PERTHES' DISEASE deserves a more detailed account, not only because our breeders and experts know almost nothing about it, but often even veterinarians, when examining dogs with impaired locomotor apparatus, overlook the possibility of its manifestation.
We especially write and argue a lot about hip dysplasia in German Shepherds, Newfoundlands and other large breeds. In some breeds, dogs are not allowed for breeding use without an x-ray showing that everything is in order. However, miniature breeds also have their own specific problem with the hip joint - Perthes disease.
In the foreign cynological literature of the last decade, including widely available periodicals, Perthes' disease has a significant place. And there is a good reason for this.
WHAT EXACTLY HURTS? The disease affects the head of the femur, which enters the acetabulum of the pelvis, forming the hip joint. At an early age, isolated structural changes such as non-infectious osteonecrosis of the upper head and neck of the femur appear. From the head of the bone, the lesion passes to the fossa of the joint. The head of the bone is destroyed so severely that the articular joint falls apart and the overall picture of the lesion begins to resemble hip dysplasia. Most often, one limb is affected, and only in 12-16% both.
In humans, this phenomenon was first described by Perthes, Legg, Calve, Waldenström in 1909-1922. It was first described in dogs in 1937-38. Schnelle and Moltzen-Nielsen. The peculiarity of the manifestation of this disease in dogs is that in them it can also affect the shoulder-blade joint.
The NAME changed simultaneously with the study and description - the names of researchers were added to it, and the names themselves became more and more. I will list the most used. Perthes disease = morbus Legg/Perthes/Calve/Waldenstrom = malum deformans juvenilis coxae (a disease that deforms the hip joint at a young age) = aseptic necrosis of the head of the humerus = juvenile osteochondrosis of the hip joint = proximal (upper) osteochondrosis of the epiphysis (head) of the femur bones = idiopathic (i.e. occurring for no apparent reason) osteosis of the head of the humerus and many others that are used less often.
WHO IS AFFECTED. As already mentioned, it occurs in small breed dogs. Most often in dwarf and toy poodles, Pekingese, French bulldogs, small terriers, schnauzers, spitz. Statistics say that the sex of the dog does not play a role - in females and males it occurs with the same frequency, namely 20:1000, which means 20 per thousand individuals are affected by the disease. The disease develops in puppies at 6-7 months. age. In general, we can say that it manifests itself at the age of 3 to 11 months.
CAUSE OF ILLNESS. There is no unequivocal answer, and there are no visible external reasons. But it is important for dog breeders to know that most researchers consider such joint damage to be a hereditary disease. We are talking about HEREDITARY PREDISPOSITION.
Recently, the influence of sex hormones on the onset and development of the disease has been proven. Among not the most rare reasons called excessive load on the surface of the joint, which occurs due to weakness of the muscles and ligaments in pampered puppies of dwarf dogs.
MANIFESTATIONS OF DISEASE. They change as it develops. But at any stage, there is rapid fatigue, a change in joint mobility, weak or severe lameness. Abduction of the limb to the side is impossible. Most often, it begins with the fact that, after running a few meters, the dog stops and draws its hind leg. Initially, the pain may subside at rest. But the condition is gradually deteriorating. In the midst of the disease, the pains are so persistent that there is a change in the character and behavior of the dog. It can reach the manifestation of aggressiveness, for example, when you have to touch the dog's paws, wash, cut. The dog does not want to move. In the advanced stage of the disease, the dog completely ceases to load this leg and constantly keeps it elevated. Therefore, atrophy of the muscles of the affected limb occurs. Already at the beginning, the affected limb looks shorter, with the development of the disease, true shortening occurs. The general condition of the dog is normal.
FIVE STAGES OF DISEASE DEVELOPMENT.
1 - HIDDEN STAGE. Microscopic changes in the bone tissue of the femoral head, gradually turning into complete necrosis (death) of the cancellous bone and bone marrow. At the same time, the cartilage covering the head remains completely intact. On a radiograph taken at the beginning of the disease, light spots, like bubbles, can be seen in the head of the bone. But otherwise, the picture does not cause alarm - the contour of the joint and the gap between the head and the articular fossa may look completely normal. External manifestations: pain passing at rest, slight lameness.
