Juvenile Pubic Symphysiodesis Research Articles

Treatment options for canine hip dysplasia

Hip dysplasia is a common orthopaedic condition in dogs which is frequently encountered by general practitioners. Multiple management options exist and an understanding of the indications for each is required when advising owners on the treatment of such cases. The majority of cases of canine hip dysplasia will likely be managed conservatively; however, a proportion of cases will not respond and therefore require surgical intervention. This article provides general practitioners with further knowledge of the surgical options available and the indications for such procedures. Immature patients with mild hip dysplasia and a lack of secondary osteoarthritic changes may be candidates for prophylactic surgical procedures, such as juvenile pubic symphysiodesis or pelvic osteotomies. In older patients or those with more severe hip dysplasia, total hip replacement results in the best outcome, with full return to function reported in over 90% of patients when performed by an experienced surgeon.

Juvenile pubic symphysiodesis associated with pectineus myectomy for treatment of hip dysplasia in dog

Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery.Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development.Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life.Keywords: hip dysplasia, juvenile pubic symphysiodesis, hip joint, osteoarthritis, dog.Título: Sinfisiodese púbica juvenil associada à miectomia do pectíneopara tratamento de displasia coxofemoral em cãoDescritores: displasia coxofemoral, sinfisiodese púbica juvenil, coxofemoral, osteoartrite.

Bilateral proximal tibial epiphysiodesis and juvenile pubic symphysiodesis in a 22-week-old golden retriever

A 22-week-old male golden retriever with acute bilateral hind limb lameness was diagnosed with bilateral complete cranial cruciate ligament rupture and hip joint laxity. Laxity index was 0.72 on the...

Three-dimensional assessment of the influence of juvenile pubic symphysiodesis on the pelvic geometry of dogs.

OBJECTIVE To evaluate the 3-D geometry of canine pelves and to characterize the long-term effects of juvenile pubic symphysiodesis (JPS) on pelvic geometry by comparing the pelvic configuration between littermates that did and did not undergo the procedure. ANIMALS 24 Labrador Retriever, Golden Retriever, or Labrador Retriever-Golden Retriever crossbred service dogs from 13 litters. PROCEDURES At 16 weeks old, puppies with a hip joint distraction index ≥ 0.5 were randomly assigned to undergo thermal JPS (n = 9), mechanical JPS (7), or a sham (control) surgical procedure (8). Ten years later, each dog underwent a CT scan of the pelvic region. Modeling software was used to create 3-D reconstructions from the CT scans, and various pelvic measurements were made and compared among the 3 treatments. RESULTS Compared with the control treatment, thermal and mechanical JPS increased the hemipelvis acetabular angle by 4°, the acetabular angle of lateral opening by 5°, and the orientation of the medial acetabular wall in a transverse plane by 6°, which indicated that JPS increased dorsal femoral head coverage by the acetabulum. Both JPS procedures decreased the pelvic canal area by approximately 20% and acetabular inclination by 6° but did not alter acetabular retroversion. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that thermal and mechanical JPS were equally effective in altering the 3-D pelvic geometry of dogs. These findings may help guide future studies of alternatives for optimizing canine pelvic anatomy to minimize the risk of hip dysplasia and associated osteoarthritis.

