written by: Dr. Ravi Haris
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As an owner of a young toy breed, you might be worried to suddenly discover your little dog is limping and in pain. Those tiny legs are certainly vulnerable to injury, but if the lameness continues or worsens, it could be something known as Legg-Calve-Perthes Disease.
Legg-Calve-Perthes Disease (also known as LCP disease) is a painful condition that tends to affect small dogs under 25 pounds. It affects male and female dogs equally and often begins as a limp in the affected limb. Most dogs who develop the condition are toy breeds; however, it can happen to larger dogs as well.
Keep reading to find out if your dog is one of the most susceptible breeds, clinical signs to watch for, treatment options available, and how well dogs recover from surgery.
WHAT IS LEGG-CALVE-PERTHES DISEASE IN DOGS?
Legg-Calve-Perthes (also known as Calve-Perthes Disease, Legg-Perthes Disease, Avascular Necrosis of the Femoral Head, or Aseptic Necrosis of the Femoral Head) is painful condition that affects the hip-and-socket joint at the top of the femur.
The condition causes an interruption of blood supply resulting in avascular necrosis of the femoral head (death of the bone cells). As this process occurs, the femoral head will try to regenerate itself by creating new bone growth.
Unfortunately, the new growth creates a great deal of pain and can lead to the development of orthopedic diseases like osteoarthritis.
To understand the process, make a fist with one hand and cup your other hand over that fist. If your cupped hand is firm, the fist can move but it can’t slip out of place. If you soften your grip or release the cupped hand, the fist has no support.
When this happens to the hip joints in dogs (and people) it can cause a femoral epiphysis which means the bone has slipped from the joint. At this point the articular cartilage that normally provides low-friction movement, has worn away leaving your dog in severe pain.
Some theories for why blood supply to the bone is interrupted include:
- Hormonal Influence
- Compression of the joint’s blood vessels
- Anatomic irregularity due to genetic components
- Hereditary condition of small breeds caused by the autosomal recessive gene (genetic cause)
Common Clinical Signs of Legg-Calve-Perthes Disease to Watch For
Initially, you might not notice the early stages of the disease. However, over a series of weeks, you may notice some of the following clinical signs:
- Lameness or worsening limp of the affected leg
- Stiffness in the rear limbs
- Licking or chewing the skin over the affected area
- Weakened muscles
- Atrophy of the hindlimb
- Aggressive behavior due to pain
- Prefers to remain alone and not socialize or go outside
Tell-Tale Signs You Could Miss
This disease affects young dogs less than one year of age. It’s mostly seen in Terrier breeds, toy and small breeds with signs developing between 5 and 8 months of age.
There are always exceptions and, in this case, signs may appear in dogs as young as 3 months or over 13 months of age.
In addition to the clinical signs mentioned above, you may also notice:
Decreased Range of Motion
Pain combined with lack of use leaves the dog with a marked decrease in range of motion.
Any attempt to manipulate the leg manually will cause the dog a great deal of pain. Lack of exercise in the area can lead to muscle atrophy of the affected limb.
Grating & Popping Sounds
Dogs with Legg Calve Perthes disease may develop a grating or popping sound from their hip joint. The sound is known as crepitus which is caused by air in the subcutaneous tissue.
Making the Diagnosis
An experienced veterinarian will combine the results of a physical examination along with radiographs of the femoral neck area. This will show whether there is any deformity of the femoral head or destruction of the area where the bone is less dense.
The first thing the veterinarian will likely do is a standard clinical examination to investigate any other potential causes of the limping and lameness.
In an attempt to uncover the true cause of the lameness, the doctor may ask a series of questions to determine any prior injuries to the affected limb, etc.
Blood tests are often necessary (especially before surgery) to ensure the dog doesn’t have any underlying conditions that could affect successful treatment.
In addition, blood tests can help to determine kidney, liver, pancreas, and heart function to ensure the dog is safe to undergo anesthesia.
