Comparative Medicine Copyright 2015 by the American Association for Laboratory Animal Science

Vol 65, No 3 June 2015 Pages 260–265

Case Report

Use of Femoral Head and Neck Ostectomy and Physical Therapy to Manage Osteoarthritis in a Rhesus Macaque (Macaca mulatta) Mayu Uchihashi,1,* Joseph A Hampel,2 Jean A Nemzek,1 Phillip A Saccone,2 Kathryn A Eaton,1 and Megan H Nowland1 Osteoarthritis is associated with pain and immobility in both humans and animals. However, available resources for osteoarthritis management in captive NHP are limited. This case report describes a novel management strategy for a 10-y-old male macaque with unilateral hindlimb lameness, prominent muscle wasting, and severely limited range of motion. Radiographs of the affected limb showed lytic lesions of the femoral head. To relieve pain and improve mobility, femoral head and neck ostectomy (FHO) was performed, and multiple pharmacotherapies were initiated. The macaque also received a unique method of physical therapy that required no sedation, acted as enrichment, and was implemented by using a conventional caging system. The response to therapy was monitored by measuring thigh circumference in the operated and nonoperated limbs, which demonstrated improvement in both legs. The unique physical therapy in conjunction with surgery and pharmacotherapy benefited the macaque with osteoarthritis by reducing discomfort and improving mobility. Abbreviations: FHO, femoral head and neck ostectomy; ROM, range of motion.

Osteoarthritis is associated with pain and is the leading cause of impaired mobility in aging humans.7 Osteoarthritis also is frequently diagnosed in companion animals, and the most common presenting complaint is lameness.4 Physical examination findings may include lameness, reduced range of motion (ROM), palpable crepitus, joint instability, and pain during joint manipulation.4 In captive NHP, clinical signs may be limited to muscle atrophy,12 in part because of their natural instincts, as wild animals and as prey species, to hide injury and pain.1 In companion animals, pain from osteoarthritis frequently is managed with a combination of drugs including NSAID, nutritional supplements, and weight reduction.11 If an underlying cause is identified, surgery may be indicated. In addition, physical rehabilitation including ROM exercises, underwater treadmill walking, low-level laser therapy, and acupuncture may be beneficial in managing pain due to osteoarthritis.11 Various challenges are associated with managing osteoarthritis in captive NHP. Due to biosafety concerns, physical rehabilitation exercises developed for companion animals are often not feasible. Physical manipulation generally requires chemical sedation; sedation itself may adversely affect hemodynamic and respiratory functions, with an increase in frequency of sedation leading to increased risks.13 The chronic use of antiinflammatory medications such as NSAID may be associated with gastrointestinal, hepatic, Received: 15 Dec 2014. Revision requested: 08 Jan 2015. Accepted: 19 Jan 2015. 1 University of Michigan, Unit for Laboratory Animal Medicine. Ann Arbor, Michigan, 2 MPI Research. Mattawan, Michigan., 3University of Michigan, Department of Pharmacology. Ann Arbor, Michigan. *Corresponding author. Email: [email protected]

and renal adverse effects. In addition, published information describing medical and surgical approaches for NHP, especially in regard to postoperative care, is limited.3,5,12,15 This case report involves an adult male rhesus macaque with osteoarthritis that led to unilateral hindlimb lameness and prominent muscle wasting. The macaque was managed with a combination of pharmacotherapy, surgery (femoral head and neck ostectomy [FHO]), and innovative physical therapy.

Case Report

Signalment and initial diagnostics. A 10-y-old male rhesus macaque was presented for right hindlimb lameness. He was housed in an AAALAC-accredited animal care facility under an IACUCapproved protocol. The macaque had arrived at the University of Michigan from another institution 4 mo prior to presentation, and no lameness was noted on intake records. Past medical history was unremarkable and included intermittent loose stool that was managed with metronidazole and fiber supplementation. He tested positive for simian T-cell lymphotropic virus and had positive measles titers 4 y prior to presentation. The macaque was released from quarantine approximately 4 wk prior to presentation, and no overt musculoskeletal abnormalities were noted during a series of quarantine examinations. During the first close-up examination since joining the colony, a technician noted a severe, weight-bearing to nonweight-bearing, right hindlimb lameness that worsened after prolonged rest. Physical examination revealed remarkable muscle atrophy of his right hindlimb. On extension of the right coxofemoral joint, severe crepitus was noted, and ROM

