Outcomes associated with treatments for medial, lateral, and multidirectional shoulder instability in dogs.

OBJECTIVES: To describe demographic factors, treatments, and outcomes associated with shoulder instability in dogs. STUDY DESIGN: Multi-center, retrospective cohort study. ANIMALS: Dog (n = 130) with shoulder instability. METHODS: Medical records (October 2007-2010) from 4 hospitals of dogs with shoulder instability were reviewed to document age, breed, weight, and gender, categorize them into diagnosis cohorts of medial (MSI), lateral (LSI), or multidirectional (MDI) instability, determine treatments, and document outcomes. Treatment cohorts were defined as nonsurgical management, radiofrequency-induced thermal capsulorrhaphy (RITC), or shoulder reconstruction. Outcomes based upon clinician reevaluation and owner input >1 year after diagnosis were used to determine success, failure, and complication rates. RESULTS: Most dogs were diagnosed with MSI, but 23% had LSI or MDI. Dogs with MSI treated by reconstruction were more likely than dogs treated without surgery to have a successful outcome (odd's ratio = 3.0; P = .01). Similarly, treatment of MDI with reconstruction was more likely to be associated with a successful outcome than nonsurgical management (odd's ratio = 5.0; P = .007). Success with surgical and nonsurgical management was equivocal between LSI treatment cohorts, but the number of dogs with LSI was small. Complication rates for all treatment cohorts were <10%. CONCLUSIONS: In dogs with shoulder instability, LSI and MDI are less common than MSI. Surgical reconstruction for treatment of MSI and MDI appears to produce a higher likelihood of achieving successful outcomes than nonsurgical management and surgical complication rates were low but these conclusions are tempered by the limitations of the study.

Relationship of physical examination test of shoulder instability to arthroscopic findings in dogs.

OBJECTIVE: To determine the diagnostic validity of commonly used physical examination maneuvers for shoulder instability. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n=24) referred for shoulder arthroscopy. METHODS: Results of physical maneuvers and arthroscopic findings were recorded and sensitivity, specificity, positive likelihood ratios (LR+), and negative likelihood ratios (LR-) were calculated for each of 4 physical examination test findings for arthroscopic changes in the medial, lateral, cranial, or caudal compartments of the shoulder joint viewed in dorsal recumbency by lateral and craniomedial portals. RESULTS: Distribution of compartment changes was: medial (17 dogs), caudal (15), cranial (12), and lateral (5). The biceps test had a moderate effect (LR+=9) on post-test probability of cranial compartment changes and a small effect on post-test probability of lateral and caudal compartment changes (LR+=3 and 2.4, respectively). Hyperabduction had a minimal effect and mediolateral instability test had a small effect (LR+=1.64 and 2.68, respectively) on post-test probability of medial compartment changes. Craniocaudal instability test had little to no effect on post-test probability of changes in any compartment. CONCLUSIONS: Physical examination tests evaluated were limited in their ability to predict the type of arthroscopic pathology in this study population. CLINICAL RELEVANCE: Clinicians should understand that a diagnostic test performs inconsistently based on prevalence of a condition in a given patient population. The use of likelihood ratios can assist clinicians in determining the probability of intraarticular changes from a group with a differing prevalence than the patient population presented.

Improved survival associated with postoperative wound infection in dogs treated with limb-salvage surgery for osteosarcoma.

BACKGROUND: Limb-salvage surgery and adjuvant chemotherapy are performed as a treatment of appendicular osteosarcoma in dogs. Approximately 50% of dogs that undergo limb-salvage surgery develop postoperative surgical wound infections. Postoperative surgical infections may affect survival in cancer patients. The purposes of this study were to examine the effect of surgical wound infection on survival, local recurrence, and metastasis in relation to other prognostic factors for dogs with spontaneous osteosarcoma treated with limb-salvage surgery. METHODS: Forty-seven client-owned dogs with osteosarcoma of the distal radius were treated with limb-salvage surgery and adjuvant chemotherapy--either carboplatin or carboplatin and doxorubicin. Hazard ratios were estimated by using the Cox proportional hazard model, and survival functions were estimated by using the Kaplan-Meier product-limit life-table method. RESULTS: Of the 47 dogs in this study, 32 (68%) developed a postoperative wound infection. Infection, dog weight, and extent of the primary tumor (percentage of length) significantly affected survival, and infection and percentage of length significantly affected time to metastasis. None of the variables considered in this study affected local recurrence. Dogs that were diagnosed with an infection were less likely to die (hazard ratio, .446), and dogs with greater body weight and greater percentage length involvement were more likely to die (hazard ratios of 3.37 and 3.66, respectively). CONCLUSIONS: In dogs with osteosarcoma treated with limb-salvage surgery, infection has a positive influence on survival, as does a smaller initial length of radius involved and lower body weight.

Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs.

OBJECTIVE: To describe a simple method of laparoscopic-assisted ovariohysterectomy (LAOHE) and compare duration of surgery, complications, measures of surgical stress, and postoperative pain with open ovariohysterectomy (OHE) in dogs. DESIGN: Randomized, prospective clinical trial. ANIMALS: 20 healthy sexually intact female dogs weighing >10 kg (22 lb). PROCEDURES: Dogs were randomly allocated to receive conventional OHE or LAOHE. Intraoperative complications, anesthetic complications, total anesthesia time, and total surgery time were recorded. Serum cortisol and glucose concentrations, temperature, heart rate, and respiratory rate were measured preoperatively and 1, 2, 4, 6, 12, and 24 hours postoperatively. Pain scores were assigned by a nonblinded observer at 1, 2, 4, 6, 12, and 24 hours postoperatively. Duration of surgery, pain scores, objective measures of surgical stress, anesthetic complications, and surgical complications were compared between OHE and LAOHE. RESULTS: Age, weight, PCV, and duration of surgery did not differ between treatment groups. Nine of 10 dogs in the OHE group required additional pain medication on the basis of pain scores, whereas none of the dogs in the LAOHE group did. Blood glucose concentrations were significantly increased from preoperative concentrations in the OHE group at 1, 2, 4, and 6 hours postoperatively and at 1 hour postoperatively in the LAOHE group. Cortisol concentrations were significantly increased at 1 and 2 hours postoperatively in the OHE group. CONCLUSIONS AND CLINICAL RELEVANCE: LAOHE caused less pain and surgical stress than OHE and may be more appropriate for an outpatient setting.