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HIP ASSESSMENT FOR DYSPLASIA DURING PRE AND POST SKELETAL MATURITY IN GERMAN SHEPHERD AND LABRADOR RETRIEVER BREEDS OF DOGS

ANANDARAJ, A. I .D. No. MVM 10059 (VSR)

DEPARTMENT OF VETERINARY SURGERY AND RADIOLOGY MADRAS VETERINARY COLLEGE CHENNAI - 600 007 TAMIL NADU VETERINARY AND ANIMAL SCIENCES UNIVERSITY 2012

HIP ASSESSMENT FOR DYSPLASIA DURING PRE AND POST SKELETAL MATURITY IN GERMAN SHEPHERD AND LABRADOR RETRIEVER BREEDS OF DOGS

ANANDARAJ, A. I .D. No. MVM 10059 (VSR)

Thesis submitted in part fulfilment of the requirements for the degree of

MASTER OF VETERINARY SCIENCE in VETERINARY SURGERY AND RADIOLOGY


to the

TAMIL NADU VETERINARY AND ANIMAL SCIENCES UNIVERSITY CHENNAI 600 051

DEPARTMENT OF VETERINARY SURGERY AND RADIOLOGY MADRAS VETERINARY COLLEGE CHENNAI - 600 007 TAMIL NADU VETERINARY AND ANIMAL SCIENCES UNIVERSITY

2012

TAMIL NADU VETERINARY AND ANIMAL SCIENCES UNIVERSITY DEPARTMENT OF VETERINARY SURGERY AND RADIOLOGY MADRAS VETERINARY COLLEGE, CHENNAI - 600 007

CERTIFICATE
This is to certify that the thesis entitled HIP ASSESSMENT FOR DYSPLASIA DURING PRE AND POST SKELETAL MATURITY IN GERMAN SHEPHERD AND LABRADOR RETRIEVER BREEDS OF DOGS submitted in part fulfilment of the requirements for the degree of MASTER OF VETERINARY SCIENCE in VETERINARY SURGERY AND RADIOLOGY to the TAMIL NADU VETERINARY AND ANIMAL SCIENCES

UNIVERSITY, CHENNAI-600051, is a record of bonafide research work carried out by ANANDARAJ, A., under my supervision and guidance and that no part of this thesis has been submitted for the award of any other degree, diploma, fellowship or other similar titles or prizes and that the work has not been published in part or full in any scientific or popular journal or magazine.

Date : Place: Chennai - 600007

(Dr. R. JAYAPRAKASH) CHAIRMAN RECOMMENDED

Date:

EXTERNAL EXAMINER

APPROVED BY Chairman : (Dr. R. JAYAPRAKASH) Members : 1. (Dr. S. AYYAPPAN) Date: Place: Chennai 600007 2. (Dr. A.P. NAMBI)

CURRICULUM VITAE

Name of the student Date of birth Place of birth Major field of specialization

: ANANDARAJ, A. : 05.06.1986 : Kallakurichi, Tamil Nadu : Veterinary Surgery and Radiology : Completed B.V.Sc. and A.H degree in the year 2009 from Madras Veterinary

College, Vepery, Chennai 600 007. Marital status Permanent address : Unmarried : 41, K. Mamanandal Road, Kallakurichi. Villupuram District, Tamil Nadu. Pin: 606 202 Mobile: 9600725750 Mail ID: anandmvc@gmail.com Membership in professional Societies : Member of Tamil Nadu State Veterinary Council, Chennai.

Dedicated to My Beloved Family

Acknowledgement

ACKNOWLEDGEMENT
Gratitude cannot be seen or expressed, it can only be felt deep in heart and is beyond description. Although thank is poor expression of debt of gratitude one feels, yet there is no better way to express it. Words fall flat when describing my sense of gratitude and thanks to the Chairman, Dr. R. Jayaprakash, Ph.D., Professor, Department of Veterinary Surgery and Radiology, Madras Veterinary College, Chennai- 7 for his latitude to pursue my research, innovative suggestions, constant and continuous encouragement throughout the period of study, the guidance when things went bad and his kindness for understanding life. I profoundly acknowledge and sincerely thank the Member of the Advisory Committee Dr. S. Ayyappan, Ph.D., Professor, Department of Clinics, Madras Veterinary College, Chennai- 7 for his continuous support, valuable comments, critical suggestion, laudable counseling, encouragement and timely help in all academic affairs throughout the study. I express my sincere gratitude to the Member of Advisory Committee Dr. A.P. Nambi, Ph.D., Professor and Head, Department of Veterinary Clinical Medicine Ethics and Jurisprudence, Madras Veterinary College, Chennai-7 for his practical and valuable suggestions, constant encouragement throughout the study. I am grateful to Dr.B.Justin William, Ph.D., Professor and Head, Department of Veterinary Surgery and Radiology for his expert advice, technical guidance, immeasurable help and suggestions in carrying out my research work. I express my profuse thanks to Dr.Ravi Sundar George, Ph.D., Professor, Department of Clinics, for his keen interest, valuable suggestions and encouragement throughout the period of my study. I am grateful to Dr.R.Suresh Kumar,Ph.D., Professor and Head, Department of Veterinary Surgery and Radiology for his valuable suggestions and encouragement.

I am extremely thankful and grateful to Dr.Capt.G.Dhanan Jaya Rao Ph.D., Professor and Head, Resident Veterinary Officer and Head, Madras Veterinary College, Dr.L.Nagarajan, Ph.D., Professor, Department of Clinics and Dr.C.Ramani, Ph.D., Professor, Department of Veterinary Surgery and Radiology for their valuable suggestions, constant encouragement throughout the study. Its a pleasure to pay tribute to Dr.Shafiuzama, Ph.D., Associate Professor and Dr.A.Arun Prasad , Ph.D., Assistant Professor, Department of Veterinary Surgery and Radiology who had and have persistent confidence in me even when I didnt believe in myself. They were always there for me by constantly encouraging and pushing me to heights by providing hands on training and creating a pleasant, fun filled working environment. They have been showering patience and support on me from day one I entered this department. They have always encouraged me to live intensively even when I was thinking about doing something else. They have always been beside me during my happy and hard moments to motivate me. I express my deep sense of gratitude to Dr.R.Ganesh, Ph.D., Professor,

Department of Veterinary Surgery and Radiology and Dr. Mala Shammi, Ph.D., Professor, Department of Clinics for their valuable suggestions, continuous encouragement and moral support given during my study. I would like to express my special thanks to Dr.R.Sivashankar, M.V.Sc., Assistant Professor, Department of Veterinary Surgery and Radiology, Dr.Velavan, Ph.D., Assistant Professor, Veterinary Teaching Clinical Complex, VC &RD, Orthanadu and Dr.Gokul, M.V.Sc., Assistant Professor, Department of Clinics,for their crucial help when I was struggling to get articles for my research. I am extremely grateful to Dr.B.Murali Manohar, Ph.D., The Dean, Madras Veterinary College and Dr.S.Prathaban, Ph.D., Director of Clinics, TANUVAS for providing all the facilities for the study. I am thankful to Dr.N.V.V.Hari Krishna, Ph.D., for his help and valuable suggestions during my research. I am thankful to Dr.V. Arun Ph.D and Dr. Anushya who in the inspiration for my post graduate studies and funds. I would like to thank him for being the first person who taught me the way, to proceed with my research. His willingness to share his bright thoughts were very fruitful for shaping up my ideas and future. I

doubt that whether I will ever be able to convey my thanks fully, but I owe him my eternal gratitude. I extend my heartfelt thanks to my batch-mates Dr. A. Elamaran, M.V.Sc. Research Scholar, Department of Pharmacology and Toxicology and Dr. A. Anantharaj, M.V.Sc. Research Scholar, Department of Meat Science, Madras Veterinary College, for working with me in odd hours so that I could finish my work as scheduled. I am indebted to all my friends and colleagues Dr.Harish Kulkarni, Dr.S.Ramanathan, Dr.A.Rajalingam, Dr.V.Bhuvana, Dr.R.Reena, Dr.Nithin, Dr.Manoj, Dr.Bharathi, Dr.Anirudh, Dr.Pradnya, Dr.Naina, Dr.Sivaprakasam, Dr.S.Prabhu, Dr.A.Arun, who have lent their hands to my thesis knowingly and unknowingly through various means. I am thankful to Mr. Jai Ganesh, Technician for helping me with X-rays and Mr. Ranganathan, Mr. Kumar and Mr. Shiva Attendors who have helped me extremely in preparation of the patient. I place my heartful thanks to my friends Mr.Pargunan,

Dr. Siranjeevikumar, Dr. N. Arvindraj, Dr. K. Deeban, Dr. Sudharshan, Dr. Sangameswaran, Dr.Enbavelan, Dr.Balaji and Dr. S. Veerapandiyan, for their needful help and pleasant company in my college life. I thank to the Tamil Nadu Veterinary and Animal Sciences University for offering the TANUVAS Merit Scholarship to my post graduate studies. I am always grateful to my father Mr. G. Annadurai, my mother Mrs. Indirani, my sister Ms.A.Sivapriya and for their unconditional love which has raised me to this level. Lord! I am always thankful and feel blessed for giving me patience and strength to overcome the difficulties which crossed my way in accomplishment of this endeavor. I also express my apology if I have failed to thank anyone of them for their help. (ANANDARAJ, A.)

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Abstract

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ABSTRACT
Title : HIP ASSESSMENT FOR DYSPLASIA DURING PRE AND POST SKELETAL MATURITY IN GERMAN SHEPHERD AND LABRADOR RETRIEVER BREEDS OF DOGS : ANANDARAJ, A. thesis : M.V.Sc. in Veterinary Surgery & Radiology : Dr. R. JAYAPRAKASH, Ph.D., Professor, Department of Veterinary Surgery and Radiology, Madras Veterinary College, Chennai- 600 007 : Veterinary Surgery and Radiology : Madras Veterinary College, Chennai 600 007 : 2012, Tamil Nadu Veterinary and Animal Sciences University, Chennai-600 051

Name of the student Degree for submitted which

Name of the Chairman

Department Place Year and University

Dogs presented with clinical signs of hip dysplasia to the Small Animal Orthopaedic unit of Madras Veterinary College Teaching Hospital were selected for the study. Clinically hip dysplastic German shepherd and Labrador retriever breeds of dogs were grouped into two groups of six numbers and subjected to hip assessment before and after skeletal maturity of long bones. The incidence of hip dysplasia with regard to age, breed and sex of 322 dogs during study period were recorded as percentage. The clinical signs, physical palpation by Ortolani manouver and haematobiochemical parameters were studied and recorded in both the groups. Under general anaesthesia radiography of hips was performed in different positioning methods namely, Standard Ventro dorsal view(SVDV), Distraction view(DV), Weight bearing view, Dorsal acetabular rim view and 60 degree stress view. From those hip

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positioning views, six different quantitative measurements of hips were calculated to grade the hips for dysplasia namely Norberg angle (NA), Distraction index (DI), Dorsolateral subluxation index (DLSI), Acetabular slope angle (ASA), Central edge angle (CEA) and Subluxation index (SI). Management and feeding schedule were advised during skeletal maturity period. The quantitative radiographic assessments of hips were repeated after skeletal maturity of long bones in all the cases in both the groups. The initial and final scores of quantitative radiographic hip assessment before and after skeletal maturity period were correlated and analyzed statistically. The score obtained from the above six quantitative radiographic methods were statistically correlated with each other and the best related methods were identified and discussed critically. The clinical symptoms, physical palpation by Ortolani maneuver were correlated with those quantitative measurements and found that in group I and group II dogs there was an improvement in pain score during skeletal maturity period whereas Lameness score was improved only in group I dogs. No significant difference observed in hematological and biochemical parameters among Group I and Group II animals between pre and post skeletal maturity period. Correlation between the Quantitative radiographic measurements were showed that high correlation between NA and DLSI, DI and SI. More relative correlation was seen between NA to DLSI and DI to SI. DI highly correlated with SI in both groups. Values which were normal and near normal, highly correlated with each others in all quantitative radiographic assessment methods.

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Contents

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CONTENTS
CHAPTER NO. LIST OF TABLES LIST OF FIGURES LIST OF PLATES LIST OF ABBREVIATIONS I II 2.1 2.1.1 2.1.2 2.1.3 2.1.4 2.1.5 2.1.6 2.2 2.3 2.3.1 2.3.2 2.3.3 2.4 2.4.1 2.4.2 2.5 2.6 2.6.1 2.6.2 2.6.3 2.6.4 2.6.5 INTRODUCTION REVIEW OF LITERATURE Incidence of hip dysplasia in dogs Congenital Breed predisposition Environmental factors Nutrition Hormonal effects Level of Activity Pathophysiology Clinical signs Pain Lameness Gait Physical examination Ortolani sign Barden`s test Radiological signs Quantitative radiological measurements Norberg angle Distraction index Subluxation index Dorsolateral Subluxation index Central edge angle 1 3 3 3 3 4 4 6 7 8 9 9 9 9 10 10 11 11 13 13 14 16 16 17 PAGE NO.

