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Basset with elbow dysplasia surgery

19331 Views 32 Replies 11 Participants Last post by  Mikey T
Hello folks - first post on this forum and thank you in advance for the assistance. My 2 year old basset (Zack) had elbow dysphasia surgery on Wednesday 8/29. No pins on the outside but the ortho used wires instead. For the most part he is doing OK - lot of pain controlled through meds but one thing is that he is refusing to put any weight on the leg. The on-call this weekend was not much help so looking for some insights from folks who have gone through similar surgeries. Many thanks.
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all basset have elbow dysplasia it is actual called for in the breed standard

" Steepness in shoulder, fiddle fronts, and
elbows that are out, are serious faults. The forelegs are short, powerful, heavy in bone, with wrinkled skin. Knuckling over of the front legs is a disqualification. The paw is massive, very heavy with tough heavy pads, well rounded and with both feet inclined equally a trifle outward, balancing the width of the shoulders"

Turning out of the feet ie require a small degree of elbow incongruity hence elbow dysplasia. Many pet quality dogs are fiddle front with the feet turned out more than slightly. this is more dysplasic than the standard calls for however it rarely causes a problem in the basset. Second there are no studies showing that surgery to correct the problem lead to higher quality of life over more conservative care. There are no studies say the opposite as well. I always caution people to get third and fourth opinion before have this surgery done


from Basset Hounds
In diagnosing the cause of a Basset's lameness, a radiograph of the forelimbs may indicate a condition called elbow incongruity. (Elbow incongruity is a poor fit between the 3 bones which comprise the elbow joint.) Studies to date indicate that elbow incongruity is normal in the Basset and is not the cause of the lameness. It is also suspected that many of the previously mentioned unnecessary (panosteitis) surgeries have been performed on Basset Pups just because radiographs that were taken showed elbow incongruity. A study on forelimb lameness in the Basset is currently underway at the School of Veterinary Medicine, University of Pennsylvania. As previously mentioned they have determined that elbow incongruity occurs in the Basset but suspect that incongruity rarely causes the lameness. During the course of the study, conservative therapy will be recommended for all cases in which panosteitis appears to be the cause of the lameness. In cases with severe growth deformities or elbow pain associated with elbow incongruity, surgery may be recommended. If your Basset develops lameness and is diagnosed with an "elbow problem", discuss with your veterinarian the possibility of panosteitis.

Mariah about as fiddle=fronted as you can get with east/west pointing feet never bothered hers see video below for proof from the same day as pictures

http://vid32.photobucket.com/albums/d33/toughynutter/Mariah/ace2008standard.mp4
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There is scant evidence that surgery really helps

http://www.offa.org/pdf/elbowarticle.pdf
Despite the ability to treat affected dogs,
there is no satisfactory medical protocol or surgical procedure
to significantly alter the progression or cure the disorder.
This poor response to medical and surgical management
is substantiated with force plate gait analysis pre- and
post-therapy.
Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity. - PubMed - NCBI
A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.
http://surgery.anzcvs.org.au/assets/sw10/elbow incongruity assessment and treatment.pdf
" No data on the effect of ulnar ostectomy on force transmission through the joint is available. The limitations of the published data also include the lack of investigation of the role that degree of elbow flexion and pronation and supination of the foot have on elbow contact and joint force. Although it is comforting to simplify the
anatomical and biomechanical abnormalities into the presence or absence of RUI in static, non-loaded imaging techniques this approach is fraught with inaccuracy and misunderstanding. In human cadaver elbow incongruity
investigations the stress distribution in the joint, measured by contact area and joint space was influenced by induced force across the joint. As load was increased a significant improvement in joint congruity was seen22 . As joint angle was modified the contact areas also changed23 . Concurrent measurement of subchondral bone density by CT osteoabsorptiometry demonstrated joint geometry and loading conditions influence the distribution of subchondral

No data on the effect of ulnar ostectomy on force transmission through the joint is available. The limitations of the published data also include the lack of investigation of the role that degree of elbow flexion and pronation and supination of the foot have on elbow contact and joint force. Although it is comforting to simplify the anatomical and biomechanical abnormalities into the presence or absence of RUI in static, non-loaded imaging techniques this approach is fraught with inaccuracy and misunderstanding. In human cadaver elbow incongruity investigations the stress distribution in the joint, measured by contact area and joint space was influenced by induced force across the joint. As load was increased a significant improvement in joint congruity was seen22 . As joint angle was modified the contact areas also changed23
. Concurrent measurement of subchondral bone density by CT osteoabsorptiometry demonstrated joint geometry and loading conditions influence the distribution of subchondral density24 and the physiologic incongruity present at some joint surfaces resolves with increasing pressure due to theviscoelastic deformation of articular cartilage and subchondral bone25,26 . These investigations have not been performed
in the canine.


