TPLO Flashcards
TPLO vs TTA, MMP
1) Wemmers Frontiers 2022 (REVIEW)
-72 studies TPLO vs TTA
-50% low quality of eidence - high heterogeneity in quality
-15% blinded randomised trials (7% of total were low overall risk of bias)
-both considered successful
-subjective and objective revealing no lameness long term in most
-TTA better OA scores up to 6m postop
-TPLO lower rate of SSI
2) Knebel VCOT 2020
-MMP
-prospective
-3m postop, more TPLO within ref range PVF
-6m postop no diff bwt TPLO and control
-TPLO superior
3) Moore VS 2020
-TTA
-OA progressed more after TTA and in bilateral sx
-TPLO better long term radiogrpahic and functional outcome than TTA
4) Livet VCOT 2019
-TTA rapid
-no diff in complications
-SI 1m postop higher for TTA group
Protective effect
Hulse VS 2010 - 2nd look arthroscopy 2y later
-those with early partial tears had near normal intra-articular appearance
-early TPLO may be protective against further disruption
single vs staged TPLO
Cappelle VCOT 2019
-similar comp rate (20% single, 30% staged major comp)
-but major comp diff in staged group (postop infection) vs single (#)
Peress VCOT 2021
-comp rate 50% single, 20% staged
-30% major comp single, 4% staged
2% TT # in single group
2-3x risk for single
> 45kg TPLO
Chiu VS 2019
-broad +/- SOP, vs standard TPLO
-broad lowest comp
MacCormick JAVMA 2023
-jumbo plate >50kg does not prevent icnrease in TPA thorugh convalescence (sig increase found)
-46% comp - 20% SSI
-owner excellent outcome
Bleeding TPLO
Matres-Lorenzo: stifle and hock flexed to 90deg - relaxation of popliteal artery
Pozzi: osteotomy with HL vertical and stifle flexed to allow gastroc to relax and cranial tibial artery to move caudally
Mullins VS 2020
-CT angiographic study greyhound cadavers
-Angle of stifle extension does not have clinically sig effect on proximity of cranial tibial artery to proximal tibia
Cieciora VCOT 2022
-Ex vivo angiographic 3D reconstruction
-fragment rotation compresses cranial tibial artery
Roses VCOT 2022
-cadaveric retrospective 9 dogs
-rotation and compression of proximal tibia, closure of pes successful
Grand JAAHA 2024
-delayed life threatening haemorrhage caused by cranial tibial artery pseudoaneurysm in 2 dogs
Mechanics
1) Zann VS 2020
-horizontal beam fluoro images of stifles during treadmill
-6m post TPLO 10 dogs
-TPLO stifles subtly different to normal - slight cranial shifting of patella relative to trochlear groove - unknown clinical sig
2) Amimoto VCOT 2020
-TPLO force plate analysis <15kg revealed markedly improved HL function, near normal at 6m
3) Shimada VCOT 2020
-TPLO provided craniocaudal stability when compressive force applied to tibiofemoral joint
4) Kanno VCOT 2019
-effect of centre of rotation in TPLO on quads tensile force
-distal osteotomy = increased tensile force on quads, may cause patellar lig thickening
-distal osteotomy needs bigger rotation for ideal TPA
5) Ober VS 2019
-TPLO and TTA on craniocaudal stability
-both decrease cranial translation of tibia
-only TPLO restored translations similar to that of intact
Husi VS 2023
Ex vivo TPLO +/- lateral augmentation
TPLO + lateral suture neutralises both craniocaudal and rotational instability
Looi VCOT 2023
ovine tibiae - custom 6hole 3.5mm angled compression hole plate vs
standard TPLO plate
angled plate increases cranially directed displacement of osteotomy in TPLO without causing change in TPA
Alvarez VS 2022 (REVIEW)
rehab interventions following CrCL surgery
studies assigned to LoE and RoB
16/19 studies yielded positive results
-Lack of class I studies
-Therapeutic exercise had most studies with positive results (Marsolais 2002, 2003, Monk 2006, Romano 2015, Verpaalen 2018, Brantberg 2024) but all high risk of bias (and 1 no effect - Jerre 2009)
-Cold compression: 3 support, 1 no effect
-ESWT: 2 supporting
-Photobiomodulation: 1 supporting, 1 negative, 2 no effect (Chavez AJVR 2024)
-Low intensity pulsed U/S: none supporting
-Electrical muscle stimulation: 1 supporting
SSI - Justifying postop a/b use
-Clean ortho 7%
-TPLO 7-14%
BUDSBERG VS 2021 REVIEW
1) Fitzpatrick 2010 - 1000 dogs, cefalexin 10mg/kg BID, retrospective
2) Hagen 2020 (SSI as PRIMARY FOCUS)
3) Nazarali 2014 (SSI as PRIMARY FOCUS)
4) Nazarali 2015 - MRSP carrier
5) Solano 2014 - use of nonlocking
6) Pratesi 2015
7) Frey 2010
8) Tuan 2019
9) Sanders 2024 - preclosure lavage
SSI - Against postop a/b use
-retrospective, varied protocols
-many confounding factors (anaesthesia/sx time, body temp, hypotension)
-varied definitions of SSI (do not ddx from inflammation)
-use of passive surveillance confounds issue
-agent, host, env approach needs to be undertaken
1) Spencer 2018 (SSI as PRIMARY FOCUS) - NNT 17
2) Aiken 2015 (SSI as PRIMARY FOCUS)
3) Clark 2020 (SSI as PRIMARY FOCUS)
4) Stine 2018 - protocol changes w/o use of a/b reduced infection rate from 7 to 1%
5) Husi 2023
Other factors
1) Increasing BWT
2) Male dogs
3) GSDs
