Re: FHO / EA and its effect on cruciate disease

james herriot lied — Sun, 04 Nov 2012 19:39:48 GMT

Thanks, Malcolm

As I say, FHO is only one option being considered. Frustratingly, the dog has already been on a couple of months of NSAIDs without response and whilst it's banged up in the rescue centre, it's one of those dogs which could exercise itself inside a small shoe box. It's coming back in mid-week for re-assessment, in the slightly optimistic hope that localisation will be more successful. One of those cases which make me doubt my abilities, really.

I'm just interested in the effects of suspension through FHO; I can't find any direct research which looks at CCL incidence post-FHO and whether it's significantly different to the general population. It's the kind of speculation that we're not so good at these days, wrapped as we are in either EBM or 'alternatives'.

Re: FHO / EA and its effect on cruciate disease

Malcolm Ness — Sun, 04 Nov 2012 16:42:21 GMT

I would put it on 3 mths of NSAID (phenylbutazone is terribly unfashionable at the moment but it is cheap and it still works!) and I would encourage full, unrestricted activity. At the end of that time (possibly before) the relative significance of hip v stifle will be obvious and the need (or otherwise) for salvage surgery of the hip will be established (or otherwise). I would only operate on either joint once I was convinced on clinical exam that there was significant pain localisable to the joint in question and then only if that pain could not be [completely] controlled medically.

If you do decide on FHO, I would suggest doing it well before any cruciate surgery - post-op FHO outcome is best when early active use of the limb is established. If you operate hip and stifle at the same sitting there is a risk that the dog will carry the leg for a long time after surgery and get a very poor ROM in the healing FHO hip.

Your speculation about the related mechanics is as likely to be correct as anybody's. However, the peak ground reaction force following FHO is massively less than that seen in a normal limb so the loads acting through the stifle will be similarly reduced. As to what direction the forces will be acting and what the secondary and tertiary effects of these interferences with hind limb biomechanics might be, I couldn't even start to guess.