Evaluation of the efficacy of meloxicam for post-operative management of pain and inflammation in horses after orthopaedic surgery in a placebo controlled clinical field trial.

BACKGROUND: The benefit of pre and post-operative administration of non-steroidal anti-inflammatory drugs for the relief of post-operative pain and control of inflammation in horses following orthopaedic surgery has not been previously investigated in controlled clinical field trials, and the utility of such treatment is a matter of ongoing dispute. Recently the utility of post-operative pain management was emphasized. It was therefore our aim to determine the efficacy of meloxicam in horses following partial resection of fractured splint bones. This condition was selected since the limited extent of the insult and the defined surgical intervention allowed the conduct of a randomized, double blinded, placebo-controlled, parallel group, multi-centre clinical field study in a homogenous patient population. RESULTS: Sixty-six client owned horses requiring unilateral partial splint bone resection were recruited in 15 centres in Germany and were allocated in a 1:1 ratio to receive meloxicam, 0.6 mg/kg for 5 days. Lameness at trot grades prior to surgery were similar in the meloxicam and placebo treatment groups but were significantly lower in the meloxicam group on day 6 post surgery. Clinical scores for soft tissue swelling and assessment of analgesic and anti-inflammatory efficacy by the investigators at the end of the study were significantly better for the meloxicam compared to the placebo group. No treatment-related adverse reactions were observed. CONCLUSION: The administration of meloxicam i.v. once prior to surgery followed by once daily oral administration for four consecutive days is efficacious for the control of post-operative pain and inflammation in horses undergoing orthopaedic surgery.

Efficacy of Postoperative Antimicrobial Use for Clean Orthopedic Implant Surgery in Dogs: A Prospective Randomized Study in 100 Consecutive Cases.

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.

Anaesthetic and cardiorespiratory effects of a constant rate infusion of fentanyl in isoflurane-anaesthetized sheep.

OBJECTIVE: To determine the anaesthetic and cardiorespiratory effects of a constant rate infusion of fentanyl in sheep anaesthetized with isoflurane and undergoing orthopaedic surgery. STUDY DESIGN: Prospective, randomised, 'blinded' controlled study. ANIMALS: Twenty healthy sheep (weight mean 41.1 ± SD 4.5 kg). METHODS: Sheep were sedated with intravenous (IV) dexmedetomidine (4 µg kg(-1) ) and morphine (0.2 mg kg(-1) ). Anaesthesia was induced with propofol (1 mg kg(-1)  minute(-1) to effect IV) and maintained with isoflurane in oxygen and a continuous rate infusion (CRI) of fentanyl 10 µg kg(-1)  hour(-1) (group F) or saline (group P) for 100 minutes. The anaesthetic induction dose of propofol, isoflurane expiratory fraction (Fe'iso) required for maintenance and cardiorespiratory measurements were recorded and blood gases analyzed at predetermined intervals. The quality of recovery was assessed. Results were compared between groups using t-tests or Mann-Whitney as relevant. RESULTS: The propofol induction dose was 4.7 ± 2.4 mg kg(-1) . Fe'iso was significantly lower (by 22.6%) in group F sheep than group P (p = 0). Cardiac index (mean ± SD mL kg(-1)  minute(-1) ) was significantly (p = 0.012) lower in group F (90 ± 15) than group P (102 ± 35). Other measured cardiorespiratory parameters did not differ statistically significantly between groups. Recovery times and recovery quality were statistically similar in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: Fentanyl reduced isoflurane requirements without clinically affecting the cardiorespiratory stability or post-operative recovery in anaesthetized sheep undergoing orthopaedic surgery.

International survey of equine orthopaedic specialists reveals diverse treatment strategies for horses with overriding spinous processes.

