Influencing attitudes towards antimicrobial use and resistance in companion animals-the impact on pet owners of a short animation in a randomized controlled trial.

Objectives: Antimicrobial resistance (AMR) is a vital One Health issue; the rational use of antimicrobials is essential to preserve their efficacy. Veterinarians cite pressure from pet owners as a contributor to antimicrobial prescription. Engaging pet owners in antimicrobial stewardship could reduce this pressure. A short educational animation could facilitate communication of this message. The impact of the animation on participant's opinions relating to antimicrobial prescribing and awareness of AMR was assessed via a randomized controlled trial. Methods: A survey was created based on the health belief model. Owners attending six UK veterinary centres were randomized to the intervention or control group (ratio 1:1). All owners completed an agreement level survey of two questions followed by 18 statements scored using a Likert agreement scale. The control group responded without interruption, whereas the animation group was shown the animation after answering the first two questions and five statements. Results: In total, 647 owners participated in the study; 350 complete responses were analysed. Responses to 10 of 13 statements asked after the animation were significantly different (all P < 0.050) between groups, whereas there was no significant difference between groups in response to any of the statements asked before the animation. The animation group were more likely to agree that lower antimicrobial use would help maintain future efficacy (P < 0.001) and that requesting antimicrobials from their vet could increase unnecessary use (P < 0.001). The animation group were more likely to disagree that they would expect antimicrobials if their pet had diarrhoea (P = 0.048). Conclusions: Pet owners that watched a short AMR engagement animation displayed greater awareness of the impact of AMR and were more likely to support measures in line with antimicrobial stewardship. This behavioural-nudge resource could support owners towards contributing to a multi-faceted approach to AMR.

Long-term outcomes after pantarsal arthrodesis with medial plate fixation without external coaptation in 30 dogs.

OBJECTIVE: To report long-term outcomes of dogs treated with pantarsal arthrodesis (PTA) with medial plate fixation without external coaptation. STUDY DESIGN: Retrospective case series. ANIMALS: Client-owned dogs (n = 30). METHODS: Medical records of dogs that had undergone a PTA with a medially applied plate without adjunctive rigid external coaptation were reviewed. Data collected included signalment, complications, and assessment of function at last physical examination. Follow-up information was obtained by phone conversations with owners. Complications were classified as minor, major II, major I, and catastrophic. RESULTS: Thirty-six PTA were performed in 30 dogs. Recorded complications included eight (22.2%) minor complications, 11 (30.6%) major II complications and 11 (30.6%) major I complications. One (2.8%) dog required amputation because of catastrophic complication. Owners provided follow-up for 26 dogs at a median duration of 1215 days (range, 325-3495) after surgery. The outcome was reported as full function in 12 dogs and acceptable function in 14 dogs, with no owners reporting unacceptable function. The owner of the dog in which amputation was required was not contacted. Incorrect contact details prevented owner follow-up in the other three dogs, but all had acceptable function at last veterinary follow up. CONCLUSION: Dogs treated with PTA by medially applied plate had a high incidence of complications requiring surgical or medical management, although full or acceptable function was achieved in 29 of 30 dogs. CLINICAL SIGNIFICANCE: Pantarsal arthrodesis offers a predictably good medium to long-term outcome in spite of a high risk of complications.

Evaluation of variables influencing success and complication rates in canine total hip replacement: results from the British Veterinary Orthopaedic Association Canine Hip Registry (collation of data: 2010-2012).

The objective of this study was to assess the variables associated with complications of total hip replacement (THR) and report owner-assessed outcomes. Entries into the British Veterinary Orthopaedic Association-Canine Hip Registry (BVOA-CHR) between September 2011 and December 2012 were reviewed separately and in conjunction with previous data (January 2010-August 2011). An outcomes assessment questionnaire was used to collect data from owners. Incidences of surgeon-reported and owner-reported complications were 8.2 per cent and 4.3 per cent, respectively. THR using the BioMedtrix BFX cup/stem prosthesis had a greater incidence of complications compared with THR using the BioMedtrix CFX cup/stem prosthesis (P=0.002); complications were 4.48 times more likely when using the BioMedtrix BFX cup/stem prosthesis versus the BioMedtrix CFX cup/stem prosthesis. THR using the BioMedtrix BFX cup/stem prosthesis had a higher incidence of complications compared with THR using a hybrid prosthesis (BioMedtrix BFX cup/CFX stem, BioMedtrix CFX cup/BFX stem) (P=0.046); complications were 2.85 times more likely when using the BioMedtrix BFX cup/stem prosthesis versus a hybrid prosthesis. In 95 per cent of cases, owner satisfaction with the outcome of THR was 'very good' or 'good'. Complication rates from the BVOA-CHR are similar to previous studies. The data suggest that prosthesis type is associated with complication rate, with BioMedtrix BFX (circa 2012) having a high short-term complication rate.

