ORTHOPEDIC SURGERY

Veterinary Orthopedic Surgery is unfortunately a common necessity for many of our pets to obtain the most from life. Orthopedic surgery is a special skill-set where the veterinarian needs to be able to understand the bio-mechanics of the bones of the animal and how the forces applied in movement will be absorbed by the bones and then to be able to use mechanical tools in a surgical setting to make the necessary corrections. Orthopedic surgery includes fracture repairs, ligament repairs, and joint repairs. The most common needs for veterinary orthopedic procedures are for problems in the knee or stifle, the shoulder, and the hip.

The knee in the human or the dog is not built very strong which is why we see so many human athletes lose their career due to knee injuries. The canine knee is supported by cruciate, patellar and collateral ligaments. The patella or knee cap needs to slide in the groove in the femur. Many small dogs have a shallow groove and an abnormal position of the attachment of the patellar tendon. These abnormalities lead to a very common problem known as patellar luxation. As the patella slides in and out of the groove, it grinds on the ridge and starts to create arthritis. The longer the condition is allowed to go on, the worse the arthritis will become. In addition a knee with a luxating patella is far more likely to rupture a cruciate ligament leading to worse lameness and arthritis. Therefore most luxating patellas should be repaired and usually the earlier the better. If allowed to progress untreated irreversible arthritis can develop and the leg can even become permanently locked in a completely unusable position.

http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/MedialPatellarLuxations/

Another common problem with the dog’s knee is a torn cruciate ligament. This is the typical athlete’s injury you see when a running back in football takes a bad hit and has to be carried off the field. The cruciate ligament is essential to normal function of the knee and it is easily ruptured. One bad jump and twist is all that it takes to rupture a cruciate. Then the knee must have surgery to replace the function of the torn ligament. Additioanlly, the canine knee is always in a flexed position which loads the cruciate ligament. Over the years many different techniques have been tried to replace the function of the cruciate ligaments. The techniques in most common use today are the Extra Capsular Technique, the Tibial Plateau Leveling Osteotomy or TPLO and the Tibial Tuberosity Advancement or TTA.

Over the past twenty five years since Dr. Slocum invented (and patented) the TPLO system, it has shown to have the best outcomes of the methods, especially in large or very athletic dogs. A cut is made in the tibia and the top of the tibia is rotated, changing the angle of contact in the knee and preventing the sliding just as the cruciate did when it was intact. The TTA similarly realigns the joint using a different technique. The results of both TPLO and TTA are similar. The main difference is that if a post-operative infection develops, the implants need to come out. This is possible with the TPLO but not with the TTA. Our surgeons perform this surgery often and are highly skilled with excellent outcomes. Dr. Walker actually helped in the development of the TPLO.

Additional information can be found here: http://www.vetsurgerycentral.com/tplo.htm

The Extra-Capsular Technique is the least traumatic of the surgeries and we use this technique in most small dogs. We use the Arthrex tightrope system or the monofilament suture method which provides excellent results in small dogs. http://www.arthrexvetsystems.com/int/mediacenter/ForPatientsOwner/upload/TightRope-Client-VLP0004C.pdf

Further information on the various techniques with the benefits and risks will be carefully explained to you prior to surgery. With the each technique, if CT warrants, the joint will be opened, the torn ligament first cleaned out of the joint and the meniscus examined and possibly removed. With an extracapsular technique,  a heavy suture material will be passed around the tiny bone behind the femur or with the tightrope, be passed through the femur and then through a hole drilled in the tibial crest. This suture lays in nearly the exact same line as the missing cruciate and provides support for the knee.

