Tightrope Cruciate Repair

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The Tightrope technique is an excellent alternative to the TPLO for treatment of cruciate ligament rupture in dogs of any size. This technique works similar to older suture techniques but is significantly stronger and simpler. The tightrope technique is stronger because it relies on small bone tunnels and stainless steel surgical “buttons” to secure the suture. This is much stronger than traditional methods of securing the suture. In addition, the suture is human orthopedic surgical grade material which is far superior to traditional materials used to stabilize the knee of dogs.

The Tightrope technique is an alternative for clients who are concerned with the bone cutting required in the TPLO.  The Tightrope can be performed with arthroscopic assistance so only a few small incisions are required.

Studies to date suggest that the Tightrope has  excellent results similar to those of the TPLO.

Sliding Humeral Osteotomy

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A new Treatment for Elbow Dysplasia in Dogs

Elbow dysplasia and the secondary arthritis are the most common causes of foreleg lameness in dogs. Fragmented coronoid process (FCP) is the most common form of elbow dysplasia in dogs. In this disease, a fragment of bone and cartilage of one of the bones of the elbow joint (ulna) is broken off. More important, the rest of the joint may be normal or there may be additional cartilage damage, including severe full-thickness cartilage loss. Damage to the cartilage in dogs with elbow dysplasia is called Medial Compartment Disease because it commonly results in severe erosion of the cartilage of the medial aspect of the joint.

Diagnosis of FCP and Medial Compartment disease (MCD)

Diagnosis of FCP and MCP can be challenging. The diagnosis is initially based on a careful orthopedic examination. X-rays (radiology) are of limited use in the diagnosis of FCP. The FCP fragment and damage to the cartilage cannot be seen on x-rays. We recommend arthroscopy for the diagnosis of FCP and MCD because it allows early and accurate diagnosis and treatment

Dogs with Medial Compartment Disease usually require more continuous medical treatment of osteoarthritis and owners should consider additional surgical treatment options.

Advanced surgical treatments of Medial Compartment Disease include Sliding Humeral Osteotomy (SHO) and total elbow replacement.

Total elbow replacement may be indicated when the cartilage is severely damaged throughout the elbow joint. Numerous total elbow replacements have been designed over that last 15 years and to date none has been proven to be safe and effective enough for routine use.

Sliding Humeral Osteotomy

Sliding Humeral Osteotomy (SHO) was developed in the Orthopedic Research Laboratory of the University of Californita by Dr Schulz. This procedure is based on similar procedures that are performed on people for arthritis of the knee. The procedure realigns the limb to shift the forces off of the area of cartilage damage and back on to healthy cartilage. This relieves the pain of grinding of bone on bone and gives the damaged joint an opportunity to heal.

The sliding humeral osteotomy procedure is the result of almost 10 years of laboratory research. These studies have demonstrated that the sliding humeral osteotomy significantly decreases joint pressure in the medial side of the elbow joint.

Clinical results

Over the last 3 years the SHO procedure has been performed in over 70 dogs. Careful clinical studies have been performed to evaluate the efficacy of this procedure. The majority of dogs undergoing SHO have decreased lameness by 12 weeks postoperatively with many dogs having no visible lameness at a 26 week evaluation. The owner satisfaction rate following SHO has been nearly unanimous.

SHO surgeons

Surgeons performing the SHO procedure are all highly experienced orthopedic veterinary surgeons. They have completed a course covering the theory, indications, and application of the SHO technique.

Shoulder OCD

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Osteochondrosis of the shoulder joint is a common cause of lameness in dogs. Fortunately the outcome with surgical treatment is generally excellent when arthroscopy is performed early in life.

What is OCD of the shoulder?

OCD (osteochondrosis dessicans) is probably the leading cause of osteoarthritis of the shoulder joint. Shoulder OCD occurs when a piece of cartilage separates from the underlying bone. Pain is due to inflammation of the joint and exposure of nerves in the bone under the cartilage flap.
Shoulder OCD in dogs has been demonstrated to be a genetic disease and cannot be caused by diet or exercise although excessive exercise in a dog with untreated shoulder OCD may make the lameness more severe.
OCD of the shoulder is usually found in young dogs ranging from 6 months to 2 years of age.
The clinical sign of shoulder OCD is lameness of one or both forelegs. Dogs with shoulder OCD may have trouble getting up and often have some muscle loss and pain when the joint is moved.

How is Shoulder OCD Diagnosed?

The diagnosis of shoulder OCD is usually straight­forward because most lesions are easy to see on radiographs (x-rays) of the shoulder joint. The normal curve of the joint surface is interrupted by a flat area representing the abnormal cartilage.

How is Shoulder OCD Treated?

