Introduction:

Joint problems can arise in our furry friends just as they do in us. In the dog this is commonly due to underlying developmental genetic issues such as hip dysplasia or developmental elbow disease. However, other injuries such as tearing of the cranial cruciate ligament (similar to our ACL), patella (kneecap luxation) or joint fractures can all lead to joint pain.

In reality anything that causes an abnormal formation, rubbing, or loading to the joint has the ability to set up the cascade of events that results in osteoarthritis. Once this occurs there is continued inflammation in the joint, pain, loss of range of motion, and joint thickening. Unfortunately, osteoarthritis is not a problem we can cure, but rather manage through a multi-modal approach.

However, once we have exhausted the medical approach to osteoarthritis and the joint has reached the end of its life span or near the end of its life span, surgical options may need to be considered. Just like with people we have the ability to replace specific joints or unload specific joints in dogs and cats at Fusion Veterinary Orthopedics.

Clinical Signs and Diagnosis:

The clinical signs of joint problems can vary pending the severity of the condition and the joint affected. For example, dogs tend to have greater lameness and difficulty with elbow related problems compared to shoulder or hip related problems. In the young skeletally immature dog, the clinical signs of a joint problem could be stiffness when rising or after play, self-limiting during play, lack of enthusiasm to go on walks or socialize; while in the older skeletally mature dog the clinical signs may be stiffness/soreness when rising or after heavy play, an intermittent to continuous limp, a change in behavior such as a lack of wanting to go on walks or lagging behind during walks, or even a change in activity such as the inability to get onto or off furniture or go up/down stairs.

Remember that joint problems and osteoarthritis are not just an old dog disease. If you suspect your dog or cat who is either young or older is having a joint related problem the first step is seeing your regular veterinarian or contact Fusion Veterinary Orthopedics. From there an initial examination may reveal changes consistent with a joint problem and in many situations radiographs (X-rays) will be performed.

Once a diagnosis of a joint problem has been delivered or a previously diagnosed joint problem is now non-responsive to medical management your veterinarian may recommend a consultation with a Board-Certified Surgeon such as Dr. David Dycus. Alternatively, you may elect to seek out and schedule a consultation with a board-certified surgeon with a particular expertise on joint problems such as our team at Fusion Veterinary Orthopedics. During the consultation our team will perform a thorough orthopedic examination to determine the joint affected and the degree of discomfort. From there additional radiographs or even advanced imaging such as a CT scan may be recommended.

If the surgeon feels your pet is a candidate for a joint replacement or a load shifting surgery they will have an in-depth conversation about the procedure, the pros/cons, benefits, and potential complications. Our goal at Fusion Veterinary Orthopedics is to ensure we provide a patient specific and centered approach.

What Joints can be Replaced:

Currently for the dog and the cat we can replace the hip joint, while in the dog we also hope to have the ability to replace the stifle (knee), elbow, and hock (ankle) in the near future.

By far the most common joint replaced in veterinary medicine is the hip joint. We now can perform total hip replacements in small to large dogs and cats. Common reasons for a hip replacement may include hip dysplasia, hip luxation, fractures of the hip, Legg-Calve-Perthes disease, and physeal dysplasia in cats. Given the longevity of the implants, if a young dog or cat is severely affected with hip pain we can perform a total hip replacement as young as 6-7 months of age. A hip replacement is performed by removing the abnormal ball and socket and placing a new synthetic component to allow the hip to function both comfortably and normally.

Following a total hip replacement, we expect our patients to return to normal function and have an excellent quality of life that is pain free.

Less commonly stifle (knee), elbow, and hock replacements are completed. The indications for replacement of these joints are usually due to severe osteoarthritis to the point where quality of life is suffering. Following a joint replacement of the stifle, elbow, and hock we expect patients to have good functional outcomes, but most of all to be pain free.

What is Load-Shifting Surgery?

For some joints if only a part of the joint is overloaded or damaged we can perform surgery to unload the portion of the joint. Where this is performed more commonly would be in the hock (ankle) joint of dogs suffering from an osteochondrosis/osteochondritis dissecans (OC/OCD) lesion, but can also be used for conditions of the stifle (knee) and elbow. Dr. Dycus at Fusion Veterinary Orthopedics is one of the few surgeons in the world performing unloading surgery. In this type of surgery, a cut is made in the bone either immediately above or below the joint and the bone is shifted to allow the load to be placed through the normal healthy portion of the joint.

Are there any Complications:

At Fusion Veterinary Orthopedics, we take great pride ensuring our patients return to as normal function as possible. As with any surgery there are small risks associated. Particularly, with load shifting surgery the most common complications noted are implant breakdown (breaking/bending of the pins, plate and/or screws), infection, and soft tissue injuries. Infection rates are relatively low; your dog will be given antibiotics during surgery and in some cases will be sent home with antibiotics after surgery. If an infection does occur, then once the bone is healed the pins, plate and/or screws will be removed to resolve the infection. Implant break down and soft tissue injuries typically occur from over activity.

Dr. Dycus is experienced with joint replacements, which is very important to further minimize complications. With joint replacements the complication rates are low and following post operative directions will facilitate keeping the risk factor minimal. In particular, luxation of the replaced joint, fracture of the surrounding bone, and infection are the 3 main concerns. Dr. Dycus likes to provide frequent rechecks of his patients following a total joint replacement to ensure there are no complications. Should you notice a change in your pets limb use following surgery we would want you to contact Fusion Veterinary Orthopedics as soon as possible to schedule a recheck.