Ch. 61 & 62: Stifle & TKR Flashcards
Kieves Vet Sx 2018
Effects of low-intensity pulsed US on radiographic healing of TPLO in dogs: a prospective, randomized, double-blinded study
- study groups
- conclusion?
Dogs were assigned to an active (LIPUS) treatment group or a placebo control (SHAM) treatment group
LIPUS tx 20min daily x 12 weeks
There was no significant difference in radiographic bone healing, or limb use as measured by objective gait analysis detected between the LIPUS treatment group and SHAM treatment group at any point in the study
Lopez JAVMA 2018
Retrospective study of factors associated with SSI in dogs following TPLO
- % SSI post-op?
- 3 factors that were associated w/ increased odds of SSI
SSI developed after 34 (8.4%) procedures
On multivariate analysis – GSD (vs other breeds), meniscectomy (vs no meniscectomy), & attending surgeon have performed < 20 (vs > 20) procedures during the study period were associated with increased odds of SSI
Mehrkens Vet Sx 2018
Factors associated with early TT fx after TPLO
- % fx?
- factors assoc w/ increased odds of fx?
Dogs (n = 2490) with cranial cruciate ligament rupture that underwent 3000 TPLO surgeries
23 (0.77%) cases of fx were ID
Factors that correlated with increased odds of fracture were:
- Placement of antirotational pins distal to insertion of patellar ligament (PL)
- Tuberosities w/ narrowest point below insertion of PL
- Placement of multiple pins distal to the PL
- Bilateral simultaneous TPLO
Selmic JAVMA 2018
Association of TPLO w/ proximal tibial OSA in dogs
- TPLO vs not and OSA
- Body weight and odds of OSA?
After adjusting for BW in multivariable model, dogs with history of TPLO were 40 x as likely to get proximal tibial OSA as were dogs with no hx of TPLO
Each 1 kg increase in BW was associated with 11% increase in odds of proximal tibial OSA
Barnes Vet Sx 2019
Randomized, prospective clinical trial
Extracorporeal shock wave therapy improves short-term limb use after canine TPLO
- weight bearing TPLO vs. TPLO + ESWT
peak vertical force (PVF) and vertical impulse (VI) of surgically treated limbs in the ESWT cohort were higher 8 wks after sx compared with preoperative
Weight bearing increased faster after TPLO in dogs treated with postoperative ESWT
Chiu Vet Sx 2019
Influence of fixation systems on complications after TPLO in dogs > 45.4 kg (100 lb)
- fixation systems
- which system had lowest odds of complications?
- which higher complications?
- conclusion
Fixation systems included a 3.5 mm broad TPLO plate alone (8 P 78.4%) , a 3.5 mm broad TPLO plate w/ SOP (8AP; 14.9%), a 3.5 mm standard TPLO plate (6 P 6.7%)
The 8P had the lowest odds ratio for complication among the 3 fixation systems.
Odds of developing complications were higher with the 8AP fixation system than with the 8P fixation system.
With nonlocking plates – for every 4.5 kg increased odds of complication by 50%
Locking fixation eliminated the association between weight and complication rate
Livet VCOT 2019
Comparison of outcomes associated with TPLO and a modified technique for TTA for the tx of CCLD in dogs: a randomized clinical study
- complications b/w groups?
- lameness high immediate post op which group?
- gait eval 1 month?
- gait 6 months?
26 dogs; 13 in TPLO and 13 in TTA rapid
no significant difference in the occurrence of complications between groups
Lameness scores were significantly higher during the first 3 days after surgery for the TPLO group
One month after surgery, the symmetry index between healthy and affected limbs for the relative stance time during the gait cycle (symmetry index/%) was significantly higher for the TTA Rapid group
No gait parameters were significantly different between the two groups 6 months after surgery
McGregor VCOT 2019
A retrospective study using the SOP TPLO locking plate for the tx of CCLD
- SOP plate healing at 6-8 weeks?
- what was assoc with increased union?
- what were two more common complications?
- SOP recommended?
The use of the SOP TPLO plating system resulted in a median grade 2 (26-50%) radiographic osteotomy union score at 6 to 8 weeks’ follow-up, less than previous TPLO locking plate studies.
Osteotomy union was associated with retention of the antirotational pin and reduced TPAc.
Major and minor complication rates were marginally greater than recent locking plate studies with fibular fracture and screw loosening common complications.