Treatment of shoulder OCD should be strongly considered by dog owners because surgical removal of the flap almost always results in elimination of the lameness whereas nonsurgical management often results in continued limping and may result in severe osteoarthritis later in life.
Removing the cartilage flap lets the underlying bone heal, stops the irritation of the joint, and keeps the flap from moving into another part of the joint where it might cause other problems. We strongly recommend using arthroscopy to re­move the flap to avoid large incisions and for a faster recovery.

Are there complications?

Complications with arthroscopic treatment for shoulder OCD are very rare (less than 2 percent). The most common complication is swelling of the shoulder that resolves in several days. Anesthetic complications, infection, or nerve damage are very uncommon.

What is the outcome of treatment?

The outcome with arthroscopic treatment of shoulder OCD is generally excellent with complete resolution of lameness over several months following surgery. Physical therapy can accelerate the recovery. In most cases there is little residual arthritis which may be apparent after very heavy exercise or as the dog becomes much older.

Arthroscopic Surgery at Peak

Arthroscopy at Peak Veterinary Referral Center is performed by a highly experienced and caring team who prioritize your pets welfare. Dr Schulz has been performing arthroscopy for over 15 years and is an author of the only textbook on small animal arthroscopy. In many cases surgery may be performed the same day as your initial appointment and because ar­throscopy is minimally invasive, many patients may go home the same day.
Dr Schulz served as chief of surgery at the University of California and has published over 60 manuscripts in canine orthopedics. He is an author of several books including Small Animal Surgery, Small Animal Arthroscopy, and the Pet Lovers Guide to Joint Problems and Osteoarthritis.

At Peak we understand the importance of your pet to your lives. Our philosophy is to educate owners and help them make the best decisions for their pet and their family.

Hip Dysplasia

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Hip dysplasia in your dog

X-ray of normal hips.

Osteoarthritis is one of the most common diseases of dogs, affecting up to 25% of all dogs during their lifetime. Osteoarthritis of the hip and knee are the most common locations but have dramatically different causes and treatments.

The majority of osteoarthritis of the hip is due to hip dysplasia. This disease is a result of genetics which lead to poor hip conformation and laxity and subluxation (loose joints) while the dog is young. As the dog ages the joints actually tighten up but the resulting poor fit of the joint (incongruence) leads to grinding of cartilage and inflammation of the joint. Many adult dogs with severe hip dysplasia and osteoarthritis have no normal cartilage remaining in their hip joint.

Exercise intolerance is actually the most common while fewer dogs actually limp with hip dysplasia.
In young dogs one of the most common signs of hip dysplasia is “bunny hopping” where the dog uses both hind limbs simultaneously.

Medical management

Medical management of hip dysplasia include 5 treatment principles.

  1. Management of body weight
  2. Nutritional supplementation
  3. Moderation of exercise
  4. Physical therapy
  5. Medications

Surgery

THERE ARE SEVERAL SURGICAL OPTIONS FOR THE YOUNGER DOG WITH HIP DYSPLASIA. THEY ARE:

X-ray of arthritic hips from hip dysplasia.

  • juvenile pubic symphodesis (JPS)
  • triple pelvic osteotomy (TPO)
  • femoral head and neck ostectomy (FHO)
  • total hip replacement (THR)

JPS

JPS is a technique of correcting the anatomy of the pelvis in a dog that is still growing. This relatively simple technique changes the anatomy of the pelvis by changing the rate of growth at one of the growth centers. This procedure is only effective in puppies under 20 weeks of age.
In JPS an electroscalpel is used to slow the growth of the pelvis at the pubic symphysis.

Triple Pelvic Osteotomy

Triple pelvic osteotomy has the same effect as JPS in increasing the coverage of the socket of the pelvis over the ball of the femur. In this procedure the pelvis is cut and rotated because the skeleton is or is nearly completely grown. Triple pelvic osteotomy is a common and safe procedure that is usually very well tolerated by dogs. In most cases they are walking on the operated leg immediately after surgery.

FHO

FHO is an excellent option in small dogs (and cats). In this surgery the ball of the ball and socket joint is removed. The hip then works by having the leg supported by the gluteal muscles. Because of their small body weight small dogs and cats tolerate this procedure very well. In larger dogs the outcome is not always as good . Ultimately the outcome of this procedure is unpredictable but is probably improved by combining the procedure with professional physical therapy.

THR

Cementless (left) and cemented (right) total hip replacements.

Total hip replacement has been performed in thousands of dogs in the US and the world. The outcome is generally excellent in 85% to 90% of dogs; however when complications occur they can be frustrating and expensive. Traditionally THR was always performed as late in life as possible because of concern for the implants wearing out. If you are considering total hip replacement in your dog please see our handout on total hip replacement in the dog.

Elbow Dysplasia in Dogs

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Osteoarthritis of the elbow joint is the most common cause of foreleg lameness in dogs. Most of the arthritic diseases of the elbow are considered forms of developmental elbow malformation (dysplasia).