How is Legg Calve Perthes Disease Treated?
In minor cases (where the femoral head has still retained its shape) conservative treatment including cage rest and physical therapy may help. However, it’s important to understand that conservative treatment isn’t always successful. Most dogs will need to be treated surgically for long-term success.
Femoral Head Ostectomy (FHO) or Femoral Head Osteotomy
FHO surgery is considered an alternative for dogs who do not qualify for a total hip replacement.
Dogs with severe osteoarthritis and/or hip dysplasia are candidates for this surgery as a way to eliminate the pain.
This type of surgery removes the “ball” part of the ball-and-socket joint from the hip. This procedure, known as a neck ostectomy (or neck excision), allows the body to heal with scar tissue and is only recommended for dogs who don’t respond to other treatment.
Once the femoral head and neck are gone, scar tissue develops in the joint space and that thickened area serves as a false hip joint.
Dogs who undergo this surgery tend to make a complete recovery, although there may be apparent limb shortening.
In some cases, conservative treatment like crate therapy and strict rest are prescribed. Most often, however, surgical intervention provides the best result. Severe cases almost always require surgery intervention.
Recovering From Surgery
Post-surgical treatment may include medication for pain relief and strict rest for a few weeks.
Experts at PetVet Care Centers suggest a 2 phased approach to recovery that focuses on controlling pain and inflammation with medications before moving to a very gradual increase of activity.
Dogs who have had FHO surgery should not have any strenuous activity for at least 30 days post surgery. Most dogs require about six weeks to recover.
Physical rehabilitation usually begins a week after surgery to slowly rebuild muscle mass. Although the point of the surgery was to allow scar tissue to develop, it’s still important to help your dog build muscle mass and improved range of motion.
The veterinarian may suggest mild activities for best results. These could include:
With the veterinarian’s permission, you can start allowing your dog to attempt a short stair climb to help build muscle in the hind leg.
Hind Leg Walking
Allow your dog the opportunity to gain some mobility and strength by gently holding him/her upright and allowing the dog to walk on the hind legs.
Short Bathroom Breaks
If your dog is not in a lot of pain, you can take him/her for short bathroom breaks. If you are concerned about exposing the dog’s surgical site to the outdoors where there is a greater risk of injury or infection, you might consider a temporary Doggie Lawn.
Doggie Lawns are a natural indoor puppy potty that offers a perfect square of real grass in a mess-free base. You can put it anywhere in your house, allowing your small breed to take the few steps necessary without overdoing it.
FOLLOW UP TREATMENT
As your dog slowly recovers from the surgery, the veterinarian may want to see monthly radiographs to get a sense of how the area is healing.
Is Your Small Dog at Risk of Legg Calve Perthes?
Unfortunately, this painful condition tends to strike toy breeds and other small dogs. According to the Orthopedic Foundation for Animals, the following breeds are at risk:
- Australian Terrier
- Bichon Frise
- Border Terrier
- Boston Terrier
- Cairn Terrier
- Cocker Spaniel
- Fox Terrier
- Jack Russell Terrier
- Lakeland Terrier
- Manchester Terrier
- Miniature Schnauzer
- Miniature Pinschers
- Toy Poodles
- Scottish Terrier
- Shetland Sheepdog
- Manchester Terriers
- Welsh Terriers
- West Highland White Terriers
- Yorkshire Terrier
Summing it Up
Dogs respond well with the right treatment options, including surgery and physical rehabilitation.
There is the possibility that your dog may have one leg uneven with the other after surgery, but they do remarkably well once the false hip joint has developed from scar tissue.
Your dog’s mobility may not be as good as it once was, but he/she will be free from the pain and able to have a much better quality of life.
DID YOU KNOW:
Georg Clemens Perthes was a German surgeon who pioneered the use of x-rays. In 1898, he took the first x-rays of a patient with this syndrome ( now known as Legg-Calve-Perthes Disease).
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