The use of SOP TPLO plates is cautioned and further study is warranted.
Cappelle VCOT 2019
Short-term complications following single-session vs staged bilateral TPLO stabilized with locking plates for tx of bilateral CCLD: a retrospective study
- difference in minor/major complications b/w procedures?
- age?
- conclusion
No significant differences in minor or major complication rates existed between study groups
Increasing age was the only significant risk factor for major complications in either group
findings support claim that BSSTPLO & STPLO performed with locking implants have similar complication rates
Aldrich VSURG 2023
Blinded, randomized, placebo-controlled study of the efficacy of bupivacaine liposomal suspension using static bodyweight distribution and subjective pain scoring in dogs after tibial plateau leveling osteotomy surgery
- conclusion?
For the population of dogs that underwent TPLO and received postoperative carprofen, LB did not provide an analgesic effect discernable by success/failure analysis, Glasgow CMPS-SF pain scores, or %BWdist measurement using a weight distribution platform, compared with saline placebo
Villatoro VRU 2023
Stifle joint osteoarthritis in small-breed and medium-breed dogs is more severe after cranial cruciate ligament injury than medial patellar luxation
- OA and weight?
- which dz process had more OA?
- conclusion
OA was more severe in heavier than lighter dogs
Joints with MPL had lower OA scores than joints w/ CCL injury or CCL injury + MPL
The retrospective nature of the study limited findings to associations but did not allow conclusions regarding factors causing OA or enhancing its progression.
Reader JAVMA 2020
Comparison of liposomal bupivacaine and 0.5% bupivacaine HCl for control of postoperative pain in dogs undergoing TPLO
- nocita vs. bupivacaine rescue analgesia
- conclusion
Dogs with Nocita were less likely to require rescue analgesia and received lower amounts of opioids than dogs given 0.5BH
Conclusion: the LEB appeared to provide adequate analgesia after TPLO with lower requirements for opioid treatments, which may allow dogs to be discharged from the hospital earlier than with traditional pain mgmt
Tinga Vet Sx 2020
Femorotibial kinematics in dogs treated with TPLO for CCL insufficiency: an in vivo fluoroscopic analysis during walking
- translation w/ CCLr
- translation post-TPLO
- conclusion
CCL rupture resulted in 10 ± 2.2 mm (mean ± SD) cranial tibial translation at midstance phase, which was converted to 2.1 ± 4.3 mm caudal tibial translation after TPLO
TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking
Vezzoni VCOT 2020
Use of a modified TPLO with double cut and medial crescentic CWO to treat dogs with CCLR and tibial valgus deformity
- mean pre + post TPA
- mean pre + post proximal tibial angle
- post-op complications
- conclusion
Mean pre and postop TPA were 27.8° and 6.5° respectively
Mean pre- and postop mechanical medial proximal tibial angle were 101° and 92.8° respectively
No postop complications recorded & all healed uneventfully
Conclusion: TPLO/medial crescentic CWO effective for this conformation and low complication rate
Alexander Vet Sx 2020
Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy
- % change in recommendations
- conclusion
1010 cases identified
Radiographic examination findings contributed to a change in recommendations in 4.15% (38/915) of dogs presented without client concerns and without abnormalities at orthopedic examination.
Radiographic examination findings are unlikely to influence the treatment of dogs that seem to be recovering uneventfully from an uncomplicated TPLO without concerns from clients, analgesia, or abnormal findings on thorough orthopedic examination by a surgical specialist, at the time of the planned clinical re-evaluation
Olivencia-Morell Vet Sx 2021
Evaluation of the clinical value of routine radiographic examination during convalescence for tibial plateau-leveling osteotomy
conclusion
At routine rechecks of dogs w/ no owner-perceived issues after TPLO, 49% had minor complications but only 2% (or 2 in 100 cases) were deemed significant enough to alter patient mgmt.
Ober Vet Sx 2019
Influence of TPLO and TTA on passive laxity of the cranial cruciate deficient stifle in dogs
conclusion
Conclusion: TPLO and TTA caused an angle dependent decrease in craniocaudal translation of tibia ; TPLO seems more effective than TTA at restoring craniocaudal stability of stifle
Moore Vet Sx 2020
Extended long-term radiographic & functional comparison of TPLO vs TTA for CCLR in the dog
- OA more with which procedures?
- long term outcome TPLO vs TTA?
