Evaluation of the short- and long-term complications and outcomes of phacoemulsification surgery in alpacas.

OBJECTIVE: To describe the complications and determine the visual outcomes associated with phacoemulsification surgery in alpacas. ANIMALS: Five alpacas (nine operated eyes). PROCEDURES: Medical records of alpacas with a clinical diagnosis of cataracts that received elective phacoemulsification surgery at Cornell University over a 15 year period were reviewed. RESULTS: The mean (± standard deviation) age of the five operated alpacas was 104 days (±64 days). The cataracts were suspected to be congenital in all alpacas. Concurrent congenital ocular abnormalities were common in the operated eyes and included microphakia, persistent patent hyaloid arteries, and persistent patent tunica vasculosa lentis. No significant intraoperative complications were identified in any cases. In the immediate postoperative period, uveitis was mild-to-moderate in most operated eyes, ocular hypertension was not detected, and clinically significant corneal edema did not occur in any eyes. The mean (± standard deviation) duration of clinical follow-up after surgery was 32 months (±25 months). A peri-incisional corneal stromal ulcer associated with fibrinous uveitis was identified in a single eye during recheck examination 4 weeks postoperative that resolved with medical therapy. Long-term complications included unilateral glaucoma in two alpacas that resulted in vision loss. On the final recheck ophthalmic examination, 78% (7 of 9) of operated eyes were visual and all operated alpacas had vision in at least one operated eye. CONCLUSIONS AND CLINICAL RELEVANCE: In this series, the visual outcomes associated with elective phacoemulsification surgery in alpacas were good. Glaucoma was the most common vision-threatening long-term postoperative complication.

Effects of intratesticular and incisional local anesthetic administration for castration of alpacas anesthetized with intramuscular ketamine-xylazine-butorphanol.

OBJECTIVE: To determine the effects of intratesticular and incisional injection of local anesthetics on response to castration, surgical ease, and recovery in alpacas. STUDY DESIGN: Prospective, blinded, randomized, and clinical trial. ANIMALS: Intact male alpacas (n = 38). METHODS: Alpacas were anesthetized with intramuscular butorphanol, ketamine, and xylazine (BKX). Once recumbent, alpacas were instrumented with electrocardiogram, pulse oximeter, oscillometric blood pressure, and capnography. Heart rate (HR), respiratory rate (RR), and blood pressure (BP) were recorded every minute. Treatment drug (lidocaine, bupivacaine, or saline) was infiltrated along the incision and into both testicles followed by a prescrotal closed castration. Timing of major events, presence of movement during the procedure, need for additional anesthesia, and ease of surgery were recorded. Alpacas were administered postoperative oral meloxicam and assessment was made 24 hours after recovery. RESULTS: Median RR and mean BP (MBP) were lower in the lidocaine compared with the saline treated group. Median RR, HR, and MBP were significantly lower in the bupivacaine group compared with the saline group. Fewer alpacas displayed physical response to surgical stimulus with bupivacaine. No significant differences were found between groups for timing of events, need for additional anesthesia, ease of surgery, or postoperative assessment. CONCLUSION: Intratesticular local anesthetic blunts autonomic response and facilitates castration in alpacas anesthetized with BKX with minimal negative effects. Bupivacaine may have some benefit for local anesthesia during castration compared with lidocaine.

Nephroureterectomy and ureteroneocystostomy in an alpaca with bilateral ectopic ureters diagnosed by computed tomographic excretory urography.

OBJECTIVE: To report diagnosis and treatment of urinary incontinence in a female Huacaya alpaca. STUDY DESIGN: Clinical case report. ANIMALS: Female intact Huacaya alpaca (n = 1) METHODS: Computed tomographic (CT) excretory urography and vaginourethrography were performed to diagnose the cause of urinary incontinence. RESULTS: Bilateral ectopic ureters and left hydronephrosis and hydroureter were diagnosed. Left nephroureterectomy and right ureteroneocystostomy were performed with subsequent resolution of clinical signs. Pyelonephritis was identified by culture of the resected left kidney. CONCLUSIONS: CT excretory urography was helpful in the diagnosis of bilateral ectopic ureters in an alpaca and provided information for surgical planning. Surgical repair by ureteroneocystostomy and unilateral nephroureterectomy was successful in resolving clinical signs.

Management of bilateral patellar luxation in an alpaca.

