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Korytárová N, Kramer S, Harms O, Volk HA. Clinical relevance of positive intraoperative bacterial culture in tibial plateau leveling osteotomy in dogs: a retrospective study. BMC Vet Res 2024; 20:175. [PMID: 38704532 PMCID: PMC11069177 DOI: 10.1186/s12917-024-04007-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Tibial plateau leveling osteotomy (TPLO) belongs to the most frequently used surgical method for the treatment of cranial cruciate ligament rupture in dogs. Surgical site infection (SSI) is one of the possible postoperative complications. The aim of this study was to evaluate the diagnostic value of intraoperative bacterial culture as a tool for the detection of intraoperative bacterial contamination progressing to infection development in canine TPLO. Electronic patient records from dogs who underwent TPLO between January 2018 to December 2020 were retrospectively reviewed. Intraoperative bacterial culture results, used antimicrobial drugs and presence of SSI were recorded. RESULTS Ninety-eight dogs were included in the study. SSI rate was 10.2%. All dogs who developed SSI (n = 10) had negative intraoperative bacterial cultures. None of the dogs with positive intraoperative bacterial culture (n = 6) developed SSI. The most cultured bacteria causing SSI was Staphylococcus pseudintermedius (n = 4). CONCLUSIONS Intraoperative bacterial culture in dogs undergoing TPLO is not suitable as a predictor of surgical site infection.
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Affiliation(s)
- Natália Korytárová
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Sabine Kramer
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Oliver Harms
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
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Dan MJ, Wills DJ, Crowley JD, Cance N, Romandini I, Walsh WR, Dejour DH. Anterior cruciate ligament zoobiquity: Can man's best friend tell us we are being too cautious with the implementation of osteotomy to correct posterior tibial slope. Knee Surg Sports Traumatol Arthrosc 2024; 32:1071-1076. [PMID: 38509848 DOI: 10.1002/ksa.12109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Anterior cruciate ligament (ACL) reconstruction (ACLR) is used to treat clinical instability post ACL rupture, however, there is a high rate of incomplete return to sport and rerupture. There is increasing interest in posterior tibial slope as an intrinsic risk factor for ACLR failure and persistent instability. Zoobiquity describes the collaboration between the human and veterinary professions in order to advance the scientific understanding of both fields. Given the cranial cruciate ligament (CCL) in dogs is synonymous with the anterior cruciate ligament in humans, functioning to control internal rotation and anterior translation, but osteotomies, rather than ligament reconstruction, are the mainstay of treatment for CCL rupture, this editorial sort to gain insights into this form of treatment from the veterinary world. Level of Evidence: Level V, evidence.
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Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
- East Coast Athletic Orthopaedics, Merewether, New South Wales, Australia
| | - Daniel J Wills
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Coast OrthoVet-Veterinary Orthopaedic Referral Services, Sydney, New South Wales, Australia
| | - James D Crowley
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Nicolas Cance
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
| | | | - William R Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - David H Dejour
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
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Kovacs JM, Mazdarani P, Nielsen MBM, Miles JE. Objective and owner-reported outcomes after modified cranial closing wedge ostectomy: a case series. Vet Res Commun 2024; 48:877-887. [PMID: 37978161 PMCID: PMC10998822 DOI: 10.1007/s11259-023-10261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023]
Abstract
Immediate and longer-term outcomes of a cranial closing wedge ostectomy variant for management of canine cranial cruciate ligament disease were assessed in this single-center retrospective consecutive study. Records and radiographs were retrieved and assessed by three independent observers to evaluate tibial plateau angle, anatomical-mechanical axis angle, tibial tuberosity distalization, and mechanical axis length before and after surgery. Kinetic gait analysis and owner questionnaires were used to assess clinical outcomes. Seventeen stifles from fifteen dogs were evaluated radiographically. Mean error from target tibial plateau angle was 0.4 degrees. Anatomical-mechanical axis angles reduced from mean 2.9 degrees preoperatively to mean - 0.9 degrees postoperatively. Tibial tuberosity distalization was mean 5.0% of mechanical axis length, and mean reduction in mechanical axis length was 0.1%. Increased tibial plateau angles were noted in 8/17 stifles, with a mean of 9.6 degrees at short-term follow-up. Major complications were observed in 9/17 stifles. Long term follow-up (mean 832 days) was obtained with gait analysis in 8/15 dogs and with questionnaire in 11/15. Most dogs (9/11) were weakly to moderately affected by osteoarthritis symptoms. All values for peak vertical force and vertical impulse normalized to body weight exceeded local lower reference limits for normal dogs, indicating acceptable limb use. Satisfactory immediate and long-term clinical outcomes appear to be possible with this technique, but the high incidence of shorter-term complications may caution against the technique or the fixation and management described here.
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Affiliation(s)
- Jenny M Kovacs
- Lunds Djursjukhus Evidensia, Porfyrvägen 6, Lund, 22478, Sweden
| | - Parisa Mazdarani
- College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, FL, 32608, USA
| | - Michelle B M Nielsen
- Department of Veterinary Clinical Sciences, University Hospital for Companion Animals, University of Copenhagen, Dyrlægevej 16, Frederiksberg C, 1870, Denmark
| | - James E Miles
- Department of Veterinary Clinical Sciences, University Hospital for Companion Animals, University of Copenhagen, Dyrlægevej 16, Frederiksberg C, 1870, Denmark.
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Nye AK, Thieman Mankin KM. Small animal patient preoperative preparation: a review of common antiseptics, comparison studies, and resistance. Front Vet Sci 2024; 11:1374826. [PMID: 38605919 PMCID: PMC11007076 DOI: 10.3389/fvets.2024.1374826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
This review aims to describe commonly used antiseptics in veterinary medicine including their mechanism of action, spectrum of activity, potential adverse effects, and application techniques. Additionally, it provides a review of the veterinary literature comparing antiseptics, a discussion of effectiveness and efficacy studies, and the potential for increased resistance to biocides and antimicrobials. This review concludes that appropriate selection and use is necessary to prevent the occurrence of surgical site infections, adverse effects, and potential for increasing resistance to antimicrobials. Continued research is needed to fill gaps in the current knowledge such as optimal preparation procedures for various surgical sites, standardization of efficacy and effectiveness testing, and the clinical impact of decreased susceptibility to chlorhexidine and other antiseptics.
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Affiliation(s)
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
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Shimada M, Huang C, Yamakawa S, Fujie H, Murakami S, Kanno N, Hara Y. Biomechanical effects of cranial closing wedge osteotomy on joint stability in normal canine stifles: an ex vivo study. BMC Vet Res 2024; 20:72. [PMID: 38402170 PMCID: PMC10893735 DOI: 10.1186/s12917-024-03923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Cranial closing wedge osteotomy (CCWO) is a functional stabilisation technique for cranial cruciate ligament (CrCL) ruptures. This biomechanical study aimed to evaluate the influence of CCWO on the stability of the stifle joint. Eighteen Beagle stifle joints were divided into two groups: control and CCWO. The stifle joints were analyzed using a six-degree-of-freedom robotic joint biomechanical testing system. The joints were subjected to 30 N in the craniocaudal (CrCd) drawer and proximal compression tests and 1 Nm in the internal-external (IE) rotation test. Each test was performed with an extension position, 135°, and 120° of joint angle. RESULTS The stifle joints were tested while the CrCLs were intact and then transected. In the drawer test, the CCWO procedure, CrCL transection, and stifle joint flexion increased CrCd displacement. The CCWO procedure and CrCL transection showed an interaction effect. In the compression test, the CCWO procedure decreased and CrCL transection and stifle joint flexion increased displacement. In the IE rotation test, CCWO, CrCL transection, and stifle joint flexion increased the range of motion. CONCLUSIONS CCWO was expected to provide stability against compressive force but does not contribute to stability in the drawer or rotational tests. In the CCWO-treated stifle joint, instability during the drawer test worsened with CrCL transection. In other words, performing the CCWO procedure when the CrCL function is present is desirable for stabilizing the stifle joint.
