Double pelvic osteotomy for the treatment of hip dysplasia in young dogs

A. Vezzoni; S. Boiocchi; L. Vezzoni; A. B. Vanelli; V. Bronzo

doi:10.3415/VCOT-10-03-0034

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2010; 23(06): 444-452
DOI: 10.3415/VCOT-10-03-0034

Clinical Communication

Schattauer GmbH

Double pelvic osteotomy for the treatment of hip dysplasia in young dogs

Authors

A. Vezzoni

¹Clinica Veterinaria Vezzoni srl, Cremona, Italy
S. Boiocchi

¹Clinica Veterinaria Vezzoni srl, Cremona, Italy
L. Vezzoni

¹Clinica Veterinaria Vezzoni srl, Cremona, Italy
A. B. Vanelli

¹Clinica Veterinaria Vezzoni srl, Cremona, Italy
V. Bronzo

²Università degli Studi di Milano, Italy, Department of Veterinary Pathology, Hygiene and Health

Abstract

Summary

The aim of this study was to evaluate the feasibility of the double pelvic osteotomy (DPO) (osteotomy of the ilium and pubis) to treat clinical cases of hip dyplasia in young dogs instead of performing a triple pelvic osteotomy (TPO) (osteotomy of the ilium, pubis, and ischium). Candidates for DPO were 4.5- to nine-month-old dogs with coxofemoral joint subluxation and laxity, indicative of susceptibility to future development of severe hip dysplasia. The angle of reduction (AR) and angle of subluxation (AS) with Ortolani's sign, Norberg angle (NA), percentage of femoral head (PC) covered by the acetabulum, and the pelvic diameters and their relationships were measured clinically and radiographically before and after surgery. The surgical technique was similar to the TPO technique, but excluded ischiatic osteotomy. A DPO was carried out in 53 joints of 34 dogs AR and AS values immediately postoperatively and at the oneand two-month follow-up examinations were significantly lower than the preoperative values (p <0.01). The complications en-countered were mainly represented by implant failure (3.5%), partial plate pull-out (9.4%), and incomplete fracture of the ischial table (7.5%). Changes in PC and NA values obtained immediately after surgery and at the first and second follow-up examinations were significantly greater (p <0.01 both) than values obtained before surgery. Sufficient acetabular ventroversion was achieved to counteract joint subluxation and the modifications of AR and AS. The NA and PC direct postoperative values reflected a significant improvement in the dorsal acetabular coverage.

Clinical relevance: Restoration of normal joint congruity (PC from 50 to 72%) and maintenance of the pelvic geometry without pelvic narrowing were the most intriguing features of DPO. The complications observed were greatly reduced when using dedicated DPO plates. Based on our experience, the morbidity after unilateral and bilateral DPO was lower than after TPO because elimination of the ischiatic osteotomy allowed for increased stability of the pelvis. The surgical technique of DPO was a little more demanding than TPO because of the difficulty in handling and rotating the acetabular iliac segment, but this difficulty was offset by elimination of ischial osteotomy.

Keywords

Juvenile hip dysplasia - DPO - TPO - corrective pelvic osteotomy - double pelvic osteotomy - triple pelvic osteotomy

