of normal function and range of motion (ROM)
forced early retirement for a working dog
difficulty getting into/out of owner's vehicle
difficulty getting on/off owner's bed
difficulty navigating stairs within/outside owner's home
decreased jumping ability for cats
trouble accessing litter boxes for cats (with resulting inappropriate toileting)
overall decreased QOL
damage to the bond between the affected pet and their people.
Earlier detection and intervention can help improve the QOL for affected pets and their people. Since many pet owners don't appreciate the prevalence of orthopedic conditions in cats and dogs, and many don't pick up on the earliest signs of such conditions, veterinary teams must be proactive in educating clients and encouraging early and appropriate screening for orthopedic issues to help advocate for and provide the best comfort and care for our patients.
3.12.2 Congenital and Acquired Orthopedic Conditions Can Be Common
3.12.2.1 Canine Hip Dysplasia (HD)
Data from the Orthopedic Foundation for Animals (OFA) puts the likelihood of canine HD at 18.3–21.2% for Rottweilers, 20.1–20.5% for German shepherd dogs, 15.5–19.9% for golden retrievers, and 8.5–12.0% for labrador retrievers [1]. (Bulldogs had the highest prevalence of HD according to OFA data, at 65.9–71.2%!)
3.12.2.2 Canine Elbow Dysplasia (ED)
OFA data also show high prevalence of ED in certain dog breeds: chow chows (48.6%), Rottweilers (38.9%), German shepherd dogs (19.1%), and golden retrievers (11.4%) [1].
3.12.2.3 Canine Osteoarthritis (OA)
In a OA screening study done on dogs undergoing dental prophylaxis, it was found that 68% had radiographic evidence of OA in at least one joint (many had more than one joint affected) [2]. It was also found in this study that 71% of the owners of the dogs that were found to have radiographic OA weren't appreciating any clinical signs of their dog's OA [2].
3.12.2.4 Feline Osteoarthritis (OA)
In one study, radiographic evidence of OA was present in approximately 30% of cats over 8 years old [3]. Another study found that 90% of cats over 12 years old had radiographic evidence of DJD [4].
3.12.3 Diagnostic Methods for Screening for Orthopedic Disease and Risk Factors
While radiographs are a central modality of orthopedic disease screening, they aren't the only diagnostic testing method to use when looking for orthopedic problems in patients.
3.12.3.1 Pain Assessment Questionnaires
Validated pet owner questionnaires exist that can help increase a clinician's index of suspicion for orthopedic (or other painful) disease in pets. When orthopedic disease is anticipated or suspected based upon breed, age, activity level, or other factors, having the client fill out one of the validated pain assessment questionnaires can help move the diagnostic process along and also assess response to interventions. Currently available pain assessment questionnaires include (see links to questionnaires in Recommended Reading section):
Canine Brief Pain Inventory (PennVet)
Helsinki Chronic Pain Index
Cincinnati Orthopedic Disability Index
Feline Musculoskeletal Pain Index (NC State CVM)
Montreal Instrument for Cat Arthritis Testing.
3.12.3.2 Palpation and ROM
At each wellness exam, make it a part of the general physical exam to look at, palpate, and do a quick ROM evaluation of each of the patient's joints. Any abnormalities detected or suspected based on this quick assessment can be discussed with the client and further evaluated specifically.
3.12.3.3 Gait Analysis
While force plate analysis isn't available in most veterinary practices, thanks to the prevalence of smartphones, we all now typically have a rather powerful tool to help in our regular gait analyses of patients. When orthopedic or gait abnormalities are suspected, take slow‐motion video using a smartphone to help in the evaluation and to show clients any abnormalities found. You can also have your client use their phone to shoot slow‐motion video of their pets going up and down stairs, running, jumping, and doing other activities at home. Not only can this help you find and localize orthopedic disorders but, by using “before” and “after” videos, it can also help you and your clients appreciate any improvements with therapies instituted. Tip: When shooting these videos, ensure that the phone is held horizontally, in “landscape” mode, and that the lighting and background provide the right detail and contrast to get the most benefit from the videos.
3.12.3.4 Radiographs
While dedicated radiographs for orthopedic disease screening generally require and benefit from sedation or anesthesia (e.g., Penn HIP, etc.), don't forget about the orthopedic information that can be gleaned from general radiographs of patients when looking for thoracic or abdominal disease. Shoulders and hips are almost always present in thoracic and abdominal radiographic views, respectively, and elbows and stifles frequently are, too. Similarly, vertebral bodies and associated intervertebral disc spaces are also frequently present for evaluation. While thoracic and abdominal views and techniques aren't specific for evaluating joints, you can still glean a lot of initial screening information from their appearance in them. It is important to realize that all pets can develop orthopedic issues, including mixed‐breeds, and so routine screening is important for all patients.
3.12.3.5 Genetic Testing
Common orthopedic disorders, such as hip and ED, patella luxation, and even cruciate disease, have been shown to have a heritable component. However, because the heritability of these conditions is complex (involving multiple mutations), truly predictive and cost‐effective genetic screening isn't yet available (see 3.4 Predicting and Eliminating Disease Traits). This is an exciting area that holds good promise for future development. In the interim, it is important to recommend routine orthopedic screening of pets with known breed predispositions to such problems (see 3.11 Integrating Genotypic and Phenotypic Testing).
3.12.4 Incorporating Orthopedic Screening into Your Practice Workflow and Client Recommendations
Several suggestions for incorporating orthopedic screening into exams and practice workflows are mentioned above. Here are a few more ways to recommend and incorporate screening and monitoring of orthopedic conditions into daily practice.
