develops, it is likely that a secondary condition - osteoarthritis can develop within the affected joint. Hip dysplasia or the development of secondary osteoarthritis can be painful. It is relatively common for both hips to be affected in the vast majority of cases.


What are the common signs of hip dysplasia?


Larger, rapidly growing breeds are most commonly affected by hip dysplasia, such as Retrievers and Rottweilers, however small dogs and cats cannot be ruled out. It is commonly diagnosed under 12 months of age. There are various clinical signs that your dog may have hip dysplasia, these include:


  • Stiffness or lameness/limping on one or both hind limbs

  • Difficulty getting up after after lying down or climbing stairs

  • Not wanting to exercise as much or difficulty exercising

  • Abnormal movement such as “swaying” of the hind limbs


**It is important if your dog displays any of these signs for you to visit your veterinarian for a full diagnosis**


Early diagnosis and taking your dog to the vet:


Your veterinarian will carry out a full assessment, if the signs have not been noted in previous routine health checks, and if there is a suspicion of hip dysplasia your veterinarian may perform radiographs to highlight joint changes and allow for a diagnosis of hip dysplasia as well as the extent of the condition.



X-rays are commonly used to diagnose hip dysplasia including the severity. As seen above, picture 1 displays perfect hips whereby the ball fits tightly into the socket. Picture 2 shows moderate hip dysplasia where the ball is barely in the socket with secondary arthritic changes. Picture 3 exhibits severe hip dysplasia whereby the ball is almost completely out of the shallow socket with significant arthritic changes.


Surgical intervention


Following diagnosis, there are various options that are available to you depending on the extent of the condition and other contributing factors. Your dog may be referred to a specialist orthopaedic surgeon to discuss these options for your pet. A total hip replacement is performed by an experienced orthopaedic surgeon which involves surgically removing the diseased hip joint and replacing with a metal and/or plastic implant, research has highlighted a success rate of approximately 90% with most dogs returning to full activity levels.


A femoral head and neck excision (FHNE) is another operation that is considered in hip dysplasia cases, particularly if a total hip replacement cannot be performed for any particular reason - such as individual anatomy preventing a total hip replacement. This procedure involves removing the femoral head and neck to remove the pain associated with hip dysplasia. The outcome of this surgery can be unpredictable however a home exercise plan can be made to optimise the return to mobility function.


ELBOW DYSPLASIA


What is elbow dysplasia?


The term “dysplasia” is described as “abnormality of development” meaning elbow dysplasia refers to the abnormal development of the elbow joint(s). The elbow joint is complex, containing three bones that articulate to create movement. If these three bones do not fit together perfectly and the conformation is abnormal, this causes forces to be placed on this joint.


As the dog begins to grow and mature, the condition begins to worsen and leads to malformation and degeneration. It is unknown how exactly the elbow develops however an uneven conformation is known to lead to abnormal weight distribution within the joint. This causes increased pressure, eventually leading to pain, reduced range of movement and secondary osteoarthritis. Factors such as obesity during puppy hood, can influence the likelihood of developing the condition.


What are the common signs of elbow dysplasia?


Elbow dysplasia is the most common cause of forelimb lameness, particularly in young, large breed dogs however it can still occur in smaller breeds. It is primarily genetic and due to skeletal growth abnormalities in the joint. It is commonly diagnosed before the age of 2. There are various clinical signs that your dog may have elbow dysplasia, these include:


  • Forelimb lameness or a limp

  • Difficulty getting up after lying down

  • Not wanting to exercise or difficulty exercising

  • Heat or swelling in the elbows

  • Changes in behaviour


Early diagnosis and taking your dog to the vet:


If there is a suspicion that your dog may be suffering from elbow dysplasia, your veterinarian will carry out a full assessment which may include scans such as radiographs or a CT to determine the extent of the condition and to gain a full diagnosis. X-rays can be helpful for this condition, however they do not always provide the best quality image for a clear diagnosis. In comparison, CT images provide more specific information such as the “fit” of the bones and the extent of the condition can be established in more detail - as seen in the images below.



Surgical intervention


The most commonly used surgery for cases of elbow dysplasia is an arthroscopy. This involves removing any loose fragments of cartilage and bone from the elbow joint. This is typically done through the use of a small camera. Recovery from this surgery is usually rapid however lameness often fails to improve due to the poor conformation of the joint and the secondary osteoarthritis associated.


CRANIAL CRUCIATE LIGAMENT RUPTURE (CCLR)


What is the cranial cruciate ligament and how does it rupture?


The cranial cruciate ligament works to stabilise the knee in dogs by preventing over-extending or rotation of the joint. Rupture of this ligament usually occurs over time due to wear and tear causing weakness and degeneration. Factors such as obesity and individual conformation can influence predisposition.


What are the common signs of CCLR?


Large and giant breed dogs are particularly affected by this condition however all breeds and sizes can rupture their cruciate ligament. Signs of a ruptured cruciate ligament include:


  • Lameness, a limp or stiffness

  • Usually sudden during or after exercise

  • Not wanting to exercise or difficulty exercising

  • Sitting with the limb extended or outwards

  • Swelling and heat of the affected knee

  • Lack of weight bearing on the affected limb

  • Yelping after landing on the limb


Taking your dog to the vet:


An orthopaedic surgeon will perform a full assessment of the joint to diagnose and establish the severity of the condition. Diagnostic tools such as an MRI or X-ray and an arthroscopy are used to confirm the diagnosis. Conservative management can be used however is not always recommended as the first option. Surgical procedures tend to be recommended to create a robust joint and reduce movement.