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Affiliation(s)
- Masakazu Shimada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan.
| | - Chenxu Huang
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Satoshi Yamakawa
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiromichi Fujie
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Sawako Murakami
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Nobuo Kanno
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Yasushi Hara
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
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Banks C, Jones GMC, Meeson RL. A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases. Vet Surg 2024; 53:113-121. [PMID: 37470173 DOI: 10.1111/vsu.13998] [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: 12/26/2022] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE (1) To determine whether Oxley's modified cranial closing wedge osteotomy (CCWO) results in a tibial plateau angle (TPA) of 5° in silico, (2) compare in silico to clinical postoperative TPA and (3) determine the impact of ostectomy distalization in silico. STUDY DESIGN Cross-sectional retrospective radiographic in silico study. SAMPLE POPULATION A total of 100 stifle radiographs; 90 dogs (small ≤25 kg = 84; large >25 kg = 16). METHODS Tibial plateau angles were measured preoperatively (TPAPre ), after in silico planning (TPAPlan ), and postoperatively (TPAPost ). Virtual ostectomies were evaluated for plate fit. Postoperative ostectomy position was measured. Virtual ostectomies were performed 5/7.5/10/15 mm from the patellar tendon insertion in 10 dogs from each preoperative TPA category (≤20°/21-25°/ 26-30°/31-35°/>35°). Comparisons for TPAPre , TPAPost , and TPAPlan were made between small and large dogs, and the outcome to the target 5° between TPA categories and ostectomy positions. RESULTS Mean ± SD TPAPre was 28.6 ± 6.2° and higher in small than large dogs. Mean TPAPlan was 7.6 ± 2.7°. Plate fit was appropriate in all. In silico, TPAs were greater than 5° except for cases with TPAPre > 35°. Median TPAPost was 5.5° (-4-21) and was higher in small (7°) than large (4.5°) dogs. Postoperative ostectomy position was more distal than Oxley's guidelines. When distalized >7.5 mm in silico, the magnitude of under-correction increased. CONCLUSIONS Oxley's modified CCWO did not result in TPA of 5° in most cases. Ostectomy distalization exacerbated under-correction. CLINICAL IMPACT Current guidelines should be modified to achieve 5° TPA postoperatively.
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Affiliation(s)
- Charlotte Banks
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, Royal Veterinary College, London, UK
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Miles JE, Mazdarani P, Gundersen RS, von Wenck A, Nielsen MBM. Cranial closing wedge ostectomies for management of canine cranial cruciate ligament insufficiency: Comparison and geometric modelling of errors. Res Vet Sci 2024; 166:105104. [PMID: 38065017 DOI: 10.1016/j.rvsc.2023.105104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/01/2024]
Abstract
Variants of the cranial closing wedge ostectomy (CCWO) may be used to manage cranial cruciate ligament deficient stifles by reduction of the tibial plateau angle (TPA). Concerns have been raised about predictability of achieving target TPA, limb shortening, axis shift, and distalization of the tibial tuberosity. Landmarks derived from tibial radiographs (n = 50) by 5 observers, along with outlines of the cranial and caudal proximal tibial cortices, were used to simulate six CCWO variants. Tested variants were Slocum-type (n = 2), modified (n = 2), isosceles, and anatomical-mechanical axis (AMA)-based CCWO. Observer specific landmarks were used to model pre- and postoperative errors in TPA measurement. Mean landmarks were used to compare key outcome variables between the variants, as well as modelling errors in positioning the wedge apex. Variants differed markedly in TPA, axis shift, mechanical axis length changes, and tibial tuberosity distalization, with more proximally positioned wedges performing better than distally positioned wedges. Errors in TPA identification appeared partially self-correcting due to altered axis shifts. Craniocaudal shifts in wedge apex position had the most severe effects on outcome variables, especially in shorter tibiae with greater initial TPA values. Recent CCWO variants are likely to achieve a satisfactory postoperative TPA with limited axis shift. The AMA-based CCWO technique appears to influence MA length and tibial tuberosity position the least, and apart from the effect on TPA where no advantage could be discerned, it appeared more robust in the face of wedge apex positioning errors than the other techniques.
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Affiliation(s)
- James E Miles
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark.
| | - Parisa Mazdarani
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
| | - Ragnhild S Gundersen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
| | - Asger von Wenck
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
| | - Michelle B M Nielsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
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Blagova B, Krastev D, Krastev N, Malinova L. Tissue changes and tissue reactivity following osteotomy by a conventional rotary device, an ultrasonic unit, and an Er: YAG laser - A comparative study in humans. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 125:101750. [PMID: 38142938 DOI: 10.1016/j.jormas.2023.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Innovative technologies from other fields of science are constantly being introduced in medicine. Research works on animals strongly confirm the belief in better results following ultrasound and laser surgery. The main conclusions are based on observations from different animal species, whose biological characteristics differ from those of humans. This requires scientific experiments to be performed and confirmed in humans. MATERIAL & METHODS Human mandible specimens harvested in vivo by a conventional low-speed rotary device, an ultrasonic unit, or an Er: YAG laser were studied and analyzed to compare their effects on bone morphology and tissue response following surgery. RESULTS The cutting surface of eighty biopsies was studied, as well the facial edema, pain levels, and jaw dysfunction were followed up in the same eighty patients from whom the slices were obtained. In the piezosurgery and drill groups, the borders exhibited irregular edges full of bone fragments and debris. Thermal alterations within the superficial surface in all bone samples were generally minimal. In all specimens, intact osteocytes were detectable away from the area of direct action of the bone-cutting device. It was established, that the reactive facial edema, pain levels, and jaw disfunction were with milder values following in vivo osteotomy by an ultrasonic unit and Er: YAG laser compared to the conventional drilling. Moreover, the recovery of the patients in these two groups was more pronounced. The observed tissue changes proved to affect the follow-up tissue reactions in the postoperative period (p ≤ 0.05). DISCUSSION Based on the established effects on human bone by its in vivo cutting, it can be concluded that laser and ultrasonic bone surgery was a superior alternative osteotomy method in humans to conventional drilling.
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Affiliation(s)
- Bistra Blagova
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, 2 Zdrave Str., Sofia 1431, Bulgaria.
| | - Dimo Krastev
- Medical College "Jordanka Filaretova", Medical University of Sofia, Bulgaria; Faculty of Public Health, Health Care and Sport, South-West University "Neofit Rilski", Blagoevgrad, Bulgaria
| | - Nikolay Krastev
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, 2 Zdrave Str., Sofia 1431, Bulgaria
| | - Lina Malinova
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, 2 Zdrave Str., Sofia 1431, Bulgaria
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De Armond CC, Lewis DD, Townsend S. Use of Preoperative 3D Virtual Planning and 3D-Printed Patient-Specific Guides to Facilitate a Single-Stage Cranial Closing Wedge Ostectomy and Tibial Plateau Leveling Osteotomy Procedure to Address Proximal Tibial Deformity, an Excessive Tibial Plateau Angle, and Cranial Cruciate Ligament Insufficiency in a Dog. Case Rep Vet Med 2023; 2023:3368794. [PMID: 38045562 PMCID: PMC10689072 DOI: 10.1155/2023/3368794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 12/05/2023] Open
Abstract
A 9-month-old mixed-breed dog was presented for bilateral proximal tibial deformity resulting in an excessive tibial plateau angle and cranial cruciate ligament insufficiency. Initial surgical management of the right pelvic limb was done by performing a cranial closing wedge ostectomy. Inadequate leveling of the plateau resulted in a postliminal meniscal tear which was addressed during a revision tibial plateau leveling osteotomy. The left pelvic limb was managed in a single-session surgery using three-dimensional (3D) virtual surgical planning and custom 3D-printed surgical guides to perform a combined cranial closing wedge ostectomy and tibial plateau leveling osteotomy. Postoperative 3D analysis of the left tibia revealed the accuracy of the surgical result within 2° of the virtual surgical plan. The dog developed a transient grade II/IV left medial patellar luxation following surgery but ultimately attained a full functional recovery and was actively engaged in competitive agility work 46 months following surgery on the left pelvic limb.
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Affiliation(s)
- Christina C. De Armond
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Daniel D. Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Sarah Townsend
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Motz AK, St. Germaine LL, Hoffmann DE, Sung J. A retrospective evaluation of the effect of oclacitinib (Apoquel) administration on development of surgical site infection following clean orthopedic stifle surgery. PLoS One 2023; 18:e0289827. [PMID: 37556416 PMCID: PMC10411735 DOI: 10.1371/journal.pone.0289827] [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: 04/17/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
The aim of this study was to determine the effect of oclacitinib (Apoquel) on development of surgical site infections in canines following clean orthopedic stifle surgery. Medical records of dogs undergoing unilateral, clean orthopedic stifle procedures were retrospectively examined for development of post-operative surgical site infections. Data collected for statistical analysis included age, sex, body weight, current medications, anesthesia and surgery times, white blood cell count, and neutrophil count. Surgical site infections were identified in 8.7% (34/390) of stifle procedures- 8.0% (29/364) in dogs not treated with oclacitinib and 19.2% (5/26) in dogs treated with oclacitinib (p = 0.053). There was a significant difference in development of surgical site infection in dogs with longer anesthesia times (p = 0.003) and higher body weights (p = 0.037). Dogs being treated with oclacitinib at the time of clean, orthopedic stifle surgery did not have a significantly higher incidence of surgical site infections. However, client education regarding risk of infection and increased patient monitoring post-operatively are recommended, especially in patients with increased body weight or longer anesthetic times.
