Economic Considerations on Costs and Pricing of Two Surgical Techniques for Treating Cranial Cruciate Disease in Dogs.

In surgical treatment of cranial cruciate ligament disease in dogs, Tibial Plateau Levelling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are commonly established procedures and have proven effective in restoring limb function. Unlike clinical outcome, economic aspects have not been studied as extensively. However, the surgical intervention poses an enormous financial burden on patients' owners. In a veterinary practice setting, this study compares prices for TPLO and TTA and examines prices differences as well as potential cost drivers. Charges for veterinary treatments are based on the Gebührenordnung für Tierärztinnen und Tierärzte (GOT), which is mandatory for veterinarians in Germany but allows a certain range in billing. This study found that TPLO is charged at a higher price than TTA; however, this might not cover the additional costs of this procedure. The price is also associated with weight, heavier dogs being more expensive. The underlying strategies for pricing decisions may be based on costs, as efforts for TPLO and heavier dogs are higher in terms of a prolonged surgical time, the number of staff involved and in surgeons' training. Price setting may also be based on a quality promise, suggesting better clinical outcome in a more expensive procedure. Future investigations should involve economic considerations and consider cost-effectiveness analysis when evaluating surgical treatment options.

Computed tomographic assessment of the completeness of arthroscopic subtotal coronoidectomy in dogs with medial coronoid disease.

BACKGROUND: Until recent years, arthroscopic subtotal coronoidectomy has been the universally accepted treatment for medial coronoid disease but has variable clinical outcomes. The aim of this study was to evaluate the completeness of arthroscopic medial coronoid debridement and to detect the most vulnerable location of failure. METHODS: Eighty-three dogs with a diagnosis of medial coronoid disease were included in the study. Arthroscopic debridement was performed in 92 elbow joints, and the completeness of removal was assessed by postoperative computed tomography scans. RESULTS: Pathological changes were confined to the coronoid apex in 92/92 (100%) of cases and combined with radial incisure lesions in 39/92 (42%). Apical lesions were completely removed in 66/92 (72%) of cases and radial incisure lesions in 2/39 (5%). Bony remnants were detected at the apex (46%) and base (24%) of the medial coronoid process, free within the elbow joint (9%), and/or within the instrument port (84%). Fissures were positively associated with the occurrence of bony remnants (p = 0.038) and a 37% higher probability of incomplete removal of radial incisure lesions (p = 0.001). CONCLUSION: In this study, incomplete removal was more likely to occur in the presence of radial incisure lesions. Thorough assessment of this region during arthroscopy is strongly recommended.

Tibial plateau levelling osteotomy using a dome-shaped saw blade for canine cranial cruciate ligament insufficiency.

BACKGROUND: Tibial plateau levelling osteotomy (TPLO) is commonly used to manage cranial cruciate ligament (CrCL) disease. The use of a spherical osteotomy blade (S-TPLO) enables correction of some tibial deformities with three rotational degrees of freedom. METHODS: As a proof of concept, this retrospective study included 45 dogs with CrCL disease that were treated with an S-TPLO. The tibial plateau angle (TPA) was measured preoperatively, immediately after surgery (pTPA0 ) and on postoperative days 42 (pTPA42 ) and 56 (pTPA56 ). Lameness and osteotomy healing were assessed until 56 days postoperatively. RESULTS: Thirty-one dogs had complete CrCL ruptures, and 14 dogs had partial ruptures. Thirty-one dogs had medial meniscal damage. The mean TPA, pTPA0 , pTPA42 and pTPA56 were 26.0°, 7.8°, 8.5° and 8.9°, respectively. The TPA from post-op to follow-up did not vary significantly (p > 1.365). Minor complications occurred in five dogs. The mean lameness score improved significantly from 3.2 preoperatively to 0.9 on day 56 (p < 0.0001). The mean healing score improved significantly from 1.6 on day 42 to 2.2 on day 56 (p < 0.001). CONCLUSION: S-TPLO was successful in treating CrCL disease in stifle joints without tibial deformities, with results comparable to previously reported TPLO outcomes.

Dorsal displacement of the rectum after proximal tail amputation and subsequent surgical repair by bilateral semitendinosus muscle transposition in a cat.

CASE DESCRIPTION: A 6-year-old cat underwent tail amputation at the sacrococcygeal joint and was evaluated 5 days later because of necrosis of the skin at the surgery site and tenesmus. Tail amputation had been necessary as a result of vehicular trauma. CLINICAL FINDINGS: Neurologic examination of the cat revealed no abnormalities. Clinical evaluation and radiography confirmed dorsal displacement of the rectum as a result of removal of the tail and transected sacrocaudal and rectococcygeal musculature as well as muscles of the pelvic diaphragm. The rectum was dilated and filled with hard feces. TREATMENT AND OUTCOME: To correct the dorsal displacement of the rectum, bilateral semitendinosus muscle transposition was performed to restore tissue to the void created by removal of the tail, sacrocaudal muscles, muscles of the pelvic diaphragm, and rectococcygeus muscle. The cat recovered uneventfully from surgery. No further displacement of the rectum occurred and no lameness attributable to bilateral transection of the semitendinosus muscles was noted during a 2-year follow-up period. CLINICAL RELEVANCE: To the authors' knowledge, dorsal displacement of the rectum after proximal tail amputation and its surgical correction in a cat have not been described previously. The favorable outcome in this case suggested that bilateral semitendinosus muscle transposition can safely be used to address large muscular defects at the level of the caudal aspect of the sacrum and the perineum in cats.

