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Fracka AB, Oxley B, Allen MJ. 3D-printed, patient-specific cutting guides improve femoral and tibial cut alignment in canine total knee replacement. Vet Surg 2023; 52:674-685. [PMID: 37114865 DOI: 10.1111/vsu.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/18/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES The purpose of this cadaveric study was to determine whether patient-specific guides (PSGs) improve the accuracy of tibial and femoral cut alignment in canine total knee replacement (TKR), as compared with generic cutting guides. STUDY DESIGN Original research. ANIMALS Sixteen pelvic limbs from skeletally mature medium- to large-breed canine cadavers. METHODS Specimens were randomly allocated to one of two groups (PSG or Generic; N = 8/group). In the Generic group, femoral and tibial ostectomies were made using the standard canine TKR femoral cutting blocks and tibial alignment guide. In the PSG group, the cuts were made using a series of custom 3D-printed cutting guides. "Planned" and "actual" tibial and femoral cut alignments were compared in the frontal and sagittal planes, and errors were calculated by subtracting actual from planned values. RESULTS Use of 3D-printed PSGs improved tibial cut alignment in the frontal plane but not the sagittal plane. PSGs also improved the alignment of the cranial and distal femoral ostectomies but did not impact varus-valgus alignment. CONCLUSIONS These findings support the use of PSGs for TKR in dogs. Clinical trials are now needed to determine whether the benefits of PSGs translate into measurable improvements in joint function and implant longevity. CLINICAL SIGNIFICANCE PSGs have the potential to improve femoral and tibial component alignment in canine TKR.
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Affiliation(s)
- Agnieszka B Fracka
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Matthew J Allen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Kvale E, Rueda RC, Fitzpatrick N. Limb-Sparing Surgery in Two Cats Using a Femoral Endoprosthesis with an Integrated Total Knee Replacement Implant. Vet Comp Orthop Traumatol 2022; 35:134-142. [PMID: 35042271 DOI: 10.1055/s-0041-1742184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to describe a novel limb-sparing technique for the management of feline bone neoplasia using a custom-made femoral endoprosthesis in combination with a total knee replacement (TKR) prosthesis. METHODS Two cats with distal femoral bone tumours underwent pelvic limb salvage procedures with custom-made implants designed from patient-specific computed tomography images to replace the distal femur and the stifle. In case 1, the first-generation implant was a combination of a cemented femoral endoprosthesis with a uniaxial hinged cemented TKR prosthesis. Due to aseptic loosening of the endoprosthesis, revision was performed with a second-generation femoral endoprosthesis modified with a short intramedullary peg and a lateral bone plate for immediate stability. In case 2, a third-generation endoprosthesis with an intramedullary peg and two orthogonal bone plates for immediate stability, combined with a custom-designed rotationally hinged cemented TKR prosthesis, was used. Clinical and radiographic follow-up was recorded. RESULTS After revision surgery in case 1 and with the third-generation implant in case 2, no complications were encountered. Both cats showed minor mechanical restriction of stifle range of motion and good clinical long-term outcome without local tumour recurrence. CLINICAL SIGNIFICANCE The combination of a femoral endoprosthesis and a TKR prosthesis can be a viable alternative for distal femoral limb salvage in cats.
