Joint SURGERY

NOAH offers general and specialist Joint Surgery, with a team of highly qualified Orthopaedic Veterinarians on hand to help

Like us, our pets require healthy and mobile joints for both movement and comfort. Whether your pet has broken a joint, is suffering from an inflammatory joint condition, or even needs an entire joint replacement, we can help.

As one of Ireland’s best-equipped animal hospitals, we provide cutting-edge pet joint surgery suitable for dogs and cats.

NOAH SOFT TISSUE SURGERY SERVICES

Cranial Cruciate Ligament Surgery (CCL)

Rupture of the Cranial Cruciate Ligament (CCL) is a common orthopaedic injury that occurs in our canine patients.

This is referred to as the ACL or Anterior Cruciate Ligament in humans and is almost always caused by acute trauma.

In dogs, CCL injury can occur as an acute trauma or more commonly, is the result of a degenerative process that leads to early and progressive arthritis.

CCL causes pain and lameness, and increases the risk of injury to other structures of the knee, such as the meniscus.

 

Techniques used to repair this injury in humans do not work well for dogs because of factors such as conformation.

In dogs, the CCL cannot be repaired or reattached.

Surgical options for dogs with this injury are based on stabilising the joint by dynamically altering the biomechanics of the joint using the TPLO or TTA.

Arthroscopic surgery is a key investigative tool in due to its minimal disruption of the joint structure and visualisation of the meniscus.

Elbow Surgery

Canine elbow dysplasia is a main cause of canine forelimb lameness. Elbow dysplasia is a set of diseases that include osteochondrosis (OCD), fragmented coronoid process (FCP) and united anconeal process (UAP). There are many different genes that contribute to elbow dysplasia with both environmental and hereditary influences. Degenerative joint disease can lead to decreased range of motion in the elbow and paw in immature large dog breeds, this usually indicates the presence of elbow dysplasia. Surgery of traumatic luxation can involve the open reduction of the elbow luxation or elbow arthrodesis.

If either the ulna or the radius does not grow to its expected length due to the closure of a growth plate too early, it can lead to deformity. This can be due to either trauma to the immature bone causing the growth plate to close early or it can be in chondrodysplastic breeds due to asynchronous growth causing incongruity. If untreated, the elbow joint would be painful and will lead to degenerative joint disease. Surgery can include ulnar lengthening osteotomy, ulnar shortening or radial lengthening.

Dr William McCartney of NOAH (North Dublin Orthopaedic Animal Hospital) was the first veterinary orthopaedic surgeon in Ireland to do total elbow replacements, PAUL procedure, sliding humeral osteotomy, arthroscopy, and arthroscopic surgery for medial compartment disease.

Hip Surgery

Many humans will be familiar with hip osteoarthritis due to either development issues or trauma. The hip is a versatile joint that provides much of the power of the hind limb, whilst having the biggest range of motion of any joint in the body.

Painful osteoarthritis can be particularly difficult to treat. The first route of treatment is to administer pain-relieving anti-inflammatories, which can be hugely successful in managing the pain. But there are problems with using long term medicine to control pain and gastrointestinal ulceration can occur, and eventually they may not work.

As well as that, some dogs simply cannot tolerate anti-inflammatories.

In these cases, the dog can have either a triple pelvis osteotomy (if less than 12 months) for hip dysplasia, femoral head and neck excision, or total hip replacement.

Triple pelvic osteotomy is a major operation to rotate the pelvis outward to cover the femoral head better than before by creating a virtually normal joint. It has its limitations in that it must be performed before 12 months for best results. Femoral head and neck excisions may be used in some cases and can provide a pain-free scar joint. Although reduced in total range of motion, it can be successful in certain cases. Total hip replacement is a very successful surgery in some dogs. Dr McCartney has a long experience doing hip replacements and even has performed the operation on cats.

