What is Legg-Calve-Perthes

(LCP) Disease?

This disease of young small breed dogs
results in destruction of the head (ball) of the
femur bone. The underlying cause of this
condition is likely genetic. The condition
typically affects only one hip, but 17% of
dogs have both hips affected. This disease
is due to a disturbance of the blood supply
within the femoral head that subsequently
results in death and resorption of the bone.
The femoral head collapses which results in
hip pain.




Signs

LCP affects small breeds of dogs with the
Yorkshire terrier most commonly affected.
Warning signs of LCP that are most
commonly seen by pet owners may include
hind limb lameness, muscle atrophy,
stiffness on the affected limb when first
getting up from a nap, exercise intolerance,
and pain upon petting the hip. The
lameness initially is mild, but with time
becomes severe. Examination by a veterinarian typically reveals pain on extending or
spreading the affected hip(s) apart.


Diagnosis

The diagnosis of LCP is based on the evaluation of x-ray images of the pelvis. In order to
obtain properly positioned x-ray images, your dog may need to receive twilight sedation.
Typical signs on the x-rays include a moth-eating appearance of the femoral head, a
misshapen femoral head and arthritis (bone spurs) of the hip joint.


The day of surgery

Our anesthesia and surgical team will prescribe a pain management program, both during and
after surgery that will keep your companion comfortable. This will include a combination of
general anesthesia, injectable analgesics, epidural analgesics, oral analgesics and anti-
inflammatory medication.


Legg-Calve-Perthes Disease
Surgery Service
Available Services

24/7 Emergency
& Critical Care
Cardiology
Computed
Tomography
Dermatology
& Allergy
Internal Medicine
Interventional
Radiology
MRI
Neurology
Neurosurgery
Oncology
Oncologic Surgery
Ophthalmology
Orthopedic Surgery
Radiology
& Fluoroscopy
Soft Tissue Surgery
Ultrasound

Locations

Auburn Hills
3412 E. Walton Blvd.
(West of Squirrel Rd.)
(248) 371-3713

Grand Rapids
1425 Michigan St. NE
(East of Fuller Rd.)
(616) 284-5300

MVS Southfield
29080 Inkster Rd.
(North of 12 Mile Rd.)
(248) 354-6660
Normal
Abnormal
Used with permission, Novartis Animal Health
Used with permission, Novartis Animal Health
Treatment

Nonsurgical treatment of LCP includes exercise restriction and administration of
medications to relieve pain. Usually this conservative treatment modality is not
effective and surgery is needed. The treatment of choice is the femoral head
and neck ostectomy (FHO). This procedure involves the surgical removal of the
misshapen femoral head and neck. Following this procedure, the hip is kept in
place with the soft tissues around the hip and the hip muscles. As healing
progresses, a false hip joint forms as scar tissue develops in the hip. After
surgery, rehabilitation therapy is critical to help the hip to have normal range of
motion and to rebuild the muscles around the hip. Rehabilitation by a
professional therapist is strongly recommended. This part of the treatment is as
important as the surgery.


Aftercare and results

After surgery, you can continue to give your pet a prescribed pain reliever to
minimize discomfort. Exercise such as swimming and walks is encouraged
following FHO. Rehabilitation therapy should be continued until your dog is bearing weight well on the operated limb
(typically 4 to 6 weeks after surgery). Your companions surgeon will monitor the healing process with at least two
follow-up examinations at 2 weeks and 2 months after surgery. By 2 weeks after surgery, most dogs are weight
bearing on the operated limb and by 2 to 4 months after surgery your companion should make a complete recovery.

Complications of femoral head and neck excision may include decreased range of motion of the false joint, loss of
function of the limb, nerve damage, and infection.

The FHO has the best outcome in small dogs; however, intermittent hip soreness may be seen with heavy activity.
Thus intermittent use of nonsteroidal anti-inflammatories may be needed.






















Legg-Calve-Perthes Continued
Diagnosis
To diagnose a UT, your veterinarian should collect a sterile urine sample from your pet. The best method to collect urine
is by a technique called cystocentesis, during which a needle is inserted through the body wall into the bladder and urine
is removed by a syringe. This technique is very safe and painless to your pet. Free catch urine samples or samples ob-
tained from the floor or office examination table are invariably contaminated samples and not suitable for evaluation to
determine infection.

Your veterinarian will analyze this urine sample (urinalysis) and examine a small amount under a microscope. f either or
both bacteria or increased numbers of white blood cells (WBC's) are present, your veterinarian will suggest performing a
urine culture. The presence of white blood cells means that inflammation is present but does not necessarily mean a UT
is present. Likewise, in an animal whose immune system is compromised or having highly diluted urine, a UT may be
present, but the urinalysis may not reveal white blood cells or bacteria. A urine culture is the best method for confirming a
UT is present.

A urine culture involves sending a small part of the collected urine to a laboratory that will try to grow the bacteria. f no
bacteria grow, then a UT is unlikely to be present. f bacteria grow, then the organism will be identified and antimicrobial
susceptibility will be performed by the laboratory. Antimicrobial susceptibility testing usually takes 2-5 days for
completion.

n some animals, additional testing may need to be done, such as blood work or imaging studies (radiographs or ultra-
sound), because a bacterial UT may occur as a result of or in combination with other diseases (e.g., bladder stones,
chronic kidney disease, feline leukemia virus).
Treatment
Antibiotics are prescribed to treat bacterial UT's. How long antibiotics need to be given to your dog or cat depends on
several factors, including whether it is a dog or cat, the age of the animal, whether this is a first time UT or a
recurrence of a UT, what the bacterial organism is, and what antibiotics it is sensitive to, and if complicating factors are
associated with the UT.

