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Thread: PennHip and Juvenile Pubic Symphysiodesis

  1. #1

    Default PennHip and Juvenile Pubic Symphysiodesis

    I have a 17 week old GSD puppy. At 14 weeks of age I noticed the following warning signs of HD:

    Bunny hopping,
    Avoiding stairs,
    Difficulty and slow to rise,
    Frog sitting,
    Hip sway.

    I took him to the vet who performed a physical exam and observation of the puppy walking, sitting and running. The vet suspects early onset HD. We have now been referred to one of Sydney's top specialists to see if he is a suitable candidate for JPS.

    I have done a lot of research into this and have noticed there is a LOT of misinformation out there so I am here to 1) Clarify some of the information, 2) See if anyone here has first hand experience in this procedure and 3) Update you all on my puppy's post-operative process.

    1) Many breeders and owners seem to think PennHip is bad for pup's. They also believe 16 weeks is too young to diagnose HD or to undergo surgery. Further, there is a lack of information available from people who have actually had this procedure done but a lot of uninformed opinions on the topic.

    The PennHip X-ray is the ONLY x-ray that can test for laxity in a young puppy. Regular hip screening is not suitable for a pup and even in a mature dog a regular x-ray (even the certification x-rays) do not test for laxity and do not assess potential for HD. Rather, they can determine the existance of HD or arthritis. PennHip does not cause permanent injury to sedated dogs except in extremely rare circumstances. The stats for PennHip related injuries match those of other x-ray types.

    JPS can only be performed in young pups. Some vets will start JPS as early as 12 weeks up to 20wks however most agree that it needs to be performed between 16-18 weeks to have a higher success rate.

    Most vets will recommend JPS without having done a radiograph as the radiograph is usually taken immediately prior to the surgery so the pup only has one anaesthetic. If the radiograph shows laxity between .3-.7 then JPS is indicated. Lower than .3 no surgery required. Higher than .7 and the chance of success is slim so other surgery or conservative treatment is better. JPS can prevent degeneration in very mild cases and can reduce further problems in mild-moderate cases. It is unlikely to be successful in severe cases but again may slow down degeneration.

    The closer the pup is to 16wks the better the result. After 20wks it is too late to do JPS and the next best option is Bilateral pelvic osteotomy or Triple pelvic osteotomy at 6-12mnths of age (preferrable 6-9mnths). This is much more invasive with a longer recovery period and much higher cost.

    JPS has the same recovery time as a spray/neuter procedure and these two procedures may be done at the same time. This means that in one session the pup has x-ray, JPS and desexing. This lowers cost and risk that comes from multiple anaesthetics.

    Most breeders do NOT do adequate screening. They will have a go at me for saying that but it is the truth. They rely on x-rays at 12mnths or 2years of age to weed out HD dogs and select appropriate dogs for breeding. The problem with this is two-fold. Furstly, at 12mnths-2yrs the dog may not have HD yet but may still develop it later and secondly, most breeding screens that test hips do not test laxity which is the single best indicator of future HD.

    Finally, Prevention of HD will increase the pup's ability to mature into an active arthritis free dog, decrease likelihood of further surgery requirements and ensure the dog has the most minimal recovery time and will not need multiple anaethetics to perform seperate ops.

    Ok so based on all of this I am going ahead with JPS if my pup is deemed suitable after his x-ray. Has anyone else done this procedure, how did the pup go?

    For anyone interested in JPS please do your research as it is definately not suitable for everyone and in most cases it is done on a pup that has no clinical signs of HD and so you may never know if the surgery was actually needed or not but in most cases it will result in better hip fit and stability overall.

    Btw here is a link to one of the studies with more conservative findings:

    Comparison of conservative management and juvenile pubic symphysiodesis in the early treatment of canine hip dysplasia.

  2. #2
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    Anicca83

    Very sorry to hear about your GSD puppy.

    When you did your research on breeders - did you ask to see hip scores for the parent dogs? Did you meet the parent dogs and see them running and walking? Did you meet any of their previous puppies and see them moving?