TITLE

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CHAPTER NO. 2.6.6 2.7 2.7.1 2.7.2 2.7.3 2.7.4 III 3.1 3.1.1 3.2 3.3 3.3.1 3.3.2 3.3.3 3.3.3.1 3.4 3.4.1 3.4.2 3.5 3.6 3.6.1 3.6.1.1 3.6.1.2 3.6.2 3.6.3 3.6.4 3.6.4.1 3.6.4.2 3.6.5 3.7 3.8 Acetabular slope angle Medical management Neutraceuticals Dietary management Physical therapy Genetic control

TITLE

PAGE NO. 17 18 18 18 18 19 20 20 20 22 22 22 22 23 23 23 23 23 24 24 24 24 26 26 31 35 35 35 38 38 41

MATERIALS AND METHODS Selection of cases Design of experiment Incidence of age, breed and sex Clinical signs Pain Lameness Physical palpation Ortolani Sign Haematological and Biochemical Parameters Haematological Parameters Biochemical parameters Anaesthetic protocol Quantitative radiographic assessment Hip Extended view Radiographic signs Norberg angle Distraction view and distraction index Dorsoventral view for Dorsolateral subluxation score Dorsal acetabular rim view Central edge angle Acetabular slope angle Stress radiographic view Degree of hip dysplasia in different quantitative assessment methods Statistical analysis

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CHAPTER NO. IV 4.1 4.1.1 4.1.2 4.1.3 4.1.4 4.2 4.2.1 4.2.2 4.3 4.3.1 4.4 4.4.1 4.4.2 4.4.3 4.4.4 4.4.5 4.4.6 4.4.7 4.4.8 4.4.9 4.4.10 4.4.11 4.5 4.5.1 4.5.2 4.5.3 4.5.4 4.5.5 RESULTS Incidence Age Sex Size of the animal Breed Clinical symptoms Pain Lameness

TITLE

PAGE NO. 42 42 42 42 42 42 46 46 46 49 49 49 49 49 51 51 51 51 52 52 52 53 53 53 53 56 57 57 58

Physical Palpation findings Ortolani sign Haematological and biochemical parameters Haemoglobin Packed Cell volume Red Blood Cell Count White Blood Cell Count Neutrophils Lymphocytes Serum alkaline phosphatase Total protein Albumin Calcium Phosphorus Quantitative radiographic assessment Norberg angle Distraction index Dorsolateral subluxation score Central edge angle Acetabular slope angle

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CHAPTER NO. 4.5.6 4.6 4.6.1 Subluxation index

TITLE

PAGE NO. 59 59 59

Correlation between quantitative radiographic assessments Correlation between Quantitative Radiographic Assessment Techniques in group I dogs during pre and post skeletal maturity period Correlation between Quantitative Radiographic Assessment Techniques in group II dogs during pre and post skeletal maturity period DISCUSSION Incidence Age Sex Size of the animal Breed Clinical symptoms Pain Lameness Physical Palpation by Ortolani manoeuver Haematological and biochemical parameters Quantitative Radiographic Assessment Norberg angle Distraction index Dorsolateral subluxation score Central edge angle and Acetabular slope angle Subluxation index Correlation between different quantitative radiographic assessment techniques SUMMARY BIBLIOGRAPHY

4.6.2

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V 5.1 5.1.1 5.1.2 5.1.3 5.1.4 5.2 5.2.1 5.2.2 5.3 5.4 5.5 5.5.1 5.5.2 5.5.3 5.5.4 5.5.5 5.6 VI

69 69 69 69 69 70 70 70 70 71 71 71 71 72 73 73 74 74 75 79

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List of Tables

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LIST OF TABLES
Table No. 1 2 3 4 5 6 7 8 Page No. 44 47 48 50 54 55 60 61

Title
Incidence of Hip dysplasia based on size of the animal Pain scoring in Group I and Group II dogs during pre and post skeletal maturity period Lameness scoring in Group I and Group II dogs during pre and post skeletal maturity period Ortolani sign in Group I and Group II dogs during pre and post skeletal maturity period

Hematological and biochemical parameters in group I dogs Hematological and biochemical parameters in group II dogs Quantitative Radiographic measurements in group I dogs during pre skeletal maturity period Quantitative Radiographic measurements in group I dogs during post skeletal maturity period Quantitative Radiographic measurements in group II dogs during pre skeletal maturity period Quantitative Radiographic measurements in group II dogs during post skeletal maturity period Paired `t`-Test in group I dogs during Pre and Post skeletal maturity period Paired `t`-Test in group II dogs during Pre and Post skeletal maturity period Correlation between Quantitative Radiographic Assessment Techniques in group I dogs during pre and post skeletal maturity period Correlation between Quantitative Radiographic Assessment Techniques in group II dogs during pre and post skeletal maturity period

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List of Figures

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LIST OF FIGURES
Figure No. 1 2 3 Page No. 43 43 45

Title Age wise incidence of hip dysplasia Sex wise incidence of hip dysplasia
Incidence in Large sized breeds

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List of Plates

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LIST OF PLATES
Plate No. 1 2 3 4 5 6 7 8 9 10 Title Clinical signs of hip dysplasia Positioning the dog for Norberg angle assessment standard ventro dorsal view Radiograph showing the measurement of norbreg angle from standard ventro dorsal view Custom deviced distractor used for distraction index assessment Positioning the dog for distraction index assessment distraction view Radiograph showing the measurement of distraction index from distraction view Positioning foam bed used for dorsolateral subluxation index assessment Positioning the dog for dorsolateral subluxation index assessment - weight bearing view Radiograph showing the measurement of dorsolateral subluxation index from weight bearing view Positioning the dog for central edge angle and acetabular slope angle assessment - dorsal acetabular rim view Radiograph showing the measurement of central edge angle and acetabular slope angle from dorsal acetabular rim view Positioning the dog for subluxation index assessment - 60 degree stress view Radiograph showing the measurement of subluxation index from 60 degree stress view Page No. 21 25 27 28 29 30 32 33 34

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List of Abbreviations

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LIST OF ABBREVIATIONS
ASA CEA CHD DI DJD DLSI HAP HD HJL NA OA QHAT SI SVDV Acetabular Slope Angle Central Edge Angle Canine Hip Dysplasia Distraction Index Degenerative Joint Disease Dorso Lateral Subluxation Index Half Axial Positioning Hip Dysplasia Hip Joint Laxity Norberg Angle Osteoarthritis Quantitative Hip Assessment Technique Subluxation Index Standard Ventro Dorsal View

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Introduction

CHAPTER I INTRODUCTION
Hip dysplasia in dogs is a multi factorial orthopaedic disease affecting the hip joints. The disease is polygenetic in origin and hence its control is attributed to selective breeding of dogs with normal hips. The main reasons for hip dysplasia are poor genetic quality of breeding dogs, indiscriminate breeding and inbreeding between dysplastic littermates (Ginja et al., 2008b). The occurrence of hip dysplasia may get reduced only if the genetic quality of breeding animals is ascertained more exactly (Janutta et al., 2008). This can be achieved by estimating the breeding value of an animal through anatomical and physiological assessment of hips by radiographic procedure. In dogs, hip dysplasia could present substantial challenges to the veterinarian because anatomical features of hip joint differ differently with different breeds and the fact that hip dysplasia is often diagnosed wrongly and sometimes delayed (Fluckiger et al., 1999). Therefore many hip assessment techniques were developed to diagnose this genetic condition at different age groups to select dogs for potential breeding and management. Different techniques of radiographic assessment for diagnosis of hip dysplasia are based on subjective and quantitative evaluations, evolved over the years. Among these, subjective assessment depends on the cumulative assessment of a hip joint by a team of radiologists, which in turn needs extensive monitoring and recording system with less dependable results (Farrell et al., 2007). A large number of quantitative measurement methods are being practiced in different countries all over the world to diagnose hip dysplasia. No single method has been proved to be an effective predictor of the disease (Fries and Remedios, 1995).

Based on the above facts, this study was undertaken to carryout different quantitative hip assessment techniques on skeletally immature and mature German Shepherd and Labrador Retriever breeds of dogs with the following objectives. 1. To study the incidence and aetiology of hip dysplasia in German shepherd and Labrador retriever breeds of dogs. 2. To study the clinical symptoms, physical palpation, haematobiochemical parameters and radiological signs in German shepherd and Labrador retriever breeds of dogs. 3. To correlate different hip assessment techniques during pre and post skeletal maturity period in German shepherd and Labrador retriever breeds of dogs. 4. To evaluate various radiographic procedures used for hip assessment during pre and post skeletal maturity period in German shepherd and Labrador retriever breeds of dogs.

Review of Literature

CHAPTER II REVIEW OF LITERATURE


2.1. INCIDENCE OF HIP DYSPLASIA IN DOGS

2.1.1. Congenital Mackenzie et al. (1985) stated that hip dysplasia was a polygenic trait caused by the interaction of hundreds of genes, each contributing a small part to the disease. At least one pair of these genes was believed to be recessive. The authors found that it was an additive trait where the severity of an individual's disease was determined by the number of affected genes present. Mki et al. (2000) found that dogs with a normal radiographic phenotype could still be carriers of certain dysplasia genes and transmit these genes to their offspring. Mki et al. (2004) observed that hip dysplasia (HD) was an inherited, noncongenital disease that was particularly prevalent in large and giant breeds of dog. The authors reported that some of the possible major genes were found to be recessive, making the use of phenotypic selection against HD ineffective resulting in very small or negligible genetic progress. Ginja et al. (2008a) stated that Hip Joint Laxity heritability was higher than the heritability of Hip Dysplasia at 0.85 and 0.43 respectively. 2.1.2. Breed predisposition Lust et al. (1973) reported that Labrador Retrievers had a high incidence (20 to 30 per cent) of hip dysplasia, and the period between 3 and 8 months appeared to be important since during that time the initial diagnosis of the disease was made. Smith et al. (1990) observed that dogs with a DI less than 0.3 did not develop CHD. In a similar study, 87 per cent of Labrador Retrievers with a DI less

than 0.4 at the age of 4 months developed normal hips, whereas 57 per cent of dogs with a DI 0.4 or greater became dysplastic. Popovitch et al. (1995) reported that, with the same DI, German shepherd dogs tended to develop coxarthrosis more readily than Rottweilers breeds of dogs. Culp et al. (2006) reported mean Norberg angle for German shepherd dogs was 99.6 and ranged from 86 to109 and for Labrador retriever was 101 ranged from 81 to110 measured from three hundered and fifty clinically normal dogs. 2.1.3. Environmental factors Kasstrom (1975) stated that without genetic predisposition, environmental influences alone could not create hip dysplasia in dogs. Bennett (1987) found no evidence in the scientific literature that mega dose of vitamin C or any other multi-vitamin/mineral supplement were beneficial in reducing the effects or preventing hip dysplasia Mki et al. (2000) observed that the phenotypic expression of HD in dogs genetically predisposed to the condition might be modified by environmental risk factors such as nutrition, exercise, bodyweight, birth weight, number of puppies in the litter, age of the dam, floor cover, pre-weaning mortality rate in the litter, season of birth and hip laxity. Silvestre et al. (2007) found that expression of HD genes would be influenced by a number of environmental factors. 2.1.4. Nutrition Kasstrom (1975) reported that a higher than needed caloric intake during the rapid growth phase might result in earlier and more severe dysplastic changes when the genetic potential for dysplasia was present. Lower caloric intake might minimize

or delay the evidence of dysplasia in the same dog, but would not change the genotype. Belfield (1976) stated that, dogs could synthesis vitamins necessary for collagen formation. Feeding high doses of vitamin C to pregnant bitches and their offspring until 2 years of age was reported to eliminate hip dysplasia. Bennett (1987) stated that excess vitamin C in puppies caused hypercalcemia and might delay bone remodeling and cartilage maturation. There was no scientific evidence that supplementing high doses of vitamin C in the diet of growing puppies prevented hip dysplasia. Hansen (1989) reported that there was no difference in plasma amino acid concentrations between normal and dysplastic dogs. Hazewinkel (1989) reported that high calcium decreased osteoclastic activity, delaying endochondral ossification and skeletal remodeling. The absolute amount of calcium rather than the calcium:phosphorus ratio was more important. The author also studied that young dogs did not have a protective mechanism against excess dietary calcium. High dietary levels increased the amount of calcium absorbed from the gastrointestinal tract. Hazewinkel (1994) stated that nutrition was a major environmental factor influencing the development of hip dysplasia, which changed the frequency and severity in genetically predisposed individuals, but it did not cause hip dysplasia. No dietary deficiencies were known to influence the development of hip dysplasia, but current research suggested that dietary excess of carbohydrate was important contributing factors. Current recommendations for large, growing dogs are to feed 15 grams of protein, 0.7 gram of calcium, and 30 IU of vitamin D per 1000 kJ of metabolizable energy. The author also reported that, vitamin D increased intestinal calcium absorption and renal resorption, excess vitamin D had an effect similar to

that of excess calcium. Excess dietary calcium and vitamin D might contribute to the development of hip dysplasia in genetically predisposed individuals and should be avoided in young, rapidly growing dogs. Kealy et al. (2000) stated that developemental orthopedic diseases with a demonstrated nutritional aetiology included canine hip dysplasia and

Osteochondritis Dissecans. The authors found that the development of degenerative joint disease associated with CHD could be manipulated to some extent by limited food consumption. 2.1.5. Hormonal effects Priester and Mulvihill (1972) studied the relative risk of sex, size and breed for canine hip dysplasia and reported that males and females were equally affected. The risk in giant breeds was 50 times more than small or medium sized breeds. Wallace (1987) stated that estrogen given to puppies could induce hip dysplasia, but Riser et al. (1985) stated that estrogen levels in dysplastic pups were not higher than in normal pups. Corley and Keller (1989) reported that, a number of hormones, including estrogen, relaxin, growth hormone, parathyroid hormone and insulin had been investigated as potential causes or contributing factors in hip dysplasia. Greg Keller (2006) stated that oestrus appeared to affect the reliability of diagnosis in some females during which some animals demonstrated a degree of subluxation (laxity) that was not present when the bitch was out of season, possibly due to the relaxation effects of estrogens on the ligaments and joint capsule. Radiography of these bitches might result in a false diagnosis of HD. The author suggested that following pregnancy, radiographs be taken at least one month after weaning the off spring.

