Outcome and owner assessment after single-session bilateral tibial plateau leveling osteotomy in 127 dogs.

Objective: To retrospectively evaluate complication rates following bilateral tibial plateau leveling osteotomy (TPLO) as well as owner assessment of outcomes and post-operative management. Methods: Medical records of dogs presenting with bilateral cranial cruciate ligament (CCL) disease that underwent single-session bilateral TPLO from 2015 to 2019 in 1 referral practice were retrospectively reviewed. A non-validated questionnaire was sent to the owners to assess their ability to cope during the rehabilitation period, as well as procedure outcome. Results: In total, 127 dogs were included for analysis. The overall complication rate was 16.5% (minor complication rate 9.4% and major complication rate 10.2%). Of the 50 owners that answered the questionnaire, 31 (62%) did not need to use sling support at home at any time and 10 (20%) used sling support for < 1 wk. Furthermore, only 1 owner indicated that they would not choose to do a bilateral TPLO surgery again. Clinical significance: Bilateral single-session TPLO surgery performed by an experienced surgeon had a similar outcome and complication rate to that of unilateral TPLO surgery. Most owners reported that postoperative care of their dog was not difficult.

Résultats et évaluation par le propriétaire après une ostéotomie bilatérale de nivellement du plateau tibial e n une seule séance chez 127 chiens. Objectif: Évaluer rétrospectivement les taux de complications après une ostéotomie bilatérale de nivellement du plateau tibial (TPLO) ainsi que l'évaluation par le propriétaire des résultats et de la prise en charge postopératoire. Méthodes: Les dossiers médicaux des chiens présentant une pathologie bilatérale du ligament croisé crânien (CCL) ayant subi une TPLO bilatérale en une seule séance de 2015 à 2019 dans une pratique de référence ont été examinés rétrospectivement. Un questionnaire non validé a été envoyé aux propriétaires pour évaluer leur capacité à faire face pendant la période de réhabilitation, ainsi que le résultat de la procédure. Résultats: Au total, 127 chiens ont été inclus pour l'analyse. Le taux global de complications était de 16,5 % (taux de complications mineures 9,4 % et taux de complications majeures 10,2 %). Sur les 50 propriétaires qui ont répondu au questionnaire, 31 (62 %) n'ont pas eu besoin d'utiliser une écharpe à domicile à tout moment et 10 (20 %) ont utilisé une écharpe pendant < 1 semaine. De plus, un seul propriétaire a indiqué qu'il ne choisirait pas de refaire une chirurgie bilatérale TPLO. Signification clinique: La chirurgie TPLO bilatérale en une seule séance réalisée par un chirurgien expérimenté a eu un résultat et un taux de complications similaires à ceux de la chirurgie TPLO unilatérale. La plupart des propriétaires ont déclaré que les soins postopératoires de leur chien n'étaient pas difficiles.(Traduit par Dr Serge Messier).

The value of routine radiographic follow up in the postoperative management of canine medial patellar luxation.

OBJECTIVE: To determine the influence of radiographic examination on the recommendations made at the time of planned re-evaluation of dogs after medial patellar luxation (MPL) surgery. STUDY DESIGN: Retrospective multi-institutional case series. ANIMALS: Client-owned dogs (N = 825) that underwent MPL surgery. METHODS: Records of 10 referral institutions were searched for dogs that had been treated surgically for unilateral MPL and underwent a planned follow-up visit, including radiographs. The frequency of, and reasons for, changes in further recovery recommendations were investigated. RESULTS: Follow up was performed at a median of 6 (range, 4-20) weeks postoperatively. Isolated radiographic abnormalities were identified in 3.3% (27/825) of dogs following MPL surgery and led to a change in recommendations in 3% (13/432) of dogs that were presented without owner or clinician concerns. Lameness, administration of analgesia at follow up, and history of unplanned visits prior to routine re-examination were associated with a change in postoperative plan (P < .001). In the absence of owner and clinician concerns, the odds of having a change in convalescence plans were not different, whether or not isolated radiographic abnormalities were present (P = .641). CONCLUSION: Routine radiographs at follow up did not influence postoperative management of most dogs after MPL surgery in the absence of abnormalities on clinical history or orthopedic examination. CLINICAL SIGNIFICANCE: Dogs that were presented for routine follow up after unilateral MPL surgery without owner concerns, lameness, analgesic treatment or a history of unplanned visits, and for which examination by a surgical specialist was unremarkable, were unlikely to benefit from radiographs.

