Treatment for Osteochondritis Dessicans
The goal of treatment is to alleviate pain, increase mobility, and prevent further damage. Factors to consider when determining treatment include the following:
- Age and health of animal
- Availability of a surgeon
- Intended use of animal
- Severity of symptoms
Conservative treatment is less expensive and requires less rigorous owner compliance than surgery. It is often used for older dogs and those with other health problems. Surgery is performed only on healthy animals, and it requires an experienced surgeon and owner compliance for proper healing. Surgery is often considered for young dogs and dogs used for breeding, showing, and working.
Conservative Treatment for Osteochondritis Dessicans
Conservative treatment includes rest, confinement for 4 to 8 weeks, and weight control. This treatment is recommended when symptoms are mild and x-rays do not show lesions.
With rest, the cartilage heals and animal often regains full function. If rest alone does not relieve the symptoms, medication may be necessary.
Losing even a small amount of weight reduces stress on the joint. The recommended diet has a low fat, protein, and calcium content, and meals are provide at specific times of the day.
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation. They cannot be used in animals with hemostatic disorders (reduced ability to form blood clots).
Buffered aspirin can be used for long-term conservative treatment. Side effects include gastric complications such as ulceration, vomiting, diarrhea, loss of appetite, and bloody stools. Giving the aspirin with food can reduce side effects.
Carprofen (Rimadyl) is an anti-inflammatory pain reliever used to treat joint pain. Side effects include nausea, diarrhea, constipation, and loss of appetite, and if they occur, the veterinarian should be notified. Tests to monitor liver function may be necessary because long-term use may cause idiosyncratic liver problems. Rimadyl is not given concurrently with other NSAIDs or with corticosteriods because the risk for side effects increases.
Corticosteriods reduce inflammation but have serious side effects such as disruption of adrenal function and suppression of the immune system. They should be used only on a short-term basis to promote healing.
Nutraceuticals to Treat Osteochondritis Dessicans
Nutraceuticals, also called dietary supplements, are oral agents that provide health benefits but are not regulated as drugs. Chondroprotective agents, made from extracts of components necessary for cartilage development, are used to promote the development of new cartilage and strengthen existing cartilage. Two chondroprotective agents used to treat arthritis in humans (chondroitin sulfate and glucosamine) are being used for joint damage in animals. Chondroitin sulfate blocks enzymes that break down cartilage, and glucosamine builds cartilage and may also decrease inflammation.
The supplements are promising but expensive and are available in tablet or capsule. These supplements include SynoviCre, Glycoflex, and Arthramine (all contain glucosamine); Adequan (contains chondroitin and glucosamine), and Cosequin (contains chondroitin, glucosamine, and manganese). Glucosamine can be injected directly into the joint or into a vein and works more quickly than the oral form.
An uncommon side effect is gastrointestinal upset; taking the supplements with food can help. If upset continues or if there is no improvement within 6 months, other treatment methods are required. Taking the supplements with aspirin may cause problems in forming blood clots.
Surgery to Treat Osteochondritis Dessicans
If conservative treatment does not improve the symptoms, surgery may be performed. The shoulder joint is accessible through an arthroscopic approach in larger dogs, if such equipment and expertise are available. Joint mice and damaged cartilage may be removed through a small incision. If an open approach is used, an incision is made above the joint, the joint is opened, and any cartilage flaps or joint mice are removed with forceps. The surgeon may scrape the cartilage bed to stimulate healing. The joint is flushed and sutured.
Complications of Osteochondritis Dessicans Surgery
Complications from surgery include adverse reactions to anesthesia (nausea, vomiting, fatigue, and in rare cases, death) and infection. Antibiotics are given after surgery to prevent infection.
Osteochondritis Dessicans Surgery After Care
The owner should monitor the incision for signs of infection (e.g., redness, swelling, heat, pain) for 2 weeks after the surgery. Fluid may build up at the site of the incision (seroma) and must be drained (aspirated).
Pain medication may be necessary. A cold pack may be applied several times a day for brief periods helps decrease swelling and control pain during the first week.
The animal must rest for 2 weeks and then may be taken for short walks on a leash. Weight control is important to reduce the amount of stress to the joint in older animals. In growing dogs, a restricted diet slows growth.
The animal should have an annual examination to evaluate the presence or progression of degenerative joint disease.