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was limited. No obvious fracture was palpated. All other joints were within normal limits when palpated, and the rest of the physical examination findings were unremarkable. Antiinflammatory treatment using oral carprofen (4 mg/kg daily; 15-mg tablet, Bio-Serv, Flemington, NJ) was initiated, and the animal was monitored for improvement. Because no improvement in mobility was seen during the 2 wk after initiating carprofen treatment, radiographs were taken. The most striking findings were seen on the ventrodorsal and dorsoventral views, which showed multiple lytic areas of the right femoral head (Figure 1). The cortical thickness of the femoral neck was reduced in the right femur. Severe right-sided femoral muscle atrophy (medial and lateral) was evident. The right acetabulum appeared enlarged and had evidence of osteophyte formation. No evidence of disease was noted on the left hindlimb. Whole-body radiographs showed no evidence of pulmonary metastasis or other radiographic abnormalities. CBC and chemistry results were unremarkable. On the basis of the radiographs, our differential diagnoses included avascular necrosis of femoral head (Legg–Calvé–Perthes disease), previous trauma, degenerative osteoarthritis, idiopathic condrolysis,8 neoplasia (chondrosarcoma, osteosarcoma), and osteomyelitis. Because the WBC counts were within normal limits, osteomyelitis seemed unlikely. To obtain a definitive diagnosis, surgical intervention with biopsy was elected. In the meantime, carprofen was discontinued due to the lack of clinical improvement, and oral tramadol (2.5 mg/kg twice daily) was initiated for pain control. Surgery. To relieve pain and improve mobility, the macaque underwent FHO. The macaque was placed in left lateral recumbency. A craniolateral approach with a partial tenotomy of deep gluteal muscle was taken to expose the joint capsule. A large amount of fibrous tissue was present over the joint capsule and was removed with a periosteal elevator. Opening the joint capsule revealed dark-red fluid with little viscosity. The synovium was proliferative and thickened. The femoral head and neck were distorted due to severe bone loss and osteophyte formation (Figure 2). An osteotome was used to remove the remnant of the femoral neck and head. The acetabulum and the coxofemoral joint were assessed visually and palpated for any residual bone fragments. The excised femoral head and a sample of proliferative synovium were fixed in 10% neutral-buffered formalin for histopathologic analysis. The irregular edges of the femoral neck were smoothed by using a rongeur, and removed pieces were submitted for bacterial culture. The joint space was flushed with copious amounts of saline. The joint capsule and tenotomy were closed by using 2-0 polydioxanone suture. Subcutaneous and dermal layers were closed by using 3-0 polydioxanone suture, and skin staples were applied over the incision. Anesthetic recovery was uneventful. Culture and histopathology. Aerobic bacterial culture of the fragments of the femoral neck was negative for growth. Histologic sections of the femoral head showed significant bony proliferation with new bone formation. Focal areas of cartilage with intramembranous ossification were present also. Sections of the joint capsule showed marked fibrosis, which replaced the majority of the tissue. No evidence of neoplasia or active inflammation was apparent. A diagnosis of end-stage degenerative joint disease was made. The inciting cause was not determined, although it was presumed to be trauma.