Cement plug technique for the management of disc-associated cervical spondylopathy in 52 Dobermann Pinscher dogs.

OBJECTIVES: To report the radiographic and clinical outcome of an intervertebral bone cement plug technique for the management of disc-associated cervical spondylopathy in Dobermann Pinscher dogs. METHODS: Retrospective study of 52 Dobermann Pinscher dogs. RESULTS: A variable degree of cement plug subsidence with loss of vertebral distraction was evident in all dogs (n = 40) that were radiographed >6 weeks postoperatively. In no case was there definitive evidence of vertebral body fusion. Eight dogs had a sudden deterioration in neurological status, cervical hyperaesthesia, or both between three days and 12 weeks following surgery that was considered to be implant-associated; six of these dogs were euthanatized. Following surgery, 43/52 dogs were considered to be neurologically normal or to have improved, however, nine of 43 subsequently deteriorated due to adjacent segment disease. At the long-term follow-up, 34 dogs were considered to be neurologically normal or to have improved. Twenty-nine dogs were dead by the end of the study period. CLINICAL SIGNIFICANCE: Intervertebral bone cement plug surgery results in an initial improvement in clinical signs in the majority of Dobermann Pinschers with disc-associated cervical spondylopathy. However, it fails to maintain vertebral distraction or achieve vertebral body fusion, and is associated with acute implant complications, additional cervical disc protrusions or mortality in a significant proportion of cases.

Highly Comminuted, Articular Fractures of the Distal Antebrachium Managed by Pancarpal Arthrodesis in 8 Dogs.

OBJECTIVE: To describe the surgical management by pancarpal arthrodesis for highly comminuted articular fractures of the distal antebrachium in 8 dogs. STUDY DESIGN: Retrospective clinical case series. ANIMALS: Eight dogs. METHODS: Medical records (2001-2014) of dogs with antebrachial fractures were reviewed and dogs with highly comminuted distal antebrachial fractures were identified. The nature of the injury, surgical management by pancarpal arthrodesis, outcome, and complications were recorded. RESULTS: Nine fractures occurred in 8 dogs. Seven dogs were ex-racing greyhounds (8 fractures) and of these, 6/7 dogs had fractures of the right thoracic limb. Compared with the hospital population of dogs with antebrachial fractures, greyhounds were over-represented for the antebrachial injury (odds ratio 117, 95% confidence interval 13-1022). Five dogs sustained injury during exertional exercise or with relatively minor trauma. Submitted bone samples (n = 4) showed no evidence of underlying neoplasia. Mean followup was 15.5 months with 11 complications recorded in 7/8 dogs, including 1 catastrophic, 5 major, and 5 minor complications. Pancarpal arthrodesis allowed a full functional outcome in 3 dogs and an acceptable outcome in 3. CONCLUSION: Comminuted articular fractures of the distal radius and ulna are complex injuries and have a similar presentation to pathologic fractures. Surgical management by pancarpal arthrodesis is associated with a high risk of complication and a guarded prognosis for a full functional outcome.

Precision of a novel computed tomographic method for quantification of femoral varus in dogs and an assessment of the effect of femoral malpositioning.