Analysis of feline humeral fracture morphology and a comparison of fracture repair stabilisation methods: 101 cases (2009-2020).

OBJECTIVES: The aims of this study were to describe the type, presentation and prognostic factors of feline humeral fractures over a 10-year period and to compare three stabilisation systems for feline humeral diaphyseal fractures. METHODS: In total, 101 cats with humeral fractures presenting to seven UK referral centres between 2009 and 2020 were reviewed. Data collected included signalment, weight at the time of surgery, fracture aetiology, preoperative presentation, fixation method, surgical details, perioperative management and follow-up examinations. Of these cases, 57 cats with humeral diaphyseal fractures stabilised using three different fixation methods were compared, with outcome parameters including the time to radiographic healing, time to function and complication rate. RESULTS: The majority of the fractures were diaphyseal (71%), with only 10% condylar. Of the known causes of fracture, road traffic accidents (RTAs) were the most common. Neutered males were over-represented in having a fracture caused by an RTA (P = 0.001) and diaphyseal fractures were significantly more likely to result from an RTA (P = 0.01). Body weight had a positive correlation (r = 0.398) with time to radiographic healing and time to acceptable function (r = 0.315), and was significant (P = 0.014 and P = 0.037, respectively). Of the 57 humeral diaphyseal fractures; 16 (28%) were stabilised using a plate-rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only. Open diaphyseal fractures were associated with more minor complications (P = 0.048). There was a significant difference between fixation groups in terms of overall complication rate between groups (P = 0.012). There was no significant difference between fixation groups in time to radiographic union (P = 0.145) or time to acceptable function (P = 0.306). CONCLUSIONS AND RELEVANCE: All three fixation systems were successful in healing a wide variety of humeral diaphyseal fractures. There was a significantly higher overall complication rate with external skeletal fixators compared with bone plating; however, the clinical impact of these is likely low.

Repair of Fractures of the Lateral Aspect of the Humeral Condyle in Skeletally Mature Dogs with Locking and Non-Locking Plates.

OBJECTIVE: The aim of this study was to report the functional outcome and complications following transcondylar screw and epicondylar plate fixation of skeletally mature dogs with fractures of the lateral aspect of the humeral condyle using a string of pearls, limited contact dynamic compression plate (LC-DCP) or locking compression plate (LCP). STUDY DESIGN: This study was a retrospective review of clinical records, radiographic images and canine brief pain inventory evaluation with a supplementary non-validated questionnaire. RESULTS: Thirty-one fractures in 29 dogs were included. The majority of dogs were Spaniels (23/29). Thirty fractures had evidence of humeral intracondylar fissure. Sixteen fractures had string of pearls, eight LCP and seven LC-DCP. There were two minor complications and three major complications. Perioperative (median: 6 weeks, range: 6-12) outcome was considered fully functional for 24 fractures and acceptable for 6 fractures. One dog had an unacceptable outcome due to the failure of an LCP that healed following revision surgery. Fractures with radiographic follow-up had a persistent visible intracondylar fracture line in 20/26. Twenty-six of twenty-seven owners perceived an excellent outcome (median: 135 weeks, range: 25-246). CONCLUSION: Repair of fractures of the lateral aspect of the humeral condyle with a transcondylar screw and epicondylar plate has a good perioperative, mid- and long-term outcome with 10% major complication rate, despite incomplete or non-union of the intracondylar fracture in 20/26 elbows.

Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy.

OBJECTIVE: To determine the influence of follow-up radiographic examination on recommendations made during routine clinical re-evaluation of dogs that had undergone uncomplicated tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective multi-institutional case series. ANIMALS: Client-owned dogs (N = 1010) that underwent uncomplicated TPLO. METHODS: Records from 11 institutions were searched for dogs that had been treated with unilateral TPLO and had no history of postoperative complications before their routine follow-up examination. The frequency of change in further clinical recommendations resulting from client- or clinician-voiced concerns or radiographic abnormalities was investigated. RESULTS: Follow-up evaluation was performed at a median of 6 (range, 4-15) weeks after TPLO. 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. Abnormal radiographic findings alone influenced the management of 3.76% (38/1010) of dogs. An association was detected between clinical features and radiological findings leading to a change in recommendations (P < .0001). Administration of analgesia at the time of follow-up was associated with radiographic abnormalities (P = .017) and change in postoperative plans (P = .0007). CONCLUSION: Radiographic examination findings at follow-up did not influence the management of most dogs with uncomplicated TPLO. CLINICAL SIGNIFICANCE: 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.

Pubic fractures secondary to extended transpelvic urethrostomy in a cat.

OBJECTIVE: To report the occurrence and describe the management of pubic fractures after the use of an extended transpelvic urethrostomy (TPU) to treat postprostatic intrapelvic urethral obstruction and laceration in a cat. ANIMAL: One 6-year-old domestic short-haired cat. STUDY DESIGN: Case report. METHODS: A cat was presented with urethral obstruction and laceration confirmed by positive contrast retrograde urethrography. Temporary urinary diversion was performed. An attempt was made to perform perineal urethrostomy, but the cranial location of the laceration precluded this technique. An extended TPU was performed, which required removal of 30% to 60% greater length of pelvic bone than has been previously described. RESULTS: Bilateral pubic ramus fractures occurred 1 week after surgery, from which the cat clinically improved with cage rest, and exhibited evidence of healing according to computed tomography after 8 weeks. CONCLUSION: Extended TPU used to treat postprostatic intrapelvic urethral laceration may lead to pubic fractures postoperatively. CLINICAL SIGNIFICANCE: It may be prudent to rest any cat that has had a TPU or extended TPU to reduce fracture risk.

Single Transsacral Screw and Nut Stabilization of Bilateral Sacroiliac Luxation in 20 Cats.

OBJECTIVE: This article aims to describe the use of a single transsacral screw and nut in a cohort of cats with bilateral sacroiliac (SI) luxation and document its radiographic and clinical outcome. METHODS: Medical records and radiographic studies of cats with bilateral SI luxation managed with a transsacral screw and nut stabilization were reviewed. Short-term follow-up included clinical examination and radiographs. Long-term follow-up was via owner questionnaire. RESULTS: Twenty consecutive cats with bilateral SI luxation were included. Six cats (35%) had additional musculoskeletal injuries that required stabilization. Luxations were stabilized with a single 2.7 cortical self-tapping transsacral screw and nylon nut (a metallic nut was used in one case). Postoperative radiographs confirmed SI reduction in all cats and a mean pelvic canal width ratio of 1.21 (a ratio of ≥1.1 was considered optimal). All cats available at follow-up examination were able to walk without signs of discomfort. Evaluation of follow-up radiographs showed maintenance of SI reduction and slight reduction of mean pelvic canal width ratio (1.18). Fourteen owner questionnaires were returned (median follow-up time of 40 months): nine cats were deemed to have normal activity and five cats were reported to have slight to mild reduced ability to jump or run. CLINICAL SIGNIFICANCE: The use of transsacral screw and nut stabilization of bilateral SI luxation in cats is a successful, repeatable and safe technique.

Radiographic, Surgeon and Owner Assessment of the BioMedtrix TATE(®) Elbow Arthroplasty.