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Affiliation(s)
- Alyssa K. Motz
- Surgery Department, Veterinary Specialists & Emergency Services, Rochester, NY, United States of America
| | - Lindsay L. St. Germaine
- Surgery Department, Veterinary Specialists & Emergency Services, Rochester, NY, United States of America
| | - Daniel E. Hoffmann
- Surgery Department, Veterinary Specialists & Emergency Services, Rochester, NY, United States of America
| | - Jed Sung
- Surgery Department, Veterinary Specialists & Emergency Services, Rochester, NY, United States of America
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11
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Biggo MR, Jones SC, Wanstrath AW, Tinga S, Dyce J, Carson BA, Schaul K, Follette CM, Kieves NR. Characteristics, surgical treatment, and outcomes of injuries involving the tarsus in greyhounds. Front Vet Sci 2023; 10:1234206. [PMID: 37614459 PMCID: PMC10442507 DOI: 10.3389/fvets.2023.1234206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/26/2023] [Indexed: 08/25/2023] Open
Abstract
Objective The first objective of this study was to describe the type of tarsal injuries sustained, surgery performed, and postoperative complications in greyhounds presenting to a single veterinary hospital. An additional objective of the study was to determine the surgical site infection (SSI) and explantation rate, and if any variables were associated with an increased risk of SSI and/or explantation. Animals 116 greyhounds receiving surgical intervention for a tarsal injury. Proceures Medical records from a single veterinary referral hospital were reviewed retrospectively. Data retrieved included signalment, details regarding the injury, surgical intervention, concurrent castration, surgical/anesthesia times, postoperative management, time to healing, and postoperative complications. In cases that underwent explantation, cause, time from initial surgery, and risk factors were evaluated. Results The most frequently diagnosed tarsal injuries were fracture of the central tarsal bone (CTB; 57.8%), calcaneal fracture (56.9%) and proximal intertarsal subluxation (34.5%). The most common injury combination was a CTB fracture with a calcaneal fracture (31.9%). In total 115 (99.1%) survived to discharge. Of these, 46 (40.0%) were diagnosed with an SSI and 59 (51.3%) underwent explantation. The most common indication for explantation was SSI. Concurrent medial and lateral surgical approaches was found to be associated with an increased likelihood of SSI and explantation. Clinical relevance Practitioners performing surgical intervention for tarsal injuries in greyhounds should be aware of the high SSI rate and likelihood that explantation will be required. This risk is elevated for injuries requiring a bilateral surgical approach.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nina R. Kieves
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
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Pennasilico L, Di Bella C, Sassaroli S, Salvaggio A, Roggiolani F, Piccionello AP. Effects of Autologous Microfragmented Adipose Tissue on Healing of Tibial Plateau Levelling Osteotomies in Dogs: A Prospective Clinical Trial. Animals (Basel) 2023; 13:2084. [PMID: 37443881 DOI: 10.3390/ani13132084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The aim of this study was to evaluate the effects of autologous microfragmented adipose tissue (MFAT) applied after mechanical fragmentation and assess these effects radiographically in bone healing in dogs subjected to tibial plateau levelling osteotomy (TPLO). Twenty dogs with unilateral cranial cruciate ligament disease were enrolled and randomly assigned to the treatment group (MFAT) or the control group (NT). The MFAT group underwent TPLO and autologous MFAT intra-articular administration, while the NT group underwent TPLO alone. Adipose tissue was collected from the thigh region, and MFAT was obtained by mechanical fragmentation at the end of the surgery. The patients were subjected to X-ray examination preoperatively, immediately postoperatively (T0), and at 4 (T1) and 8 (T2) weeks postoperatively. Two radiographic scores that had previously been described for the evaluation of bone healing after TPLO were used. A 12-point scoring system (from 0 = no healing to 12 = complete remodelling) was used at T0, T1, and T2, while a 5-point scoring system (from 0 = no healing to 4 = 76-100% of healing) was used at T1 and T2. The median healing scores were significantly higher at T1 and T2 for the MFAT group compared with the NT group for the 12-point (p < 0.05) and 5-point (p < 0.05) scoring systems. The intra-articular injection of autologous microfragmented adipose tissue can accelerate bone healing after TPLO without complications.
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Affiliation(s)
- Luca Pennasilico
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Caterina Di Bella
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Sara Sassaroli
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
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Miles JE, Nielsen MBM. Reported accuracy of cranial closing wedge ostectomy variants for management of canine cranial cruciate ligament insufficiency: A systematic review and meta-analysis. Vet J 2023; 295:105989. [PMID: 37148995 DOI: 10.1016/j.tvjl.2023.105989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
Concerns have been raised about the predictability of achieving appropriate tibial plateau angles (TPA), the occurrence of axis shift and tibial length reduction following cranial closing wedge ostectomy (CCWO). The primary objective of this review was to quantify typical errors in achieving target TPA with CCWO, with secondary objectives of assessing axis shift and length reduction. Retrospective or prospective studies of CCWO used as the primary treatment, from any date and in English, were eligible for inclusion. Searches were performed in EMBASE, Ovid MEDLINE, Agricola, Scopus, Web of Science, and CAB abstracts. Risk of bias was assessed, and data were screened for outliers and influential cases. Extracted data from 11 included studies were tabulated and underwent meta-analysis using R. Mean errors in TPA after CCWO ranged from - 0.6-2.9°, indicating the possibility of both under- and over-correction depending on the selected technique. Errors were relatively consistent for technique subgroups. Mean axis shifts ranged from 3.4° to 5.2°, and length reduction ranged from 0.4% to 3.2% of initial length, based on 6/11 and 3/11 studies, respectively. Data had high heterogeneity, many studies had small populations, and reporting standards were inconsistent. Concerns about the predictability of postoperative TPA may be overstated. With the limited data available, limb shortening does not appear to be a clinically important consideration. Axis shift will occur to varying degrees and must be considered during CCWO planning, as it influences the postoperative TPA. Careful choice of CCWO technique may allow clinicians to reliably achieve predictable TPA values.
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Affiliation(s)
- J E Miles
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark.
| | - M B M Nielsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
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Rial García A, Craig A. Stifle hyperextension identified in a dog with an excessively negative tibial plateau angle and a grossly intact cranial cruciate ligament following inappropriate cranial closing wedge ostectomy. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alba Rial García
- Southern Counties Veterinary Specialists, Ringwood, BH24 3JW, UK
| | - Andrew Craig
- North Dows Specialists Referrals, Bletchingley, UK
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Comparison of tibial anatomical-mechanical axis angles and patellar positions between tibial plateau levelling osteotomy (TPLO) and modified cranial closing wedge osteotomy (AMA-based CCWO) for the treatment of cranial cruciate ligament disease in large dogs with tibial plateau slopes greater than 30° and clinically normal Labradors retrievers. BMC Vet Res 2021; 17:368. [PMID: 34861875 PMCID: PMC8641203 DOI: 10.1186/s12917-021-03094-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) > 30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed 2 months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after 2 months. Results Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P = 0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (− 1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)). At 8 weeks, PLT grade differed significantly in the two operated groups (P = 0.000) (TPLO 40% 0–2, 20% 2–4, 40% > 4; CCWO 98.8% 0). Conclusions TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results 2 months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA > 30°.
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Peress R, Mejia S, Unis M, Sotgiu G, Dore S, Bruecker K. Comparison of Intra- and Postoperative Complications between Bilateral Simultaneous and Staged Tibial Plateau Levelling Osteotomy with Arthroscopy in 176 Cases. Vet Comp Orthop Traumatol 2020; 34:91-98. [PMID: 33129211 DOI: 10.1055/s-0040-1716682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the resulting short-term complications after simultaneous (SIM) or staged (ST) tibial plateau levelling osteotomy (TPLO) in patients that presented with bilaterally torn cranial cruciate ligaments. STUDY DESIGN This was a retrospective study. MATERIALS AND METHODS Medical records of dogs diagnosed with bilateral cranial cruciate ligament disease that underwent bilateral SIM or ST TPLO surgery with arthroscopy (2005-2015) were reviewed to evaluate the intra- and postoperative complications. Data were analysed and major and minor complications were compared between the two groups. RESULTS A total of 176 client-owned dogs (352 stifles) that had TPLO performed bilaterally with SIM or ST procedures were included for analysis. The overall complication rate was 47.5% for the SIM group and 19.5% for the ST group. The incidence of major complications was 10.1 and 3.8% in the SIM and ST groups respectively. Minor complications were 38.4 and 15.6% in the SIM and ST groups respectively. Tibial tuberosity fractures requiring revision were noted in 2% of the SIM group and none of the ST group. CLINICAL SIGNIFICANCE Although no significant difference was noted in major complication rate or tibial tuberosity fractures in our cohort of patients, a Type II statistical error was found. The complication rate in the SIM group is numerically greater by a factor of 2-3× or more for nearly all categories. Surgeons should consider the risks and benefits of SIM versus ST procedures as well as relevant individual patient and client factors before electing either alternative.
