Practical Matters: Early screening and the role of DARthroplasty as an intervention in young dogs with hip dysplasia - Veterinary Medicine
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Practical Matters: Early screening and the role of DARthroplasty as an intervention in young dogs with hip dysplasia


VETERINARY MEDICINE


DARTHROPLASTY: AN OVERVIEW


3. The harvested cortical-cancellous strips of bone from the ilium have been sutured into a cup and are ready to be placed under the deep gluteal and gemelli muscles directly over the joint capsule. The heavy suture, which has been preplaced in the joint capsule, when tied, will hold the implant in place. The patient is in lateral recumbency. The access incision to the wing of the ilium for harvesting the bone grafts is seen on the left.
You will most likely refer patients for DARthroplasty. The procedure involves harvesting autogenous bone grafts from the wing of the ilium and placing them to fuse over the deficient dorsal acetabular rim.6,7 A caudodorsal approach to the coxofemoral joint is used. The exposed bony portion of the dorsal rim of the acetabulum is prepared to accept bone grafts by the drilling of multiple holes along the bony portion of the dorsal acetabulum, exposing activated cancellous bone. The cortical-cancellous strips harvested from the ilium through a separate incision are formed into a cup, tucked under the muscle separation between the deep gluteal muscle and the gemelli muscle, and tied to the joint capsule with a preplaced suture (Figure 3). A cancellous bone graft from the ilium is packed into the area of the drill holes in the acetabular rim and covered with additional pieces of cortical graft from the ilium (Figure 4).6,7 Sutures are placed between the deep gluteal and gemelli muscles to help hold the free graft in place, and the two surgical wounds are closed with a standard layered protocol.


4. A transection view of the coxofemoral joint shows the relative position of the harvested graft (free cortical-cancellous­ strips) sutured to the joint capsule, the layering of the cancellous bone graft into the drill holes along the dorsal rim of the acetabulum, and the blocking strips (cortical graft from the ilium) holding the cancellous graft in place.
The aftercare protocol is strict: Patients must have cage rest with short leash walks only for elimination for eight weeks. After this initial healing time, a dorsal acetabular rim position radiographic examination is done to verify the graft presence and position (Figure 5). A physical therapy regimen to rebuild muscle strength and agility can then begin and will continue for another eight weeks. If rehabilitation is successful, patients can resume normal activity.


5. A dorsal acetabular rim position radiograph taken eight weeks after a DARthroplasty procedure in a dog showing positive graft formation (white arrows) and increased width of the dorsal acetabular rim (black arrows).
A comprehensive, proactive hip wellness program can be used to correct deficiencies of the canine hip in young, growing, dysplastic patients, resulting in diminished hip osteoarthritis and pain and better activity as adults. DARthroplasty may be especially useful in severely affected patients when hip dysplasia is diagnosed at an early age.8

David Luck, DVM
Veterinary Surgical Relief Services
2237 Meade St.
Denver, CO 80211

REFERENCES

1. Dueland RT, Adams WM, Fialkowski JP, et al. Effects of pubic symphysiodesis in dysplastic puppies. Vet Surg 2001;30(3):201-217.

2. Patricelli AJ, Dueland RT, Adams WM, et al. Juvenile pubic symphysiodesis in dysplastic puppies at 15 and 20 weeks of age. Vet Surg 2002;31(5):435-444.

3. Dueland RT. Juvenile pubic symphysiodesis (JPS) update, in Proceedings. Am Coll Vet Surg Summit 2007.

4. Fossum TW. Triple pelvic osteotomy. In: Small animal surgery. 3rd ed. Philadelphia, Pa: Mosby Elsevier, 2007;1238.

5. Luck DR. DARthroplasty: overlooked and underused (poster presentation). Veterinary Orthopedic Society Proceedings, Sun Valley, Idaho, 2007.

6. DARthroplasty. In: Bojrab MJ, ed. Current techniques in small animal surgery. 4th ed. Baltimore, Md: Williams & Wilkins, 1998;1168-1170.

7. Slocum B, Slocum TD. DARthroplasty. Slocum Enterprises, Inc., Eugene, Ore. Available at: http://www.slocumenterprises.com/Articles/darthroplasty.htm.

8. Gahring DR. Long-term results with DARthroplasty. San Carlos Veterinary Hospital, San Diego, Calif. Available at: /Prof/DARthroplasty/DARthroplasty_Long_Term_Followup.html


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