The following is a list of orthopedic procedures that Dr. John performs at CMVH.
Platelet Rich Plasma (PRP) Intra-Articular Injections
Platelets are small, colorless, cell fragments in the blood. They are formed in the bone marrow and are freely passing through the bloodstream in a resting state. However, when an injury occurs, the platelets become activated and start to gather at the injury site to release beneficial proteins called growth factors. This is the beginning of the healing process.
Autologous Conditioned Plasma is a specific blood product made by concentrating a patient's own platelets and growth factors in a small volume of plasma (yellow colored fluid portion of blood in which whole blood cells are suspended). ACP can then be used as a concentrated version of the patient's own growth factors to improve signaling and recruitment of cells to an injury site to optimize healing.
Tears, defects, degeneration, or inflammation of muscles, tendons and ligaments can often be treated successfully with ACP. ACP can also be an effective augmentation for surgical repair of these tissues. ACP has shown significant promise for improving pain relief and function in the treatment of osteoarthritis. Having the potential to provide an autologous (the patient's own platelets and plasma), therapeutic option to help treat this common, debilitating disease is a welcome advance for veterinarians and clients. ACP uses the patient's own natural healing properties to treat the injury. Side effects utilizing ACP are very uncommon.
For more information on ACP & PRP injections, please click here.
TPLO: Tibial Plateau Leveling Osteotomy
The procedure is based on the fact that the top part of the tibia bones normally sloped, resulting in tendency for the femur to slide backward when the dog stands and puts weight on its knee. The Cranial Cruciate Ligament (CCL) normally holds the femur in place and prevents this motion. But when the CCL has ruptured, the femur can slide back and forth along the sloped tibia, when the dog is standing or walking. The continued motion contributes to pain and degeneration in the knee joint.
A solution to the knee joint instability would be to either replace the torn CCL, or remove the slope in the tibia. The TPLO does the latter: after making a cut in the top part of the tibia, the surgeon rotates this segment of bone until it is almost perpendicular to the ground. To allow the cut bone segments to heal, the tibia is then stabilized with a bone plate and screws. The result is that when your dog stand on its leg, the femur is resting on a flat tibia surface, and there is no longer the sliding motion in the knee.
TTA: Tibal Tuberosity Advancement
TTA is a new-comer to the arena of procedures advocated to stabilize the cranial cruciate deficient knee in the canine. 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 is 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:
- 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.
- Less implant failure - the implants are made of titanium and are therefore less reactive and less likely to break. The strain put on the implants is less than what is seen with TPLO.
- Ease of procedure - less technically demanding procedures are less likely to have operator-dependent failures, resulting in better clinical results.
- 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.
- Ability to operate on both knees at once - a small percentage of dogs will have the condition undiagnosed in the opposite knee.
* * Now offering XORPTION cages for use in Tibial Tuberosity Advancements (TTA's). XORPTION cages are a specially manufactured cage that use a compound that is bioabsorbable. This bioabsorbable compound means that the cage will not cause any tissue reactions at the site of implantation, it will provide faster bone growth and great scaffolding for tissue growth, and it will absorb into the body over time. * *
TTA 2: Tibal Tuberosity Advancement 2
We also offer the TTA2 as an option for surgical correction of a cranial cruciate ligament rupture.
Tight Rope CCL
This technique was developed to provide a minimally invasive and improved method for extracapsular stabilization of the cranial cruciate ligament (CCL). This technique does not require cutting of bone like the TPLO or TTA procedures. Instead, it uses small drill holes in the femur and tibia to pass a synthetic ligament-like biomaterial through a small incision to provide bone-to-bone stabilization during healing. The biomaterial used for the TightRope CCL is called FiberTape®. This is a kevlar-like material that is used extensively in human surgery for many orthopaedic applications. This material has properties that make it stronger and less prone to failure than any other suture materials currently being used for CCL reconstructions.
This technique is commonly used in small dogs and cats. The initial part of the surgery is joint "house keeping" where the remnants of the torn ligament are removed and the joint is inspected for other damage. If damage to the meniscus is found, the torn portion is removed. Two very strong sutures are passed around the small bone (lateral fabella) on the back side of the femur bone and then passed through a hole drilled in the top of the tibia bone. The sutures are placed in the same orientation as the cranial cruciate ligament and are then tied to the appropriate tension to tighten the stifle joint. Scar tissue will develop on the side of the stifle joint which will ultimately serve to keep the stifle stable.