Postoperative management and complication. Postoperatively, the macaque received carprofen and tramadol at the preoperative dosages. During the first few postoperative days, the macaque spent the majority of time sitting in his cage. Four days after surgery, the animal was able to stand on all 4 limbs. A sedated exam was performed 1 wk after surgery, during which passive ROM at the pseudoarthrosis was 100% compared with the left leg, no crepitus was palpated, and the incision was healing well. At 2 wk postoperatively, the macaque was sedated for removal of the surgical staples. Passive ROM remained 100%, but no obvious change in muscle mass was evident. The macaque had minor, intermittent weight-bearing on the operated limb. Carprofen was discontinued, and the macaque was weaned off of tramadol over the next 2 wk. Approximately 10 wk postoperatively, a pressure sore developed over the left coxofemoral joint, contralateral to the operated side. The lesion was a raised, red, granulomatous mass that measured approximately 1.5 × 3.0 cm and was thought to be due to the animal favoring the operated limb and frequently lying down on the nonoperated limb. The animal was placed in a larger cage to encourage increased mobility. The pressure sore was monitored for signs of improvement, which was assessed as a reduction in lesion size. The pressure sore healed rapidly after the animal was moved to the larger cage. Within 5 wk, the sore had contracted to form a flat scab and had decreased to approximately half the original size. No recurrence was noted. Physical therapy. Initial physical therapy after surgery included passive ROM exercise under ketamine sedation by laboratory staff once weekly and placement of a foraging board in the upper part of the cage to encourage the use of his hindlimbs. Increasing the cage size and placing food in different parts of the cage also encouraged mobility. About 4 mo postoperatively, the circumference of the operated leg had increased by approximately 10%, his mobility improved, and ROM remained 100%. However, weight bearing on the operated limb remained intermittent, and grimacing (indicative of mild pain) was noted on hip extension during a follow-up examination under light ketamine anesthesia. At this time, the veterinary and laboratory staff worked together to institute a new treatment plan consisting of pharmacologic and physical therapy. Initial pharmacotherapy consisted of fish oil (1200 mg PO twice daily; 360-mg ω3 capsules, Nature Made, Mission Hills, CA). Physical therapy was expanded by the macaque’s participation in an operant behavioral study. A task was designed to assess pain-depressed behavior, defined as a behavior that has decreased in frequency as a result of pain.6 Preclinical evaluation of analgesic drugs typically relies on measuring pain-elicited behavior, such as the tail-flick procedure in rodents. Measuring pain-depressed behavior may provide a method to evaluate analgesics in circumstances that are more clinically relevant. The task was conducted in a large 2-section cage (47 in. × 75 in. × 31 in.), which also served as the macaque’s home cage (Figure 3). A box containing different-colored stimulus lights was placed on the bottom level, and a food dispenser containing sugar pellets was placed at the top of the cage. Both the light box and food dispenser were custom-made at University of Michigan and controlled by a computer program written by the researcher. An operator used a video monitor located

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Figure 1. Radiographs of the coxofemoral joint. (A) Ventrodorsal view showing the osteolysis of the right femoral head and enlarged acetabulum (arrow), and the atrophy of the right muscle mass compared with the left side (double headed arrow). (B) Close-up view of the lytic area of the femoral head (arrow).

Figure 2. The appearance of the femoral head and neck prior to the femoral head and neck ostectomy. The operated leg is rotated to allow visualization of the femoral head and neck (arrow). Severe deformation of the femoral head and neck due to extensive bone loss and osteophyte formation is evident. The acetabulum is underneath the distorted femoral head and neck. The * indicates the tendon of deep gluteal muscle after partial tenotomy was performed.

in an observation room to track the macaque’s performance and remotely controlled the lights and food dispenser. When the red stimulus light was activated, the animal was trained to come to the bottom of the cage. Once the macaque reached the bottom, the stimulus light extinguished, and a food pellet was dispensed. The macaque then climbed to the top of the cage and retrieved the pellet, at which point the red stimulus light returned and there was another opportunity to receive a pellet. A response was recorded each time the macaque retrieved a pellet. We hypothesized that, as a result of the animal’s limited mobility, the number of completed trails prior to pharmacologic and behavioral intervention would be less than that after treatment with carprofen. The experimental design of the study is shown in Figure 4. Prior to data collection, the macaque was introduced to the cage set-up and became familiar with the tasks (data not shown). Once data collection began, the macaque performed the task during a single daily session over the period of 17 d, with each session lasting 45 min. Initially, the baseline data were collected over 9 sessions until stable behavior was observed. Stable behavior was defined as no increasing or decreasing trend in the number of pellets received in 4 consecutive sessions. Then, the macaque received carprofen (2 mg/kg twice daily) for 3 d, during which period the animal had the opportunity to work for pellets by using procedures identical to those in the training phase. The number of pellets significantly increased (one-way ANOVA, P = 0.0002 after Tukey multiple-comparisons tests) between baseline (n = 9)

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measuring circumferences of the mid- and distal thigh and proximal crus. The objective was to confirm that the macaque was using both hindlimbs (operated and nonoperated) during the sessions. The increase in the circumference was the greatest during the first 48 d after the initiation of the operant behavioral study for the operated limb and the first 20 d for the nonoperated limb. The circumference of the non-operated limb was consistently greater than that of the operated side, however, an 8.5% increase in the circumference of the operated leg was noted between day 0 (initiation of the study) and day 90. Monitoring systemic effects of pharmacotherapy. Baseline bloodwork (CBC and serum chemistry) was performed before initiating chronic administration of NSAID and fish oil. Bloodwork was repeated during and after the therapy was completed, and routine physical examinations and alopecia scoring were performed. There were no clinically significant changes before or after the treatment. No clinical signs (for example, melena, diarrhea, inappetence) were noted in association with chronic administration of NSAID or fish oil.

