Short-Term Complications following Single-Session versus Staged Bilateral Tibial Plateau Levelling Osteotomies Stabilized with Locking Plates for Treatment of Bilateral Cranial Cruciate Ligament Disease: A Retrospective Study

Abstract

Objective The aim of this study was to compare complications between dogs with bilateral cranial cruciate ligament disease treated with single-session bilateral tibial plateau levelling osteotomies (BSSTPLO) versus staged bilateral TPLO (STPLO) procedures stabilized with locking plates.

Study Design Medical records of client-owned dogs treated with BSSTPLO or STPLO stabilized with locking plates between March 2017 and July 2018 at two associated institutions were reviewed. Patient data and complications from 37 dogs with BSSTPLO and 18 with STPLO were compared between groups. Major complications were defined as any complication that required further surgical or medical treatment whereas minor complications did not.

Results Incidence for major complications for BSSTPLO and STPLO was 7/37 and 6/18 respectively. Incidence for minor complications for BSSTPLO and STPLO was 3/37 and 2/18 respectively. No significant differences in minor or major complication rates existed between study groups (p = 0.2). Mean body weight was significantly higher in the STPLO group (p = 0.001); however, no correlation between weight or BCS and complication rate existed within either group. Increasing age was the only significant risk factor for major complications (p = 0.01) in either group.

Conclusion Our findings support the claim that BSSTPLO and STPLO performed with locking implants have similar complication rates. The decision to perform BSSTPLO or STPLO in dogs with bilateral cranial cruciate ligament disease should be based on other considerations rather than just complication rates.

Keywords

cranial cruciate ligament rupture - bilateral - complications - locking plates - tibial plateau levelling osteotomy

• References

• 1 Wilke VL, Robinson DA, Evans RB, Rothschild MF, Conzemius MG. Estimate of the annual economic impact of treatment of cranial cruciate ligament injury in dogs in the United States. J Am Vet Med Assoc 2005; 227 (10) 1604-1607
• 2 Johnson J, Austin C, Breur G. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 34 (02) 93-98
• 3 Grierson J, Asher L, Grainger K. An investigation into risk factors for bilateral canine cruciate ligament rupture. Vet Comp Orthop Traumatol 2011; 24 (03) 192-196
• 4 Guthrie JW, Keeley BJ, Maddock E, Bright SR, May C. Effect of signalment on the presentation of canine patients suffering from cranial cruciate ligament disease. J Small Anim Pract 2012; 53 (05) 273-277
• 5 Barnhart MD. Results of single-session bilateral tibial plateau leveling osteotomies as a treatment for bilaterally ruptured cranial cruciate ligaments in dogs: 25 cases (2000-2001). J Am Anim Hosp Assoc 2003; 39 (06) 573-578
• 6 Priddy II NH, Tomlinson JL, Dodam JR, Hornbostel JE. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001). J Am Vet Med Assoc 2003; 222 (12) 1726-1732
• 7 Bergh MS, Rajala-Schultz P, Johnson KA. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. Vet Surg 2008; 37 (04) 374-382
• 8 Cronier P, Pietu G, Dujardin C, Bigorre N, Ducellier F, Gerard R. The concept of locking plates. Orthop Traumatol Surg Res 2010
• 9 Strauss EJ, Schwarzkopf R, Kummer F, Egol KA. The current status of locked plating: the good, the bad, and the ugly. J Orthop Trauma 2008; 22 (07) 479-486
• 10 Aguila AZ, Manos JM, Orlansky AS, Todhunter RJ, Trotter EJ, Van der Meulen MC. In vitro biomechanical comparison of limited contat dynamic compression plate and locking compression plate. Vet Comp Orthop Traumatol 2005; 18 (04) 220-226
• 11 Bordelon J, Coker D, Payton M, Rochat M. An in vitro mechanical comparison of tibial plateau levelling osteotomy plates. Vet Comp Orthop Traumatol 2009; 22 (06) 467-472
• 12 Kloc II PA, Kowaleski MP, Litsky AS, Brown NO, Johnson KA. Biomechanical comparison of two alternative tibial plateau leveling osteotomy plates with the original standard in an axially loaded gap model: an in vitro study. Vet Surg 2009; 38 (01) 40-48
• 13 Conkling AL, Fagin B, Daye RM. Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology. Vet Surg 2010; 39 (04) 475-481
• 14 Solano MA, Danielski A, Kovach K, Fitzpatrick N, Farrell M. Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg. Vet Surg 2015; 44 (01) 59-64
• 15 Thompson AM, Bergh MS, Wang C, Wells K. Tibial plateau levelling osteotomy implant removal: a retrospective analysis of 129 cases. Vet Comp Orthop Traumatol 2011; 24 (06) 450-456
• 16 Cook JL, Evans R, Conzemius MG. , et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39 (08) 905-908
• 17 Coletti TJ, Anderson M, Gorse MJ, Madsen R. Complications associated with tibial plateau leveling osteotomy: a retrospective of 1519 procedures. Can Vet J 2014; 55 (03) 249-254
• 18 Stauffer KD, Tuttle TA, Elkins AD, Wehrenberg AP, Character BJ. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc 2006; 42 (01) 44-50
• 19 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39 (04) 460-474
• 20 Mehrkens LR, Hudson CC, Cole GL. Factors associated with early tibial tuberosity fracture after tibial plateau leveling osteotomy. Vet Surg 2018; 47 (05) 634-639
• 21 Frey TN, Hoelzler MG, Scavelli TD, Fulcher RP, Bastian RP. Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006). J Am Vet Med Assoc 2010; 236 (01) 88-94
• 22 Taylor J, Langenbach A, Marcellin-Little DJ. Risk factors for fibular fracture after TPLO. Vet Surg 2011; 40 (06) 687-693
• 23 Duerr FM, Martin KW, Rishniw M, Palmer RH, Selmic LE. Treatment of canine cranial cruciate ligament disease. A survey of ACVS Diplomates and primary care veterinarians. Vet Comp Orthop Traumatol 2014; 27 (06) 478-483
• 24 Mehta M, Strube P, Peters A. , et al. Influences of age and mechanical stability on volume, microstructure, and mineralization of the fracture callus during bone healing: is osteoclast activity the key to age-related impaired healing?. Bone 2010; 47 (02) 219-228
• 25 Ramanauskaitė K, Riškevičienė V, Grigalevičienė B, Juodžentė D. Factors that affect healing in cases of canine antebrachium fractures. Vet Med Zoot 2017; 75 (97) 58-64
• 26 Leitner M, Pearce SG, Windolf M. , et al. Comparison of locking and conventional screws for maintenance of tibial plateau positioning and biomechanical stability after locking tibial plateau leveling osteotomy plate fixation. Vet Surg 2008; 37 (04) 357-365
• 27 Krotscheck U, Thompson MS, Ryan KK, Mohammed HO. Comparison of TPA, bone healing, and intra-articular screw placement using conventional nonlocked application of surgeon-contoured versus locked application of precontoured TPLO plates in dogs. Vet Surg 2012; 41 (08) 931-937
• 28 Hans EC, Barnhart MD, Kennedy SC, Naber SJ. Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight. Vet Comp Orthop Traumatol 2017; 30 (04) 299-305