OBJECTIVE: To assess the precision of a novel protocol for determination of femoral varus angle (FVA) using computed tomography (CT) in dogs, and to quantify the effect of femoral rotational and sagittal plane malpositioning on measured FVA. STUDY DESIGN: Cross-sectional study. SAMPLE POPULATION: Femora (n = 66) from dogs that had pelvic limb CT examination for patellar instability (26) or other reasons (10). METHODS: Three observers measured FVA of each of 66 femora on three separate occasions. Standardized orientation of a volume rendered image was achieved by superimposition of the caudal and distal aspects of the femoral condyles on a lateral projection, definition of a sagittal plane axis, and finally rotation through 90° to yield a cranial projection. Intra- and inter-observer variability were estimated using the intra-class correlation coefficient. The effect of variation in rotational and sagittal plane orientation on measured FVA was subsequently quantified using 6 femora with FVAs between -0.4° and 19°. RESULTS: Intra-class correlation coefficients for the 3 observers, indicating intra-observer variation, were 0.982, 0.937, and 0.974. The intra-class correlation coefficient of the means of the results from each observer, indicating inter-observer variation, was 0.976. Consistent linear variations in measured FVA occurred as a result of rotational malpositioning in all 6 tested femora, and as a result of sagittal plane malpositioning in femora with FVAs ≥ 7.9°. CONCLUSIONS: The reported protocol for the measurement of FVA in dogs is repeatable and reproducible. Small variations in femoral orientation, as might be expected with conventional radiography, lead to clinically significant alterations in measured FVA.

Comparison of complication rates and clinical outcome between tibial plateau leveling osteotomy and a modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament disease in dogs.

OBJECTIVE: To report complication rates and clinical outcomes after tibial plateau leveling osteotomy (TPLO) and a modified cranial closing wedge osteotomy (mCCWO) for treatment of cranial cruciate ligament disease in dogs. STUDY DESIGN: Prospective cohort study. ANIMALS: Dogs weighing 20-60 kg with unilateral cranial cruciate ligament disease treated by either TPLO (n = 97) or mCCWO (n = 74). METHODS: Clinical and radiographic assessments including lameness score, morphometric measurements and tibial plateau angle (TPA) were made before surgery and 8 weeks after either TPLO or mCCWO. Long-term outcome assessment by owner questionnaire or interview was undertaken at ≥6 months postoperatively. RESULTS: Significant differences in lameness scores between groups were not identified at short- or long-term follow-up. Major complication and reoperation rates did not differ significantly between groups (TPLO 7.2% and 6.1%; mCCWO 9.5% and 5.4%). Median postoperative TPA did not differ significantly between groups (TPLO group 5.5°; mCCWO group 6.5°). At >6 months owner assessed lameness, disability, quality of life and satisfaction were not different between groups and were good in 90-97% of dogs. CONCLUSIONS: In dogs weighing 20-60 kg, TPLO and mCCWO are associated with similar complication rates and clinical outcomes when performed by surgeons experienced with the surgical techniques.

Complications and owner assessment of canine total hip replacement: a multicenter internet based survey.

OBJECTIVE: To assess the variables associated with the complications of total hip replacement (THR) and report owner-assessed outcomes, through surgeon-based registration of cases via an online database, informed owner consent, and prospective outcomes assessment using a client-administered clinical metrology instrument. STUDY DESIGN: Prospective case series ANIMALS: Dogs (n = 170) METHODS: Entries into the British Veterinary Orthopaedic Association-Canine Hip Registry (BVOA-CHR) between January 2010 and August 2011 were reviewed. Variables evaluated included dog age, body weight, breed, and indication for THR and prosthesis. Associations between each variable and the incidence of complications were assessed using logistic regression. Additionally, an on-line, owner-administered outcomes assessment questionnaire (modified from the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire) was used to collect data from owners. RESULTS: One hundred and seventy cases met the inclusion criteria. Surgical indications included hip dysplasia and coxofemoral osteoarthritis (n = 150), Legg-Calves-Perthes disease (7), coxofemoral luxation (6), fracture (4), slipped capital physis (2), and femoral head and neck ostectomy revision (1). Surgical implants were from 4 systems. The incidence of surgeon-reported complication was 9.4%. No significant association was identified between weight, age, sex, breed, indication for THR, surgical technique and prosthesis, and the incidence of complications. In 82% of the cases, owners described their satisfaction with the outcome of THR as "very good" and a total of 20% complication rate was reported. There was a statistically significant improvement in owner-assessed questionnaire score before and after THR (P < .001). CONCLUSIONS: The BVOA-CHR offers a novel framework for the prospective studies on THR and on a national/international scale. Initial complication rates from the BVOA-CHR are similar to previous studies.