2 - IMPRESSION FRACTURE. The necrotic femoral head cannot withstand the usual load, a subchondral fracture occurs from compression of dead tissues. There is a flattening of the head and indentation of the cartilaginous surface. The height of the affected head is reduced compared to the head on the healthy side. X-ray shows flattening of the head and widening of the joint gap. Light bubbles on the roentgenogram merge into large ones. External manifestations - severe pain, severe lameness. The dog may lean slightly when moving on the affected leg, but sometimes suddenly screams and presses it. The affected limb appears shorter than the healthy one.
3 - RESOLUTION. Slow resorption of necrotic areas
at the expense of cellular elements of surrounding healthy tissues. Fibrin fibers from the femoral neck begin to penetrate into the depth of the necrotic areas, and cartilaginous islands lace up from the cartilaginous cover and grow into the head. The contour of the head becomes discontinuous. As resorption progresses, the femoral head becomes progressively flatter. On x-ray, the head looks like a "bitten". External manifestations - the dog practically ceases to rely on the affected limb, keeps it on weight all the time. Lies down and gets up with difficulty, while he can scream.
4 - RECOVERY. Neoplasm of bone tissue - living dense spongy tissue replaces necrotic bone areas. But the shape of the head is not restored. External manifestations - the soreness of the joint decreases, but the limitation, even the impossibility of movement, remains.
5 - FINAL. The bone structure of the head is almost completely restored, but the shape is significantly changed. Very rarely, the shape of the head remains close to spherical, most often it takes the form of a mushroom or roller. In addition, the femoral neck shortens and thickens, and sometimes completely disappears. External manifestations - the affected limb is constantly compressed, shortened, seems thinner due to complete muscle atrophy. Pain is almost absent, but movement in the joint is almost impossible.
Simultaneously with tissue necrosis and a change in the contour of the head, similar processes occur in the articular fossa (acetabulum of the pelvic bone). On the x-ray, the edges of the cavity become fuzzy, it can be seen that it is flattening. In the end, the whole picture of the joint begins to resemble dysplasia in a very severe degree. Head displacement may occur.
It is worth recalling that the peculiarity of the course of Perthes' disease in dogs is that processes that destroy bone tissue, change the shape of the joint and its mobility can also occur in the upper part of the humerus.
TREATMENT. Peace, warmth, massage. In most cases, painkillers and injections of anabolic steroids (artificial hormone testosterone) are prescribed, as well as all those techniques and treatment that are used for exacerbation of hip dysplasia. In severe cases (such as a hip fracture), only surgery can help.
FORECAST. It is impossible to stop the process, but by starting treatment early, severe joint deformity can be avoided. Although shortening of the limb, lameness and pain during movement will remain in any case.
BREEDERS SHOULD UNDERSTAND that from a breeding point of view, we are talking about an inherited disease, that there is a hereditary predisposition to it, moreover, of a polygenic nature. This
confirmed by the studies of many authors (H.Heinen, G.Ljunggren, H.C.Niemand, S.Paatsama, etc.).
As a predisposition to the disease, they call a violation of the blood supply to the femoral head, demineralization of bone tissue, which may be the result of disturbances in the hormonal system of the body, vitamin deficiency and a general metabolic disorder (P. Bruyere and others). Often, when examining dogs affected by Perthes disease, the consequences of insufficient thyroid function, pituitary variant of dwarfism (pituitary toy poodles), and achondroplasia (hereditary changes in the process of ossification of the skeleton of the limbs that can cause short legs) are simultaneously detected. All this testifies to endogenous, i.e. lying in the internal environment of the body, the causes of Perthes disease.
BREEDERS SHOULD BE CAREFUL when dealing with representatives of lines affected by this disease, given the hereditary predisposition to it.
Honesty and exactingness. Nothing new. But, apart from that, nothing concrete can be advised yet.
Calve-Legg-Perthes disease, also known as osteochondropathy of the femoral head, is a disease that is accompanied by aseptic necrosis of the femoral head. This pathology affects mainly dogs of small and medium breeds at a young age.
Perthes disease in dogs of some breeds occurs under the influence of hereditary factors, develops due to an autosomal recessive gene, therefore, dogs with signs of this disease must be excluded from breeding.