BACKGROUND: Overriding spinous processes, also known as 'kissing spines', are one of the most common causes of back pain in horses. The aim of this study was to investigate which options for diagnosis and treatment are preferred by equine orthopaedic specialists and assess which techniques are used for local injection. METHODS: An online survey was distributed among members of the European/American College of Veterinary Surgeons, the European/American College of Veterinary Sports Medicine and Rehabilitation, the International Society of Equine Locomotor Pathology and nationally recognised advanced equine orthopaedic practitioners. RESULTS: The survey was completed by 353 respondents. The injection techniques most commonly used involve placing two needles abaxial to the interspinous space (42%) under ultrasonographic guidance (32%) or one needle in the midline (35%) between two spinous processes. The most popular combination for overriding dorsal spinous process therapy was local injection (26.7%) combined with controlled exercise (25.5%). Manual therapy was considered by 42% of European and 25% of American specialists (p = 0.01). Surgical intervention as a first-line treatment was recommended mainly by specialists working in the United States, the UK or Ireland (p = 0.001). Overall, most equine orthopaedic veterinarians (71%; n = 201) preferred conservative management and recommended surgery only for horses that did not respond to conservative therapy. LIMITATIONS: Respondents' personal bias may have skewed the findings. CONCLUSIONS: Despite a growing body of evidence, the therapeutic approach to 'kissing spines' in horses is influenced by professional specialisation and regional preferences. Variations in injection techniques and differing criteria for surgical intervention warrant further investigation.

Equine cellular therapy--from stall to bench to bedside?

Pioneering clinical stem cell research is being performed in the horse, a recipient of cutting edge veterinary medicine as well as a unique animal model, paving the way for human medical applications. Although demonstrable progress has been made on the clinical front, in vitro characterization of equine stem cells is still in comparatively early stages. To translate the promising results of clinical stem cell therapy in the horse, advances must be made in the characterization of equine stem cells. Aiming to improve communication between veterinarians and other natural scientists, this review gives an overview of veterinary "bedside" achievements, focusing on stem cell therapies in equine orthopedics as well as the current state of in vitro characterization of equine multipotent mesenchymal stromal cells (MSCs) and equine embryonic stem cells (ESCs).

The Ontario Veterinary College Hip Certification Program -- assessing inter- and intra-observer repeatability and comparison of findings to those of the Orthopedic Foundation for Animals.

In Canada, the Ontario Veterinary College (OVC) has offered radiographic screening for hip dysplasia for many years, but there are other options for this service including the Orthopedic Foundation for Animals (OFA). There are some differences between the OFA and the OVC methods, and this study compares the OVC and OFA hip certification results in 37 dogs. There was good agreement between the two programs but in some instances there was a difference in the pass/fail status of a dog. Neither the OFA nor the OVC was more likely to fail or pass a given dog. The repeatability of the OVC results was assessed by both inter- and intra-observer comparisons in 100 dogs. There was at least 86% agreement among and within radiologists, but in 5 cases the disagreement resulted in a difference in the pass/fail status of the dog. These results illustrate the inherent variation in radiographic hip evaluation and highlight the importance of consensus grading practices to improve the accuracy of hip evaluation.

Programme de certification des hanches de l'Ontario Veterinary College ­ Évaluation de la reproductibilité inter- et intra-observateur et comparaison des résultats à ceux de l'Orthopedic Foundation for Animals. Au Canada, l'Ontario Veterinary College (OVC) offre le dépistage radiographique de la dysplasie de la hanche depuis de nombreuses années, mais il y a d'autres options pour ce service, incluant l'Orthopedic Foundation for Animals (OFA). Il y a certaines différences entre les méthodes de l'OFA et de l'OVC et cette étude compare les résultats de certification de la hanche de l'OVC et de l'OFA chez 37 chiens. Il y avait une bonne concordance entre les deux programmes, mais dans certains cas, il y avait une différence au niveau du statut d'échec-réussite d'un chien. Ni l'OFA ni l'OVC ne présentait une probabilité accrue de donner un résultat d'échec ou de réussite à un chien particulier. La reproductibilité des résultats de l'OVC a été évaluée par des comparaisons inter- et intra-observateur chez 100 chiens. Il y avait au moins 86 % de concordance entre et parmi les radiologistes, mais dans 5 cas, la discordance s'est traduite par une différence du statut de réussite et d'échec chez le chien. Les résultats illustrent la variation inhérente à l'évaluation radiographique de la hanche et souligne l'importance de pratiques de classification par consensus afin d'améliorer l'exactitude de l'évaluation de la hanche.(Traduit par Isabelle Vallières).