2.1.6. Level of Activity Barr et al. (1987) observed that progression of the disease varied in hip dysplastic dogs and the clinical signs could sometimes be due to concurrent neurological or orthopaedic diseases of the hind limbs. Bennett and May (1995) reported that failure of muscles and skeleton to mature together at the right time results in joint instability. Smith et al. (1995) stated that hip joint laxity (HJL) was considered a major risk factor leading to abnormal weight-bearing forces and subsequent development of osteoarthritis during or after maturity. Cardinet et al. (1997) observed that greater pelvic muscle mass was associated with a reduced incidence of hip dysplasia. Moore et al. (2001) described HD as a biomechanical disease characterised by abnormal development of the hip joint and could be a highly debilitating condition for both working and pet dogs. Greg Keller (2006) stated that periods of prolonged inactivity might affect the reliability of diagnosis of HD. The author observed that few animals exhibited subluxation after prolonged periods of inactivity due to illness, weather conditions, etc. and on later examination, when the animal was in good muscular tone, the hips appeared normal. Therefore radiography was recommended when the animal was in good health and muscular tone. Manley et al. (2007) found that there were two ages at which dogs were presented with clinical signs of hip dysplasia; younger than one year of age with hip instability and overloading of some articular areas where in the pain was caused mainly by tearing or stretching of the round ligament, synovitis and acetabular microfractures and in adult dogs with chronic pain due to osteoarthritis.

2.2.

PATHOPHYSIOLOGY Lust and Summers (1981) and Shepherd (1986) reported that pups

genetically predisposed to hip dysplasia were normal at birth. Stretching of the joint capsule and ligament of the femoral head was observed as early as 2 weeks of age. Mild proliferative, nonsuppurative synovitis, edema, and fibroplasia of the ligament of the femoral head, as well as joint effusion, were present at 4th week. By 12th week, affected individuals had changes in both the synovium and the articular cartilage grossly with flaking and fissuring of the surface cartilage and microscopically, surface chondrocytes were lost and changes in the matrix's proteoglycan content and collagen fibril network had occurred. Lust et al. (1985) reported that cartilage degeneration, joint capsule thickening, stretching or rupture of the ligament of the femoral head, proliferation of the dorsal acetabular rim, thickening of the femoral neck and atrophy of local muscle was characterized in advanced hip dysplasia. At this point, joint stability might improve or progress to complete luxation. The rate and degree of disease progression varied with the individual and the amount of joint instability present. Alexander (1992) reported that hip dysplasia was a biomechanical disease where hip instability in the young dog altered the concentration of forces on the growing femoral head and acetabulum. This affected the bone growth and remodeling, resulting in abnormal joint conformation and secondary degenerative joint disease. Abnormal weight bearing forces caused microfractures in the subchondral bone of the dorsal acetabular rim and femoral head. With healing, the bone became harder and less able to absorb shock. More force was transmitted to the overlying cartilage, increasing its degeneration at these sites. Cartilage on the medial aspect of the femoral head and dorsal acetabular rim was gradually worn away, exposing the subchondral bone. The subchondral bone became sclerotic and eburnated. Sharpey's fibers were torn, causing osteophytes to form along the joint capsule's attachment to the acetabulum and femoral neck.

Kealy et al. (1993) observed that dysplastic dogs had higher synovial fluid osmolalities than did normal dogs due to differences in synovial fluid electrolyte concentrations of sodium, potassium and chloride. Smith (1998) stated that synovial fluid volume had been implicated in the pathogenesis of hip dysplasia through its effect on joint laxity. When normal synovial fluid volumes were present, displacement of the femur created negative intra articular pressure that tended to pull the femoral head back into the acetabulum. This mechanism was lost when joint effusion was present. 2.3. CLINICAL SIGNS

2.3.1. Pain Barr et al. (1987) observed that majority of dogs afflicted with HD showed minimal or no clinical sign. 2.3.2. Lameness Newton (1985) stated that the normal ranges of motion during different position were: flexion 70 to 80 , extension 80 to 90 , abduction 70 to 80 , adduction 30 to 40 , internal rotation 50 to 60 and external rotation 80 to 90 . Fry and Clark (1992) stated that a complete clinical examination should include observation of the patient at rest, walking and trotting and re-examination after vigorous exercise. 2.3.3. Gait Ginja et al. (2008b) reported that, gait abnormalities, such as stiffness, reduced height of step, shortened stride length, bunny hopping, difficulty in rising, climbing stairs or in jumping over obstacles were the typical clinical signs observed in dogs with hip dysplasia.

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2.4.

PHYSICAL EXAMINATION Fry and Clark (1992) had categorized number of clinical tests into two

groups that could give information about the hip joint. The first group of signs provided information on HJL, recommended mainly for use on young animals (Ortolani, Bardens and Barlow tests) and second group of signs to detect signs of osteoarthritis (palpation and range of motion tests). Farrell et al. (2007) reported that in case of OA crepitus might be detected during palpation of hip joint and the range of motion might be decreased due to the presence of osteophytes, capsular fibrosis, subluxation or fixed luxation. 2.4.1. Ortolani sign According to Chalman and Butler (1985) and Ginja et al. (2008c) Ortolani test is a common physical manipulation examination used in veterinary clinical medicine to diagnose Hip Joint Laxity. The dog is to be placed in lateral recumbency, the examiner stands behind the animal and grasps the upper stifle firmly putting the hip in a neutral position and the femur parallel to the surface of the examination table. A proximally directed force is applied to the shaft of the femur to elicit hip subluxation, while the pelvis is supported with the other hand. Then the stifle is slowly abducted to reduce the hip joint. Hip joints are considered to exhibit a positive Ortolani sign when a palpable or audible clunk was present during hip joint reduction. If a clunk cannot be elicited, the result of the Ortolani test was considered negative. Puerto et al. (1999) stated that a positive Ortolani test suggested excessive laxity, but its absence did not always indicate a tight hip. Fibrosis and thickening of the joint capsule, and the acetabular rim and femoral head destruction prevented the detectable clunk. The authors also found a significant relationship between the result of Ortolani maneuver and radiographic distraction index in the absence of any existing degenerative joint disease.

11

Adams et al. (2000) and Ginja et al. (2009) observed that Ortolani test also lacked sensitivity in puppies around 8 weeks of age but was most sensitive in young dogs older than 4 months of age. Vezzoni et al. (2008) reported that in positive cases of HD Ortolani technique could be used to determine the angles of reduction (AR) and angles of subluxation (AS), as the inclination of the femur relative to the sagittal plane at the moment of reduction and subluxation, respectively. This was particularly relevant when a triple pelvic osteotomy or pubic symphysiodesis were being considered. 2.4.2. Barden`s test Bardens and Hardwick (1968) stated that Bardens test was recommended to evaluate HJL in puppies at 6 to 8 weeks of age. With the animal on lateral recumbency, the examiners stand behind the puppy and grasp the upper femur. Upward pressure is applied by that hand to elevate the femur horizontally. The index finger of the other hand is placed on the greater trochanter and its mobility is used to estimate HJL. Adams et al. (2000) stated that only Bardens maneuver was significantly predictive of degenerative joint disease incidence when performed on 7.3 weeks old puppies. 2.5. RADIOLOGICAL SIGNS Riser (1975) reported that, the first signs of HD could be noticed as early as 30 to 60 days of age radiographically, characterised by femoral head subluxation and delayed ossification of the craniodorsal acetabular rim in severely affected individuals. Morgan (1987) observed that occurrence of caudolateral curvilinear osteophyte on the proximal aspect of femoral neck was an important radiological

12

sign of degenerative joint disease due to canine hip dysplasia in young large breed dogs. Corley (1992) reported radiographic changes as early as the 7th week after birth in severely dysplastic hips, however in mild dysplasia the secondary radiographic changes might not be apparent until 14 months of age or older. Flckiger (1995) and Gibbs (1997) reported that a definitive diagnosis could be made, only if characteristic signs of HD were evident on a standard ventro dorsal radiograph of the pelvis. Powers et al. (2004) stated that an indistinct linear sclerosis on the femoral neck termed as puppy line had been reported as an incidental, transient radiographic finding that could be confused with caudolateral curvilinear osteophyte in dogs up to 18 months of age but distinction between the caudolateral curvilinear osteophyte and the puppy line had not been established. The caudolateral curvilinear osteophyte was a distinct white line on the femoral neck while the puppy line was a less distinct line on the femoral neck, both were seen on the extended hip ventro-dorsal pelvic radiograph. Szabo et al. (2007) observed that a circumferential femoral head osteophyte was also associated with degenerative joint disease due to canine hip dysplasia. This radiographic finding was defined as a thick, indistinctly margined to thin, faint, radiopaque line encircling the junction of the femoral neck and head at the region of attachment of the joint capsule. Ginja et al. (2009) stated that radiographic studies could be separated into two main groups: (1) to evaluate joint congruence and to detect signs of osteoarthritis using the standard ventrodorsal hip extended view (SVDV) and (2) to provide information on HJL demonstrated by stress radiography (PennHIP, dorsolateral subluxation [DLS], Fluckiger and Half-Axial Position [HAP] methods).The authors also insisted that these radiographic techniques were to be performed under anaesthesia or heavy sedation, to facilitate accurate positioning and decrease the need for repeat films and human restraint.

13

Risler et al. (2009) stated that the age of 24 weeks, at which time the presence of a femoral neck line, termed caudolateral curvilinear osteophyte or Morgan line might be predictive of subsequent canine hip dysplasia and degenerative joint disease. If both caudolateral curvilinear osteophyte and a circumferential femoral head osteophyte were present at 24 to 27 weeks of age and radiographic signs of hip degenerative joint disease by one year of age were certain in large breeds of dogs. 2.6. QUANTITATIVE RADIOLOGICAL MEASUREMENTS

2.6.1. Norberg angle Olsson (1961) reported that Norberg angle (NA) was a measurement used in the evaluation of canine femoral head displacement from the aetabulum. The author stated that, for the depth to be considered normal, the cranial edge of the acetabulum had to be considerd normal. The cranial edge of the acetabulum had to be situated not less than 15 laterally to a line at right angles to the line between the centers of the femoral heads. Essentially, it was established that NA of <105 was indicative of abnormal hip status and it had to be measured on a hip extended radiographic projection. Smith et al. (1990) and Vezzoni et al. (2005) observed that the SVDV had been considered to lack sensitivity while detecting HJL because the standard position tightened the joint capsule, the ligaments of the femoral head and associated muscles. Corley (1992) recommended the Orthopaedic Foundation for Animals (OFA) guidelines commonly used in the United States for scoring of hip dysplasia. In that seven grades were used (three normal, one borderline and three dysplastic). Flckiger (1995) stated that there were other screening and scoring methods in other countries, such as the system used in Switzerland, which evaluated six parameters using a score of 0 to 5 (total score ranging from 0 to 30).

