Outcomes and complications reported from a multiuser canine hip replacement registry over a 10-year period.

OBJECTIVE: To report outcomes and complications associated with total hip replacements (THR) using a multiuser canine hip registry (CHR) and owner-administered questionnaire. STUDY DESIGN: Prospective longitudinal clinical study. ANIMALS: Dogs (n = 1852). METHODS: Total hip replacement cases submitted to a CHR were reviewed. An online questionnaire including an adapted "Liverpool Osteoarthritis in Dogs" (LOAD) score was e-mailed to owners. Data were analyzed to determine associations between clinical variables and the agreement by veterinary surgeons and owners for complications. RESULTS: A group of 1329 (72%) dogs had unilateral THRs and another group of 523 (28%) dogs had bilateral THRs, resulting in 2375 THRs. Indications included hip dysplasia and osteoarthritis (n = 2028/2375, 85%). Implants were manufactured by Kyon (n = 1087, 46%), BioMedtrix CFX (n = 514, 22%), BioMedtrix hybrid (n = 264, 11%), BioMedtrix BFX (n = 221, 9%), and Helica (n = 107, 4.5%). Median veterinary surgeon and owner follow up were 1328 and 900 days respectively. Postoperative LOAD scores (21 ± 9) reported by 461 owners improved compared to preoperative scores (11 ± 9) (P < .001). Veterinary surgeons reported complications in 201/2375 (8.5%) THRs and owners in 107/461 (23%) THRs, with moderate agreement (weighted kappa = 0.44). No associations were identified between complications and weight, age, sex, or breed. BioMedtrix BFX and Helica implants were associated with increased complications (P = .031) when used for revisions of femoral head and neck excisions. CONCLUSION: Excellent outcomes, including improved canine mobility, were reported after THRs. Complications were underreported by veterinary surgeons compared to owners in this first multiuser CHR. CLINICAL SIGNIFICANCE: Canine THRs are safe, effective procedures but THR implants should be carefully selected when revising femoral head and neck excisions.

Tibial Plateau Leveling Following Tibial Tuberosity Advancement: A Case Series.

Persistent stifle instability is a recognized complication following tibial tuberosity advancement techniques (TTAT). The aim of this study is to report the feasibility and outcome of tibial plateau leveling techniques (TPLT) to treat dogs with persistent lameness, suspected to be secondary to persistent stifle instability, following (TTAT). Medical records of dogs presented for persistent lameness after TTAT were reviewed. Preoperative data included orthopedic examination, lameness score and radiographs. Inclusion criteria included performance of a surgery to address persistent lameness and suspected instability. Short-term follow up data included orthopedic examination and radiographs of the stifle. Long-term follow up was based on postoperative Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Seven dogs were included in the study. Mean subjective preoperative lameness score was 3 ± 1.53. Mean preoperative patellar ligament angle relative to the tibial plateau (PLATP) was 94° and mean tibial plateau angle (TPA) was 28°. Six dogs had tibial plateau leveling osteotomy and one had modified cranial closing wedge ostectomy. Mean postoperative PLATP was 79° and mean TPA was 5°. Mean subjective lameness score at follow up was 0.57 ± 0.49. Minor complications were present in 2 dogs and major complication in 1 dog. Mean LOAD questionnaire score was 6.6/52. TPLT can be performed after TTAT and may improve clinical function and stability in these cases in which persistent instability is suspected.

Use of an extended CT scale reconstruction to diagnose metal implant failure in a canine elbow.

A Cocker Spaniel presented for recurrence of right forelimb lameness 33 months following transcondylar screw placement for a humeral intracondylar fissure. Elbow radiographs showed no evidence of implant-related complications. Standard CT scale reconstruction images failed to demonstrate implant failure. Extended CT scale reconstruction images revealed a fracture through the mid-portion of the screw. Revision surgery confirmed the implant failure; the screw was replaced and the lameness subsequently resolved. Extended CT scale reconstruction images allow detailed assessment of metal implants and should be considered when implant failure is suspected.

Management of feline tibial diaphyseal fractures using orthogonal plates performed via minimally invasive plate osteosynthesis.