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Affiliation(s)
- Eirik Kvale
- Fitzpatrick Referrals, Orthopaedics and Neurology, Godalming, United Kingdom.,Fredrikstad Dyrehospital, Fredrikstad, Norway
| | - Rocio Chicon Rueda
- Fitzpatrick Referrals, Orthopaedics and Neurology, Godalming, United Kingdom
| | - Noel Fitzpatrick
- Fitzpatrick Referrals, Orthopaedics and Neurology, Godalming, United Kingdom
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Memarian P, Pishavar E, Zanotti F, Trentini M, Camponogara F, Soliani E, Gargiulo P, Isola M, Zavan B. Active Materials for 3D Printing in Small Animals: Current Modalities and Future Directions for Orthopedic Applications. Int J Mol Sci 2022; 23:ijms23031045. [PMID: 35162968 PMCID: PMC8834768 DOI: 10.3390/ijms23031045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
The successful clinical application of bone tissue engineering requires customized implants based on the receiver's bone anatomy and defect characteristics. Three-dimensional (3D) printing in small animal orthopedics has recently emerged as a valuable approach in fabricating individualized implants for receiver-specific needs. In veterinary medicine, because of the wide range of dimensions and anatomical variances, receiver-specific diagnosis and therapy are even more critical. The ability to generate 3D anatomical models and customize orthopedic instruments, implants, and scaffolds are advantages of 3D printing in small animal orthopedics. Furthermore, this technology provides veterinary medicine with a powerful tool that improves performance, precision, and cost-effectiveness. Nonetheless, the individualized 3D-printed implants have benefited several complex orthopedic procedures in small animals, including joint replacement surgeries, critical size bone defects, tibial tuberosity advancement, patellar groove replacement, limb-sparing surgeries, and other complex orthopedic procedures. The main purpose of this review is to discuss the application of 3D printing in small animal orthopedics based on already published papers as well as the techniques and materials used to fabricate 3D-printed objects. Finally, the advantages, current limitations, and future directions of 3D printing in small animal orthopedics have been addressed.
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Affiliation(s)
- Parastoo Memarian
- Department of Animal Medicine, Productions and Health, University of Padova, 35020 Padova, Italy; (P.M.); (M.I.)
| | - Elham Pishavar
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.P.); (F.Z.); (M.T.); (F.C.)
| | - Federica Zanotti
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.P.); (F.Z.); (M.T.); (F.C.)
| | - Martina Trentini
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.P.); (F.Z.); (M.T.); (F.C.)
| | - Francesca Camponogara
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.P.); (F.Z.); (M.T.); (F.C.)
| | - Elisa Soliani
- Engineering Department, King’s College, London WC2R 2LS, UK;
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavík University, 101 Reykjavík, Iceland;
- Department of Science, Landspítali, 101 Reykjavík, Iceland
| | - Maurizio Isola
- Department of Animal Medicine, Productions and Health, University of Padova, 35020 Padova, Italy; (P.M.); (M.I.)
| | - Barbara Zavan
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.P.); (F.Z.); (M.T.); (F.C.)
- Correspondence:
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Altwal J, Wilson CH, Griffon DJ. Applications of 3-dimensional printing in small-animal surgery: A review of current practices. Vet Surg 2021; 51:34-51. [PMID: 34633081 DOI: 10.1111/vsu.13739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/27/2021] [Accepted: 09/14/2021] [Indexed: 01/25/2023]
Abstract
Three-dimensional (3D) printing, also called rapid prototyping or additive manufacturing, transforms digital images into 3D printed objects, typically by layering consecutive thin films of material. This technology has become increasingly accessible to the public, prompting applications in veterinary surgery. Three-dimensional prints provide direct visualization of complex 3D structures and also haptic feedback relevant to surgery. The main objective of this review is to report current applications of 3D printing in small-animal surgery, including surgical education, preoperative planning, and treatment of tissue defects. The reported uses of 3D prints, their proposed advantages, and current limitations are discussed considering published evidence. Aspects of the manufacturing process specific to each application are described, along with current practices in veterinary surgery.