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Gibbs (1997) stated that the British Veterinary Association/Kennel Club scoring scheme was commonly used in UK and was based on a detailed points system for the assessment of radiographic features. Nine parameters for each joint were evaluated and each parameter was given a score between 0 and 6 (except for one parameter which was scored 0 to 5). The total score thus ranged from 0 to 106. Ginja et al. (2008b) stated that the SVDV was a universal view that involves placing the dog in dorsal recumbency on the X-ray table, with the rear limbs extended parallel to each other and the stifles internally rotated. The correct positioning of the dog was of utmost importance for an accurate radiographic interpretation, the pelvis should be positioned symmetrically with the femurs parallel to each other and the patella superimposed over the centre of the femoral condyles. Genevois et al. (2008) stated that, Federation Cynologique Internationale followed in France, which does not require any sedation or anaesthesia for radiographic evaluation of hips. Lack of muscle relaxation clearly influenced the HD score and was preferred by owners. 2.6.2. Distraction index Smith et al. (1990) stated that the PennHIP method required appropriate training to certify users and incorporated three radiographic views of the dog in the supine position: hip-extended, compression and distraction. The distraction view was taken with the hips at a neutral position and maximally displaced laterally using the PennHIP distractor and was used to estimate HJL by calculating the distraction index (DI). To calculate the DI, the distance between the geometric centres of the acetabulum and the femoral head was divided by the radius of the femoral head. The DI ranged from 0 to 1, with 0 representing full congruency of the hip joint and 1 representing complete luxation. Heyman et al. (1993) positioned the hindlimbs at an 80 angle to the table top, avoiding joint capsule tensioning. The authors used a distractor but could

15

achieve lateral displacement only because there was no dorsal force component. The degree of instability was quantified by a dimensionless distraction index (DI = d/r), defined as the ratio of the distance from the center of the femoral head to the center of the acetabulum (d) and the radius of femoral head (r). Lust et al. (1993), Ginja et al. (2008c) and Ginja et al. (2009) found that HJL estimated using the distraction index in stress radiographs in dogs at 2 months and 4 months of age was correlated or associated with HJL and HD after 1 year of age. Popovitch et al. (1995) reported that Penn HIP(University of Pennsylvania Hip Improvement Program, Philadelphia, PA) method was another radiographic method to assess hip status. It incorporated 3 radiographic views: standard hipextended projection, a compression projection and a distraction projection. The distraction radiograph was originally developed to quatitate the amount of passive hip laxity of the coxofemoral joint reported as a distraction index (DI). Hip laxity (DI) profiles vary among breeds, but in general, a DI of < 0.3 for all breeds signified minimal chance of developing radiographic DJD. Dogs with DI values increased susceptibility for radiographic hip DJD as the DI increases. According to Smith et al. (1995) the admissible DI range for normal coxofemoral development varied among breeds. Adams et al. (2000) stated that distraction indices measured from radiographs in 6.5 to 9.0 weeks old pups might not correlate with PennHip measurements in the same dogs at one year of age. The authors also studied hips with distraction index measurement greater than 0.60 or greater than 0.70 at 7.3 weeks, 24 per cent and 33 per cent developed degenerative joint disease by one year respectively. Culp et al. (2006) reported that the linear correlation between NA and DI was (0.336) in German shepherd breed of dogs and (0.452) in Labrador retriever breed of dogs and also reported that the concordance of positive susceptibility using 0.3 had an

16

NA threshold of <105 and DI threshold of >0.32 was 56 per cent and 44 per cent in German shepherd and Labrador retriever breeds of dogs respectively. 2.6.3. Subluxation index Smith et al. (1990) stated that, coxofemoral laxity was considered the most important factor promoting CHD. The degree of coxofemoral joint laxity could be evaluated reliably using the standard radiographic positioning of the dog with the hindlimbs pulled caudally and rotated inwards because SVDV method caused overextension of the hip joint and spiral tensioning of the nonelastic joint capsule that resulted in repositioning of a subluxated femoral head back into the acetabulum. Flckiger et al. (1999) stated that the Flckiger method to created the stress view of hip joint in the dogs placed in dorsal recumbency on the X-ray table. The femurs were positioned at a 60 angle to the table surface, the stifles were adducted and manually pushed craniodorsally by the examiner during X-ray exposure. The degree of laxity was calculated in the same way as the DI but was defined as the subluxation index. 2.6.4. Dorsolateral Subluxation index Farese et al. (1998) reported that for DLS test, no manual restraint was required, the dogs were placed in sternal recumbency in a kneeling position on a foam containing openings for the hind limbs. The hind limbs were fixed in an adducted position with medical tape, proximal to the stifles and around the hocks. The HJL was estimated by calculating the DLS score. To calculate the DLS score, the perpendicular distance between the most medial edge of the femoral head and the lateral margin of the cranial acetabulum was divided by the diameter of the femoral head. The DLS showed a strong correlation with the DI in 8 month old dogs. Farese et al. (1999) found that DLS and DI measured different components of the hip joint; DLS test was specially indicated to evaluate the chondro-osseous conformation whereas DI represented passive laxity of the joint and was

17

independent of the potential stabilising effects of the acetabulum on femoral head positioned within the joint. The authors noticed that intra- articular injection of 2 mL of sodium hyaluronate increased the mean DI by 56 per cent and decreased the mean DLS score minimally 2.5 per cent. 2.6.5. Central edge angle Meomartino et al. (2002) calculated the mean central edge angle for normal and dysplastic dogs, as No signs of dysplasia Borderline hips joints Mild dysplasia Moderate dysplasia Severe dysplasia 16.91 12.55 10.65 6.62 9.25

2.6.6. Acetabular slope angle Slocum and Devine (1990) measured the acetabular slope angle from dorsal acetabular rim radiographic view for evaluation of acetabualr coverage. Meomartino et al. (2002) calculated the mean acetabular slope angle for normal and dysplastic dogs, as No signs of dysplasia Borderline hips joints Mild dysplasia Moderate dysplasia Severe dysplasia 7.14 11.6 11.84 15.04 25.23

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2.7.

MEDICAL MANAGEMENT

2.7.1. Neutraceuticals Lust et al. (1992) stated that puppies treated prophylactically with intramuscular injections of poly-sulfated glycosaminoglycans showed less subluxation than untreated animals. The published outcomes of long-term results of non-surgical management of HD in dogs are controversial, some being considered favourable (Barr et al., 1987) and others unfavourable (Farrell et al., 2007 and Vezzoni et al., 2008). According to Manley et al. (2007) and Vezzoni et al. (2008) conservative management may be effective in palliating the discomfort associated with HD or HJL, but was unlikely to prevent development and progression of osteoarthritis. 2.7.2. Dietary management Kealy et al. (1992) studied that limiting food consumption to 75 per cent of the amount given to ad libitum-fed control dogs after 8 weeks of age resulted in a 67 per cent reduction in HD prevalence at 2 years of age. Vezzoni et al. (2008) reported that prevention of obesity was recommended as a way to decrease the stress placed on joints and periarticular tissues. A nonweight bearing activity such as swimming yielded positive benefits of exercise on muscle strength and cartilage nutrition without undesirable secondary effects. 2.7.3. Physical therapy Riser (1975) stated that restricting exercise by confining puppies in a cage had been reported as an alternative for young dogs with a predisposition to HD development. By confining a puppy in a small area they stay seated for long periods, thereby maintaining an abduction-flexion position, which supports a forced hip congruence. However, this treatment was not recommended since such dogs did not develop socially.

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Barr et al. (1987) observed that some chronic hip alterations (i.e. bony remodelling, fibrosis and thickening of the joint capsule) actually improved joint congruity and stability, which resulted in spontaneous improvement in hind-limb function. Johnson et al. (1998) and Farrell et al. (2007) reported that HD was generally diagnosed by worsening of symptoms when osteoarthritis was already at an advanced stage that renders conservative or surgical therapy practically useless to limit the development of the disease or its severity. Treatments were focused on alleviating pain and improving the function of the hip joints and quality of life. 2.7.4. Genetic control Smith (1998) stated that controlling polygenic diseases like HD required selective breeding programmes. Since there were no definitive molecular diagnostic tests, the animals genotype was estimated by evaluating hip phenotype. The relationship between phenotype and genotype resulted in the concept of heritability, defined as the ratio of additive genetic variance to the overall phenotypic variance. Chase et al. (2004) and Todhunter et al. (2005) attempted the isolation of genetic markers for diagnosis of HD in dogs and they also found that complex segregation and molecular genetic analysis revealed that major dominant and recessives genes for HD existed in dogs, few major genes were responsible for the major differences in favourable or unfavourable hip conformation. Janutta and Distl (2006) reported that the possible existence of major genes and the detection of quantitative trait loci associated with HD could be important for diagnosis and selection against HD, which enabled the elimination of carriers from breeding programmes. Farrell et al. (2007), Ginja et al. (2008b) and Janutta et al. (2008) stated that active genetic control based on diagnostic tests for HD and selective breeding were the best tools to achieve genetic changes decreasing the disease to acceptable levels.

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Materials and Methods

20

CHAPTER III MATERIALS AND METHODS


3.1 SELCTION OF CASES Dogs presented with clinical signs of hip dysplasia to the Small Animal Orthopedic unit of Madras Veterinary College Teaching Hospital were selected for the study (Plate 1). 3.1.1 Design of Experiment Based on the age of occurrence of clinical symptoms suggestive of hip dysplasia, 12 dogs were selected for the study and grouped. Clinically hip dysplastic German shepherd and Labrador retriever breeds of dogs were grouped into two groups of six numbers in each groups and subjected to hip assessment before and after skeletal maturity of long bones. Groups Group I Group II Breed German shepherd Labrador retriever : No of Animals 6 6 Hip Assessment Period Before skeletal maturity Before skeletal maturity After skeletal maturity After skeletal maturity

Initial assessment

Before skeletal maturity: Assessment was performed between four and nine months of age. After skeletal maturity: After nine months of age with a minimum interval of three months between the assessment.

Reassessment

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PLATE 1 CLINICAL SIGNS OF HIP DYSPLASIA

22

3.2

INCIDENCE OF AGE, BREED AND SEX The incidence of hip dysplasia with regard to age, breed and sex of dogs

were recorded in percentage. 3.3 CLINIAL SIGNS The following clinical signs of hip dysplasia were studied. 3.3.1 Pain The degree of pain in hip dysplasia was assessed by a numerical rating system which was advocated by Hielm-Bjorkman et al. (2003). The factors considered for pain assessment were `mood with a score very alert = 0, alert = 1, neither nor indifferent = 2, indifferent = 3 and very indifferent = 4; willingness to play games scored as very willing = 0, willing = 1, reluctant = 2, very reluctant = 3 and does not participate at all = 4; vocalization scored as never = 0, hardly ever = 1, sometimes = 2, often =3 and very often =4; Walking, trotting, jumping and galloping were scored as very willingly = 0, willingly = 1, reluctantly = 2, very reluctantly = 3 and does not participate in action at all = 4; Lying down and getting up was scored as with great ease = 0, easily = 1, neither easily nor with difficulty = 3 and with great difficulty = 4; Problems with moving after long rest and exercise were scored as never = 0, hardly ever = 1, sometimes = 2, often = 3, very often = 4. 3.3.2 Lameness The degree of lameness was assessed by a score system suggested by Welsh et al. (1993). The score assigned were clinically sound = 0, barely detectable lameness = 1, obvious lameness =2, severe head nod and resting the affected hind leg = 3, carrying the leg at the trot = 4. The individual lameness score of left and right hind legs in dogs of group I and group II was recorded.

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3.3.3 Physical palpation The physical palpation of the hip joints was performed in the dorsal recumbency using Ortolani method of palpation under general anesthesia prior to quantitative radiographic assessment (Chalman and Butler, 1985). 3.3.3.1 Ortolani Sign The dog was positioned in dorsal recumbency and the examiner stood behind the animal and grasped the stifles firmly (with the femur perpendicular to the surface of the examination table). Pressure was applied down the shaft of the femur towards the acetabulum. Each femur was individually abducted to its limit. In dysplastic dogs downwards pressure on the femur elicited audible or palpable clunk as the subluxated femur was reduced (Chalman and Butler, 1985). A palpable or audible clunk during the technique was known as a positive Ortolani sign. The presence or absence of Ortolani sign was recorded in percentage in group I and group II dogs. 3.4 HAEMATOLOGICAL AND BIOCHEMICAL PARAMETERS

3.4.1 Haematological Parameters EDTA sample of blood was collected and the haematological parameters such as haemoglobin, PCV, red blood cell count and differential count were recorded in both group I and II (Coles, 1986). 3.4.2. Biochemical parameters The serum samples were collected and the biochemical parameters such as calcium, phosphorus, serum alkaline phosphatase and total protein were estimated in group I and II.

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3.5.

ANAESTHETIC PROTOCOL The dogs were premedicated with atropine sulphate at the dose rate of

0.04mg/kg intramuscularly and sedated with xylazine at the dose rate of 1mg/kg intramuscularly and general anaesthesia was induced with ketamine (at the dose rate of 5mg/kg) and diazepam (at the dose rate of 0.125mg/kg) combination (4 ml of Ketamine 50mg/ml + 1 ml of diazepam 5mg/ml) to effect and maintained by half the dose of induction, as and when required. 3.6 QUANTITATIVE RADIOGRAPHIC ASSESSMENT All the twelve dogs were anaesthetized and subjected to the following six different quantitative radiographic hip assessment methods before skeletal maturity of long bones. 3.6.1 Hip Extended view The anaesthetized dog was positioned in dorsal recumbency and the cranial position of the patient was supported with the aid of sand bags (Plate 2). The hind limbs were held at the level of the hocks and pulled in a distal caudal direction. The hind limbs were rotated medially to superimpose the patella over the sagittal plane of femurs and the femurs were kept parallel to each other and along with the long axis of the veretebrae. The paws were placed 4 to 5 inches (10 to 12.5cm) above the table top in giant breeds of dogs and 2 to 3 inches (5 to 7.5 cm) in small breeds in order to relive excessive tension of pelvic muscles (Rendano and Ryan, 1985). 3.6.1.1 Radiographic signs The radiographic signs suggestive of hip dysplasia in dogs were studied from the standard hip extended view. The radiographic signs such as subluxation of femoral head and presence or absence of remodeling changes were observed and recorded.