Objectives The objective was to assess the medium- and long-term outcomes (radiographic and owner questionnaire) of feline tibial diaphyseal fractures with orthogonal plate fixation via a minimally invasive plate osteosynthesis (MIPO) approach. Methods Medical records and radiographs of cats that had tibial diaphyseal fractures stabilised with orthogonal plates were obtained (2012-2016). Immediate postoperative radiographs were reviewed to assess the construct configuration and follow-up radiographs (where available) were used to assess bone healing and implant-related complications. An owner-completed questionnaire (feline musculoskeletal pain index [FMPI]) was used at a minimum of 6 months following surgery to assess the cats' ability to perform normal activities. Results Eight feline tibial diaphyseal fractures met the inclusion criteria. One major complication was observed, most likely due to an operative technical error. There were no further complications following revision surgery. Six of the eight cases that had radiographic follow-up either had clinical bone union or showed evidence of bone healing. All cases were classified as successful according to FMPI. Conclusions and relevance Orthogonal plating of feline tibial diaphyseal fractures via an MIPO approach resulted in successful outcomes and a lower complication rate compared with previously reported techniques.

Pantarsal arthrodesis in cats using orthogonal plating.

Case series summary Pantarsal arthrodesis (PTA) was performed in seven tarsi of six cats, using orthogonal (dorsal and medial) veterinary cuttable plates (VCPs) without postoperative external coaptation. Short-term outcomes, arthrodesis progression and complications were assessed using a retrospective review of case notes (veterinary examination) and radiographs. Long-term outcomes were assessed via owner questionnaire (Feline Musculoskeletal Pain Index [FMPI]). Mean angle of PTA was 136° (range 116-166°). Intraoperative complications were recorded in two cases, both involving failure of the drill bit during drilling for calcaneotibial screws. Postoperative complications were encountered in a case of bilateral single-session PTA. These included gastrocnemius myotendinopathy on the right, and long-term protrusion of a screw head from the skin on the left. Both complications were resolved surgically, through resection of the implicated gastrocnemius tendon of insertion and removal of the plate, respectively. FMPI assessment was performed for all six cats a mean of 8.8 months (range 6-16 months) following surgery. Mean score for the first part (assessing ability to perform normal activities) was 92.2% (range 80.9-97.1%). Mean score for the second part (owner perception of pain) was 95.8% (range 87.5-100%). Mean overall score (mean score for parts 1 and 2 combined) was 92.3% (range 81.6-97.4%). PTA may be performed in cats using orthogonal VCPs to treat severe tarsal injuries. It may be prudent to avoid single-session bilateral PTA in cats. Relevance and novel information This case series documents a novel technique as an alternative for PTA in cats with talocrural injuries. Long-term outcome and complications presented in this case series are evaluated and discussed.

Locking T-Plate Repair of Ilial Fractures in Cats and Small Dogs.

Objectives To assess screw loosening and pelvic narrowing following the use of locking implants to stabilise ilial body fractures in cats and small dogs. Methods Review of clinical records and post operative and follow up radiography of 12 cats and five small dogs to evaluate accuracy of fracture reduction, screw purchase and subsequent screw loosening and reduction in pelvic diameter. Results No screw loosening or reduction in pelvic diameter was observed at follow up. Clinical Significance Locking T-plates may prevent complications reported following the use of conventional implant systems for the repair of ilial fractures in cats and small dogs.

Sagittal accuracy of tibial osteotomy position during in vivo tibial plateau levelling osteotomy performed without an alignment jig and cutting guide.

