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Loh JR, Cleland N, Beierer L, Drew J, Wilson L, Delisser P. Caudoventral hip luxation in 160 dogs (2003-2023): A multicenter retrospective case series. Vet Surg 2024; 53:586-595. [PMID: 38558417 DOI: 10.1111/vsu.14093] [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: 09/30/2023] [Revised: 02/13/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To describe patient characteristics, etiology, treatment outcomes and complications of caudoventral hip luxation (CvHL) in a large cohort of dogs and investigate factors associated with nonsurgical treatment outcomes. STUDY DESIGN Multicenter retrospective case series. ANIMAL POPULATION A total of 160 client-owned dogs (170 limbs). METHODS Medical records from 2003 to 2023 were reviewed for signalment, history, treatment outcomes and complications. Logistic regression was performed to investigate factors associated with nonsurgical treatment outcome. RESULTS Low-trauma accidents accounted for 82.9% of cases. Over-represented breeds included poodles (38.1%) and poodle crosses (11.3%). On a per-treatment basis, success rates of closed reduction alone, closed reduction/Ehmer sling, closed reduction/hobbles were 9.1%, 15.2% and 48.8%, respectively. When accounting for repeated attempts using closed reduction alone, Ehmer sling, or hobbles, eventual success rate increased to 10.3%, 18.5% and 61.8%, respectively. Success rate for toggle rod stabilization was 88.2%. Complication rate of hobbles was 31.9% versus 60.6% for Ehmer slings. Use of hobbles (OR:7.62, p = .001, CI:2.23-26.05), treatment by specialist surgeons (OR:2.68, p = .047, CI: 1.01-7.08) and increasing age (OR:1.15, p < .005, CI: 1.08-1.23) were associated with successful nonsurgical treatments. CONCLUSION Low-trauma etiology, and poodles and their crosses were over-represented in cases of CvHL. Success rate of nonsurgical treatments was lower than previously reported. Hobbles were 7.6 times more likely to be successful when compared to dogs treated without hobbles and remains a viable noninvasive first-line treatment. CLINICAL SIGNIFICANCE/IMPACT Hobbles are recommended as a low-morbidity first-line treatment for CvHL. An Ehmer sling is not recommended. Toggle rod stabilization is an effective surgical treatment for CvHL.
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Affiliation(s)
- Jun Ren Loh
- Veterinary Specialist Services, Brisbane, Australia
| | | | - Lucas Beierer
- Queensland Veterinary Specialists, Brisbane, Australia
| | - Jarrod Drew
- Animal Referral Hospital, Brisbane, Australia
| | | | - Peter Delisser
- University of California, School of Veterinary Medicine, Davis, California
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Rivenburg RE, Maxwell EA, Bertran J, Souza CHDM, Smith BL. Biomechanical comparison of canine median sternotomy closure using suture tape and orthopedic wire cerclage. Vet Surg 2023; 52:1057-1063. [PMID: 37603027 DOI: 10.1111/vsu.14015] [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: 05/13/2022] [Revised: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To compare the mechanical properties of suture tape and orthopedic wire cerclage in an ex vivo canine median sternotomy model. STUDY DESIGN Ex vivo. ANIMALS Twelve large-breed canine cadaveric sternums. METHODS Median sternotomies were performed, leaving the manubrium intact. The specimens were randomly assigned to group W (20-gauge stainless steel orthopedic wire cerclage in a figure-of-eight pattern) or group ST (suture tape in a figure-of-eight pattern). Each specimen was laterally distracted until failure using an electrodynamic materials-testing system. RESULTS No differences were observed for displacement, yield load, maximum load, implant failure between the groups. The orthopedic wire construct was stiffer than the suture tape construct. CONCLUSION Suture tape was biomechanically similar to orthopedic wire cerclage for sternotomy closure in dogs, although wire constructs were stiffer. CLINICAL SIGNIFICANCE Suture tape may represent an alternative to cerclage wire for sternotomy closure in dogs. Additional studies evaluating its clinical use are needed.
