Centerline canine cementless total hip arthroplasty as an alternative implant system; results in 17 dogs (2015-2020)

OBJECTIVE

To evaluate the clinical outcomes associated with the Biomedtrix Centerline canine cementless total hip arthroplasty implant (C-THA).

ANIMALS

17 dogs (20 hips) surgically implanted with C-THA to treat coxofemoral pathology.

CLINICAL PRESENTATION AND PROCEDURES

Dogs with C-THA (2015 through 2020) with follow-up of ≥ 6 months were evaluated. Data included signalment, complications, management of complications, radiographs (bone implant interface), and clinical outcomes. Outcomes were assessed radiographically and subjectively via surgeon orthopedic examinations.

RESULTS

15 of 20 (75%) with long term radiographic follow-up had an excellent outcome. 5 hips (25%) had postoperative complications: femoral neck fracture (n = 1; 5%), aseptic loosening (2; 10%), and septic loosening (2; 10%).

CLINICAL RELEVANCE

C-THA can restore function in dogs with coxofemoral pathology. This novel procedure showed outcomes comparable to initial reports of other traditional THA implants (cemented, cementless, and hybrid) but complications occurred at a higher rate than recent outcomes of other long-standing THA procedures. Increased case numbers and surgeon experience with this novel implant system may eventually yield results comparable to other accepted THA systems.

[Comparison of the reoperation rates of three techniques for tibial tuberosity transposition in medial patellar dislocation]

INTRODUCTION

A common technique for the treatment of medial patellar luxation is the lateral transposition of the tibial tuberosity. Two variations of a new surgical method with a retention plate and fixation with a wire or a security plate, were tested against each other and against the existing fixation with Kirschner wires and a tension band by the number of reoperations. The new method using a retention plate and security plate showed the lowest rate of reoperations (5 %), followed by the new technique using retention plate and wire (14 %) and the existing fixation with Kirschner wires and a tension band (34 %). A possible explanation for the good result of the new method can be the fixation of the implants on the medial side of the tibia and the non-use of Kirschner wires.

Long-term outcome and risk factors associated with death or the need for revision surgery in dogs with permanent tracheostomies

OBJECTIVE

To evaluate long-term outcomes and identify factors associated with death or the need for revision surgery in dogs with permanent tracheostomies (PTs).

DESIGN

Retrospective cohort study.

ANIMALS

69 client-owned dogs that received a PT between January 2002 and June 2016 at 1 of 4 veterinary teaching hospitals.

PROCEDURES

Medical records were reviewed, and data extracted included signalment, history, clinical signs, radiographic and laryngeal examination findings, presence of esophageal abnormalities, date and reason for receiving a PT, postoperative complications, cause of death, and survival time. Dogs surviving < 2 weeks after receiving a PT were excluded.

RESULTS

Major complications occurred in 42 of 69 (61%) dogs, with aspiration pneumonia (13 [19%]), skinfold occlusion (13 [19%]), and stoma stenosis (12 [17%]) being most common. Revision surgery was performed in 24 of 69 (35%) dogs, most commonly because of stoma stenosis or skinfold occlusion (9/24 [38%] each). Brachycephalic dogs were more likely (OR, 3.5; 95% confidence interval, 1.2 to 10.2) to require revision surgery than were nonbrachycephalic dogs. The overall median survival time was 1,825 days, and dogs that received corticosteroids before receiving a PT, had tracheal collapse, or were older had shorter survival times.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of the present study indicated that creation of a PT was a viable treatment option for obstructive upper airway diseases in dogs and that long-term survival after receiving a PT was possible; however, a PT may not reduce the risk of aspiration pneumonia in dogs.

Surgical sponges in small animal surgery

Sponges are commonly used in veterinary practice. Uses for sponges in the operative arena include hemostasis, retraction, protection, dissection, and general wound management. Blood loss can be quantitated by counting blood-soaked sponges. Complications may arise when sponges are retained in the patient. Sponge retention is a risk whenever sponges are used during surgery, regardless of surgical procedure. This article reviews physical characteristics and proper uses of sponges, complications of sponge retention, and techniques to avoid retained sponges.

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 4: Early (acute) relaparotomy

REASONS FOR PERFORMING STUDY

Early (acute) relaparotomy after surgery for equine colic is widely considered to be an acceptable treatment option for management of certain post operative complications. However, there is relatively little published information about resulting complication rates and short- and long-term outcomes.

OBJECTIVES

To document the proportions, indications, complication rates and survival rates of horses undergoing acute relaparatomy following colic surgery.

METHODS

History, clinical findings, surgical findings and procedures, post operative treatments and outcome of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners.

RESULTS

Acute relaparotomy was performed in 27/254 horses (10.6%) that recovered from initial general anaesthesia. The indications for relaparotomy included persistent pain, persistent ileus, peritonitis and wound breakdown. Of these 27 horses, 21 (77.8%) recovered from the second surgery, of which 8 (29.6%) died during the immediate post operative period. Thirteen of the 27 horses (48.2%) were discharged. Of these 13 horses, 5 (38.5%) were re-admitted to the hospital for surgical treatment of a subsequent bout of colic. The long-term survival rate for the 27 horses that underwent relaparotomy was 22.2%. Colic following discharge after relaparotomy was recorded in 69.2% of cases.

CONCLUSIONS

Relaparotomy is necessary in approximately 10% of horses undergoing surgery for acute colic. Persistent pain and post operative ileus were the most common indications. The short-term survival rate for horses requiring relaparotomy was approximately 50% and the long-term survival rate 22%. Nearly 40% of horses surviving relaparotomy developed episodes of acute colic that necessitated further surgery.

POTENTIAL RELEVANCE

Owners of horses requiring early (acute) relaparotomy should be advised of the high complication rates for this procedure.

