Tibial Plateau Leveling Osteotomy Research Articles

Torsional comparative biomechanical test of modified tibial-plateau-leveling osteotomy plate and locking plate in canine synthetic tíbias

ABSTRACT The objective of this study was to develop a locked tibial-plateau-leveling osteotomy (TPLO) plate and to compare this implant with the conventional bone fixation method using a locked plate to determine bone stabilization against torsion forces. Maximum force, angle at peak torque, and stiffness values were determined. Ten synthetic tibias were used, divided into 2 groups. The results in Group 1 (modified TPLO plate) and Group 2 (locked plate) were assessed using analysis of variance and the means were compared using Tukey’s test at 5% probability. There were significant differences in the angle at peak torque and stiffness. The group Modified TPLO plate had higher mean values of stiffness compared with Group locked plate. Group locked plate showed a greater angle at peak torque compared with Group modified TPLO plate. All constructs failed due to tibial fractures distal to the plate. The modified TPLO plate presented higher stiffness indexes than conventional locked plate in torsion. The locked plate presented greater elasticity than modified TPLO plate having greater angle at the peak of torque.

In canine cranial cruciate ligament rupture is outcome following TPLO improved compared with lateral suture?

PICO question
 In dogs over 15 kg, with cranial cruciate ligament rupture is there evidence of improved outcome following tibial plateau levelling osteotomy or lateral fabellotibial suture?
 Clinical bottom line
 Although the evidence is not conclusive, the literature reviewed here suggests that tibial plateau levelling osteotomy (TPLO) results in superior limb function and owner satisfaction compared to placement of a lateral fabellotibial suture (LFS).
 There is currently insufficient evidence to determine if there is a difference in complication rates or osteoarthritis (OA) development following TPLO or LFS.

Extracorporeal shock wave therapy improves short-term limb use after canine tibial plateau leveling osteotomy.

To determine the influence of postoperative extracorporeal shock wave therapy (ESWT) on hind limb use after tibial plateau leveling osteotomy (TPLO). Randomized, prospective clinical trial. Sixteen client-owned dogs, 2 to 10 years old weighing 18 to 75 kg. Dogs were randomly assigned to treatment cohorts, TPLO with ESWT (ESWT, n = 9) or TPLO without ESWT (control, n = 7). Treatment consisted of 1000 pulses at 0.15 mJ/mm2 immediately and 2 weeks after surgery. Subjective pain, stifle goniometry, stifle circumference, peak vertical force (PVF) and vertical impulse (VI) were measured before surgery, prior to ESWT, and 2 and 8 weeks after surgery. Measures were compared between treatments at each time point and among time points for each treatment (P < .05). The PVF (5.5 ± 1.0 N/kg, mean ± SD) and VI (0.67 ± 0.14 N-s/kg) of surgically treated limbs in the ESWT cohort were higher 8 weeks after surgery compared with preoperative (3.8 ± 1.1 N/kg, P < .0001 and 0.47 ± 0.21 N-s/kg, P = .0012, respectively) values. In the control cohort, PVF (2.9 ± 1.3 N/kg, P = .0001) and VI (0.33 ± 0.20 N-s/kg, P = .0003) 2 weeks after surgery and VI (0.42 ± 0.2 N-s/kg, P = .0012) 8 weeks after surgery were lower (4.59 ± 2.33 N/kg and 0.592 ± 0.35 N-s/kg, respectively) than before surgery. Other parameters did not differ between groups. Weight bearing increased faster after TPLO in dogs treated with postoperative ESWT. This study provides evidence to consider adjunct ESWT after TPLO.

Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms.

