chronic hip dysplasia

January 2015 Case of the Month – Happy New Year!!!
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January 2015 Case of the Month – Happy New Year!!!

Mieka

Happy New Year, 2015!!! Meet Mieka, she has made the January 2015 Case of the Month (COTM). Read on to hear about her story!!!

Mieka was selected for the COTM and rightfully so, her story began about a year ago and her total recovery took about 6 months. She is a sweet Pomeranian with a vivacious personality, as you will see in the videos below. She can be quite demanding, but with all that she has been through, we will let it slide.

Mieka presented when she was 7 months of age. She was adopted when she was 2-3 months old and according to her owners never really walked normally. As she developed and got older, her walking declined to the point that she would not place normal weight on the hind limbs and would walk with an arched back and her hind legs crossed. Below is a video of her at the initial presentation.

Based on the examination and x-rays taken, her diagnosis was complex with severe expression of congenital/hereditary diseases affecting both her stifles/knees, patellas (knee caps), and hips (hip dysplasia and bilateral hip luxation – out of socket).

It is fairly rare to see these conditions, this severe in such a young dog. We see knee cap/patella issues very commonly in small breed dogs – but not this severe. She has what is called medial patella luxation (Grade 4/4), this is where the knee cap slides inward and in her case both were permanently fixed in the wrong position. Due to the severity of the knee caps, the attachments points on the tibia were also malformed as well as the bottom part of the femur. As for her hips, she had severe hip dysplasia to the point where the hips would “pop” out of joint during motion. Here are some pictures and x-rays that show some of the deformities.

Note the hind limb deformities and the crossing over of her legs.

Note the hind limb deformities and the crossing over of her legs.

Note the positioning of the hind legs.

Note the positioning of the hind legs.

Note that her patellas are located inward and that on this x-ray the left hip is out of joint.

Note that her patellas are located inward and that on this x-ray the left hip is out of joint.

Not to bore with all the details of surgery, but four surgeries were planned for Mieka. We decided to start with the left side, however both were bad. We corrected the alignment in her knee by correcting the deformities in the tibia and the femur and then secured the patella. In order to correct the alignment, we had to cut the bones (tibia and femur) and adjusted with a plate and screws. Once she began to heal from that surgery, we addressed the hip by performing a femoral head ostectomy (removal of the femoral head).

Note the more normal appearance of the tibia, femur and patella.

Note the more normal appearance of the tibia, femur and patella.

With the assistance of the physical therapy department and the dedication of her owners, she rapidly began to improved. As soon as she was strong enough on the left side, the right side was tackled. The same procedures were performed on the right side as well as intense physical therapy following surgery. Below is Mieka about two months after the last surgery. You can see how demanding she can be as she makes herself known. We are thrilled to see her do well.

The shortness of this post underscores the journey Mieka endured. She has definitely earned a case of the month distinction and more. Way to go Mieka!!!

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Frankie’s Journey

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I want to share this story of Frankie with everyone, as it will be an ongoing story for the next year or so as we continue to help him though this hard time. Frankie was seen by me about two months ago when he was six months old. He is a Golden Retriever that presented for lameness in all legs. He had been enrolled in a service dog program when his owners started to realize that he was having trouble walking. He was referred to me after being evaluated by a local neurologist, who couldn’t diagnose a neurologic issue.

On presentation, Frankie had lameness (limping) in all four limbs. He had pain on manipulation of both elbows, especially when pressure was placed on the inside of the elbows. He had a shortened stride to both hind limbs and was painful on hyperflexion and hyperextension of both hips. Another interesting finding, was that both hips could be felt subluxating on exam (positive ortolani test). This means that you could feel the femoral head rub and partially come out of joint.

Radiographs (x-rays) were taken of all joints and a diagnosis of bilateral elbow dysplasia (osteochondrosis dissecans (OCD) and fragmented coronoid process) and bilateral hip dysplasia was made. Unfortunately, Frankie’s career as a service dogs had to abruptly end. Because of the extensive orthopedic work that would be needed (both elbows and both hips) he was in need of a new home to care for his special needs. My wife and I may be a glutton for punishment, but we thought long and hard about this decision and decided to open our home and give this Golden puppy a second chance.

So my intention for this “Featured Article” segment is to follow the course of Frankie’s treatment including surgery, recovery, physical therapy, and final outcome. I feel that other owners may be in similar circumstances and this may help encourage some and educate others. This will also give a forum to discuss congenital issues such as elbow dysplasia and hip dysplasia. Going through these issues on our own pet, has been an eye-opening experience for us and me professionally. I can now relate to my patients and clients on a much more personal level.

In future segments (soon to follow) we will go through diagnosis, diagnostic test (radiographs and CT scan) and surgeries. So far, Frankie has had surgery on one elbow and is recovering well from that, we will go into more specifics as we go. The plan will be for the other elbow in the near future and then total hip replacements.

Also, please do not ask to donate financially to Frankie, I am not trying to raise money. I am just trying to educate others. There are so many generous people out there and there are many charitable animal organizations that can benefit from your generosity, as it is always appreciated!