Factors affecting long-term survival of horses recovering from surgery of the small intestine

REASONS FOR PERFORMING STUDY

Epiploic foramen entrapment (EFE) has been associated with a particularly poor post operative prognosis for equine colic cases, but the reasons for this are unknown.

OBJECTIVES

To identify variables associated with post operative survival following surgery for small intestinal disease; develop a model describing long-term post operative survival; and identify reasons for the poor prognosis associated with EFE.

METHODS

Data from 382 horses undergoing surgery were used to identify variables associated with survival. A multivariable Cox proportional hazards model for post operative survival was developed and model fit evaluated.

RESULTS

The final model included the variables total plasma protein (TP) and packed cell volume (PCV) at admission, duration of surgery and the dichotomous variable relaparotomy (yes/no). Risk of death was positively associated with increasing PCV, but negatively associated with increasing TP (which decreased the probability of death). In a univariable model, EFE cases had a significantly higher death rate than other types of small intestinal disease (hazard ratio = 1.7, P = 0.035). Multivariable modelling indicated that some of the increased risk associated with EFE cases was due to lower TP values and longer duration of surgery.

CONCLUSIONS

Preoperative TP is associated negatively with the risk of post operative death in horses recovering from small intestinal surgery. Other variables associated with the probability of survival are preoperative PCV, duration of surgery and relaparotomy. The increased post operative death rate of EFE cases can be explained in part by lower TP and longer surgery times of these cases.

POTENTIAL RELEVANCE

Total plasma protein may be not simply a measure of hydration status in small intestinal colic cases, but an important determinant of survival. Further investigation of this relationship is warranted. Our model for post operative survival highlights the importance of preoperative TP, PCV and duration of surgery as prognostic indicators. This information should allow a more accurate post operative prognosis following small intestinal surgery.

Caudal compression of the infraorbital nerve: a novel surgical technique for treatment of idiopathic headshaking and assessment of its efficacy in 24 horses

REASONS FOR DESIGNING AND REPORTING TECHNIQUE: Idiopathic headshaking has remarkable similarities to human neuropathic facial pain syndromes associated with post herpetic and trigeminal neuralgia. These derive from abnormal sensory function within the peripheral or central pathways of the trigeminal nerve (TgN). Limiting input from the TgN can be helpful in controlling the perception of pain. Rhizotomy of the infraorbital branch of the TgN as it emerges from the infraorbital canal has been reported but has a poor efficacy. A novel technique involves compression of the nerve at a more caudal location within the infraorbital canal and the technique requires validation.

HYPOTHESIS

Caudal compression of the infraorbital nerve with platinum coils, performed in horses diagnosed with idiopathic headshaking, results in a decrease in clinical signs.

METHODS

Caudal compression of the infraorbital nerve, using platinum embolisation coils, was performed under fluoroscopic guidance. Clinical records of 24 idiopathic headshakers that had undergone this procedure were reviewed. Follow-up information was obtained by telephone questionnaire with the owner or referring veterinary surgeon.

RESULTS

All 24 horses had at least one surgical procedure. Median follow-up time was 6 months. There were 2 horses which had surgery 2 weeks before follow-up and these were excluded from the analysis of outcome. Following one surgery, 13/22 horses (59.0%) had a successful outcome. Of the 9 horses that did not improve, surgery was repeated in 6 cases. Two of these horses had a successful outcome. Overall, a successful outcome was obtained in 16/19 horses (84.2%).

CONCLUSIONS

This surgical technique is likely to prevent input from the TgN at a more caudal location then the previously described infraorbital neurectomy. The technique requires refinement.

Feline combined diaphyseal radial and ulnar fractures. A retrospective study of 28 cases

Feline combined diaphyseal radial and ulnar fractures were reviewed in a retrospective study of cases that were admitted to two university teaching hospitals. A high incidence of complications was noted, with 6/26 (23.1%) of cases requiring revision surgery. Open fractures were significantly more likely to require revision surgery. The two main repair methods were external skeletal fixation (ESF) or radial plating. The success rate was greater for radial plating, with only 1/10 (10%) cases requiring revision versus 4/14 (28.6%) for ESF. However, ESF tended to be applied to the more complicated fractures. Stabilisation of both bones proved to be an effective repair strategy with only 1/8 cases (12.5%) requiring revision versus 5/18 cases (27.8%) where only one bone was stabilised. Synostoses and radiohumeral luxation were noted as complications associated with the fractures stabilised by ESF. Final limb function following recovery was assessed as 'good' or 'excellent' in 93.3% of cases.

Treatment of equine cheek teeth by mechanical widening of diastemata in 60 horses (2000-2006)

REASON FOR PERFORMING STUDY

Cheek teeth (CT) diastemata are a significant cause of painful dental disease in horses and limited factual information is available on the treatment of this disorder.

OBJECTIVE

To assess the response to mechanical widening in the treatment of diastema.

METHOD

Details of the presenting signs and treatment of cases of CT diastema by widening were recorded and the response to treatment of these cases assessed by re-examinations and by obtaining follow-up information from owners.

RESULTS

Sixty horses of various breeds, median age 9 years, with clinically significant CT diastemata were classified as having primary (inadequate rostro-caudal CT compression: n = 29) and secondary (to other dental abnormalities: n = 31) diastemata. Quidding was present in 82% of cases, weight loss in 35%, halitosis in 17% and bitting disorders in 12%; 85% of the identified CT diastemata involved mandibular CT and 15% maxillary CT, with caudal CT more commonly affected. Of 273 identified diastemata in the 60 horses, 207 were deemed to have significantly associated periodontal food pocketing and were widened to 4.5-5.5 mm diameter on their occlusal surface using a mechanical burr. The 29 horses with primary diastemata received a median of 1.3 treatments each and at 10 months following their last treatment 72% showed complete remission of signs and 28% showed good improvement. The 31 horses with secondary diastemata received a median of 2.2 treatments each and, at mean 9 months following their last treatment, 48% showed full improvement, 42% good improvement, 6% slight improvement and 3% no improvement. Inappropriate areas of the clinical crown were removed from 4 CT without causing pulpar exposure; one case was reported to have a transient oral infection post treatment and another developed an apical infection in a treated tooth that was unrelated to the diastema widening.