To compare surgical site infection (SSI) rates after double locking plate and screw fixation (DLP), standard locking plate and screw fixation (LP), and conventional nonlocking plate and screw fixation (NLP) in dogs weighing >50 kg undergoing tibial plateau leveling osteotomy (TPLO). Retrospective study (January 2003-October 2017). Two hundred seventy-five dogs weighing >50 kg with cranial cruciate ligament disease treated with TPLO. Medical records of dogs weighing >50 kg that underwent TPLO by DLP, LP, and NLP with a minimum follow-up period of 12 months were included. Data collected included signalment, details of any concurrent surgical procedure, type of implant used, use of postoperative antibiotic therapy, occurrence of perioperative complications, and presence of postoperative infection. The probability, risk difference, and relative risk of SSI were estimated for each fixation with a marginal model. Nonlocking plate and screw fixation was used in 114 (41.5%) dogs, LP was used in 128 (46.5%) dogs, and DLP was used in 33 (12%) dogs. Surgical site infection was diagnosed in 48 of 275 (17.5%) dogs. Postoperative antibiotic therapy was used in 74 (64.9%) dogs, 62 (48.4%) dogs, and 32 (97.0%) dogs in the NLP, LP, and DLP groups, respectively. Dogs with NLP, LP, and DLP had postoperative infection rates of 24.5%, 13.3%, and 9.1%, respectively. There were no risk differences for the three groups (Holm-adjusted P > .05). No difference in infection rates was detected between DLP, LP, or NLP for TPLO in these dogs weighing >50 kg. Fixation of TPLO with DLP in dogs weighing >50 kg does not seem to increase the risk of SSI compared with LP and NLP.

Surgical Treatments for Canine Anterior Cruciate Ligament Rupture: Assessing Functional Recovery Through Multibody Comparative Analysis.

Anterior cruciate ligament (ACL) deficiency can result in serious degenerative stifle injuries. Although tibial plateau leveling osteotomy (TPLO) is a common method for the surgical treatment of ACL deficiency, alternative osteotomies, such as a leveling osteotomy based on the center of rotation of angulation (CBLO) are described in the literature. However, whether a CBLO could represent a viable alternative to a TPLO remains to be established. The aim of this study is to compare TPLO and CBLO effectiveness in treating ACL rupture. First, a computational multibody model of a physiological stifle was created using three-dimensional surfaces of a medium-sized canine femur, tibia, fibula and patella. Articular contacts were modeled by means of a formulation describing the contact force as function of the interpenetration between surfaces. Moreover, ligaments were represented by vector forces connecting origin and insertion points. The lengths of the ligaments at rest were optimized simulating the drawer test. The ACL-deficient model was obtained by deactivating the ACL related forces in the optimized physiological one. Then, TPLO and CBLO treatments were virtually performed on the pathological stifle. Finally, the drawer test and a weight-bearing squat movement were performed to compare the treatments effectiveness in terms of tibial anteroposterior translation, patellar ligament force, intra-articular compressive force and quadriceps force. Results from drawer test simulations showed that ACL-deficiency causes an increase of the anterior tibial translation by up to 5.2 mm, while no remarkable differences between CBLO and TPLO were recorded. Overall, squat simulations have demonstrated that both treatments lead to an increase of all considered forces compared to the physiological model. Specifically, CBLO and TPLO produce an increase in compressive forces of 54% and 37%, respectively, at 90° flexion. However, TPLO produces higher compressive forces (up to 16%) with respect to CBLO for wider flexion angles ranging from 135° to 117°. Conversely, TPLO generates lower forces in patellar ligament and quadriceps muscle, compared to CBLO. In light of the higher intra-articular compressive force over the physiological walking range of flexion, which was observed to result from TPLO in the current study, the use of this technique should be carefully considered.

The effect of tibial plateau leveling osteotomy on patellofemoral kinematics in dogs: An in vivo study.

To quantitatively evaluate patellofemoral (PF) kinematics during walking in dogs with cranial cruciate ligament (CrCL) deficiency treated by tibial plateau leveling osteotomy (TPLO). Longitudinal observational study. Dogs with unilateral CrCL deficiency treated by TPLO (n = 10). Horizontal beam fluoroscopic images of the stifles during treadmill walking were acquired 6 months after TPLO. Computed tomography was performed, and digitized bone models of both femurs and patellae were created. These digital models were superimposed over the fluoroscopic images with shape-matching software, and sagittal plane PF kinematics for TPLO-treated and normal contralateral stifles were calculated. Patellofemoral kinematics were described according to phase of gait cycle as well as relative to femorotibial flexion angle. In TPLO-treated stifles, there was an approximately 1-mm increase in cranial displacement of the patella (P < .05) compared with the normal stifle at equivalent femorotibial flexion angles between 120° and 140° and predominately during the stance phase. Proximal-distal translation and patellar flexion angle were mostly unaffected by TPLO when they were assessed according to either equivalent phase of gait cycle or femorotibial flexion angles. In vivo PF kinematics in TPLO-treated stifles were subtly different from normal, characterized by slight cranial shifting of the patella relative to the trochlear groove. The clinical significance of these results remains unknown. These results may provide further understanding into extensor mechanism abnormalities associated with TPLO.

