Orthopedic Procedures

Dr. John can perform the following orthopedic procedures here at Caledon Mountain Veterinary Hospital.

Orthopedic Surgery for Pets

Angular limb deformities can occur as the result of a genetic defect, in which the growth plates in long bones stop growing prematurely in the animal’s development. This condition can cause severe problems with mobility and function once the animal becomes unable to compensate for their deformity. Cats and dogs can adapt to having a shortened limb, but their gait will be affected, and the adjacent joints will be put under greater strain. Over time, this can lead to degenerative joint disease. We can correct these deformities by sectioning and repositioning pieces of bone to correct the angular change.

Medial Compartment Disease (MCD) is the final stage of elbow dysplasia where the inside section of the joint collapses and results in the grinding of bone on bone. To correct this, we can offer CUE surgery as a safe and effective option for dogs that can no longer benefit from arthroscopic treatments and other non-surgical alternatives.

With CUE surgery, we focus on the medial compartment. The CUE implant allows us to spare bone and provide a much less invasive alternative for resurfacing the medial compartment while also preserving the patient’s own cartilage in the lateral compartment. Overall, this procedure can reduce or even eliminate the pain and lameness associated with bone-on-bone contact.

Dr. John can perform Total Hip Replacements (THR) on dogs to relieve their pain, improve hip function and mobility and allow them to return to an active, happy life. An implant replaces the arthritic joint, eliminating the pain caused by bone rubbing against bone. This also restores the full range of motion of the limb.

Dogs with hip dysplasia over 9 months of age and weighing over 30 pounds are likely candidates for THR. Before committing your pet to surgery, we will perform a mandatory pre-operative exam to rule out other problems. If your dog has undergone a femoral head excision, they will likely not be a good candidate for THR.

The overall goal of this surgery is to alleviate your pet’s pain, return them to normal hip function and improve their quality of life. Other benefits include an increase in muscle mass, improved hip motion and increased activity levels.

The goal of DPO or TPO is to alter the dog’s natural hip joint and prevent the progression of arthritis. This procedure involves cutting the pelvis in two (DPO) or three (TPO) places to allow the hip socket to be rotated at a predetermined amount in order to fit a specially designed bone plate, thus improving the stability of the hip joint. Plate and screws are used to keep the rotation in proper position.

Dogs experiencing complete luxation of the hip and grade IV hip dysplasia are not ideal candidates for the DPO or TPO procedure. The best candidates are younger dogs (between five and 10 months of age) with sufficiently deep hip sockets to accommodate rotation of the hip bone, and hip joints untouched by arthritis.

Femoral head osteotomy is the surgical removal of the femoral head and neck (the ball end of the femur connecting to the hip joint). This surgery is performed on pets with painful and debilitating hip and joint disease unable to undergo alternative treatments (or whose past treatments did not produce desirable results). The surgery involves exposing the head and neck section of the femur, and then removing it with a small saw or hammer and chisel. Often, one side is done at a time to allow the patient to heal.

The head of the femur is not replaced; the resulting space relieves pressure on the joint capsule and surrounding cartilage. A fibrous scar tissue joint, known as a pseudarthrosis, will form in its place.

To repair a fracture, the ends of the bone must be brought together, and the continuity of the bone must be restored as close to its original state as possible. This can be done using a ‘closed’ technique, or without exposing the bones, using traction and manipulation and trying not to disturb the natural healing processes taking place. Fracture repair can also be performed using the open technique, or exposing the bones by separating or cutting through muscle to visualize the fracture and put the pieces back together. The fracture must be immobilized to allow for healing, and this can be achieved in several ways.

External fixation is the use of at least three pins passed from the outside of the leg, through the skin and into the bones of the limb, above and below the fracture. These pins can be connected to one another by bars, rods, cement or rings. External fixators can be applied open or closed, and combined with various other techniques.

Internal fixation is the use of pins, wire, plate and screws. Plates and screws can be used to secure a variety of different fragments, and provide exceptionally stable fixation and, in some cases, the ability to squeeze or compress the ends of the bone fragments together. These repairs allow the patient to be up and using their fractured limb as soon as they are able.

FCP is a condition in which the radius and the ulna (forearm bones), two of the three bones making up the elbow joint, grow at unequal rates. As a result, greater pressure is placed on a section of the ulna known as the medial coronoid process, which can develop cracks or break off into the joint. If this causes pain and lameness in the patient, arthroscopy or surgery may be recommended to stop or slow the progress of degenerative joint disease.

Surgery and arthroscopy are recommended for pets under 12 months of age that have not yet experienced the effects of arthritis. With arthroscopy, we can visualize the joint to safely remove the bone fragment and smooth any lesions on the joint.

This technique is commonly used for small dogs and cats. The initial part of the surgery involves cleaning up the joint by removing remnants of torn ligament and inspecting the joint for additional damage. If part of the meniscus is torn, that is also removed. A pair of strong sutures are passed around the small bone at the back of the femur (known as the lateral fabella), 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 tied to the appropriate tension to tighten the stifle joint. Over time, scar tissue will form on the side of the stifle joint and keep it stable.