Initial Psychometric Evaluation of the Portuguese Version of the Canine Orthopedic Index.

OBJECTIVE: The aim of this study was to perform the initial psychometric evaluation of the Portuguese version of the Canine Orthopaedic Index (COI). STUDY DESIGN: In a prospective, randomized study, a group of 50 police working dogs with bilateral hip osteoarthritis was assessed. A copy of the translated Portuguese version of the COI was completed by canine handlers, native Portuguese speakers. This result was compared with that of 50 sound dogs. Construct validity was determined by comparing sound dogs and dogs with osteoarthritis scores with the Mann-Whitney test. Additionally, the Kaiser-Meyer-Olin measure of sampling adequacy, eigenvalue, and scree-plot analysis were performed. Internal consistency was tested with Cronbach's α. RESULTS: A significant difference was observed between osteoarthritis and sound dogs in all dimensions of the COI (p < 0.01 for all), indicating construct validity. Two factors accounted for 87.8% of the total variance. Cronbach's α was 0.98, with a high interitem correlation, accounting for strong internal consistency. CONCLUSION: We presented criterion and construct validity of the Portuguese version of the COI. It is a step in providing clinicians with a validated and accessible tool to evaluate orthopaedic patients. Further studies are required.

Procedural sedation combined with locoregional anesthesia for orthopedic surgery of the pelvic limb in 10 dogs: case series.

HISTORY: Ten dogs weighing 36 (21.4-75) kg [median (min-max)] and aged 3 (1-9) years scheduled for orthopedic surgery involving the stifle and structures distal to it. PHYSICAL EXAMINATION: Patients were classified as ASA I or II based on physical examination and basic hematology and biochemistry. MANAGEMENT: Each dog was managed using combined femoral and sciatic nerve blocks and procedural sedation with an intravenous infusion of propofol (0.07-0.15 mg kg(-1) minute(-1)) and dexmedetomidine (1 µg kg(-1) hour(-1)). None of the patients required conversion to general anesthesia as a result of response to surgical stimulation. The level of sedation was considered adequate in all patients and was characterized by occasional head lifting, thoracic limb stretching, yawning, lingual movements and swallowing. The eye position ranged from central to partial ventromedial rotation and was accompanied by spontaneous blinking. Intra-operative cardiovascular and ventilatory variables were considered within acceptable limits. Muscle relaxation at the surgical field was adequate and surgical conditions were indistinguishable from those produced by general anesthesia. Intraoperatively, no additional analgesics were considered necessary. The quality of the recoveries was considered excellent in all cases. FOLLOW UP: No additional pain relief was required in any of the dogs within the 10 hours following blockade. All dogs ate 5.5 (3.5-12) hours after recovery. Ambulation occurred at 4 (2-6) hours. No evidence of esophagitis or aspiration pneumonitis has been reported during a period of 1 year after the procedures in any of the dogs. CONCLUSION: When combined with femoral and sciatic nerve blocks, procedural sedation has the potential of being an alternative to general anesthesia for orthopedic surgery involving the stifle and structures distal to it in the dog.

Abstract Presentation at Two Veterinary Surgery Conferences and the Impact on Publication Rate.