Extended long-term radiographic and functional comparison of tibial plateau leveling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog.

To report extended long-term outcomes of dogs with cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy (TPLO) or tibial tuberosity advancement (TTA). Retrospective clinical cohort study. Client-owned dogs with ≥3 years follow-up (118 dogs, 166 stifles). Records from June 2012 to May 2015 were reviewed. Follow-up examination and radiography were performed in dogs meeting the inclusion criteria. Measures of outcomes included a radiographic osteoarthritis score (preoperative, 8 weeks postoperative, and ≥3 years postoperative), the Canine Brief Pain Inventory, and the Canine Orthopedic Index. Ninety-four dogs treated with TPLO (133 stifles) and 24 dogs treated with TTA (33 stifles) met the inclusion criteria. All dogs underwent meniscal release or partial medial meniscectomy. Osteoarthritis score progressed more after TTA (P = .003) and in dogs with bilateral surgery (P = .022). Long-term outcomes that were better after TPLO compared with TTA included average pain in the last 7 days (P = .007), interference with walking (P = .010), morning stiffness (P = .004), jumping (P = .003) and climbing (P = .040), limping during mild activities (P = .001), and overall quality of life (P = .045). Osteoarthritis progressed more after TTA and in dogs with bilateral stifle surgery. Dogs treated with TPLO subjectively seemed to have less pain and fewer mobility issues. Tibial plateau leveling osteotomy provides a better long-term radiographic and functional outcome than TTA.

A Retrospective Study Using the String of Pearls Tibial Plateau Levelling Osteotomy Locking Plate for the Treatment of Cranial Cruciate Ligament Disease.

The aim of this study was to describe the use of String of Pearls (SOP) tibial plateau levelling osteotomy (TPLO) locking plates for the treatment of cranial cruciate ligament disease and retrospectively assess osteotomy healing, tibial plateau angle (TPA) change (c) and overall complication rates. Medical records and radiographic studies of 170 SOP TPLO surgical procedures were analysed. Radiographic measurement of TPAc and osteotomy union was determined 6 to 8 weeks postoperatively. Intra- and postoperative major and minor complications were identified. Factors influencing TPAc, osteotomy union and complications were assessed. Mean (standard deviation) TPAc was 1.3° (1.61) and median osteotomy union was graded as 2 (26-50%) union. Improved osteotomy union was associated with retention of the antirotational pin (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.3-4; p = 0.005) and reduced TPAc (OR: 0.8; 95%CI: 0.66-0.97; p = 0.02). Complications occurred in 42 (24.7%) procedures with 11 (6.5%) considered major and 31 (18.2%) minor. 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.

Financial impact of ultrasound-guided lumbar plexus and sciatic nerve blocks with electrostimulation for tibial plateau leveling osteotomy surgery in dogs