Discussion

Figure 3. The setup of the operant behavioral study. This large (47 in. × 75 in. × 31in.) 2-section cage also served as the macaque’s home cage. The food dispenser was wired to the laser-emitting light box. The laser and food dispenser were remotely controlled by an operator in a separate observation room. A sugar pellet was dispensed from the food dispenser when the macaque reached the bottom of the cage. To retrieve the pellet, the macaque climbed to the top section of the cage. The macaque was allowed to repeat this process at will throughout the entire session (45 min), and the number of pellets earned was recorded (see Figure 5).

and carprofen treatment (n = 3). The number of pellets declined shortly after the cessation of carprofen, although the average number of pellets retrieved was not statistically significant (oneway ANOVA, P = 0.406 after Tukey multiple-comparisons tests) between the group of carprofen-treatment sessions (n = 3) and that after carprofen treatment (n = 4; Figure 5 A and B). In addition, there was no dramatic increase in the number of pellets when carprofen was restarted. Because the objective of this pilot study was to assess the efficacy of analgesics on pain-depressed behavior, and because no significant changes were observed when carprofen was restarted, data collection was discontinued. Fish oil supplementation (but not carprofen) was restarted, and the macaque continued to perform tasks approximately 3 to 5 times each week for the next 2 mo. The number of pellets plateaued (data not shown), and the macaque remained active even after discontinuation of the tasks. The animal reached the study endpoint and was euthanized approximately 2 y after the initial presentation. Monitoring treatment response. In addition to the number of pellets obtained, response to the operant behavioral study was monitored by estimating the hindlimb muscle mass in both operated and nonoperated limbs (Figure 6). This was done by

This case report describes our multimodal strategy to treat a singly housed, older male macaque with severe hindlimb lameness and muscle atrophy. Radiographs were suggestive of Legg– Calvé–Perthes disease, idiopathic condrolysis, malignancy, or infection. Surgery (FHO) was elected to obtain a diagnosis and to provide pain management. FHO improved ROM, and hindlimb atrophy decreased with postoperative care that included pharmacotherapy and novel physical therapy using an operant behavioral study design. A review of the literature suggests that the prevalence of osteoarthritis in NHP may be as high as 55% to 79%.15 In macaques, the hands, spine, stifle, and hip joints seem to be commonly affected.2,15 However, it is challenging to find a specific therapeutic regimen for NHP with osteoarthritis. A review of the literature suggested that osteoarthritis of the stifle joint has been treated medically in chimpanzees.5,15 One case involved medical management,15 and another case used acupuncture.5 There have been two reports of coxofemoral osteoarthritis in NHP, both of which were treated with FHO.3,12 One of the FHO cases involved physical therapy that included ROM exercises of the coxofemoral and stifle joint of the operated limb.3 This case illustrates some challenges associated with managing osteoarthritis in NHP. On presentation, severe muscle atrophy was noted, and the duration of the condition was unknown. Delay in the detection was likely a combination of the tendency of NHP to mask pain and the shy nature of this particular animal, as he initiated less interaction with the laboratory personnel than did other macaques. In addition, we were concerned about the limited availability of information regarding recovery and postoperative care after FHO in NHP. However, the procedure proved beneficial, in that the ROM of the limb improved significantly postoperatively, as was the macaque’s ability to bear weight on the affected limb. In addition, surgery allowed us to rule out malignancy and severe infections such as osteomyelitis. A multimodal approach with fish oil and NSAID was elected to further address this animal’s pain. Administration of fish oil (ω3 fatty acids) decreases the amount of NSAID necessary to achieve therapeutic antiinflammatory effects by replacing arachidonic

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Figure 4. Experimental design. Sessions were conducted once daily for the entire duration of data collection (17 sessions in 17 d). Prior to data collection, the macaque was trained and the protocol optimized; fish oil was discontinued. After the baseline was established, carprofen was added, removed, and then restarted. Fish oil was restarted, but carprofen was discontinued when the data collection was completed. After data collection, the macaque continued to perform tasks 3 to 5 times each week for the next 2 mo.