It is also hypothesized that in small dogs, the diameter of the blood vessels in the round ligament, joint capsule, and growth zones of the bone is insufficient to withstand thrombosis and other damage that may result from trauma, bruises, or fractures. Most predisposition to Legg-Perthes disease is observed in dogs:
- pygmy and toy poodles;
- pugs;
- dwarf pinschers;
- cairn terriers;
- Yorkshire Terriers;
- Manchester Terriers;
- lakeland terriers;
- West Highland White Terriers;
- and others.
Histologically, after ischemic necrosis of the head and neck of the femur, trabecular collapse occurs, which further leads to rupture of the articular cartilage, incompatibility of the articular surfaces and expansion of the joint space. This leads to joint instability and secondary osteoarthritis. Ischemic bone is replaced by granulation tissue. The whole process of the disease is accompanied by pain.
Symptoms
Progressive limb lameness can appear in dogs as young as 5 months of age. With a unilateral lesion, lameness of a hanging limb is observed, with a bilateral lesion, a galloping, “rabbit” gait is observed.
On clinical examination, symptoms of Perthes disease in dogs are observed, such as pain during extension and abduction of the hip joint, crepitus during passive movements, and with a long history, atrophy of the gluteal muscles can be noted.
Establishing diagnosis
To confirm the diagnosis, an x-ray is taken in the ventrodorsal projection. On the radiograph, a decrease in the density of the neck and head of the femur, an irregular shape of the head, and other signs of secondary coxarthrosis are noted.
Treatment
Treatment of Legg-Perthes disease in dogs is surgical. Resection arthroplasty is used - excision of the head and neck of the affected femur. Before removing the stitches for 10-14 days, complete rest is recommended, then a gradual increase in the load on the diseased limb.
Forecast is usually favorable.
The article was prepared by the doctors of the surgical department "MEDVET"
© 2014 SVTS "MEDVET"
If you are caring for a four-legged friend, you need to know what Legg-Calve-Perthes disease in dogs is, its symptoms and treatment. Pathology is considered severe, can lead to the destruction of a significant part of the tissues of the joint. Individuals that have such a deviation are not allowed to breed, since the disease can be transmitted genetically.
The presented ailment affects mainly animals of small breeds. It develops in animals that have not previously been injured and had no other pathologies, which greatly complicates its diagnosis. To cope with the disease, a person needs to pay attention to the strange behavior of the pet as soon as possible and go to the veterinarian.
This is aseptic necrosis of the femoral head, which develops against the background of a violation of the processes of blood supply to the head of the joint. Pathology is diagnosed mainly in representatives of such breeds: spitz, terriers, chihuahuas, poodles. The disease develops rapidly, which is why it is almost impossible to notice in the early stages. Pronounced symptoms of pathology appear when a part of the head of the joint is destroyed and its functionality is impaired. There are such stages in the development of the disease:
- Hidden. It is characterized by the appearance of foci of necrosis in the bone marrow, as well as spongy substance. Cartilaginous tissues at this stage remain unchanged. When conducting an X-ray examination during this period, doctors note the appearance of white spots of unclear etymology on the bones. Since the function of the joint is not affected at this stage, the dog does not show anxiety.
- Impression fracture. At this stage, due to increased loads, the femoral head breaks. The bone shortens, the joint space increases. The stage is characterized by acute pain. The pet begins to limp, pull its paw, refuse active games, walks.
- Resorption. The stage is characterized by the spread of necrotic areas to healthy tissues, a change in the contour and shape of the head of the joints. There is a strong pain syndrome. A pet constantly keeps a limb in an elevated state.
- Recovery. In areas affected by necrosis, connective tissue grows. Joint functions are not restored. The four-legged friend does not experience severe pain, but cannot show the same activity as before the disease.
- Finite. It is characterized by the complete replacement of dead areas with healthy tissues. Since the animal at this stage has complete muscle atrophy, it cannot step on its paw when walking or playing.
Thus, as the disease develops, the dog systematically loses the ability to fully move, play, and participate in training. If the owner of the pet does not intervene in this process, the dog will remain disabled. In the later stages of the development of the disease, the doctor can only eliminate the symptoms of the disease. Only special exercises, swimming and gentle training can restore the mobility of the injured limb. In 80% of cases, the disease cannot be defeated without surgery.
Why does it occur in dogs?
The factors that provoke the development of the disease are not fully understood. It is believed that pathology can develop under such conditions:
- Violation of the hormonal background.
- Weakness of muscles and ligaments in a puppy. This leads to increased stress on the joints and their destruction.