    I know it is possible for parent dogs with good hip scores to produce puppies with dodgy hips but health testing and avoiding mating two dogs with a family history of dodgy hips - is reducing this.

    Have you asked your vet to provide the breed history of your puppy to the NSW LIDA Dog DNA database - so they can help keep track of this kind of problem
    LIDA Dogs - LIDA Dogs - Faculty of Veterinary Science - The University of Sydney

    And my info on Pennhip - was that it is the most accurate way of diagnosing hip dysplasia in dogs. But all HD diagnosis requires the dog / puppy to undergo general anaesthetic (GA) and xrays - and the younger the puppy - the more risky a GA is.

    I had never heard of Juvenile Pubic Symphysiodesis as a treatment - and your post and link does not describe what that is. I suppose you could construe the complete absence of information as "misinformation". I'd like more descriptive details.

    This link describes it a bit. Something to do with operating on cartilage to allow a better fit of hip joint ball and socket.
    http://adelaidevet.com.au/puppy-hip-dysplasia

    With that description - it makes sense that the younger the puppy is when it has the operation, the better - so that the poor fitting hip - would be less damaged by use and load.

    but hip dysplasia also covers when the hip joint is deformed (genetic problem) so realigning the joint for a better fit won't fix the fact that the joint is not formed properly in the first place (mal-formed socket or ball) - in which case - something else would need to be done.

    The Adelaide vet article describes combining the HD op with the desex op at about 20 weeks (4 months old) but in large breed dogs - it is usually best for bone growth and joint formation - to desex when they're older like about 18 months. So I wouldn't combine the operation if I had a choice.

    http://www.curtinvet.com.au/desexing.html
    Last edited by Hyacinth; 11-24-2014 at 01:29 PM.

  3. #3

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    Hi Hyacinth,

    I did research the breeder first and the breeder has a very good rep with their stud dogs and bitches used by many other breeders. The parents look good and have excellent hip scores (but were never assessed by Pennhip for laxity). There is no history of HD in the past 5 generations. In saying that, the Stud dog was a german import and I have no idea what their testing procedures invole.

    You pointed out that I did not describe what JPS is. That is because my thread was aimed at people who have done it before or who already know about it. For those who don't here is a description:

    Juvenile Pubic Symphysiodesis (JPS)
    A JPS is a minor surgical procedure that can be done on puppies prone to hip dysplasia in order to improve their hips. Before the decision is made to perform the procedure the puppy is examined under general anaesthetic and an x-ray is taken of the hips. Based on the examination and the x-ray if the puppy’s hips are abnormal the JPS procedure is performed.
    The JPS procedure involves fusing the cartilage on the two sides of the pelvis in order to rotate the hip sockets into a more normal position hence providing a better fit between the femoral head (top of the thigh bone) and the acetabulum (pelvis). This procedure is best done on puppies between 16 and 20 weeks of age, the pelvis of puppies older than 20 weeks of age is usually too developed for the procedure to be successful.
    Puppies that have a JPS procedure done are almost always desexed at the same time. This is partly because they are about the right age to be desexed so it is easy to do both procedures in one anaesthetic. The other reason is that puppies with abnormal hips should not be used for breeding as their hip problems can be passed onto their puppies. If the pup does not need the JPS procedure they can still be desexed in the same anaesthetic if you do not intend to breed from them.
    The recovery time from the JPS procedure is no longer than a desexing procedure and complications from this procedure are rare. Puppies that have had a JPS procedure are much less likely to get hip dysplasia later in life and those that do have much less severe symptoms.

    The whole point of the PennHip is to determine suitability for the JPS. Obviously if he is not suitable due to deformity or existing degeneration then the procedure will not be performed. As for the desexing at an early age, this is somewhat controversial and many breeders would definately not recommend desexing at such a young age, however shelters have been desexing early for many many years with no evidence of this causing problems later on. In fact, RSPCA actually recommend early age desexing as do PETA. Even some breeders only sell desexed pups. I guess this comes down to personal preference but our last GSD was desexed at 4mnths due to medical requirements in relation to a problem with his testes and he lived a full and happy life with no health issues so my person experience is that it is not an issue. Also, RSPCA and other sources cite evidence that early age desexing has a faster recovery period with less trauma to the surgical site and claim GA is not more risky for young pups. Again this is controversial as other sources claim the opposite... Many specialists insist on neutering at the time of the JPS procedure though so again I am not concerned anout this at all. I am more concerned about keeping our pup inactive during healing.

