Discrepancy between true distance of tibial tuberosity advancement and cage size: An ex vivo study.

OBJECTIVE: To determine the discrepancy between true distance of tibial tuberosity advancement (tTTA) and the most commonly used cages. The null hypothesis was that tTTA would be within 1.5 mm difference of the cage size. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Eight foam cortical shell specimens modeled from canine tibias. METHODS: Modified tibial tuberosity advancement (TTA) was performed to allow repeated measurement of the tTTA. The Pearson correlation test was used to evaluate the relationships of tTTA and cage sizes (P < .05). The difference between tTTA and cage size was calculated to establish the degree of underadvancement during the TTA. RESULTS: Two hundred forty tTTA measurements were recorded. The tTTA was less than each corresponding cage size (P < .001). Four cage sizes resulted in a difference greater than 1.5 mm (P < .001-.04). The 6-mm cage resulted in median tTTA of 4.3 mm, which did not differ significantly from 4.5 mm (range, 3.2-6.65). The median underadvancement ranged from 1.7 to 2.5 mm for the tested cage sizes. The percentage underadvancement ranged from 21% to 28% for the tested cage sizes. CONCLUSION: The tTTA was less than the corresponding cage sizes by at least 1.5 mm in all except the 6-mm cage. CLINICAL SIGNIFICANCE: Selection of a larger cage size during the TTA may be advantageous to compensate for underadvancement and to minimize the risk of residual cranial tibial translation.

Effect of dorsal acetabular rim loss on stability of the zurich cementless total hip acetabular cup in dogs.

OBJECTIVE: To evaluate magnitude and mode of acute load to failure of the Zurich Cementless acetabular cup prosthesis in cadaveric specimens with and without 50% dorsal acetabular rim loss. STUDY DESIGN: In vitro mechanical study. SAMPLE POPULATION: Cadaveric hemipelves of adult dogs (n = 8). METHODS: Each pair of hemipelves was prepared by dissection of surrounding musculature and implantation of a Zurich Cementless acetabular cup prosthesis. One hemipelvis had the dorsal rim left intact (group 1) and the contralateral hemipelvis had 50% of the dorsal rim excised (group 2). Each hemipelvis underwent acute load to failure with an axial load applied through a prosthetic femoral head. Load at failure was compared between hemipelves with and without dorsal rim loss with a paired t-test; P < .05 was considered significant. RESULTS: Mean failure load was not significantly different between group 1 (3,713 ± 362 N) and group 2 (3,640 ± 751 N; P = .8). Bone fracture (n = 6), ventroversion of the cup (1), and absolute failure unreached at 6,000 N (1) occurred in group 1 and bone fracture (6), ventroversion of cup (1), and cup loosening (1) occurred in group 2. CONCLUSIONS: Zurich Cementless acetabular cup stability does not appear to be compromised by 50% acetabular rim loss at normal physiologic weight bearing loads. Thus, for this system, modifying procedures such as augmentation of the dorsal acetabular rim or deeper reaming for acetabular bed preparation may not be necessary with up to 50% dorsal rim loss with the Zurich Cementless acetabular cup.

Mechanical evaluation of adjunctive fixation for prevention of periprosthetic femur fracture with the Zurich cementless total hip prosthesis.

