Orthopedics

Allandale Veterinary hospital is pleased to offer a wide array of advanced procedures to its patients. These include: soft tissue and orthopedic surgical procedures, and regenerative medicine through the use of PRP (platelet rich plasma). Using these advanced procedures, we can significantly improve your pet's quality of life.

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If your pet is in need of orthopedic work, please contact us today so that we may arrange the necessary steps to help your pet. Whether it be regenerative medicine like PRP injections for joint discomfort, to surgical and rehabilitation therapies, we want your pet to have a happy, comfortable, and active life!

Below are some of the common orthopedic procedures that we offer at our hospital. Should you have any questions, please let us know or contact your veterinarian.

Physical rehabilitation often goes hand in hand with many orthopedic conditions and procedures. Talk with your veterinarian about how it could potentially benefit your pet after one of the below procedures.

CRANIAL CRUCIATE LIGAMENT DISEASE

The cranial cruciate ligament (CCL) is an integral part in maintaining the stability of your pet’s stifle (knee) joint. In dogs (and cats), the tibia (shin bone) is sloped. The CCL is responsible for keeping the stifle stable when the animal is standing and weight bearing on the limb. When the CCL ruptures or becomes torn, the stability of the stifle is compromised. Now, when the pet is standing on the limb, there is nothing stopping the femur (thigh bone) from following the slope on the tibia and sliding forward. This is called a positive cranial drawer (which is a test your veterinarian can do to help diagnose a CCL rupture).

If the CCL becomes torn or ruptured, there are several different surgical procedures that can be done to re-stabilize the stifle depending on the size of the dog, their lifestyle, and conformation. The type of surgical repair is determined by an experienced orthopedic surgeon and discussed with you, the owner.

If nothing is done, the joint remains unstable. This causes increased and abnormal forces on the other parts of the joint and can cause secondary damage to the meniscus, other ligaments, and advanced arthritis.

One type of repair is called a TPLO (Tibial Plateau Leveling Osteotomy). This is considered the Gold Standard repair for a CCL rupture in large or extremely active dogs. This procedure changes the geometry of the stifle joint by changing the angle of the tibia and removing the slope mentioned above. An incision is made through the skin and the top part of the tibia is cut at a specific angle with a surgical saw. It is then rotated and put back in place with a metal bone plate and screws. Now the stifle joint is level and there is no longer any instability in the knee when the dog is standing on the limb. It can take 8-12 weeks for the dog to recover completely and return to doing the things they enjoy!

Another method of repair is called a TTA (Tibial Tuberosity Advancement). This repair also involves surgically cutting the bone and changing the position of the tibial tuberosity. By moving the tibial tuberosity, it changes the position of the patellar tendon so it is directly perpendicular to the plateau of the tibia and stabilizes the knee. The third method of repair of a CCL rupture is called an Extracapsular Repair. This type of repair does not involve the cutting of any bone like the TTA or TPLO procedures. Instead, small holes or anchors are drilled/applied into the femur and tibia to allow a special type of high tensile strength suture to be passed through. The joint is then stabilized by looping this suture in a specific way to stabilize the joint outside of the joint capsule. This repair can be done with different techniques and equipment (i.e. TightRope® or FasTak™), but the end result is the same, a stable knee. This repair is best suited for cats, small dogs, or dogs that are not highly active.

PATELLAR LUXATION

The patella in dogs, just like in people, is a small sesamoid bone located at the front of the knee. Its usual place of residence is in a groove at the front of the femur. In some dogs, the patella does not follow its designated path and luxates (usually to the inside, or medial aspect of the knee). This luxation can happen in varying degrees and may require surgical correction. A cranial cruciate ligament rupture often goes hand in hand with a patellar luxation due to the abnormal forces on the joint.

When repairing a luxating patella, the groove which the patella resides in is often deepened and if necessary, the tibial tuberosity is repositioned. This is done after a complete assessment of the stifle joint has been completed to determine if there are any other potential issues that need to be addressed (i.e. meniscal damage, CCL tear, etc.).