CONCLUSION

Diastema widening is an effective treatment of periodontal pocketing in CT diastemata.

POTENTIAL RELEVANCE

The described treatment of CT diastema widening by trained personnel is an effective and safe treatment, but repeated treatments are often necessary, especially with secondary diastemata.

Limb lengthening in three dogs using distraction rates without a latency period. Radius/ulna, tibia, femur

OBJECTIVE

To report three clinical cases suffering from limb shortening secondary to monostotic physeal closure, in which distraction osteogenesis had been performed without a latency period and with high distraction rates.

METHODS

Three dogs had limb lengthening performed, using an Ilizarov ring fixator in two dogs and a linear dynamic fixator in the other dog. Bone lengthening achieved for a radius/ulna was 27 mm at 2 mm per day , a tibia was 78 mm at 3 mm per day, and a femur of 45 mm was 3 mm per day .

RESULTS

Complications related to pin loosening occurred in each case, thus requiring surgical corrective procedures, but these did not affect the final outcome. Lateral bowing of the bar and bone and some musculo-cutendinous contracture occurred in the femur. Fixation frames were on for 12 weeks in Case 1, eight weeks in Case 2 and nine weeks in Case 3. All three of the cases had a good functional outcome.

DISCUSSION

The faster rates of lengthening were not associated with any long-term deleterious soft tissue complications, but they were associated with pin loosening and bending of the bar. In each case there was excellent osteogenesis.

CONCLUSIONS

From the results achieved in these three cases it can be concluded that a latency period prior to distraction osteogenesis may not be necessary. Also, distraction rates up to 3 mm per day can be used to shorten the time needed to achieve lengthening; however further studies are needed to investigate the high level of complications.

Diphtheroid necrotic laryngitis in three calves - diagnostic procedure, therapy and post-operative development

Diphtheroid necrotic inflammation of the larynx in calves in its advanced stage mostly requires surgical therapy. Diagnostic procedure, surgery and post-operative care were described for three calves (aged 3-8 weeks). The clinical diagnosis was confirmed by laryngoscopy. In all three cases, a laryngotomy with resection of necrotic tissue was performed. After surgery two calves showed complications (tracheal stricture, mucosal hyperplasia). Both were cured in further surgery. In cases of post-operative complications, further surgical intervention can be very promising.

Intraluminal tracheal stent fracture in a Yorkshire terrier

An 8-year-old Yorkshire terrier was presented with tracheal collapse. Two intraluminal nitinol stents were implanted. The implanted stents were found to be fractured 4 weeks after implantation. The fractured stents were removed. To restore the collapsed trachea, ring prostheses were applied. However, the dog was euthanized because of a bad outcome following surgery.

Risk Factors for Ventral Luxation in Canine Total Hip Replacement

OBJECTIVE

To identify risk factors associated with ventral luxation (VL) of canine total hip replacement (THR), and outcome.

STUDY DESIGN

Retrospective study.

ANIMALS

Dogs (n=602) that had THR (563 cemented, 35 cementless, 4 hybrid).

METHODS

Dogs (1999-2004) with VL after THR were compared with dogs with uncomplicated THR. Data included signalment, body weight, diagnosis, implant size, acetabular cup orientation, and femoral displacement ratio (FDR).

RESULTS

VL was diagnosed in 11 (1.8%) dogs after primary THR. Including 2 other dogs that had VL after the study period, 10 (77%) of 13 dogs had VL within 7 days of surgery. Risk factors for VL included Saint Bernard-type dogs (P=.0001), short neck extension (P=.0005), and high angle of lateral opening in other breeds (P=.018). There were trends toward higher risk of VL with lower FDR in Saint Bernard types (P=.060), and with cementless implants (P=.061). Twelve dogs had revision arthroplasty that was successful in all cementless and 2 cemented VL cases. Five dogs had recurrent VL and a poor outcome.

CONCLUSION

VL is generally an early complication of THR, with no single common risk factor identified.

CLINICAL RELEVANCE

Saint Bernard types and short neck extensions are associated with increased risk of VL. Poor cup orientation is a determining factor for VL in some dogs, but a protective orientation of the acetabular cup was not found. Revision is successful in most dogs, but recurrent VL merits a guarded prognosis.

Tibial Tuberosity Advancement for Stabilization of the Canine Cranial Cruciate Ligament-Deficient Stifle Joint: Surgical Technique, Early Results, and Complications in 101 Dogs

OBJECTIVE

To describe the surgical technique, early results and complications of tibial tuberosity advancement (TTA) for treatment for cranial cruciate ligament (CrCL)-deficient stifle joints in dogs.

STUDY DESIGN

Retrospective clinical study.

ANIMALS

Dogs (n=101) with CrCL-deficient stifles (114).

METHODS

Medical records of 101 dogs that had TTA were reviewed. Complications were recorded and separated into either major or minor complications based on the need for additional surgery. In-hospital re-evaluation of limb function and time to radiographic healing were reviewed. Further follow-up was obtained by telephone interview of owners.

RESULTS

Complications occurred in 31.5% of the dogs (12.3% major, 19.3% minor). Major complications included subsequent meniscal tear, tibial fracture, implant failure, infection, lick granuloma, incisional trauma, and medial patellar luxation; all major complications were treated with successful outcomes. All but 2 minor complications resolved. The mean time to documented radiographic healing was 11.3 weeks. Final in-hospital re-evaluation of limb function (mean, 13.5 weeks), was recorded for 93 dogs with lameness categorized as none (74.5%), mild (23.5%), moderate (2%), and severe (1%). All but 2 owners interviewed were satisfied with outcome and 83.1% reported a marked improvement or a return to pre-injury status.