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PLATE 2 POSITIONING THE DOG FOR NORBERG ANGLE ASSESSMENT - STANDARD VENTRO DORSAL VIEW

26

3.6.1.2 Norberg angle The standard hip extended radiographic view was used for measurement of Norberg angle. The femoral head centers were found and joined by a straight line. Each femoral head center was then connected to the tangential line of the ipsilateral cranial dorsal acetabular edges. The angle subtended by the tangential line of the dorsal acetabular edge and the line joining the femoral head centers was the Norberg angle (Adams et al., 2000) (Plate 3). 3.6.2 Distraction view and distraction index: For radiography of the hips in the distraction view, the dog was positioned in dorsal recumbency. A fabricated adjustable wooden frame aluminium distractor (Plate 4) was placed between the hind-legs, and an assistant firmly pressed it down onto the pelvis. While grasping the hocks, the examiner pushed the knees together, using the device as a fulcrum to impose a lateral distractive force on the hip joints. The spacing of the distractor bars was set at approximately with the interacetabular distance. This spacing allowed for the proper stance-phase distance between the knees during force application of the distraction procedure. Even and firm downward force on the distractor helped to maintain pelvic positioning while manipulation was performed. Distraction was maintained for a short duration sufficient enough to permit exposure of the radiographic film (Plate 5). The DI was calculated from the following formula DI =d/r, (Plate 6) d- separation distance after the distraction between the femoral head center and acetabular centre of each hip joint, measured in centimeter.

27

PLATE 3 RADIOGRAPH SHOWING THE MEASUREMENT OF NORBREG ANGLE FROM STANDARD VENTRO DORSAL VIEW

28

PLATE 4 CUSTOM DEVICED DISTRACTOR USED FOR DISTRACTION INDEX ASSESSMENT

29

PLATE 5 POSITIONING THE DOG FOR DISTRACTION INDEX ASSESSMENT - DISTRACTION VIEW

30

PLATE 6 RADIOGRAPH SHOWING THE MEASUREMENT OF DISTRACTION INDEX FROM DISTRACTION VIEW

31

r radius of the femoral head of that particular hip joint measured in centimeters.(Smith et al., 1990) 3.6.3 Dorsoventral view for Dorsolateral subluxation score: The hind limbs of the anaesthetized dogs were positioned in an adducted position with medial tape, proximal to the stifle for the DLS test. The hocks were adducted and held together with tape. The dog were positioned in sternal recumbency an a kneeling position on a foam pad, with their hock joints extended, the stifles flexed and placed through a cut opening of 7`` diameter in the foam pad measuring 4524 4 (Plate 7). Cotton was packed within the cut opening between the foam pad and the thighs of the dog to help in proper positioning of the hind limb. The hole in the pad allowed the stifle to have direct contact with the table and transmit force along the longitudinal axis of the femur to the hip joints, permitting dorsolateral subluxation of the femoral heads. The hips were slightly extended so that the diaphyses were nearly perpendicular to the table but not superimposed over the femoral heads and acetabulae. The hocks, hind paws and trochanter were checked for symmetry from the lateral and caudal aspects. The image was evaluated for positioning and symmetry on the doesoventral radiographic projection (Plate 8). The DLS was a percentage calculated from the dorsoventral projection view in a DLS test. It was calculated from the formula DLS score = d/100 (Plate 9) d is the distance between the perpendicular lines dropped from the dorsal cranial acetabular edge and the perpendicular lines from the line joining the dorsal acetabular edges tangential to the femoral head of eah side of the coxofemoral joint and is the diameter of the femoral head of each side of the coxofemoral joint (Farese et al., 1998).

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PLATE 7 POSITIONING FOAM BED USED FOR DORSOLATERAL SUBLUXATION INDEX ASSESSMENT

33

PLATE 8 POSITIONING THE DOG FOR DORSOLATERAL SUBLUXATION INDEX ASSESSMENT - WEIGHT BEARING VIEW

34

PLATE 9 RADIOGRAPH SHOWING THE MEASUREMENT OF DORSOLATERAL SUBLUXATION INDEX FROM WEIGHT BEARING VIEW

35

3.6.4 Dorsal acetabular rim view Under general anesthesia, the dog was positioned in sternal reumbency. The hind limbs were pulled forward, so that the femurs were parallel with the long axis of the body. A belt was placed around the dog thighs and torso. This was to pull the femurs close to the dog`s body. The stifles were flexed so that the tibia was 90 to the femur and the hip was internally rotated 45 so that on the radiograph the greater trochanters did not usually interface with the dorsal acetabular rim. The hocks were raised by placing 2 inch tape underneath the tubercalcis. This placed a pull on the hamstring muscle and drew the tuber ischii cranially with respect to the tuber sacrale. This caused the pelvis to be aligned vertically so the x-ray beam passed through the shaft of the ilium (Plate 10). The ideal position of the pelvis was vertical alignment of tuber ischii and tuber sacrale with both the ischiatic tuberosities on the radiographic table. This position helped to prevent any rotation in the positioning of the dog on its sternum (Slocum and Devine, 1990). 3.6.4.1 Central edge angle The Central edge angle was calculated from the dorsal accetabular rim view. Central edge angle was defined by two straight lines originating from the centre of the femoral head of each hip joint (Plate 11). a. b. Tangential to the acetabular rim and Parallel to the mid sagittal line respectively (Meomartino et al., 2002).

3.6.4.2 Acetabular slope angle Acetabular slope angle was formed by a straight line tangential to the acetabulum at the point of lateral contact with the femoral head and by a line normal to the mid sagittal line (Meomartino et al., 2002) (Plate 11).

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PLATE 10 POSITIONING THE DOG FOR CENTRAL EDGE ANGLE AND ACETABULAR SLOPE ANGLE ASSESSMENT - DORSAL ACETABULAR RIM VIEW

37

PLATE 11 RADIOGRAPH SHOWING THE MEASUREMENT OF CENTRAL EDGE ANGLE AND ACETABULAR SLOPE ANGLE FROM DORSAL ACETABULAR RIM VIEW

38

3.6.5 Stress radiographic view This stress view was taken with the dog placed in dorsal recumbency. Femurs were positioned at 60 angle to the table top, stifles were adducted and manually pushed craniodorsally by a tester during exposure, the tibia served as a lever. Such manipulation resulted in cranial, dorsal, and lateral displacement of the femoral head in an unstable hip joint (Plate 12). Maximal subluxation was assumed as long as the radiographic angle formed by the line connecting the two femoral heads and the femoral longitudinal axis did not exceed 90 on each side. A slight pelvic tilt over the long axis, reflected by a difference of the obturator foramina diameters of up to 5 mm at their broadest, was tolerated. As more muscle tissue had to be penetrated, exposure was increased by 30% compared with the standard technique. The degree of laxity was quantified identical to the DI method described by Smith et al. (1995) but was termed subluxation index (SI) instead (Plate 13), to separate the results of the two dislocation techniques from each other. (Fluckiger, 1995 and Fluckiger et al., 1999) 3.7 DEGREE OF HIP DYSPLASIA IN DIFFERENT QUANTITATIVE ASSESSMENT METHODS Degree of NA hip (Degree) dysplasia Normal Moderate Severe >105 90-105 <90 <0.3 0.3-0.7 >0.7 >60 40-60 <40 >16 6-16 <6 <7 7-25 >25 <0.3 0.3-0.5 >0.5 (Ratio) (Percentage) (Degree) (Degree) (Ratio) DI DLS CEA ASA SI

39

PLATE 12 POSITIONING THE DOG FOR SUBLUXATION INDEX ASSESSMENT - 60 DEGREE STRESS VIEW

40

PLATE 13 RADIOGRAPH SHOWING THE MEASUREMENT OF SUBLUXATION INDEX FROM 60 DEGREE STRESS VIEW

41

Management and feeding schedule were advised during skeletal maturity period. The quantitative radiographic assessments of hip were repeated after skeletal maturity of long bones in all twelve cases from group I and group II. The initial and final scores of hip assessment before and after skeletal maturity period were correlated and analyzed statistically. 3.8 Statistical analysis The score obtained from the above six quantitative radiographic methods were recorded. The data obtained were analyzed statistically and discussed critically. The score obtained from the above six quantitative radiographic methods were statistically correlated with each other and the best related methods were identified and discussed critically.

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Results

42

CHAPTER IV RESULTS
4.1. INCIDENCE

4.1.1 Age Of the 322 dogs examined during the study period 46.27 per cent (149 dogs) were in the age group of less than 1 year, 31.67 per cent (102 dogs) were in the age group between 1-6 years and 22.04 per cent (71 dogs) were in the age group more than 6 years. (Figure 1) 4.1.2 Sex Of the 322 dogs studied 57.45 per cent (185 dogs) were males and 42.54 per cent (137 dogs) were females. (Figure 2) 4.1.3 Size of the animal Of the 322 dogs studied, small sized dogs weighing 1-10 kgs had an incidence of 13.04 per cent (42 dogs), medium sized dogs weighing 11-25 kgs had an incidence of 8.69 per cent (28 dogs) and large breeds weighing 26 kgs and above had a high incidence of 78.26 per cent (252 dogs). (Table 1) 4.1.4 Breed Among the 322 dogs observed, Labrador Retrievers had a high incidence of hip dysplasia in 44.09 per cent (142 dogs), German shepherd dogs 16.14 per cent (52 dogs), Doberman 3.72 per cent (12 dogs), Golden Retrievers 2.48 per cent (8 dogs), Rottweiler 3.10 per cent (10 dogs), Great Dane 5.59 per cent (18 dogs), Mastiff 0.62 per cent (2 dogs) and Saint Bernard 2.48 per cent (8 dogs). (Figure 3)

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Figure 1: Age wise incidence of hip dysplasia

71

149

< 1 yr 1-6 yr >6 yr

102

Figure 2: Sex wise incidence of hip dysplasia

Female

137

Male

185

50

100

150

200

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Table 1 Incidence of Hip dysplasia based on size of the animal Size of animal Name of the breed Spitz Lashapso Small sized (1-10kgs) Pug Terrier Daschund Cross breed Medium sized (11-25 kgs) Dalmation Siberian Husky Labrador retriever German shepherd Doberman Large sized (26 kgs and above) Golden retriever Rottweiler Great Dane Mastiff Saint Bernard No of animals 24 3 6 3 6 20 6 2 142 52 12 8 10 18 2 8

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Figure3: Incidence in Large sized breeds

Large sized breeds 160 140 120 100 80 60 40 20 0 12 8 10 52 18 2 142

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4.2

CLINICAL SYMPTOMS

4.2.1 Pain In group I during pre skeletal maturity period 33.33 per cent of dogs (two nos) were with a pain score of four, 50.00 per cent of dogs (three nos) with a pain score of three and 16.67 per cent of dogs (one no) with a pain score of two. Whereas, during post skeletal maturity period 16.67 per cent of dogs were (one no) with a pain score of four, 33.33 per cent of dogs (two nos) with a pain score of three and 50 per cent of dogs (three nos) with a pain score of two. (Table 2) In group II during pre skeletal maturity period 66.67 per cent of dogs (four nos) were with a pain score of four and 33.33 per cent of dogs (two nos) with a pain score of three. Whereas, during post skeletal maturity period 50.00 per cent of dogs (three nos) with a pain score of four, 33.33 per cent of dogs (two nos) with a pain score of three and 16.67 per cent of dogs (one no) with a pain score of two. (Table 2) 4.2.2 Lameness In group I during pre skeletal maturity period 50.00 per cent of dogs (three nos) were with a score of four, 33.33 per cent of dogs (two nos) with a score of three and 16.67 per cent of dogs (one no) with a score of two. Whereas, during post skeletal maturity period 16.67 per cent of dogs (one no) were with a score of four, 33.33 per cent of dogs (two nos) with a score of three and 50.00 per cent of dogs (three nos) with a score of two. (Table 3) In group II during pre skeletal maturity period 50 per cent of dogs (three nos) were with a score of four, 33.33 per cent of dogs (two nos) with a score of three and 16.67 per cent of dogs (one no) with a score of two. Whereas, during post skeletal maturity period 33.33 per cent of dogs (two nos) were with a score of four, 50.00 per cent of dogs (three nos) with a score of three and 16.67 per cent of dogs (one no) with a score of two. (Table 3)

47

Table 2 Pain scoring in Group I and Group II dogs during pre and post skeletal maturity period Group I Dog No Pre skeletal maturity period 1 2 3 4 5 6 4 3 4 3 2 3 Post skeletal maturity period 4 2 3 2 2 3 Group II Pre skeletal maturity period 4 4 3 4 3 4

Post skeletal maturity period

4 4 2 3 3 4

48

Table 3 Lameness scoring in Group I and Group II dogs during pre and post skeletal maturity period Group I Dog No Pre skeletal maturity period 1 2 3 4 5 6 4 3 4 3 2 4 Post skeletal maturity period 4 2 3 2 2 3 Group II Pre skeletal maturity period 4 3 2 4 3 4

Post skeletal maturity period

4 3 2 3 3 4

49

4.3.