- The dog's genetic predisposition to the disease. If you know that the dog's parents suffered from such a pathology, remember that it is highly likely that your pet will also have it.
Provoke the development of the disease can malnutrition, hanging physical activity. Pathology manifests itself in puppies from the age of five months. Representatives of both sexes are inclined towards it.
The following signs indicate the development of Perthes disease:
- Lameness. An animal that has such a pathology will be afraid to stand on the affected limb, it may limp, in severe cases it will walk in a semi-squat position.
- Pain that appears even with minor physical exertion.
- Atrophy of the thigh muscles.
- Weakness, apathy, decreased activity. Even puppies who previously could not sit still for several minutes will refuse to play and walk because of this disease.
- Irritability, nervousness.
- Licking, in some cases - biting the affected limb.
- In the advanced stages of the disease, the owner of the animal may hear a crunch or crack when the pet walks. At an early stage in the development of pathology, the presented syndrome is absent.
It must be remembered that as the disease develops, the pet will increase pain and lameness will increase. For this reason, it is important to immediately consult a doctor when symptoms of the disease appear. The sooner he takes up the treatment of your four-legged friend, the sooner you can save your pet from suffering and return to a full life.
How can pathology be diagnosed?
To establish the presence of the presented disease in a dog, a number of studies are carried out, including:
- examination of the dog
- interviewing the host to establish the probable causes and timing of the disease;
- x-ray.
The most accurate diagnostic data can be obtained if only one joint is affected in a dog, while the second remains unchanged. By comparing their x-rays, the veterinarian will be able to determine how far the pathological process has gone, as well as prescribe the most effective treatment in this clinical case.
Treatment Methods
In the early stages, dogs are prescribed drug therapy aimed at eliminating the symptoms of the disease. It involves taking non-steroidal anti-inflammatory drugs, glucocorticosteroids, analgesics. Treatment can slow down the development of pathology, but not stop it. Taking medication should be considered as a temporary measure, since such treatment can lead to the development of complications.
The most effective treatment for Legg-Calve-Perthes disease is surgery. It is done like this:
- The doctor performs a resection of the affected fragment of bone and cartilage tissue.
- Instead of a remote site, a bundle is formed. At the request of the owners, artificial joint implantation can be performed.
- After the operation, the dog is prescribed conservative therapy: taking analgesics, anti-inflammatory drugs, treatment of sutures with local agents - antiseptic gels or ointments.
For the first few weeks after the operation, the owner of the dog should regularly carry it to the veterinarian for check-ups. If necessary, an X-ray can be taken to make sure that the bone implantation was successful. If in the first days after treatment you cannot spend time with your four-legged friend, you must leave him in the clinic, where he will be provided with full care.
Video: Legg-Calve-Perthes disease in dogs, its symptoms and treatment
Pet recovery after surgery
In order for a dog to recover from an illness, it needs to be well cared for at home. It provides:
- Passage of a course of massages. They must be performed by a veterinarian in the clinic.
- Swimming, therapeutic exercises, exercises with a weighting agent. They are aimed at developing the damaged joint, restoring its mobility. In the early days, such exercises will be painful for the dog, but then he will perform them without significant discomfort.
- Regular walks with your pet. Their duration is determined depending on the general condition of the dog, the recommendations of the veterinarian.
- Complete nutrition, taking vitamins as recommended by the attending physician.
Rehabilitation of the animal after surgery may take several weeks. If it is difficult for a person to deal with a dog, it must be given to a specialized veterinary center. Only constant long-term exercises with a four-legged friend will allow him to fully recover from his illness. If you do not deal with your pet after the operation, ignore the recommendations of doctors, refuse physiotherapy exercises, the animal will never be able to stand on the operated paw on its own.
Legg-Calve-Perthes disease(aseptic or avascular necrosis of the femoral head) is observed in dogs of dwarf and decorative breeds, especially Toy Terriers, Yorkshire Terriers, Miniature Pinschers, Poodles, Jack Russell Terriers, West Highland White Terriers, Pugs.
This is a disease of the femur and hip joint, associated with impaired blood supply to the femoral head and malnutrition of its articular cartilage, followed by necrosis.
Refers to a group of diseases united under the general name of osteochondropathy.
What is the cause of Perthes disease?