ObjectiveTo determine the anesthesia cost from ultrasound-guided lumbar plexus and sciatic nerve blocks confirmed with electrostimulation for unilateral tibial plateau leveling osteotomy (TPLO) surgery in dogs. Study designProspective, randomized, blinded clinical trial. AnimalsA group of 20 dogs weighing 33.9 ± 6.0 kg (mean ± standard deviation). MethodsAll dogs were administered hydromorphone and atropine, propofol for induction of anesthesia and isoflurane for maintenance. Hydromorphone and carprofen were administered for recovery. The dogs were randomly assigned to one of two groups, lumbar plexus and sciatic nerve blocks with ropivacaine [regional anesthesia (RA)] or sham blocks with saline [control (CON)]. Fentanyl was administered for rescue analgesia intraoperatively and postoperatively. The cost to manage anesthesia was divided into fixed and variable costs using the micro-costing method. The variable costs were compared using Student’s t test or Mann–Whitney U test. ResultsThe fixed anesthesia costs were equal between groups at US$354.00 per case. The variable anesthesia cost range was US$27.90–100.10 for RA and US$21.00–180.50 for CON. Overall, cost per dog in CON was from –US$6.9 to US$80.4 compared with RA. For 160 TPLO cases per year, hospital cost when RA is performed decreased the cost by $12,864 per year up to increased cost by $1104 per year, depending on the requirements for systemic drugs and incidence/severity of anesthesia complications. The estimated fee charge per case for service necessary to reimburse the cost of a new ultrasound (US$25,000.00) and nerve locator (US$925.00) over their life span of 6 and 10 years, respectively, is US$26.62. Conclusions and clinical relevanceUltrasound-guided lumbar plexus and sciatic nerve blocks with electrostimulation confirmation can increase the anesthesia cost through use of specific equipment. However, in most cases, the anesthesia cost decreased as a result of decreased costs for pain management and treatment of complications.

Comparison of ultrasound-guided lumbar plexus and sciatic nerve blocks with ropivacaine and sham blocks with saline on perianesthetic analgesia and recovery in dogs undergoing tibial plateau leveling osteotomy surgery

ObjectiveTo assess the effects of ultrasound-guided lumbar plexus and sciatic nerve blocks on perianesthetic analgesia and recovery quality in dogs undergoing tibial plateau leveling osteotomy (TPLO). AnimalsA group of twenty 20 dogs. Study designProspective, randomized, blinded, clinical study. MethodsDogs were administered lumbar plexus and sciatic nerve blocks with ropivacaine (1.5 mg kg–1; group RA) or sham blocks with saline (group CON). Dogs were administered hydromorphone (0.2 mg kg–1) and atropine (0.02 mg kg–1) subcutaneously before anesthesia was induced with intravenous propofol and maintained with isoflurane. Variables included duration to perform nerve blocks, intraoperative rescue analgesia, recovery score, postoperative pain scores (modified University of Melbourne, Colorado State University and visual analog pain scales), postoperative rescue analgesia-sedation and complications observed. Two-tailed Student t test, Mann–Whitney test, repeated measures analysis of variance, Friedman test and Fisher exact test were used for comparison. Significance was p < 0.05. ResultsTime to perform nerve blocks was [median (range)] 4.3 (2.6–6.1) minutes after aseptic skin preparation. Total fentanyl requirements were 14.2 ± 9 μg kg–1 and 25.4 ± 10 μg kg–1 (p = 0.02) and incidence of hypotension (mean arterial pressure < 60 mmHg) was 40% and 80% (p = 0.16) for groups RA and CON, respectively. Six of eight group CON dogs required more intensive treatment for hypotension than group RA dogs. Recovery scores were 1 (1–4) and 2.5 (1–4) for groups RA and CON, respectively (p = 0.04). RA dogs were less likely to require fentanyl rescue analgesia during the postoperative period (p = 0.04). Conclusion and clinical relevanceAs part of a multimodal analgesia regimen, ultrasound-guided lumbar plexus and sciatic nerve blocks provided greater analgesia and improved recovery quality in dogs during TPLO surgery.

Use of an amikacin-infused collagen sponge concurrent with implant removal for treatment of tibial plateau leveling osteotomy surgical site infection in 31 cases.