    Thank you for your thoughts, you did raise some interesting points. If he was not showing symptoms I would have probably not considered this at all but as he is showing symptoms including pain I am definately going for the PennHip. Whether he gets surgery will entirely depend on the results of the PennHip. If he does have surgery then I will post updates on his progress and any complications that arise.

  4. #4
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    Hi Anicca83

    Thanks for the extra info. Surely your target audience of people who have already had experience of the JPS operation - would not be misinformed about what the operation is. That's why I was a bit puzzled about the purpose of your post.

    It is horrible bad luck that your GSD has got bad hips when it seems his parents were ok. I think in Germany for a dog to be registered suitable for breeding - it has to pass a bunch of health tests, temperament and performance tests (eg Success at IPO or equivalent). Not just look pretty like the show lines here.

    So I don't know if the parent dog had passed the German requirements for breeding or not or if it was registered here based on its parents being registered there or some loop hole. Would be interesting to find out. Doesn't do that breeder's reputation much good either. Sigh.

    I hope that your puppy can be healed and lives a good life. And I look forward to progress updates.

  5. #5

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    Thank you for your response. Sorry if I was unclear. Obviously I would expect that people who have gone through with it are informed (at least one would hope so). These are the people I would love to hear from to find out how it all went, whether they have any regrets or advice etc. I am also hoping my post will be helpful in clarifying information for those who are aware of the procedure but have not gone through it. I am in no way suggesting people should choose this option for their pup, I am simply explaining what I have learnt and why I am going through with the testing and the procedure if applicable. I hope my experience will benefit others and give them the confidence to embark on their own journey if they feel this is right for them but have been scared off by the misconceptions and misinformation being plastered over multiple forums.

    I am well aware there are conflicting medical opinions and research so it is not easy to make the decision for surgery as it is but when there are people out there providing completely incorrect information it makes it that much harder. These people have every right to disagree with the procedure or the process but it is not fair to condemn people considering this procedure based on inaccurate information, a lack of understanding or incorrect assumptions. Sadly this seems to be a widespread problem. The fact we are discussing this topic without having a heated debate is already completely different to most of the threads I have found elsewhere, so thank you for your input and your requests for clarification of information. That is helpful as I do not want to confuse anyone or start a thread that will not benefit someone interested in this topic.

    Factually, there are pros and cons to considering JPS. It may be beneficial, it may not. But people need to understand the process involved from diagnosis to testing to recovery and make informed choices. They need to consult professionally qualified practioners before making a decision but a lot of people do not have confidence in their vet and turn to forums for advice, Sadly not all the advice given in relation to JPS is accurate and yet people are influenced by this advice.

    I have been unfortunate to have bought a pup experiencing symptoms at such an early age but I am glad there is an option out there that may be able to improve his chances of having a normal healthy life. I do think that some breeders need to educate themselves better regarding the benefits and limitations of the different screening methods and prevention/treatment procedures. I also think breeders and dog owners without veterinary expertise need to refrain from telling others what they should or should not do (advice vs opinion) in medical situations just because they think they know best when the person they are talking to has received advice from a veterinary professional (and preferrably a second opinion or specialist advice). But that is just my opinion and is getting off topic so I will stop there.

  6. #6
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    Anicca83

    Hopefully someone else googling about hip dysplasia will visit and post too.

    As for non-professionals giving opinions - that is pretty much the nature of forums - I have been known to do it - probably not about HD tho - so far so good - I might have it but pretty sure my dog doesn't. And it doesn't matter a lot if the topic wanders off topic in here. Other forums the mods might get picky about it but here - doesn't matter a lot.