PHYSICAL PALPATION FINDINGS

4.3.1 Ortolani sign In group I dogs, during pre skeletal maturity period 33.33 per cent of dogs (two nos) exhibited unilateral positive Ortolani sign, 33.33 per cent of dogs (two nos) exhibited bilateral positive Ortolani sign and the remaining 33.33 per cent of dogs (two nos) did not show positive Ortolani sign. Whereas, during post skeletal maturity period 16.67 per cent of dogs (one no) exhibited unilateral positive Ortolani sign, 33.33 per cent of dogs (two nos) exhibited bilateral positive Ortolani sign and the remaining 50.00 per cent of dogs (three nos) did not show positive Ortolani sign. (Table 4) In group II dogs, both during pre skeletal maturity period and post skeletal maturity period 16.67 per cent of dogs (one no) exhibited unilateral positive Ortolani sign and the remaining 83.33 per cent of dogs (five nos) exhibited bilateral positive Ortolani sign. (Table 4) 4.4 HAEMATOLOGICAL AND BIOCHEMICAL PARAMETERS

4.4.1 Haemoglobin The mean haemoglobin (g/dl) values in group I during pre skeletal and post skeletal maturity period were 12.450.39 and 12.380.28 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 12.000.28 and 12.480.28 respectively (Table 6). No significant difference in haemoglobin values, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.2 Packed Cell Volume The mean packed cell volume (percentage) values in group I during pre skeletal and post skeletal maturity period were 33.782.55 and 33.662.46 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 33.382.02 and 32.512.81 respectively (Table 6). No significant difference in packed cell volume values, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed.

50

Table 4 Ortolani sign in Group I and Group II dogs during pre and post skeletal maturity period Group I Dog No Pre skeletal maturity period 1 2 3 4 5 6 Bilateral Unilateral Bilateral Negative Negative Unilateral Post skeletal maturity period Bilateral Unilateral Bilateral Negative Negative Negative Group II Pre skeletal maturity period Bilateral Bilateral Unilateral Bilateral Bilateral Bilateral

Post skeletal maturity period

Bilateral Bilateral Unilateral Bilateral Bilateral Bilateral

51

4.4.3 Red Blood Cell count Red blood cell count (millions/cumm) in group I during pre skeletal and post skeletal maturity period were 5.470.21 and 5.570.18 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 5.770.14 and 5.260.28 respectively (Table 6). No significant difference in red blood cell count, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.4 White Blood Cell count White blood cell count (per cumm) in group I during pre skeletal and post skeletal maturity period were 14683.332033.78 and 153001926.30 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 149501510.38 and 183752185.39 respectively (Table 6). No significant difference in white blood cell count, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.5 Neutrophils Neutrophil count (percentage) values in group I during pre skeletal and post skeletal maturity period were 83.330.84 and 80.331.84 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 77.670.62 and 79.671.02 respectively (Table 6). No significant difference in neutrophil count, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.6 Lymphocytes Lymphocyte count (percentage) values in group I during pre skeletal and post skeletal maturity period were 16.831.57 and 17.831.53 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 20.830.47 and 21.001.03 respectively (Table 6).

52

No significant difference in lymphocyte count, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.7 Serum Alkaline Phosphatase Serum alkaline phosphatase (IU/lit) values in group I during pre skeletal and post skeletal maturity period were 165.8110.08 and 165.4813.34 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 89.1010.08 and 146.4615.02 respectively (Table 6). No significant difference in Serum alkaline phosphatase values, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.8 Total Protein Total protein (g/dl) values in group I during pre skeletal and post skeletal maturity period were 6.350.20 and 6.760.16 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 6.720.17 and 6.570.09 respectively (Table 6). No significant difference in total protein values, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.9 Albumin Albumin (g/dl) values in group I during pre skeletal and post skeletal maturity period were 3.120.09 and 3.100.09 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 2.300.09 and 2.670.10 respectively (Table 6). No significant difference in albumin values, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed.

53

4.4.10 Calcium Calcium (mg/dl) values in group I during pre skeletal and post skeletal maturity period were 11.690.83 and 11.310.72 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 10.840.42 and 15.490.83 respectively (Table 6). No significant difference in calcium values, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.4.11 Phosphorus Phosphorus (mg/dl) values in group I during pre skeletal and post skeletal maturity period were 5.610.58 and 5.520.49 respectively (Table 5). Whereas, values in group II during pre skeletal and post skeletal maturity period were 7.270.53 and 6.160.70 respectively (Table 6). No significant difference in phosphorus values, (P<0.05) between pre skeletal and post skeletal maturity period in Group I and Group II were observed. 4.5 QUANTITATIVE RADIOGRAPHIC ASSESSMENT

4.5.1 Norberg angle Of the twelve hips studied in Group I dogs during pre skeletal maturity period, the Norberg angle was moderate in 58.33 per cent (90-105 degree) and 41.67 per cent (<90 degree) were severely dysplastic. Whereas, during post skeletal maturity period 33.33 per cent (>105 degree) were normal, 50.00 per cent (90-105 degree) moderate and 16.67 per cent (<90 degree) severely dysplastic. (Table 7, 8) Out of the twelve hips studied in Group II dogs during pre skeletal maturity period, 100.00 per cent (<90 degree) were severely dysplastic. Whereas, during post skeletal maturity period, 16.67 per cent (90-105 degree) were moderate and 83.33 per cent (<90 degree) were severely dysplastic. (Table 9, 10)

54

Table 5 Haematological and biochemical parameters in group I dogs Pre skeletal maturity period 12.450.39 Post skeletal maturity period 12.380.28

Parameter Haemoglobin (g/dl) Packed cell volume (percentage) Red Blood Cell (millions/cumm) White Blood Cell (per cumm) Neutrophils (percentage) Lymphocytes (percentage) Serum Alkaline Phosphatase (IU/lit) Total Protein (g/dl) Albumin (g/dl) Calcium (mg/dl) Phosphorus (mg/ dl)

t-Test

P-value

0.44

0.67

33.782.55

33.662.46

0.24

0.82

5.470.21

5.570.18

0.62

0.56

14683.332033.78

153001926.30

0.69

0.52

83.330.84

80.331.84

1.11

0.31

16.831.57

17.831.53

0.68

0.52

165.8110.08

165.4813.34

0.10

0.92

6.350.20 3.120.09 11.690.83 5.610.58

6.760.16 3.100.09 11.310.72 5.520.49

1.55 0.12 0.97 0.69

0.18 0.90 0.37 0.52

55

Table 6 Haematological and biochemical parameters in group II dogs Pre skeletal maturity period 12.000.28 Post skeletal maturity period 12.480.28

Parameter Haemoglobin (g/dl) Packed cell volume (percentage) Red Blood Cell (millions/cumm) White Blood Cell (per cumm) Neutrophils (percentage) Lymphocytes (percentage) Serum Alkaline Phosphatase (IU/lit) Total Protein (g/dl) Albumin (g/dl) Calcium (mg/dl) Phosphorus (mg/ dl)

t-Test

P-value

0.69

0.52

33.382.02

32.512.81

1.10

0.32

5.770.14

5.260.28

2.43

0.05

149501510.38

183752185.39

0.62

0.56

77.670.62

79.671.02

1.21

0.27

20.830.47

21.001.03

0.15

0.88

89.1010.08

146.4615.02

0.12

0.90

6.720.17 2.300.09 10.840.42 7.270.53

6.570.09 2.670.10 15.490.83 6.160.70

1.78 0.10 0.94 0.44

0.13 0.92 0.31 0.67

56

Mean Standard error of Norberg angle values in group I during pre skeletal and post skeletal maturity period were 90.923.56 and 95.673.29 respectively. Whereas, values in group II during pre skeletal and post skeletal maturity period were 85.000.71 and 82.831.66 respectively. (Table 11, 12) Statistical analysis revealed high significance (0.01 level) in group I values between pre skeletal and post skeletal maturity period with respect to Norberg angle. Whereas, in group II no significant (0.05 level) change was found between pre skeletal and post skeletal maturity period. (Table 11, 12) 4.5.2 Distraction index Of the twelve hips studied in Group I dogs during pre skeletal maturity period, 58.33 per cent (0.3-0.7) were moderate and 41.67 per cent (>0.7) were severely dysplastic. Whereas, during post skeletal maturity period 16.67 per cent (<0.3) were normal, 58.33 per cent (0.3-0.7) were moderate and 25.00 per cent (>0.7) were severely dysplastic. (Table 7, 8) Out of the twelve hips studied in Group II dogs during pre skeletal maturity period 100.00 per cent (>0.7) were severely dysplastic. Whereas, during post skeletal maturity period 16.67 per cent (0.3-0.7) were moderate and 83.33 per cent (>0.7) were severely dysplastic. (Table 9, 10) Mean Standard error of DI values in group I during pre skeletal and post skeletal maturity period were 0.630.05 and 0.540.06 respectively. Whereas, values in group II during pre skeletal and post skeletal maturity period were 0.750.009 and 0.780.01 respectively. (Table 11, 12) Statistical analysis revealed high significance (0.01 level) in group I values between pre skeletal and post skeletal maturity period with respect to DI. Whereas, in group II no significance (0.05 level) was found between pre and post skeletal maturity period with respect to DI. (Table 11, 12)

57

4.5.3 Dorsolateral subluxation score Of the twelve hips studied in Group I dogs during pre skeletal maturity period 66.67 per cent (40-60 percentage) were moderate and 33.33 per cent (<40 percentage) were severely dysplastic. Whereas, during post skeletal maturity period 33.33 per cent (>60 percentage) were normal, 33.33 per cent (40-60 percentage) were moderate and 33.33 per cent (<40 percentage) were severely dysplastic. (Table 7, 8) Out of the twelve hips studied in Group II dogs during pre skeletal maturity period 100.00 per cent (<40 percentage) were severely dysplastic. Whereas, during post skeletal maturity period 33.33 per cent (40-60 percentage) were moderate and 66.67 per cent (<40 percentage) were severely dysplastic. (Table 9, 10) Mean Standard error of dorsolateral subluxation score values in group I during pre and post skeletal maturity period were 43.414.05 and 48.244.42 respectively. Whereas, values in group II during pre and post skeletal maturity period were 27.871.47 and 26.923.51 respectively. (Table 11, 12) Statistical analysis revealed high significance (0.01 level) in group I values between pre skeletal and post skeletal maturity period with respect to DLSI. Whereas, in group II no significance was observed between pre skeletal and post skeletal maturity period. (Table 11, 12) 4.5.4 Central edge angle Of the twelve hips studied in Group I dogs the central edge angle during pre skeletal maturity period 91.67 per cent (6-16 degree) were moderate and 8.33 per cent (<6 degree) were severely dysplastic. Whereas, during post skeletal maturity period 50.00 per cent (>16 degree) were normal and 50.00 per cent (6-16 degree) were moderately dysplastic. (Table 7, 8) In Group II dogs the central edge angle during pre skeletal maturity period, 16.67 per cent (6-16 degree) were moderate and 88.33 per cent (<6 degree) were severely dysplastic. Whereas, during post skeletal maturity period, 16.67 per cent

58

(>16 degree) were normal, 50.00 per cent (6-16 degree) were moderate and 33.33 per cent (<6 degree) were severely dysplastic. (Table 9, 10) Mean Standard error of Central edge angle values in group I during pre skeletal and post skeletal maturity period were 11.501.00 and 15.251.40 respectively. Whereas, values in group II during pre skeletal and post skeletal maturity period were 5.581.02 and 8.251.37 respectively. (Table 11, 12) Statistical analysis revealed high significance (0.01 level) in group I values between pre skeletal and post skeletal maturity period with respect to CEA. Whereas, in group II also high significance (0.01 level) was found between pre skeletal and post skeletal maturity period. (Table 11, 12) 4.5.5 Acetabular slope angle In Group I dogs the acetabular slope angle during pre skeletal maturity period 100.00 per cent (7-25 degree) was moderate. Whereas, during post skeletal maturity period 50.00 per cent (<7 degree) were normal and 50.00 per cent (7-25 degree) were moderately dysplastic. (Table 7, 8) Out of the twelve hips studied in Group II dogs during pre skeletal maturity period, 33.33 per cent (7-25 degree) were moderate and 66.67 per cent (>25 degree) were severely dysplastic. Whereas, during post skeletal maturity period 16.67 per cent (<7 degree) were normal, 50 per cent (7-25 degree) were moderate and 33.33 per cent (>25 degree) were severely dysplastic. (Table 9, 10) Mean Standard error of acetabular slope angle values in group I during pre skeletal and post skeletal maturity period were 15.251.99 and 13.672.70 respectively. Whereas, values in group II during pre skeletal and post skeletal maturity period were 22.752.35 and 22.502.78 respectively. (Table 11, 12) Statistical analysis revealed no significance (0.05 level) in group I values between pre skeletal and post skeletal maturity period with respect to ASA. In group II also no significance (0.05 level) was found between pre skeletal and post skeletal maturity period. (Table 11, 12)