To report the use and long-term outcome of dogs with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPO), treated with an amikacin-infused collagen sponge and implant removal. Retrospective study. Thirty-one client-owned dogs. Medical records were reviewed for dogs with SSI after a TPLO that were treated with surgical implant removal and concurrent implantation of an amikacin-infused collagen sponge. Relevant clinical and surgical data were recorded. The TPLO implants were routinely removed; the surgical site was swabbed for culture. The sponge was aseptically infused with amikacin prior to implantation. Postprocedure examinations consisted of visual inspection of the incision by the surgeon and lameness scoring. Thirty-one dogs met all inclusion criteria. Median follow-up time was 687 days. Short-term examination after implant removal and sponge implantation revealed uneventful incisional healing in 24 dogs. Six (19.4%) dogs exhibited inflamed incision sites a median of 4 days (range, 3-9) postoperatively that resolved without additional treatment. One (3.2%) dog required empirical antibiotic treatment 7 days postoperatively but was lost to long-term follow-up. Long-term follow-up examination revealed no clinical evidence of SSI recurrence and no lameness in the remaining 30 cases. Surgical implant removal and implantation of an absorbable collagen sponge infused with amikacin alone was an effective treatment for postoperative TPLO SSI. This procedure had a 96.8% long-term resolution of SSI. It should be considered as a treatment option for TPLO SSI.

Radiographic evaluation of patellar ligament length after tibial plateau leveling osteotomy in dogs

To radiographically compare patellar ligament length (PLL) in dogs undergoing tibial plateau leveling osteotomy (TPLO) for unilateral cranial cruciate ligament rupture at preoperative, postoperative, and follow-up evaluations. 105 dogs that underwent TPLO for unilateral cranial cruciate ligament rupture at a referral veterinary hospital from October 1, 2008, through November 30, 2017. Medical records were reviewed to obtain information on dog signalment, surgical procedure, and radiographically measured PLL at preoperative, postoperative, and follow-up evaluations. Dogs undergoing TPLO had a shorter PLL at the postoperative and follow-up evaluations, compared with the PLL at the preoperative evaluation. Mean ± SD overall unadjusted PLL decreased significantly by 2.3 ± 3.4% between the preoperative and postoperative evaluation and by 2.8 ± 3.9% between the preoperative and follow-up evaluation. The PLL did not differ significantly between the postoperative and follow-up evaluation; mean PLL decreased by 0.4 ± 3.8% between the postoperative and follow-up evaluation. The PLL was shorter after TPLO in dogs, which was similar to changes observed for humans after high tibial osteotomy procedures. Further evaluation of clinical assessments, joint mobility, ultrasonographic assessments, and kinematic results are needed to determine the relevance of the PLL and whether a decrease in ligament length results in decreased mobility and persistent lameness in dogs, as has been reported for humans.

Autotransfusion using a novel ultrafiltration device (Hemosep, Advancis Surgical) for the management of acute intraoperative haemorrhage in a dog

A one-year-old entire male Caucasian Mountain Dog underwent tibial plateau levelling osteotomy. During surgery the tibialis cranialis artery and vein were inadvertently severed and blood loss reached 20 per cent...

Diagnostic Ultrasound Detection of Changes in Femoral Muscle Mass Recovery after Tibial Plateau Levelling Osteotomy in Dogs.

The goal of this study was to develop a clinically feasible ultrasound (US) protocol that can detect changes in thigh muscle mass in dogs after stifle surgery. The primary aim of this study was to compare previously described US measurement locations of the canine thigh for detecting changes in muscle mass in dogs recovering from tibial plateau levelling osteotomy (TPLO). This was a prospective, exploratory pilot study. Adult dogs (n = 7) undergoing pet-owner elected TPLO were enrolled. Twelve different US measurements were performed in triplicate by a single experienced observer. Measurements were performed at 0, 2, 4 and 8 weeks after surgery at a proximal and distal location along the femur. Data from all available time points and locations were analysed for the main effect of time within modalities. A total of 1,008 US measurements were performed. Measurements of the transverse sectional area of the rectus femoris muscle detected significant (p ≤ 0.05) muscle loss between weeks 0 and 2 at the lateral and medial aspects of the distal location (19% and 15% respectively). Measurements of the thigh muscle thickness were significantly (p < 0.01) increased between 2nd- and 8th- week time points at the lateral aspect of the proximal location (26%). The proximal femoral location, measured from the lateral aspect, appears to be the most suitable US measurement for detecting increases in femoral muscle mass in dogs recovering from TPLO. The provided pilot data suggest that further research evaluating this outcome measure is indicated.