CONCLUSIONS

TTA is a procedure comparable with alternate methods of CrCL repair with expected good to excellent functional outcome.

CLINICAL RELEVANCE

TTA procedure can be successfully used to obtain the dynamic stability of a CrCL-deficient stifle joint in dogs.

Congenital retrosternal (Morgagni) diaphragmatic hernias in three horses

CASE DESCRIPTION

3 Horses were examined and treated because of sudden onset of signs of abdominal pain.

CLINICAL FINDINGS

All horses had a retrosternal (Morgagni) hernia involving the right side of the diaphragm. In each horse, the large colon was incarcerated in a right muscular defect in the diaphragm with a large hernial sac.

TREATMENT AND OUTCOME

Definitive surgical repair of the hernia was not performed during the initial celiotomy. The hernia was repaired with mesh herniorrhaphy, but without resection of the hernia sac in 2 horses. For 1 horse, conservative management was applied. In the 2 horses treated with surgical correction, no major postoperative complications developed, and all 3 horses have been free of signs of abdominal pain.

CLINICAL RELEVANCE

Horses with retrosternal hernias involving the diaphragm can develop clinical signs of intermittent obstruction of the large colon and chronic colic. In horses, retrosternal diaphragmatic hernias appear to develop exclusively in the right ventral aspect of the diaphragm and could represent an embryologic defect of diaphragm formation. Affected horses can be successfully treated with mesh herniorrhaphy or, in some instances, with conservative management.

Treatment of a shoulder luxation in a forelimb amputee dog

An eight-year-old, male, thoracic limb amputee Whippet presented with a traumatic lateral luxation of the scapulohumeral joint. Surgical reduction and stabilisation of the shoulder joint by means of a modified Campbell scapulohumeral prosthesis and capsulorrhaphy was unsuccessful and reluxation of the shoulder joint occurred. Subsequent surgical stabilisation using bicipital tendon transposition and a modified Campbell scapulohumeral encircling prosthesis in combination with a novel body cast / Spica splint resulted in a return to satisfactory function of this limb.

Two cases of planned relaparotomy for severe peritonitis secondary to gastrointestinal pathology

Planned relaparotomy is a technique in which two or more surgeries are planned before or during the initial surgery. Two dogs underwent planned relaparotomy for severe peritonitis secondary to gastric ulceration and linear foreign body. Both dogs had good outcomes, and unnecessary procedures that would likely have led to increased morbidity were avoided. This technique may be useful in avoiding unnecessary procedures as well as providing for better stabilization of the animal.

Evaluation of primary re-excision after recent inadequate resection of soft tissue sarcomas in dogs: 41 cases (1999–2004)

OBJECTIVE

To determine the efficacy of primary re-excision alone for treatment of soft tissue sarcomas after recent incomplete resection, the frequency and clinical importance of detecting residual tumor in resected scars, and prognostic factors associated with the procedure.

DESIGN

Retrospective case series.

ANIMALS

41 dogs.

PROCEDURES

Medical records of dogs that had undergone recent incomplete excision of a soft tissue sarcoma at a referring veterinary practice and subsequent re-excision of the scar at the Colorado State University Veterinary Medical Center were reviewed. Owners and referring veterinarians were contacted for follow-up information. Slides from re-excised specimens were reviewed. Dogs that underwent radiation therapy after the re-excision procedure were excluded.

RESULTS

41 dogs met the inclusion criteria, and long-term follow-up information was available for 39 dogs. Median follow-up time was 816 days. Local recurrence of tumor developed in 6 of 39 (15%) dogs, and distant metastasis occurred in 4 of 39 (10%) dogs. Healthy tissue margins of 0.5 to 3.5 cm were achieved at re-excision. Residual tumor was identified in 9 of 41 (22%) resected scars. No tumor-, patient-, or treatment-related variables were associated with local recurrence except for the presence of liposarcoma or fibrosarcoma or whether fine-needle aspiration had been performed prior to surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

After incomplete resection of soft tissue sarcomas, resection of local tissue should be performed, even if excisable tissue margins appear narrow. A long-term favorable prognosis is achievable without radiation therapy or amputation. The presence of residual tumor in resected scar tissue should not be used to predict local recurrence.

Management of bilateral choanal atresia in a foal

CASE DESCRIPTION

A 1-day-old Standardbred foal with a history of extreme respiratory distress after birth consistent with upper airway obstruction was evaluated. A temporary tracheostomy tube was placed by the referring veterinarian.

CLINICAL FINDINGS

On initial examination, there was evidence of hypoxic-ischemic syndrome, secondary to perinatal asphyxia. Endoscopy revealed obstruction of both nares at the level of the choanae; a diagnosis of bilateral choanal atresia was made.

TREATMENT AND OUTCOME

The foal was anesthetized and underwent transendoscopic laser fenestration of the buccopharyngeal membranes. Three weeks after surgery, cicatricial narrowing of the choanae was apparent and further transendoscopic ablation was performed. Recurrent stenosis necessitated revision surgeries involving a combination of laser ablation with topical administration of mitomycin and, subsequently, a combination of radial incisions into the stenotic tissue and repeated bougienage with a cuffed endotracheal tube. The degree of stenosis decreased, and at 1 year of age, the horse was an appropriate size for its age, had choanae that were almost maximally open (> 85%), and had entered training. Mild stenosis was still evident when the horse was reexamined the following year, although there was no evidence of exercise intolerance or respiratory compromise.