Hybrid cemented/cementless total hip replacement in dogs: seventy-eight consecutive joint replacements.

OBJECTIVE: To evaluate the use of hybrid total hip replacement (THR), using a cementless acetabular component and a cemented femoral component. STUDY DESIGN: Prospective case series. SAMPLE POPULATION: Client-owned dogs (n = 71). MATERIALS AND METHODS: Consecutive clinical cases that had hybrid THR were studied. Radiographic features, pain scores, and lameness scores were recorded pre- and postoperatively. Longer term outcome was assessed by owner questionnaire. RESULTS: Hybrid THRs (n = 78) were performed in 71 dogs. Four cases (5%) had major postoperative complications; 3 were resolved after revision surgery, and 1 owner requested an explantation. No other major complications were identified on follow-up radiographs (67 THR) at 12 weeks. On clinical follow up (77 THR) at 4 weeks, lameness had improved in 68, was unchanged in 8, and was worse in 1. Pain had decreased in 72, was unchanged in 4, and was worse in 1. At 12 weeks (69 THR) compared with preoperative status, lameness had improved in 67 and was unchanged in 2. Pain had improved in 68 and was unchanged in 1. Longer term follow-up (mean, 16 months) was available for all hips. No further complications were reported. Owner satisfaction was good for 76 THRs and reasonable for 2. CONCLUSIONS: Hybrid THR can be performed successfully with a low complication rate and represents an alternative to either entirely cemented or cementless implantation.

Radiographic evaluation of BFX acetabular component position in dogs.

OBJECTIVE: To assess the reliability of radiographic measurement of angle of lateral opening (ALO) and angle of version of BFX acetabular cups. STUDY DESIGN: In vitro radiographic study. SAMPLE POPULATION: BFX cups (24, 28, and 32 mm). METHODS: Total hip replacement constructs (cups, 17 mm femoral head and a #7 CFX stem) were mounted on an inclinometer. Ventrodorsal radiographs were obtained with ALO varying between 21° and 70° and inclination set at 0°, 10°, 20°, and 30°. Radiographs were randomized using a random sequence generator. Three observers blinded to the radiograph order assessed ALO using 3 methods: (1) an ellipse method based on trigonometry; (2) using a measurement from the center of the femoral head to the truncated surface of the cup; (3) by visual estimation using a reference chart. Version was measured by assessing the ventral edge of the truncated surface. RESULTS: ALO methods 2 and 3 were accurate and precise to within 10° and were significantly more accurate and precise than method 1 (P < .001). All methods were significantly less accurate with increasing inclination. Version measurement was accurate and precise to within 7° with 0-20° of inclination, but significantly less accurate with 30° of inclination. CONCLUSIONS: Methods 2 and 3, but not method 1, were sufficiently accurate and precise to be clinically useful. Version measurement was clinically useful when inclination was ≤ 20°.

Evaluation of a joint distractor to facilitate arthroscopy of the canine stifle.

OBJECTIVES: To assess a novel technique for arthroscopic evaluation of the canine stifle avoiding the need for fat pad debridement. STUDY DESIGN: Prospective study. SAMPLE POPULATION: Cadaveric canine stifles (n=10); Client-owned dogs (15). METHODS: In cadaveric stifles, the femoropatellar space was assessed before placement of a joint distractor and examination of the femorotibial joint. Time to complete evaluation of the femoropatellar space, to observe the cruciate ligaments, and to completion of examination of the femorotibial joint were recorded. Distractor-assisted arthroscopy was then performed in 15 consecutive clinical cases. Clinical information, time to complete joint evaluation, and ability to perform any additional arthroscopic surgery were recorded. RESULTS: Observation and palpation of intra-articular structures were possible in all cadaveric stifles. Mean time to evaluate the femoropatellar space was 3.2 minutes (range, 2-4 minutes); to observe the cruciate ligaments, 5.8 minutes (range, 3-8 minutes); and to completion of joint inspection, 9.1 minutes (range 6-13 minutes). In the clinical cases, observation of intra-articular structures was also possible in all stifles. Mean time to complete joint inspection was 21 minutes (range, 10-40 minutes). Partial meniscectomy was performed successfully in 5 stifles. CONCLUSIONS: Use of a joint distractor allowed arthroscopic observation of all relevant structures. Partial meniscectomy was readily performed. CLINICAL RELEVANCE: Use of a joint distractor may simplify arthroscopic assessment of the canine stifle and avoid potential morbidity associated with fat pad debridement.

