Integrated therapeutic strategies for managing canine hip osteoarthritis

Introduction

Osteoarthritis (OA) is a chronic degenerative joint disease-causing pain, stiffness, swelling, and lameness due to cartilage deterioration and synovial joint changes (Vaughan-Scott & Taylor, 1997; Pasquini et al., 2003) [14,20] . It affects cartilage, synovial fluid, and bone, often leading to synovial inflammation and osteophyte formation. OA management aims to reduce pain, control inflammation, slow degeneration, and improve mobility. A multimodal approach is essential, combining nutraceuticals, physiotherapy (ultrasound, thermotherapy, laser, electrical stimulation), and pharmacological treatments such as NSAIDs and glycosaminoglycans. Pentosan Polysulfate Sodium, a heparin-like glycosaminoglycan, is widely used for OA management. It helps reduce inflammation and has shown promise in clinical trials for noninfectious arthritis, effectively preserving cartilage proteoglycans (Suheb et al., 2015) [18] . Excision arthroplasty, or femoral head and neck ostectomy (FHO), is a salvage procedure used for painful hip conditions such as dysplasia, Legg-Calve-Perthes disease, OA, chronic luxation, fractures, or failed hip surgeries (Ganesh et al., 2017; Harper, 2017) [5,6] . By removing the femoral head and neck, it creates a pseudoarthrosis that reduces pain and restores comfortable mobility (Sutradhar et al., 2019) [19] . Physiotherapy has been used in veterinary medicine for over 25 years, and companion animal rehabilitation is now a rapidly growing specialty with increasing scientific support (Millis, 2015) [9] . Hence, the present research work was undertaken with the following objective: (1) To evaluate the efficacy of physiotherapeutic management alone and or in combination with medicinal management in hip joint osteoarthritic dogs. (2) To evaluate the efficacy of femoral head and neck ostectomy followed by physiotherapy in hip joint osteoarthritic dogs.

Materials and Methods

The present study "Integrated Therapeutic Strategies for Managing Canine Hip Osteoarthritis" included 24 canine cases at Department of Veterinary Surgery and Radiology, Kamdhenu University, Anand. Dogs were divided into four groups (n=6) and treated with different protocols. The dogs will be positioned in ventrodorsal depending on the hip joint examination. Radiographs will be interpreted to identify any structural changes or abnormalities indicative of OA (McCarthy et al., 2007) [8] . Large multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of bone contour The degree of pain was assessed by palpating the affected limb or joint and graded according to the criteria described by McCarthy et al. (2007) [8] . [8] . [8] . [8] .

Table 10:

Lameness during walk was recorded on a scale of 0-3 as; [8] on day 0 and day 28. Mean±SE scores at presentation were 2.33±0.21 (RE), 1.33±0.21 (PP), 1.83±0.30 (JM), 1.33±0.33 (WBS), and 1.67±0.21 (LW). By day 28, these improved to 1.50±0.22, 0.33±0.21, 0.67±0.21, 0.33±0.21, and 0.67±0.21, respectively, indicating significant therapeutic progress. Statistical analysis showed that Group 1 had significant improvement in RE, PP, JM, WBS, and LW scores, indicating the effectiveness of pentosan polysulfate, carprofen, and chondroprotective agents in managing hip osteoarthritis. The therapeutic benefits are likely due to the chondroprotective and disease-modifying actions of pentosan. These findings align with reports by Akaraphutiporn et al. (2020) [1] , Smith et al. (2022) [17] , and Mosley (2022) [10] .

