Joint Diseases

Question 1

What are the two categories of joint diseases

Answer 1

Mechanical (dysplasia, ligament rupture)

Affecting articulate cartilage (OCD, DJD)

Question 2

What is Hip Dysplasia? Who is it common in?

Answer 2

A congenital malformation of the hip (coxofemoral) joint

Most common in large breed dogs (90% of English bulldogs)

Question 3

What do you see on X-ray with hip dysplasia

Answer 3

The acetabulum should surround/cover 50% of the femoral head, there should be smooth narrowing from the head to the body of the femur

You would not see the 50% coverage (shallow hip) and the femoral head is often not round and the smoothness of the bone is lost

Question 4

What can the progression of hip dysplasia lead to

Answer 4

Stress on the joints causes it to worsen

Wear and tear can result in osteoarthritis

Lack of stability, mobility issues, pain, lameness

Subluxation to luxation

Question 5

True or false
When hip dysplasia is seen in young dogs it is over more severe than it is in older dogs

Answer 5

True

Question 6

What are the causes of hip dysplasia

Answer 6

Polygenetic inherited condition

Environmental risk factors (too rapid weight gain during growth, high BCS, prior hip injuries, OCD)

Question 7

What is the Medical management and pain management for hip dysplasia

Answer 7

Controlled low impact exercise
Rest
Weight control
Joint supplements
NSAIDs
Physical therapy
Surgery

Question 8

What are the surgical options for young patients with hip dysplasia

Answer 8

Triple pelvic osteotomy (rotates acetabulum

Juvenile pubic symphysoidesis

Question 9

What are the surgical options for older patients with hip dysplasia

Answer 9

Total hip replacements (gold standard)

Femoral head osteotomy

Question 10

How can you prevent hip dysplasia

Answer 10

Selective breeding
Appropriate diet selection
Avoid severe, intense exercise especially with large breed puppies
Weight control

Question 11

What is the orthopedic foundation for animals

Answer 11

The foundation that can diagnose or certify animals with or without hip dysplasia

Question 12

What is elbow dysplasia

Answer 12

A congenital inherited malformation of the elbow

Question 13

What are the 4 different forms of elbow dysplasia

Answer 13

1) fragmented medial coronoid progress

2) un-united anconceal process (fails to fuse) (this is why you need a flex X-ray view)

3) joint incongruity (something causes the bones to grow at different rates, fractures, injuries to the growth plates) -puzzle pieces don’t fit

4) osteochondritis dissecans of the distal humerus (inflammation and irregularities of the joint)

Question 14

Describe the clinical onset and presentation of elbow dysplasia

Answer 14

Age of onset depends on severity

Mild changes usually present in older animals (arthritis)

Severe changes present in young animals (mechanical issues cause pain and lameness) (surgery is an option)

Question 15

What are the causes of elbow dysplasia

Answer 15

Genetics

Environmental factors (growing too fast when young, obesity, prior injury, OCD)

Question 16

How is elbow dysplasia diagnosed

Answer 16

Radiographs, CT, scopes

Question 17

What is the surgical treatment for elbow dysplasia

Answer 17

Repair the abnormal Anatomy

Clean up the joint, remove cartilage fragments if OCD

Question 18

What is the medical management/pain of elbow dysplasia

Answer 18

NSAIDs
Joint supplements
Physical therapy
Rest and controlled exercise
Weight control
Surgery

Question 19

How do you prevent elbow dysplasia

Answer 19

Selective breeding
Appropriate diets
Prevent injury
Weight control

Question 20

What is patellar luxation

Answer 20

Slipping kneecaps

Commonly seen in tiny dogs; toy, miniature, small breeds

Occasionally seen in cats

In small dogs it is often a medial luxation, in large dogs it is usually lateral

The groove that holds the patella tends to not be as deep as normal allowing the patella to slip out of place

Question 21

What do owners often describe happens with patella luxation

Answer 21

Animals will be walking normally and then kick out to the side (this knocks it back into place)

And abnormal walking

Question 22

What is the progression of patella luxation

Answer 22

Congenital, chronic, progressive

Starts with patella slipping, and will eventually lead to arthritis

Question 23

What are some complications of patellar luxation

Answer 23

Pain when bone is rubbing on bone

Arthritis

Increased risk of cruciate ligament rupture

Question 24

When is surgery indicated to correct patellar luxation

Answer 24

If they are in pain or if there is ruptured ligaments

Surgery involved making the groove deeper

Question 25

What are the causes of cruciate ligament rupture/injury

Answer 25

Degenerative disease (60-80% chance of doing it to the other joint) Trauma Can be made worse with obesity