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Affiliation(s)
- Johnny Altwal
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.,Schmid College of Science and Technology, Chapman University, Orange, California, USA
| | - Caroline H Wilson
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, California, USA
| | - Dominique J Griffon
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
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Tilton M, Lewis GS, Hast MW, Fox E, Manogharan G. Additively manufactured patient-specific prosthesis for tumor reconstruction: Design, process, and properties. PLoS One 2021; 16:e0253786. [PMID: 34260623 PMCID: PMC8279401 DOI: 10.1371/journal.pone.0253786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/12/2021] [Indexed: 01/20/2023] Open
Abstract
Design and processing capabilities of additive manufacturing (AM) to fabricate complex geometries continues to drive the adoption of AM for biomedical applications. In this study, a validated design methodology is presented to evaluate AM as an effective fabrication technique for reconstruction of large bone defects after tumor resection in pediatric oncology patients. Implanting off-the-shelf components in pediatric patients is especially challenging because most standard components are sized and shaped for more common adult cases. While currently reported efforts on AM implants are focused on maxillofacial, hip and knee reconstructions, there have been no reported studies on reconstruction of proximal humerus tumors. A case study of a 9-year-old diagnosed with proximal humerus osteosarcoma was used to develop a patient-specific AM prosthesis for the humerus following tumor resection. Commonly used body-centered cubic (BCC) structures were incorporated at the surgical neck and distal interface in order to increase the effective surface area, promote osseointegration, and reduce the implant weight. A patient-specific prosthesis was fabricated using electron beam melting method from biocompatible Ti-6Al-4V. Both computational and biomechanical tests were performed on the prosthesis to evaluate its biomechanical behavior under varying loading conditions. Morphological analysis of the construct using micro-computed tomography was used to compare the as-designed and as-built prosthesis. It was found that the patient-specific prosthesis could withstand physiologically-relevant loading conditions with minimal permanent deformation (82 μm after 105 cycles) at the medial aspect of the porous surgical neck. These outcomes support potential translation of the patient-specific AM prostheses to reconstruct large bone defects following tumor resection.
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Affiliation(s)
- Maryam Tilton
- Department of Mechanical Engineering, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Gregory S. Lewis
- Department of Mechanical Engineering, Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, Pennsylvania, United States of America
| | - Michael W. Hast
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Edward Fox
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, Pennsylvania, United States of America
| | - Guha Manogharan
- Department of Mechanical Engineering, Pennsylvania State University, University Park, Pennsylvania, United States of America
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Huang YM, Huang CC, Tsai PI, Yang KY, Huang SI, Shen HH, Lai HJ, Huang SW, Chen SY, Lin FH, Chen CY. Three-Dimensional Printed Porous Titanium Screw with Bioactive Surface Modification for Bone-Tendon Healing: A Rabbit Animal Model. Int J Mol Sci 2020; 21:ijms21103628. [PMID: 32455543 PMCID: PMC7279243 DOI: 10.3390/ijms21103628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
The interference screw fixation method is used to secure a graft in the tibial tunnel during anterior cruciate ligament reconstruction surgery. However, several complications have been reported, such as biodegradable screw breakage, inflammatory or foreign body reaction, tunnel enlargement, and delayed graft healing. Using additive manufacturing (AM) technology, we developed a titanium alloy (Ti6Al4V) interference screw with chemically calcium phosphate surface modification technology to improve bone integration in the tibial tunnel. After chemical and heat treatment, the titanium screw formed a dense apatite layer on the metal surface in simulated body fluid. Twenty-seven New Zealand white rabbits were randomly divided into control and additive manufactured (AMD) screw groups. The long digital extensor tendon was detached and translated into a tibial plateau tunnel (diameter: 2.0 mm) and transfixed with an interference screw while the paw was in dorsiflexion. Biomechanical analyses, histological analyses, and an imaging study were performed at 1, 3, and 6 months. The biomechanical test showed that the ultimate pull-out load failure was significantly higher in the AMD screw group in all tested periods. Micro-computed tomography analyses revealed early woven bone formation in the AMD screw group at 1 and 3 months. In conclusion, AMD screws with bioactive surface modification improved bone ingrowth and enhanced biomechanical performance in a rabbit model.
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Affiliation(s)
- Yu-Min Huang
- Department of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-M.H.); (S.-W.H.); (F.-H.L.)
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei 100, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 100, Taiwan
| | - Chih-Chieh Huang
- Department of Materials Science and Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan; (C.-C.H.); (S.-Y.C.)
| | - Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Kuo-Yi Yang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Shin-I Huang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Hsin-Hsin Shen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Hong-Jen Lai
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan;
| | - Shu-Wei Huang
- Department of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-M.H.); (S.-W.H.); (F.-H.L.)
| | - San-Yuan Chen
- Department of Materials Science and Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan; (C.-C.H.); (S.-Y.C.)
| | - Feng-Huei Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-M.H.); (S.-W.H.); (F.-H.L.)
