Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement.

OBJECTIVE: The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant. MATERIALS AND METHODS: Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians. RESULTS: Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases. CONCLUSIONS: While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.

Complications of porous-coated press-fit cementless total hip replacement in dogs.

OBJECTIVE: To report postoperative complications using a commercially available porous-coated press-fit cementless total hip replacement (THR) system in dogs. METHODS: Medical records were reviewed for client-owned dogs with hip pathologies requiring THR. A minimum of six-week postoperative orthopaedic examination and orthogonal pelvic radiographs were used to assess outcome and complications in the perioperative period. Referring veterinarian medical records, phone interviews with clients, or both were used to assess long-term functional outcome and complications. RESULTS: Bilateral THR was performed in 36 dogs, and unilateral in 147 dogs, making a total of 219 THR procedures in 183 dogs. A total complication rate of 31.1% (68/219) was observed. A catastrophic complication was observed in 8.2% (n = 18), a major complication in 9.6% (n = 21), and a minor complication in 13.2% (n = 29) of procedures. The most common complications were intra-operative femoral fissure (n = 46), diaphyseal femoral fracture (n = 15), and coxofemoral luxation (n = 9). Full return to function was achieved in 88.1% of procedures with a median follow-up period of 42 months. CLINICAL SIGNIFICANCE: Porous-coated press-fit cementless collarless total hip replacements have a high complication rate. The majority of complications occur intra-operatively or perioperatively, with few complications occurring beyond 12 weeks postoperatively. Both fissure fractures and diaphyseal femoral fractures carry a favourable prognosis with immediate cerclage wiring and plate fixation, respectively.

Evaluation of fluid production and seroma formation after placement of closed suction drains in clean subcutaneous surgical wounds of dogs: 77 cases (2005-2012).

OBJECTIVE: To evaluate fluid production and factors associated with seroma formation after placement of closed suction drains in clean surgical wounds in dogs. DESIGN: Retrospective case series. ANIMALS: 77 client-owned dogs with a subcutaneous closed suction drain placed following a clean surgical procedure. PROCEDURES: Medical records (January 2005 to June 2012) were reviewed, and signalment, site of surgery and underlying disease process, histologic evaluation results, total drain fluid production, fluid production rate (mL/kg/h) at 12-hour intervals, cytologic evaluation of drain fluid, and development of dehiscence, infection, or seroma were recorded. Associations among variables were evaluated. RESULTS: The most common complication was dehiscence (n = 18), followed by seroma (14) and infection (4). Dogs that developed a seroma had significantly greater total drain fluid volume relative to body weight and greater fluid production rate at 24 and 72 hours as well as the last time point measured before drain removal. Dogs in which drains were removed when fluid production rate was > 0.2 mL/kg/h (0.09 mL/lb/h) were significantly more likely to develop a seroma. CONCLUSIONS AND CLINICAL RELEVANCE: Seroma formation was more common in dogs with a higher rate of fluid production relative to body weight, but was not associated with the number of days that a closed suction drain remained in situ. Dogs may be at greater risk of seroma formation if their drains are removed while drainage is still occurring at a rate > 0.2 mL/kg/h.