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Affiliation(s)
- Raz Peress
- Surgery Department, Leader Animal Specialty Hospital, Cooper City, Florida, United States
| | - Sebastian Mejia
- Surgery Department, Leader Animal Specialty Hospital, Cooper City, Florida, United States
| | - Marcos Unis
- Surgery Department, Leader Animal Specialty Hospital, Cooper City, Florida, United States
| | | | - Simone Dore
- Surgical and Experimental Sciences, Sassari, Italy
| | - Kenneth Bruecker
- Veterinary Medical and Surgical Group, Ventura, California, United States
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Rohwedder T, Buchheim S, Böttcher P. Bilateral proximal tibial epiphysiodesis and juvenile pubic symphysiodesis in a 22‐week‐old golden retriever. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Sophie Buchheim
- Department for Small Animal MedicineUniversity of Leipzig Faculty of Veterinary MedicineLeipzigSachsenGermany
| | - Peter Böttcher
- Small Animal ClinicFreie Universität BerlinBerlinGermany
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Pownall W, Rytz U, Schuepbach G, Spadavecchia C, Rohrbach H. The influence of the choice of preemptive analgesia on long-term postsurgical pain after tibial plateau leveling osteotomy in dogs. Vet Surg 2020; 50:71-80. [PMID: 32956535 DOI: 10.1111/vsu.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/02/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the prevalence of chronic postsurgical pain (CPSP) after tibial plateau leveling osteotomy (TPLO) in dogs and to determine the influence of preemptive locoregional analgesia on CPSP. STUDY DESIGN Retrospective study. ANIMALS One hundred twenty client-owned dogs. METHODS Medical records of dogs that underwent TPLO between 2012 and 2016 were reviewed for demographic information and type of preemptive analgesia. Owners were contacted to retrospectively assess the quality of life of their dogs by using the Helsinki Chronic Pain Index (HCPI) before and 6 months after surgery and at the time of questioning. An HCPI score > 12 was considered indicative of CPSP. Medical records were reviewed for demographic information and type of preemptive analgesia. A cumulative logit model was used to assess correlation of type of perioperative analgesia, HCPI, and demographic data. RESULTS The HCPI score was consistent with CPSP in 41 of 101 dogs with long-term follow-up (2.9 ± 1.5 years after surgery). Chronic postsurgical pain was documented in 11 of 32 and 13 of 28 dogs that received a spinal or epidural injection, respectively, or in 28 of 80 and 25 of 67 dogs with sciatic-femoral block at 6 months or with long-term follow-up after TPLO, respectively (P > .05). A negative correlation was found between HCPI and both weight and age 6 months after surgery. Only weight remained negatively correlated 2.9 years after surgery. CONCLUSION Forty-one percent of dogs that were evaluated exhibited HCPI values compatible with CPSP long-term after TPLO, regardless of the type of preemptive analgesia. Increased body weight was a negative prognostic factor for CPSP development. CLINICAL SIGNIFICANCE Additional studies are required to evaluate CPSP development after TPLO.
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Affiliation(s)
- William Pownall
- Department of Surgery, Small Animal Clinic, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Ulrich Rytz
- Department of Surgery, Small Animal Clinic, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Gertraud Schuepbach
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Claudia Spadavecchia
- Division of Veterinary Anaesthesia and Pain Management, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Helene Rohrbach
- Division of Veterinary Anaesthesia and Pain Management, Vetsuisse Faculty, University of Berne, Berne, Switzerland
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Terreros A, Daye RM. Modified cranial closing wedge osteotomy to treat cranial cruciate ligament deficient stifles with excessive tibial plateau angles: Complications, owner satisfaction, and midterm to long-term outcomes. Vet Surg 2020; 49:1109-1117. [PMID: 32529724 DOI: 10.1111/vsu.13431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/08/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report midterm to long-term outcomes of dogs with cranial cruciate ligament (CCL) rupture and excessive tibial plateau angles (TPA) treated with a modified cranial closing wedge osteotomy (m-CCWO). STUDY DESIGN Retrospective case series. STUDY POPULATION Dogs (n = 21) with CCL rupture and excessive TPA treated with m-CCWO (n = 28). METHODS Medical records, midterm and long-term follow-up radiographic examination records, Canine Orthopedic Index data, and owner surveys were reviewed to determine functional outcomes, owner satisfaction, and complications associated with the technique. RESULTS Tibial plateau angle decreased from 42.3° ± 4.8° preoperatively to 4.8° ± 3.3° after m-CCWO. No catastrophic complications occurred, while major and minor complications occurred in three of 28 and six of 28 stifles, respectively. Canine Orthopedic Index scores and owner surveys were available in 16 of 21 dogs at a median of 608 days postoperatively (range 279-1225). Functional midterm or long-term outcomes for these dogs treated with m-CCWO were excellent in eight dogs, acceptable in seven dogs, and unacceptable in one dog. Progression of osteoarthritis was noted on all midterm and long-term follow-up radiographs. All owners but one were satisfied. CONCLUSION Modified cranial closing wedge osteotomy was associated with an acceptable morbidity and resulted in satisfactory functional outcomes in most dogs of this series. CLINICAL SIGNIFICANCE Modified cranial closing wedge osteotomy should be considered as an alternative to treat CCL rupture in dogs with excessive TPA.
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Affiliation(s)
- Alex Terreros
- Ohio Veterinary Surgery and Neurology, Metropolitan Veterinary Hospital, Copley, Ohio
| | - R Mark Daye
- Ohio Veterinary Surgery and Neurology, Metropolitan Veterinary Hospital, Copley, Ohio
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Lee SJ, Frederick SW, Cross AR. Use of an amikacin-infused collagen sponge concurrent with implant removal for treatment of tibial plateau leveling osteotomy surgical site infection in 31 cases. Vet Surg 2019; 48:700-706. [PMID: 31168817 DOI: 10.1111/vsu.13249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/03/2019] [Accepted: 05/16/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To report the use and long-term outcome of dogs with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPO), treated with an amikacin-infused collagen sponge and implant removal. STUDY DESIGN Retrospective study. ANIMALS Thirty-one client-owned dogs. METHODS Medical records were reviewed for dogs with SSI after a TPLO that were treated with surgical implant removal and concurrent implantation of an amikacin-infused collagen sponge. Relevant clinical and surgical data were recorded. The TPLO implants were routinely removed; the surgical site was swabbed for culture. The sponge was aseptically infused with amikacin prior to implantation. Postprocedure examinations consisted of visual inspection of the incision by the surgeon and lameness scoring. RESULTS Thirty-one dogs met all inclusion criteria. Median follow-up time was 687 days. Short-term examination after implant removal and sponge implantation revealed uneventful incisional healing in 24 dogs. Six (19.4%) dogs exhibited inflamed incision sites a median of 4 days (range, 3-9) postoperatively that resolved without additional treatment. One (3.2%) dog required empirical antibiotic treatment 7 days postoperatively but was lost to long-term follow-up. Long-term follow-up examination revealed no clinical evidence of SSI recurrence and no lameness in the remaining 30 cases. CONCLUSION Surgical implant removal and implantation of an absorbable collagen sponge infused with amikacin alone was an effective treatment for postoperative TPLO SSI. CLINICAL SIGNIFICANCE This procedure had a 96.8% long-term resolution of SSI. It should be considered as a treatment option for TPLO SSI.
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Affiliation(s)
- Sylvia J Lee
- Surgery Department, BluePearl Veterinary Partners, Tampa, Florida
| | - Steven W Frederick
- Surgery Department, BluePearl Veterinary Partners, Sandy Springs, Georgia
| | - Alan R Cross
- Surgery Department, BluePearl Veterinary Partners, Sandy Springs, Georgia
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Patella tendinopathy Zoobiquity - What can we learn from dogs? Knee 2019; 26:115-123. [PMID: 30554911 DOI: 10.1016/j.knee.2018.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/30/2018] [Accepted: 11/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patella tendinopathy is an overuse condition. Pathogenesis and identification of intrinsic risk factors have largely eluded the orthopaedic world. The cranial cruciate ligament (CrCL) in dogs is the equivalent to the human anterior cruciate ligament (ACL). We report the effect of two canine proximal tibial osteotomy procedures in the veterinary literature on patella tendon moment arm and describe the biomechanical rationale for a tibial tubercle osteotomy for treatment of patella tendinopathy in the human. METHODS A literature review of studies reporting clinical complications of TTA and TPLO to form an observational animal cohort study in dogs. RESULTS The veterinary literature reports an overall clinical complication rate of up to 61% for TTA and up to 50% for TPLO respectively. Complications associated with the extensor mechanism of the knee are <1% for TTA compared to 1.9-19% for TPLO. Radiographic thickening of the patella tendon and tendinopathy is seen in one to 80% of TPLO cases. The TPLO decreases the moment arm of the extensor mechanism meaning increased force is required in the patella tendon to achieve the same torque when compared to the TTA which increases the efficiency of the extensor mechanism. This difference may account, in part, for the post-operative complications reported to the patella and patella tendon following TPLO. CONCLUSION This observational animal cohort study demonstrates a biomechanical rationale for investigating diagnostic and potential treatment options, including a tibial tubercle osteotomy, for patella tendinopathy in humans based on this principle.
