We have a 16 month old boy with pretty bad elbow dysplasia who has just had surgery and I thought that I'd share our experiences with you so if you're ever in this situation it may make your decision making a bit easier. We did a bunch of research and saw several docs to try to figure out what's best. Bottom line--no one knows for sure. My task was perhaps a bit easier since I could talk doc-to doc and the anatomy is similar.
Elbow dysplasia is thought by most to be caused by incongruency between the radius and ulna (bones in the forearm). This is thoought to be very small in teh range of a few millimeters. This causes changes in the way weight is born on the joint leading to wear on the cartilage in places it was not meant to wear, eventually exposing bone.
There are several procedures that have been tried to fix this--none of which work reliably. (FWIW anytime there are multiple surgical procedures to fix a problem it means none of them works very well.)
The first procedure was an ulnar osteotomy--cutting the ulna to shorten it thus changing the stress on the joint. My understanding is that almost nobody does this anymore because it doesn't work.
The current vogue is radial osteotomy--cutting the radius to shorten it (it seems to me that it woul be pretty much the same as lengthing the ulna) . Sometimes this seems to help. BUT and it is a huge but. You can't accurately predict wihich animal it will help and it almost as frequently hurts. Dr. Davis at UC Davis has done a lot of research on this. It is felt by the guys that do this that it corrects the inconguency. Dr. Davis has done research that shows that you can't tell when a joint is incongruent. He created incongruent joints in cadaver dogs, x-rayed them and sent the pictures to radiologists. They were no better than chance and figuring out whether the joint was incongruent or not. In other words the test to see whehter or not surgery might help is NOT RELIABLE. He thinks the dogs that do get better are largely a matter of chance. Remember we are talking about millimeters here--so if you get it just right it works if not it doesn't---orthopedic surgery just isn't that precise.
Another new procedure is called an ulnar splitting osteotomy, where they split the ulna to change the weight bearing. The folks that do this are apparantly clicquish and have not published any data in any journals to show that the procedure actually works. Dr Schulz is very sceptical about this since there is no published data.
The last procedure is one he has "invented" a humeral osteotomy, changing the weight bearing at the elbow by changing the angle that the humerus impacts the elbow as I understand it. He's been doing these for a couple of years and says he's got an 80% success rate, but also has a 5% complete failure rate, making the joint worse. He's still trying to figure out what makes the difference.
All 4 of these are major procedures with a long recovery time, think months. In addition you can only do one limb at a time. A lot of rehab is needed.
Probably the best initial step, the one Dr Schulz recommends, and the way we went is arthroscopy. First it allows you to see exactly what is going on. Second, it allows you to remove loose bodies from the joint. If there are loose bodies they will cause more damage if they are left behind. Third you can do both elbows at once. As he does the procedure he makes micro-fractures in the radius with the thought of possibly bringing stem cells to the surface and creating new cartilage. He admits that this might be witchcraft, but feels it is worth a try. Bloom is just over 2 weeks post op and is pretty much back to normal and has gained about 10-15 degrees of flexion in both elbows. In another 3 or 4 weeks he can go back to normal activites.
Most importantly----NONE of the procedures cure the problem--they hope to slow it down. The most important single thing is weight control. I thought my little guy was pretty slim at 102--he wants him down to about 95. He uses glucosamine chondroitin---there have been bioavailibility issues with some of preparations and Rimadyl or other anti inflamatory as needed. If this doesn't work then he would ad Adequan injections, followed by hyaluronidase injections in the joint. Only after these have failed would he even think aboout humeral osteotomy. Next month he will be putting in two sets of "total elbows" and figures that using them routinely is five or so years off.
FWIW he has just published a text on veterinary arthroscopic surgery. The folks at Davis were GREAT and it is a very nice town. It was well worth the 1100 mile drive from Tacoma. FWIW the cost was around 2K--about half the price of the local guy who was not nearly as experienced as Dr. Schulz.
If you have questions don't hesitate to ask
Tim
Tim McNair M.D.
Tim McNair M.D. Please respond to [EMAIL PROTECTED]
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