Extracapsular articulating implant to treat cranial cruciate ligament disease in a dog with multiple myeloma

An 11-year-old Border collie was presented for left hindlimb lameness associated with cranial cruciate ligament disease. The history included right tibial plateau levelling osteotomy performed approximately two years previously, with...

Effect of the Centre of Rotation in Tibial Plateau Levelling Osteotomy on Quadriceps Tensile Force: An Ex Vivo Study in Canine Cadavers.

The aim of this study was to determine the effect of the centre of rotation in tibial plateau levelling osteotomy (TPLO) on the tensile force of the quadriceps. Tibial plateau levelling osteotomy was performed on the left pelvic limbs from 20 normal adult Beagle cadavers. To replicate the tensile force of the quadriceps, gastrocnemius and stifle flexor muscles, these muscles were replaced with wires. The tensile force of each wire, cranial tibial displacement and internal tibial rotation were measured under the following conditions: intact cranial cruciate ligament, transected cranial cruciate ligament, ideally centred osteotomy TPLO (ICO group) and distally centred osteotomy TPLO (DCO group). The ratios of the tensile forces for the wires divided by the vertical force were used for analyses. The mean intact and post-TPLO tibial plateau angles (TPA) in the ICO group were 30.3° ± 1.9° and 6.1° ± 1.6°, respectively, and those in the DCO group were 29.8° ± 2.4° and 6.8° ± 0.9°, respectively. The mean quadriceps tensile force after TPLO was significantly greater in the DCO group (3.9 ± 0.3) than the ICO group (3.3 ± 0.4) (p = 0.006). Both groups exhibited tibial caudal displacement after TPLO. The tensile force of the quadriceps muscles changed in accordance with the centre of the osteotomy in TPLO. The DCO group had increased tensile force, which may cause patellar ligament thickening after TPLO. Setting the postoperative TPA at 6° may cause excessive rotation in patients with a normal tensile force of the stifle flexor muscles.

Influence of tibial plateau leveling osteotomy and tibial tuberosity advancement on passive laxity of the cranial cruciate deficient stifle in dogs.

To evaluate the effect of tibial plateau leveling osteotomy (TPLO) and tibial tuberosity transposition (TTA) on craniocaudal stability of the cranial cruciate ligament (CCL) deficient stifle at 3 joint angles. Ex vivo biomechanical study. Eight stifles from 4 dogs. One of the hind limbs was randomly assigned to undergo TPLO or TTA, with the contralateral limb assigned to the alternate procedure. Each specimen was tested with the stifle at 150°, 135°, and 120° of flexion. Cranial translation of the tibia relative to the femur was measured under cranial loads ranging from 0.2 to 2.0 kg with a single motion tracking sensor (Nest of Birds) fixed to the tibia. Each stifle was tested before and after transection of the CCL and after performing the assigned procedure. Tibial plateau leveling osteotomy and TTA caused a decrease in the cranial translation of the tibia relative to the femur, especially at greater angles of flexion. Tibial plateau leveling osteotomy caused a greater decrease in tibial cranial translation and was associated with a degree of translation that did not differ from joints with intact CCL, regardless of the degree of stifle flexion. Tibial plateau leveling osteotomy and TTA caused an angle dependent decrease in craniocaudal translation of the tibia in the CCL deficient stifle. Only TPLO restored translations similar to those of the intact joint at all angles tested. Tibial plateau leveling osteotomy and TTA provide passive stability to the stifle. Tibial plateau leveling osteotomy seems more effective than TTA at restoring craniocaudal stability of the stifle.

Influence of fixation systems on complications after tibial plateau leveling osteotomy in dogs greater than 45.4 kilograms (100 lb).

