Visiting Veterinarian : Preventive surgery is hip
Imagine you just bought a beautiful golden retriever puppy. Let's call her Bunny. You did your homework, researching breeders, checking bloodlines. You met the parents, both gorgeous specimens with lovely temperaments. You spent a bundle because you wanted to be sure to get a healthy dog. Now imagine you take Bunny to your veterinarian, budgeting for puppy shots, worming, heartworm meds, flea and tick stuff, and eventual neutering. Then imagine your veterinarian wants to do a special test on Bunny for hip dysplasia.
"Not necessary," you insist. "She runs perfectly. Both parents had their hips certified by the Orthopedic Foundation for Animals." Unfortunately the latest research shows that, despite years of evaluating dogs with radiographs prior to breeding, and removing visibly affected individuals from the gene pool, hip dysplasia is still a problem.
Canine hip dysplasia (CHD) is a malformation of the hip characterized by instability of the joint leading to osteoarthritis. A multifactorial condition affected by genetics, nutrition, and growth rate, CHD is most common in large breed dogs. The hip is a ball and socket style joint. The socket is called the acetabulum (which is Latin for "vinegar cup.") The ball is made from the top of the big thigh bone and is called the femoral head. In dogs with dysplasia, the acetabulum is typically too shallow and does not hold the femoral head firmly in place.
When Bunny runs around, the joint rattles around excessively. Over time this extra wear and tear causes arthritic changes...and pain. If Bunny has a severe case, she may have an abnormal gait early on but many affected dogs do not develop clinical signs until they are much older.
"Okay," you say, agreeably. "Anything for Bunny. Go ahead and take an X-ray." Well, we can do that, but Bunny's hips are not fully formed yet. If she has very severe dysplasia, we might see that, but hips that appear normal on films at this young age can still have excessive laxity that will later lead to osteoarthritis. In the early 1980s, Dr. Gail Smith at the University of Pennsylvania School of Veterinary Medicine developed a new method to measure joint laxity in young dogs' hips. Officially called the PennHIP, this technique has become the gold standard for hip evaluation. Pups four months or older are anesthetized, so all muscles are completely relaxed, then three precisely positioned radiographs are taken, one of which uses a patented device called a distractor. By comparing the hip conformation in the different positions and measuring various parameters, the doctor can determine the maximum laxity and quantify it as a Distraction Index (DI). The higher the DI, the greater the laxity. The greater the laxity, the greater the risk of dysplasia and arthritis.
"Okay," you sigh, noting your checking account balance. "I'm game. Even if today's X-ray looks fine, when Bunny is four months old, we'll take her for the PennHIP evaluation." Well, we could do that. Then if she has severe problems, specialists might advise a Triple Pelvic Osteotomy (TPO). This involves cutting the pelvic bones in three places, rotating the socket down to provide better seating of the femoral head, and putting everything back together with metal plates and screws: three plus hours of surgery and $3,500 per hip. Then wait a little while and do the flip side. And the two to three-month recovery periods aren't fun.
"Sounds awful," you groan, checking your credit card limit. "I have to tell you, doc, we can't afford that. I guess we should just skip any tests and hope for the best."
Hold on. You have another option. Recently Dr. William Henry of Boston and Cape Cod Veterinary Specialists presented a seminar to Island veterinarians and their staff about juvenile pubic symphysiodesis (JPS), a new early intervention procedure aimed at preventing CHD. This minimally invasive surgery fuses a portion of the growth plate of the pelvis in puppies with excessive joint laxity.
The result? As the unfused portion of the pelvis continues to grow, the angle of the acetabulum is altered to create a more stable hip socket. No bone cutting. No hardware installation. It's a one-time procedure with an easy two-week recovery. Cost? A relative bargain at $1,300 to $1,500. Does it work? Specialists have been doing JPS for less than ten years, but studies to date look good. In order to decide if Bunny might benefit from juvenile pubic symphysiodesis, we need to anesthetize her and check for a symptom called the Ortolani sign. Yes, we need the anesthesia to be accurate. Bunny must be totally relaxed when we roll her onto her back, and then try to partially pop her hips out of the sockets and pop them back in. It's not as gruesome as it sounds. All we really do is manipulate her legs in a specified manner while listening and feeling for a "pop." If her hips pop, that's a positive Ortolani sign, and almost certainly indicates excessive hip laxity.
"Hmmm," you shake your head, checking how far the Dow has dropped today. "I really don't like the idea of giving her anesthesia so young. We'll do it later when you spay her." Sorry. That won't work. The ideal time for the JPS procedure is between the ages of 12 and 16 weeks. By the time she's 20 weeks, you've missed your chance,
"Okay," you surrender. "If this is what you really recommend for all puppies." Ah. Hmmm. Well, if Bunny's projected adult weight is less than 40 pounds, then no, I wouldn't recommend it. If you are 100 percent positive you would not spring for any type of surgery now, no matter how bad Bunny's hips, then, no, I wouldn't recommend it. But if you have a large breed pup, especially one of the high-risk breeds, if you would go for early corrective surgery, if finances are not a major issue, if there are no obvious contraindications for anesthesia, then, yes, let's hop to it. Talk to your vet about checking Bunny's hips and checking them early.