OBJECTIVES: To assess the accuracy of tibial osteotomy location for tibial plateau levelling osteotomy (TPLO) in the sagittal plane and its effect on the postoperative tibial plateau angle (TPA), when performed without an alignment jig and saw guide. Also, to document the improvement gained with experience. METHODS: Medical records and stifle radiographs of dogs undergoing TPLO, without the use of an alignment jig and saw guide, by one surgeon were reviewed (2010-2014). Postoperative radiographs were reviewed to record the distance and direction of eccentricity. Postoperative TPA was also recorded. RESULTS: In a series of 401 TPLO procedures, 231 met the inclusion criteria. The absolute distance of eccentricity (DOE) for all dogs was 3.0 ± 1.6 mm. When evaluating surgical experience, the DOE for the final 77 cases (2.72 ± 1.43 mm), the middle 77 cases (3.18 ± 1.49 mm), and the first 77 cases (3.24 ± 1.7 mm) were not significantly different (p = 0.07157). There was a very weak correlation between DOE and postoperative TPA (R = 0.029). CLINICAL SIGNIFICANCE: The location of the tibial osteotomy when performing TPLO without an alignment jig and saw guide compared favourably with previously documented use of an alignment jig and saw guide. Whilst the location of the tibial osteotomy has a theoretical impact on the postoperative TPA, other factors appear to be of greater importance. Surgeon experience did not result in significant improvement in accuracy up to 231 procedures.

Clinical comparison of the hybrid dynamic compression plate and the castless plate for pancarpal arthrodesis in 219 dogs.

OBJECTIVE: To describe and compare a large population of dogs that had pancarpal arthrodesis (PCA) using either a hybrid dynamic compression plate (HDCP) or a CastLess Plate (CLP). STUDY DESIGN: Multicenter, retrospective, cohort study. ANIMALS: Dogs (n = 240; 261 PCA). METHODS: Medical records (2000-2012) from 12 UK orthopedic centers were reviewed for dogs that had PCA to document signalment, diagnosis, arthrodesis method, and complication rates. Follow-up data were used to compare outcome (lameness evaluation and radiographic healing) after use of HDCP and CLP plates. RESULTS: PCA was performed with HDCP in 125 cases, CLP in 105, and by other techniques in 31. Carpal hyperextension injury was the most common diagnosis in HDCP and CLP groups. Surgical site infection (18.3%) was the most common postoperative complication. There was no difference in intra- (11% HDCP, 21% CLP) or postoperative (34% HDCP, 41% CLP) complication rates. Use of external coaptation did not affect postoperative complication rates or outcome. External coaptation related complications occurred in 32% HDCP and 18% CLP (P = .02). At median follow-up, most dogs were classified as having no or mild lameness (73% HDCP, 83% CLP) and there was radiographic healing in 40% HDCP and 46% CLP (P = .8) cases. CONCLUSIONS: CLP and HDCP may both be used successfully to achieve pancarpal arthrodesis. Adjunctive external coaptation does not appear to have a measurable clinical benefit but is associated with morbidity.

Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5 mm locking T-plate.

OBJECTIVES: To report clinical experiences with tibial plateau leveling osteotomy (TPLO) to address cranial cruciate ligament (CCL) disease in small breed dogs with high tibial plateau angles (TPA) using a specific 4-hole locking T-plate. STUDY DESIGN: Retrospective case series. ANIMALS: Small breed dogs (<15 kg) with high TPA (>30°): n = 19 (29 CCL ruptures). METHODS: TPLO was performed by standard technique using a 1.9/2.5 mm 4-hole locking T-plate. Preoperative, immediate postoperative, and 6-8 weeks postoperative TPA were measured from radiographs. Lameness was scored subjectively preoperatively and 6-8 weeks postoperatively. Mid to long term follow-up was by client telephone questionnaire (mean, 12.1 months after surgery). RESULTS: Mean ± SD preoperative TPA was 37.0 ± 4.9°, immediate postoperative TPA, 6.4 ± 2.8° and 6-8 weeks postoperative TPA, 8.0 ± 4.9°. Postoperative complications occurred in 4 dogs (13.8%) all of which had been operated as single-session bilateral procedures. Three stifles had failure of a single screw and postoperative increase in TPA. Periprosthetic infection necessitated plate removal in 1 dog. Lameness scores by veterinary assessment reduced from mean 3.4/5 preoperatively to 0.4/5 at 6-8 weeks postoperatively. Mid to long-term follow-up revealed no lameness by owner assessment. CONCLUSION: A 4-hole 1.9/2.5 mm locking T-plate may be used in the stabilization of unilateral TPLO in small breed dogs with high TPA.