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Zuckerman JS, Dyce J, Arruda AG, Kramer CM, Ben-Amotz R. Fibular osteotomy to facilitate proximal tibial rotation during tibial plateau leveling osteotomy. Vet Surg 2018; 47:923-931. [PMID: 30239027 DOI: 10.1111/vsu.12945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/23/2018] [Accepted: 06/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify factors that restrict proximal tibial rotation during tibial plateau leveling osteotomy (TPLO) and report on the outcome of concurrent fibular osteotomy (TPLO-FO). STUDY DESIGN Retrospective case-control study. ANIMALS Dogs undergoing TPLO-FO (n = 23) and dogs undergoing routine TPLO (n = 49). METHODS Medical records and radiographs of dogs that had undergone TPLO-FO were reviewed. Data that were collected included signalment, preoperative tibial plateau angle (TPA), mechanical medial proximal tibial angle (mMPTA), postoperative and recheck TPA and mMPTA, ratio of fibular width to tibial width (FW:TW), presence of tibiofibular synostosis, tibial osteotomy location, and use of additional implants. RESULTS The odds of exhibiting rotational constraints requiring FO during TPLO were 62-fold greater in dogs with tibiofibular synostosis than in dogs without synostosis. Dogs with FW:TW greater than 0.24 were 7.8-fold more likely to exhibit rotational constraints. After TPLO-FO, the postoperative increase in TPA was greater after single-plate fixation (mean, 5.4 ° ± 4.5 °) compared with fixation with 2 plates (mean, 1.4 ° ± 0.6 °). CONCLUSION Proximal tibiofibular synostosis and a relatively wide fibula restricted tibial plateau rotation. In these dogs, concurrent fibular osteotomy allowed adequate rotation. Adjunct plate fixation limited loss of rotation after TPLO-FO. CLINICAL SIGNIFICANCE Successful TPLO relies on adequate rotation of the proximal tibial segment. Fibular osteotomy and adjunct plate fixation are recommended to achieve and maintain adequate rotation of the osteotomized tibia in dogs with rotational constraints.
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Affiliation(s)
| | - Jonathan Dyce
- The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Andréia G Arruda
- The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Caroline M Kramer
- Veterinary Specialty and Emergency Center, Philadelphia, Pennsylvania
| | - Ron Ben-Amotz
- Veterinary Specialty and Emergency Center, Philadelphia, Pennsylvania
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Lopez DJ, VanDeventer GM, Krotscheck U, Aryazand Y, McConkey MJ, Hayashi K, Todhunter RJ, Hayes GM. Retrospective study of factors associated with surgical site infection in dogs following tibial plateau leveling osteotomy. J Am Vet Med Assoc 2018; 253:315-321. [DOI: 10.2460/javma.253.3.315] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Christ JP, Anderson JR, Youk AO. Modified cranial closing wedge ostectomy in 25 dogs. Vet Surg 2018; 47:683-691. [DOI: 10.1111/vsu.12912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jeffrey P. Christ
- Pittsburgh Veterinary Specialty and Emergency Center; Pittsburgh Pennsylvania
| | | | - Ada O. Youk
- Department of Biostatistics; University of Pittsburgh; Pittsburgh Pennsylvania
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Löfqvist K, Kjelgaard-Hansen M, Nielsen MBM. Usefulness of C-reactive protein and serum amyloid A in early detection of postoperative infectious complications to tibial plateau leveling osteotomy in dogs. Acta Vet Scand 2018; 60:30. [PMID: 29784055 PMCID: PMC5963089 DOI: 10.1186/s13028-018-0385-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 05/16/2018] [Indexed: 11/22/2022] Open
Abstract
Background Cranial cruciate ligament rupture is a prevalent injury in dogs, and tibial plateau leveling osteotomy (TPLO) is one of the preferred surgical techniques. Surgical site infection is a possible complication following TPLO and measurement of serum acute phase proteins is suggested to be a way to early recognize and distinguish postoperative infectious complications from normal postoperative inflammatory conditions. In this study we investigate the changes in concentrations of the systemic inflammatory markers C-reactive protein (CRP) and serum amyloid A (SAA) following tibial plateau leveling osteotomy (TPLO) in dogs and evaluate if deviations from the changes expectedly induced by the surgical procedure are useful in early detection of post-surgical infections. Dogs with cranial cruciate ligament injuries treated by TPLO at the Region Animal Hospital of Helsingborg during 2012 were included. Dogs with concurrent diseases, other orthopedic problems, or noninfectious post-surgical complications were excluded. Serial measurements of CRP and SAA concentrations were made. Changes in concentrations were visualized graphically and the discriminative capacity to detect infectious post-surgical complications was tested at different time points. Results A characteristic pattern of changes in concentrations of CRP and SAA were observed following TPLO with a significant increase 24 h post-surgery in all dogs and baseline-concentrations re-established at day 12. In dogs that developed post-surgical infections, a deviation in form of significantly higher concentrations of CRP and SAA were observed at day 6, compared to un-complicated cases. High-discriminative clinical decision limits of CRP (43.9 mg/L) and SAA (63.8 mg/L) could be established for differentiation of dogs with and without clinical signs of infectious complications at day 6 post-operatively, applicable to reliably rule out presence of infectious complications due to very high sensitivity (no false negatives). Conclusions The CRP and SAA levels in dogs with clinical signs of post-surgical infectious complication deviated from the typical levels expected at day 6 after surgery, and clinical decision limits to reliably rule out presence of infectious complications was suggested.
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Knight R, Danielski A. Long-term complications following tibial plateau levelling osteotomy in small dogs with tibial plateau angles > 30°. Vet Rec 2018; 182:461. [DOI: 10.1136/vr.104491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/26/2017] [Accepted: 12/31/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Rebekah Knight
- Hertfordshire UK
- Queen Mother Hospital for Animals, Royal Veterinary College; Hertfordshire UK
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Bacterial recovery using sonication versus swabbing of titanium and stainless steel implants inoculated with Staphylococcus pseudintermedius or Pseudomonas aeruginosa. Vet Comp Orthop Traumatol 2017; 30:346-350. [DOI: 10.3415/vcot-17-02-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To evaluate the use of sonication to improve recovery of bacteria from metal discs infected with bacteria commonly associated with implant infections in veterinary medicine.Methods: In vitro study in which sterile titanium (Ti6Al4V) and stainless steel (AIS1316-L) discs were incubated with either Staphylococcus pseudintermedius or Pseudomonas aeruginosa for 24 hours. The following three groups were compared: 1) the sonication group involved immersing the discs in sterile saline and sonicating for five minutes; 2) the sham group was considered a negative control in which the discs were immersed in saline for five minutes without sonication; and 3) the swab group involved systematically swabbing the implant with a sterile culturette. All samples were plated on blood agar and incubated for 24 hours. Colonies were then counted and compared.Results: For both species of bacteria, there was a significant increase in bacterial colonies isolated using sonication compared to the other two study groups (p = 0.0001). No differences in bacterial growth were found between the two types of metal implants. There was a significant increase in bacterial colony counts for S. pseudintermedius when comparing the swab group versus the sham group, but this was not significant for P. aeruginosa.Clinical significance: Sonication significantly improves recovery of bacteria commonly associated with veterinary implant-associated surgical site infections compared to swabbing of implants in vitro. A prospective clinical evaluation is indicated to determine the in vivo efficacy of sonication in veterinary patients.
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Outcome following removal of TPLO implants with surgical site infection. Vet Comp Orthop Traumatol 2017; 26:260-5. [DOI: 10.3415/vcot-11-12-0177] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 01/12/2013] [Indexed: 11/17/2022]
Abstract
SummaryObjective To evaluate the outcome of surgical site infection (SSI) associated with tibial plateau levelling osteotomy (TPLO) implants following treatment by medical management alone or implant removal with or without the administration of antibiotic medication.Animals Ninety dogs (104 TPLO surgical procedures).Methods Records of dogs that had undergone TPLO implant removal due to SSI were reviewed. Outcome following treatment with antibiotic medications without implant removal, and treatment with implant removal with and without the administration of antibiotic medications was evaluated.Results Treatment of SSI with antibiotic medication alone failed in 88.9% (64/72) of the dogs. The clinical signs of SSI resolved in 94.9% (74/78) of the dogs treated with implant removal (with and without the administration of antibiotic medication postimplant removal). The effect of administration of antibiotic medication on outcome of treatment of the SSI by implant removal was not significant. The rate of SSI associated with the Synthes implant was higher than with the Slocum implant, but not the New Generation implant.Conclusion Implant removal with or without the administration of antibiotic medication post-implant removal for treatment of TPLO SSI provided superior outcome compared to treatment with antibiotic medications without implant removal.Clinical significance Implant removal should be considered for TPLO SSI that have not responded to appropriate medical management. Further investigation of the various TPLO implants and their effects on postoperative infection rate is warranted.