...Current surgical treatment of dysplastic patients has two potential components. Firstly the removal of coronoid fragments with debridement of the exposed subchondral bed with or without subtotal coronoidectomy27-30. Results with these procedures alone have been variable and subjective with many dogs having an apparent improvement in their gait and degree of joint pain31-33 . There is no peer-reviewed, published evidence that supports that this procedure slows or stops the ongoing development of elbow osteoarthritis33,34 . The second surgical manipulation is an osteotomy or ostectomy of the ulna, radius or humerus to attempt an improvement in the elbow congruity and decrease the biomechanical loading of the medial joint compartment. There are no comprehensive prospective, standardized studies with control groups and force plate data that has looked at the effect of these procedures in clinically affected elbow dysplasia dogs. In vitro studies of mid-humeral wedge and sliding osteotomy in loaded cadaver limbs demonstrated an alteration in joint surface contact in both the radius and ulna35 with a mean decrease in proximal ulnar articular force of 28% when an 8mm sliding humeral osteotomy (SHO) was performed 36 . Clinical investigation of the SHO is ongoing and preliminary results are encouraging37 . There are no published peer-reviewed reports on radial osteotomy and a paucity of reports on ulna ostectomy38,39.

The decision to perform an osteotomy following arthroscopic debridement of the coronoid must be made with limited scientific data as support and with the knowledge that some procedures have an inherently high morbidity and potential complications are serious and if they develop may lead to the loss of functional use of the thoracic limb. These risks are balanced against the subjective opinion of experienced surgeons who feel strongly that without an attempt to improve joint congruity and biomechanical loading of the medial compartment the surgical results with coronoid debridement
alone are sub-optimal. When attempting a procedure with potentially disastrous complications the individual surgeon must fully inform the client of the potential benefits and possible complications with the proposed procedure and must continue to honestly assess the individual results that they achieve with standardized outcome measures to justify the semi-experimental nature of the treatment
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can't have crooked legs without it. It is also why basset breeders in the US forgo OFA on elbows because what the standard is does not work for bassets. Just as all dwarf breed have a problem with the grading of Hips as well.
Sophies before and after xrays show the clear improvement in the elbow congruency
there is no long term evidence surgery reduces degenerative joint disease over conservative approach which include weight control and pain management. No is there any evidence that it improve mobility for the most part because studies have not been done. and Has been demonstrated in HD (hip dysplasia) radiographic images correlate poorly to clinical signs which is also the case in ED the fact that x-ray imaged show improvement in alignment are nice but do not demonstrate functional improvement like force plate measurements. Contrary to popular belief much of Medicine is not evidence or Scientifically based and is more seat of the pants.


The lack of evidence does not mean that it does not work it is simply a lack of evidence that it does and that should be a relevant part of any decision to have the procedure done or not.
Elbow dysplasia is a group of Different elbow problems OCD, UAP, FAP, and Elbow incongruity that is thought by many to be the cause or a contributing factor to all but OCD . For the vast majority of case when discussing elbow dysplasia in basset they are actual talk elbow incongruity and that is specifically what I am talking about. OCD UAP and FAP should they occur need to be correct that said it is noted in Basset UAP as late as 8 month can be normal and not need correction which very few vets are aware of as well Orthopedics
"The ossification center at the anconeal process normally fuses by 5 months of age, and so the presence of a lucent line on radiographs confirms the diagnosis in dogs past this age. The exceptions are the St. Bernard and basset hound, in which the anconeal process may fuse as late as 7 to 8 mo (2). "

I would find it hilarious if it were not so sad and potential harmful that a couple of you think that basset hound are like no other dogs when it comes to behavior , feed. training yet in the regards of how they are put together orthopedically should be no different the labs. It is quite clear however what would WORK for a lab or other medium to large herding or sporting breed is not going to work for a basset hound. Straight legs from the shoulders Would be very painful and not allow proper front end support. In order to function support the front end of a basset properly they must have crooked front Legs. How is the Crook achieved. Quite simply by differential length in the radius and ulna that cause the leg to bow around the chest. A different length in the ulna and radius by definition is elbow incongruity. A basset needs some to function properly. Therefore some elbow incongruity is requires. Elbow incongruity is not a deformity in the breed or any dwarf breed it is required for proper functioning. To expected orthopedically a dwarf breed to need the same structure as a non dwarf breed is ridiculous. While no incongruity or to0 much incongruity certainly can be a deformity it is the matter of amount not if it exists at all. While rare too much or too little can lead to problems as well like pain, limping and Degenerative Joint Disease (arthritis). Keep in mind the real issue is not Elbow dysplasia, elbow incongruity. or Hip Dysplasia . It is DJD that occurs later as a result of these conditions. keeping in mind that they are only contributing factors and many/most dogs with Dysplasia or incongruities never develop DJD.

Hip scores do not correlate anywhere near as well as they should with soundness or comfortable working lives. When I spoke to the orthopedic surgeon about Clue, I got some very good and very candidly given information. He said several things: This is not a breed he sees, as a surgeon who does lots of work to relieve pain in hips or to analyze x-rays. This is not a breed coming in with pain issues. It’s not a breed he associates with dysplasia symptoms with any regularity. He does not recommend OFA for corgis of any type, because he feels that the scoring is more or less guesswork unless the joint is clearly already arthritic or the socket just plain doesn’t exist, and EVEN THEN he rarely sees dogs come in with pain.
He said, and this is close to an exact quote, “These are dogs with weird hips, and they get along just beautifully on those weird hips.”