CLINICAL RELEVANCE

Bilateral choanal atresia in a foal can be successfully treated via transendoscopic fenestration of the buccopharyngeal membranes, enabling the horse to subsequently participate in athletic activities. Secondary problems resulting from initial asphyxia and recurrent stenosis at the surgical site can be overcome but may require prolonged and extensive treatment.

Vaginoperitoneal fistula after ovariohysterectomy in three bitches

Vaginoperitoneal fistulation was detected in three neutered bitches undergoing retrograde positive contrast vaginourethrography. This is a rarely detected complication of ovariohysterectomy and appears to result in no clinical signs.

Medical and surgical management of traumatic elbow luxation in a juvenile ferret

Elbow luxation is a common orthopedic injury in the ferret. The injury is usually caused by trauma but can also occur spontaneously. The most successful treatment involves a combination of surgical and medical intervention. Surgical treatment includes open reduction of the elbow joint and stabilization with orthopedic implants. Medical treatment includes external coaptation, analgesia, and prevention of infection. Owner compliance also plays an important role in return to full function of the luxated ferret elbow joint.

Surgical Revision of the Urethral Stoma Following Perineal Urethrostomy in 11 Cats: (1998–2004)

Eleven cats required urethral stoma revision because of urethral stricture following perineal urethrostomy. At surgery, eight cats had evidence of inadequate dissection to the bulbourethral glands, and three cats had evidence of urine extravasation into the subcutaneous tissues. Following revision of the stoma, long-term follow-up was obtained in nine cases. For eight cats, owners reported no complications after the revision. Failure to dissect beyond the bulbourethral glands and inadequate mucosa-to-skin apposition resulted in postoperative stricture formation. Stoma revisions were performed a median of 71 days following the initial perineal urethrostomy, indicating that long-term evaluation of cases is necessary.

Ovarian remnant in a 2-year-old queen

A 2-year-old domestic shorthair queen was presented for recurrent estrus behavior. Ovariohysterectomy had been performed 9 months earlier. An ovarian remnant was diagnosed, based on vaginal cytology and hormonal stimulation. Following exploratory laparotomy to remove the aberrant tissue, the animal recovered without further complications.

Use of the ComPact UniLock System for ventral stabilization procedures of the cervical spine: a retrospective study

This study evaluates clinical application of the ComPact UniLock system for ventral stabilization of the cervical spine. Patient material included 13 consecutive cases, 12 dogs and one cat, with cervical spinal instabilities secondary to disc-associated wobbler syndrome (six dogs), traumatic, iatrogenic, and disc-associated cervical spinal instability of small dogs (four cases), cervical spinal fractures (one dog and one cat), and congenital atlantoaxial instability (one dog). The 2.0 system was used in smaller patients and the 2.4 system was applied in large dogs. Implant failure was observed on follow-up radiographs in one dog with a healed C2 fracture and screw pullout occurred in one dog with caudal cervical spondylomyelopathy, necessitating revision surgery. Implants remained stable throughout the follow-up period in the other cases. 'Good' or 'excellent' clinical outcome was achieved in 12 patients, including the dog with revision surgery. One dog had to be euthanatized due to postoperative deterioration of neurological status and development of pneumonia. The ComPact UniLock system was found to be a suitable implant for treating cervical instabilities of different origin in both small and large patients with lesions from C1/C2 to C6/C7. Some problems were encountered in the dogs with disc-associated Wobbler syndrome, such as lack or slow rate of vertebral fusion and partial collapse of the distracted intervertebral space on follow-up radiographs. A lack of adequate fusion was most likely related to grafting techniques used.

Retrospective Study on Vulvar Conformation in Relation to Endometrial Cytology and Fertility in Thoroughbred Mares

Changes in the conformation of the vulva predispose the mare to uterine infection. Vulvoplasty for closure of the upper vulvar lips improves fertility. Not all mares are resutured after parturition, but are resutured after mating. No clinical data have hitherto been published on the reproductive outcome in mares that are resutured or not after parturition. The objectives of the present study were to investigate relationships between vulvar status (not Caslick-operated, group A; previously Caslick-operated and/or not resutured after the last parturition, groups B and C respectively) and endometrial cytology, conception rate and live foal rate for different age groups and categories of Thoroughbred mares. A careful examination of the vulvar area, and endometrial sampling for bacteriology and cytology was performed. The mares were naturally mated once during oestrus (never foal heat) by one of two stallions. Mares belonging to vulvar status group A had the highest conception rate and live foal rate, whereas the lowest conception rate and live foal rate occurred in mares with vulvar status group C. A multifactorial analysis revealed that the vulvar status at arrival had a significant effect on pregnancy rate and live foal rate, but not on fetal loss. Stallion, year and age group had no significant effect on any of the three variables analysed. In conclusion, optimizing managerial factors such as resuturing Caslick-operated mares immediately after parturition to minimize growth of micro-organisms with a subsequent endometritis will contribute to their conception and that they carry a pregnancy to term.

Modelling long-term survival of horses following surgery for large intestinal disease

REASONS FOR PERFORMING STUDY

Large intestinal diseases are an important cause of equine colic that require surgical management, but there is little published information about long-term survival of such cases.

OBJECTIVES

To identify variables associated with post operative mortality and to develop a model for post operative survival following surgery for large intestinal disease.

METHODS

Clinical data and long-term follow-up information from 275 horses undergoing surgery for large intestinal disease were used. A multivariable, Cox proportional hazards model for post operative death was developed and the fit of the model evaluated.

RESULTS

The continuous variables age, heart rate and packed cell volume (PCV) were associated positively with the risk of post operative death, as were the categorical variables resection (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-5.1) and relaparotomy (OR 3.5, 95% CI 1.4-8.4).

CONCLUSIONS

In the population studied, the probability of post operative survival following surgery for large intestinal disease was associated with the cardiovascular parameters heart rate and PCV on admission, age of the horse and whether it underwent resection or relaparotomy.