Full Text

References

References
1 Slocum B, Devine T. Triple pelvic osteotomy. In: Current Techniques in Small Animal Surgery, 4th Edition. Bojrab M.J., Ellison G.W.Slocum B, editors. Baltimore: Lippincott Williams & Wilkins; 1998: gs. 1159-1165.
2 Slocum B, Devine T. Pelvic osteotomy for axial rotation of the acetabular segment in dogs with hip dysplasia. Vet Clin North Am Small Anim Pract 1992; 22: 645-646.
3 Slocum B, Devine T. Pelvic osteotomy technique for axial rotation of the acetabular segment in dogs. J Am Anim Hosp Assoc 1986; 22: 331-338.
4 Slocum B, Devine T. Pelvic osteotomy in the dog as treatment for hip dysplasia. Semin Vet Med Surg (Small Anim) 1987; 2: 107-116.
5 Vezzoni A, Dravelli G, Vezzoni L. et al. Comparison of conservative management and juvenile pubic symphysiodesis in the early treatment of canine hip dysplasia. Vet Comp Orthop Traumatol 2008; 21: 267-279.
6 Borostyankoi F, Rooks RL, Kobluk CN. et al. Result of single-session bilateral triple pelvic osteotomy with an eight-hole iliac bone plate in dogs: 95 cases (1996–1999). J Am Vet Med Assoc 2003; 222: 54-59.
7 Whelan MF, McCarthy RJ, Boudrieau RJ. et al. Increased sacral screw purchase minimizes screw loosening in canine triple pelvic osteotomy. Vet Surg 2004; 33: 609-614.
8 Graehler RA, Weigel JP, Pardo AD. The effects of plate type, angle of ilial osteotomy, and degree of axial rotation on the structural anatomy of the pelvis. Vet Surg 1994; 23: 13-20.
9 Doornink MT, Nieves MA, Evans R. Evaluation of ilial screw loosening after triple pelvic osteotomy in dogs: 227 cases (1991–1999). J Am Vet Med Assoc 2006; 229: 535-541.
10 Plante J, Dupuis J, Beauregard G. et al. Long term results of conservative treatment, excision arthroplasty, and triple pelvic osteotomy for the treatment of hip dysplasia in the immature dog. Vet Comp Orthop Traumatol 1997; 10: 101-110.
11 Hosgood G, Lewis DD. Retrospective evaluation of fixation complications of 49 pelvic osteotomies in 36 dogs. J Small Anim Pract 1993; 34: 123-130.
12 Remedios AM, Fries CL. Implants complications in 20 triple pelvic osteotomies. Vet Comp Orthop Traumatol 1993; 6: 202-207.
13 Koch D, Hazewinkel H, Nap R. et al. Radiographic evaluation and comparison of plate fixation after triple pelvic osteotomy in 32 dogs with hip dysplasia. Vet Comp Orthop Traumatol 1993; 6: 9-15.
14 Sukhiani HR, Holmberg DL, Hurtig MB. Pelvic canal narrowing caused by triple pelvic osteotomy in the dog. Part I: the effect of pubic remnant length and angle of acetabular rotation. Vet Comp Orthop Traumatol 1994; 7: 110-113.
15 Sukhiani HR, Holmberg DL, Binnington AG. et al. Pelvic canal narrowing caused by triple pelvic osteotomy in the dog. Part II: a comparison of three pubic osteotomy techniques. Vet Comp Orthop Traumatol 1994; 7: 114-117.
16 Haudiquet PH, Guillon JF. Radiographic evaluation of double pelvic osteotomy versus triple pelvic osteotomy in the dog: an in vitro experimental study. Proceedings of 13th ESVOT Congress Munich, Germany: 2006. September 7–10 gs. 239-240.
17 Haudiquet PH. Other strategies for HD – DPO vs TPO. Proceedings of 14th ESVOT Congress Munich, Germany: 2008. September 10–14 gs. 85-86.
18 McLaughlin Jr R, Miller CW. Evaluation of hip joint congruence and range of motion before and after triple pelvic osteotomy. Vet Comp Orthop Trauma-tol 1991; 20: 291-297.
19 Tomlinson JL, Cook JL. Effect off degree of acetabular rotation after triple pelvic osteotomy on the position of the femoral head in relationship to the acetabulum. Vet Surg 2002; 31: 398-403.
20 Tomlinson JL, Johnson JC. Quantification of measurement of femoral head coverage and Norberg angle within and among four breeds of dogs. Am J Vet Res 2000; 61: 1492-1500.
21 Vezzoni A, Baroni E, Petazzoni M. TPO: retrospective multicentric study in 218 cases. Proceedings SCIVAC Congress Montecatini Terme; Italy: 2000. March 30 – April 2 gs. 329-330.
22 Schrader SC. Triple pelvic osteotomy of the pelvis and trochanteric osteotomy as a treatment for hip dysplasia in the immature dog: the surgical technique and results of 77 consecutive operations. J Am Vet Med Assoc 1986; 189: 659-665.
23 Hunt CA, Litsky AS. Stabilization of canine pelvic osteotomies with AO/ASIF plates and screws. Vet Comp Orthop Traumatol 1988; 01: 52-57.
24 Fitch RB, Kerwin S, Hosgood G. et al. Radiographic evaluation and comparison of triple pelvic osteotomy with and without additional ventral plate stabilization in forty dogs – part 1. Vet Comp Orthop Traumatol 2002; 15: 164-171.