This we know there is a loose association with elbow dysplasia and Hip dysplasia as designated by radiographic images and Degenerative Joint Disease. but this association is not a strong as most believe, There is no correlation with the severity of elbow dysplasia, hip lacticity and Hip dysplasia and the occurrence of DJD . It is why many of us feel that way to often surgery is being performed on elbows without a substantial realistic expectation that it is going to help long term over conservative treatment,


One also has to question the usefulness of the Current scheme to reduce incidence OFA testing for more than a decade has resulted in a reduction of 1% in the incidence of hip dysplasia. Yet we find that something as simple as keep the puppy slim during the major growth period results in a nearly 50% decrease in Hip dysplasia. It appears that the proportion attributed to genetics is overstated,

http://barbety.pl/wp-content/uploads/2011/10/Controlling-canine-hip-dysplasia-in-Finland.pdf
As a retrospective study, records of hip-dysplasia screening of 69,349 dogs in 22​
breeds that were born in 1988±1995 were analyzed and compared to data from prior to 1988. In​
most breeds, no significant changes in dysplasia prevalence could be found


LABRADORNET - Hip dysplasia (CHD)
"At present, the strongest link to contributing factors other than genetic predisposition appears to be to rapid growth and weight gain. In a recent study done in Labrador retrievers a significant reduction in the development of clinical hip dysplasia occurred in a group of puppies fed 25% less than a control group which was allowed to eat free choice"



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2
To evaluate front ends you need a standing ie weight bearing Picture and a video of the dog moving at a trot is helpful as well

question is the dog Spayed if not hold of spaying until full maturity 18 months to two years spaying before than can exaggerate any genetic issues.

2. the fact the dog in limping as a puppy makes it more likely there will be an issue later on than if it did not. This is even more true if the limp is because of an orthopedic/bone issue other than pano or a soft tissue strain/sprain injury.

3. Seen a lot worse without a problem Visual manifestation of a poor front is not a good indication of pain or future problems. That is how bad it looks does not correlate to pain and/or developing arthritis.



Is a fiddled fronted as it gets and IMHO the most gifted agility basset ever.



but she is not knuckled under. I find a dog that is knuckled over along with being easty -westy more likely to have problems than one that is not.
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The loss of sex hormones delay growth plate closure early nuetered/spayed dogs average 1/4" taller than intact. some Growth plates start to close before six months of age. Spaying at this time is thought to have an adverse effect on bone pairs. like in the forearm and lower rear leg and lead to or exacerbate incongruities (ie bone pairs of unequal length)
It is well documented that early spay increase incidence of Hip dysplasia and CCL ruptures. as compared to intact dogs.

In the first picture it she is likely Knuckled under in addition to the point pointing to far out. It has been my experience this tends to create bigger problems than turning out with limp and long term.

Knuckling over is caused by excessive laxticity in the carpal (wrist) tendons. There is no surgical fix supporting the area with a brace may help and lessen chances of arthritis developing. and pain in the near term



this is a pretty sever example.

Think of the front leg of the dog as your arm. the paw =your hand. Joint closest to the ground is called carpal joint (wrist) next is the elbow. Note the in this dog the Carpal joint(wrist) is far forward and in front of the paw. ie knuckled over The entire paw should be forward of the wrist

some threads from the forum on this issue

http://www.basset.net/boards/general-basset-hound-discussion/12875-odd-leg-posture-normal.html

http://www.basset.net/boards/genera...93-advice-knuckling-over-front-leg-brace.html

http://www.basset.net/boards/general-basset-hound-discussion/13740-doggie-leg-braces.html

http://www.basset.net/boards/genera...97-question-about-my-bassets-legs-feet-2.html

Knuckling over in basset hounds
Standard Disqualifications | Basset Hound Club of Southern California | BHCSC
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" The front should curve around the chest meaning there will be a SMALL degree of turning out of the front legs. This is not elbow dysplasia. a SMALL degree of turning out of the front legs. This is not elbow dysplasia. "

and just how does this happen? The crook in the foreleg is the result of Uneven length between the radius and ulna this is know as Elbow incongruity, which is one of several disease/bone adnormalities know as elbow dysplasia. A small amount of incongruity is helpful and required a large amount can be a problem but most often is not as well. That said because it is a problem at a young age it is much amore likely to be a problem as the dog ages.


as for knuckling as the leg turns out more that is going to change the plane of the knuckling, knuckling is caused by lacticity of the Carpal tendons not shoulder placement,

See attached photo . Pay particular attention to area in circle, note how dog on left it appears the wrist joint is forward of the turned out foot. If it were an ankle it that the dog is beginning to roll it. Note on the dog on the right this is not the case even though the feet are turned out even more, This lacticity in the carpal area that allows the foot to be rolled over IMHO is a bigger issue than the turn out,. Often these two things accompany one another but not always,

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I know this is old but I'm hoping Boat Cop will reply. I have a ten month old basset hound mix. He's only 19% basset hound but he got ALL basset front legs. He has the exact same issue you describe with your girl above. I'm wondering how your girl is doing these years later....thank you...
see How's Casper?

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