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Here at County Animal Hospital we perform various orthopedic and neurologic surgeries.  When being evaluated for a lameness issue, it is important to determine if it is due to nerve damage or musculoskeletal inury.  The doctors here at County will spend a little extra time with you and your beloved pet so that an accurate diagnosis is made.  Radiographs (x-rays) are commonly used to help us deterimine the exact location or locations.  At County, we have digital x-ray so the images are much better than conventional film.   We commonly use bone models so you can "see" where your pet  "hurts."  Just a few of the orthopedic/neurologic procedures that we offer are listed here: ACL repair (TPLO, TTA, Tightrope, fibular head advancement, and lateral suture), total hip replacement, medial and lateral patella luxation repair, femoral head and neck excision, fracture repair (internal and external), dorsal and hemilaminectomy, and joint arthrodesis. 

ACL rupture in dogs is the leading orthopedic injury in the United States.  Since there are several methods of repair, listed below are some basic history and information about TPLO and TTA.  Additionally, we are performing total hip replacement for the treatment of hip dysplasia and hip arthritis.  Please view the information below or contact us for a consultation.

Michael Vitucci MS, DVM has accreditations in AO ASIF (Association for the Study of Internal Fixation), External Skeletal Fixation, Tibial Tuberosity Advancement (TTA), Tibial Plateau Leveling Osteotomy (TPLO), and HELICA Total Hip Replacement.  He is also an active member of the Veterinary Orthopedic Society. 

Tibial Plateau Leveling Osteotomy (TPLO) 

In 1978, a new test for identifying rupture of the anterior cruciate ligament was described.
 
After using this test for several years, Dr. Barclay Slocum began to understand how the stifle really works. In 1982, Dr. Slocum described the cranial tibial thrust which is a dogs natural force created in the stifle. The cranial tibial thrust is responsible for rupture of the anterior cruciate ligament. Understanding how this force is created led to the design of a surgical procedure for controlling this force and its destructive side effects. A new version of the procedure, called Tibial Plateau Leveling Osteotomy has proven effective in returning dogs to full function.
 
Healing takes about two months for the bone and slightly longer for the soft tissues to heal. Because the plateau leveling permits the joint pain to subside, the major problem in this surgery has been related to excessive patient activity before bone healing is complete. Owners are advised that absolute restriction of activity is mandatory during the healing process. Most patients return to very light yard work at 2-3 months, light training at 4-5 months, full training at 5-6 months, and are functioning normally under field trial conditions at 6 months.
 
The surgery results over the past 10 years have been excellent. Even patients that had ruptured ligaments for periods up to 5 years have made marked improvement. Many of these cases have a longer period for regaining flexibility in the stifle. Dogs that have had a previous surgery (up to seven on the same stifle) still show improvement. Patients with poor conformation may not respond well to this surgery but those patients can also have their conformation corrected at the time of surgery. This surgery is not size dependent, it works on all stifles of all breeds with the described mechanism of injury.

TTA Surgery (Tibial Tuberosity Advancement)

TTA was developed by Dr. Slobodan Tepic of Zurich, Switzerland. Dr. Tepic is well known in medicine for developing the Zurich Cementless Total Hip Replacement, the state-of-the-art in canine hip replacement surgery. This procedure is also used for hip replacement in humans. 

TTA is a new-comer to the arena of procedures advocated to stabilize the cranial cruciate deficient knee in the canine. The theory of TTA arose out of a modification of the proposed model by Slocum, in that the net “joint reaction” is approximately parallel to the patellar tendon, and that if the patellar tendon is perpendicular to the tibial plateau (joint surface), the cruciate ligaments are not under any load. If we move the patellar tendon forward to the point that it is perpendicular to the tibial plateau in a standing angle, we relieve the load on the cranial cruciate ligament. The net result being that the patellar tendon takes over the load of the cranial cruciate ligament.  The result is a stable knee. Apparent advantages to TTA when compared to TPLO include;

1. Quicker recovery – as a result of less invasive surgical technique, less swelling, shorter surgical time, and improved postoperative stability. Many patients are walking better when they leave the hospital postoperatively.  Recent studies by A. Pozzi, show that dogs that have had a TTA have "more normal" joint forces than that of TPLO. 
 
2. Ease of procedure – less technically demanding procedures are less likely to have operator-dependent failures, resulting in better clinical results.
 
3. Good results with chronically arthritic knees – since TTA does not require a rolling of the tibial plateau (like TPLO), stability is easily achieved even in the most chronic knees.

HELICA Total Hip Replacement (for hip dysplasia and arthritis)

Canine hip dysplasia is a developmental orthopedic disease.  When a dog has dysplasia, it has an abnormal development of the ball-in-socket joint that makes up the hip.  In a dysplastic hip, the ball (the head of the femur, or thighbone) and the socket (the acetabulum, a portion of the pelvis), do not fit together snugly.  The result is a painful and damaging friction.  When a dog bears its weight on the joint, the friction strains the joint capsule, which is a fibrous tissue that surrounds the joint and produces joint fluid.  The straining  then damages the cartilage and leads to the release of inflammatory proteins within the joint.  Thus begins the cycle of cartilage destruction, inflammation, and pain the symptoms we associate with arthritis.

