- Hand Hygiene
- Life of a Wildlife Carer
- Dirty Wounds? We have the solution!
- Pet Of The Month
- The Basic of Fluid Therapy
- Joint disorders in dogs and corrective procedures
- The differences between TPLO, TTA and MMP cranial cruciate ligament rupture surgery
- Body And Muscle Condition Scoring
- Fluid Therapy - Rehydration Calculations
With the advancements in technology and medicine, we are seeing our patients living longer than ever before. However, with this increase in lifespan, the prevalence of degenerative joint disease (DJD) has increased as well.
What is a degenerative joint disease (DJD)?
Degenerative joint disease is simply, arthritis in dogs. It is when the cartilage within freely moving joints deteriorates over time. This thinning of the cartilage can be accompanied by a build-up of fluid within the joint, and the formation of bony outgrowths around the joint as well (Harari, 2018).
Signs of DJD
Degenerative joint disease in dogs can present in a number of different ways:
- Lameness
- Reduced range of motion
- Joint/soft tissue swelling
- Muscle wastage
- Thickening and scarring of the joint membrane
Risk factors
Whilst it is common to see older dogs with DJD, any dog can develop and suffer from arthritis. Below are several risk factors that can contribute to the likelihood that the dog will develop this condition.
- Obesity
- Large or giant breeds are at an increased risk
- Dogs who compete in high-impact sports
- Poor nutrition
- Joint conformation
- Genetics
Certain types of trauma can also contribute to the development of joint disorders. The types of trauma that can affect joint health are broken down into three main categories, luxation, fracture, or ligament damage.
Luxations
➢ Elbow luxation is most commonly the direct result of trauma.
● Presentation - The dog will usually refuse to weight-bear on the affected leg and the pain experienced is variable. The leg is usually held forward in semi-flexion with the lower limb abducted and supinated (Denny, 2004).
● Diagnosis - Physical examination will find an obviously deformed elbow as well as a limited range of motion through flexion and extension (Denny, 2004). Physical examination is often combined with radiographs as they are utilised to diagnose the dislocation.
● Treatment - this will likely involve open reduction, however, the results and the recovery is extremely positive (MSD Veterinary Manual, 2022). In saying this, in a study of 31 dogs with elbow luxations, Schaeffer & others (1999) found that patients had a good recovery following early closed reduction provided there was adequate joint stability.
➢ Hip luxation is generally a result of sudden and severe injury or trauma. In saying this, hip dislocations can occur with less severe trauma if the hip joint has abnormalities (e.g. hip dysplasia).
● Presentation - The dog usually presents with lameness in the affected limb, often with the leg tucked, outwardly rotated, and shortened, or inwardly rotated and deviated depending on the direction of the dislocation. In 90% of cases, the femoral head is displaced forward above the acetabulum, however, a subluxation (partial dislocation) can occur where joint degeneration is also present, and this often occurs bilaterally (ACVS, 2022, B). Pain is also evident during the movement of the hip joint.
● Diagnosis - Physical examination, as well as radiographs, are used to confirm the dislocation and rule out the presence of any additional damage such as fractures (MSD Veterinary Manual, 2022).
● Treatment - this can be managed conservatively (closed reduction) or surgically. Closed reduction involves a short anaesthesia and the use of force to move the joint back into the correct position. It often uses a sling to support the position of the leg afterwards, however, this needs to be monitored for rub sores. This technique has a 50% success rate (ACVS, 2022, B). Surgical interventions range from surgical reduction, femoral head ostectomy and total hip replacement depending on the severity of the luxation. The surgical reduction is a hip joint surgery where the hip is replaced and the supporting structures are restored, this is considered open reduction. There may be the need for additional implants to assist in supporting the structure to heal, and there are a variety of techniques used to complete the surgery ( ACVS, 2022, B). Femoral head ostectomy involves removing the femoral head and neck producing a false joint. Whilst this technique results in very good function, it is often not feasible due to injury or poor hip confirmation (ACVS, 2022, B). Lastly, total hip replacement is the complete replacement of the joint with synthetic materials and implants.
➢ Ankle luxation is quite a common injury in dogs that have been involved in a car accident. Usually, luxations are often in conjunction with fractures as well as tearing of the ligaments that hold the tarsus together.
● Presentation - Dogs will present non-weight-bearing on the affected limb, and you may find the foot swings in unusual directions.
● Diagnosis - Physical examination, as well as radiographs, are required to assess the extent of other injuries.
● Treatment - Surgical intervention is usually necessary (MSD Veterinary Manual, 2022).
Fractures
In younger animals, fractures can be more likely to occur where the growth plates are at the end of the bones (MSD Veterinary Manual, 2022). However, fractures can occur in dogs of all ages due to injury and the most common areas involved are the shoulder, elbow, carpal, hip, stifle, and tarsal joints (MSD Veterinary Manual, 2022). Diagnosis is made from physical examination, the patient usually presents lame, swollen and in pain, and from radiography. Depending on the severity and location of the fracture, surgical intervention may be necessary. The primary goal of treatment is to allow the fracture to heal in proper alignment. The use of casts, splints, or internal pins, wires and screws can assist to maintain correct alignment (MSD Veterinary Manual, 2022).
