Luxation Repair Research Articles

Surgical site infection-inflammation in dogs draped with a single-layer Kraton elastic seal extremity drape for stifle surgery.

To compare the incidence of surgical site infection-inflammation in dogs undergoing elective orthopedic surgery of the stifle after draping with a single-layer Kraton elastic seal patient drape or conventional double-layer drapes. Prospective clinical trial. A total of 789 dogs. Dogs were assigned to one of two groups: (1) conventional draping with 4-corner drapes and an overlying patient drape (n=390) or (2) a Kraton seal extremity patient drape without 4-corner drapes (n=399). All dogs were evaluated for surgical site infection-inflammation by 21 days and 6months postoperatively. The distribution of surgical procedures did not differ between draping techniques and included tibial tuberosity advancement (TTA, n=480), tibial plateau leveling osteotomy (TPLO, n=10), extracapsular lateral suture (ECLS, n=130), medial patellar luxation repair (MPL, n=63), lateral patellar luxation repair (LPL, n=1), ECLS/MPL (n=68), TTA/MPL (n=12), TTA with joint capsule biopsy (n=1), and stifle arthroscopy combined with TTA or TPLO (n=24). Duration of follow up was 180 days (range 3-180 days) for clinical examinations and 182 days (range 2-182 days) for phone communications. Infection-inflammation was documented in 9 dogs after double-layer draping and 11 dogs after single-layer draping at 21 days postoperatively and in 12 dogs after double-layer draping and 7 dogs after single-layer draping at 6 months postoperatively. No difference in postoperative infection-inflammation was detected between canine stifle surgeries draped with a single-layer Kraton extremity patient drape or double-layer drapes. The single-layer Kraton extremity patient drape is a viable alternative to conventional double-layer draping in canine stifle surgery.

Hyperkalaemia during two consecutive anaesthetics in an aggressive Bengal cat

AbstractThe development of unanticipated hyperkalaemia during general anaesthesia in healthy veterinary patients is an increasingly recognized phenomenon. Cases have been reported in dogs, cats, horses and non‐domestic felids. However, recurrent hyperkalaemia has not yet been described in domestic cats. We report the development of hyperkalaemia during two consecutive anaesthetics in a 5‐year‐old, Bengal cat, anaesthetised for medial patella luxation repair and 3 months later for implant removal. During both procedures, hyperkalaemia was diagnosed. However, it was only during the first anaesthetic that the hyperkalaemia became life‐threatening, necessitating treatment. The reasons why some animals develop hyperkalaemia during general anaesthesia are still unknown. Considering the apparent increasing frequency of this condition, hyperkalaemia should be considered as a potential cause of intraoperative bradydysrhythmias and must be investigated and treated appropriately.

Antimicrobial prophylaxis is considered sufficient to preserve an acceptable surgical site infection rate in clean orthopaedic and neurosurgeries in dogs

BackgroundSurgical site infections (SSI) are associated with increased morbidity and mortality. To lower the incidence of SSI, antimicrobial prophylaxis is given 30–60 min before certain types of surgeries in both human and veterinary patients. However, due to the increasing concern of antimicrobial resistance, the benefit of antimicrobial prophylaxis in clean orthopaedic and neurosurgeries warrants investigation. The aims of this retrospective cross-sectional study were to review the rate of SSI and evaluate the compliance with antimicrobial guidelines in dogs at a veterinary teaching hospital in 2012–2016. In addition, possible risk factors for SSI were assessed.ResultsNearly all dogs (377/406; 92.9%) received antimicrobial prophylaxis. Twenty-nine dogs (7.1%) did not receive any antimicrobials and only four (1.1%) received postoperative antimicrobials. The compliance with in-house and national protocols was excellent regarding the choice of prophylactic antimicrobial (cefazolin), but there was room for improvement in the timing of prophylaxis administration. Follow-up data was available for 89.4% (363/406) of the dogs. Mean follow-up time was 464 days (range: 3–2600 days). The overall SSI rate was 6.3%: in orthopaedic surgeries it was 6.7%, and in neurosurgeries it was 4.2%. The lowest SSI rates (0%) were seen in extracapsular repair of cranial cruciate ligament rupture, ulnar ostectomy, femoral head and neck excision, arthrotomy and coxofemoral luxation repair. The highest SSI rate (25.0%) was seen in arthrodesis. Omission of antimicrobials did not increase the risk for SSI (P = 0.56; OR 1.7; CI95% 0.4–5.0). Several risk factors for SSI were identified, including methicillin-resistant Staphylococcus pseudintermedius carriage (P = 0.02; OR 9.0; CI95% 1.4–57.9) and higher body temperature (P = 0.03; OR 1.69; CI95% 1.0–2.7; mean difference + 0.4 °C compared to dogs without SSI).ConclusionsAntimicrobial prophylaxis without postoperative antimicrobials is sufficient to maintain the overall rate of SSI at a level similar to published data in canine clean orthopedic and neurosurgeries.