All dogs had meniscal release (49.6%) or partial medial meniscectomy (51.3%)
OA score progressed more after TTA and in dogs with bilateral surgery
Long-term outcomes that were better after TPLO compared with TTA included avg pain in last 7 days, interference with walking, morning stiffness, jumping, and climbing, limping during mild activities, and overall QoL
Shimada VCOT 2020
Biomechanical effects of tibial plateau leveling osteotomy on joint instability in normal canine stifles: an in vitro study
findings suggest that TPLO influences tension of the collateral ligaments and might generate laxity of the tibiofemoral joint
Johnson VSURG 2022
Outcome of cranial cruciate ligament replacement with an enhanced polyethylene terephthalate (PET) implant in the dog: A pilot clinical trial
- outcome of PET implant
- conclusion
Prospective, clinical, 10 dogs
The PET implant appeared
- intact and functioning in 2/10
- partially intact and functioning in 4/10
- completely torn in 3/10
- infection and removed in 1/10
Although function improved over the course of this study, only 2/10 implants appeared intact 6 months after placement
Lechner JFMS 2020
Comparison of a novel extracapsular suture technique with a standard fabellotibial suture technique for cranial cruciate ligament repair using a custom-made limb-press model in cats
All fabellotibial sutures and Mini TightRope fixations neutralized excessive cranial tibial thrust.
Barnhart VCOT 2019
Biomechanical comparison of 4 methods of fixation of a polymeric cranial cruciate ligament in the canine femur & tibia
conclusion
The mean ultimate load was significantly greater for femur fixations than for tibias, when SW was added (spiked washer) and for 5 mm IS (interference screw) compared with 4.5 mm sizes
Conclusion: a 5 mm IS + SW provided superior fixation strength in femurs/tibias vs 4.5 IS without SW
Biskup Vet Sx 2020
Long-term arthroscopic assessment of intra-articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog
- % grafts survived at 12mo
- conclusion
According to scope – 45% of grafts seemed to survive at 12 mo after surgery
Conclusion: about ½ of intra-articular allografts survived 12 mo after implantation in CCL-deficient stifles ; dogs with intact graft had successful outcomes at 12 mo after sx
Agnello VCOT 2021
Arthroscopic articular cartilage scores of the canine stifle joint with naturally occurring cranial cruciate ligament disease
- which site had high cartilage score damage?
- did bucket handle tear change OA score?
- presence of synovitis?
- conclusion?
the proximal trochlear groove has significantly higher cartilage scores (2) than all other sites examined
bucket handle tear of medial meniscus present in 33.3% of cases but was not associated with increased MOCS or synovitis scores
all stifles had synovitis
conclusion: arthroscopic articular cartilage damage is common at the time of sx intervention for CrCL dz but changes are mild
Fox VCOT 2020 PQ
Average TPA of 3922 stifles undergoing surgical stabilization for CCLR
- avg pre-op TPA?
- breeds with higher TPA?
- breeds with smaller TPA?
- neuter status? PQ
Avg preop TPA was 29°, average breed specific preop TPA ranged 27° to 35.1° with 4 breeds having significantly lesser TPA and 4 greater TPA
Beagles, Bichon Frises, Westies, and Yorkies have highest at 32, 34, 35 & 34
Smaller were Cane Corso, German Shepherds, Labradors, Rottweilers
*Neutered dogs had a higher TPA of 28.9° than non-neutered dogs with avg 26.88°
Flesher VCOT 2019
Technique and outcome of a modified TPLO for tx of concurrent MPL and CCLR in 76 stifles
- technique
- complication rate?
- conclusion
After osteotomy made, proximal segment rotated for TPA and simultaneous medially translated 1-5 mm to adjust alignment of quadriceps mechanism & center patella; then Fixin plate was contoured
Overall complication rate 18.4% in treatment group and 28.9% in non-tibial translation group
Conclusion: modified TPLO can be used to tx patients with concurrent MPL & CCLR with good clinical outcome; complication rates comparable to traditional repairs for MPL
Amimoto VCOT 2020
Force plate gait analysis & clinical results after TPLO for CCLR in small breed dogs
- TPLO impact on HL function?
- conclusion
Hindlimb fxn markedly improved after TPLO with all 3 postop symmetry index significantly higher after month than preop values
Conclusion: limb fxn improved continuously and reached near normal values 6 mo post-op