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli County 360, Taiwan
| | - Chih-Yu Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei 100, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-970-747767
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Thitiyanaporn C, Chantarapanich N, Sompaisarnsilp S, Thengchaisri N. Comparison of canine stifle kinematic analysis after two types of total knee arthroplasty: A cadaveric study. Vet World 2020; 13:956-962. [PMID: 32636593 PMCID: PMC7311880 DOI: 10.14202/vetworld.2020.956-962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Osteoarthritis is a common consequence of cranial cruciate ligament rupture (CCLR) in the canine stifle. Total knee replacement is a valuable method for managing end-stage osteoarthritis. Materials and Methods: Two new designs of total knee replacement implants were fabricated with information from computed tomography scans. Canine hind limbs of cadavers were tested with a biomechanical testing machine with C-arm fluoroscopy. The four groups tested were as follows: Intact stifles (INTACT), CCLR, total knee arthroplasty (TKA) with a peg on top of the tibial component (TKAP), and TKA with no peg on top of the tibial component (TKAN). Extension, flexion, adduction, abduction, internal rotation, external rotation, cranial translation, caudal translation, and range of motion were measured. Results: The cranial translation of the tibia relative to the femur increased significantly after cutting off the cranial cruciate ligament. After arthroplasty, adduction/abduction and cranial/caudal translation within the TKAN group was increased compared with the intact stifle group. In the TKAP group, only adduction was greater than it was in the intact stifle group. Conclusion: The design of the prosthesis used for the TKAP group was more appropriate for total knee replacement in dogs than the design of the prosthesis for the TKAN group.
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Affiliation(s)
- Chaiyakorn Thitiyanaporn
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | - Nattapon Chantarapanich
- Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi, 20230, Thailand
| | - Somchai Sompaisarnsilp
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand.,Faculty of Veterinary Medicine, Rajamangala University of Technology Tawan-ok, Chonburi, 20110, Thailand
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
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Blake C, Birch S, Brandão J. Medical Three-Dimensional Printing in Zoological Medicine. Vet Clin North Am Exot Anim Pract 2019; 22:331-348. [PMID: 31395318 DOI: 10.1016/j.cvex.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Medical 3-dimensional printing allows the creation of anatomic models by using a sequence of computer software programs. Diagnostic imaging data are used to create a physical model that allows clinicians to plan for surgical procedures and create prosthetics and surgical implants and instruments, among other applications. Its use in zoological medicine is limited, but is an area with a great growth potential. This publication reviews the process of creating a 3-dimensional anatomic model, its application in human and small animal medicine and surgery, and reviews peer-reviewed data regarding its use in exotic animals, wildlife, and zoo animals.
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Affiliation(s)
- Cara Blake
- Small Animal Surgery, Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, 2065 West Farm Road, Stillwater, OK 74078, USA.
| | - Scott Birch
- Pixelbeaker, 4834 Hillsdale Circle, Chattanooga, TN 37416, USA
| | - João Brandão
- Zoological Medicine, Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, 2065 West Farm Road, Stillwater, OK 74078, USA
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Tilton M, Armstrong A, Sanville J, Chin M, Hast MW, Lewis GS, Manogharan GP. Biomechanical Testing of Additive Manufactured Proximal Humerus Fracture Fixation Plates. Ann Biomed Eng 2019; 48:463-476. [PMID: 31555983 DOI: 10.1007/s10439-019-02365-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/12/2019] [Indexed: 01/24/2023]
Abstract
Achieving satisfactory fracture fixation in osteoporotic patients with unstable proximal humerus fractures remains a major clinical challenge. Varus collapse is one of the more prominent complications that may lead to screw cutout. This aim of this study was to compare the fixation provided by conventional locking plates with novel design concepts that are only feasible through additive manufacturing (AM) techniques. In addition to reversed engineered implants, two novel implant designs with integrated struts were included in the study to provide medial support to humeral head. The medial strut was either solid or included a porous lattice structure intended to promote bone ingrowth. Biomechanical tests were performed using low density synthetic bones with simulated 3-part comminuted fractures. Nondestructive torsion and compression were performed, followed by increasing cyclic loading. The relative displacements between the bone fragments were determined using a 3D motion capture system. The AM manufactured implants with medial strut showed significant reduction of varus displacement during the increasing cyclic loading when compared to conventional designs. AM reversed-engineered locking plates showed similar mechanical behavior to conventional plates with identical geometry. This study demonstrates the feasibility and potential of employing alternative design via AM for fixation of unstable comminuted proximal humerus fractures to reduce fragment displacement.