Proximal Tibial Epiphysiodesis in a Growing Dog

Background: It is believed that the inclined tibial plateau angle to be a major cause of cranial cruciate ligament (CCL) rupture, and the treatment of this disease is the tibial plateau leveling for decrease the cranial tibial thrust. However, there are breeds predisposed to rupture of the cranial cruciate ligament and in this patterns breed the tibial plateau is more in­clined due to the conformation of the limb. The aim of this communication was to evaluate the effectiveness of the locking screw and cauterizing the growth plate of the tibial plateau as a preventive method of cranial cruciate ligament rupture. Case: In a young dog, one stifle joint randomly chosen for placing a screw in order to block the tibial plateau growth line. There was placed a 3.5 mm x 20 mm cancellous bone screw in the dorsocranial surface of the tibial plateau of the left hindlimb. Two months after the first surgical intervention, the contralateral limb was cauterized in the tibial plateau growth line. Electrocauterization was performed with a spatula electrode set at 60 watts, performing ablation on the cra­nial third of the tibial plateau physis with access to the medial and lateral surfaces of the proximal tibia. The electrode was placed against the physis for 10 seconds at each site. Both members were followed radiographically to measure the tibial plateau angle and observed the angle reduction. After 30 and 60 days post-surgery, the tibial plateau angle in left hindlimb decreased to 11o and -4o, respectively. However, the decrease plateau tibial angle was intense and severe and the screw was removed of the bone. However, even with the proximal tibial physis still open, withdrawing the screw did not alter the tibial plateau angle, which remained at -4º until the animal reached adulthood. The right left hindlimb was used as a control until the dog was 6 months old, when the tibial plateau angle exhibited a 26°. With the electrocauterization technique the tibial plateau angle decreased to 18° and 16° at 30 and 60 days after surgery, respectively, remaining at this last value until the animal completed its growth. Discussion: In the animals with cranial cruciate ligament rupture is indicate same surgical procedures like tibial plateau leveling osteotomy. In these cases, the recommended tibial plateau angle is aproximattely 5o. This study sought to block the line of growth of the tibial plateau to be reached an angle of approximately 5o. Epiphysiodesis technique with screw was already described for treating CCL rupture in young dogs, and the tibial plateau slope was reduced in all dogs studied. The surgical technique used was effective in blocking the physis; however, we observed that the tibial plateau slope was excessively modified and the screw was removed. This fact is explained by the dog’s immaturity, since the plateau leveling occurs more intensively in very young dogs. In epiphysiodesis using the electrocauterization technique, the same surgical principle of juvenile pubic symphysiodesis for treating coxofemoral dysplasia was used. However, in the current pilot study, it was unable to achieve the desired tibial plateau slope with this technique, possibly due to performing the procedure at an age in which the proximal tibial physis would have limited functional capacity. In this study, there was a reduction in the angle of the tibial plateau in both the techniques. However, further studies should be conducted to in order to confirm the actual effectiveness of both techniques described in this report. Keywords: cranial cruciate ligament, locking screw, electrocauterization, stifle joint

A systematic review of the literature describing the efficacy of surgical treatments for canine hip dysplasia (1948-2012).

To systematically evaluate the literature reporting outcome of surgical treatments for canine hip dysplasia (CHD) and to evaluate whether adequate evidence exists to support a procedure that will allow a consistent return to normal function. Systematic literature review. Dogs with naturally occurring CHD. An a priori question was defined and a computer-based bibliographic search was performed on PubMed, Medline, CAB Abstracts, and Veterinary Information Network through November 2012. Studies were compared and evaluated with regard to surgical technique, study design, outcome measurements, evidence classification, and evidence quality. Unilateral surgeries with >6 months postoperative follow-up were included. Manuscripts (n = 477) were identified and reviewed; 17 met the inclusion criteria. One study provided level I evidence, 2 provided level II evidence, 3 provided level III evidence, and 11 provided level IV evidence relative to the study question. The most common outcome measurements were orthopedic examination (70.6%), owner interview (70.6%), and visual gait observation (64.7%). Three studies used objective kinetic gait assessment. Two studies with level III evidence (total hip replacement) and 1 study with level IV evidence (juvenile pubic symphysiodesis) documented a consistent return to normal function after surgery. Despite a large number of publications describing clinical outcome after surgical treatments for CHD, few provided strong evidence to allow an adequate assessment of therapeutic efficacy.

Hip joint replacement using monofilament polypropylene surgical mesh: an animal model.

Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head and neck resection (FHNE). The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform.

Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis

The hypothesis of this study was that juvenile pubic symphysiodesis (JPS) results in pelvic changes that can be identified radiographically in adult dogs. The medical records at the Clinica Veterinaria Vezzoni were searched for standard ventro-dorsal views of the pelvis of adult Labrador and Golden Retrievers that had undergone JPS or had not undergone surgery. The objective assessment of radiographs included the analysis of various pelvic measurements. Subjective evaluation of radiographs was undertaken by 18 specialists and 21 general practitioners and was based on five criteria relating to 1) the acetabular fossae, 2) the pubic symphysis, 3) the margin of the cranial pubic area, 4) the pubic rami, and 5) the obturator foramen. The radiographs of 42 Labrador Retrievers and 16 Golden Retrievers were evaluated. The most useful criteria were the radiographic measurement of the shape of the obturator foramen and two different ratios of length to width of the pubic rami; these values were significantly smaller in dogs after JPS. The pelvic canal width was the same in both groups. All objective measurements were repeatable within and between evaluators. The most reliable subjective criterion was number 4, followed by number 5 in Golden Retrievers and by 2 in Labrador Retrievers. Our objective and subjective evaluations were simple and yielded useful and repeatable results. There was no significant difference between general practitioners and specialists with regard to subjective evaluation, which indicates that these evaluation criteria can be used by small animal clinicians after minimal training.

Canine hip dysplasia treated by juvenile pubic symphysiodesis

To determine the clinical effects of juvenile pubic symphysiodesis (JPS) treatment in hip dysplasia-prone puppies with comparison to similar untreated control puppies. Controlled clinical case study. Thirty-nine dysplastic puppies, of which six were part of the control group, with a positive Ortolani or hip distraction index (DI)≥0.40. The following eight clinical tests were evaluated preoperatively, and at one and two years postoperatively: Ortolani, hip reduction angle (HRA), gait evaluation, osteoarthritis, hip pain, and three Norberg angles (angle-extended mode [N-OFA], angle-compression mode [N-COM], and angle-distracted mode [N-DIS]). Juvenile pubic fusion (JPS) was performed by unipolar electro-cautery at 12 to 24 weeks of age; the control puppies received a sham operation. For the JPS puppies, the mean osteoarthritis level did not significantly increase (11%). There was a 74% reversal of preoperative positive Ortolani signs. Hip reduction angle, DI and N-DIS also improved significantly. Only N-DIS fully detected Norberg angle laxity. Within the control group, osteoarthritis increased significantly (55%) with no improvement in Ortolani incidence, N-OFA or N-COM angles. A decrease in HRA and DI was associated with increased osteoarthritis levels. Signs of hip pain increased by 33%, which was not significant. Dogs with initial severe hip laxity (DI≥0.70) experienced progressive osteoarthritis. In JPS dogs with preoperative mild to moderate hip laxity (DI = 0.40-0.69), insignificant osteoarthritis occurred at two years. Juvenile pubic symphysiodesis surgery also improved other clinical criteria (Ortolani, HRA, hip pain, N-DIS). Osteoarthritis was generally not prevented by JPS in dogs with initial severely lax hips (DI≥0.70). Juvenile pubic symphysiodesis surgery at 12 to 24 weeks of age was an effective and safe pre-emptive bilateral treatment for mild to moderate hip dysplasia.

Canine hip dysplasia treated by juvenile pubic symphysiodesis

To measure one and two year effects of juvenile pubic symphysiodesis (JPS) in puppies defined as 'at-risk' for canine hip dysplasia (CHD) using the following objective hip conformation criteria: Acetabular angle (AA), dorsal acetabular rim angle (DARA) and hip laxity (PennHIP© distraction index (DI). Controlled clinical case study. Thirty-nine dysplastic puppies (six controls). The dogs were anaesthetised and acetabular angle, DARA, and DI values were obtained by computed tomography and radiography preoperatively. Electro-cautery fusion of the pubic symphysis was performed between 12 - 24 weeks of age. The imaging was repeated at one and two years of age. Significant hip improvements were seen at the two-year follow-up appointments for: AA (JPS dogs 31% increase, control 3%), DARA (JPS 38% decrease, control 15%) and DI (JPS 41% decrease in laxity, controls 20%) for all postoperative versus preoperative values. Pubic fusion occurred with minor morbidity. Juvenile pubic symphysiodesis resulted in significant improvements in hip conformation (AA and DARA), especially in mild to moderately lax hips (DI = 0.40-0.69). Most dogs with DI≥0.70 increased in osteoarthritis grade by two years of age. Juvenile pubic symphysiodesis surgery at 12-24 weeks of age significantly improved hip conformation and decreased laxity in at-risk CHD dogs. Early-age (12 to 16 week) recognition of hip laxity offered greater JPS benefits than surgery performed at 19- to 24-weeks-old. Dogs with severe laxity (DI≥0.70) continued to increase in osteoarthritis. An early (12-16 weeks) positive laxity test (Ortolani) should alert one to obtain objective laxity determinations (PennHIP© DI).