POTENTIAL RELEVANCE

The prognosis for post operative survival for horses with large intestinal disease may be improved by early surgery, prior to the development of cardiovascular compromise. Surgeons should be aware that increasing age, resection of large colon and relaparotomy are all associated with a worsening prognosis for survival.

Repair of femoral capital physeal fractures with 7.0-mm cannulated screws in cattle: 20 cases (1988-2002)

OBJECTIVE

To evaluate long-term outcome of repair of femoral capital physeal fractures with 70 mm cannulated screws in juvenile bulls that weighed >350 kg (770 lb).

DESIGN

Retrospective study.

ANIMALS

20 bulls.

PROCEDURE

Medical records of affected cattle were identified and reviewed. Follow-up information was obtained by means of a written questionnaire, 1 to 15 years after discharge, from the veterinarians who supervised the postoperative care at bull stud facilities.

RESULTS

Mean age and body weight at time of repair were 19 months (range, 11 to 27 months) and 513 kg (1128.6 lb; range, 364 to 720 kg [800.8 to 1584 lb]), respectively. Surgical repair was performed with 70 mm cannulated screws. A second surgery to replace malpositioned implants was required in 1 bull. Fourteen of the 20 bulls were considered serviceable for semen collection after surgical repair, and persistent lameness was evident in 11 of the 14. Mean duration for bulls to become serviceable was 5.5 months (range, 2 to 11 months). Age, weight, duration of injury at the time of repair, and degree of reduction did not have a significant effect on whether surgical repair was successful. Six bulls remained severely lame and were euthanatized.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that surgical repair of femoral capital physeal fractures in adolescent bulls with 70 mm cannulated screws placed in lag fashion has a good prognosis for long-term function in a semen collection facility.

Short-Term Aseptic Loosening of the Femoral Component in Canine Total Hip Replacement: Effects of Cementing Technique on Cement Mantle Grade

OBJECTIVES

To evaluate the effects of different cementing techniques on radiographic cement mantle grade and short-term aseptic loosening of the femoral component in canine total hip replacement (THR).

STUDY DESIGN

Retrospective study.

SAMPLE POPULATION

Radiographs of 284 dogs that had THR.

METHODS

Immediate postoperative radiographs of 284 dogs that had cemented THR were reviewed by 4 surgeons and 1 radiologist and assigned a cement mantle grade using a 4-grade classification system. Dog age and weight at surgery, cementing technique (1st, 2nd, 3rd generation), complications (type and timing), and follow-up time were retrieved and analyzed.

RESULTS

Mean cement mantle score for 2nd generation technique was significantly higher than 3rd generation technique and both were significantly higher than 1st generation technique (P<.001). Aseptic loosening was the 2nd most common complication observed with an incidence of 2.1%. Mean time from surgery to last follow-up examination was 122 days. No statistically significant difference in incidence of aseptic loosening was identified among different cement mantle grades or cementing techniques.

CONCLUSIONS

Advanced cementing techniques resulted in better cement mantles based on grading of immediate postoperative radiographs, however grading did not predict short-term aseptic loosening. Cementing technique seemingly did not affect the incidence of short-term aseptic loosening of the femoral component for dogs in this study.

CLINICAL RELEVANCE

Our study suggests that advances in cementing technique may result in improvements in the radiographic grade of cement mantles. With respect to aseptic loosening of the femoral component, our data only suggest that short-term (3 months-3 years) loosening cannot be predicted by immediate postoperative radiographic evaluation of cement mantle.

Early Detection and Treatment of Screw Loosening in Triple Pelvic Osteotomy

OBJECTIVE

To detect early screw loosening in triple pelvic osteotomy (TPO) and to evaluate the efficacy of retightening using fluoroscopic guidance and minimally invasive surgery to maintain acetabular alignment and achieve bone healing.

STUDY DESIGN

Prospective clinical study.

SAMPLE POPULATION

Sixteen dogs that had TPO.

METHODS

Dogs (16) had TPO (21) by using pre-angled plates secured with 3.5 and 4.0 mm screws, with ischiatic or iliac cerclage, for osteosynthesis. In all but 1 TPO at least 1 screw was inserted into the sacral body (43 screws). The mean radiographic screw length inserted in the sacrum was 10.2 mm, and the mean percent sacral engagement was 22%. Dogs were examined clinically and radiographically immediately postoperatively, and at 10, 30, 60, and 90 days to evaluate screw position. Loose screws were retightened through stab incisions using fluoroscopy to locate the screw.

RESULTS

TPO was performed without operative complications. At 10 days, 12 TPOs (57%; 11 dogs) had loose screws primarily located in the cranial aspect of the plate. This represented 20% (25) of the inserted screws. In 5 dogs, screw loosening resulted in medial rotation of the acetabular segment. All loose screws were retightened; 3 screws loosened again in 2 dogs and were detected at 60 days. However, the osteotomies healed with the planned acetabular rotation without further intervention. Screw tightening corrected the acetabular segment displacement. Screws correctly seated at 10 days did not subsequently loosen. Clinical and radiographic outcome was judged excellent in all dogs.

CONCLUSION

Loose screws in TPO plates can be identified by 10 days postoperatively and retightened using fluoroscopic guidance to achieve acetabular realignment and healing without need for further surgery.

CLINICAL RELEVANCE

Postoperative radiographic evaluation of screw position at 10 days after TPO is recommended to detect loose screws. Retightening loose screws should be considered as an alternative to TPO revision or confinement, especially in immature dogs.

Bilateral flexor tendon contracture following onychectomy in 2 cats

Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes.