Effects of quadriceps angle on patellofemoral contact pressure.

BackgroundAn inappropriate Q angle may affect the biomechanics of the canine patellofemoral joint.ObjectivesThe purpose of this study was to evaluate the effects of changes in quadriceps angle (Q angle) on patellofemoral joint pressure distribution in dogs.MethodsEight stifles were positioned at 45, 60, 75, 90, 105, and 120° of flexion in vitro, and 30% body weight was applied through the quadriceps. Patellofemoral contact pressure distribution was mapped and quantified using pressure-sensitive film. For the pressure area, mean pressure, peak pressure, medial peak pressure, and lateral peak pressure, differences between groups according to conditions for changing the Q angle were statistically compared.ResultsIncreases of 10° of the Q angle result in increases in the pressure area (P = 0.04), mean pressure (P = 0.003), peak pressure, and medial peak pressure (P ≤ 0.01). Increasing the Q angle by 20° increases the pressure area (P = 0.021), mean pressure (P ≤ 0.001), peak pressure (P ≤ 0.01), and medial peak pressure (P ≤ 0.01) significantly, and shows higher mean (P ≤ 0.001) and peak pressures than increasing by 10°. Decreasing the Q angle increases the mean pressure (P = 0.013), peak pressure, and lateral peak pressure (P ≤ 0.001).ConclusionsBoth increases and decreases in the Q angle were associated with increased peak patellofemoral pressure, which could contribute to the overloading of the cartilage. Therefore, the abnormal Q angle should be corrected to the physiologically normal value during patellar luxation repair and overcorrection should be avoided.

Effect of Serum IL-1beta of PCSO-524 and Firocoxib in Dogs Undergoing Medial Patellar Luxation Repair

Effect of Serum IL-1beta of PCSO-524 and Firocoxib in Dogs Undergoing Medial Patellar Luxation Repair

Degenerative Joint Disease After Medial Patellar Luxation Repair in Dogs with or Without Trochleoplasty

We evaluated outcomes of dogs surgically treated for grade 2 or 3 medial patellar luxation (MPL) with and without trochleoplasty. A retrospective study of 63 dogs with grade 2 or 3 MPL surgically treated with or without trochleoplasty was performed. Results of radiographic evaluation were expressed numerically as degenerative joint disease score and were compared between the groups with and without trochleoplasty. The study included 7 (7/68, 10.3%) cases of reluxation and 1 case of tibial tuberosity transposition implant failure. Reluxation and complications requiring additional surgery were confirmed in 3 cases (3/47, 6.4%) in trochleoplasty group and in 1 case (1/21, 4.8%) in nontrochleoplasty group. The nontrochleoplasty group showed a shorter recovery time than the trochleoplasty group (P < 0·05). There was a significant difference in degenerative joint disease scores over time between the groups, with nontrochleoplasty group having lower scores (P < 0·05). This study suggests that surgical treatment without trochleoplasty results in favorable outcomes compared to treatment with trochleoplasty. It is not mandatory to exclude trochleoplasty when performing surgery for grade 2 or 3 MPL, but we propose that surgical treatment without trochleoplasty is one option when choosing a combination of surgical techniques.

