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Elbow Dysplasia

Background
  • Elbow Dysplasia” is often used to describe three separate conditions of the elbow joint:
      • Ununited Anconeal Process (UAP)
      • Osteochondrosis Dissecans (OCD)
      • Fragmented Coronoid Process (FCP)
  • Young, intermediate to large breed dogs such as the Rottweiler, German Shepherd Dog, Bernese mountain dog, Golden retriever and Labrador retriever are most often affected.
  • Involvement of both elbows is common.
Anatomy
The elbow is comprised of three bones along with tendons, muscles, and ligaments working together to provide normal function of the joint:
Elbow Dysplasia
  • The exact cause of elbow dysplasia is not known, but many theories exist.
  • Defects of the elbow bones lead to instability and inflammation of the elbow joint.
  • Osteoarthritis, elbow pain and lameness are the end result of elbow dysplasia
Symptoms
  • Foreleg lameness or, if both elbows are involved, generally abnormal gait. 
  • Exercise intolerance and reluctance to exercise may also be noticed. 
  • The elbow is often painful, thickened, swollen, or unable to be completely flexed
Diagnosis is typically made based on symptoms, exam findings and X-rays of both elbows.
Treatment Options
  • Medical treatment with pain relievers, “joint formulas”, physical therapy, leash exercise, and weight control is usually recommended for dogs greater than 2 years of age.
  • Surgical treatment is generally recommended dogs less than 2 years of age with minimal osteoarthritis.
Surgery for Elbow Dysplasia

Important Facts

  • Dogs less than 2 years of age with minimal osteoarthritis are the best surgical candidates.
  • Dogs greater than 2 years of age with mild to moderate DJD may also be surgical candidates, but expectations are limited regarding post-operative improvement. 
  • Most moderately affected dogs, with or without surgery, are able to cope with the disease by having their weight and exercise controlled and periodic use of pain relievers.
  • Regardless of the treatment, some arthritis will develop in the elbow.
  • General anesthesia is utilized for the procedure 
  • The faint scar remaining after surgery usually becomes covered with fur again.
  • An overnight stay is required so discomfort can be controlled with injectable medication.
Goals of Surgery
  • Confirm the pre-operative diagnosis.
  • Relieve pain associated with bone defects.
  • Decrease the amount of arthritis which will inevitably develop in the elbow.
  • Limit stress put on the opposite limb and other limbs and joints.
The Procedures
  • OCD and FCP require a single incision on the inside of the elbow to remove the defects.
  • UAP requires two incisions; one on the outside for the known defect and one on the inside to identify and remove other defects which are present as much as 80% of the time.
  • Arthroscopic surgery has reportedly been used in older dogs to remove arthritis.  I do not advocate or perform this procedure. 
  • Total Elbow Replacement may be available in the near future for older dogs with severe symptoms.  This procedure will require special training, equipment, and facilities. 
The Recovery
  • The recuperative period typically lasts for a total of 6-8 weeks.
  • Lameness is worse immediately following surgery and improves slowly over the following weeks.
Post-Operative Care
  • Initially, exercise is limited to walks to eliminate only.
  • Skin sutures and a light bandage are removed 10-14 days after surgery.
  • Leash exercise is gradually increased over the following weeks; swimming is also fine.
  • Pain medication and antibiotics are administered for several days after surgery.
  • No running, jumping or playing is permitted for at least 8 weeks following surgery.
Expectations
  • Most pets are permitted to resume normal activity several months after surgery.
  • Some dogs have lameness after surgery which is controlled with medication. 
  • In general, the younger the dog and the less arthritis present at the time of treatment, the better the prognosis.
Cost of the Procedure
  • This typically includes examination, pre-anesthetic bloodwork, anesthesia, surgery, hospital care, post-operative medications, and two follow-up examinations.
  • Please ask your veterinarian for a detailed surgical estimate for your pet.

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