What Is The Evidence?

Abstract

Problem A 6-year-old spayed female Newfoundland weighing 57.5 kg (126.5 lb) was evaluated at the University of Missouri Veterinary Medical Teaching Hospital for a 5-month history of right hind limb lameness manifested as a decrease in physical activity, difficulty rising from a recumbent position, and disinterest in swimming, one of the dog’s preferred activities before the lameness developed. The dog was a household pet that lived indoors and was allowed to roam freely on the owners’ farm. The owners initially sought advice from their local veterinarian who had sequentially prescribed 2 types of NSAIDs; the owners reported minimal improvement with administration of either NSAID and so were referred to the teaching hospital for further evaluation of their dog. General, orthopedic, and neurologic examinations were performed. The only pertinent abnormalities were detected during the orthopedic examination and included signs of pain in the dog during manipulation of the right elbow joint, extension of the right stifle joint, and extension of both hip joints. The dog was sedated with nalbuphine hydrochloride (0.5 mg/kg [0.23 mg/lb]) and dexmedetomidine hydrochloride (5 µ g/kg [2.3 µ g/lb]) for radiographic examination. Mediolateral and craniocaudal radiographic views of the right elbow joint revealed changes consistent with a fragmented medial coronoid process and secondary osteoarthritis. Mediolateral and craniocaudal radiographic views of the right stifle joint showed no evi dence of lesions. Lateral and ventrodorsal hip-extended radiographic views of the pelvis and hind limbs revealed changes indicative of severe osteoarthritis secondary to hip dysplasia, with more severe subluxation, remodeling, and osteophytosis noticed in the right versus left joint. The relative severity of radiographic changes was consistent with the owner’s observation that the patient was more frequently lame on the right hind limb. The diagnostic findings, options for treatment, as sociated complications, and prognoses were discussed with the owner. The complexity of the case given the multiple orthopedic abnormalities noted was discussed thoroughly, and the supervising clinician and the owner agreed that the first priority for surgical treatment would be the right hip joint as it seemed most clinically debilitating. The owner’s objective was to pursue treatment that would alleviate the dog’s discomfort and improve hind limb function defined as renewed interest in and ability to play and swim without reluctance or difficulty.