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Hawksmoor News

February 2017 Case Study – Maisie

Name:                Maisie

Age:                   6 years old

Breed:                West Highland White Terrier

Condition:        Previous Femoral Head and Neck Excision Right Hind. Subsequent Osteoarthritis of Hips and Stifles.

 

Maisie started attending the centre for hydrotherapy rehabilitation in August 2016 following a diagnosis of osteoarthritis in her hips and stifle joints.  She also presented with right hind limb lameness.  Maisie attended the centre in 2011 following surgery to remove her femoral head; a Femoral Head and Neck Excision (FHNE).  This surgery was performed on the right hind also.

Femoral Head and Neck Excision surgery is carried out following diagnosis of Legg Perthes disease or in cases of hip dysplasia in small dogs.  This operation is a salvage procedure usually only considered in cases where THR cannot be performed (e.g. due mainly to variations in individual anatomy that could preclude THR). In this technique, the femoral head and neck (the “ball” part of the joint) are completely removed allowing a “false joint” to form. Pain is relieved by elimination of bony contact between the ball and the edge of the socket, but the resulting “false joint” is typically limited in its function, so clinical outcome may be unpredictable, particularly in larger dogs.

The above diagrams demonstrate how an X-ray of the hip joint following surgery and which portion of the bone is removed during the surgery.  Once this part is removed, the joint will stabilise using the muscles and ligaments to hold the remaining bones in place so it is vital that muscle mass is built up to an appropriate amount to work as a support system.  Maisie did really well with her initial hydrotherapy treatment, until recently when she was showing signs of lameness in the right hind leg at this point X-Rays were taken and Osteoarthritis was confirmed in the hip and stifle joints.  On the initial assessment session carried out on Maisie’s return to hydrotherapy she had obvious muscle atrophy in the gluteal and hamstring muscle groups and was adjusting her gait in order to reduce the weight bear through the hind limbs

 

On the first session her muscle mass measurements were taken as follows:-

Limb Measurement
Left Fore 16cm
Right Fore 16cm
Left Hind 27cm
Right Hind 27cm

 

Although this demonstrated her muscle mass measurements were even she had obvious atrophy on palpation.  It was decided that hydrotherapy pool treatment would be the most appropriate for Maisie in order to provide none weight bearing exercise and build appropriate muscle mass by increasing overall function and strength through the hind limbs.  As Maisie had swam in the hydrotherapy pool previously she took to it well again and was soon using her hind limbs in an appropriate manner.  On the first session, Maisie carried out 3 swims of between 40-50 seconds each and coped well with this.

 

Following on from this initial session Maisie attended the centre twice per week for 10 sessions and progressed well during these sessions.  On the 10th session she was swimming wearing a harness with a head float attached as she had become lazy using a life jacket and she was carrying out 7 circuits plus 10-20 seconds of static swimming with overall improved hind limb range of motion.

Her muscle mass measurements on this session were as follows:-

 

Limb Measurement
Left Fore 17cm
Right Fore 17cm
Left Hind 28cm
Right Hind 28cm

These measurements demonstrated an increase of 1cm in muscle mass in the fore and the hind limbs which was a good result for Maisie. At this point her sessions were maintained at twice per week.  On the 20th session, Maisie was re-measured as follows:-

Limb Measurement
Left Fore 17cm
Right Fore 17cm
Left Hind 28cm
Right Hind 28cm

 

This demonstrated that Maisie had maintained her muscle mass which was a good result as her overall gait pattern had started to improve.  It was decided following this that Maisie would attend hydrotherapy once every 2 weeks.  Maisie is doing well in general and the owner is pleased that she is able to exercise further with little or no problems at all.  She now carries out 6 sets comprising of 3 circuits each with some additional static swims at the end of each set and she copes extremely well with this.

We are pleased with how Maisie is progressing through her sessions, as is her owner, and we hope she continues to do well. Such a lovely, friendly girl who really enjoys her swims and especially the gravy bones!

Well done Maisie, keep it up!