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Affiliation(s)
- Rachel E Rivenburg
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Elizabeth A Maxwell
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Judith Bertran
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Carlos H De Mello Souza
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Benjamin L Smith
- Arthrex Inc., Department of Orthopedic Research, Naples, Florida, USA
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Abibe RB, Rahal SC, dos Reis Mesquita L, Doiche D, da Silva JP, Mamprim MJ, Pinho RH, Battazza A, Alves CEF, Saunders WB. Ligamentum teres reconstruction using autogenous semitendinosus tendon with toggle technique in rabbits. PeerJ 2023; 11:e14777. [PMID: 36987457 PMCID: PMC10040178 DOI: 10.7717/peerj.14777] [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: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 03/30/2023] Open
Abstract
Background Ligamentum teres (LT) has traditionally been considered a vestigial or redundant structure in humans; however, based on new studies and the evolution of hip arthroscopy, the LT injury has been viewed as a source of hip pain. Therefore, LT reconstruction can be beneficial in some cases. Rabbits have been frequently used as a model for cranial cruciate ligament reconstruction but few studies are available for ligamentum teres reconstruction. Objective To evaluate the semitendinosus tendon to replace ligamentum teres with the toggle technique, using rabbits as an experimental model. Methods Twenty-six female Norfolk rabbits with approximately 3 months of age were divided into two equal groups after excision of ligamentum teres (LT) from the right hip joint: G1-no reconstruction of LT and capsulorrhaphy; G2-double-bundle reconstruction of the LT using semitendinosus tendon autograft. In both groups, the LT was removed from the right hip joint. In G2 the autograft was harvested from the left hind limb of the same rabbit. The rabbits were evaluated clinically at different time intervals; before surgery (M1), 48 h (M2), 15 days (M3), 30 days (M4) and 90 days (M5) after surgery. Results The rabbits supported their limbs on the ground in both the groups. As complications of the procedure, four hip joints showed subluxations in the radiographic evaluation of G1; three at M4 and one at M5. In G2; two luxations of hip joints at M3 and one subluxation at M4 were seen. On ultrasound, irregular articular surface was seen in 30.8% of the rabbits that had subluxation of hip joints. Gross evaluation identified tendon graft integrity in 76.92% of the rabbits. Histological analysis revealed graft adhesion to the bone in the early phase comprised of sharpey-like collagen fibers. Conclusion The double-bundle reconstruction of the LT using autologous semitendinosus tendon associated with the toggle rod shows an early phase of tendon graft ligamentization at 90 days post-operatively in young rabbits, but biomechanical bias suffered by the tendon during gait must be considered.
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Affiliation(s)
- Rebeca Bastos Abibe
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Sheila Canevese Rahal
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Luciane dos Reis Mesquita
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Danuta Doiche
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Jeana Pereira da Silva
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Maria Jaqueline Mamprim
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Renata Haddad Pinho
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Alexandre Battazza
- Department of Veterinary Clinic, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Carlos Eduardo Fonseca Alves
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - W. Brian Saunders
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, United States
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Letesson J, Goin B, Viguier E, Cachon T. Validation of a biomechanical testing protocol of craniodorsal hip luxation in feline cadavers and comparison of two ultra-high molecular weight polyethylene materials used for extra-articular hip stabilisation. J Feline Med Surg 2022; 24:e360-e369. [PMID: 36074899 PMCID: PMC10812304 DOI: 10.1177/1098612x221114851] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of our study was to describe a biomechanical testing protocol to reproduce ex vivo craniodorsal hip luxation specific to the feline model, and evaluate the biomechanical properties of an intact hip joint compared with the fixation strength of two different techniques of extra-articular hip stabilisation. METHODS Eighteen hip joints (femur and hemipelvis) were harvested from nine mature feline cadavers. CT was performed for each hip joint so that a biomechanical base specific to each joint morphotype could be created using computer-aided design. The biomechanical bases were then produced using a three-dimensional printer to secure the hip joints during testing. A total of 34 biomechanical compression tests were performed. Eighteen compression tests were performed in the control group, of which two fractured. The remaining 16 hip joints were then randomly assigned either to group A (hip joints stabilised with an extra-articular ultra-high molecular weight polyethylene (UHMWPE) implant secured by an interference screw [n = 8]) or to group B (hip joints stabilised with a UHMWPE iliofemoral suture [n = 8]). RESULTS Mean ± SD yield, failure load and linear stiffness in the control group were 616 ± 168 N, 666 ± 158 N and 231 ± 50 N/mm, respectively. The relative fixation strength (% of intact joint) before hip luxation in groups A and B was 43.8% and 34.7%, respectively. No statistical difference was found between groups A and B for yield and failure load. However, the reoccurrence of craniodorsal hip luxation was higher in group B than in group A, in 5/8 and 0/8 tests, respectively. Moreover, in group A, the extra-articular UHMWPE implant induced caudodorsal hip luxation, reported as failure mode in 7/8 cases. CONCLUSIONS AND RELEVANCE This modified biomechanical protocol for testing craniodorsal hip luxation in a feline model was validated as repeatable and with acceptable variance. The extra-articular UHMWPE implant stabilisation technique proved to be more efficient in avoiding reoccurrence of craniodorsal hip luxation than UHMWPE iliofemoral suture.