Caprine obstructive urolithiasis: requirement for 2nd surgical intervention and mortality after percutaneous tube cystostomy, surgical tube cystostomy, or urinary bladder marsupialization

OBJECTIVES

To determine the requirement for 2nd surgical interventions and mortality after 3 different surgical techniques (percutaneous tube cystostomy [10 goats], surgical tube cystostomy [25 goats], urinary bladder marsupialization [10 goats]) for caprine obstructive urolithiasis, and to determine whether pre- or 24-hour postoperative physical examination findings or serum chemistry results could be used as predictors of mortality.

STUDY DESIGN

Retrospective study.

ANIMALS

Male goats (45) with obstructive urolithiasis.

METHODS

Medical records for all male goats admitted and operated for obstructive urolithiasis between 1993 and 2003 were reviewed. Data retrieved included signalment, pre- and 24-hour postoperative values for temperature, pulse, respiratory rate, packed cell volume, serum K(+), serum creatinine, and blood urea nitrogen [BUN]. The type of initial surgical procedure, time to 2nd surgical intervention, time to death, and duration and cost of hospitalization were also obtained.

RESULTS

Percutaneous tube cystostomy was associated with a significantly increased requirement for (5.6-fold increased hazard) and decreased time to a 2nd intervention (P=.002). There were no differences between the 3 procedures for time to mortality. Increased BUN and respiratory rate at admission were associated with increased mortality (hazards ratio of 4.8 and 5.0, respectively). Urinary bladder marsupialization was associated with significantly decreased hospitalization time (P=.02) and cost (P=.04) compared with surgical tube cystostomy and percutaneous tube cystostomy.

CONCLUSION

Surgical tube cystostomy and bladder marsupialization are both acceptable surgical methods for treatment of caprine obstructive urolithiasis. Each procedure has inherent complications that should be discussed with the owner before choosing the surgical treatment.

CLINICAL RELEVANCE

There are acceptable options for treatment of caprine obstructive urolithiasis; however, percutaneous tube cystostomy should be avoided.

Fracture of an endoluminal nitinol stent used in the treatment of tracheal collapse in a dog

A 5-year-old castrated male Pomeranian was evaluated because of severe dyspnea and coughing, and a diagnosis of complete, static collapse of the trachea at the thoracic inlet was made. After failure to improve with medical management alone, an endoluminal tracheal stent was placed, which resulted in resolution of signs. Ten weeks after stent placement, the dog underwent tracheal resection and anastomosis because the stent had fractured at the level of the thoracic inlet. One year after surgery, the dog was doing well and required treatment with hydrocodone infrequently. Compared with other surgical treatment options, placement of an endoluminal tracheal stent is a relatively noninvasive intervention that can provide effective relief from the clinical signs associated with tracheal collapse in dogs. Implantation of endoluminal tracheal stents may be associated with complications; therefore, the procedure may best be regarded as a salvage procedure for dogs with end-stage disease that are refractory to appropriate medical management, have extensive collapse of the intrathoracic portion of the trachea, or are poor candidates for surgery.

Use of cisplatin, 5-fluorouracil, and second-look laparotomy for the management of gastrointestinal adenocarcinoma in three dogs

Three dogs with advanced-stage adenocarcinoma of the gastrointestinal tract were treated by use of resection, adjuvant chemotherapy with cisplatin and 5-fluorouracil, and second-look laparotomy (SLL). In combination with histologic examination of biopsy specimens obtained during the procedure, SLL is the most accurate diagnostic procedure for identification of residual or recurrent microscopic or macroscopic abdominal neoplasia; however, to the authors' knowledge, there are no reports of its clinical use in the field of veterinary oncology. This lack of clinical use in animals is likely because of factors such as cost, procedure-associated risks perceived by the owners and veterinarians, lack of data to define proper clinical application, and, perhaps to some degree, an entrenched belief that treatment of advanced stage cancer in animals is inappropriate. Nevertheless, the use of SLL should be considered for evaluation of abdominal tumors or intra-abdominal metastases in dogs that appear to be in complete clinical remission near or at the anticipated completion of chemotherapy (especially if effective second-line chemotherapy protocols are available) or when secondary cytoreduction might be beneficial.

Evaluation of a Sheep Laparoscopic Uterine Trauma Model and Repeat Laparoscopy for Evaluation of Adhesion Formation and Prevention with Sodium Carboxymethylcellulose

OBJECTIVE

To evaluate topical application of 1% sodium carboxymethyl cellulose (SCMC) for prevention of postoperative adhesions in a laparoscopic model of uterine trauma in sheep.

STUDY DESIGN

Experimental study.

ANIMALS

Fourteen non-pregnant ewes.

METHODS

Ewes were randomly assigned to 1 of 2 groups: control (saline solution) or 1% SCMC treatment. By left flank laparoscopy, traumatic forceps were used to create serosal trauma (1.5 x 5 cm) and hemorrhage on the left uterine horn. Either 30 mL saline solution or 30 mL 1% SCMC was applied topically to the traumatized uterine horn. Adhesion formation was evaluated by repeat laparoscopy at days 14 and 21. Sheep were euthanatized on day 28 for necropsy evaluation of adhesions.

RESULTS

Five control sheep had adhesions of the uterine horn by day 14, but only 4 had adhesions at day 21, and 2 at day 28. Adhesions did not occur in SCMC-treated sheep. No adhesions occurred elsewhere in the abdomen.

CONCLUSIONS

Laparoscopically created uterine trauma is an effective method for induction of uterine adhesions, and laparoscopy is an excellent method for serial evaluation of adhesion formation. SCMC (1%) was effective at preventing adhesion formation in sheep and no inflammatory response was noted.

CLINICAL RELEVANCE

SCMC (1%) should be considered for prevention of adhesions in abdominal surgery in sheep.