Among animals with hip dysplasia, the onset of arthritis will vary.  Some dogs will get it in early youth; for others, it may not present itself until much later in life.  Frequently, two types of hip dysplasia are described: acute and chronic.  The acute (early) stage, usually seen in young dogs, is characterized by intense pain in the hips and mild to severe lameness. This stage can last from weeks to months.  The chronic (late) stage of hip dysplasia is characterized by pain, decreased range-of-motion in the hips, and progressive arthritis.  Chronic dysplasia can develop in dogs less than one year old or it can take many years to occur. 

Hip dysplasia can result in a variety of clinical signs.  Dogs can have significant hip dysplasia and arthritis and show minimal or no outward signs.  Alternatively, hip dysplasia can and frequently does result in crippling arthritis.

Hip dysplasia is most common among larger breeds, especially the German shepherd, rottweiler, Labrador retriever, Golden retriever, mastiff, Saint Bernard, and others.  It can also be seen in smaller breeds such as the Cocker spaniel and Springer spaniel, as well as in mixed breed dogs.  Cats suffer from hip dysplasia, too, but their symptoms are usually minor.

There are conservative, or non-surgical, methods for treating hip dysplasia, such as pain medications, weight loss programs, controlled exercise, and physical therapy. These methods can be very effective in certain cases. However, conservative treatments do have their limitations.

The other option is surgery. There are two surgical approaches for dealing with hip dysplasia: prophylactic procedures, which are designed to prevent the progression of arthritis, and therapeutic procedures, which aim to treat or salvage already arthritic hips. The primary prophylactic procedure available is called a triple pelvic osteotomy. In this procedure, three separate bone cuts are made in order to free the acetabular component (the socket or cup) of the hip joint from the rest of the pelvis. The acetabulum is then rotated to provide better coverage, and a bone plate is applied to maintain this new position and allow the bone cuts to heal. This procedure is quite effective if it is performed before significant arthritis is present; after this time period, it is no longer a useful procedure. The vererinarians at County Animal Hospital can assess whether the dog is a good candidate for this procedure. Another type of preventative surgery, is a pubic symphysiodesis (JPS), a procedure for very young dogs (12-18 wks) that manipulates the way the pelvis grows to create a tighter hip.

Aimed at treating hips that have already become arthritic, the therapeutic procedures available for dysplastic dogs include total hip replacement, and femoral head and neck excision.  In a total hip replacement procedure, which is generally performed on a  dog weighing more than 50 pounds, a prosthetic hip socket and a femoral head are implanted into the dog, forming an artificial ball-in-socket joint. This gives the dog a pain-free hip joint and nearly normal function after the recovery period. Total hip replacement is a technically demanding surgery, and usually is done by appropriately trained individuals. 

Femoral head and neck excision is a surgery performed on severely arthritic dogs. With this procedure, the femoral head (ball part of the joint) is removed, allowing the femur to float about freely and causing scar tissue to form. As the scar tissue hardens and thickens, it serves to create a false-joint called a pseudoarthrosis. The femoral head and neck excision is a last resort procedure and generally is not recommended for mild cases of arthritis. This procedure is more effective in smaller, well-muscled dogs. Among dogs weighing more than 50 pounds, the results will vary.

With any treatment, postoperative recovery depends not only on the procedure, but also on the aftercare. The same principles of non-surgical therapy are applied following surgery: obese animals must lose weight and pain medications should be used when needed. Follow the veterinarian’s recommendations closely.

The HELICA hip prothesis system is a newer technique that has helped dogs suffering from hip dysplasia and arthritis.  Early hip replacements used cement and  have been an established surgical alternative for many years, but recently the shift has been to cementless hip implants. The primary reason for using a cementless prosthesis is to avoid the many systemic problems that can potentially occur with cemented implants. Utilizing the body’s natural healing interaction has become a major consideration as it has in human orthopedic medicine. Unfortunately conventional canine cementless designs have serious inherent problems such as the potential proximal femoral shaft fracture, implant loosening, and rare revision successes. Because of the inherent problems of other cementless systems, the HELICA screw prosthesis was conceived. The intention of this type of prosthesis is to eliminate the key problems by promoting a firm implant fixation. This contributes to near painless post operative weight bearing and rapid recovery. The HELICA’s femoral and acetabular implant components have self-cutting threads that allow firm anchorage into the bone. The surfaces of the screw prosthesis are rough-molded to provide optimal fixation and osteointegration into the bone. The HELICA design also allows the prosthesis to be re-implanted several times during the procedure to assure optimal biomechanical alignment. When compared to a conventional cementless hip prosthesis, The HELICA Screw prosthesis provides the following advantages: • Only a minor bone resection-- saving as much of the bones natural structure as possible • Screw implants provide firm anchorage into the bone • Dramatically lowers the patients post operative pain • Promotes rapid healing and osteointegration • Mimics the joints natural biomechanical forces • Can be revised and re-implanted easily without complications

Before Surgery   After HELICA Prosthesis Implantation