Hip Toggle Stabilization Using the TightRope® System in 17 Dogs: Technique and Long‐Term Outcome

To describe the technique for, and long-term clinical outcome of, a modified hip toggle stabilization using the TightRope® system for coxofemoral luxation repair. Retrospective case series. Medical records (July 2008-July 2010) including radiographs (17 limbs) of dogs that had coxofemoral luxation repaired with the TightRope system were reviewed. Follow-up (≥12 months) was obtained by telephone interview of owners. Six dogs were available for re-evaluation, radiographs, and objective gait analysis. Follow-up (mean, 24 months; range, 12-43 months) by telephone interview was available for 17 dogs. Of these, 6 dogs were re-evaluated (mean, 7.5 months; median 12.5 months: range, 4-24 months) and had gait analysis. Mean duration of luxation before surgical intervention was 7.5 days (median, 7 days; range, 2-44 days). There was a single case of relaxation 27 months postoperatively. One dog died from non-surgical related circumstances. Objective gait analysis showed equal pelvic limb use in all 6 dogs available for re-evaluation. All owners of living dogs reported limb function as being good to excellent, and perceived that their dogs were pain free. Radiographs (mean, 7.5 months; median, 12.5 months; range, 4-24 months post surgery) of 6 dogs showed no progression of osteoarthritis in comparison to immediate postoperative radiographs. Hip toggle with the TightRope system as a prosthetic ligament of the head of the femur produces a favorable clinical outcome with high owner acceptance.

Isoflurane Concentration when Compared with Intramuscular Morphine during Patellar Luxation Repair in Dogs

Isoflurane Concentration when Compared with Intramuscular Morphine during Patellar Luxation Repair in Dogs

Tube Realignment for Patellar Luxation Repair in Dogs

Tube Realignment for Patellar Luxation Repair in Dogs

Ventral abdominal approach for screw fixation of sacroiliac luxation in clinically affected cats

To investigate sacroiliac luxation repair with positional screw insertion from the ventral surface of the sacral wing via a ventral abdominal approach in cats. 18 European shorthair cats. All cats underwent clinical examination including orthopedic and neurologic examination and assessment of lameness and pain before and immediately after surgery and 6 and 16 weeks after surgery. All sacroiliac luxations were stabilized with a single positional 2.4-mm cortical titanium self-tapping screw. The pelvic floor was also repaired in selected cats. Screw entry points and angles determined in a prior study of cadavers were used. Radiographs were taken before surgery and during follow-up evaluations to assess postoperative sacroiliac luxation reduction, implant placement, and repair stability. All implants were placed correctly. Iatrogenic sciatic nerve injuries occurred in 2 cats. Median time to ambulation was 1.5 days for cats with sacroiliac luxation as the sole injury. Radiographic outcome of sacroiliac luxation repair was excellent in 15 of 17 repairs, good in 1 of 17 repairs, and poor in 1 of 17 repairs. Clinical outcome was excellent in 11 of 15 cats and good in 4 of 15 cats. Insertion of a positional screw across the sacroiliac joint via a ventral abdominal approached can be an alternative to conventional techniques of sacroiliac luxation repair in cats. This novel technique allowed repair of bilateral sacroiliac luxation, repair of pelvic floor fractures, and treatment of soft tissue injuries of the abdominal cavity or abdominal organs with a single approach.

Iatrogenic Sciatic Nerve Injury in Eighteen Dogs and Nine Cats (1997–2006)