OBJECTIVE: To report surgical management bilateral lateral patellar luxation in a mature alpaca using a combination of trochlear wedge recession (TWR), tibial tuberosity transposition (TTT), and joint capsule imbrication. STUDY DESIGN: Clinical case report. ANIMALS: 9-year-old castrated male Alpaca. METHODS: Bilateral, grade III/IV, lateral patellar luxation was identified by palpation, lameness examination and confirmed with radiography and ultrasonography. Surgical procedures were staged, with the left stifle treated first. Bilateral TWR, TTT, and joint capsule imbrication were performed. Outcome was assessed by radiography and follow up lameness examinations. RESULTS: An immediate improvement in weight bearing occurred after surgery of the left hind limb. Five months after initial surgery, right hind limb patella luxation was corrected. After surgery on the 2nd limb, the alpaca had progressive improvement in weight bearing during hospitalization. At 12 months, there were no signs of lameness and the alpaca had resumed normal activities. CONCLUSIONS: For bilateral lateral patellar luxation, a combination of TWR, TTT, and joint capsule imbrication resulted in excellent long-term outcome.

Carpal valgus in llamas and alpacas: Retrospective evaluation of patient characteristics, radiographic features and outcomes following surgical treatment.

This study evaluated outcomes of surgical treatment for carpal valgus in New World camelids and correlated successful outcome (absence of carpal valgus determined by a veterinarian) with patient characteristics and radiographic features. Univariable and multivariable analyses of retrospective case data in 19 camelids (33 limbs) treated for carpal valgus between 1987 and 2010 revealed that procedures incorporating a distal radial transphyseal bridge were more likely (P = 0.03) to result in success after a single surgical procedure. A greater degree of angulation (> 19°, P = 0.02) and younger age at surgery (< 4 months, P = 0.03) were associated with unsuccessful outcome. Overall, 74% of limbs straightened, 15% overcorrected, and 11% had persistent valgus following surgical intervention. To straighten, 22% of limbs required multiple procedures, not including implant removal. According to owners, valgus returned following implant removal in 4 limbs that had straightened after surgery.

Valgus carpien chez les lamas et les alpagas : évaluation rétrospective des caractéristiques des patients, des radiographies et des résultats après un traitement chirurgical. Cette étude a évalué les résultats du traitement chirurgical pour le valgus carpien chez des camélidés du nouveau monde et a établi une corrélation entre les résultats fructueux (absence de valgus carpien déterminée par un vétérinaire) et les caractéristiques du patient et des radiographies. Des analyses à variable unique et à variables multiples des données de cas rétrospectifs chez 19 camélidés (33 jambes) traités pour le valgus carpien entre 1987 et 2010 ont révélé que les procédures intégrant un pont radial distal transphyséal présentaient une plus grande probabilité de succès (P = 0,03) après une seule intervention chirurgicale. Une déviation supérieure (> 19°, P = 0,02) et un jeune âge à la chirurgie (< 4 mois, P = 0,03) étaient associés à des échecs. Dans l'ensemble, 74 % des jambes ont été redressés, 15 % ont été corrigées et 11 % présentaient un valgus persistant après l'intervention chirurgicale. Pour le redressement, 22 % des jambes ont nécessité des procédures multiples, ce qui n'incluait pas l'enlèvement de l'implant. Selon les propriétaires, le valgus est réapparu après l'enlèvement de l'implant dans 4 jambes qui avaient été redressées après la chirurgie.(Traduit par Isabelle Vallières).

Toggle-pin technique for management of coxofemoral luxation in an alpaca.

OBJECTIVE: To report repair of a coxofemoral joint luxation in an Alpaca using a toggle-pin technique. STUDY DESIGN: Case report. ANIMALS: An 11-month intact male Alpaca with luxation of the right coxofemoral joint. METHODS: The Alpaca was anesthetized and an open repair and reduction of the luxation was performed using a toggle-pin technique. RESULTS: The luxation was successfully reduced. An Ehmer sling was used for the initial 3 days after surgery and the Alpaca was discharged 7 days postoperatively without complications. Follow-up examinations confirmed maintained reduction of the coxofemoral joint, as well as no evidence of lameness or muscle atrophy. CONCLUSIONS: Coxofemoral joint luxations in Alpacas can be successfully repaired using a toggle-pin technique alone, without the need for other techniques such as capsular reconstruction or greater trochanter transposition. Use of an Ehmer sling for the immediate postoperative period provided additional protection to the repair and was tolerated well.

Partial carpal arthrodesis in a 2-year-old alpaca.

A 2-year-old alpaca was presented for acute onset right forelimb lameness. Clinical findings included bilateral carpal valgus (more severe in the affected forelimb) and medial instability of the right radio-carpal joint. Surgical treatment consisted of radio-carpal joint arthrodesis, which is presented as a therapeutic option for severe carpal instability secondary to injury to the supporting ligamentous structures of the carpus.