Patellar luxation occurs when the structures making up your pet’s knees are misaligned or misshapen. A normally-functioning knee joint relies on the kneecaps (patella). The kneecaps are meant to rest in a groove on the face of the femur. The patella acts as a pulley, providing leverage to extend the knee while walking. In a pet that has a luxating (out of place) patella, this small bone jumps out of its normal groove while the leg is in motion. In a majority of these cases in dogs, the patella shifts out of its groove to the inside of the pet’s knee (medial patellar luxation or MPL).

Repairing patellar luxation involves three major steps:

  • Exploring the knee joint to check for ligament or cartilage damage
  • Realignment of the tibial tuberosity with the femoral groove
  • Formation of a normal femoral groove by making it deeper and wider

Platelets are small, colorless cell fragments found in the blood. They form in the bone marrow and pass freely through the bloodstream in a resting state. When an injury occurs, the platelets become activated and immediately begin gathering at the injury site to release beneficial proteins known as growth factors, initiating the healing process.

Autologous Conditioned Plasma (ACP) is a specific blood product made by concentrating the patient’s own platelets and growth factors into a small volume of plasma (the yellowish fluid portion of the blood in which whole blood cells are suspended). ACP can be used as a concentrated version of the patient’s own growth factors to improve signaling and the recruitment of cells to the injury site for optimal healing.

ACP can effectively treat conditions such as tears, defects, degeneration or inflammation of the muscles, tendons and ligaments. It can also be used to augment the surgical repair of the tissues. ACP also has the potential to effectively relieve pain and improve function for patients suffering from osteoarthritis. It uses the patient’s own natural healing abilities to treat injury. There are few side effects associated with ACP and PRP use.

Tight Rope CCL was developed to provide a minimally invasive and improved method for the extracapsular stabilization of the cranial cruciate ligament (CCL). Unlike TPLO and TTA, this technique does not require the cutting of bone. Instead, small holes are drilled into the femur and tibia, through which a synthetic, ligament-like biomaterial is passed to provide bone-to-bone stabilization during the healing process. The biomaterial used for this procedure is called FiberTape®, a kevlar-like material that can be used for many orthopedic applications and is stronger and less prone to failure than any other suture materials currently being used for CCL reconstructions.

The top of the tibia bone should not be sloped in such a way that the femur slides backward when the dog stands and puts weight on its knee. Under normal circumstances, the cranial cruciate ligament (CCL) holds the femur in place to prevent this motion from occurring. However, if the CCL ruptures, the femur can end up sliding back and forth on the sloped tibia when the dog is standing or walking. This continued back-and-forth movement can cause pain and degeneration in the knee joint.

To repair the knee joint, we can either replace the torn ligament or correct the slope of the tibia. With TPLO, we take the latter approach—after making a cut on the top part of the tibia, this segment of bone is rotated until it is almost perpendicular to the ground. To allow for healing, the tibia is stabilized with a bone plate and screws. The goal of this procedure is to keep the femur resting on a flat tibia surface and eliminate the knee’s back-and-forth sliding motion.

TTA is a relatively new procedure for stabilizing knee joints with a deficient cranial cruciate ligament (CCL). To accomplish this result, we need to reposition the patellar tendon forward using a special implant until it is perpendicular to the tibial plateau in a standing angle to reduce strain on the CCL. As a result, the patellar tendon takes over for the CCL, handling the load and resulting in a stable knee.

Advantages of TTA over TPLO include:

  • A quicker recovery due to a less invasive surgical technique, along with reduced swelling, shorter surgical time and improved postoperative stability
  • Less implant failure, as the implants are made of titanium and are therefore less reactive and less likely to break. Less strain is placed on the implants, compared with TPLO
  • An easier procedure that is less technically demanding and less likely to have operator-dependent failures, resulting in better clinical results
  • Since TTA does not require a rolling of the tibial plateau as with TPLO, stability is more easily achievable in even the most chronically arthritic knees
  • The ability to operate on both knees at once

*We now offer XORPTION cages for use in TTA surgeries. XORPTION cages are a specially manufactured cage that use a bioabsorbable compound. This compound indicates the cage will not cause any tissue reactions at the implantation site, will facilitate faster bone growth, will provide effective scaffolding for tissue growth and will absorb into the body over time.

We can also offer TTA 2 as an option for surgically correcting a ruptured cranial cruciate ligament.

An ununited anconeal process occurs if the anconeal process, a section of bone located at the growth plate at the top of the ulna, does not fuse with the ulna. This fusion usually takes place in dogs between 16 and 24 weeks of age. When the bones fail to fuse together, this leads to instability in the joint which results in damage of the articular cartilage, along with lameness, pain and arthritis of the elbow joint. It is absolutely necessary to correct this problem with surgery, and surgical excision is the most widely accepted method. The loose anconeal process is removed from the joint to prevent further irritation and discomfort and to reduce the severity of arthritis in the future.