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Complications of tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2017; 25:349-58. [DOI: 10.3415/vcot-11-09-0122] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 03/10/2012] [Indexed: 11/17/2022]
Abstract
SummaryThe tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intraoperative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO.
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Modification of the cranial closing wedge ostectomy technique for the treatment of canine cruciate disease. Vet Comp Orthop Traumatol 2017; 24:457-62. [DOI: 10.3415/vcot-10-11-0159] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 07/02/2011] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To describe a modification of the cranial closing wedge ostectomy (CCWO) technique and to compare its efficacy to the standard technique on cadaveric specimens.Methods: The standard and modified CCWO technique were applied to eight pairs of cadaveric tibiae. The following parameters were compared following the ostectomy: degrees of plateau levelling achieved (degrees), tibial long axis shift (degrees), reduction in tibial length (mm), area of bone wedge removed (cm2), and the area of proximal fragment (cm2).Results: The size of the removed wedge of bone and the reduction in tibial length were significantly less with the modified CCWO technique.Clinical significance: The modified CCWO has two main advantages. Firstly a smaller wedge is removed, allowing a greater preservation of bone stock in the proximal tibia, which is advantageous for implant placement. Secondly, the tibia is shortened to a lesser degree, which might reduce the risk of recurvatum, fibular fracture and patella desmitis. These factors are particularly propitious for the application of this technique to Terrier breeds with excessive tibial plateau angle, where large angular corrections are required. The modified CCWO is equally effective for plateau levelling and results in an equivalent tibial long-axis shift. A disadvantage with the modified technique is that not all of the cross sectional area of the distal fragment contributes to load sharing at the osteotomy.
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Martini FM, Brandstetter de Bellesini A, Miolo A, Del Coco L, Fanizzi FP, Crovace A. Combining a joint health supplement with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture. An exploratory controlled trial. Int J Vet Sci Med 2017; 5:105-112. [PMID: 30255058 PMCID: PMC6137840 DOI: 10.1016/j.ijvsm.2017.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
Canine cranial cruciate ligament rupture (CrCLR) is a very common pathology. Surgical stabilization is the first choice treatment, although it does not fully eliminate the increased risk of osteoarthritis. This preliminary study was carried out to explore whether a newly formulated joint health supplement would benefit metabolic, clinical and radiographic changes in dogs with CrCLR surgically treated with tibial plateau leveling osteotomy (TPLO). Besides chondroitin sulfate and glucosamine hydrochloride, the studied supplement contained anti-inflammatory and antioxidant ingredients, the main ones being N-palmitoyl-D-glucosamine (Glupamid®) and quercetin. It was thus intended to target not only chondrodegenerative components of osteoarthritis, but also post-injury inflammatory response and oxidative stress of joint tissues. Thirteen dogs underwent TPLO and were randomly allocated to treatment (n = 6) and control groups (n = 7), the former receiving the joint supplement for 90 days. Lameness and radiographic osteoarthritis changes were scored before (i.e., baseline) and at 30 and 90 days post-surgery. Synovial fluid samples were collected from injured stifles at the same time points. Levels of representative metabolites were measured by proton nuclear magnetic resonance spectroscopy in a blinded fashion. In the metabolomic analysis, special attention was paid to lactate, due to its emerging recognition as a key marker of inflammation. In the last time period (from the 30th to the 90th day), lameness improved by a factor of 2.3 compared to control dogs. No significant difference was observed in the radiographic osteoarthritis score between groups. In the first postoperative month, lactate and creatine levels significantly dropped in treated compared to control dogs. Compared to surgery alone, combining the joint supplement with TPLO resulted in a trend to a better clinical outcome in the later time interval but did not influence osteoarthritis radiographic progression. A significantly better rebalance of joint microenvironment in the early time interval (baseline - 30 days) was shown by metabolomic analysis, thus suggesting that the study supplement could limit ongoing inflammatory responses.
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Affiliation(s)
- Filippo M Martini
- University of Parma, Department of Veterinary Medicine, via del Taglio, 8, I-43126 Parma, Italy
| | | | - Alda Miolo
- CeDIS, Science Information and Documentation Centre, Innovet Italia, via Einaudi, 13, I-35030 Saccolongo (Padova), Italy
| | - Laura Del Coco
- University of Salento, Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Prov.le Lecce-Monteroni, 7, I-73100 Lecce, Italy
| | - Francesco P Fanizzi
- University of Salento, Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Prov.le Lecce-Monteroni, 7, I-73100 Lecce, Italy
| | - Antonio Crovace
- University of Bari, Emergency and Organ Transplantation Department (D.E.T.O.), Veterinary Surgery Division, Piazza G. Cesare, 11, I-70010 Valenzano (Bari), Italy
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Bureau S. Owner assessment of the outcome of tibial plateau levelling osteotomy without meniscal evaluation for treatment of naturally occurring cranial cruciate ligament rupture: 130 cases (2009 to 2013). J Small Anim Pract 2017; 58:468-475. [DOI: 10.1111/jsap.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 02/09/2017] [Accepted: 03/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S. Bureau
- Clinique Veterinaire Alliance; 8 bd Godard, 33300 Bordeaux France
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McCready DJ, Ness MG. Systematic review of the prevalence, risk factors, diagnosis and management of meniscal injury in dogs: Part 1. [corrected]. J Small Anim Pract 2017; 57:59-66. [PMID: 27168486 DOI: 10.1111/jsap.12433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/02/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To systematically evaluate the evidence reporting the frequency and risk factors of meniscal injury in dogs with cranial cruciate ligament failure. STUDY DESIGN Systematic literature review. MATERIALS AND METHODS Research questions were defined. An electronic database search of PubMed and CAB Abstracts was performed during November 2013. Data were extracted for study participants, design, intervention, outcome measures and results. Studies were evaluated using a validated instrument for assessing methodological quality and assigned a quality index score. A level of evidence was then assigned to each study. RESULTS Sixty-two studies were identified. The median quality index score was 14 out of a possible 26. Twenty-four studies were prospective case series, 37 retrospective case series and 1 animal research study. There were no class I or class II studies, 24 class III studies and 38 class IV studies. CLINICAL SIGNIFICANCE Despite a large number of publications the quality of evidence was generally low. No one study or combination of studies provided high quality evidence to establish the true frequency or risk factors for meniscal injury in dogs with cranial cruciate ligament failure.
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Affiliation(s)
- D J McCready
- Croft Veterinary Hospital, Cramlington, Northumberland, NE23 7RH
| | - M G Ness
- Croft Veterinary Hospital, Cramlington, Northumberland, NE23 7RH
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Campbell KA, Payne JT, Doornink MT, Haggerty J. Outcome of Tibial Closing Wedge Osteotomy in 55 Cranial Cruciate Ligament-Deficient Stifles of Small Dogs (<15 kg). Vet Surg 2016; 45:1056-1062. [DOI: 10.1111/vsu.12558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn A. Campbell
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
| | - John T. Payne
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
| | - Michael T. Doornink
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
| | - Jamie Haggerty
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
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Brown G, Maddox T, Baglietto Siles MM. Client-assessed long-term outcome in dogs with surgical site infection following tibial plateau levelling osteotomy. Vet Rec 2016; 179:409. [DOI: 10.1136/vr.103688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 12/16/2022]
Affiliation(s)
- G. Brown
- Grove Referrals; Grove Veterinary Group; Fakenham UK
| | - T. Maddox
- School of Veterinary Science; University of Liverpool; Leahurst Campus Neston Wirral CH43 5SQ UK
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Bergh MS, Sullivan C, Ferrell CL, Troy J, Budsberg SC. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. J Am Anim Hosp Assoc 2016; 50:315-21. [PMID: 25028440 DOI: 10.5326/jaaha-ms-6356] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgery for cranial cruciate ligament disease is often recommended; however, it is unclear if one procedure is superior. The aim of this systematic review was to answer the a priori question, "Is there a surgical procedure that will allow a consistent return to normal clinical function in dogs with cranial cruciate ligament disease and is that procedure superior to others?" A systematic literature search was performed through September 2013. Peer reviewed publication in the English language and 6 mo of postoperative follow-up were required. In total, 444 manuscripts were identified and reviewed, and 34 met the inclusion criteria. Two studies provided level 1, 6 provided level 2, 6 provided level 3, and 20 provided level 4 evidence relative to the study question. The most common surgical procedures included tibial plateau leveling osteotomy (TPLO, n = 14), lateral extracapsular suture (n = 13), tibial tuberosity advancement (n = 6). The strength of the evaluated evidence most strongly supports the ability of the TPLO in the ability to return dogs to normal function. It also provided strong support that functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture. There was insufficient data to adequately evaluate other surgical procedures.