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Affiliation(s)
| | - Bastien Goin
- University of Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l’Etoile, France
- Novetech Surgery, Monaco
| | - Eric Viguier
- University of Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l’Etoile, France
| | - Thibaut Cachon
- University of Lyon, VetAgro Sup, Interactions Cellules Environnement (ICE), Marcy l’Etoile, France
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Traumatic Coxofemoral Luxation in Cats Treated with Hip-Toggle Stabilization Using the Mini Tightrope® Fixation System. ACTA VET-BEOGRAD 2022. [DOI: 10.2478/acve-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of 21 cats that underwent coxofemoral toggle stabilization using the Mini TightRope® Fixation System (mTR®). Data were compiled from client-owned cats with traumatic hip luxation. Each cat underwent the same protocol including orthopedic assessment, preoperative radiographic evaluation, surgical procedure, postoperative management and clinical re-examination at 14 days, 8 weeks and 12 months following surgery. Age, body weight, implants and osteoarthritis progression were recorded. A lameness score 0-4 was assigned to each cat. Pain upon hip extension was not quantified but as pain reaction or no pain reaction. Major complications and osteoarthritic (OA) changes were recorded. Osteoarthritic changes were classified on a 0-4 scale. Twenty-one cats were included in the study. Coxofemoral luxations were stabilized using a mTR®. At 8 weeks, weight bearing was considered normal (grade 0) in all cats and no pain reaction was elicited during hip extension. One year after surgery, orthopedic examination was within the normal limits and according to the owners, all animals exhibited a normal physical activity. No complications were recorded. Evidence of slight OA changes were observed in 5 out of 21 cats. The final outcome was considered excellent in 16/21 patients and good in 5/21 cats. The application of the mTR® system can be considered a suitable surgical treatment in cats affected by traumatic hip luxation.
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Rivenburg RE, Murphy SM, Jones CT, Martin KW. Arthroscopic-Assisted Toggle Rod Stabilization in Canine Coxofemoral Luxation: A Cadaveric Study. Vet Comp Orthop Traumatol 2022; 35:298-304. [PMID: 35853474 DOI: 10.1055/s-0042-1748880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to describe an arthroscopic-assisted technique for coxofemoral toggle rod placement, and to report on the feasibility, drill tunnel trajectory and accuracy of tunnel aperture location using this method. STUDY DESIGN Cadaveric pilot study. SAMPLE POPULATION Eight coxofemoral joints. METHODS Craniodorsal coxofemoral joint luxations were artificially created. A simulated open hip reduction and stabilization with a toggle rod were performed through a limited arthrotomy under arthroscopic guidance. Computed tomography scans were performed to evaluate drill hole trajectory across the femoral neck, and joints were disarticulated and photographed. Digital imaging software was used to determine the percent overlap of the drill hole apertures relative to the origin and insertion of the round ligament on the acetabulum and fovea. RESULTS The exit point of the tunnel was entirely within the fovea capitis in five of eight femurs, three of eight femoral drill apertures were only partially within the target area. Of the eight acetabular bone tunnels examined, all were centred occupying the acetabular fossa. CONCLUSIONS Coxofemoral toggle rod placement can be performed under arthroscopic guidance through a limited arthrotomy. Comparable femoral tunnel accuracy with the standard open technique should be achieved with the current method prior to its clinical use.