Knee Surgery

The knee joint in dogs (known as the stifle) is similar to humans. Because we stand upright, there is differentstress to the ligaments in our knee compared to dogs. Dogs, however, stand with the ankle elevated and the knee forward. The top of the dog’s tibia (tibial plateau) is sloped and weight-bearing creates a force that pushes the femur down the slope of the tibia. This force is called ‘tibial thrust’ and it is the job of the CCL to prevent this motion. Each time the dog bears weight, the CCL is under tension. When the ligament is ruptured, each time the dog bears weight this motion occurs and causes discomfort. When the CCL is ruptured (even partially), there will be inflammation and swelling, referred to as synovitis and effusion. The two menisci are the ‘shock absorbers’ of the knee and are located between the femur and the tibia. When the knee is unstable due to a CCL rupture, either complete or partial, the menisci are at risk for injury.

Actions that could cause a rupture include:

Complete rupture results in a non-weight bearing lameness. In the case of a partial rupture, the pet will be weight-bearing lame or have intermittent lameness. Lameness will often worsen with activity. Stiffness upon rising and/or a stiff gait is another common complaint. You may note that your pet sits with the affected leg out to the side. He or she may have difficulty rising and be less active. Physically, you may note a swelling or thickening of the knee and muscle atrophy (wasting) in the affected limb. Dogs that have ruptured the CCL in both knees do not have lameness in a particular limb since he or she does not have a good limb to stand on.

Extracapsular Stabilization stabilizes the stifle joint with placement of a non-absorbable suture material, typically a mono-filament nylon such as fishing leader line, around the lateral fabella and through a hole in the tibial crest mimicking the pattern of the CCL. Although often referred to as an ‘artificial ligament’, the suture provides only temporary stabilization and will loosen over time. This technique relies on scar tissue to ultimately stabilize the joint. Recovery time following the Extracapsular Stabilization is approximately 3 to 5 months. While this technique can be successful, it is more likely to fail in large breed dogs as the prosthetic ligament can stretch or rupture. Another common complication is over-tightening of the prosthetic ligament with applies excessive compression of the joint. This can lead to cartilage damage, increased risk of meniscal injury, limited range of motion of the joint, and discomfort.

This technique differs from the traditional extracapsular stabilization in that it is a bone to bone fixation and utilizes a method for more accurate isometric implant placement. FiberTape®, an implant designed specifically for ligament repair, has superior strength and stiffness compared to conventional materials used for extracapsular stabilization. The FiberTape® is passed through these tunnels. Toggle buttons are inserted and used to apply appropriate tension to the FiberTape® providing stabilization of the knee

The TPLO procedure is a dynamic procedure and stabilizes the knee by levelling the tibial plateau. The surgeon will measure the tibial plateau angle (slope) from X Rays and accurately and precisely determine the amount of rotation that is needed to reduce the angle to between 5 and 8 degrees. The basis of the TPLO procedure is that the surgeon will make a curved cut (Osteotomy) in the tibia and rotate the segment so that the load-bearing surface of the tibia is between 5 to 8 degrees. A plate and screws is then applied to hold the tibia in this position and allow for the bone to heal. Recovery time following the TPLO procedure is approximately 2 to 3 months. Following TPLO surgery, patients use the limb and are more comfortable much sooner than following the Extracapsular Stabilization. Additionally, studies show that there is less arthritic development long-term following the TPLO verses the Extracapsular Stabilization (Lazar T, Vet Surg, 2005).

Surgical correction is the only way to resolve a Luxating Patella. Corrective surgical techniques such as sulcoplasty, osteotomy, and desmotomy will be needed to realign the quadriceps mechanism and counteract the muscular forces pulling the patella in the wrong direction. Correction is possible in approximately 95% of cases.

The TTA is a dynamic procedure similar in principle to the TPLO but relies on the patellar tendon to stabilize the knee. This involves moving the patellar tendon forward to the point that it is perpendicular (at 90 degrees) to the tibial plateau with the limb in a standing angle. This movement relieves the load of the CCL, applying that load to the patellar tendon. The amount of distance necessary to advance the patellar tendon to make it perpendicular to the tibial plateau is measured from preoperative radiographs.

The patellar tendon is attached to the tibial tuberosity (the front top portion of the tibia) and it is the tibial tuberosity that is actually advanced.

The tibial tuberosity is cut in a wedge fashion and moved forward the predetermined amount. It is held in place by a titanium cage, fork, and tension band plate. Bone grows over and through the cage and fills in between the tibia and the advanced tibial tuberosity. This technique is not appropriate for dogs with tibial slopes greater than 27° to 30°.