OBJECTIVE: To evaluate whether cerclage wire or a lateral plate increases the peak-torque load to failure, compared to femora without adjunctive fixation, in femora implanted with Zurich Cementless stems. STUDY DESIGN: In vitro biomechanical study. SAMPLE POPULATION: Paired femora from adult dogs (n = 24) weighing 28-35 kg. METHODS: Pairs of femora were implanted with a stem and randomly assigned to 2 treatment groups: cerclage or plate. Within each pair, either 3 loop cerclage wires or a laterally applied 12-hole Advanced Locking Plate System 10-mm plate (ALPS 10) were implanted in a femur, whereas the contralateral femur acted as control with no adjunctive fixation. After application of a static axial load each specimen was loaded to failure in torsion. Peak torque load at failure was compared between femora with each adjunctive fixation and the control using a paired t-test; P < .05 was considered significant. RESULTS: In both treatment groups, femora with adjunctive fixation failed at higher loads compared to the femora without fixation; however, significant difference in peak torque at failure between treated femora and control was found only in the plated group (P < .05). Femora implanted with plates and with cerclage were 13.9% and 7.2% stronger in torsion than the femora without fixation, respectively. CONCLUSIONS: Adjunctive fixation with a laterally applied ALPS 10 may aid in the prevention of peri-prosthetic fractures associated with Zurich Cementless medium stems.

Effect of a locking triple pelvic osteotomy plate on screw loosening in 26 dogs.

OBJECTIVE: To evaluate the complication rate of the double (DPO) and triple pelvic osteotomy (TPO) procedure (unilateral and bilateral) with a locking purpose-specific plate. STUDY DESIGN: Retrospective case series ANIMALS: Dogs (n = 26; 38 hips) MATERIALS: Medical records (January 2007-January 2011) of dogs that had unilateral or bilateral DPO or TPO were evaluated. Signalment, age, body weight, estimated preoperative subluxation and reduction angles, lameness, and complications were evaluated. Follow-up radiographs were evaluated for implant loosening or failure, femoral head coverage (FCH), pelvic dimensions, and radiographic evidence of healing. RESULTS: Screw loosening occurred in 1 of 266 (0.4%) screws placed and in 1 of 38 hips (2.6%). The rate of screw loosening was significantly lower than previously reported. Only 1 hip (2.6%) developed a major complication. Minor complications involving implants occurred in 2 hips (5.3%). Three to 5 locking screws were used per plate. There was a significant increase in FCH and Norberg angle (NA) compared with preoperative values. No clinically significant change in pelvic canal dimensions measured at 3 locations was identified. CONCLUSION: Locking 7-hole TPO plates with 3-5 locking screws resulted in a lower rate of major and minor implant associated complications than the reported complication rate for conventional 6-hole plates. En bloc pullout of the caudal aspect of the plate is an infrequent but repeatable complication associated with the locking TPO implant.

Radiographic evaluation of the anconeal process in skeletally immature dogs.

OBJECTIVE: To determine if a secondary center of ossification (SCO) of the anconeal process is present in skeletally immature dogs that do not develop an ununited anconeal process (UAP). STUDY DESIGN: Case series. ANIMALS: Dogs 77-154 days of age with conditions other than developmental disease of the elbow (n=78 dogs; total elbows=100). METHODS: Mediolateral radiographic projections of the elbow were reviewed for presence or absence of a SCO of the anconeal process. RESULTS: A SCO was radiographically evident in 16% of elbows from breeds that have been reported to be affected by UAP. The appearance of the SCO was different to an UAP fragment. None of the elbows with SCO of the anconeal process developed UAP. A SCO was not present in any small breed dogs. CONCLUSIONS: A SCO of the anconeal process is uncommon in medium and large breed dogs and the presence of a SCO does not indicate that UAP will develop. CLINICAL RELEVANCE: Because radiographic diagnosis of a SCO of the anconeal process and UAP lesions have distinct appearances, an earlier diagnosis of UAP is possible.

Influence of canal preparation depth on the incidence of femoral medullary infarction with Zurich Cementless Canine Total Hip arthroplasty.