Assessment of low-cost teleradiology for grading elbow dysplasia.

Teleradiology involves the creation of a radiographic image that is then transmitted electronically. It has been shown that low-cost teleradiology has a high level of agreement when comparing the original radiograph to the digital image. However, there has been little investigation of the effect of digitization on the score allocated by a grading scheme. Radiographs of 60 canine elbows were selected, each in three projections (mediolateral flexed, mediolateral neutral, craniocaudal). Each radiograph was photographed at 3 megapixel (3 M) and 6 megapixel (6 M) resolution using a digital camera. The images were placed in groups (radiographs, 3 M and 6 M) and randomized. Each elbow was independently graded by a radiologist and an orthopedic surgeon using the BVA elbow scoring scheme, with the different image sets interpreted separately. Intra and interobserver agreement was compared using a kappa analysis. The radiologist had substantial intraobserver agreement for repeated grading of radiographs, and moderate agreement for the other intraobserver tests (3 M vs. radiographs, 6 M vs. radiographs, 3 vs. 6 M). The surgeon had moderate to substantial agreement for the intraobserver tests. There was reduced interobserver agreement for all image groups. These results suggest that low-cost teleradiology may only allow moderate accuracy when used for grading schemes, and this may affect its use for breed scoring schemes. However, there appears to be an inherent subjectivity present in the elbow-grading scheme, seen in both intra and interobserver analysis. Therefore, further study of teleradiology using a different scoring model (e.g., hip dysplasia) may be indicated.

In vitro validation of a technique for assessment of canine and feline elbow joint collateral ligament integrity and description of a new method for collateral ligament prosthetic replacement.

OBJECTIVE: To assess the ability of an operator to differentiate intact from transected canine and feline elbow joint collateral ligaments (CL) using a reported manipulative test (Campbell's test) and to determine the potential for elbow joint luxation in canine and feline elbows with intact, transected, and surgically stabilized CL. STUDY DESIGN: In vitro biomechanical study. SAMPLE POPULATION: Canine (n=6) and feline cadavers (n=3). METHODS: Thoracic limb specimens were mounted on a custom-built jig with the elbows and carpi fixed in 90 degrees of flexion. Angles of pronation and supination were recorded after applying rotational forces to the manus. Attempts were made to manually luxate each elbow with intact CL. Constructs were re-evaluated after sequential sectioning of the medial (MCL) and lateral (LCL) collateral ligaments and after insertion of a new CL prosthesis. RESULTS: Mean (+/-SD) angles of rotation in dogs increased from 27.3+/-8 degrees (range, 16.7-41.3 degrees ) in pronation to 58.9+/-9.2 degrees (range, 38-88.3 degrees ) after sectioning the MCL and from 45.5+/-10.8 degrees (range, 30.7-67.3 degrees ) in supination to 68.9+/-17.2 degrees (range, 45-94 degrees ) after sectioning the LCL. Angles of pronation and supination were subject to significant interanimal variability, with a strong correlation between increasing animal weight and smaller angles of rotation. Elbow luxation in dogs was not possible unless at least the LCL was transected. In cats, mean angles of rotation increased from 49.8+/-14.9 degrees (range, 30.7-70 degrees ) in pronation to 99.1+/-17.6 degrees (range, 79-111.7 degrees ) after sectioning the MCL and from 128.7+/-18.8 degrees (range, 108.3-151.7 degrees ) in supination to 166.7+/-13.1 degrees (range, 157.3-181.7 degrees ) after sectioning the LCL. Luxation in cats was not possible unless both CL were cut. Use of the ligament prosthesis without primary CL repair reliably prevented reluxation in all canine and feline elbows. CONCLUSIONS: Campbell's test allowed reliable differentiation of intact, transected and surgically stabilized canine and feline elbow joint CL in a cadaveric model. Luxation could not be performed by application of rotational forces to specimens with intact CL. CLINICAL RELEVANCE: Clinical examination findings, specifically Campbell's test, can be used to determine elbow CL integrity in dogs and cats. The contralateral elbow should be used as a control, because of interanimal variability in angles of rotation.