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724   Osteochondrosis


           Acute General Treatment            •  Dogs should not be fed ad libitum; volume
           Conservative management:             of food should be based on the animal’s body              Glenoid
  VetBooks.ir  •  Nonsteroidal   antiinflammatory   drugs   ments and manufacturers’ recommendations
                                                condition score. Calculated energy require-
           •  Exercise restriction for 6 weeks
                                                should only be used as starting points
            (NSAIDs): never administer more than one
            at a time nor with concurrent corticosteroids:
                                                (p. 1077).
            carprofen  2.2 mg/kg  PO  q  12h,  etodolac   •  During  growth,  owners  should  feed  their
            10-15 mg/kg PO q 24h, deracoxib 1-2 mg/  pets a commercially available dog food with
            kg PO q 24h, firocoxib 5 mg/kg PO q 24h,   a  calcium  content  not  exceeding  3.5 g/           Flap
            ketoprofen 0.25-1 mg/kg PO q 24h, meloxi-  1000 kcal  and energy  density  <  4 kcal/g
            cam  0.1 mg/kg  PO  q  24h,  or  grapiprant   (<17% fat). Optimal calcium levels are found
            2 mg/kg PO q 24h                    in  many  purpose-made  large/giant-breed
           •  Targeted  analgesics  can  be  used  in  addi-  puppy foods; owners should not feed adult
            tion for multimodal pain management:   dog food to puppies.                                   Humeral
            tramadol 2-5 mg/kg PO q 8-12h, amanta-  ○   Owners should not add supplements.                head
            dine 3-5 mg/kg PO q 24h, or gabapentin   ○   These feeding guidelines are especially
            5-10 (can increase up to 20 mg/kg if needed)    important in the preweaning and post-
            mg/kg PO q 8-12h                      weaning periods.               OSTEOCHONDROSIS  Arthroscopic view of OCD
           Surgical management:                                                  of the humeral head.
           •  Arthrotomy or arthroscopy to debride loose   Behavior/Exercise
            or devitalized cartilage, cartilage flaps, and   •  Limit/control activity to low impact.
            intraarticular osteochondral fragments  •  For joint instability, consider commercially   •  Hock:  fair;  joint  capsule  thickening  helps
           •  Curettage  and  forage  (drilling)  of  the   available, custom-fitted support wrap.  stabilize the joint, although residual instabil-
            subchondral bone lesion to stimulate                                   ity remains, and DJD is likely.
            fibrocartilage formation          Drug Interactions
           •  The talus is NOT curetted to avoid creating   Intraarticular glucocorticoid injections increase    PEARLS & CONSIDERATIONS
            additional joint instability      lesion severity and are contraindicated.
           •  Autogenous  osteoarticular  grafting  and                          Comments
            prosthetic resurfacing of defects has been   Possible Complications  Although lameness may be unilateral, radio-
            reported.                         •  Untreated cartilage flaps irritate the joint and   graphs of the contralateral joint are indicated.
                                                cause more DJD. In OCD of the shoulder
           Chronic Treatment                    joint, the flap can loosen and migrate into   Prevention
           DJD may occur at a later age:        the biceps tendon sheath or attach to the   •  Only breed animals screened for OCD (and
           •  Prevent joint overload (activity moderation   joint capsule and grow (ossicle).  other hereditary diseases); affected dogs and
            and  weight  management)  and  administer   •  Perioperative and postoperative complications:  their relatives (parents and siblings) should
            NSAIDs and analgesics as listed above for   ○   Seroma formation due to excessive postop-  not be bred.
            osteoarthritis pain                   erative physical activity occurs commonly   •  Diet management (see above)
           Disease-modifying agents help relieve discom-  after arthrotomy.
           fort, reduce degradative and inflammatory   ○   Swelling from irrigating fluid leaking into   Technician Tips
           enzyme levels, and stimulate production of   the periarticular soft tissue may occur after   •  Application of cold compress immediately
           synovial fluid, proteoglycan, and collagen:  arthroscopy.               after surgery and continued at intervals for
           •  Glucosamine  hydrochloride,  chondroitin   ○   Infection (uncommon)  the first 2-3 days can minimize swelling and
            sulfate, manganese ascorbate, and avocado/  ○   Failure to remove all the osteochondral   inflammation.
            soybean unsaponifiables combination product   fragments              •  Application  of  heat  compress  is  recom-
            (Dasuquin)                          ○   Tarsocrural joint instability  mended after swelling and inflammation
           •  Polysulfated glycosaminoglycans (PSGAG)                              have subsided.
            4.4 mg/kg IM q 3-4 days for up to 4 weeks   Recommended Monitoring
            (maximum of 8 injections)         •  The  contralateral  joint  is  often  affected   Client Education
           •  Pentosan polysulfate: intraarticular 5-10 mg/  and should be evaluated clinically and   •  Pre-purchase knowledge of lineage/parental
            joint weekly, IM or SQ 3 mg/kg once weekly   radiographically.         history of heritable orthopedic disorders
            for 4 weeks, or PO 10 mg/kg weekly for 4   •  If lameness persists, synovial fluid analysis   •  Dietary management
            weeks, repeated every 3 months      and culture, radiographs, arthroscopy, CT,   •  Owners should give the puppy time to grow
           •  Hyaluronan 3-5 mg intraarticular  or MRI may be indicated.           and should not train the dog too heavily or
           •  Acupuncture,  cold  laser  therapy,  physical                        too early.
            rehabilitation                     PROGNOSIS & OUTCOME
           •  Platelet-rich  plasma  (PRP)  and  adipose                         SUGGESTED READING
            tissue–derived stem cells         •  Shoulder: good after treatment, even in cases   Fitzpatrick N, et al: Early clinical experience with
                                                with DJD. Most dogs become sound 4-8   osteochondral autograft transfer for treatment of
           Nutrition/Diet                       weeks after surgery.               osteochondritis dissecans of the medial humeral
           •  Avoid  feeding  excessive  calories,  calcium   •  Elbow: fair to good when cartilage damage is   condyle in dogs. Vet Surg 38:246, 2009.
            (bones, bone meal, milk, tablets, powder),   small in young animals and DJD is minimal;   AUTHOR: Joseph C. Glennon, VMD, DACVS
            or vitamin D (drops, tablets, fish diets).  fair to poor when combined with medial   EDITOR: Kathleen Linn, DVM, MS, DACVS
           •  The  lowest  risk  of  diet-induced  disease  is   coronoid  disease  and/or  severe  cartilage
            found in animals whose body condition score   damage
            is maintained at 2/5 during the period of   •  Stifle: varies; a large lesion in a young animal
            growth.                             may carry a poor prognosis.



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