    Maybe you could make some video of your dog's movement - now - before the operation for reference for later... eg get someone to recall him and video from each side and from the front and from behind, and maybe some of him doing turns or gentle turns clockwise or anti clockwise, and then do the same again post op when he's moving freely again.

    There are some OS specialists that can provide advice based on video of the dog's movement. I have a friend who has a BC with major joint problems as well as heat induced collapse (or muscles that fail to manage their own heat generation). And she posts videos for a USA specialist to view and advise - tho so far - joint problems have been diagnosed but no treatment has been successful.

    I'd love to see some pictures or video but I understand if you don't want to post.

  7. #7
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    I have a friend have this procedure done on her young dog because there were early signs that HD was a possibility. It is a reletively cheap procedure compared to the adult procedures I think. I can ask her if she thinks it was worth doing.

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    Puppies that have a JPS procedure done are almost always desexed at the same time. This is partly because they are about the right age to be desexed so it is easy to do both procedures in one anaesthetic. The other reason is that puppies with abnormal hips should not be used for breeding as their hip problems can be passed onto their puppies. If the pup does not need the JPS procedure they can still be desexed in the same anaesthetic if you do not intend to breed from them.
    This part I find absolute stupidity. You want to change the shape of an immature animal that may still be OK in a lot of instances, but then you want to remove a major source of growth hormones...

    Your problem is in two parts with this. I'm not the greatest fan of operating on very young puppies because they are still developing ... remember they are not born 'ready to go' they are technically a little premature. Here is a 2 week old puppy x-ray, nothing is even connected.
    puppy x ray.jpg

    So with this in mind unless you have a problem as in your case, which severe physical limitation yes is a very concerning issue, how can a lot of people be 100% sure a surgery is the right option? I knew a vet that did PennHIP and he pretty much just went, yup, HD, surgery. It became insanity. We have to look at environment and diet too in how we raise our pups... very concentrated foods, over nutrition and very restricted exercise compared to their wild and feral counterparts. Majority of pups I see have barely been out of the whelping box before purchase and are quite chubby. The bigger the breed, the more pressure on an unformed skeleton.
    http://i24.photobucket.com/albums/c11/Mali_nut/K9LOGO.jpg

  9. #9
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    My friend certainly didnt get her pup desexed at the same time as the JPS. I desex my bitches at 12 months, after they have had their first heat and the same for the dog in question. My friend was lucky to have the guidance of a first class orthopedic surgeon well respected in sporting circles.

    I think the procedure just aligns things a little better for growing. I dont think there is a guarantee that it will make a difference. However if there are signs that all is not entierely well it is a chance to have a less extensive surgery early than may be required down the track.

    I would certainly consider it if my trusted orthovet felt it was appropriate. I had my young dog operated on for what we suspected might be bilateral ED. The vet said it was line ball, but he would take the chance as it usually is only really successful if done young before major damage sets in so I decided to do it. Best decision I think. Lesions and bits of cartilage were removed before the joint surfaces were eroded. She is rising 7 now and fully functional in both elbows. What if I hadnt done the surgery - we dont know, but she is certainly the most functional of the dogs I know who had surgery done later, or no surgery.

    Yes puppies are often too chubby, mine certainly are not. I grow em out lean as do my sporting friends. I have a dog with mild HD, however I didnt pick it up till he was 12 months old and after his sister, a working BC was diagnosed. My ortho said surgery was not required at that time. Just keep him lean and muscled which I do and he is one of my best working dogs.



    Yahoo has a group dedicated to HD, lots of experiences on there.
    Last edited by Kalacreek; 11-26-2014 at 12:06 AM.

  10. #10

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    Hello Anicca93, I just found this thread while googling about JPS. I was also seeking for advice by someone who actually had the procedure done. I have a malamute puppy who has been diagnosed with HD and exactly today he had the surgery, so it would be nice to have some info about other puppies recovery and the results itself. I've seen you haven't posted here anymore, so I don't know if you went through with it or even if you'll see my post, but if you did (or anyone else for that matter) and see this, please share your experience. It would be of great help and I'd love to know how he is doing today.

    Thanks

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