The true cause of Perthes disease in dogs has not been elucidated. Dogs are not sexually predisposed to this disease. One joint is most often affected, and only in 10-15% of cases both joints are affected. Most researchers consider such joint damage to be a hereditary disease.
Recently, a certain influence of sex hormones on the onset and development of the disease has been proven.
Among not the most rare causes, they call an excessive load on the surface of the joint, which occurs due to weakness of the muscles and ligaments in puppies.
Often, when examining dogs affected by Perthes' disease, signs of insufficient thyroid function, pituitary variant of dwarfism (pituitary dwarfism), as well as achondroplasia (a hereditary change in the process of ossification of the skeleton of the limbs, which can cause short legs) are simultaneously detected.
All this testifies to endogenous, i.e. lying in the internal environment of the body, the causes of Perthes disease.
How does this disease develop?
There are five stages in the development of Perthes disease:
- Hidden stage. Microscopic changes in the bone tissue of the femoral head, gradually turning into complete necrosis (death) of the cancellous bone and bone marrow. In this case, the cartilage covering the head remains completely intact. External manifestations - pain passing at rest, slight lameness in the dog.
- Impression fracture. The necrotic femoral head is unable to withstand the load and a subchondral fracture occurs, followed by flattening and indentation. The dog usually leans slightly when moving on the affected limb.
- Resorption (resorption). There is a slow resorption of necrotic areas due to the cellular elements of the surrounding healthy tissues. Fibrocartilaginous tissue begins to penetrate into the depth of necrotic areas. The dog practically ceases to rely on the affected limb with such a lesion.
- Recovery (reparation). There is a replacement of necrotic areas with bone tissue. But the shape of the head is deformed and cannot be restored. Pain in the joint is determined in a dog with movement restrictions.
- Ultimate. The bone structure of the head is almost completely restored, but the shape is significantly changed. Very rarely, the shape of the head remains close to spherical, most often it takes the form of a mushroom or roller. In addition, the femoral neck shortens and thickens, and sometimes completely disappears. The affected limb is shortened, atrophic. Pain in the joint of the dog is almost absent, but the movement is sharply limited.
How does Perthes disease manifest in dogs?
The disease only affects young dogs between the ages of 4 and 12 months. On the run, the dog pulls up one of the hind legs. Sometimes skips a few steps, holding it on weight. On closer examination, you can often notice a decrease in the thickness of the affected thigh - muscle wasting. Over time, with the development of the disease, the dog, when running, keeps the limb in weight, while moving at a pace, sometimes stepping on it. Muscle atrophy rapidly increases, bone protrusions of the femur protrude more clearly. If any of these signs are found in a dog, the owner is advised to consult a veterinarian as soon as possible.
How to diagnose aseptic necrosis of the femoral head?
Diagnosis of Perthes disease in dogs involves a clinical and instrumental study.
The type of lameness in dogs, the muscle mass of the hip joint area, and the mobility of the hip joint are clinically assessed.
Instrumental methods include radiography of the hip joint, arthroscopy, computed tomography, ultrasound of the hip joint.
These diagnostic measures allow you to accurately diagnose and differentiate from diseases such as dislocation of the hip joint, infectious arthritis, fractures of the head and neck of the femur.
How is Perthes disease treated?
In most cases, attempts at conservative treatment, which includes cell content for 4-6 months, good nutrition and the administration of anti-inflammatory drugs, fail and lead to even more severe hypotrophy of the femoral muscle groups.
It is more expedient to carry out surgical treatment, which consists in the creation of a pseudocapsule of the hip joint.
You can get advice from an orthopedic surgeon and perform (removal of the femoral head) after the necessary examination.
How will the dog feel after the operation?
After the operation, normal movements in the hip joint return to the animal in different ways, but on average, the rehabilitation period is from 1 to 6 months, depending on the degree of muscle hypotrophy.
It is necessary that 7-10 days after the operation, the dog already began to passively use the limb. After removing the stitches, hydrotherapy (swimming) and other physiotherapy methods help to speed up recovery.
Unfortunately, diseases of a traumatological nature for dogs are not uncommon lately. Large breeds are most susceptible to such ailments, in some cases it is even necessary to euthanize thoroughbred healthy people due to the fact that in an eight-year-old, healthy-looking dog, the hind limbs are completely paralyzed. Small breeds are no exception, and an example of this is the pathology of Calve Legg Perthes.