Ultrasound-guided psoas compartment and sciatic nerve blocks for pain management of hind limb procedures in the alpaca (Vicugna pacos).

Background: Loco-regional anesthetic techniques are considered important in the multimodal approach to analgesia in both human and veterinary medicine. No such techniques are described in the alpaca, bar the use of epidural. This is in part due to the lack of anatomical description for this species. While this limitation exists, the use of ultrasound guidance makes peripheral nerve blocks a viable possibility in the alpaca. Case description: A 12-month-old alpaca was referred for the treatment of a septic left tarso-crural joint. Due to a poor prognosis, amputation of the limb under general anesthesia was performed. Sciatic and psoas compartment blocks were attempted with the ultrasound-guided injection of ropivacaine prior to the start of the procedure. While the femoral nerve was possible to visualize, no obturator nerve was identified. A 5-year old alpaca was also referred for a left hind lateral claw removal, due to a squamous cell carcinoma. The sciatic nerve block was performed prior to the claw amputation under general anesthesia. No changes in heart and respiratory rate, or blood pressure suggestive of nociception, were observed in either of these cases. At the end of both the procedures, the patients experienced uneventful recoveries characterized by the ability to maintain the standing position, interest in food, and normal behavior. Conclusion: This report identifies the ease of performance and the challenges encountered using the ultrasound-guided psoas compartment and sciatic nerve blocks in the alpaca. It is our hope that this report encourages the use of ultrasound-guided loco-regional techniques in this species.

Total hip replacement in an alpaca using a cementless implant.

OBJECTIVE: To report use of a cementless total hip prosthesis in an alpaca. STUDY DESIGN: Case report. ANIMALS: Alpaca (n=1) with chronic craniodorsal coxofemoral luxation. METHODS: A 2.5-year-old Suri alpaca, 3 months pregnant, was admitted for evaluation of acute onset severe left hind limb lameness (grade 4/5) of 6 weeks duration. After diagnosis of craniodorsal luxation of the left femoral head, total hip replacement (THR) using a cementless implant was performed because of the poor prognosis for reduction of a chronic luxation. RESULTS: A press-fit prosthesis was used and the alpaca delivered a live cria 8 months later. Persistent mild mechanical lameness remained after surgery, with moderate reduction in mobility of the coxofemoral joint. The prosthesis was stable and correctly positioned at 7 weeks and at 9 months. There was mild exostosis surrounding the proximal aspect of the femur at 9 months, and Steinmann pins used to repair the trochanteric osteotomy were removed because of migration. At 1 year, the alpaca has a slight gait abnormality, remains with the herd on pasture and has been re-bred. CONCLUSION: Chronic coxofemoral luxation in an alpaca can be managed by THR. CLINICAL RELEVANCE: THR is a viable treatment option in alpacas with severe coxofemoral disease.

Trochlear block recession in an alpaca with traumatic lateral patellar luxation.

OBJECTIVE: To report surgical treatment of traumatic lateral patellar luxation using trochlear block recession in an alpaca. STUDY DESIGN: Clinical case report. ANIMALS: Five-year-old female alpaca. METHODS: Grade IV/IV lateral, left patella luxation and mild femoropatellar joint effusion was identified by palpation and visual assessment, and confirmed by ultrasonography and radiographs. Trochlear block recession combined with lateral retinacular release and medial imbrication to restore patella function. RESULTS: Progressive improvement in weight bearing occurred during hospitalization (6 days) and at 3.5 weeks, no lameness was observed; radiographically, the patella was in normal anatomic alignment. At 15 months, there were no signs of lameness with unrestricted exercise and the alpaca had given birth to another cria. CONCLUSIONS: In this alpaca with traumatic origin of the lateral patellar luxation and normal femoro-tibial alignment, a combination of retinacular imbrication, contralateral release, and trochlear block recession were successful for long-term treatment of lateral patellar luxation. CLINICAL RELEVANCE: Although trochlear block recession is most commonly performed in small animals, this technique may be useful in treatment of traumatic patellar luxations in camelids.

Complications after orthopedic surgery in alpacas and llamas: 24 cases (2000-2006).