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Affiliation(s)
- Rachel E Rivenburg
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, United States
| | - Sean M Murphy
- WestVet Animal Specialty & Emergency Center, Garden City, Idaho, United States
| | | | - Kyle W Martin
- Colorado Animal Specialty & Emergency, Boulder, Colorado, United States
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Espinel Rupérez J, Arthurs GI, Hewit A, Langley-Hobbs S, Trostel CT, Phillips ASJ, Keeley B, Maritato KC, Jones SC, Franklin PH, Whitelock R, Fernández Pérez C, Mullins RA. Complications and outcomes of cats with coxofemoral luxation treated with hip toggle stabilization using ultrahigh-molecular-weight-polyethylene or nylon (2009-2018): 48 cats. Vet Surg 2021; 50:1042-1053. [PMID: 33713478 DOI: 10.1111/vsu.13595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/12/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report overall rate and type of complications and outcomes of cats with coxofemoral luxation managed with hip toggle stabilization (HTS), to compare rate of postoperative complications and outcomes of cats treated with ultrahigh-molecular-weight-polyethylene (UHMWPE) or nylon, and to identify risk factors for reluxation and non-excellent outcomes. STUDY DESIGN Multi-institutional retrospective cohort study. SAMPLE POPULATION Forty-eight client-owned cats. METHODS Medical records of cats that underwent HTS from 2008-2018 using UHMWPE or nylon were reviewed. Univariable and multivariable logistic regression was performed to assess for factors associated with reluxation and non-excellent outcome. Final outcome was obtained from owner questionnaire. RESULTS Intraoperative and postoperative complications were recorded in two (4.2%) and 11 (24.4%) cats, respectively. The most common postoperative complication was reluxation (n = 5 [11.1%]). Outcome was classified as excellent in 81.1% and good in 16.2% of cats after a median of 445.5 days (range, 53-3720). No difference in rate of complications or outcomes was identified between UHMWPE and nylon. Performance of additional orthopedic procedures, occurrence of intraoperative complications, and non-performance of capsulorrhaphy were associated with reluxation. Performance of additional non-hip procedures (orthopedic/nonorthopedic) was associated with non-excellent outcome. CONCLUSION Hip toggle stabilization was associated with a low rate of intraoperative complications and reluxation and excellent long-term outcomes in most cats. No difference in rate of postoperative complications or outcomes of cats treated using UHMWPE or nylon was identified. Cats that underwent additional orthopedic procedures had greater risk of reluxation. CLINICAL SIGNIFICANCE Hip toggle stabilization is an effective technique for management of coxofemoral luxation in cats. Comparable results are expected using UHMWPE or nylon.
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Affiliation(s)
- Jorge Espinel Rupérez
- Section of Veterinary Clinical Sciences, University College Dublin, Dublin 4, Ireland
| | | | - Andrew Hewit
- Dick White Referrals, Cambridgeshire, United Kingdom
| | | | - C Todd Trostel
- Inland Valley Veterinary Specialists and Emergency Center, California
| | - Andrew S J Phillips
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Ben Keeley
- Manchester Veterinary Specialists, Worsley, Manchester, United Kingdom
| | - Karl C Maritato
- MedVet Medical and Cancer Centers for Pets, Cincinnati, Ohio
| | - Stephen C Jones
- The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Phil H Franklin
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Richard Whitelock
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Cristina Fernández Pérez
- Servicio de Medicina Preventiva, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Ronan A Mullins
- Section of Veterinary Clinical Sciences, University College Dublin, Dublin 4, Ireland
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Mathews ME, Barnhart MD. Risk factors for reluxation after toggle rod stabilization for treatment of coxofemoral luxation in 128 dogs. Vet Surg 2020; 50:142-149. [PMID: 32809245 DOI: 10.1111/vsu.13498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/22/2020] [Accepted: 07/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evaluate the risk factors for reluxation and outcomes for dogs with a toggle rod construct. STUDY DESIGN Retrospective case series. ANIMALS One hundred twenty-eight client-owned dogs. METHODS Medical records from 2007 to 2018 were reviewed for signalment, history, surgery, and outcome for dogs with a coxofemoral luxation repaired with a commercial toggle rod and nylon monofilament suture construct. Univariate and multiple logistics regression analysis were performed to assess risk factors associated with postoperative luxation. Primary veterinarians and owners were contacted for follow-up via telephone or electronic communication. RESULTS The overall complication rate was 24.2%, and the reluxation rate was 14.8%. There was a decreased risk of reluxation when the cause was traumatic in origin (odds ratio [OR] 0.10) or when the lameness was severe at presentation (OR 0.42). Fifteen of 58 (25.9%) owners contacted completed a follow-up survey. CONCLUSION Dogs with nontraumatic, low impact luxations were at a higher risk for reluxation. CLINICAL SIGNIFICANCE Dogs of any body condition with a traumatic coxofemoral luxation are at lowest risk for reluxation.
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