Goals of Treating Legg-Perthes Disease
When an owner suspects that her dog is suffering from some form of hip or hind limb lameness, it is time to get a veterinarian’s assessment of the dog’s health and physical status. The therapeutic goals of treating Legg-Perthes disease are to return the dog to normal (or near-normal) pain-free activity, stabilize the hip joint and restore mechanical weight-bearing hip function.
In mild or very early cases of Legg-Perthes disease, non-surgical medical management may be sufficient to alleviate the dog’s pain and lameness. This might involve enforced activity restriction and strict cage rest, together with intermittent or chronic administration of oral pain-relief medications (analgesics) and/or nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy may also be very helpful. Corticosteroids, which can be quite effective at reducing inflammation, should not be administered together with NSAIDs, because the interaction between these two classes of drugs can cause several gastrointestinal discomfort, up to and including intestinal ulceration and even perforation.
Surgical treatment has a much higher rate of success than does medical management alone. In most cases, surgery ultimately will be necessary as the disease progresses, even if non-surgical approaches are tried first. The most common surgical procedure is a femoral head and neck ostectomy (FHO), also sometimes called a femoral head and neck excision (FHNE). This involves surgically removing the head and usually the neck of the long upper thigh bone (the femur) that, together with the pelvis and surrounding cartilage, forms the hip joint. The procedure basically allows a “false joint” to form from fibrous tissue, granulation tissue and other scar tissues that fill in and replace the removed ball-and-socket joint of the affected dog’s hip.
A total hip replacement is another surgical option. This procedure in dogs, as in people, involves removing the entire damaged joint and replacing it with an artificial femoral head and pelvic hip joint socket. This is usually reserved for the uncommon large dog that is affected by Legg-Perthes disease. The procedure requires tremendous technical skill by the surgeon and should only be performed by a veterinarian who specializes in complicated orthopedic surgeries. The recovery time and expense of a total hip replacement are prohibitive to many owners, as well.
Use of a non-weight-bearing sling, sometimes called an Ehmer sling, reportedly allowed one dog’s damaged femoral head and neck to remodel sufficiently without surgical intervention. However, this is highly controversial and is not considered to be a reliable treatment option by most veterinary orthopedic specialists.
Post-operative bandaging, cold-packing the affected site (cryotherapy) and activity restriction are all critical to a dog’s recovery from hip surgery. Physical therapy is particularly important to rehabilitating the affected limb, sometimes including early limited weight-bearing exercises, depending upon the advice of the surgeon and other rehabilitation professionals. Small lead weights may be attached above the hock joint as “anklets” to encourage leg use, once exercise becomes safe and appropriate. Physical range-of-motion exercises are often part of the physical therapy protocol, as are swimming and other water exercises. Owners must manage their dogs’ diet carefully to prevent obesity, which can put enormous stress on the hip joints.
Other less traditional techniques that may benefit dogs with Legg-Perthes disease, in addition to medical treatment, might include: massage therapy to help reduce pain, maintain healthy muscular tone and reduce collateral strain from compensation; possible application of acupuncture and/or acupressure techniques; use of herbal or other non-regulated supplements or homeopathic “remedies”; and other forms of supportive care that may help to ease pain, increase circulation, speed healing and otherwise promote wellness, relaxation and comfort. Some of these adjunct approaches lack controlled studies of their effectiveness and may not have established quality control methods or ways to assess their benefit to dogs with Legg-Perthes disease or other degenerative musculoskeletal disorders.
The prognosis for dogs treated surgically for Legg-Perthes disease is very good to excellent, as long as owners are diligent about post-operative physical rehabilitation and supportive care. After treatment and rehabilitation, most dogs regain pain-free function of the affected hind leg and hip and are able to enjoy normal canine activities such as running, jumping, walking and playing throughout the course of a normal life span.