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Affiliation(s)
- Mary Sarah Bergh
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, IA (M.B., C.S., J.T.); Department of Small Animal Medicine and Surgery, The University Of Georgia College of Veterinary Medicine, Athens, GA (C.F., S.B.)
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Rajitha Gunaratne GD, Khan R, Fick D, Robertson B, Dahotre N, Ironside C. A review of the physiological and histological effects of laser osteotomy. J Med Eng Technol 2016; 41:1-12. [DOI: 10.1080/03091902.2016.1199743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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38
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Kishi EN, Hulse D. Owner Evaluation of a CORA-Based Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Injury in Dogs. Vet Surg 2016; 45:507-14. [PMID: 27041682 DOI: 10.1111/vsu.12472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate a center of rotation of angulation (CORA)-based leveling osteotomy for cranial cruciate ligament injury in dogs. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n=70). METHODS Medical records (March 2011 to March 2012) of dogs diagnosed with a cranial cruciate ligament (CCL) injury treated with a CORA-based leveling osteotomy and stabilized using a bone plate and headless compression screw were reviewed. Radiographs were reviewed for tibial plateau angle and radiographic healing at final evaluation graded on a 5-point scale. Follow-up for a minimum of 6 months postoperatively was conducted by owner completion of a questionnaire regarding their dog's function after surgery. Based on owner responses, clinical outcomes were established. RESULTS CORA-based leveling osteotomy was used for 70 stifles with CCL injury. The mean time to final radiographic recheck was 107 days (range, 32-424 days). Radiographic healing scores were 42 dogs (69%) with grade 4, 17 dogs (28%) with grade 3, and 2 dogs (3%) with grade 2. The mean time to follow-up was 11.9 months (range 6-18 months). Fifty-four of the 70 (77%) dogs had full function, 13 (19%) had acceptable function, and 3 (4%) had unacceptable function. Complications occurred in 11 stifles (16%), including 3 incisional, 6 late-onset meniscal tears, and 2 implant related. CONCLUSION The described method of a CORA-based leveling osteotomy can be successfully performed for treatment of CCL injury in dogs. At the time of mid-term and long-term owner follow-up, most dogs in this case series had returned to full function.
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Affiliation(s)
- Erin N Kishi
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri
| | - Don Hulse
- Department of Small Animal Medicine and Surgery, Texas A&M University, College Station, Texas
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Pratesi A, Moores AP, Downes C, Grierson J, Maddox TW. Efficacy of Postoperative Antimicrobial Use for Clean Orthopedic Implant Surgery in Dogs: A Prospective Randomized Study in 100 Consecutive Cases. Vet Surg 2015; 44:653-60. [PMID: 25756814 DOI: 10.1111/vsu.12326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate whether administration of postoperative oral antimicrobial drugs has a beneficial effect on preventing surgical site infections (SSI) in clean orthopedic surgery involving stainless steel plating systems. STUDY DESIGN Randomized prospective clinical study. ANIMALS Dogs (n = 97). METHODS One hundred consecutive cases (97 dogs) that had clean orthopedic surgery requiring stainless steel plate fixation were randomly assigned using a random number generator to either YES group (administration of postoperative oral antimicrobials) or NO group (no administration of postoperative oral antimicrobials). Dogs in YES group were administered oral cefalexin or potentiated amoxicillin for 7 days, whereas dogs in NO group were discharged without oral antibiotics. Minimum follow-up was 12 months. Multivariable logistic regression was used to determine risk factors for SSI. RESULTS Overall postoperative infection rate was 12.9%. Infection occurred in 2 cases (4.3%) administered postoperative oral antimicrobials and in 10 cases (21.3%) not administered postoperative antimicrobials. Total anesthetic time and use of oral antimicrobials were the only significant factors associated with SSI. Use of postoperative antimicrobials was associated with a significant reduction in the risk of infection by ~84% and risk of infection was increased by ~2% for each minute increase in anesthesia time. CONCLUSIONS Administration of oral postoperative antimicrobials had a protective effect against development of SSI in clean orthopedic implant surgery.
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Affiliation(s)
- Andrea Pratesi
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Andrew P Moores
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Ciara Downes
- Torrington Orthopaedics, Brighouse, United Kingdom
| | - James Grierson
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Thomas W Maddox
- School of Veterinary Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
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40
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Nazarali A, Singh A, Weese JS. Perioperative Administration of Antimicrobials During Tibial Plateau Leveling Osteotomy. Vet Surg 2014; 43:966-71. [DOI: 10.1111/j.1532-950x.2014.12269.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Alim Nazarali
- Department of Clinical Studies; University of Guelph; Guelph Canada
| | - Ameet Singh
- Department of Clinical Studies; University of Guelph; Guelph Canada
| | - J. Scott Weese
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph Canada
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Levien AS, Brodbelt DC, Arthurs GI. Retrospective analysis of complications and outcomes in Boxers and Staffordshire Bull Terriers undergoing cranial cruciate ligament surgery. Aust Vet J 2014; 91:220-5. [PMID: 23718790 DOI: 10.1111/avj.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether Boxers and Staffordshire Bull Terriers (SBT) have a higher incidence of complications or a worse outcome after cranial cruciate ligament (CCL) surgery compared with control breeds. DESIGN The design was a retrospective cohort study with data reviewed from medical records and outcome assessed by owner questionnaire. RESULTS The cohort included 210 canine stifles comprising 33 Boxers, 47 SBTs and 130 controls. For Boxers, the overall complication rate (39.4%), major complication rate (30.3%) and revision surgery rates (18.2%) were significantly higher than those of the control groups (14.6%, 10.8% and 4.6%, respectively). Overall, SBTs were no more likely to suffer complications or repeat surgery than the control group. Considering only lateral fabello-tibial suture (LFS) stabilisation, both Boxers (32.0%) and SBTs (23.3%) had higher complication rates than the control group (6.3%). There were no significant differences in outcome among the Boxer, SBT and control groups; median follow-up time was 2 years (range 0.5-7 years). CONCLUSIONS The overall complication rate for Boxers undergoing CCL surgery was higher compared with other breeds of dog. When surgical techniques were analysed separately, the LFS was associated with a higher complication rate in Boxers and SBTs. Further investigation into breed-specific surgical techniques is indicated.
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Affiliation(s)
- A S Levien
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK.
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Olive J, Thiery M, Chailleux N, Blond L. A pitfall on postoperative radiographs in dogs after tibial plateau leveling osteotomy. Vet Surg 2014; 43:150-4. [PMID: 24400679 DOI: 10.1111/j.1532-950x.2014.12094.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 02/18/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the cause of an occasional radiolucent line in the tibia on postoperative radiographs after tibial plateau leveling osteotomy (TPLO) in dogs. STUDY DESIGN Retrospective case series and ex vivo experiment. SAMPLE POPULATION Dogs (n = 80; 87 stifles) with cranial cruciate ligament (CCL) rupture that had TPLO; and 4 canine tibia specimens. METHODS Medical records (2007-2010) and radiographs of dogs that had TPLO were reviewed and examined for presence of a radiolucent line on postoperative radiographs. The TPLO procedure was reproduced ex vivo to determine the origin of this line by use of metallic wires to identify bone contours. RESULTS A curvilinear radiolucent line was visible in 14 (16%) tibias and was 5.4 times more likely to be visible with lateral misalignment of the tibial diaphysis relative to the plateau and 2.6 times more likely visible on caudocranial radiographs with the stifle in outward rotation. Fracture complication rate was higher in dogs with this radiolucent line (P = .02) and with lateral misalignment of the tibial diaphysis relative to the plateau (risk ratio, 3.8). The line could be reproduced ex vivo and caused by superimposition of the craniomedial border of osteotomy with the tibial plateau. CONCLUSIONS The radiolucent line was a spurious fracture line created by the medial margin of the tibial osteotomy and confounding factors such as tibial misalignment may explain the apparently associated higher complication rate.