"Unfortunately, CCLR often occurs in both knees, and about 30- 50% of dogs will rupture both CCLs within 1-2 years of each other"

Surgical intervention


TPLO or tibial plateau levelling osteotomy is the most common surgical intervention for this condition. It involves changing the angle of the shin bone through cutting and rotating it and stabilising it with screws. This choice is often when the knee joint is completely unstable and the dog has persistent lameness however this will be decided by your veterinarian as to the best option for your pet. Exercise and movement must be restricted following surgery however the use of physiotherapy and hydrotherapy will work to restore function.



LUXATING PATELLA


What is the patella and what is luxation?


The patella is a small bone in a dog's knee that acts as a lever during movement. During normal movement, it glides up and down within a groove - forming the knee cap. It can, however, dislocate or luxate out of this groove, leading to an inability to extend the knee joint. This can be graded depending on severity and degree of pain associated.


What are the common signs of patella luxation?


Patella luxation is particularly common in smaller dogs and cats however all breeds and sizes can be affected. Signs of patella luxation includes:


  • "Bow-legged" stance

  • "Skipping" or kicking whilst walking

  • Stiff or awkward gait

  • Limited extension in knees during walking

  • Holding a hind limb up- particularly after exercise


How is it diagnosed?


A veterinary examination is used to determine the grade of luxation. This condition can sometimes be picked up on a routine examination if your dog is not showing signs. A grading system is commonly used to determine the severity of the condition and to determine how it is managed. The common grading system includes:


Grade 1: Knee cap luxates with manual pressure

Grade 2: Knee cap spontaneously luxates

Grade 3: Knee cap permanently luxates, it can be manually replaced in the groove

Grade 4: Knee cap permanently luxates, it can't be manually replaced in the groove





Surgical intervention


The grading of the condition will define the management of the condition. If it is a grade 1 luxation, these dogs tend to manage well without the need for surgery. If the grading is 3 or 4, surgery may be the best option however this will be determined by your vet. The key surgeries are quadriceps mechanism realignment, to realign the patella into the groove, trochlea deepening, to deepen the groove and femoral osteotomy, to reposition the patella and stabilise with screws.


OSTEOARTHRITIS


What is osteoarthritis?


Osteoarthritis is a condition that affects us humans as well as our four legged friends. It involves the degeneration of articular cartilage leading to bone on bone rubbing during movement. It is the most common cause of chronic pain in dogs, affecting 4 out of 5 older dogs. It usually begins in the moving joints but eventually targets the whole body. It is a non-curable, progressive disease.


What are the signs of osteoarthritis?


  • Lameness, a limp or stiffness

  • Not wanting to or difficulty exercising

  • Difficulty/stiffness getting up after lying down

  • Not wanting to or difficulty climbing stairs

  • Low mood or changes in behaviour

  • Difficulty getting comfortable

  • Change in movement or posture


Diagnosis and taking your dog to the vet


Osteoarthritis affects all dogs of any breed and size. In older dogs it affects 4 out of 5 older dogs and is often seen as owners often say ’he’s slowing down’ or ‘he’s getting old’. If you suspect that your dog is showing any signs of osteoarthritis, it is best to get them checked over by your veterinarian. They will perform a thorough examination and may do further checks including scans and blood tests to confirm the extent of the condition and the joints it is affecting.


Management of osteoarthritis


Although osteoarthritis is a progressive, non-curable disease, there are various things that can work in conjunction with one another to manage and maintain the condition including physiotherapy, acupuncture, hydrotherapy, weight and exercise management and pain relief.


CONSERVATIVE MANAGEMENT


As discussed, there is often a surgical option for these orthopaedic conditions that is determined by your vet. If it is suitable for your pet, conservative management can be chosen and often works incredibly well in managing the condition through a variety of complementary therapies.


Conservative management is heavily case dependent and will be decided by your vet. When conservative management is suggested and applied, each individual dog will have a pain and exercise threshold and the plan will be tailored to their individual needs. The type and duration of exercise that the dog can tolerate will depend on the severity, extent and pain levels of the condition. Weight management is a large factor of conservative management for the majority of canine orthopaedic conditions. Ensuring body weight is healthy and maintained, this reduces the excess strain placed on the joints whilst coping with an orthopaedic condition (click here to read more about weight management)


Following veterinary consent and referral, veterinary physiotherapy can be put in place to enhance conservative management. Following a thorough static and dynamic assessment and palpation from a qualified veterinary physiotherapist, exercises and physiotherapy techniques can be put in place to create an accurate rehabilitation plan for your dog’s condition, tailoring it to their individual needs, aims and fitness.


Physiotherapy alongside other therapies such as hydrotherapy and acupuncture can be used individually or in conjunction with one another to reduce pain, strengthen surrounding musculature to, in-turn, support the joint, improve joint range of motion and reduce the effects of compensatory movement. The hydrotherapy pool and/or underwater treadmill can be used together or individually to provide an environment where your dog can perform a comfortable range of movement whilst supporting the joints and building muscle. Electrotherapies, such as laser therapy, can also be offered to manage pain levels and enhance healing.


Home management plans can also be put in place to help manage pain levels and reduce the risk at home. This includes: raised food bowls, putting mats down on slippery floors, preventing your dog from jumping in and out of the car and on and off furniture.


If conservative management is followed thoroughly including: carrying out physiotherapy exercises provided correctly, exercise and home modifications, weight management, medication and regular hydrotherapy, non-surgical management can show significant improvements and may not ever require surgery if managed appropriately. It should, however, be noted that this improvement may not be maintained long-term and further exercise modification and medication may be required.


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© 2019 by Eve Bestwick