Elbow dysplasia refers to a group of congenital diseases of the elbows of dogs, which include:

  • Fragmented coronoid process (FCP)
  • Medial compartment disease (MCD)
  • Osteochondrosis dessicans (OCD)
  • Ununited anconeal process (UAP)
  • Incomplete ossification of the humeral condyle

FCP and Medial Compartment Disease

Fragmented coronoid process (FCP) is the most common form of elbow dysplasia in dogs. In this disease, a fragment of bone and cartilage of one of the bones of the elbow joint (ulna) is broken off. The rest of the joint may be normal or there may be additional cartilage damage, including OCD or severe full-thickness cartilage loss. This is termed Medial Compartment Disease and unfortunately can occur in dogs as young as 1 year of age.

FCP and medial compartment disease are best diagnosed and initially treated with arthroscopy. Arthroscopy is the fastest, most effective, and least invasive method for fragment removal. Advanced medical options for treatment of Medial Compartment Disease include joint injections with Hyaluronan or autogenous Stem Cells (link to stem cell page).

Advanced surgical treatments of Medial Compartment Disease include Sliding Humeral Osteotomy (SHO) and total elbow replacement. Sliding Humeral Osteotomy was developed in the Orthopedic Research Laboratory of the University of Californita by Dr Schulz and is currently in clinical trials with very positive results. For more information on this procedure please see our handout on Sliding Humeral Osteotomy

Osteochondrosis Desiccans

Osteochondrosis dessicans (OCD) is an abnormality in the development of cartilage that leads to a cartilage flap. In the elbow this occurs on the humerus and can usually be detected on radiographs.

Treatment of elbow OCD involves removing the loose cartilage flap by arthroscopy. Removal of the cartilage flap may enable the underlying bone to heal with fibrous cartilage tissue, stopping the irritation of the opposing cartilage surface. OCD is best treated by elbow arthroscopy.

 

Ununited Anconeal Process

The anconeal process is the top part of one of the bones of the elbow called the ulna. In some dog breeds, especially German shepherds, this fragment of bone may fail to unite with the rest of the ulna during a puppy’s growth in the first year of life. When this occurs, the loose fragment contributes to joint instability and inflammation.

Diagnosis of ununited anconeal process is easily made with x-rays in dogs older than 6 months. Treatment involves surgical techniques to either remove or stabilize the bone fragment. The key to successful surgery of ununited anconeal process is early diagnosis when the osteoarthritis is not yet severe and the body is still able to heal the fragment to the remainder of the bone.

Incomplete Ossification of the Humeral Condyle

Incomplete Ossification of the Humeral Condyle (IOHC) is an uncommon disease of the elbow joint seen most often in Spaniel breeds. In this disease two of the parts of the humeral bone fail to unite. The end result is a permanent crack in the upper bone of the elbow joint. IOHC is very difficult to diagnose on x-rays because the crack in the bone is very narrow. The crack is however easily seen by arthroscopy. Treatment of IOHC is to place a screw across the bottom of the humerus (humeral condyle) and the bone crack to stabilize the bone and prevent future fracture.

Arthroscopic Surgery at Peak Veterinary Referral Center

Arthroscopy at Peak is performed by a highly experienced and caring team who prioritize your pets welfare. Dr Schulz has been performing arthroscopy for over 15 years and is an author of the only textbook on small animal arthroscopy. In many cases surgery may be performed the same day as your initial appointment and because arthroscopy is minimally invasive, many patients may go home the same day.

Dr Schulz served as chief of surgery at the University of California and has published over 60 manuscripts in canine orthopedics. He is the author of several books including Small Animal Surgery, Small Animal Arthroscopy, and the Pet Lovers Guide to Joint Problems and Osteoarthritis.

At Peak we understand the importance of your pet to your lives. Our philosophy is to educate owners and help them make the best decisions for their pet and their family.

Arthroscopy

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Arthroscopy is the most advanced surgical technique for examination and treatment of joint diseases. In arthroscopy the surgeon makes a small incision and inserts a pen sized instrument (arthroscope) to work inside the joint. Arthroscopy provides better visualization and greater opportunities for treatment of joint disease while being much less invasive than traditional surgery. Many arthroscopy patients can be treated on an out-patient bases.

Dr. Kurt Schulz is a internationally recognized leader in the field of veterinary arthroscopy. He is an author of the only textbook available on small animal arthroscopy. (link to Amazon page?) and lectures and instructs arthroscopy courses nationally and internationally. He developed arthroscopy techniques and instrumentation during his 10 years as a faculty at the University of California Davis performing an average of 5 to 10 cases a week.

Diseases of dogs commonly treated with arthroscopy include:

Arthroscopic view of a normal (top) and ruptured cranial cruciate ligament.

Shoulder

  • OCD
  • Soft tissue injuries
  • Biceps disease
  • osteoarthritis

Elbow

  • Elbow dysplasia
  • OCD
  • Fragmented coronoid process
  • Osteoarthritis

Knee

  • OCD
  • Cruciate and meniscal disease