Figure 5. (A) The number of pellets that the macaque obtained during each session and (B) the number (mean ± 1 SD) of pellets obtained according to various treatments. Sessions were conducted once daily for the entire duration of data collection (17 sessions in 17 d). Significant differences were seen between the baseline and carprofen sessions (+, P = 0.0002) and the baseline and postcarprofen sessions (‡, P = 0.001).

acid, which contributes greatly to the inflammatory response, with eicosapentanoic acid.4 In addition, dietary supplementation with ω3 fatty acids is effective in ameliorating the symptoms of osteoarthritis in dogs and of rheumatoid arthritis in humans.9,10,14 In our case, no adverse clinical signs associated with NSAID or fish oil administration were observed. In addition, the laboratory staff reported that the macaque readily consumed the fish-oil capsules. In this study, the efficacy of the operant behavioral study, which acted as physical therapy, was evaluated by the number of pellets obtained and the estimation of the leg muscle mass using the leg circumferences. Improvement in mobility and muscle mass were correlated with increased number of pellets and increased leg circumferences, respectively. We noted a significant increase in the number of pellets retrieved between the baseline sessions and the carprofen-treatment sessions (Figure 6). Although the analgesic property of carprofen presumably contributed to this increase, physical therapy likely had a positive effect as well, in light of the upward trend in the number of pellets obtained immediately before beginning carprofen administration. The numbers of pellets obtained in sessions during and after carprofen treatment were not significantly different, yet the number of pellets fell acutely between the first and second sessions after termination of caprofen. This result may reflect a residual effect of carprofen during the first session of the

Figure 6. The circumferences of the operated (right) and control (left) legs. The average leg circumference was calculated from the measurements at the midthigh, distal thigh, and proximal crus. Day 0 refers to the initiation of operant behavioral study (physical therapy). The measurements were used to estimate the muscle mass.

postcarprofen group, although the last dose of carprofen (2 mg/ kg) was administered at least 24 h prior to the first session of the postcarprofen group. In addition, a dramatic increase in the number of pellets did not occur when carprofen was restarted (the ‘second carprofen’ group). Our data do not allow us to speculate on whether carprofen would have further increased the animal’s performance. As with any clinical case, there was no control animal for comparison. However, we noted an overall improvement in

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this macaque’s mobility (indicated as a significantly increase in the number of pellets earned between the baseline and postcarprofen sessions), corroborated by the increase in the muscle mass (8.5% increase in the circumference of the operated leg). According to these results, our multimodal management strategy consisting of surgery (to reduce discomfort and improve ROM), early pharmacotherapy (to reduce inflammation and pain), and later physical therapy (to improve mobility and build muscle mass) all contributed to the macaque’s recovery. For the veterinary staff, this form of physical therapy was nearly ideal. The task required voluntary activity by the animal; this was achieved by using positive reinforcement. The task also provided a form of enrichment. Sedation was not required, and direct contact with the laboratory personnel was eliminated, thus minimizing biosafety concerns. A decrease in performance could be used to signal the need for intervention, such as provision of analgesic therapy. Our approach was similar to that used in a case report on the efficacy of acupuncture in chimpanzees with osteoarthritis in stifle joints,5 in that the animal could voluntarily participate in treatments. In our case report, however, physical therapy did not require specialized equipment or training, and may be more applicable to institutions with limited resources. This therapy could be performed in a conventional caging system. In our case, the items used—the light box, pellet dispenser, and computer program—were all custom-made at the University of Michigan. However, similar equipment is available commercially. Our case has several limitations associated with validating the use of operant conditioning therapy as an efficacious physical therapy. Due to the nature of the case (a clinical case with spontaneous pain), multiple therapies were administered to this macaque to manage pain and promote mobility. In addition, this was a pilot study involving a single animal in a limited number of sessions, and the protocol needed optimization. Clinically assessing the use of the animal’s limb was difficult, because he was singly housed and was a relatively subordinate animal; other methods such as video monitoring3 or a mobility scoring system5 may have been beneficial. In conclusion, this report describes our approach to managing osteoarthritis in a NHP by using a combination of therapeutic regimens. The information we obtained from estimating muscle mass in parallel with the animal’s performance may be useful in planning a rehabilitation program for NHP with similar clinical conditions and in setting realistic expectations for postoperative recovery. In addition, the operant behavioral study acted as an excellent physical therapy and enrichment for the animal. We believe that we were able to improve this macaque’s wellbeing by restoring ROM through surgery, providing pharmacotherapy, and increasing mobility with physical rehabilitation.