OBJECTIVE: To determine the incidence of femoral medullary infarction after modifying the depth of femoral reaming and filing when performing total hip replacement (THR) using the Zurich Cementless Total Hip Replacement system (ZCTHR). STUDY DESIGN: Case series. ANIMALS: Dogs (n=31) that had ZCTHR (34). METHODS: Thirty-one dogs (34 THR) had ZCTHR (May 2003-September 2006) and with >1 year radiographic (craniocaudal, mediolateral views) follow-up after THR were evaluated for the presence of femoral medullary infarcts. Incidence was compared with a previous study performed before the technique modification. RESULTS: Femoral medullary infarction occurred in 1 femur (2.9%; dog <18 months at THR) compared with 19.5% before the technique change, a significant decrease (P<.001). CONCLUSION: Limiting the depth of reaming and filing of the medullary canal resulted in a significant decrease in the incidence of femoral medullary infarction. CLINICAL RELEVANCE: Depth of reaming and filing the medullary canal should be limited when performing THR using the ZCTHR.

Femoral medullary infarction prevalence with the Zurich Cementless Canine Total Hip arthroplasty.

OBJECTIVE: To document the prevalence of femoral medullary infarction associated with the Zurich Cementless Total Hip Replacement (ZCTHR) system in dogs. STUDY DESIGN: Case series. ANIMALS: Dogs (n=35) with 41 ZCTHR implants. METHODS: Medical records (February 1999-December 2002) were reviewed for dogs that had ZCTHR and at least 1 year follow-up with radiographic evaluation. Thirty-five dogs (41 ZCTHR) met the inclusion criteria. Femoral morphologic data, implant to bone relationships, and medullary infarcts were recorded. Data were analyzed for associations between infarct occurrence and morphologic details and dog characteristics. RESULTS: Eight of 41 femurs had radiographic evidence of infarcts (19.5%). Dogs with infarcts were significantly younger (mean [+/-SD] age, 18.5+/-5.2 months) compared with those without infarction (mean age, 44.4+/-5.6 months; P=.027). None of the other variables were significantly different between dogs with and without infarcts. Three femurs with infarcts ultimately developed stem loosening. CONCLUSION: A higher prevalence of femoral medullary infarcts was identified with ZCTHR compared with incidence reported for other total hip systems. Younger dogs were more likely to develop infarction. CLINICAL RELEVANCE: Femoral infarction appears to be associated with stem loosening. Adjustments in surgical technique or delaying surgery beyond 18 months of age may reduce incidence of infarction but needs further evaluation.

Inter- and intra-observer variability of radiography and computed tomography for evaluation of Zurich cementless acetabular cup placement ex vivo.

OBJECTIVE: To evaluate the inter- and intra-observer variability in measurement of the angle of lateral opening (ALO) and version angle measurement using digital radiography and computed tomography (CT). METHODS: Each hemipelvis was implanted with a cementless acetabular cup. Ventrodorsal and mediolateral radiographs were made of each pelvis, followed by CT imaging. After removal of the first cup, the pelves were implanted with an acetabular cup in the contralateral acetabulum and imaging was repeated. Three surgeons measured the ALO and version angles three times for each cup from the mediolateral radiographic projection. The same measurements were made using three-dimensional multiplanar reconstructions from CT images. Two anatomical axes were used to measure pelvic inclination in the sagittal plane, resulting in six measurements per cup. Two-way repeated measures analysis of variance evaluated inter- and intra-observer repeatability for radiographic and CT-based measurements. RESULTS: Version angle based on radiographic measurement did not differ within surgeons (p = 0.433), but differed between surgeons (p <0.001). Radiographic measurement of ALO differed within surgeons (p = 0.006) but not between surgeons (p = 0.989). The ALO and version angle measured on CT images did not differ with or between surgeons. CLINICAL SIGNIFICANCE: Assessment of inter- and intra-observer measurement of ALO and version angle was more reproducible using CT images than conventional mediolateral radiography for a Zurich cementless acetabular cup.

Incidence of pulmonary embolism after non-cemented total hip arthroplasty in eleven dogs: computed tomographic pulmonary angiography and pulmonary perfusion scintigraphy.