Juvenile Pubic Symphysiodesis and Juvenile Pubic Symphysiodesis Associated with Pectineus Myotomy: Short-Term Outcome in 56 Dysplastic Puppies

(1) To compare short-term outcome of juvenile pubic symphysiodesis (JPS) in puppies aged 12-17 weeks with lax hips (group JPS1), in puppies aged 18-22 weeks (group JPS2), and control (group C) puppies; and (2) to document outcome of bilateral pectineus myotomy (PM) associated with JPS in 18-22-week-old puppies (group JPS-PM). Prospective study. Puppies (12-22 weeks) from large and giant breed dogs with a combination of a positive Ortolani sign, poor acetabular coverage (Norberg angle [NA]<or=100 degrees ), and a subluxation index (SI) >0.5 for one or both hips were selected. Puppies aged <18 weeks were randomly assigned to group JPS1 or C. Puppies aged 18-22 weeks were randomly assigned to group JPS2, JPS-PM, or C. Three to 4 months later, surgery was considered successful in pain-free dogs with negative Ortolani sign, normalized acetabular coverage (NA>or=105 degrees ), and SI>0.5. Success rates were compared using Fisher's exact tests: JPS1 versus JPS2 versus C; JPS2 versus JPS-PM. Significance was set at P<.05. All dysplastic hips from nonoperated (C) groups were dysplastic at follow-up, meaning that our criteria for case selection were accurate. JPS1 had significantly better success rate than JPS2 (85 versus 17.8%, respectively). JPS-PM dysplastic hips failed to demonstrate a better outcome than JPS2 hips. This study confirms, on a large series of dysplastic hips, the age-dependent effects of JPS, with better results if performed before 18 weeks of age. There is no benefit of adding PM to the procedure in candidates >18 weeks at surgery.

Alterations in Hip Angles Following of Juvenile Pubic Symphysiodesis in Ten Dogs with Hip Dysplasia

The purpose of this study is to evaluate of preand postoperative clinical and radiological outcomes of 3-5 month-old, 10 dogs with hip dysplasia after juvenile pubic symphysiodesis. Pain scoring of hip extension test, Ortolani signs and Bardens palpations were performed preand postoperatively, on 1st, 3rd, and 6th months by clinical examinations. Norberg-Olsson angles on standard ventrodorsal on extended radiological views and distraction index on distracted hip radiological views were evaluated by radiological examinations. Juvenile pubic symphysiodesis was applied every 2.0 to 3.0 mm among to the entire length of the growth plate of the pubis via unipolar needle electrocautery (40 W, for 12 to 30 seconds). Acetabular full coverage on the femoral head was provided as a result of ventrolateral rotation of the acetabulum following juvenile pubic symphysiodesis procedure. The hip extension test, Ortolani signs and Bardens palpations were turned from positive to negative. In conclusion, juvenile pubic symphysiodesis is a successful and safe procedure which can be easily applied for prophylaxis and/or treatment of hip dysplasia (HD) in 3-5-month-old, large-breed puppies, which are predisposed to hip dysplasia or showing the initial clinical signs of hip dysplasia.