OBJECTIVE: To report the long-term radiographic and clinical outcome of the BioMedtrix TATE elbow arthroplasty system in dogs. Assessment was via radiographs, a surgeon-based questionnaire, and owner assessment of outcome using the Liverpool osteoarthritis in dogs (LOAD) and canine brief pain inventory (CBPI) questionnaires. STUDY DESIGN: Retrospective multicenter, case series. ANIMALS: Client-owned dogs undergoing TATE elbow arthroplasty. METHODS: Questionnaires were distributed to surgeons in the United Kingdom performing TATE elbow arthroplasty and to the owners of the dogs operated on. Owners completed the LOAD and CBPI questionnaires. All completed questionnaires from surgeons and owners, and radiographs of the dogs were collated and analyzed. RESULTS: Surgeon questionnaires and radiographs were obtained for 33 elbows from 32 dogs, with owner questionnaires obtained for 19 dogs. Perioperative, short-term, and mid-term complication rates were 60%, 15%, and 15%, respectively. Radiographic assessment of component alignment showed 62% of cartridges were valgus or varus malaligned and 56% of cartridges were either translated medially or laterally relative to the long axis of the ulnar. There was no significant association between component alignment and final clinical outcome. Surgeon assessment reported 24% of dogs to have full, 52% acceptable, and 24% unacceptable outcome. Owner assessment showed significant decreases in pain severity and pain interference from preoperative to final status but no change in mobility scores. CONCLUSIONS: A high complication rate and variability in component placement was recorded with TATE athroplasty. However, component malalignment did not negatively impact clinical outcome. Final clinical outcome was favorable for most cases with significant reductions in pain severity and interference scores despite no changes in mobility scores.

Efficacy of Postoperative Antimicrobial Use for Clean Orthopedic Implant Surgery in Dogs: A Prospective Randomized Study in 100 Consecutive Cases.

OBJECTIVES: To investigate whether administration of postoperative oral antimicrobial drugs has a beneficial effect on preventing surgical site infections (SSI) in clean orthopedic surgery involving stainless steel plating systems. STUDY DESIGN: Randomized prospective clinical study. ANIMALS: Dogs (n = 97). METHODS: One hundred consecutive cases (97 dogs) that had clean orthopedic surgery requiring stainless steel plate fixation were randomly assigned using a random number generator to either YES group (administration of postoperative oral antimicrobials) or NO group (no administration of postoperative oral antimicrobials). Dogs in YES group were administered oral cefalexin or potentiated amoxicillin for 7 days, whereas dogs in NO group were discharged without oral antibiotics. Minimum follow-up was 12 months. Multivariable logistic regression was used to determine risk factors for SSI. RESULTS: Overall postoperative infection rate was 12.9%. Infection occurred in 2 cases (4.3%) administered postoperative oral antimicrobials and in 10 cases (21.3%) not administered postoperative antimicrobials. Total anesthetic time and use of oral antimicrobials were the only significant factors associated with SSI. Use of postoperative antimicrobials was associated with a significant reduction in the risk of infection by ~84% and risk of infection was increased by ~2% for each minute increase in anesthesia time. CONCLUSIONS: Administration of oral postoperative antimicrobials had a protective effect against development of SSI in clean orthopedic implant surgery.

Hips, elbows and stifles: common joint diseases in the cat.

PRACTICAL RELEVANCE: Cats commonly present with joint disease and trauma. A methodical approach to diagnostics and treatment can aid the clinician in the management of these cases. CLINICAL CHALLENGES: Cats with joint disease may present with a vague history owing to their independent nature, and gait assessment is often challenging when compared with the dog. Knowledge of feline-specific anatomy is important to avoid over- or misinterpretation of physical examination or imaging findings. AUDIENCE: This review of feline joint disease focuses on the more common, non-traumatic conditions of the hip, stifle and elbow. It aims to provide first opinion clinicians with a guide to decision making that will assist them in achieving a diagnosis and formulating a management strategy. EVIDENCE BASE: There is an extensive body of original articles and textbooks in the published literature relating to aspects of feline joint disease. This article combines information from key companion animal and feline-specific references together with the author's clinical experience to provide a practical overview of joint disease, and highlight important differences between cats and dogs in terms of presentation and treatment.