OBJECTIVE: To compare the incidence of pulmonary embolism (PE) in 11 dogs that had non-cemented total hip replacement (THR) to that reported in dogs after cemented THR. STUDY DESIGN: Prospective clinical study. ANIMALS: Large mixed breed dogs (n=11). METHODS: Thoracic computed tomographic pulmonary angiography (CTA) was performed on all dogs pre- and postoperatively. Pulmonary perfusion scintigraphy was performed postoperatively. RESULTS: PE was not identified on postoperative CTA or pulmonary perfusion scintigraphy. CONCLUSIONS: The incidence of PE after non-cemented THR in these 11 dogs, as evaluated with pulmonary perfusion scintigraphy and thoracic CTA was lower than reported in dogs undergoing cemented THR. CLINICAL RELEVANCE: Based on the results of this study the incidence of PE as a complication of total hip arthroplasty is reduced when a non-cemented system is used.

Radiographic evaluation of the Zurich cementless total hip acetabular component.

OBJECTIVE: To radiographically evaluate the Zurich cementless total hip (ZCTH) cup and correlate lucency with clinical signs of implant instability, time since surgery, and implant generation, using zonal analysis. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n = 53). METHODS: Radiographs of dogs that had ZCTH arthroplasty (>1 year) were evaluated using zonal analysis, for lucency surrounding the cup-bone interface (number of zones, length, area). Dogs were examined for clinical signs of implant instability (lameness, hip pain). Lucency was correlated with lameness, time after surgery, and implant generation. RESULTS: Radiographs of 68 implants (18 generation I, 50 generation II) were evaluated. Eight dogs were lame (11.8%). Dogs with lameness were more likely to have lucency in > or =2 zones of analysis (per view), have >2 times the average curvilinear length of lucency, and have >4 times the average area of lucency surrounding the implant compared with non-lame dogs. A weak relationship was observed between time after surgery and implant generation; however, there was no relationship between time after surgery and lucency. CONCLUSIONS: Dogs with lameness after ZCTH arthroplasty were more likely to have lucency at the cup-bone interface. Lucency was better evaluated by radiographic projection than zonal analysis. Temporal progression of lucency was weakly correlated with implant generation. CLINICAL RELEVANCE: Dogs with lucency in > or =2 zones of analysis should be evaluated more frequently for clinical signs of implant loosening. Further investigation of serial radiographs after ZCTH arthroplasty is warranted.

Radiographic and ultrasonographic evaluation of the patellar ligament following tibial plateau leveling osteotomy.

Objective evaluation of patellar ligament changes following tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament injury has not been published to date. In this study, the patellar ligament was evaluated using radiographs and high-resolution ultrasound in 31 stifles (29 dogs) preoperatively and at 1 month (n=31), 2 months (n=18), and 6 months (n=13) postTPLO. A ratio of the thickness of the proximal to distal patellar ligament was determined for all radiographs evaluated. Ultrasound evaluation included proximal, middle, and distal mid-sagittal thickness and transverse thickness, and transverse area measurements. Subjective grading (0 being normal through a scale of 3) of the ultrasound changes was also performed at each evaluation. Significant thickening of the distal patellar ligament was noted postoperatively as evidenced by thickness and area measurements and a decreased radiographic ratio (P < 0.01). Preoperative patellar ligament thickness and area were similar at the proximal, middle and distal sites. Ultrasound-derived thickness and area measurements of the distal patellar ligament were increased at 1 and 2 months (P < 0.01). The radiographic ratio was significantly decreased at 1, 2 and 6 months (P < 0.01). Subjectively, all patellar ligaments scored a 0 preoperatively and 16/31 received a score of 2 or 3 during follow-up evaluation. Additionally, these dogs had ultrasonographic and radiographic changes consistent with distal patellar ligament thickening. Body weight (kg) and postoperative TPLO angle had a significant influence on 1-month postoperative distal patellar ligament area using a stepwise logistic model (P < 0.05). Patellar ligament desmitis is a common postoperative sequela to the TPLO procedure, however its clinical significance (i.e., correlation with a residual lameness) was not evaluated in this study.

Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog.

OBJECTIVE: Comparison of 2 methods of surgical management of cranial cruciate ligament (CCL) injury in large-breed dogs using a radiographic osteoarthrosis (OA) scoring system. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n=66). METHODS: Radiographs were evaluated from dogs weighing >/=22.7 kg, with surgical management of CCL rupture using extracapsular repair (ECR) or tibial plateau leveling osteotomy (TPLO). Radiographs were taken immediately before surgery and >/=12 months later. An OA score was assigned to each set of radiographs taken at the preoperative and final examinations by evaluating 32 specific features of stifle OA. The difference between preoperative and final OA scores were subtracted and 2 final score categories of a change 5 were created. A logistic regression model was used to evaluate the effect of right versus left pelvic limb, age, preoperative weight, postoperative weight, days from surgery until final radiographic recheck, cranial cruciate status at surgery, medial meniscus status at surgery, and ECR versus TPLO. RESULTS: The ECR group had 27 stifles (22 dogs) and the TPLO group had 52 stifles (44 dogs). ECR dogs had a preoperative weight of 33.4+/-9.3 kg (range 22.7-54.1 kg) and a preoperative OA score of 13.0+/-8.4 (range 1-34) compared with TPLO dogs that had a preoperative weight of 38.9+/-9.1 kg (range 25-63.9 kg) and preoperative OA score of 15.9+/-8.4 (range 4-44). Postoperative weights for ECR and TPLO dogs were 33.6+/-9 kg (range 21.8-54.6 kg) and 39.4+/-10.1 kg (range 24-72 kg), respectively. Final OA scores were: ECR dogs, 26.3+/-10.8 (range, 10-54); TPLO dogs, 23.3+/-9.5 (range, 12-50). Dogs with a final change in OA score of >/=6 were 5.78 times more likely to have had ECR compared with those that had TPLO as stabilization procedure (odds ratio=5.78; Log-likelihood test P-value=.025). Other dependent variables were not significant. CONCLUSIONS: Based on logistic regression analysis, dogs with larger OA score differences were 5.78 times more likely to have had ECR than TPLO. CLINICAL RELEVANCE: Prospective, randomized surgical trials with pre-defined objective measures would be required to further evaluate the clinical importance of these preliminary findings which suggest that TPLO may help stabilize the cranial tibial thrust as originally proposed.

Radiographic, computed tomographic and histopathologic appearance of a presumed spinal chordoma in a dog.

A 4-year-old Labrador Retriever presented for urinary incontinence and constipation of 2 weeks duration. There was a tender abdomen, lumbar pain and conscious proprioceptive deficits in both pelvic limbs. Depressed pelvic limb reflexes were present consistent with a lower motor neuron lesion. In radiographs of the lumbar spine there was narrowing of the intervertebral disc space at L5-L6 with irregular, multifocal areas of mineralized opacities dorsal to the intervertebral disc space, presumably within the vertebral canal. On computed tomography, an intramedullary, partially mineralized mass was identified in the spinal cord at the level of caudal L5 through cranial L6. At necropsy there was a four-centimeter enlarged, irregular segment of spinal cord at the level of L5-L6. When sectioned, the spinal cord bad a mineralized texture. Histologically there were variable sized cells that were stellate in appearance with vacuolated cytoplasm (physaliferous cells) and mucinous background consistent with a chordoma. Chordoma is a rare, skeletal neoplasm that originates from mesoderm-derived notochord and has been reported in humans and animals. Extraskeletal development of a chordoma within the spinal cord is a rare manifestation of this neoplasm. However, based on other reports in dogs, solitary extraskeletal locations of chordomas may be the typical expression of this neoplasm in the dog. Differentiation of similar histologically appearing tumors, such as a parachordoma or myxoid chondrosarcoma, will require immunohistochemical characterization of these tumors in veterinary patients.