The clinical path of a patient with lameness starts with a thorough orthopaedic examination, which thanks to the use of the latest diagnostic tools will guide us in making a diagnosis and prescribing the most appropriate medical-surgical treatments for all types of orthopaedic disorders.
Hip dysplasia is a hereditary disorder caused by abnormal development of the hip joint and can be seen in all breeds of cats and dogs. In most cases, it is bilateral and its clinical impact can vary in different subjects depending on multiple environmental and nutritional factors, as well as on the subject’s lifestyle. The consequences of this disorder cause an early alteration in the morphology of the hip leading to rapid cartilage damage and subsequent development of ostoarthritis that can become invalidating. Hip dysplasia is a disorder that has been widely studied and innovations in diagnosis and therapy are constantly emerging. Currently, it is possible to identify affected patients at an early age (4-6 months) using clinical-radiographic studies and to treat the disorder with remodelling surgery (Juvenile Pubic Symphysiodesis and DPO) that is able to avoid or slow down the natural evolution of osteoarthritis . In young subjects and adults, in the presence of serious osteoarthritis and lameness, the most effective treatment currently available is THR – Total Hip Replacement. Since this disorder is hereditary, subjects affected by this pathology should be excluded from breeding. For this reason, radiological examinations are carried out to select breeders.
Elbow dysplasia (ED) is a hereditary disorder characterised by growth disturbances in the elbow joint and can be seen in numerous dog breeds leading to the development of osteoarthritis already from a young age. The pathological complex of ED includes Ununited Anconeal Process (UAP), Fragmented medial Coronoid Process of the ulna (FCP), Osteochondritis Dissecans of the humeral trochlea (OCD) and Elbow Incongruity (EI). The etiopathogenesis of the disorder is still not completely understood. However, it appears to be caused by an abnormal distribution of loads across the joint. Early clinical signs such as pain and lameness often appear from approximately 4 months of age and evolve with a worsening of the clinical picture due to joint inflammation and degeneration (osteoarthritis) throughout the life of the patient occasionally leading to seriously invalidating conditions. Clinical diagnosis is through radiology and it is possible to identify the disorder already from early clinical manifestations. In most cases, surgery is recommended and should be carried out as early on as possible to avoid or slow down the development of osteoarthritis. Multiple and different surgical treatments are possible and vary from case to case: arthroscopic removal of the fragmented coronoid process, distal ulnar osteotomy (DUO), bi-oblique ulnar osteotomy, screw fixation of the ununited anconeal process and elbow prosthesis. Ulnar osteotomies carried out on young subjects allow to redistribute abnormal intra-articular loads in the elbow affected by dysplasia with the objective of balancing homogeneously loads and thus limiting joint degeneration and development of osteoarthritis. Since ED is a hereditary disorder, affected subjects might be excluded from breeding and this is why official radiological studies are carried out to select breeders.
Cranial cruciate ligament rupture is a surgical disorder that represents one of the major causes of hind limb lameness. This disorder affects dogs of all sizes and can also be seen in cats. In dogs, the cranial cruciate ligament is one of the main ligaments that allows stabilisation of the stifle and is responsible for maintaining the articulation between the femur and the tibia. Due to its function, this structure can be subjected to complete or partial rupture following both degenerative causes that lead to progressive wear or traumatic events that causes a complete acute rupture. The instability of the knee that originates from cranial cruciate ligament rupture triggers lameness, pain and an inflammatory process that if neglected, can become chronic leading to the early onset of osteoarthritis with subsequent deterioration of the quality of life of the affected subject and worsening of lameness. The treatment of choice for the resolution of this condition is surgery; there are several surgical procedures (Extracapsular surgery, TPLO, TTA, CBLO, CWO), each of which with specific characteristics and indications. The orthopaedic surgeon decides which surgical procedure to adopt depending on the individual characteristics of the subject to be treated.
Patellar luxation is one of the most frequently diagnosed orthopaedic disorders in both small and large breed dogs and can lead to degenerative joint disease, pain and lameness. It occurs when the patella dislocates or moves out of its physiological position in the femoral trochlear groove; it can be medial (MPL) or lateral (LPL), of congenital or more rarely of traumatic origin. The disease is classified into 4 grades of severity and is sometimes associated with severe musculoskeletal deformities. Surgical options include trochleoplasty, tibial tuberosity transposition and corrective osteotomies of the femur and tibia; however, it is not possible to establish beforehand which is the best surgical option, as each individual patient requires specific treatment with one or more associated techniques. Selection of the best therapeutic option is possible exclusively after thorough orthopaedic examination and radiological study of the pelvic limb.
Osteochondritis dissecans (OCD) is the evolution of Osteochondrosis (OC), which is defined as impaired endochondral ossification (lack of ossification) in animals with rapid growth rate. Impaired ossification leads to thickened and weakened cartilage, which then detaches with the formation of a cartilage flap (fragment). 
The ethiopathogenesis of this disease includes hereditary, nutritional and growth factors.
OCD can involve various joints and those most affected are the shoulder (humeral head), elbow (humeral trochlea), stifle (medial and lateral condyles), and hock (astragalus). OCD of the shoulder mainly affects large or giant breed dogs with rapid growth rate and is more frequent in males and subjects often present bilateral lesions. Border Collies and English Setters are also frequently affected. The disease causes lameness in one or both front limbs and typically appears between 5 and 8 months of age. Surgical treatment of choice consists in the arthroscopic removal of the dissected cartilage flap and guarantees complete functional recovery in nearly all treated subjects. When left untreated or treated without following correct methods and timing, the disease evolves into osteoarthritis with progressive functional limitation of the affected joint.
Agility dogs, utility dogs, hunting dogs, field trials dogs, search and rescue dogs, obedience dogs: our dogs are increasingly involved in athletic/recreational activities. The athletic dog must reach skeletal and muscular perfection; this is why it becomes essential to take athletic dogs to regular orthopaedic examinations before and during athletic activity. Small or serious injuries can not only reduce athletic performance but also cause the dog to suffer. It is the utmost duty of the owner to recognise even the slightest of problem and take their dogs to the most suitable check-ups in order to guarantee optimal psychophysical wellness that is fundamental for reaching important goals.
Most geriatric patients that have not undergone preventive and early orthopaedic examinations have a high probability in adult age of deterioration of their quality of life due to the presence of one or more joints affected by osteoarthritis. Osteoarthritis is the chronic-degenerative inflammation of all joint structures, which leads to a progressive reduction of function; in this situation, the patient tends to become more and more sedentary progressively increasing joint disuse. Today, Veterinary Medicine offers multimodal management of the patients with osteosrthritis consisting in the use of special anti-inflammatory drugs associated with body weight management and physical activity. Moreover, today, increasing interest towards modern technologies in the field of Regenerative Medicine, has opened the way to new curative options for the arthritic patient thanks to the use of intra-articular infiltrations with platelet-rich plasma (PRP) or stem cells.