OBJECTIVE: To report complications associated with orthopedic surgery in alpacas and llamas. STUDY DESIGN: Retrospective study. ANIMALS: Alpacas (n=18) and llamas (n=6) that orthopedic surgery using internal or external fixation. METHODS: Medical records (January 2000-December 2006) and radiographs were reviewed and owners contacted for follow-up information for alpacas and llamas that had orthopedic surgery involving internal or external fixation. Fourteen camelids had internal fixation, 7 had external fixation, and 3 had a combination of internal and external fixation. RESULTS: Twenty-two animals (92%) were discharged after surgery (mean hospitalization, 15 days). Of 20 animals with >or=1 year follow-up information, 18 were alive (82%). Postoperative complications related to fracture healing, infection, soft tissue structures, or joints occurred in 21 camelids (87%). Thirteen animals returned to their intended use, 4 animals returned to breeding but not their intended use, 4 were euthanatized, and 3 were only able to be used as pets. CONCLUSIONS: Fixation type (internal, external) did not have any significant effect on complications involving fracture healing, infection, soft tissue structures, or chronic lameness. Camelids with open fractures were more likely to have complications associated with fracture healing, repair, and infection than closed fractures. CLINICAL RELEVANCE: Complications after orthopedic surgery in alpacas and llamas are more common than previously reported and may result in chronic lameness or prevent return to their intended use.

Balanced anesthesia and ventilation strategies for an alpaca (Lama pacos) with an increased anesthetic-risk.

We report the use of a balanced anesthetic technique in a three-year-old, female Huacaya alpaca with an increased anesthetic risk that underwent an extensive dental surgery. Anesthesia was provided with an infusion of midazolam, fentanyl, S-ketamine and low concentrations of isoflurane in oxygen. The mandibular alveolar nerve was desensitized with a lidocaine-bupivacaine combination. The alpaca showed signs of hypoxemia fifteen minutes after anesthesia induction and arterial blood gases confirmed severe venous admixture. Application of positive end expiratory pressure (PEEP) of 6-9 cm H2O improved the arterial oxygenation. Other cardiopulmonary variables remained within the normal range. At the end of surgery, sarmazenil was administered to antagonize the effects of midazolam and emergence from anesthesia was smooth and uneventful. Flunixine meglumine and a transdermal delivery system for fentanyl were administered for post-operative analgesia. This method of balanced anesthesia allowed for an adequate anesthetic plane and a safe recovery, however, special ventilation strategies (PEEP) had to be applied.

Diagnosis and surgical removal of brain abscesses in a juvenile alpaca.

CASE DESCRIPTION: A 1-month-old female alpaca was examined because of progressive clinical signs consistent with an intracranial lesion. CLINICAL FINDINGS: Clinical signs included signs of depression, lethargy, tetraparesis, and neck weakness. Two large isointense intracranial masses could be seen on T1-weighted magnetic resonance images. On T2-weighted images, the masses contained concentric rings of hypointense and hyperintense material. TREATMENT AND OUTCOME: 2 abscesses were removed via a craniotomy that incorporated removal of the sagittal crest and surrounding skull and transection of the sagittal sinus. The bony deficit was replaced with polypropylene mesh. The alpaca recovered within 2 weeks and was fully integrated into the herd within 1 month after surgery. CLINICAL RELEVANCE: Findings indicated that surgical removal is a feasible means of successfully treating intracranial abscesses in juvenile alpacas.

Tooth root abscesses in llamas and alpacas: 123 cases (1994-2005).

OBJECTIVE: To determine features, outcome, and complications of surgical treatment of camelid tooth root abscesses. DESIGN: Retrospective case series. ANIMALS: 123 camelids with tooth root abscesses. PROCEDURES: Signalment, history, teeth involved, surgery performed, ancillary diagnostic tests, and short-term complications were recorded from each medical record. An owner questionnaire was used to obtain long-term (> 1 year) follow-up information. RESULTS: The most common surgical treatments included tooth extraction (n = 106) and apicoectomy (13). Owners provided follow-up information on 84 animals. Postoperative complications were reported in 42 of 84 animals. The most common complications included reinfection (n = 15), chronic draining tract (14), and osteomyelitis (14). Significantly more camelids that were in good or obese body condition at the time of surgery were alive at the time of follow-up, compared with those with thin body condition at the time of surgery. Camelids with 2 teeth extracted had significantly more complications than those with 1 tooth extracted. Thirty-four of 47 owners reported that they were completely satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Owners of camelids in poor body condition should be forewarned that such animals are at greater risk for complications following dental surgery. Clinicians should recognize that the number of teeth affected was not associated with a poorer outcome.

Use of a circular external skeletal fixator for stabilization of a comminuted diaphyseal metatarsal fracture in an alpaca.

