SASH : Juvenile pubic symphysiodesis by Dr Daniel R James
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This document discusses juvenile pubic symphysiodesis (JPS), a minimally invasive surgical procedure to alter pelvic conformation in dogs. JPS involves cauterizing the pubic symphysis to arrest pubic growth and change the orientation of the acetabulum. Studies have shown JPS can partially or completely close the pubic symphysis, shorten and broaden the pubic ramus, and widen the obturator foramen. JPS has also been shown to decrease acetabular angle, reduce hip laxity, decrease osteoarthritis scores, and lower the probability of developing hip dysplasia in select dysplastic dogs between 16-20 weeks old with distraction indices of 0.
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SASH : Juvenile pubic symphysiodesis by Dr Daniel R James
- 1. JUVENILE PUBIC SYMPHYSIODESIS Daniel R James, BVSc MANZCVS (Radiology/ Surgery)
- 2. www.sashvets.com JPS- The premise • Identification of HD in juveniles – Distraction radiography – Clinical examination/ palpation (ortolani) • Pre-emptive/ prophylactic procedure – Non/ pre-clinical dogs • Minimally invasive/ low morbidity
- 3. www.sashvets.com JPS Rationale • Derived from the work of Mathews on altering pelvic conformation through early intervention in a guinea pig model
- 6. www.sashvets.com Rationale Continued dorsal growth Bilateral ventro-lateral rotation of acetabula
- 7. www.sashvets.com Improved hip coverage -> Dynamic Stability
- 8. www.sashvets.com Surgery Physeal closure via thermal destruction
- 9. www.sashvets.com Surgical Technique • Midline Approach to pubis • Cauterization of symphysis with monopolar cautery – 40W – 10-30 seconds at each point – Repeated every 2-3mm – Cranial 1/3->1/2 of symphysis
- 10. www.sashvets.com Surgical Technique • Pelvic structures, particularly urethra, must be protected from excessive heat – Trans-rectal retraction
- 11. www.sashvets.com Surgical Technique • Pelvic structures, particularly urethra, must be protected from excessive heat – Trans-rectal retraction – Malleable retractor or tongue depressor through pre-pubic incision
- 12. www.sashvets.com Surgical Technique • Pelvic structures, particularly urethra, must be protected from excessive heat – Trans-rectal retraction – Retractor/ tongue depressor – Surgeon’s digit through pre-pubic incision
- 13. www.sashvets.com Radiographic changes after JPS • XXXXX JPS Group Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis Objective and subjective evaluation S. Boiocchi et al Vet Comp Orthop Traumatol 2013 Control group (good hip conformation) Comparison of radiographic evaluation: +Partial or complete closure of the cranial part of the pubic symphysis- 2
- 14. www.sashvets.com Radiographic changes after JPS • XXXXX JPS Group Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis Objective and subjective evaluation S. Boiocchi et al Vet Comp Orthop Traumatol 2013 Control group (good hip conformation) Comparison of radiographic evaluation: +Shortening and broadening of the pubic ramus- 4
- 15. www.sashvets.com Radiographic changes after JPS • XXXXX JPS Group Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis Objective and subjective evaluation S. Boiocchi et al Vet Comp Orthop Traumatol 2013 Control group (good hip conformation) Comparison of radiographic evaluation: +Widening of the obturator foramen- 5
- 16. www.sashvets.com CT changes- Acetabular Angle • XXXXX R. T. Dueland et al.: Pt. I – Canine hip dysplasia treated by juvenile pubic symphysiodesis VCOT 2010 15 weeks 2 years
- 17. www.sashvets.com CT changes- Acetabular Angle • XXXXX R. T. Dueland et al.: Pt. I – Canine hip dysplasia treated by juvenile pubic symphysiodesis VCOT 2010 15 weeks 2 years JPS Control
- 18. www.sashvets.com Ortolani • 77% of ortolani + hips treated by JPS became ortolani – by 2 yrs • 8% of ortolani + hips not treated by JPS became ortolani – by 2 yrs
- 19. www.sashvets.com Osteoarthritis- Percentage change 26% JPS dogs had decrease in OA score
- 20. www.sashvets.com Osteoarthritis grade- severe laxity (>0.7) Osteoarthritis score increased by 57% and 83% at one and 2 years Most dogs with DI>0.7 had OA by 2 years
- 22. www.sashvets.com 0 10 20 30 40 50 60 70 80 90 100 Birth 12 weeks 17 weeks 24 weeks 52 weeks When to perform JPS • Pelvic growth capacity
- 23. www.sashvets.com When to perform JPS 8-12% loss of AA improvement for each week of delay between 12 and 24 weeks
- 24. www.sashvets.com Window of opportunity 0 10 20 30 40 50 60 70 80 90 100 Birth 12 weeks 17 weeks 24 weeks 52 weeks Distraction radiography not considered accurate < 16 weeks JPS efficacy dropping rapidly >20 weeks
- 25. www.sashvets.com In summary • JPS is minimally invasive
- 26. www.sashvets.com In summary • JPS is minimally invasive
- 27. www.sashvets.com In summary • JPS is minimally invasive • Changes pelvic conformation
- 28. www.sashvets.com In summary • JPS is minimally invasive • Changes pelvic conformation – Large body of literature documenting the capacity of JPS to alter pelvic growth and acetabular orientation
- 29. www.sashvets.com In summary • JPS is minimally invasive • Changes pelvic conformation • Decreases development of DJD
- 30. www.sashvets.com In summary • JPS is minimally invasive • Does change pelvic conformation • Can decrease development of DJD in a SELECT group of dysplastic patients – Age 16 (12?) to 20 weeks – DI 0.4 – 0.7
- 31. www.sashvets.com.au twitter: @SASHvets Phone - (02) 9889 0289 Fax - (02) 9889 0431 Level 1, 1 Richardson Place, North Ryde 2113, Sydney, NSW