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Affiliation(s)
- Maryam Tilton
- Department of Mechanical Engineering, Pennsylvania State University, 232 Reber Bldg, University Park, PA, 16802, USA
| | - April Armstrong
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jennifer Sanville
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Chin
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael W Hast
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Guha P Manogharan
- Department of Mechanical Engineering, Pennsylvania State University, 232 Reber Bldg, University Park, PA, 16802, USA.
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Total knee replacement in a dog with a non-union type B3 tibial plateau fracture. Vet Comp Orthop Traumatol 2017; 27:159-65. [DOI: 10.3415/vcot-13-07-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/23/2013] [Indexed: 11/17/2022]
Abstract
SummaryA six-year-old German Shorthaired Pointer was presented with a 12 month history of left pelvic limb lameness following trauma. Clinical examination revealed marked thickening and reduced range-of-motion of the left stifle and radiographs were suggestive of a nonunion type B3 tibial plateau fracture with severe secondary osteoarthritis. Total knee replacement was performed with adjunctive stabilization of the proximal tibial fracture fragment. Clinical follow-up at six and 12 months with quantitative gait analysis revealed significant improvement in limb function.
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Complex angular and torsional deformities (distal femoral malunions). Vet Comp Orthop Traumatol 2017; 29:416-25. [DOI: 10.3415/vcot-15-08-0145] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 06/21/2016] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To describe the surgical technique of complex distal femoral deformity correction with the aid of stereolithography apparatus (SLA) biomodels, stabilized with locking plate fixation.Methods: Full-size replica epoxy bone bio-models of the affected femurs (4 dogs/5 limbs) were used as templates for surgical planning. A rehearsal procedure was performed on the biomodels aided by a guide wire technique and stabilized with locking plate fixation. Surgery performed in all dogs was guided by the rehearsal procedure. All pre-contoured implants were subsequently used in the definitive surgical procedure with minimal modification.Results: All dogs had markedly improved, with near normal functional outcomes; all but one had a mild persistent lameness at the final in-hospital follow-up examination (mean: 54.4 weeks; range: 24–113 weeks after surgery). All femurs healed without complications (mean: 34 weeks, median: 12 weeks; range: 8–12 weeks for closing osteotomies, and 26–113 weeks for opening wedge osteotomies). Long-term follow-up examination (mean: 28.6 months; range: 5–42 months) revealed all but one owner to be highly satisfied with the outcome. Complications were observed in two dogs: prolonged tibiotarsal joint decreased flexion that resolved with physical therapy. In one of these dogs, iatrogenic transection of the long digital extensor tendon was repaired, and the other had a peroneal nerve neurapraxia.Clinical significance: Stereolithography apparatus biomodels and rehearsal surgery simplified the definitive surgical corrections of complex femoral malunions and resulted in good functional outcomes.Online supplementary material is available for this paper at: http://dx.doi.org/10.3415/VCOT-15-08-0145
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Canine total knee replacement performed due to osteoarthritis subsequent to distal femur fracture osteosynthesis. Vet Comp Orthop Traumatol 2017; 25:427-32. [DOI: 10.3415/vcot-11-01-0012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 05/16/2012] [Indexed: 11/17/2022]
Abstract
SummaryA 27-kg German Shorthaired Pointer was referred for evaluation due to the complaint of left pelvic limb lameness and signs of pain in the left stifle joint. Radiographs revealed signs of a healed supracondylar femoral fracture that had been previously repaired at another hospital with an intramedullary pin and two cross pins. In addition, there were signs of severe osteoarthritis (OA). The OA had been managed medically with administration of carprofen and nutraceuticals for nine months without any improvement. Left total knee replacement (TKR) surgery was performed to alleviate signs of pain. The patient was assessed preoperatively and at six months, one year, and two years after surgery using radiology, force platform analysis of gait, thigh circumference measures, goniometry, and lameness evaluation.Following surgery, the dog resumed normal activity without any signs of pain and a good quality of life at 3.5 months. Force plate analysis found that peak vertical force on the TKR limb was 85.7% of the normal contralateral limb after two years.Total knee replacement was a successful treatment to manage knee OA associated with a healed distal femoral fracture and internal fixation in this dog.