Ex vivo cadaveric study of a laterally placed Leipzig stifle distractor for arthroscopic evaluation of the lateral meniscus in dogs.

OBJECTIVE: To evaluate safety and accuracy of lateral pin placement for the use of a Leipzig stifle distractor (LSD) and to assess improvements in visualization and treatment of the lateral meniscus in the canine stifle. STUDY DESIGN: Ex vivo cadaveric study. SAMPLE POPULATION: Paired canine cadaveric hind limbs (n = 10). METHODS: Pins for the LSD were placed from lateral to medial in the distal femur and proximal tibia. Safety and accuracy of lateral pin placement were evaluated via anatomical dissection, computed tomography (CT), and arthroscopy. In every case, distraction of the lateral compartment of the femorotibial joint space was evaluated arthroscopically, and the meniscus was probed. Afterward, the limbs were assigned to 1 of 2 groups, and a partial meniscectomy was attempted with or without distraction. Stifles were disarticulated to evaluate the meniscectomy and iatrogenic cartilage damage. RESULTS: Computed tomography revealed some variation in pin placement, although sufficient distraction was achieved for all stifle joints. No damage to the surrounding structures was observed during anatomical dissection, CT, or arthroscopy. Disarticulation provided evidence that using an LSD allowed for complete caudal horn meniscectomies and less articular cartilage damage than when meniscectomy was attempted with manual distraction. CONCLUSION: Lateral placement of an LSD proved to be safe and effective for the distraction of the lateral femorotibial joint space and the examination and treatment of the lateral meniscus in dogs weighing 18-42 kg. CLINICAL SIGNIFICANCE: Canine lateral meniscus pathology, although rare, leads to severe pain. A laterally placed LSD improves arthroscopic evaluation and treatment of this pathology.

Individualized mini-hemilaminectomy-corpectomy (iMHC) for treatment of thoracolumbar intervertebral disc herniation in large breed dogs.

OBJECTIVE: To assess the short-term, mid-term, and long-term results after an individualized mini-hemilaminectomy-corpectomy (iMHC) procedure for treatment of acute and chronic thoracolumbar intervertebral disc disease in non-chondrodystrophic dogs. STUDY DESIGN: Prospective study. ANIMALS: Client-owned non-chondrodystrophic large breed dogs (n = 57). METHODS: The iMHC procedure, combining mini-hemilaminectomy (MH) and partial lateral corpectomy, was performed on non-chondrodystrophic dogs with thoracolumbar disc disease. Neurological status was evaluated before surgery, for short-term outcome on days 1 and 7 after surgery, for mid-term outcome at 6 months after surgery, and for long-term outcome at the conclusion of the study. Prognostic factors were statistically evaluated. P < .05 was considered significant. RESULTS: iMHC was performed on 57 dogs, with minimal intraoperative and postoperative complications. Short-term neurological improvement was observed in 85.7% of dogs. Median hospitalization time after surgery was 2 days (range 0-14) and was significantly shorter for dogs with a chronic history of clinical signs (1 day, range 0-5) compared to acute onset (3 days, range 0-14) and for those that were ambulatory at initial presentation (1 day, range 0-5) compared to those that were not (3 days, range 0-14). Long-term evaluation included 53 surgeries with a mean follow-up time of 29.4 months. Outcome was excellent in 19 dogs and good in 29 dogs (90.6% success rate). Excellent mid-term and long-term results were significantly more common in the dogs with only 1 affected disc space. CONCLUSION: The iMHC procedure resulted in a short hospitalization time, minimal postoperative deterioration, and a high success rate.

Intraoperative contamination of the suction tip in clean orthopedic surgeries in dogs and cats.

OBJECTIVE: To (1) determine suction tip (intermittent and continuous mode) contamination rate in orthopedic surgery in dogs and cats; (2) examine the effect of surgical time on contamination; and (3) report bacteria isolated. STUDY DESIGN: Clinical study. SAMPLE POPULATION: Clean orthopedic surgeries (n = 50). METHODS: Surgical procedures were assigned to 1 of 2 groups: (1) continuous (n = 25) or (2) intermittent suction (n = 25). A control suction was operated in each surgery. Samples for aerobic and anaerobic bacteriologic examination were collected from the surgical suction at 0, 20, 60 minutes, and at the end of surgery, and from the control suction at the end of the surgery only. Comparison of continuous and intermittent suction data, and the effect of surgical time on contamination rate were analyzed using a Kaplan-Meier survival analysis followed by a Cox proportional hazards model. P < .05 was considered significant. RESULTS: Aerobic contamination occurred in 22 of 50 surgical procedures and there was no anaerobic growth. There was no significant difference between continuous and intermittent suction mode groups (P = .40). Surgical time did not influence the contamination rate (P = .79). Bacterial cultures mainly revealed coagulase-negative Staphylococci, however multiresistant bacteria were isolated. CONCLUSIONS: We failed to find superiority of the intermittent operation mode of the suction tip over the continuous mode. A safe time frame before contamination of the suction tip occurs that could not be defined.