OBJECTIVES: The aim of this study was to compare the publication rate (PR) and report descriptive findings from abstracts presented at the American College of Veterinary Surgeons (ACVS), the Veterinary Orthopaedic Society (VOS), and those presented at both conferences. STUDY DESIGN: All conference abstracts from 2001 to 2010 ACVS and VOS meetings were reviewed. PR in peer-reviewed journals was evaluated and compared between Group 1 (abstracts presented at ACVS only; n = 1,277), Group 2 (abstracts presented at VOS only; n = 645), and Group 3 (abstracts presented at both conferences; n = 121) abstracts. Abstracts were assigned a level of evidence (LoE) score. RESULTS: Approximately 6% of all abstracts evaluated were presented at two scientific meetings (Group 3). The PR of Group 1 (66%) and Group 3 (62%) abstracts was significantly higher than that of Group 2 (45%). The majority of abstracts were assigned a low LoE (3 or 4). Once presented, most Group 3 abstracts took <12 months to be submitted and <24 months to be published. CONCLUSION: This study found that a limited number of abstracts were presented at both ACVS and VOS, and PR was significantly different between those presented at ACVS only or both ACVS and VOS compared with VOS only. There was no significant difference in PR between Group 1 and Group 3 abstracts. This study has provided the initial comparison between abstracts presented at two veterinary surgical conferences.

Economic and Clinical Benefits of Orthopedic/Sports Medicine and Rehabilitation.

Orthopedic/Sports Medicine and Rehabilitation can be both a valuable comprehensive patient care service and economic addition to many veterinary practices. As partners within the hospital, the Orthopedic/Sports Medicine and Rehabilitation service not only provides consultations for all patients with the ultimate goal of return to function (regardless of their "job"), the service also contributes to the recovery of patients in hospital, provides critical pain management and mobility assistance for hospitalized and postoperative patients, and champions a wide variety of supportive patient care solutions in many services within a hospital. After patient discharge, the team can then aid in the client and patient recovery at home with key home exercise programs and communications to bolster the patient's home recovery, ongoing rehabilitation, and eventual return to function.

Orthopedic Imaging: A Practical Clinical Guide.

Many imaging options are available to the practitioner both in-house and on a referral basis to help make a definitive diagnosis for orthopedic injuries. To guide treatment, a complete understanding of the nature and extent of the injury is ideal. While a thorough orthopedic physical examination is the first step, a complete diagnostic work-up will include at least one and often more than one imaging modality. The goal of this article is to discuss the imaging options for some of the more common orthopedic issues encountered in dogs to help guide the practitioner through the selection of which should be considered to accomplish a diagnosis.

Evidence-Based Complementary and Alternative Canine Orthopedic Medicine.

The use of complementary and alternative veterinary medicine (CAVM) continues to become more widespread, especially for the management of chronic pain conditions such as canine osteoarthritis. Many patients have comorbidities that preclude traditional medical options, have not adequately responded to conventional therapies, or have owners interested in pursuing a complementary approach. Evidence-based CAVM can serve as a safe and effective adjunct to manage chronic pain conditions. There is growing evidence in the veterinary literature for the use of acupuncture and some herbal supplements in the multimodal management of canine osteoarthritis. The majority of evidence supporting chiropractic is limited to equine and human literature.

Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. A retrospective study of sixty dogs and cats.

OBJECTIVES: Casts applied for orthopaedic conditions can result in soft-tissue injuries. The purpose of our study was to describe the nature and prevalence of such complications. METHODS: We performed a retrospective review of medical records of dogs and cats that had a cast placed for an orthopaedic condition between October 2003 and May 2009. The data were analysed and categorised. RESULTS: Of the 60 animals that had a cast placed, 63% developed a soft-tissue injury (60% mild, 20% moderate and 20% severe). Injuries could occur any time during coaptation, and an association with duration of casting and severity (p = 0.42) was not shown. Severe injuries took the longest to resolve (p = 0.003). Sighthounds were significantly more likely to develop a soft-tissue injury (p = 0.04), and cross-breeds were less likely (p = 0.01). All common calcaneal tendon reconstructions suffered soft-tissue injuries, but significance was not shown (p = 0.08). Veterinarians identified the majority of injuries (80%) rather than the owners. The financial cost of treating soft-tissue injuries ranged from four to 121% the cost of the original orthopaedic procedure. CLINICAL SIGNIFICANCE: Soft-tissue injuries secondary to casting occur frequently, and can occur at any time during the casting period. Within our study, sighthounds were more likely to develop soft tissue injuries, and should therefore perhaps be considered as a susceptible group. The only reliable way to identify an injury is to remove the cast and inspect the limb.