When the structures that make up your pet's knees (stifles) are misaligned or misshapen, a problem called a patellar luxation often occurs. Your pet's kneecaps are an important component of a normally-functioning knee joint. These kneecaps (patella) are meant to ride in a groove on the face of the femur. The patella acts as a pulley, giving leverage to extend the knee as your pet walks. When a pet has a luxating (out of place) patella, this small bone jumps out of its normal grove as the leg is in motion. In over 90% of these cases in dogs, the patella jumps out of its tract to the inside of the pet's knee (medial patellar luxation or MPL). The signs you will see in your dog depend on how severe the problem is and how long the problem has been present.
Repair of patellar luxation involves three important steps:
- Exploration of the knee joint to identify any ligament or cartilage damage.
- Realignment of the tibial tuberosity with the femoral groove.
- Formation of a normal femoral groove by deepening and widening it.
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 opentechnique, 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.
Cementless Total Hip Prosthesis
Total Hip Replacement's are performed to relieve pain, improve hip function, and allow your dog to return to an active life style. The arthritic joint is replaced with the implant to eliminate the pain resulting from bone rubbing on bone in the arthritic joint. The reduced motion of the arthritic joint is also corrected allowing your pet to regain a full range of motion of that limb.
If your dog has Hip Dyplasia, is over 9 months of age (with growth plates fully developed) and weighs more than 30 pounds, you have a likely candidate for a THR. A thorough examination to rule out other problems is a mandatory part of the preoperative examination. Dogs that have had femoral head excision (FHO - Femoral Head Osteotomy) are usually not good candidates.
The goal of surgery is to return your pet to pain-free, mechanically sound, normal hip function. Generally, dogs are found to be more comfortable and have an improved quality of life. Many owners report that their pet can do things they have not done since they were a puppy. Increase in muscle mass, improved hip motion, and increased activity levels have been observed in most patients. For more information and FAQ's about Total Hip Replacement, please visit BioMedtrix.
FHO: Femoral Head Osteotomy
A FHO is a a surgical procedure that involves removal of the femoral head. The procedure is performed when hip joint disease results in continuing pain and other methods of treatment are not feasible or did not produce the desired results. The procedure exposes the head section of the femur bone (the ball of the ball and socket joint), and then the head is removed using a small saw or a bone hammer and chisel. Rarely both sides are done in one operation, most times one side is done and allowed to heal before the other side is done. Unlike most other hip surgeries, the head of the femur is not replaced, When the femoral head is removed, the pain from pressure on the joint capsule and the cartilage is relieved. The patient forms what is called a pseudarthrosis, which is a fibrous (scar) tissue joint. The neck of the femur is usually removed at the same time as the head.
DPO: Double Pelvic Osteotomy / TPO: Triple Pelvic Osteotomy
The objective is to alter the dog's own natural hip joint, by eliminating the laxity and preventing the progression of arthritis. The pelvis is cut in two (DPO) or three (TPO) places, allowing the acetabulum (socket of the hip) to be rotated to a predetermined amount, to fit a specifically designed bone plate. This allows better coverage of the ball and therefore a more stable hip joint. The rotation is held in position using a special plate and screws. It takes approximately 6 to 8 weeks for the bones to heal solidly.
Dogs with complete luxation of the hip, grade IV hip dysplasia, are not candidates for this procedure. This surgery is reserved for younger dogs who still have a hip joint worth saving, and who meet stringent pre-operative requirements set by the surgeon.
Dogs who are candidates are:
- Usually 5-10 months old
- Have hip sockets deep enough to accommodate the hip bone after rotation
- Have hip joints that are free of arthritis
FCP: Fragmented Coronoid Process
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. 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, and surgery and 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.
UAP: Ununited Anconeal Process
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 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.
CUE: 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. For more information on this surgical technique, please click here.
Angular Limb Deformaties
Angular Limb Deformaties can be caused by genetic defects causing the growth plates in long bones to stop prematurely. Angular deformities of an animals long bones can cause severe functioning issues once the deformity is beyond the animals 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.