FRACTURE REPAIRS: PINNING, PLATING & INTERNAL OR EXTERNAL FIXATION

To repair a fracture, the ends of the bone must be brought together and the continuity of the bone restored as close to normal as possible. This can be done with a closed technique that is without exposing the bones, using traction and manipulation, trying not to disturb the natural healing processes already underway. Or, it can be done as an open technique, surgically exposing the bones by separating and, if necessary, cutting through muscle to visualize the fracture and to put it back together. The fracture must be immobilized to allow it to heal and this can be done in several ways. External fixation describes the use of pins passed from outside the leg, through the skin and into the bones of the limb, ideally with at least three pins above and below the fracture. These pins can then connect to one another either by bars, or rods or cement or rings. External fixators can be applied open or closed, and combined with many other techniques making them extremely versatile. Internal fixation describes the use of pins and wire, plate and screws. Plates and screws can be used for a variety of different fragments but offer exceptionally stable fixation and in some cases the ability to squeeze or compress the ends of the bone fragments together. Such repairs can ensure an animal can be up and using a fractured limb as soon as possible.

HIP DYSPLASIA

Hip dysplasia is unfortunately, a common occurrence in many dogs (and cats). It is characterized in varying degrees, but essentially it means that the hip joint has poor congruency between the ball of the femur and the socket of the hip. This incongruency often causes chronic pain and arthritis in dogs and cats. There are a couple of surgical methods used to fix this issue.

The gold standard of repair is a Total Hip Prosthesis (or Replacement). Just like in people, the hip joint itself is completely replaced with a prosthetic one. Dogs that are nine months of age or older, with growth plates fully closed, and weight more than 30 pounds, are possible candidates for this procedure.

A Femoral Neck and Head Ostectomy (FHO) is used as a salvage procedure. This technique involves surgically removing the head and neck from the femur. This means that there really isn’t a “hip joint” anymore, but instead a pseudo hip joint. The surrounding musculature of the hip and pelvis become the “joint”.

ELBOW DYSPLASIA

Elbow dysplasia is another, unfortunately, common ailment dogs have. There are various versions of elbow dysplasia, and depending on the type your dog has, determines the type of repair required.

The elbow joint is made up of three bones: the humerus (upper arm bone), radius, and ulna (forearm bones). In this disease a small portion of the ulna breaks off into the joint. This portion of the bone is called the medial coronoid process. A Fragmented Coronoid Process (FCP) is the result of unequal growth rates of the radius and ulna, either individually or together. The joint space between the ulna and humerus is narrower than the joint space between the radius and humerus. The resulting uneven pressure on the medial coronoid process can develop cracks or fragments of the coronoid process. Surgery or arthroscopy is generally indicated for your pet if he or she is lame or painful. The surgery/arthroscopy can stop or slow the progression of DJD. Surgery and arthroscopy tend to be more successful in younger patients (less than 12 months) and in patients that have not yet developed significant arthritis. Arthroscopy allows the surgeon to visualize the joint, remove the fragmented piece of bone, and help smooth out any lesions in the joint. Surgery usually involves exposing the medial coronoid process via one of several methods and removal of the fragment.

The anconeal process is a large piece of bone located at the growth plate at the top of the ulna. Normally, in growing dogs, this area will close or fuse between 16-24 weeks of age. An Ununited Anconeal Process (UAP) is the failure of the anconeus to fuse with the ulna. Instability within the joint leads to damage of the articular cartilage, lameness, and arthritis of the elbow joint. Surgical treatment is necessary to correct this condition and surgical excision is the most widely accepted method. In this procedure, the loose anconeal process is removed to prevent further irritation to the joint.

Canine Unicompartmental Elbow (CUE) surgery is a safe and effective option to consider in pets who suffer from Medial Compartment Disease (MCD) of the elbow. MCD is the “end-stage” form of elbow dysplasia where the inside part of the joint collapses with eventual grinding of bone-on-bone. The CUE was developed as a treatment for MCD for dogs in which arthroscopic treatment and nonsurgical options are no longer successful. By focusing on the specific area of disease (the medial compartment), the CUE implant provides a less invasive, bone-sparing option for resurfacing the bone-on-bone medial compartment while preserving the dog’s own “good” cartilage in the lateral compartment. This medial resurfacing procedure reduces or eliminates the pain and lameness that was caused by the bone-on-bone grinding.

ANGULAR LIMB DEFORMITIES

Angular Limb Deformities can be caused by genetic defects causing the growth plates in long bones to stop prematurely. Angular deformities of an animal's long bones can cause severe functioning issues once the deformity is beyond the animal’s ability to compensate for the deformity. Angular deformities have the effect of shortening the limb, and while dogs and cats often show remarkable abilities to compensate, their gait will be greatly altered. The deformity will also cause stress and strain on adjacent joints, which can contribute to degenerative joint disease over time. Deformities are usually corrected by sectioning pieces of bone and repositioning them to correct the angular change.