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Comparison of goniometric measurements of the stifle joint in seven breeds of normal dogs. Vet Comp Orthop Traumatol 2017; 29:214-9. [DOI: 10.3415/vcot-15-05-0090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 01/28/2016] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To compare the goniometric measurements of the stifle joint in seven dog breeds, and to determine the relationship among goniometric measurements, age, body weight, tibial plateau angle, crus and thigh circumferences, and widths of quadriceps, hamstring, and gastrocnemius muscles in healthy dogs.Methods: We used a total of 126 dogs from seven different breeds, and recorded the angle of the stifle joint at standing, extension, and flexion together with the range of motion (ROM). The circumferences of the thigh and crus were also measured. Medio -lateral radiographic projections of the tibia and the femur were obtained from the dogs, and the tibial plateau angles, as well as the widths of quadriceps, hamstring, and gas -trocnemius muscles, were measured from these images.Results: Neither the sex of the dog nor the differences in the side measured affected the goniometric measurements of the stifle joint. The standing, extension, flexion, and ROM angles were different among the breeds. The standard deviations of the standing and extension angles were small relative to their means, but the standard deviations of the flexion angle were large relative to their means in all breeds. Body weight and muscular measurements were the most influential factors on the stifle flexion angle and ROM.Clinical significance: Breed differences, body weights, and muscle mass should be taken into consideration during assessment of the stifle function using goniometric measurements.
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Bray JP, Kersley A, Downing W, Crosse KR, Worth AJ, House AK, Yates G, Coomer AR, Brown IWM. Clinical outcomes of patient-specific porous titanium endoprostheses in dogs with tumors of the mandible, radius, or tibia: 12 cases (2013–2016). J Am Vet Med Assoc 2017; 251:566-579. [DOI: 10.2460/javma.251.5.566] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schoenfeld-Tacher RM, Horn TJ, Scheviak TA, Royal KD, Hudson LC. Evaluation of 3D Additively Manufactured Canine Brain Models for Teaching Veterinary Neuroanatomy. JOURNAL OF VETERINARY MEDICAL EDUCATION 2017; 44:612-619. [PMID: 28534721 DOI: 10.3138/jvme.0416-080r] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Physical specimens are essential to the teaching of veterinary anatomy. While fresh and fixed cadavers have long been the medium of choice, plastinated specimens have gained widespread acceptance as adjuncts to dissection materials. Even though the plastination process increases the durability of specimens, these are still derived from animal tissues and require periodic replacement if used by students on a regular basis. This study investigated the use of three-dimensional additively manufactured (3D AM) models (colloquially referred to as 3D-printed models) of the canine brain as a replacement for plastinated or formalin-fixed brains. The models investigated were built based on a micro-MRI of a single canine brain and have numerous practical advantages, such as durability, lower cost over time, and reduction of animal use. The effectiveness of the models was assessed by comparing performance among students who were instructed using either plastinated brains or 3D AM models. This study used propensity score matching to generate similar pairs of students. Pairings were based on gender and initial anatomy performance across two consecutive classes of first-year veterinary students. Students' performance on a practical neuroanatomy exam was compared, and no significant differences were found in scores based on the type of material (3D AM models or plastinated specimens) used for instruction. Students in both groups were equally able to identify neuroanatomical structures on cadaveric material, as well as respond to questions involving application of neuroanatomy knowledge. Therefore, we postulate that 3D AM canine brain models are an acceptable alternative to plastinated specimens in teaching veterinary neuroanatomy.