Use of a latissimus dorsi myocutaneous flap for one-stage reconstruction of the thoracic wall after en bloc resection of primary rib chondrosarcoma in five dogs.

OBJECTIVE: To describe a thoracic wall reconstructive technique using a latissimus dorsi myocutaneous flap after en bloc resection of primary rib chondrosarcoma and report outcome in 5 dogs. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n=5) with primary rib chondrosarcoma. METHODS: Medical records (2003-2005) were reviewed for signalment, staging investigations, surgical findings, complications, and outcomes. Owners and veterinary surgeons were contacted for outcome information. RESULTS: A latissimus dorsi myocutaneous flap provided an air-tight thoracic wall closure after chondrosarcoma resection. Paradoxical respiratory movement of the flap occurred; however, from physical examination and blood gas analysis (2 dogs), ventilation was adequate. All flaps survived, 1 had superficial skin necrosis distally and 2 had minor wound dehiscence. One dog without tumor-free margins died of tumor-related disease 56 days after surgery. Tumor recurrence did not occur in 4 dogs with tumor-free margins. One dog was euthanatized 10 months after surgery for unrelated disease; 3 dogs were alive at writing (median follow-up: 20 months; range, 18-27 months) and all had a satisfactory functional and cosmetic outcome. CONCLUSIONS: Reconstruction of ventral thoracic wall defects using a latissimus dorsi myocutaneous flap yields a functional, cosmetic outcome. CLINICAL RELEVANCE: A latissimus dorsi myocutaneous flap can be used as a successful 1-stage reconstructive technique for ventral thoracic wall defects.

Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995-2006).

OBJECTIVE: To determine indications for cystostomy tube use in dogs and cats, complications associated with their use, and outcome of dogs and cats in which cystostomy tubes had been inserted. DESIGN: Retrospective case series. ANIMALS: 37 dogs and 39 cats. PROCEDURES: Information was obtained from medical records. Long-term follow-up information was obtained by use of a client questionnaire. RESULTS: Indications for cystostomy tube placement were bladder dysfunction, urinary tract rupture, obstructive urinary tract neoplasia, urinary diversion following urogenital surgery, obstructive urolithiasis, and feline lower urinary tract disease. Median time tubes were in place was 11 days, but duration of tube use was significantly longer for animals with bladder dysfunction than for animals with urinary tract trauma, urinary diversion, or urinary tract obstruction. Thirty-seven (49%) animals had tube complications. Development of complications was not significantly associated with species, age, body weight, duration of tube use, or tube type, except that animals were significantly more likely to develop complications following long-rather than short-term use. In 42 animals, the underlying condition resolved and the tube was removed; 22 animals died or were euthanatized with the tube in place. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that cystostomy tubes may be used for animals with various conditions related to problems with urine outflow. Nearly half the animals in the study developed complications related to the cystostomy tube, suggesting that potential complications should be discussed with owners prior to tube placement. However, most complications were easily resolved.

Lingual haemangiosarcoma in a crossbred dog.

An eight-year-old, male neutered, crossbred dog was presented for investigation of a lingual mass of four months duration. Oral examination revealed a 7 cm × 5 cm soft, fluctuant mass at the caudal aspect of the tongue. Ultrasound examination of the mass demonstrated mixed echogenicity, with cavitations containing hypoechoic and anechoic regions. Lingual haemangiosarcoma was diagnosed on histopathological examination of multiple biopsy samples, with confirmation of the vascular endothelial origin of tumour cells by positive immunolabelling for factor VIII-related antigen.