A simple (or uncomplicated UT) occurs primarily in spayed female dogs and is not associated with systemic illness or
complicating diseases. n this case, antibiotics are typically given for 7 to 14 days.

A complicated UT occurs when there are one or more complicating diseases or if the UT is recurrent. Remember, that
young cats rarely have a UT and in older cats UT is usually complicated by chronic kidney disease. Another example of
a complicating disease is diabetes mellitus or hyperadrenocorticism (Cushing's disease). n animals with a complicated
UT, antibiotics may be recommended for 3 to 6 weeks. A urine culture will likely be recommended partway through the
treatment to make sure the UT is under control, and then again after the antibiotic treatment is finished to make sure the
UT is cleared.

Although other treatments are sometimes recommended (i.e., cranberry juice), no conclusive evidence proves they are of
benefit to dogs and cats. Prompt and appropriate antibiotic treatment based on urine culture and sensitivity is the best
way to eradicate a bacterial UT.
Urinary Tract InIection (UTI) Continued...
Prevention
n most instances nothing specific can be done to prevent a UT from occurring. Your dog or cat should be re-evaluated if
clinical signs recur. With complicated UT, your veterinarian should periodically evaluate your pet to make sure that the
UT has not recurred or is under control. n some animals with complicating factors present, a urinary antiseptic or an
antibiotic must be given long term to prevent a UT from reoccurring.

Assessment and recommendations

Patient: ________________________________________ Date: _______________

Treatment
Surgery is recommended
Surgery is not recommended

The following has been prescribed
No medications or special diet are necessary at this time.
Prescription joint diet: ____________________________________________
Neutroceutical: __________________________________________________
Nonsteroidal anti-inflammatory medication: ___________________________
Other medication: ________________________________________________

Exercise
Unlimited
Confine your pet to the house other than very short leash walks necessary for bowel movements and
urination
Restrict exercise to leash walks 10 minutes twice daily

Preparation for surgery
Start fasting your companion at midnight before the surgery; water should not be withheld
Pepcid AC 10 mg tablets: give ______ tablet(s) with water (use a syringe if needed) at 6
AM on the day of surgery

Composed by Daniel A. Degner, DVM, DACVS
Edited by Ned F. Kuehn, DVM, MS, DACVIM


Legg-Calve-Perthes Continued
Diagnosis
To diagnose a UT, your veterinarian should collect a sterile urine sample from your pet. The best method to collect urine
is by a technique called cystocentesis, during which a needle is inserted through the body wall into the bladder and urine
is removed by a syringe. This technique is very safe and painless to your pet. Free catch urine samples or samples ob-
tained from the floor or office examination table are invariably contaminated samples and not suitable for evaluation to
determine infection.

Your veterinarian will analyze this urine sample (urinalysis) and examine a small amount under a microscope. f either or
both bacteria or increased numbers of white blood cells (WBC's) are present, your veterinarian will suggest performing a
urine culture. The presence of white blood cells means that inflammation is present but does not necessarily mean a UT
is present. Likewise, in an animal whose immune system is compromised or having highly diluted urine, a UT may be
present, but the urinalysis may not reveal white blood cells or bacteria. A urine culture is the best method for confirming a
UT is present.

A urine culture involves sending a small part of the collected urine to a laboratory that will try to grow the bacteria. f no
bacteria grow, then a UT is unlikely to be present. f bacteria grow, then the organism will be identified and antimicrobial
susceptibility will be performed by the laboratory. Antimicrobial susceptibility testing usually takes 2-5 days for
completion.

n some animals, additional testing may need to be done, such as blood work or imaging studies (radiographs or ultra-
sound), because a bacterial UT may occur as a result of or in combination with other diseases (e.g., bladder stones,
chronic kidney disease, feline leukemia virus).
Treatment
Antibiotics are prescribed to treat bacterial UT's. How long antibiotics need to be given to your dog or cat depends on
several factors, including whether it is a dog or cat, the age of the animal, whether this is a first time UT or a
recurrence of a UT, what the bacterial organism is, and what antibiotics it is sensitive to, and if complicating factors are
associated with the UT.

A simple (or uncomplicated UT) occurs primarily in spayed female dogs and is not associated with systemic illness or
complicating diseases. n this case, antibiotics are typically given for 7 to 14 days.

A complicated UT occurs when there are one or more complicating diseases or if the UT is recurrent. Remember, that
young cats rarely have a UT and in older cats UT is usually complicated by chronic kidney disease. Another example of
a complicating disease is diabetes mellitus or hyperadrenocorticism (Cushing's disease). n animals with a complicated
UT, antibiotics may be recommended for 3 to 6 weeks. A urine culture will likely be recommended partway through the
treatment to make sure the UT is under control, and then again after the antibiotic treatment is finished to make sure the
UT is cleared.

Although other treatments are sometimes recommended (i.e., cranberry juice), no conclusive evidence proves they are of
benefit to dogs and cats. Prompt and appropriate antibiotic treatment based on urine culture and sensitivity is the best
way to eradicate a bacterial UT.
Urinary Tract InIection (UTI) Continued...
Prevention
n most instances nothing specific can be done to prevent a UT from occurring. Your dog or cat should be re-evaluated if
clinical signs recur. With complicated UT, your veterinarian should periodically evaluate your pet to make sure that the
UT has not recurred or is under control. n some animals with complicating factors present, a urinary antiseptic or an
antibiotic must be given long term to prevent a UT from reoccurring.