59

4.5.6 Subluxation index The subluxation index in Group I dogs during pre skeletal maturity period was moderate in 58.33 per cent (0.3-0.5 degree) and severely dysplastic in 41.67 per cent (>0.5 degree). Whereas, during post skeletal maturity period 16.67 per cent (<0.3 degree) were normal, 58.33 per cent (0.3-0.5 degree) were moderate and 25.00 per cent (>0.5 degree) were severely dysplastic. (Table 7, 8) Out of the twelve hips studied for subluxation index in Group II dogs during pre skeletal maturity period 100.00 per cent (>0.5 degree) were severely dysplastic. Whereas, during post skeletal maturity period 8.33 per cent (0.3-0.5 degree) were moderate and 91.67 per cent (>0.5 degree) were severely dysplastic. (Table 9, 10) Mean Standard error of subluxation index values in group I during pre skeletal and post skeletal maturity period were 0.510.04 and 0.420.04 respectively. Whereas, values in group II during pre skeletal and post skeletal maturity period were 0.700.01 and 0.720.029 respectively. (Table 11, 12) Statistical analysis revealed high significance (0.01 level) in group I values between pre skeletal and post skeletal maturity period with respect to SI. Whereas, in group II no significance (0.05 level) found between pre skeletal and post skeletal maturity period. (Table 11, 12) 4.6 CORRELATION BETWEEN QUANTITATIVE RADIOGRAPHIC ASSESSMENT 4.6.1 Correlation between Quantitative Radiographic Assessment Techniques in group I dogs during pre and post skeletal maturity period Norberg angle negatively correlated with Distraction index and Subluxation index with significant values (0.05 level) of 0.87, 0.89, 0.90 and 0.78 during pre and post skeletal maturity period respectively. Whereas, Norberg angle positively correlated with Dorsolateral subluxation index with highly significant values (0.01 level) of 0.95 and 0.91 during pre and post skeletal maturity period respectively. (Table 13)

60

Table 7 Quantitative Radiographic measurements in group I dogs during pre skeletal maturity period Dog No

Hip R

NA 68.00 69.00 95.00 100.00 82.00 88.00 100.00 102.00 100.00 104.00 88.00 95.00

DI 0.86 0.88 0.55 0.65 0.80 0.72 0.40 0.50 0.40 0.32 0.80 0.65

DLSI 21.10 21.25 43.30 53.30 35.00 30.00 58.00 55.00 58.00 60.00 42.00 44.00

CEA 6 5 8 12 10 13 14 12 14 15 14 15

ASA 22 24 18 24 22 20 8 10 8 9 10 8

SI 0.67 0.79 0.35 0.45 0.70 0.60 0.35 0.45 0.35 0.30 0.60 0.50

1 L R 2 L R 3 L R 4 L R 5 L R 6 L

61

Table 8 Quantitative Radiographic measurements in group I dogs during post skeletal maturity period Dog no 1 Lt Rt 2 Lt Rt 3 Lt Rt 4 Lt Rt 5 Lt Rt 6 Lt 100.00 0.55 50.00 20 4 0.40 110.00 92.00 0.20 0.68 68.00 48.00 20 18 4 6 0.20 0.45 108.00 107.00 0.40 0.28 61.30 64.00 20 18 6 5 0.40 0.20 98.00 106.00 0.60 0.30 37.00 62.00 16 18 23 4 0.50 0.30 94.00 90.00 0.60 0.75 56.80 39.00 15 12 25 24 0.40 0.65 78.00 90.00 0.82 0.50 22.20 47.20 6 13 23 20 0.65 0.30 Hip Rt NA 75.00 DI 0.80 DLSI 23.40 CEA 7 ASA 20 SI 0.60

62

Table 9 Quantitative Radiographic measurements in group II dogs during pre skeletal maturity period Dog no 1 Lt Rt 2 Lt Rt 3 Lt Rt 4 Lt Rt 5 Lt Rt 6 Lt 82.00 0.75 25.20 4 26 0.65 88.00 85.00 0.72 0.80 28.00 21.50 5 3 24 28 0.68 0.75 85.00 86.00 0.72 0.75 35.00 25.00 4 4 28 26 0.60 0.72 86.00 87.00 0.75 0.75 30.00 38.00 14 5 6 26 0.70 0.70 86.00 80.00 0.75 0.80 25.00 32.00 4 12 26 5 0.72 0.75 85.00 88.00 0.80 0.72 21.50 28.00 3 5 28 24 0.75 0.68 Hip Rt NA 82.00 DI 0.75 DLSI 25.20 CEA 4 ASA 26 SI 0.65

63

Table 10 Quantitative Radiographic measurements in group II dogs during post skeletal maturity period Dog no 1 Lt Rt 2 Lt Rt 3 Lt Rt 4 Lt Rt 5 Lt Rt 6 Lt 80.00 0.80 20.00 4 30 0.70 82.00 75.00 0.78 0.85 20.00 19.00 8 3 22 32 0.75 0.85 83.00 84.00 0.73 0.80 45.00 16.00 9 9 25 23 0.65 0.78 96.00 83.00 0.65 0.78 42.00 42.00 18 8 4 24 0.50 0.72 84.00 90.00 0.80 0.70 16.00 44.00 9 16 23 3 0.78 0.60 75.00 82.00 0.85 0.78 19.00 20.00 3 8 32 22 0.85 0.75 Hip Rt NA 80.00 DI 0.80 DLSI 20.00 CEA 4 ASA 30 SI 0.70

64

Table 11 Paired `t`-Test in group I dogs during Pre and Post skeletal maturity period Pre skeletal QHAT No of hips maturity period Mean NA DI DLSI CEA ASA SI 12 12 12 12 12 12 90.92 0.63 43.41 11.50 15.25 0.51 SE 3.56 0.05 4.05 1.00 1.99 0.04 Post skeletal maturity period Mean 95.67 0.54 48.24 15.25 13.67 0.42 SE 3.29 0.06 4.42 1.40 2.70 0.04 3.25 9.85 8.14 6.63 1.91 7.49 0.00 0.00 0.00 0.00 0.08 0.00 ** ** ** ** NS ** tTest P Value Result

NS **

: :

Statistically not significant (P > 0.05) Statistically highly significant (P 0.01)

65

Table 12 Paired `t`-Test in group II dogs during Pre and Post skeletal maturity period QHAT No of hips NA DI DLSI CEA ASA SI 12 12 12 12 12 12 Group I Mean 85.00 0.75 27.87 5.58 22.75 0.70 SE 0.71 0.00 1.47 1.02 2.35 0.01 Group II Mean 82.83 0.78 26.92 8.25 22.50 0.72 SE 1.66 0.01 3.51 1.37 2.78 0.02 tTest 1.17 1.38 0.40 4.39 0.27 0.84 P Value 0.26 0.19 0.69 0.00 0.78 0.41 NS NS NS ** NS NS Result

NS **

: :

Statistically not significant (P > 0.05) Statistically highly significant (P 0.01)

66

Distraction index negatively correlated with Dorsolateral subluxation index with significant values (0.05 level) of 0.89 and 0.90 during pre and post skeletal maturity period respectively. Whereas, Distraction index positively correlated with Subluxation index with highly significant values (0.01 level) of 0.94 and 0.92 during pre and post skeletal maturity period respectively. (Table 13) The Dorsolateral subluxation index negatively correlated with Subluxation index with significant values (0.05 level) of 0.88 and 0.87 during pre and post skeletal maturity period respectively. (Table 13) 4.6.2 Correlation between Quantitative Radiographic Assessment Techniques in group II dogs during pre and post skeletal maturity period Norberg angle negatively correlated with Distraction index, Subluxation index and Acetabular slope angle with significant values of 0.93, 0.87 and 0.93 only during post skeletal maturity period respectively. Whereas, Norberg angle positively correlated with Central edge angle with significant value (0.05 level) of 0.96 only during post skeletal maturity period. (Table 14) Distraction index positively correlated with Subluxation index with highly significant values (0.01 level) of 0.83 and 0.95 during pre and post skeletal maturity period respectively. Whereas, Distraction index positively correlated with Acetabular slope angle with significant values (0.05 level) of 0.89 only during post skeletal maturity period and Distraction index negatively correlated with Central edge angle with significant values (0.05 level) of 0.92 only during post skeletal maturity period. (Table 14) Subluxation index negatively correlated with Dorsolateral subluxation index and Central edge angle with significant values (0.05 level) of 0.88 and 0.80 only during post skeletal maturity period respectively. (Table 14) Central edge angle negatively correlated with Acetabular slope angle with highly significant values (0.01 level) of 0.98 and 0.97 during pre and post skeletal maturity period respectively. (Table 14)

67

Table 13 Correlation between Quantitative Radiographic Assessment Techniques in group I dogs during pre and post skeletal maturity period

NA QHAT Pre Post Pre

DI

DLSI

CEA

ASA

SI

Post

Pre

Post

Pre

Post

Pre

Post

Pre

Post

NA

-0.87

-0.90

0.95

0.91

0.78

0.92

-0.65

-0.70

-0.89

-0.78

DI

-0.89

-0.90

-0.61

-0.76

0.69

0.70

0.94

0.92

DLSI

0.74

0.86

-0.70

-0.68

-0.88

-0.87

CEA

-0.76

-0.76

-0.60

-0.72

ASA

0.63

0.66

SI

68

Table 14 Correlation between Quantitative Radiographic Assessment Techniques in group II dogs during pre and post skeletal maturity period

NA QHAT Pre Post Pre

DI

DLSI

CEA

ASA

SI

Post

Pre

Post

Pre

Post

Pre

Post

Pre

Post

NA

-0.48

-0.93

-0.09

0.61

-0.22

0.96

0.32

-0.93

-0.02

-0.87

DI

-0.43

-0.77

0.13

-0.92

-0.23

0.89

0.83

0.95

DLSI

0.38

0.65

-0.30

-0.62

-0.38

-0.75

CEA

-0.98

-0.97

-0.18

-0.80

ASA

-0.27

0.78

SI

69

Discussion

69

CHAPTER V DISCUSSION
5.1 INCIDENCE

5.1.1 Age Dogs in the age group of less than one year of age had higher incidence of hip dysplasia (46.27 per cent) when compared to dogs in the age group between one to six years of age (31.67 per cent) and dogs in the age group of more than six years of age (22.04 per cent). The increase in incidence in young animals less than one year might be due to early rapid growth, disproportionate skeletal and muscular growth, overloading of articular areas and tearing or stretching of round ligament resulting in dysplasia. These findings concurred with the observation of Bennett and May (1995), Kasstrom (1975) and Maki et al. (2004). 5.1.2 Sex In this study, male dogs had higher incidence of hip dysplasia (57.45 per cent) than female dogs (42.54 per cent). Priester and Mulvihill (1972) recorded equal distribution of incidence of hip dysplasia in male and females. The increase in incidence in male dogs may probably be due to the smaller number of population studied or preference of the pet owners for male dogs higher in the studied population. (Corley and Keller, 1989) 5.1.3 Size of the animal Among the 322 dogs studied, highest incidence of canine hip dysplasia was seen in large breeds of dogs (78.26 per cent), followed by small sized dogs (13.04 per cent) and medium sized dogs (8.69 per cent). This might be due to rapid growth and early weight gain in large breed dogs (Genevois et al., 2008) resulting insufficient relative strength for the hip muscles to prevent subluxation of the hip joint during weight bearing. These findings concurred with, Alexandar (1992), Lust and Summers (1981), Lust et al. (1985) and Riser (1975).