Assessment of Orthopedic Versus Neurologic Causes of Gait Change in Dogs and Cats.

Diagnosis of forelimb lameness may be challenging, as it not only can be due to multiple common orthopedic diseases but also may occasionally be caused by neurologic disease. A thorough orthopedic and neurologic examination is key to determining which disease category is the likely culprit. Deficits identified on the neurologic examination, such as proprioceptive deficits, changes in reflexes, and presence of spinal hyperesthesia, are key in identifying neurologic causes of forelimb lameness.

Item generation and design testing of a questionnaire to assess degenerative joint disease-associated pain in cats.

OBJECTIVE: To determine the items (question topics) for a subjective instrument to assess degenerative joint disease (DJD)-associated chronic pain in cats and determine the instrument design most appropriate for use by cat owners. ANIMALS: 100 randomly selected client-owned cats from 6 months to 20 years old. PROCEDURES: Cats were evaluated to determine degree of radiographic DJD and signs of pain throughout the skeletal system. Two groups were identified: high DJD pain and low DJD pain. Owner-answered questions about activity and signs of pain were compared between the 2 groups to define items relating to chronic DJD pain. Interviews with 45 cat owners were performed to generate items. Fifty-three cat owners who had not been involved in any other part of the study, 19 veterinarians, and 2 statisticians assessed 6 preliminary instrument designs. RESULTS: 22 cats were selected for each group; 19 important items were identified, resulting in 12 potential items for the instrument; and 3 additional items were identified from owner interviews. Owners and veterinarians selected a 5-point descriptive instrument design over 11-point or visual analogue scale formats. CONCLUSIONS AND CLINICAL RELEVANCE: Behaviors relating to activity were substantially different between healthy cats and cats with signs of DJD-associated pain. Fifteen items were identified as being potentially useful, and the preferred instrument design was identified. This information could be used to construct an owner-based questionnaire to assess feline DJD-associated pain. Once validated, such a questionnaire would assist in evaluating potential analgesic treatments for these patients.

Evaluation of the relationship between Orthopedic Foundation for Animals' hip joint scores and PennHIP distraction index values in dogs.

OBJECTIVE: To compare 2 screening methods for detecting evidence of hip dysplasia (Orthopedic Foundation for Animals [OFA] and PennHIP) in dogs. DESIGN: Diagnostic test evaluation study. Animals-439 dogs >or= 24 months of age that received routine hip joint screening from June 1987 through July 2008. PROCEDURES: Dogs were sedated, and PennHIP radiography was performed (hip joint- extended [HE], compression, and distraction radiographic views). The HE radiographic view was submitted for OFA evaluation. A copy of the HE radiographic view plus the compression and distraction radiographic views were submitted for routine PennHIP evaluation, including quantification of hip joint laxity via the distraction index (DI). RESULTS: 14% (60/439) of dogs had hip joints scored as excellent by OFA standards; however, 52% (31/60) of those had a DI >or= 0.30 (range, 0.14 to 0.61). Eighty-two percent of (183/223) dogs with OFA-rated good hip joints had a DI >or= 0.30 (range, 0.10 to 0.77), and 94% (79/84) of dogs with OFA-rated fair hip joints had a DI >or= 0.30 (range, 0.14 to 0.77). Of all dogs with fair to excellent hip joints by OFA standards, 80% (293/367) had a DI >or= 0.30. All dogs with OFA-rated borderline hip joints or mild, moderate, or severe hip dysplasia had a DI >or= 0.30 (range, 0.30 to 0.83). CONCLUSION AND CLINICAL RELEVANCE: Dogs judged as phenotypically normal by the OFA harbored clinically important passive hip joint laxity as determined via distraction radiography. Results suggested that OFA scoring of HE radiographs underestimated susceptibility to osteoarthritis in dogs, which may impede progress in reducing or eliminating hip dysplasia through breeding.