Calve-legg-perthes disease in a dog
What is a disease? For some reason, necrosis begins to develop on the surface of the femoral head, which leads to complete deformation of the bone and articular tissue at the site of the necrotic lesion.
The origin of this process is still unclear. , but it is known that young puppies of dwarf and small breeds are most susceptible to development.
Puppies of dwarf dog breeds are at risk.
Causes
Since external provoking factors are not traceable, scientists tend to believe that possible cause is genetic factor- the presence of a hidden genetic disease or simply an innate predisposition. The mechanism of development is quite simple - due to an unknown provocateur, the flow of blood, innervation in the bone epiphysis is disrupted, so the bone tissue dies intensively.
Heredity is a possible cause of the disease.
Peculiarities
The joint that is affected disfigures over time, gradually collapses, and the dog constantly feels pain. As a rule, the first signs of the disease begin in puppies under the age of one year. It is noteworthy that this pathology captures only the hind legs.
Typically, sick puppies are spayed to prevent diseased offspring.. Particular attention should be paid to terriers due to the fact that dogs of this breed have a gene for a similar disease.
Terriers have the disease gene.
Complications
During the death of bone cells in the first stages, the body still makes attempts to fight, while trying to replace the dead cell areas with fibrous granulation. However, the difficulty lies in the fact that fibrous granulations are very fragile for bones, but for a large number of animals this state of affairs becomes the basis for continuing a normal lifestyle.
But the disease still continues to develop, albeit more slowly, and the consequences can be expressed in the form of paralysis.
Perhaps a complication in the form of paralysis.
Signs of illness
The early stage of the disease is caused by damage directly to the femoral cavity, and the more the pathology progresses, the more visible the degeneration of the joint.
The bone is significantly compacted, the articular neck and, possibly, the head are rapidly deformed and change shape. Further, the bone split into small particles gradually occurs, causeless fractures are possible. A timely reaction to the problem will help the pet live long and without problems. Main features:
- lameness;
- walking on bent legs;
- pain syndrome;
- general weakness;
- lethargy;
- atrophic muscular process;
- aggression;
- nervousness;
- constant chewing of the diseased area.
During the period of the disease, the dog becomes aggressive.
Symptoms
The dog is lethargic and weak.
- Lameness in the pet begins to appear first on one limb, then, as it progresses, the dog limps on both legs. Begins to walk uncertainly, on half-bent legs.
- Any even the most insignificant physical activity causes unbearable pain to the dog. . The animal refuses to play active games, run, then does not even want to get up from the bedding and just move around. There is weakness, lethargy, apathy.
- The hind limbs lose weight, which is explained by the development of an atrophic process in the muscles . The dog becomes noticeably aggressive, irritable, nervous, rushes at others, can bite. Periodically licks or chews the affected limb or thigh.
- When the disease progresses and reaches the stage of neglect, a crunch is recorded when walking . In some cases, you can hear crackling or creaking. As a rule, the presence of such symptoms can mean only one thing - there is practically nothing to help the pet, the disease has severely damaged the joints and the treatment will bring little effect.
Establishing diagnosis
The basis of diagnosis is differentiation.
The diagnosis is made by X-ray.
- The fact is that symptoms are very similar with dislocation, dysplasia, fractures, bursitis.
- With similar ailments, similar symptoms are recorded and when making a diagnosis, it is necessary to separate them.
- Next is carried out radiography hip bone and visual examination with palpation. Radiography it is especially effective in cases where the lesion is unilateral, so that the doctor can clearly distinguish from other pathologies and establish an accurate diagnosis.
Treatment
Early stage treated with symptomatic therapy.
- Painkillers in the form of analgesics are recommended for use.
- Non-steroidal anti-inflammatory drugs are used.
- A good effect in the treatment gives physiotherapy.
- If non-steroidal drugs are not prescribed, then corticosteroid drugs can be used, but they cannot be prescribed together, since such a combination will not bring the desired effect, but can only aggravate the situation.
- However, the most effective method is surgery.
- Often it is necessary to resort to partial or complete excision of the head of the hip joint.
- In some cases, the head and neck are completely removed, and along with them, part of the cartilage tissue or pelvic bones is also removed.
- An artificial joint is implanted in place of the removed fragment, or a forming ligament is made.
Physiotherapy is used to treat the dog.
Video about Perthes disease in dogs