Grade

Clinical Parameter of Group 2

Dogs were evaluated for radiographic changes, pain on palpation, joint motion, weight bearing, and lameness using a 0-3 grading scale (McCarthy et al., 2007) [8] on day 0 and day 28. Mean±SE scores at presentation were 2.33±0.42 (RE), 1.83±0.48 (PP), 2.00±0.52 (JM), 1.83±0.48 (WBS), and 2.17±0.30 (LW). By day 28, these improved to 1.50±0.22, 0.33±0.21, 0.67±0.21, 0.33±0.21, and 0.67±0.21, respectively, reflecting significant clinical improvement. Statistical analysis revealed that Group 2 showed significant improvement in pain on palpation, joint motion, weight bearing, and lameness, confirming the effectiveness of physiotherapy for managing hip osteoarthritis. However, physiotherapy alone did not influence radiographic findings. These results align with Pankaj (2022) [13] , who reported clinical improvement but no radiographic changes in musculoskeletal cases treated with modalities such as PEMF, LLLT, TU, TENS, PROM, and hydrotherapy. The benefits observed may be due to physiotherapy's ability to reduce pain, enhance circulation, decrease muscle tightness, stimulate the nervous system, and promote faster functional recovery (Rivière, 2007) [16] .

Clinical Parameter of Group 3

Dogs in Group 3 were evaluated for radiographic changes, pain on palpation, joint motion, weight bearing, and lameness on day 0 and day 28. Mean±SE scores at presentation were 2.50±0.33 (RE), 2.60±0.22 (PP), 2.67±0.30 (JM), 2.80±0.17 (WBS), and 2.13±0.17 (LW), which improved to 1.17±0.30, 0.00±0.00, 0.17±0.17, 0.00±0.00, and 0.33±0.21 by day 28.

Table 13: Mean±SE values of radiographic evaluation, pain on palpation, joint motion, weight bearing during standing and lameness during walk of group 3.

2.50 a ±0.33 2.60 a ±0.22 2.67 a ±0.30 2.80 a ±0.17 2.13 a ±0.17 Statistical analysis confirmed significant improvement across all parameters, indicating that pentosan polysulfate combined with physiotherapy is highly effective for managing hip osteoarthritis. The strong therapeutic impact may be due to PPS's anti-inflammatory and chondroprotective actions, supported by findings from Kumagai et al. (2010) [7] , Suheb et al. (2015) [18] , and Akaraphutiporn et al. (2020) [1] . Physiotherapy further contributed to pain reduction, improved circulation, decreased muscle tension, nervous system stimulation, and faster recovery, consistent with observations by Pankaj (2022) [13] .

Clinical Parameter of Group 4

Dogs in Group 4 were assessed for radiographic changes, pain on palpation, joint motion, weight bearing, and lameness using a 0-3 scale on day 0 and day 28. Mean±SE scores at presentation were 2.83±0.17 (RE), 2.67±0.21 (PP), 2.50±0.22 (JM), 2.67±0.21 (WBS), and 2.83±0.17 (LW). By day 28, these improved to 1.17±0.30, 0.00±0.00, 0.17±0.17, 0.00±0.00, and 0.33±0.21, respectively, showing marked recovery following femoral head and neck ostectomy with postoperative physiotherapy. Statistical analysis showed significant improvement in RE, PP, JM, WBS, and LW scores in Group 4, indicating that femoral head and neck ostectomy followed by postoperative physiotherapy is effective for managing hip osteoarthritis.

Postoperative VD radiographs revealed a clear gap between the proximal femur and acetabulum with no bony proliferation, consistent with findings from Off and Matis (2010), Nagaraju (2016), and Rahul (2023) [12,11,15] . 3. Dogs undergoing femoral head and neck ostectomy followed by postoperative physiotherapy showed satisfactory recovery, regained functional limb use, and achieved high owner satisfaction. The study indicates that FHO is a simple, reliable salvage procedure for managing chronic hip osteoarthritis in dogs weighing 25-30 kg. 4. In medicinal management group with pentosan polysulfate sodium, oral nutraceuticals and Tab. Carprofen shows effective results for the management of hip OA. 5. In this study, physiotherapy alone produced good recovery in all dogs, demonstrating its effectiveness in reducing pain, improving mobility, and enhancing quality of life in hip osteoarthritis. While beneficial on its own, physiotherapy is most effective when combined with conventional treatments, as it accelerates overall recovery.

References

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