Examination of the joint without opening the joint results in faster recovery for your pet. In people, an MRI is routinely performed. Due to the anesthetic time involved, veterinarians do not routinely perform MRIs prior to surgery. Thanks to our ultra-advanced CT, Gentle Vets routinely performs a novel technique in dogs, the positive contrast arthrogram to determine the extent of meniscal injury prior to surgery. We are performing clinical studies in association with Nele Ondreka, Dr. med. vet., DipECVDI who is the Head of Department of Diagnostic Imaging
at the Vet School in the University of Giessen, Germany.  If the meniscus is not damaged, we can avoid entering the joint and you pet’s recovery time will be more rapid. In addition to CT, we also can use our arthroscopic facility to visually examine the joint prior to surgery.

Although common in people, total knee replacements in dogs are still rare. Due to their keen interest in orthopedic surgery, Dr.s Joseph and Mariel Edhlund have received the special training needed for implantation of total knees in dogs. This procedure offers hope for dogs with severe degenerative disease of the knees.

http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/CranialCruciateLigamentRupture/

The hip is also an important sore spot for dogs – especially large breeds. Many dogs have dysplastic hips which is where the ball and socket of the hip are improperly formed. As a result the femur is constantly sliding in and out of the joint. This constant wearing on the rim of the hip socket will eventually lead to crippling arthritis. Many large breed dogs eventually are euthanized because of the pain from bad hips. There are two excellent surgeries to help prevent this from happening. In smaller dogs a femoral head ostectomy can be performed by the veterinary orthopedic surgeon. In this surgery, the ball of the femur is cut off and the body will form a fibrous capsule to replace the hip joint. Since there is no bone on bone grinding the pain will stop. Larger dogs will benefit from Total Hip Replacement. This procedure is very common in people. The hip socket is ground out and a smooth plastic hip socket is glued in place or press-fit and actually heals as part of the body. The head of the femur is cut off and a titanium stem is inserted into the femur. The major complications of this surgery come from infection so an ultra-sterile surgical field must be maintained. Gentle Vets Advanced Care has been established with a surgery suite especially designed for Total Hip Replacement, including laminar flow air supply and HEPA filtered air intake. Doctors Edhlund have studied THR extensively with both Biomedtrix courses, training at Advanced Veterinary Care in Melbourne Australia under Dr. Sam Snelling, head of the Australian Board of Veterinary Surgeons and special in-house training under Dr. Jon Dyce, Head of Surgery at Ohio State University and unequivocally the leading THR veterinarian in the world.Gentle Vets inaugural total hip replacements were performed in early June 2013. Quinn and Lucie our first two hip patients were walking on their new hips within a day of surgery. Quinn is actually featured in the 2016 Biomedtrix calendar.  In adition, we work with Dr. Tom Walker and Dr. Peter Vogel, both board certified surgeons,  performing total hip replacements. Dr. Joseph Edhlund performed his first total hip with Dr. Walker on a great dane almost twenty years ago.

Prior to surgery we will want to completely clean you pet’s teeth in advance of the surgery and also treat any skin or urinary tract  infections.  Recovery from total hip replacement is usually quite rapid.

http://youtu.be/BTLhcLxT-0o

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http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/TotalHipReplacement%28THR%29inDogs/

http://www.youtube.com/watch?v=3SZK2zjYkf0

Dr. Joseph Edhlund is highly experienced in orthopedic surgery with over 35 years of experience. Dr. Peter Vogel has over 25 years of surgical experience and is Board Certified by the American College of Veterinary Surgery and is a Professor of Surgery. Dr. Tom Walker has almost 40 years of experience and has taught orthopedic surgeries at multiple universities, including the University of Cambridge in England. He has served as chairman of the College of Veterinary Surgeons examination committee. No surgery has a 100% success rate but the chances of a good outcome are directly proportional to the experience and abilities of the surgeon(s). Drs. Walker,  Edhlund and Vogel are three of only a few veterinarians in Hawaii who who feel comfortable with advanced veterinary orthopedic surgery techniques. Gentle Vets Advanced Care is the only veterinary hospital in Hawaii with Fluoroscopy, 64 slice in-house CT abilities, Arthroscopy and a HEPA filtered surgical suite, all of which help improve outcomes.