To determine the influence of 3 fixation systems on complications rate after tibial plateau leveling osteotomy (TPLO) in dogs >45.4 kg. Retrospective case series. Dogs (N = 287, 342 stifles) >45.4 kg with cranial cruciate ligament tear treated with TPLO. The medical records of dogs treated with TPLO were reviewed for fixation and postoperative complications, with a follow-up of at least 6 weeks. A random effects logistic regression model was used to evaluate the association between the type of TPLO fixation system and complications. The fixation systems included a 3.5-mm broad TPLO plate alone (8P; 78.4%), a 3.5-mm broad TPLO plate with SOP (String of Pearls) plate (8AP; 14.9%), and a 3.5-mm standard TPLO plate (6P; 6.7%). Among the included stifles, 214 (62.6%) fixation systems were classified as locking, and 128 (37.4%) were classified as nonlocking. The fixation system was predictive of complications. 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. Locking fixation eliminated the association between weight and complication rate. Fixation of a TPLO with the 8AP increased the risk of complications compared with the 8P in this population of large dogs. Locking fixation of TPLO with a 3.5-mm broad TPLO plate alone should be considered in large dogs because it may reduce complications.

Intra-articular proximal jig pin placement during tibial plateau leveling osteotomy.

Background:During tibial plateau leveling osteotomy (TPLO), a TPLO jig is often used. For placement of the jig, one of the pins is placed slightly distal to the joint line. Erroneous pin placement may lead to intra-articular damage; however, the path of the pin tract has not been thoroughly investigated.Aim:To document the rate and identify potential risk factors of intra-articular jig pin placement in dogs undergoing TPLO with the use of a TPLO jig.Methods:Medical records and pre- and postoperative radiographs (2007–2017) of 696 dogs with TPLO performed with a jig were reviewed. Primary surgeon and tibial plateau angles (TPA) were recorded. Postoperative radiographs were evaluated and classified according to intra-articular jig pin placement. Medial tibial plateau jig pin placement was defined as a radiolucent tract on the osteochondral junction of the medial tibial plateau. Lateral tibial plateau placement was defined as a radiolucent tract within 3 mm of the medial tibial plateau with a pin trajectory penetrating the lateral tibial plateau. Rates of intra-articular jig pin placement were calculated, and associations between intra-articular jig pin placement and surgeon experience and TPA were assessed with a chi-squared test.Results:Thirty-seven (5.32%) dogs had intra-articular placement of the jig pin. Seven dogs had medial tibial plateau jig placement, and 30 had lateral tibial plateau placement. There was no relationship between the TPA or surgeon level of experience and intra-articular placement of the pin.Conclusion:This study serves as a reminder to be cautious when placing the proximal jig pin during TPLO to avoid intra-articular placement. In addition, guidelines for evaluating proximal jig pin placement on postoperative radiographs are provided.

Prospective Evaluation of Surgical Wound Dressings and the Incidence of Surgical Site Infections in Dogs Undergoing a Tibial Plateau Levelling Osteotomy.

The main aim of this study was to evaluate the efficacy of a topical 2-octyl cyanoacrylate (2OC) tissue adhesive and an adhesive barrier dressing (BD) in minimizing the incidence of surgical site infections (SSI) in dogs undergoing a tibial plateau levelling osteotomy (TPLO). In a prospective clinical study, 437 client-owned dogs undergoing a TPLO as treatment for cranial cruciate ligament disease with or without concurrent patellar luxations from July 2015 to September 2016 were included. In each dog, the type of postoperative wound dressing was randomly selected as either no dressing (ND), a 2OC tissue adhesive or an adhesive BD. Direct examination by a veterinarian was performed at 14, 30, 60 and 90 days postoperatively. If dogs did not return for direct examination, owners were contacted with a questionnaire for the final follow-up of at least 90 days. The overall rate of SSI was 2.3% (10/437). Methicillin-resistant Staphylococcus pseudintermedius was the most common bacteria isolated in 9/10 cases. Infection was confirmed in 2.76% (4/145) of dogs with ND, 2.01% (3/149) of dogs with 2OC and 2.10% (3/143) of dogs with BD. Of the dogs that developed an SSI, type of dressing was not a significant risk factor (p = 0.5305) for infection. Increasing body weight was the only significant risk factor that increased the risk of overall infection (odds ratio = 1.03 [95% confidence interval: 1.02-1.05]). In dogs undergoing a TPLO, there may be no clear benefit in the usage of postoperative wound dressings for the prevention of SSI. Increasing body weight was the only significant factor associated with the development of an SSI.