Five Puppies with a Hip Dysplasia at a Litter Treated by a Juvenile Pubic Symphysiodesis

股関節形成不全を持った同胎犬5頭に若齢期恥骨結合癒合術（JPS）を16週齢以前に実施した。それら症例の術前および30週齢時にX線画像のPennHIPのDI値、背側寛骨臼辺縁角（DARA）およびノルベルグ角を計測して比較した。5症例の左右股関節のDI値は、術後の30週齢時において明らかな減少は認められなかった。一方、5症例の左右股関節のDARA値は、術前に比較して30週齢時に減少し、ノルベルグ角は、術後の30週齢時にはほとんどが増加した。これら症例について3歳齢時に身体検査ならびにCT検査を実施したが、股関節に特記すべき異常は認められなかった。

Comparison of conservative management and juvenile pubic symphysiodesis in the early treatment of canine hip dysplasia

To evaluate the efficacy of juvenile pubic symphysiodesis (JPS) in a clinical setting for the early treatment of canine hip dysplasia (CHD), and to identify its indications and contraindications. The final degree of CHD using the FCI (Fédération Cynologique Internationale) CHD classification in 5 Grades (A, B, C, D, E) was assessed at skeletal maturity in two homogeneous groups of dogs assessed at the age of 14 to 22 weeks and selected according to their susceptibility to CHD; one group was treated with JPS and one group was conservatively managed. Two hundred seventeen puppies completed the study; 81 were treated with JPS (group 1) and 76 were conservatively managed (group 2). A third group of 60 puppies with normal hips was followed as a negative control group. In group 1, 43.2% of the puppies had regression or a lack of progression of the disease in the final evaluation (Grade A & B), 25.9% had mild CHD (Grade C) and 30.9% had moderate and severe CHD (Grade D & E). In group 2, 23.6% of the puppies did not show any development of the disease (Grade A & B), 21.1% had mild CHD (Grade C) and 55.3% developed moderate to severe CHD (Grade D & E). Further investigation was done by comparing the severity of early signs of susceptibility to CHD with the final FCI Grades at adulthood in both groups. The JPS procedure increased the odds of arresting or limiting the progression of CHD in mild to moderate grades of CHD, while it was less effective or ineffective in more severe forms.

Long-term outcome of juvenile pubic symphysiodesis and triple pelvic osteotomy in dogs with hip dysplasia

To compare long-term outcomes of juvenile pubic symphysiodesis (JPS) and triple pelvic osteotomy (TPO) in dogs with hip dysplasia. Prospective clinical trial. 18 dogs with hip dysplasia (ie, distraction index > or = 0.5 in at least 1 hip joint and no, mild, or moderate radiographic evidence of degenerative joint disease [DJD]). Dogs between 4 and 5.5 months old at enrollment were assigned to undergo JPS, and dogs between 5 and 12 months old were assigned to undergo TPO. All dogs were reexamined at 2 years of age. At 2 years of age, there were no significant differences between groups in regard to lameness scores, angle of extension of the hip joints, distraction index, peak vertical force, acetabular angle, radiographic DJD score, or owner-assigned scores of clinical function. Dorsal acetabular rim angle was significantly higher in dogs that underwent JPS than in dogs that underwent TPO. For dogs that underwent TPO, dorsal acetabular rim angle was significantly decreased and acetabular angle was significantly increased at 2 years of age, compared with values obtained prior to surgery. Results suggest that JPS and TPO have similar effects on hip joint conformation in dogs with moderate to severe hip dysplasia but that neither procedure eliminates the hip joint laxity characteristic of hip dysplasia or the progression of degenerative changes.

THE EFFECTS OF PATIENT POSITIONING AND SLICE SELECTION ON CANINE ACETABULAR ANGLE ASSESSMENT WITH COMPUTED TOMOGRAPHY

Acetabular angles (AAs) and dorsal acetabular rim angles acquired by computed tomographic (CT) imaging have been used to assess patient response to juvenile pubic symphysiodesis surgery. The purpose of this study was to evaluate the effects of patient positioning and slice selection on these angles, and an attempt was made to devise a repeatable method of measuring these angles that would eliminate positioning effects. We found significant variation in AAs with small differences in pelvic tilt and slice selection. Dorsal acetabular rim angles were not affected. As a result of positioning differences from one CT study to the next, every attempt should be made to standardize pelvic tilt, or eliminate its effect on AAs by standardizing gantry angle in relation to an anatomic landmark that will not change over time. The floor of the sacral vertebral canal may be a reasonable landmark for this purpose and deserves further study.