Effect of intravenous ketamine and lidocaine on isoflurane requirement in sheep undergoing orthopedic surgery.

Intravenous ketamine and lidocaine infusions may be useful adjuncts to inhalation anesthesia for sheep undergoing orthopedic surgery. In this study, 50 female sheep underwent experimental stifle surgery (29 received a meniscal implant and 21 received sham surgery). To induce anesthesia in the sheep, the authors intravenously injected ketamine and diazepam. They administered isoflurane in oxygen to maintain anesthesia and used mechanical ventilation to maintain normal arterial carbon dioxide pressure. Some sheep received intravenous infusions of ketamine and lidocaine during surgery, whereas others did not. Sheep that received a meniscal implant without ketamine-lidocaine required approximately 23% greater isoflurane concentrations than sheep that were given ketamine-lidocaine. These findings suggest that intravenous infusion of ketamine and lidocaine decreases the requirement for isoflurane during orthopedic surgery on anesthetized sheep.

Enhancing bone healing and regeneration: present and future perspectives in veterinary orthopaedics.

Methods currently used to restore bone defects in human and veterinary orthopaedics are often not satisfactory. This is especially the case in the healing of large, irregular defects which result in the formation of tissues with inferior qualities compared to the original structures. For these reasons, several new approaches are currently being explored to improve bone healing capacities in different situations. This review will examine the different techniques used to enhance bone regeneration, highlighting both experimental and clinically applicable methods with regard to veterinary orthopaedics.

Revision of an unstable HELICA endoprosthesis with a Zurich cementless total hip replacement.

A six-year-old, female, spayed Labrador Retriever was evaluated for progressive lameness of one year duration, ending in non-weight-bearing of the right hindlimb. The dog had a history of severe coxarthrosis of both hip joints, and had a HELICA hip prosthesis implanted in the right hip 18 months before. On survey radiographs, the acetabular and femoral components appeared unstable, with a large void in the proximal femur and a lacy periosteal reaction on the trochanter. Arthrocentesis was performed to rule out septic loosening. As culture samples were negative, the dog underwent surgery. We report the successful revision of an unstable HELICA screw hip prosthesis with a Zurich cementless total hip replacement. The patient had a good clinical and radiological outcome seven months postoperatively.

Update of a retrospective cohort study of changes in hip joint phenotype of dogs evaluated by the OFA in the United States, 1989-2003.

OBJECTIVE: To determine whether there has been improvement in canine hip joint phenotype classifications of dogs whelped from 1989 to 2003 by the Orthopedic Foundation for Animals (OFA), by examining results of radiographic evaluations and identifying any trends in percentages of dogs classified as having desirable hip joint phenotypes. STUDY DESIGN: Retrospective cohort study. SAMPLE POPULATION: OFA radiographic classifications (n=431,483) on dogs whelped between 1989 and 2003. METHODS: Numbers and percentages of dogs classified by hip joint phenotypes were determined for 2-year cohorts. Differences between breeds and sexes were assessed using the Fisher's exact test, and odds ratios with 95% confidence intervals were calculated to express associations. The Cochran-Armitage test for trend was calculated to identify significant trends over time. RESULTS: There were statistically significant (P<.05) increases in the proportion of all breeds of dogs evaluated as excellent and good from 1993 to 2003, controlling for gender and age at evaluation. Labrador Retrievers, Bernese Mountain Dogs, and Rottweilers had the highest proportions of excellent and good scores, and the highest rates of improvement in excellent and good scores were seen in Bernese Mountain Dogs and Rottweilers. CONCLUSIONS: Results support the contention that there have been improvements in hip joint phenotype classifications in dogs in the United States since the previous study (1989-1992), through increases in the proportion of dogs receiving excellent and good classifications. CLINICAL RELEVANCE: Hip joint phenotype classifications can be used by dog breeders to develop breeding programs to improve the hip joints of future generations of dogs.