Ligament Damage
➢ Palmar carpal ligament breakdown is usually the result of an injury involving jumping or falling. When the limb extends past its usual range of motion it puts excessive force through the carpus which can result in damage and then tearing of the ligaments (MSD Veterinary Manual, 2022).
● Presentation - The dog will exhibit lameness, swelling of the carpus and a stance in which the heel is touching the ground.
● Diagnosis - Clinical examination is usually invaluable as an abnormal movement can often be detected. However, radiographs are advised to detect the full extent of the ligament damage.
● Treatment - Surgical intervention is usually the preferred treatment plan, however, mild tears may be able to use just a splint or a cast. If surgery is undertaken, the affected joints are fused using bone plates, screws, pins and wires with the recovery outcome said to be good (MSD Veterinary Manual, 2022).
➢ Cranial cruciate ligament tear (CrCL) is usually a result of slow degeneration over time, however acute trauma can also result in ligament rupture. Joint degeneration plays a factor, as well as the dog’s immune system, obesity, poor physical condition, defects in conformation and breed (A, B). Susceptible breeds to CrCL rupture include:
- Rottweiler
- Newfoundland
- Staffordshire Terrier
- Mastiff
- Akita
- Saint Bernard
- Labrador Retriever
(ACVS, 2022, A).
Due to the variety of factors contributing to the ligament disease, 40-60% of dogs that have cranial cruciate ligament disease in one stifle will develop a similar problem at some stage in the other stifle.
● Presentation - Complete rupture of the CrCL is one of the most common reasons for dogs presenting with hind limb lameness, joint pain, and subsequent stifle arthritis (ACVS, 2022, A).
● Diagnosis - Physical examination, palpation of stifle instability and radiographs.
● Treatment - There are conservative ways to manage the condition, however, things such as activity level, size, age, and stifle instability should be taken into consideration when determining the treatment plan. Surgical intervention is usually the best course for treatment as it is the only way to permanently control the stifle instability (ACVS, 2022, A). These days there are a variety of surgical options broken down into various technique-based categories.
● Osteotomy-based techniques. These include Tibial Tuberosity Advancement (TTA), Triple Tibial Osteotomy (TTO), CORA based Levelling Osteotomy (CPLO) and the Tibial Plateau Levelling Osteotomy (TPLO). These all differ in their approach; however, they all require a bone cut that changes the way the quadriceps muscles acts on top of the tibial plateau (ACVS, 2022, A). These techniques work well for large dogs and dogs whose activity levels are high.
● Suture-based techniques. The extra-capsular suture stabilisation (The DeAngelis Suture) is popular in smaller breeds under 15kg. It involves using suture material and securing various implants in the attempt to mimic the function of the ruptured
CrCL and provide the required stability (ACVS, 2022, A)
Treatment of Degenerative Joint Disease in Dogs
DJD in dogs is mostly irreversible. Due to the progressive nature of the condition, treatment of arthritis in dogs focuses on reducing the pain in the joint capsule and surrounding ligaments, and this is mostly limited to medicinal and physical therapy. (Veterinary Surgical Centers, 2022). However, modifying the environment and activity levels can also be beneficial for improving the quality of life as well.
Medicinal therapy can include pain relief, anti-inflammatories, and the use of nutraceuticals, some of these are listed below:
- NSAIDs
- Tramadol
- Cartrophen
- Glucosamine
- Methylsulfonylmethane
- Hyaluronic acid
- Chondroitin sulphate
Physical therapy can involve:
- Laser therapy
- Hydrotherapy
- Ultrasound therapy
- Acupuncture
There are surgical options also available, however, the necessity of these options depends on the severity of the joint disease (Harari, 2018). The surgical options could include: joint fusion, joint replacement, cutting of the joint, and amputation.
Prevention
As mentioned earlier, DJD is a progressive disease and once it begins it can become a vicious cycle with the damage being caused irreversible, so prevention is important.
● Weight management is one of the most crucial parts of preventing the onset or progression of DJD.
● Attending regular vet check-ups, not only will the weight be checked during the consultation, but range of motion, joint stability and overall joint health can be monitored.
● Regular exercise helps not only in weight management but keeps the joints healthy.
● Joint supplementation can slow the progression of degenerative joint disease and promote the healing of the cartilage.
Summary
Degenerative joint disease in dogs is a painful condition, yet fortunately, it can be managed. Maintaining a dog’s healthy weight, regular vet visits, as well as frequent exercise, are all ways in which to assist in preventing this disease. Once DJD has been diagnosed, the use of supplements, nutraceuticals, pain relief and/or anti-inflammatory medications can greatly assist in improving a pet's quality of life. Knowing the signs and educating owners on joint care in dogs, is important and can be beneficial in the ongoing management of DJD in pets as well.