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Liska WD. In Memory of Jere. Vet Surg 2015. [DOI: 10.1111/vsu.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marcellin-Little DJ, Levine D. Principles and application of range of motion and stretching in companion animals. Vet Clin North Am Small Anim Pract 2014; 45:57-72. [PMID: 25440753 DOI: 10.1016/j.cvsm.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Optimal function after injury, surgery, or in patients with chronic conditions requires adequate motion in joints, muscles, tendon, fascia, and skin. Range of motion and stretching exercises are commonly used in companion animal rehabilitation programs to maintain or improve motion of musculoskeletal tissues. Range of motion exercises and stretching prevent adhesions from forming, help scar tissue remodeling, may improve muscle tone, and prevent future injury from occurring. Stretching is used to avoid loss of motion or to regain lost joint motion. Stretching is done manually, using external coaptation, or using therapeutic exercises. Careful documentation of range of motion is necessary.
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Affiliation(s)
- Denis J Marcellin-Little
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, NCSU CVM VHC #2563, 1052 William Moore Drive, Raleigh, NC 27607-4065, USA.
| | - David Levine
- Department of Physical Therapy, 615 McCallie Avenue, Chattanooga, TN 37403-2598, USA
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Abstract
Total joint replacement is now considered a routine surgical option for small animals with advanced joint disease. This review highlights the current state of the art in total hip, elbow and knee replacement in small animals, as well as the potential for application to other joints such as the intervertebral discs, hock and shoulder. Advances in cementless fixation, the use of less-invasive, bone-sparing procedures, and the development of custom implant options for revision surgery and oncologic reconstruction will be discussed. As growth in this field continues, it is important that future developments in total joint replacement are built on a foundation of detailed laboratory evaluation of new implant designs and surgical techniques, objective assessment of clinical outcomes, and a comprehensive, coordinated retrieval program that evaluates both well-functioning and failed joint replacements.
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Affiliation(s)
- M J Allen
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH 43210, USA
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Allen MJ, Leone KA, Lamonte K, Townsend KL, Mann KA. Cemented total knee replacement in 24 dogs: surgical technique, clinical results, and complications. Vet Surg 2009; 38:555-67. [PMID: 19573056 DOI: 10.1111/j.1532-950x.2009.00528.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterize the performance of cemented total knee replacement (TKR) in dogs. STUDY DESIGN Preclinical research study. ANIMALS Skeletally mature, male Hounds (25-30 kg; n=24) with no preexisting joint pathology. METHODS Dogs had unilateral cemented TKR and were evaluated at 6, 12, 26, or 52 weeks (6 dogs/time point) by radiography, bone density analysis, visual gait assessment, and direct measurement of thigh circumference and stifle joint range of motion as indicators of functional recovery. At study end, the stability of the cemented tibial component was determined by destructive mechanical testing. RESULTS Joint stability was excellent in 16 dogs (67%) and good in 8 dogs. None of the tibial components had evidence of migration or periprosthetic osteolysis whereas 1 femoral component was loose at 52 weeks. There was an early and significant decrease in tibial bone density, likely because of disuse of the operated limb. Dogs returned to full activity by 12 weeks. The tibial cement-bone interface maintained its strength over 52 weeks. CONCLUSIONS Cement provides stable fixation of the tibial component in canine TKR. CLINICAL RELEVANCE Cemented TKR yields adequate clinical function and stifle joint excursion in the dog. Clinical studies are needed to determine the long-term fate of cemented TKR implants, to assess the influence of implant design on implant fixation and wear, and to obtain objective functional data.
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Affiliation(s)
- Matthew J Allen
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA.
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LISKA WILLIAMD, DOYLE NANCYD. Canine Total Knee Replacement: Surgical Technique and One-Year Outcome. Vet Surg 2009; 38:568-82. [DOI: 10.1111/j.1532-950x.2009.00531.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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