Surgical management of compound odontoma in two horses

Two horses were admitted for evaluation of mandibular swelling (horse 1) or maxillary distortion (horse 2). Both horses had radiographic evidence of tumors of dental origin that had the appearance of a compound odontoma. Extensive surgical resection was performed for treatment. Horse 1 was treated with 1-stage surgical resection, but an iatrogenic fracture occurred during surgery, which was managed successfully with a type I external fixator and extraoral alimentation. Horse 2 was treated in multiple stages to remove all portions of the tumor. To manage an extensive orosinal fistula, a custom-designed dental bridge was constructed to occlude the fistula. For both horses, the histopathologic diagnosis was compound odontoma. Compound odontomas are benign, locally expansive tumors of dental origin. Compound odontomas can be treated successfully; however, multiple surgeries may be necessary.

A Retrospective Comparison of Cervical Intervertebral Disk Disease in Nonchondrodystrophic Large Dogs Versus Small Dogs

Medical records of 144 small-breed dogs (≤15 kg) and 46 medium- to large-breed dogs (&gt;15 kg) with surgically confirmed, Hansen type I, cervical intervertebral disk extrusions were reviewed. The most common clinical presentation was cervical hyperesthesia. The most common sites affected were the second (C2) to third (C3) cervical intervertebral disk space in small-breed dogs and the sixth (C6) to seventh (C7) cervical intervertebral disk space in the larger dogs. Following surgery, 99% of the dogs had resolution of cervical hyperesthesia and were able to ambulate unassisted. Seven (4%) dogs required a second surgery; four of these were large-breed dogs.

Urethral obstruction as a complication of staged bilateral triple pelvic osteotomy

A 5-month-old, neutered male Labrador retriever developed urethral obstruction secondary to staged, bilateral, triple pelvic osteotomy procedures. Conventional medical therapy failed to resolve the urinary dysfunction, and eventual surgical correction was required. Prior anecdotal reports exist on this complication, but little to no information is available in the veterinary literature. It was the objective of this case report to document this rare complication and describe its correction.

Use of a caudal auricular axial pattern flap in three cats and one dog following orbital exenteration

Orbital exenteration accompanied by wide eyelid excision in the cat and dog may leave a defect that cannot be closed in a primary fashion. This report describes the use of a caudal auricular axial pattern flap to effect closure following orbital exenteration in three cats and one dog. The most common complication was distal flap necrosis, which necessitated a second surgery in two patients.

Repair of femoral capital physeal fractures in 12 cattle

OBJECTIVE

To document signalment, clinical signs, and long-term outcome of surgical treatment for femoral capital physeal fractures in cattle.

STUDY DESIGN

Retrospective study. Animals-Twelve cattle with femoral capital physeal fractures.

METHODS

Cases were identified by a search of radiographic records. Historical, diagnostic, surgical, and outcome data were collected from the medical records. Owners were contacted for follow-up information by telephone.

RESULTS

Fractures were repaired by screws inserted in lag fashion in 4 animals and by use of multiple intramedullary pins in 8 animals. Six of 12 animals required repeat surgery to reposition screws or pins. Nine animals were considered successfully treated at discharge. Six months after surgery, 6 of 11 animals for which follow-up was obtained were still sound. At 12 months, 4 of 4 animals alive were still sound. Animals that bore weight earliest postoperatively were more likely to have a successful outcome. Animals <12 months of age had better outcomes than animals >12 months of age.

CONCLUSIONS

Prognosis for serviceable soundness is good in cattle <12 months of age and fair in animals >12 months of age after surgical repair of femoral capital physeal fracture by stacking intramedullary pins or by screws inserted in lag fashion.

CLINICAL RELEVANCE

Surgical repair of femoral capital physeal fracture is most successful in younger cattle and can result in productive animals.

Use of intraluminal nitinol stents in the treatment of tracheal collapse in a dog

Tracheal collapse is a common problem that is typically observed in middle-aged and older small-breed dogs. It is a structural, obstructive airway disease with a dynamic component that can affect the intra- and extrathoracic portions of the trachea and mainstem bronchi. Many methods of treatment have been suggested, including medical management and provision of extraluminal and intraluminal support. All techniques used to treat intrathoracic and mainstem bronchial collapse have been associated with major complications or limitations. This report describes the implantation of intraluminal nitinol stents to successfully treat intrathoracic as well as extrathoracic tracheal collapse in a dog. The stents are composed of material that has characteristics similar to those of the trachea; nitinol stents may provide a method of supporting intrathoracic tracheal and mainstem bronchial collapse in dogs.

Equine surgical colic: risk factors for postoperative complications

The reason for undertaking this study was that postoperative complications of colic surgery lead to patient discomfort, prolonged hospitalisation and increased cost. Potential risk factors for the 6 most common postoperative complications (jugular thrombosis, ileus, re-laparotomy, wound suppuration, incisional herniation and colic) were evaluated using multivariable models. Jugular thrombosis was associated significantly with heart rate greater than 60 beats/min and with increased packed cell volume (PCV) at admission. The risk of postoperative ileus also increased with increasing PCV at admission and was higher in horses recovering from pedunculated lipoma obstruction. Incisional herniation was strongly associated with wound suppuration and with increasing heart rate at admission. The emergence of cardiovascular parameters as risk factors for several postoperative complications is consistent with the hypothesis that endotoxaemia is important in the development of these complications. Early referral of colic cases, prior to the development of severe endotoxaemic shock, may minimise the risk of some postoperative complications. Horses that have suffered epiploic foramen entrapment, are more than 4 times as likely to undergo re-laparotomy than other horses. Horses that have suffered postoperative ileus have a similarly increased risk of undergoing re-laparotomy. The risk of postoperative colic is significantly associated with horses recovering from large colon torsion (>360 degrees) and with having undergone re-laparotomy. Hazard ratios (with 95% confidence intervals) for these last two effects are 3.1 (1.7, 5.7) and 3.4 (1.9, 6.2), respectively. Knowledge of the risk factors for postoperative complications allows more accurate prognostication postoperatively and suggests ways in which the risk of postoperative complications can be minimised.