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Affiliation(s)
- Julien Olive
- Département des Sciences Cliniques, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Canada
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Mölsä SH, Hielm-Björkman AK, Laitinen-Vapaavuori OM. Use of an owner questionnaire to evaluate long-term surgical outcome and chronic pain after cranial cruciate ligament repair in dogs: 253 cases (2004–2006). J Am Vet Med Assoc 2013; 243:689-95. [DOI: 10.2460/javma.243.5.689] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Oxley B, Gemmill TJ, Renwick AR, Clements DN, McKee WM. Comparison of Complication Rates and Clinical Outcome Between Tibial Plateau Leveling Osteotomy and a Modified Cranial Closing Wedge Osteotomy for Treatment of Cranial Cruciate Ligament Disease in Dogs. Vet Surg 2013; 42:739-50. [DOI: 10.1111/j.1532-950x.2013.12033.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/19/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Bill Oxley
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
| | - Toby J. Gemmill
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
| | | | - Dylan N. Clements
- Division of Veterinary Clinical Sciences; Royal (Dick) School of Veterinary Studies and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Easter Bush Veterinary Centre; Roslin; Midlothian, Scotland
| | - W. Malcolm McKee
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
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Guerrero TG, Pozzi A, Dunbar N, Kipfer N, Haessig M, Beth Horodyski M, Montavon PM. Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints. Vet Surg 2011; 40:839-48. [PMID: 21848944 DOI: 10.1111/j.1532-950x.2011.00866.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the effect of tibial tuberosity advancement (TTA) on patellofemoral (PF) contact mechanics, and alignment of the PF and femorotibial (FT) joints in cranial cruciate ligament (CrCL)-deficient stifles of dogs. STUDY DESIGN Ex vivo biomechanical study. ANIMALS Unpaired cadaveric hind limbs (n=9). METHODS Digital pressure sensors placed in the PF joint were used to measure contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. The FT and PF poses were obtained using a 2-dimensional computer digitization technique. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Data was normalized and analyzed, after testing for normality by Wilk-Shapiro, using 1 sample T-test, paired T-test, and ANOVA; P≤.05 was considered significant. Bonferroni's correction was used when needed. RESULTS A significant cranioproximal tibial displacement and increase in patellar tilt were found in the CrCL-deficient joints. Both FT and PF alignments were restored after TTA. Contact areas and peak pressure did not vary between conditions. Peak pressure location displaced proximally from intact to CrCL-deficient condition and returned to normal after TTA. Total force measured in the CrCL-deficient stifle and TTA conditions were significantly lower than in the control. CONCLUSION TTA restored the normal FT and PF alignment, and reduced the retropatellar force by about 20%.
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Affiliation(s)
- Tomás G Guerrero
- Clinic for Small Animal Surgery, Vetsuisse-Faculty University of Zurich, Zurich, Switzerland.
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Steinberg EJ, Prata RG, Palazzini K, Brown DC. Tibial Tuberosity Advancement for Treatment of CrCL Injury: Complications and Owner Satisfaction. J Am Anim Hosp Assoc 2011; 47:250-7. [DOI: 10.5326/jaaha-ms-5574] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this retrospective study of 171 dogs that underwent 193 tibial tuberosity advancement (TTA) surgeries was to describe complications and owner satisfaction associated with the procedure. Complications occurred in 21 cases (11%). Subsequent meniscal tear was the most common complication (10/193, 5.2%). Increasing body weight (P=0.02–0.04) and small cage size (P=0.06) were significantly associated with postsurgical complications. Ninety-two percent of owners were satisfied with the outcome of the TTA procedure, but only 84% stated that they would be willing to have the procedure performed again. The authors concluded that TTA had a complication rate and owner satisfaction similar to other tibial osteotomies for the surgical correction of cranial cruciate ligament disease.
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Affiliation(s)
- Ezra J. Steinberg
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
| | - Raymond G. Prata
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
| | - Karen Palazzini
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
| | - Dorothy C. Brown
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
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Stübinger S, Nuss K, Pongratz M, Price J, Sader R, Zeilhofer HF, von Rechenberg B. Comparison of Er:YAG laser and piezoelectric osteotomy: An animal study in sheep. Lasers Surg Med 2011; 42:743-51. [PMID: 20886507 DOI: 10.1002/lsm.20946] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES It was the aim of this study to compare the feasibility of complete osteotomy of long bones in sheep using a newly designed variable square pulsed Er:YAG laser and piezoelectric surgery. In addition to uneventful bone healing after laser osteotomy, the goal was to assess the possibility to cut thick bony structures with both techniques in a surgically acceptable time frame of 2-3 minutes. MATERIAL AND METHODS A tibia midshaft osteotomy was performed in 24 sheep using either an Er:YAG laser (n = 12) or piezoelectric device (n = 12). Laser and piezoelectric groups were divided in two subgroups (n = 6) with sheep sacrificed after 2 and 3 months, respectively. A complete radiological, histological and histomorphometric analysis was performed to compare the course of bone/fracture healing and remodelling. RESULTS Laser and piezoelectric osteotomies of the sheep tibia up to a depth of 22 mm were possible without any thermal damage. Radiological and histological results after 2 months showed primary gap healing with distinct periosteal callus formation on the transcortex. After 3 months, radiological and histological analysis revealed less callus formation on the transcortex, with almost no visible osteotomy gap and a distinct formation of lamellar bone crossing the original osteotomy gap. CONCLUSION Er:YAG laser osteotomy can successfully be used in long bones with a depth of up to 22 mm, thus challenging the dogma of adverse effects of laser osteotomy due to thermal or other damages.
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Affiliation(s)
- Stefan Stübinger
- Competence Center for Applied Biotechnology and Molecular Medicine, University of Zürich, Winterthurerstr. 190, CH-8057 Zürich, Switzerland.
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Apelt D, Pozzi A, Marcellin-Little DJ, Kowaleski MP. Effect of cranial tibial closing wedge angle on tibial subluxation: an ex vivo study. Vet Surg 2010; 39:454-9. [PMID: 20345522 DOI: 10.1111/j.1532-950x.2010.00670.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of cranial tibial wedge osteotomy (CTWO) angle on cranial tibial subluxation (CTS) and postoperative tibial plateau angle (TPA). STUDY DESIGN Ex vivo biomechanical study. SAMPLE POPULATION Canine pelvic limbs (n=6). METHODS TPA determined from a lateral radiographic projection. CTS under 30% body weight load was measured from radiographs in the intact limb and after transection of the cranial cruciate ligament. A CTWO equal to TPA+10 degrees was performed at the distal extent of the tibial crest, and was stabilized with a custom designed hinge plate and external skeletal fixator. TPA and CTS in the loaded limb was determined from radiographs at 4 CTWO angles: TPA-5 degrees, TPA, TPA+5 degrees, and TPA+7.5 degrees. Comparison of CTS between the intact limb and the 4 CTWO angle groups was performed using 1-way repeated-measures ANOVA and a Dunnett multiple comparison test (significance at P<.05). RESULTS CTS was significantly greater than that of the intact limb in the TPA-5 degrees and TPA groups. CTS was not significantly different from the intact limb in the TPA+5 degrees or TPA+7.5 degrees groups with corresponding TPAs of 5.9 degrees and 3.8 degrees, respectively. CONCLUSION Using this model, CTS was neutralized at a TPA of approximately 4-6 degrees with a CTWO angle between TPA+5 degrees and TPA+7.5 degrees. CLINICAL RELEVANCE A CTWO angle between TPA+5 degrees and TPA+7.5 degrees is necessary to neutralize CTS and achieve a postoperative TPA of 4-6 degrees if the CTWO is performed at the distal extent of the tibial crest and the caudal cortices are aligned.
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Affiliation(s)
- Detlef Apelt
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The University of Florida, Gainesville, FL, USA
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Cook JL, Luther JK, Beetem J, Karnes J, Cook CR. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39:315-23. [PMID: 20345535 DOI: 10.1111/j.1532-950x.2010.00658.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop and test a novel extracapsular technique, TightRope CCL technique (TR), and compare its 6-month clinical outcomes to tibial plateau leveling osteotomy (TPLO) in dogs with cranial cruciate ligament (CCL) deficiency. STUDY DESIGN Prospective clinical cohort study. ANIMALS Medium, large, and giant breed dogs (n=47) with CCL deficiency. METHODS Before clinical use, TR was evaluated by mechanical testing and the surgical technique was developed and evaluated in canine cadavers. For the clinical study, dogs were assigned to either TR (n=24) or TPLO (n=23) groups and the assigned technique performed after arthroscopic assessment and treatment of joint pathology. Postoperative management was standardized for both groups. Outcome measures were performed immediately postoperatively and up to 6 months after surgery and included complication types and rate, subjective measurement of cranial drawer and tibial thrust, subjective assessment of radiographic progression of osteoarthritis (OA), and function using a validated client questionnaire (6 months only). RESULTS TR with a fiber tape suture had superior mechanical properties for creep, stiffness, yield load, and load at failure. Duration of anesthesia, total surgical time, and stabilization procedure (TR versus TPLO) were all significantly (P<.001) shorter for TR compared with TPLO. Complications requiring further treatment occurred in 12.5% of TR cases and 17.4% of TPLO cases. No significant differences were noted between groups for cranial tibial thrust, but cranial drawer was significantly (P<.05) lower in TR stifles at all postoperative time points. No significant differences were noted between groups for radiographic OA scores. No statistically or clinically significant differences were noted between TR and TPLO for scores for each of the client questionnaire categories. CONCLUSIONS TR resulted in 6-month outcomes that were not different than TPLO in terms of radiographic progression of OA and client-evaluated level of function. TR was associated with shorter anesthesia and surgery times as well as a lower complication rate. CLINICAL RELEVANCE The TR technique is safe and effective and can be considered an appropriate surgical option as part of the overall treatment plan for CCL deficiency in dogs.
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Affiliation(s)
- James L Cook
- Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO 65211, USA.
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