Question 26

What is the diagnosis of cranial cruciate ligament injuries

Answer 26

Cranial drawer side Tibial thrust Radiographs May or may not need sedation

Question 27

What do animals with cranial cruciate ligament injuries present with

Answer 27

Waxing and waning lameness to non weight bearing Not an emergency

Question 28

What is the treatment of cranial cruciate ligament injuries in small dogs

Answer 28

Rest NSAIDs Physical therapy Will develop arthritis and take a long time to recover, as well as risk of doing it to other side

Question 29

What is the treatment for large dogs with cranial cruciate ligament injuries

Answer 29

Surgery (faster recovery than small dogs and may decrease risk of doing it to other side)

Question 30

What are the surgical repair options for cranial cruciate ligament injuries (90% success rate)

Answer 30

Lateral suture (used in small Dogs because it is easier to tear) a suture is made through the bone to “replace” the ligament and hold the bones in place and prevent sliding Tibial plateau levelling osteotomy (large dogs) cut the tibia and level the bone, plates hold the bones together to stabilize the joint Tibial tuberosity advancement (large dogs) pulling the patellar ligament and pulling the femur forward, the hardware mimics the ligament

Question 31

What is the healing time and post operative care for cranial cruciate ligament injuries

Answer 31

10-12 weeks Physical therapy is needed

Question 32

What are some complications of cranial cruciate ligament injuries

Answer 32

Rupture if the other ligament within 1-2 years Arthritis with it without surgical repair Reduced mobility Infections and pain

Question 33

What is osteochondritis dissecans (OCD)

Answer 33

Developmental disease Common in young/growing animals and large breeds Common in the shoulder Developmental defect in cartilage and/or Endochondral bone

Question 34

Describe what happens with OCD

Answer 34

Cartilage is weak and abnormal Interferes with articulation of the joints Cracks in the cartilage can result in small pieces (and potentially small pieces of bone) floating around the joint The joint is unable to withstand normal forces

Question 35

What is the treatment of OCD

Answer 35

May require surgical removal of the cartilage and bone fragments

Question 36

How do you prevent OCD

Answer 36

Diet control Weight control Controlled exercise Prevent injuries

Question 37

What are the two most commonly diagnosed diseases in SA medicine

Answer 37

Dental disease and Degenerative joint disease

Question 38

What is degenerative joint disease (osteoarthritis)

Answer 38

Inflammation of the joint (may or may not involve the synovium) Degenerative, slowly progressive Can occur in any articular joint

Question 39

What is the signalment for osteoarthritis

Answer 39

Any animals Other animals Large breeds Obesity History of injury or joint disease

Question 40

Describe the pathology of an inflamed joint

Answer 40

Damaged cartilage releases pro-Inflammatory molecules Inflammation of the synovium causes more joint fluid (less viscous) Less cushioning so there is increases rubbing and damage Stretching joint capsule triggers osteophyte formation Thicken joint capsule restricts movement

Question 41

What are the predisposing factors of DJD

Answer 41

normal wear and tear Obesity Intense exercise Poor cartilage formation (OCD) Dysplasia Prior injury

Question 42

What do patients with DJD Present as

Answer 42

Painful, lame, slow, sore, stiff Stiff when they first start moving but loosen up with time

Question 43

What are the commonly affect joints with DJD in dogs and cats

Answer 43

Dogs: hips, stifle, elbows and carpus in small dogs Cats: thoracolumbar spine, elbows, hips

Question 44

Describe osteoarthritis in the intervertebral joint spaces

Answer 44

Common in cats and German shepherds or animals with prior back injuries Excessive bone growth that bridges the intervertebral spaces (fusing)

Question 45

What is the treatment for DJD

Answer 45

On going treatment Controlled activity Rest Weight control Medications/joint supplements Physical therapy Still Must Maintain muscle mass/range of motion /flexibility

Question 46

What is solensia

Answer 46

Feline specific monoclonal antibody (binds to feline nerve growth factors) SQ injection monthly Has been tested in cats with IRIS stage one and two CRF must be above 7mo and >2.5 kg

Question 47

What is the prevention of DJD

Answer 47

Selective breeding Weight control Low impact exercise Appropriate diets Joint supplements