CASE DESCRIPTION: A 3-year-old male alpaca was evaluated because of non-weight-bearing lameness (grade 5/5) in the left hind limb. CLINICAL FINDINGS: Clinical and radiographic examination revealed a closed, comminuted, nonarticular, displaced diaphyseal fracture of the left third and fourth metatarsal bones. TREATMENT AND OUTCOME: Initial attempts at treatment via reduction of the fracture under traction and subsequent application of a cast were unsuccessful, and more stable fracture fixation was pursued. The alpaca underwent closed reduction of the fracture, which was stabilized by the application of a 3-ring circular external skeletal fixator (CESF). Improved weight bearing on the affected limb was evident soon after surgery and gradually increased; full weight bearing was evident by the seventh day after discharge from the hospital (day 20 after application of the CESF). Lameness was hardly noticeable during walking at that time. After 3 months, complete fracture healing was evident and the CESF was removed; mild outward rotation of the distal fragment and metatarsophalangeal joint was present. A Robert Jones bandage was applied to the limb, and the alpaca was kept in a stall for another 4 weeks. Eleven months after CESF application, the owners and referring veterinarian reported that the alpaca was healthy, not lame, and serving as a stallion without apparent impediment. CLINICAL RELEVANCE: Although mostly restricted to small animals, application of a CESF can be a viable alternative for management of long bone fractures in South American camelids.

Bilateral metatarsophalangeal valgus and subluxation in two adult llamas treated by medial bone plate arthrodesis.

The clinical signs and diagnostic imaging of two adult llamas with severe metatarsophalangeal valgus angular limb deformity causing metatarsophalangeal instability, severe osteoarthritis and marked bilateral hindlimb lameness are described. The metatarsophalangeal axis was corrected and arthrodesis of the metatarsophalangeal joint was achieved by distal medial metatarsal condylectomy and the medial application of a custom-made angled 4.5 mm dynamic compression plate. A secure construct with normal limb angulation and a good biomechanical outcome was achieved in each of the hindlimbs of both llamas. The development and final dimensions of the implants are described to assist decision making during the evaluation of the surgical management of such cases.

Surgical correction of metacarpophalangeal valgus deformity in an alpaca.

A 1-month-old alpaca cria presented with a 13 degree valgus deformity of the left metacarpophalangeal joint. The angular limb deformity was centered on the distal metacarpal physes. Transphyseal bridging of the physes was recommended. Two 2.7 mm cortical bone screws were placed either side of the distal metacarpal physes and a figure of eight wire was placed medially around the screw heads. The screws extended through the medial metacarpus into the axial cortex of the lateral metacarpus. Seven weeks after surgery the limb was straight and the screws and wire were removed. Transphyseal bridging of the distal metacarpal physes can be effectively used for the treatment of metacarpophalangeal valgus in crias with open physes.

Surgical repair of femoral fractures in New World camelids: five cases (1996-2003).

Five New World camelids were admitted to the Western College of Veterinary Medicine between 1996 and 2003 for evaluation of femoral fractures. There were three alpacas and two llamas. Four of the animals were female and three were less than 3 months of age. Fracture configurations consisted of distal physeal fractures (three), a comminuted diaphyseal/metaphyseal fracture, and a transverse diaphyseal fracture. Fractures were diagnosed with a combination of physical examination and radiographs in all cases. All five fractures were repaired with internal fixation and three animals were discharged from the hospital with fractures that healed. One cria underwent successful internal fixation but died from pulmonary oedema during recovery from anaesthesia. Postoperative complications were rare and limited to inadequate fracture stability in one alpaca and prolonged recovery to weight bearing in another. One llama with a comminuted metaphyseal fracture, repaired with a 4.5 mm dynamic compression plate, subsequently had catastrophic failure of the bone 17 days after surgery. Overall the clients were pleased with the outcome of discharged animals. Although femoral fractures are considered rare, they pose a unique opportunity for the large animal veterinarian to successfully achieve fracture union with the aid of internal fixation.

Interventional Closure of a Patent Ductus Arteriosus Using an Amplatz Canine Duct Occluder in an Alpaca Cria.

A 6-month old female alpaca cria presented to The Ohio State University for evaluation of a cardiac murmur. Echocardiography revealed a left-to-right shunting patent ductus arteriosus, a restrictive left-to-right shunting perimembranous ventricular septal defect, and secondary moderate left atrial and ventricular dilation. Aortic root angiography demonstrated a type IIA patent ductus arteriosus (PDA). Interventional closure of the PDA was successfully performed, without complication, using an Amplatz canine duct occluder. This case report describes the materials and methods used for interventional closure of a PDA in an alpaca cria.