Acknowledgments

We thank Dr James Woods; research technicians Angela Lindsey, Matthew Zaks, and Kathy Zelenock; and ULAM veterinary technicians Gail Rising and Taryn Hetrick, for their generous assistance. We thank the histology personnel of the ULAM In Vivo Animal Care (IVAC) for preparing histologic sections.

References

1. Bohm RP Jr, Gilbert MH. 2012. Emergency medicine and critical care for nonhuman primates, p 359–389. In: Abee CR, Mansfield K, Tardif S, Morris T, editors. Nonhuman primates in biomedical research: biology and management 2nd ed. Boston (MA): Academic Press. 2. DeRousseau CJ. 1985. Aging in the musculoskeletal system of rhesus monkeys: II. Degenerative joint disease. Am J Phys Anthropol 67:177–184. 3. Dufour JP, Phillippi-Falkenstein K, Bohm RP, Veazey RS, Carnal J. 2012. Excision of femoral head and neck for treatment of coxofemoral degenerative joint disease in a rhesus macaque (Macaca mulatta). Comp Med 62:539–542. 4. Fossum TW. 2007. Small animal surgery, 3rd ed. St Louis. (MO): Mosby. 5. Magden ER, Haller RL, Thiele EJ, Buchl SJ, Lambeth SP, Schapiro SJ. 2013. Acupuncture as an adjunct therapy for osteoarthritis in chimpanzees (Pan troglodytes). J Am Assoc Lab Anim Sci 52:475–480. 6. Negus SS, Bilsky EJ, Do Carmo GP, Stevenson GW. 2010. Rationale and methods for assessment of pain-depressed behavior in preclinical assays of pain and analgesia. Methods Mol Biol 617:79–91. 7. Neogi T, Zhang Y. 2013. Epidemiology of osteoarthritis. Rheum Dis Clin North Am 39:1–19. 8. Rao S, Bryant M, Herbert R, Sullivan N, Murray C, Bacher J, Safdar N. 2009. Idiopathic chondrolysis condition in 2 young, wild-caught cynomolgus monkeys (Macaca fascicularis) reared in captivity. Vet Pathol 46:509–513. 9. Roush JK, Cross AR, Renberg WC, Dodd CE, Sixby KA, Fritsch DA, Allen TA, Jewell DE, Richardson DC, Leventhal PS, Hahn KA. 2010. Evaluation of the effects of dietary supplementation with fish oil ω3 fatty acids on weight bearing in dogs with osteoarthritis. J Am Vet Med Assoc 236:67–73. 10. Roush JK, Dodd CE, Fritsch DA, Allen TA, Jewell DE, Schoenherr WD, Richardson DC, Leventhal PS, Hahn KA. 2010. Multicenter veterinary practice assessment of the effects of ω3 fatty acids on osteoarthritis in dogs. J Am Vet Med Assoc 236:59–66. 11. Rychel JK. 2010. Diagnosis and treatment of osteoarthritis. Top Companion Anim Med 25:20–25. 12. Smedley JV, Lomax LG, Williams JF, Barras PW, Hasselschwert DL. 2004. Legg–Calvé–Perthes disease in a rhesus macaque (Macaca mulatta). Comp Med 54:585–588. 13. Tobias JD, Leder M. 2011. Procedural sedation: a review of sedative agents, monitoring, and management of complications. Saudi J Anaesth 5:395–410. 14. Vandeweerd JM, Coisnon C, Clegg P, Cambier C, Pierson A, Hontoir F, Saegerman C, Gustin P, Buczinski S. 2012. Systematic review of efficacy of nutraceuticals to alleviate clinical signs of osteoarthritis. J Vet Intern Med 26:448–456. 15. Videan EN, Lammey ML, Lee DR. 2011. Diagnosis and treatment of degenerative joint disease in a captive male chimpanzee (Pan troglodytes). J Am Assoc Lab Anim Sci 50:263–266.

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Use of Femoral Head and Neck Ostectomy and Physical Therapy to Manage Osteoarthritis in a Rhesus Macaque (Macaca mulatta).

Osteoarthritis is associated with pain and immobility in both humans and animals. However, available resources for osteoarthritis management in captiv...
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