70

5.1.4 Breed Of the 322 dogs studied, highest incidence of canine hip dysplasia was seen in Labrador retrievers (44.09 per cent) than German shepherd dogs (16.14 per cent). The increase in the incidence of dysplasia in Labrador retrievers might be due to genetic predisposition (Chase et al., 2004 and Shepherd, 1986), anatomically shallow acetabulum, early rapid weight gain (Barr et al., 1987), and loose skin, heavy rounded stocky conformation (Fries and Remedios, 1995) with less developed muscle and more than 10 per cent of subcutaneous fat (Hazewinkel, 1989) . Similar observations were recorded by Riser et al. (1985) and Scartazzini (1970). 5.2 CLINICAL SYMPTOMS

5.2.1 Pain In Group I, three animals showed improvement in pain score and in Group II, two animals showed improvement in pain score. This might be due to neutraceuticals administered (Belfield, 1976 and Bennett, 1987) during the skeletal maturity period would have likely helped in alleviating the pain associated with HD (Farrell et al., 2007 and Vezzoni et al., 2008). Also management advice given during the skeletal maturity period such as restricted exercise and feeding (Kealy et al., 1992; Kealy et al., 1993 and Kealy et al., 2000), confining puppies in a cage, stay seated for long time in abduction-flexion position, to support the forced hip congruence would have also helped in improvement in pain score. Manley et al. (2007) and Vezzoni et al. (2008) reported similar findings in their study of hip dysplasia. 5.2.2 Lameness Four animals in group I and one in group II showed improvement in lameness score. The improvement in lameness score in animals in both the groups may be attributed to increased pelvic muscle mass (Smith, 1998), decrease in hip laxity (Corley, 1992) and decreased pain during the developmental stage (Fry and Clark, 1992). Less severe degree of dysplasia in the animals presented in group I

71

might be the contributing factor for the increased improvement in the lameness score in this group during the skeletal maturity period. The findings of this study concurred with that of Cardinet et al. (1997), Greg Keller (2006) and Newton (1985). 5.3 PHYSICAL PALPATION BY ORTOLANI MANOEUVER Persistence of positive Ortolani sign in group I and group II animals both the period of assessment and an improvement or absence of Ortolani sign in one animal in group I might be due to decrease in joint laxity. Ortolani sign showed correlation with Norberg angle (Bardens and Hardwick, 1968) and Distraction index values of respective animals in both groups. This finding concurred with Adams et al. (2000) who noticed a significant relation between Ortolani maneuver results and radiographic distraction index. (Puerto et al., 1999) 5.4 HAEMATOLOGICAL AND BIOCHEMICAL PARAMETERS No significant difference was observed in haematological and biochemical parameters among Group I and Group II animals between pre and post skeletal maturity period. This probably might be due to slow onset of hip dysplasia which could not have produced any effect on reticulo-endothelial system and biochemical values. These findings are in concurrence with the study of Hansen (1989), Lust et al. (1973) and Lust et al. (1993). 5.5 QUANTITATIVE RADIOGRAPHIC MEASUREMENTS

5.5.1 Norberg angle Highly significant increase in mean Norberg angle values were noticed between pre and post skeletal maturity in group I. In group II there was non significant decrease in the mean Norberg angle values found between pre and post skeletal maturity period. All hips in group I except two, irrespective of the severity showed improvement in Norberg angle values. In group II, Norberg angle values in all hips except two showed a decrease.

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The improvement in Norberg angle values in group I might be due to anatomically developed moderately deep acetabulum in German shepherd breeds of dogs (Scartazzini, 1970), increased ossification centers during the developmental stage (Cardinet et al., 1997), increased pelvic muscle mass (Greg Keller, 2006) and fibrosis and thickening of the joint capsule of the coxofemoral joint. (Janutta and Distl, 2006 and Janutta et al., 2008) The decrease in Norberg angle values in group II might be due to anatomically shallow acetabulum in Labrador retriever breeds of dogs (Scartazzini, 1970), early rapid weight gain which led to abnormal weight bearing forces across the joint (Kasstrom, 1975) and loose skin, heavy rounded stocky conformation with less developed muscle and more than 10 per cent subcutaneous fat (Lust et al., 1992). 5.5.2 Distraction Index The mean DI value of German shepherd breeds of dogs in group I had highly significant decrease noticed from pre skeletal maturity period to post skeletal maturity period. Appreciable decrease of DI was noticed on all animals in this group. But in Group II there was no significant increase in DI values were seen in post skeletal maturity period. Distraction index is the indicative of passive joint laxity (Gibbs, 1997) which allows the femoral head move away from the articular surface of the acetabulum and responsible for development of degenerative joint disease in dogs. (Ginja et al., 2008a; Ginja et al., 2008b and Ginja et al., 2008c) In group I improvement in DI values during post skeletal maturity period might be due to increased ossification (Hazewinkel et al., 1991) of moderately deep acetabulum in German shepherd breeds of dogs (Scartazzini, 1970). Whereas, in Labrador retriever breeds of dogs in Group II even though skeletal muscle mass development and muscular tone contributed for increase in DI (Lust et al., 1993), the genetically shallow acetabulum (Scartazzini, 1970) and unique early rapid weight

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gain (Silvestre et al., 2007) for the breed characteristic would have caused negative effect resulted in non significant raise in DI values. 5.5.3 Dorsolateral Subluxation Score DLSI value that is percentage of acetabular coverage in weight bearing position (Farese et al., 1999) increased in all animals in group I from pre skeletal maturity period to post skeletal maturity period. More increase in acetabular coverage in dogs with upper limit of moderate values, which became normal that is more than 60 percentage. This might be due to progressive strength of supporting soft tissue structures namely joint capsule and muscle mass (Popovitch et al., 1995) and also gradual deepening of acetabulum during the development in German shepherd breeds (Mackenzie et al., 1985) of dogs. This finding concurred with Hazewinkel (1994). In group II the animals with DLSI values below 30 percentage in pre skeletal maturity period reduced further during the skeletal maturity period. This might be due to rapid weight gain due to increased fat percentage and shallow acetabulum during skeletal maturity period would have allowed dorsolateral movement of the femoral head during weight bearing. This finding concurred with Smith et al. (1990). 5.5.4 Central edge angle and Acetabular slope angle All dogs in group I and II except dog no 1 and 6 in group II showed increase in CEA and ASA values during skeletal maturity period. The animals in both the group which were severely dysplastic retained the CEA and ASA values during skeletal maturity period. Since CEA and ASA indicative of damage to the dorsal acetabular rim (Morgan, 1987) and have no effect on the hip laxity which is the definitive reason for development of hip dysplasia in dogs. This finding concurred with Meomartino et al. (2002) and Risler et al. (2009).

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5.5.5 Subluxation index SI that is displacement of femoral head from the acetabulum during dorsally directed manual force (Olsson, 1961) decreased in all animals in group I (German shepherd dogs) during skeletal maturity period. But in Labrador retriever breeds of dogs the laxity was more in all animal except one hip in one animal. Even though subluxation of femoral head depends on dorsally applied pressure, recoiling effect of supporting structure of the hip joint especially elasticity of the joint capsule, strength of the muscle mass, surface area of the dorsal acetabulum plays a major role in opposing the manual pressure. The difference in strength in those structures in group I and group II animals might be the reason for the difference in the values. This finding concurred with Fluckiger et al. (1999). 5.6 CORRELATION BETWEEN DIFFERENT QUANTITATIVE

RADIOGRAPHIC ASSESSMENT TECHNIQUES The negative correlation between NA and DI (r 0.8) suggests that Norberg

angle and DI has a strong relation. An increase in Norberg angle correspondingly shows a decrease in DI percentage denoting good hip and decreasing Norberg angle and increasing DI denoting susceptibility to dysplastic hip. The positive correlation between NA and DLSI (r 0.8) suggests that as

Norberg angle and DLSI has a strong relation. An increase in Norberg angle correspondingly shows an increase in DLSI percentage denoting good hip and decreasing Norberg angle and decreasing DLSI denoting susceptibility to dysplastic hip. The negative correlation between NA and SI (r 0.8) suggests that as

Norberg angle and SI has a strong relation. An increase in Norberg angle correspondingly shows a decrease in SI percentage denoting good hip and decreasing Norberg angle and increasing SI denoting susceptibility to dysplastic hip.

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The negative correlation between DI and DLSI (r

0.8) suggests that as DI

and DLSI has a strong relation. An increase in DI correspondingly shows a decrease in DLSI percentage denoting dysplastic hip and decreasing DI and increasing DLSI denoting good hip. The positive correlation between DI and SI (r 0.8) suggests that as DI and

SI has a strong relation. An increase in DI correspondingly shows an increase in SI percentage denoting dysplastic hip and decreasing DI and decreasing SI denoting good hip. The negative correlation between DLSI and SI (r 0.8) suggests that as

DLSI and SI has a strong relation. An increase in DLSI correspondingly shows a decrease in SI percentage denoting good hip and decreasing DLSI and increasing SI denoting dysplastic hip. Displacement or subluxation of femoral head away from acetabular cavity was measured through different quantitative radiographic assessment techniques after application of external forces (Heyman et al., 1993). In Norberg angle measurement position recoiling effect of winding of joint capsule pushes the femoral head and maintains it in congruence with acetabulum. In DI laterally directed force over the femoral head luxates it from the acetabular cavity if the supporting soft tissue structures were week. Dorsally directed force towards the acetabulum in DLSI and SI luxate the femoral head, in reduced contact surface area of the acetabulum and weekend supporting soft tissue structures around the hip joint. ASA and CEA reveal the dorsal acetabular coverage surface area over the femoral head when there were no externally applied forces. (Ginja et al., 2009) More relative correlation was seen between NA to DLSI and DI to SI. DI highly correlates with SI in both groups. Values which were normal and near normal, highly correlates with each others in all quantitative radiographic assessment methods. This indicates stronger supporting structures around the hip joint in normal anatomical alignment overcome the external pressure and maintains the femoral head in congruence with the acetabulum.

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Defects either hereditary or acquired in any one of the structures like shallow acetabulum, weekend joint capsule, poor muscular development and rapid weight gain before the skeletal maturity might fail to resist the external forces. Failure in different structures deviate the normal value of quantitative assessment procedure like week joint capsule and reduced muscle mass affects the NA and DI, decreased dorsal surface area of the acetabulum cover affects the DLSI and SI. These were the reasons most probably occurred in Labrador retriever breeds of dogs where the quantitative hip assessment values were not effectively correlated with each other as seen with German shepherd breeds of dogs. There were no significant correlation between CEA and ASA with other methods since defects in dorsal acetabular coverage happened during later stage of the disease progress like enthesophyte formation and bony remodeling which leads to the OA and DJD. (Johnson et al., 1998; Powers et al., 2004 and Szabo et al., 2007) Culp et al. (2006) noticed linear correlation between NA and DI in all breeds of dogs and also found a high correlation in animals with normal values of NA and DI. Farese et al. (1998) found high correlation between DLSI and DI in predicting OA susceptibility in dogs. DI value of 0.3 and DLSI value of 64.001.5 were proved to be unsusceptible to OA. Because it produces least passive laxity. DI value of 0.7 and DLSI value of 39.002.6 had high probability of developing OA. (Smith et al., 1995) Fluckiger (1995) stated that most of the stress study reveals that positive correlation between the coxofemoral joint laxity and coxarthrosis. The author also noted 87 percentage of Labrador retriever with the DI value of less than 0.4 at the age of 4 months developed normal hips and 57 percentage of dog with DI value greater than 0.4 became dysplastic. He also noticed high correlation between DI and SI, since both the techniques dislocate the hip when using differently directed external forces.

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Summary

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CHAPTER VI SUMMARY
Dogs presented with clinical signs of hip dysplasia to the Small Animal Orthopedic unit of Madras Veterinary College Teaching Hospital were selected for the study. Clinically hip dysplastic German shepherd and Labrador retriever breeds of dogs were grouped into two groups of six numbers in each groups and subjected to hip assessment before and after skeletal maturity of long bones. Under general anesthesia radiography was performed in different positioning methods namely, Standard Ventro dorsal view(SVDV), Distraction view(DV), Weight bearing view, Dorsal acetabular rim view and 60 degree stress view. From these positioning methods, six different quantitative measurements of hips were taken to grade the hips for dysplasia namely Norberg angle, Distraction index, Dorsolateral subluxation index, Acetabular slope angle, Central edge angle and subluxation index. The clinical signs, physical palpation by Ortolani manouver and haematobiochemical parameters were studied and found that in group I and group II dogs there was an improvement in pain score during skeletal maturity period whereas Lameness score was improved only in group I dogs. No significant difference observed in Hematological and Biochemical Parameters among Group I and Group II animals between pre and post skeletal maturity period.. Correlation between the Quantitative radiographic measurements were showed that high correlation between NA and DLSI, DI and SI. More relative correlation was seen between NA to DLSI and DI to SI. DI highly correlates with SI in both groups. Values which were normal and near normal highly correlates with each others in all quantitative radiographic assessment methods. Defects either hereditary or acquired in any one of the structures like shallow acetabulum, weekend joint capsule, poor muscular development and rapid weight gain before the skeletal maturity might fail to resist the external forces and deviate

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the normal value of quantitative assessment procedures. Week joint capsule and reduced muscle mass affects the NA and DI, decreased dorsal surface area of the acetabulum cover affects the DLSI and SI. Those were the reasons most probably occurred in Labrador retriever breeds of dogs where the quantitative hip assessment values were not effectively correlated with each other as seen with German shepherd breeds of dogs. Since both CEA and ASA represent dorsal acetabular coverage, there was no significant correlation seen between these values in both groups. As there was no defects in dorsal acetabular coverage noticed which usually happened during later stage of the disease progress due to enthesophyte formation and bony remodeling which leads to the OA and DJD. No significant correlation was noticed between CEA and ASA with other quantitative assessment methods.

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