This week, Gretel was diagnosed with a disease that is common to dogs and even humans. Gretel is an eight-month-old teacup Yorkshire terrier with a lovely temperament. Her owners brought her to the clinic because they had become increasingly concerned about her mobility. A few weeks ago, they noticed a slight limp when she walked, but because it happened intermittently, they had dismissed it as growing pains. However, lately, her limp and discomfort had increased considerably.

After giving Gretel a general physical examination and discussing her medical history, I concentrated on the hip area.  Gretel’s owners were correct in their impression: their dog exhibited clear signs of pain when her right hip joint was extended, and even more so when the joint was rotated. I could feel a grating sensation in the movement, which meant that there was probably a loss of joint cartilage. With a loss of cartilage, the joint bones would be scraping against one another, causing considerable pain. An X-ray of Gretel’s hips confirmed she had Legg-Calvé-Perthes disease.

Legg-Calvé-Perthes disease is named after the orthopaedic surgeons Arthur Legg, Jacques Calvé and Georg Perthes, who wrote about their findings of this disease in children at the turn of the last century.

Legg-Calvé-Perthes is a disease of the hip joint, particularly the head of the femur bone, which we also refer to as the ball of the joint. It starts when the blood supply to the ball joint is compromised, called ischemia, and it can happen even if there was no trauma to bone. As the blood supply slows down, the ball joint starts to die. The dying joint then starts to crumble and collapse and the cartilage that normally coats the joint starts to crack and deform. The body tries to repair itself by reabsorbing the fragments of cartilage and rebuilding the area with fibrous tissues. The result is generally unsuccessful as these tissues tend to be granular in texture. In time, the hip joint loses structural integrity, becoming arthritic and disfigured. Any movement of the joint would cause considerable pain.

Unfortunately, there is no known cause for the interruption to the blood supply that brings about this degeneration of the hip joint. Because of this, the disease is termed ‘idiopathic’. It also tends to occur mostly in small and miniature breeds of under-one-year-olds, in both males and females. Predisposed breeds include, but are not limited to, Yorkshire terriers, chihuahuas, pugs, poodles, miniature pinschers, West Highland white terriers, dachshunds and the Lhasa Apso.

Early diagnosis could prevent serious problems, and give your dog a chance for a full recovery without invasive therapy

Very importantly, the disease is genetically inherited, so owners who find that their pet dog is suffering from this disease should avoid mating their dog to minimise the risk of suffering in later generations. Although the disease can strike in both hip joints, where it is called bilateral, it more commonly occurs in only one joint when is referred to as unilateral.

Owners of dogs unlucky enough to suffer from this degenerative disease will initially notice gradual and perhaps intermittent signs of limping when their dog is still a puppy, usually under a year. Symptoms may range from a difficulty in sitting or lying down and standing up, reluctance to walk, run, climb or descend stairs, staggering gait, persistent licking or gnawing of the leg area, maybe even a clicking sound coming from the hind legs, increasing irritability brought on by the pain, progressively increasing lameness in the hind quarters, pronounced limping and wasting away of the thigh muscles of the affected limbs.

In its advanced state, the wasted thigh muscles will bring about a foreshortening of the leg compared to the healthy leg. Left untreated, Legg-Calvé-Perthes disease is a very painful condition that has the potential to cripple your pet.

Although not all signs of limping or lameness are a symptom of Legg-Calvé-Perthes disease, you should always immediately refer the problem to your veterinarian. Early diagnosis of Legg-Calvé-Perthes could prevent serious problems from developing, and even give your pet dog a fighting chance for a full recovery without invasive therapy.

Following a discussion of the medical history of your pet, as well as the symptoms exhibited, your vet will perform a full physical examination that will include a focus on the hip area. This will typically involve palpating the area to feel the inside of the hips, as well as manipulating the hips by gently extending and rotating to assess the level of pain endured by the dog. Depending on the case, the vet may also opt for blood tests and urinalysis to further obtain a complete picture of the state of health of your dog and rule out other likely causes.

Other conditions that promote lameness, such as arthritis, knee injury or fractures, will then be ruled out. With a suspected Legg-Calvé-Perthes, your vet will then opt for a range of radiographic imaging such as X-rays which provide a digital image of the bones.  Having diagnosed Legg-Calvé-Perthes, treatment will depend on the extent of the damage sustained.

If the disease is diagnosed early, it may be possible to treat it with prescribed medication and supplements, as well as by restricting activity and enforcing rest. Physiotherapy may also be an option. But if the disease is too advanced for medication to have any lasting effect, surgery is required.

This typically involves removing the ball joint that has been compromised together with the upper part of the thigh bone. The removal of this part of the bone naturally encourages the body to develop a new joint, in this case known as a ‘ false joint’, as it is kept together only by  fibrous tissue. It is amazing how well most dogs recover and perform with this type of surgery, possibly due to the fact that in the dog, as opposed to us humans, the hind legs are used mostly for propulsion rather than weight bearing.

Specialist hip replacement is generally reserved for the rare cases when this disease affects larger breeds; your veterinary surgeon will guide you in this respect. Either way, the long-term goal is to get your dog back to a relatively pain-free life.

If you follow your veterinarian’s advice, the prognosis after treatment is generally good.  Although Gretel’s case called for surgery, I know that her owners will be diligent with the post-operative case, as they have already invested in a dog cage to make sure that complete rest and restricted activity is enforced.

They have also made arrangements for water physiotherapy once she is well enough to start moving again. There should be no reason why Gretel won’t enjoy a normal life again.

thisweekwiththevet@gmail.com

Dr Martin Debattista is a veterinary surgeon.

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