To report clinical features associated with iatrogenic peripheral nerve injury in dogs and cats admitted (1997-2006) to a referral teaching hospital. Retrospective study. Dogs (n=18), 9 cats. Patients had acute signs of monoparesis attributable to sciatic nerve dysfunction that developed after treatment. Neurologic examination and electrodiagnostic testing were performed. Surgical therapy was used for nerve entrapment and delayed reconstructive surgery used in other cases. Of 27 nerve injuries, 25 resulted from surgery (18 with treatment of pelvic injuries). Iliosacral luxation repair resulted in tibial (4 cats) and peroneal (3 dogs) nerve dysfunction. Other causes were intramedullary pinning of femoral fractures (3), other orthopedic surgery (cemented hip prosthesis [2] and tibial plateau-leveling osteotomy [1]), and perineal herniorrhaphy [1]. Nerve injury occurred after intramuscular injection (1 cat, 1 dog). Immediate surgical treatment was removal of intramedullary nails, extruded cement, or entrapping suture. Delayed nerve transplantation was performed in 2 dogs. Within 1 year, 13 patients recovered completely, clinical improvement occurred in 7, and there was no improvement in 7. Five of the 7 dogs that did not recover had acetabular or ilium fracture. Iatrogenic sciatic nerve injury occurred most commonly during treatment of pelvic orthopedic diseases and had a poor prognosis. Clinical variation in sciatic nerve dysfunction in dogs and cats can be explained by species anatomic differences. Iatrogenic sciatic nerve injury leads to severely debilitating locomotor dysfunction with an uncertain prognosis for full-functional recovery.

Biomechanical evaluation of a veterinary suture anchor in the canine cadaver pelvis and femur

A commercially available veterinary suture anchor was tested in the acetabula and femurs of canine cadavers. Size #2 suture anchor constructs were compared to a traditional screw and Teflon spiked washer constructs in a model of coxofemoral luxation repair. The screw/washer constructs failed at a higher maximum load than the #2 anchor constructs. In the acetabulum, significant differences in strength were also found in the position of the implant and in the direction of pull. The constructs in a more caudal position, and constructs pulled 90 degrees to the axis of insertion, failed at higher loads. The predominant mode of failure of the constructs was a suture failure. In the femur, size #5 suture anchors were used in a model of cranial cruciate ligament repair and collateral ligament repair. The anchor constructs failed predominantly by anchor pull-out in the distal femur. The constructs pulled 90 degrees to the axis of insertion were stronger than construcs pulled at 0 degrees to the axis of insertion. Varying the location of the implant in the femur did not affect the maximum load to failure.

Stifle Luxation Repair by Articular Stabilization Technique with Non-Absorbable Suture in a White-Fronted Goose and Therapeutical Trial in a Domestic Pigeon

Stifle Luxation Repair by Articular Stabilization Technique with Non-Absorbable Suture in a White-Fronted Goose and Therapeutical Trial in a Domestic Pigeon

A Novel Surgical Technique for Luxation Repair of the Femorotibial Joint in a Monk Parakeet (Myiopsitta monachus)

An 8-week-old male monk parakeet (Myiopsitta monachus) was presented with hyperextension of the right femorotibial joint. A craniolateral luxation of the right tibiotarsus was observed radiographically. A new surgical repair technique was applied. Intramedullary pins were normograded into the femur and tibiotarsus from the knee. These pins were joined with an acrylic fixator at the exit from the joint with the leg placed in normal anatomic position. This technique and physical therapy resulted in repair of the luxation, normal range of motion, and full return to function of the femorotibial joint.

Stifle Luxation Repair in a Moluccan Cockatoo and a Barn Owl

New York, New York 10021 An eight-year-oldMoluccan Cockatoo developed a severe stifle luxation after a traumatic event. Due to the severity of the injury, the decision was made to arthrodese the stifle. In order to fuse the stifle in a functional position, multiple K-wires were placed in the lateral aspect of the femur and tibiotarsus, and a type-1 external fixator with a connecting bar composed of an acrylic polymer was used. The bird was weight bearing by day 4 after surgery, and 7 months after surgery the stifle was stable with no detectable movement. A seven-month-old Barn Owl was examined because of a closed stfle luxation. The stifle luxation was reduced and stabilized by an externalfixation method similar to the one used for the cockatoo. External fixation for stifle repair in birds offers the advantages of no permanent implant, use of the limb during convalescence, and early return to function.

Stifle Luxation Repair in a Moluccan Cockatoo and a Barn Owl

Stifle Luxation Repair in a Moluccan Cockatoo and a Barn Owl