Today on the Kansas State University podcast Dr. James Roush, orthopedic surgeon at Kansas State's Veterinary Medical Teaching Hospital, discusses the intricacies of veterinary surgery and recovery.
Dr. Roush:
You know that I specialize primarily in orthopedic surgery so the injuries that I see on a daily basis, probably the two biggest groups are trauma fractures in animals in this area and then cruciate ligament ruptures. If you lump all of the developmental diseases in dogs, the growing orthopedic diseases of young dogs, that would be a third large group. And then other forms of traumatic injuries, for instance tendon lacerations, joint laxation or dislocation, those kind of injuries are sporadic and come as they're seen.
There are two really common surgeries for cruciate ligament rupture, again the most common thing we do, one is TPLO, tibial plateau leveling osteotomy, and we perform those here probably an average of six a week. That's the bread and butter of most orthopedic specialists in private practice quite frankly because of the high number of cruciate ruptures. We perform bone plating or fracture fixation. Those are one appliance but applied in different circumstances and how the fracture looks and what bone is fractured, but we do that fairly frequently.
More sporadically, specifically, things we'll do are total hip replacements, joint explorations, corrections for growth abnormalities. I warn every client whose dog has a cruciate rupture that they can expect the opposite knee likely to go in the lifetime. Part of that is due to the fact as I said that probably the largest group of dogs have a tendency to develop a little arthritis to generate their ligaments, but the other part of that is as they're recovering from one cruciate ligament, they're putting more weight on the other leg, the wrong stumble, the pop of the other leg. I've seen them do it while we're trying to heal the first one. I've seen them do it before they can get here to have surgery on the first one due within a few days then the other. It's a very high probability. Throw in the obesity, that contributes to most of them that can't get the weight off, you're just adding to this issue. Same thing that occurs with some of the young dog genetic diseases, for instance, many of those diseases can occur just on one joint or can occur bilateral. If you have osteochondritis desiccant or OCD in the shoulder of a dog, veterinarians are taught you should always x-ray the opposite shoulder because about 50 percent of those dogs will have a lesion, they just won't be as painful in the other shoulder. And once in a while you fix the shoulder that they've shown up lame in and they become lame in the other leg when the first shoulder feels better to them.
Surgeries have varying success rates and for instance, one fairly common surgery in small breed dogs, medial patellar luxation, so knee cap dislocation is a congenital problem that gets worse as they age, it's often in both knees. When we do the surgery, you know, you tell clients there's a -- and it depends on who you read and where the surgeries were done -- but there's between a 10 and a 30 percent chance this will come back or we won't correct the whole problem. Most often patellar dislocations are graded as to how severe they are and grade four being the worst, grade zero being normal. If you go into a grade four you've got a fairly high chance to convert it to a grade two, but it still should maybe have a little more improvement and so it may need another surgery later. But if you do a fracture fixation, you've fixed the bone, there's not very many of those that just fall apart and often it's something that either we or the client can't control - the dog busts out of the house and rips off the leash and goes and re-fractures it and breaks the bone plate, you know does something strange like that, those are less controllable. The alternative to doing a TPLO for cruciates is called an extra-capsular suture stabilization, you just use a nylon suture to restrain that abnormal movement of the joint. And that's done fairly frequently. There's some debate as to which is better, but one thing that I'm pretty sure of is when I use the nylon suture it's going to break eventually. Now most of those dogs won't come back and be lame when it breaks, but about 10 percent of them are. It's less costly then doing a TPLO but I present them to clients and I say, "If you're going to choose to do the extra-capsular, just recognize some of those dogs are going to be back in here in a year asking me to do a TPLO on them." For most surgeries we do, which technique you do depends on your experience, your comfort level, but most orthopedic surgeries now you're down to a choice of maybe one or two that are generally accepted as being successful.
Fracture fixations we actually teach a little differently. If you see a general fracture and the radius is normal for instance, when I ask a resident how are you going to fix that, we make them actually tell us all the possible ways you can fix it. I can use a bone plate on this fracture, I can cast this fracture, I can put an external fixator on this cast and then you look at those options which is better for cost, which is better for if this owner can't confine the animal as well as you'd like. Does it make a difference whether it's a young animal at three months of age where you're probably a little more likely to cast something or an older animal at 12 years of age where they're going to have a little more trouble healing in their bone so you want an internal plate for instance - now those things start to figure into those types of procedures.
Now there are also some diseases let's say hip dysplasia, for example in dogs, where the owner will often choose. There are several options for an older dog with hip dysplasia. We can treat them medically with analgesics or pain control, there are some dietary modifications you can make to help it. We can treat them with a total hip replacement. We can do a salvage procedure which is cutting the ball off of the femur, leaves them with kind of a false joint. You know the owner will make those choices based on cost, how good they want that animal to be, how much is it bothering them at home. You know if they're running everyday and the dog's always lame they may want a total hip replacement to go ahead and run with that dog. If the dog just mostly lays around the house and you want to relieve its pain a little bit and you don't want to have to give it a daily pill, that's when you choose to take the head off the femur. If it's only lame once every three weeks, then a couple of pills at those times will get them through the worst of it.
Most orthopedic surgery - because you're talking about either healing the bone, healing the connective tissue like the capsule around a joint, or something like that, you're talking about at least a four-week and probably usually between an eight-and 12 week period of confinement. For most things that's going to mean we want the dog in a small area when it's not observed and when it's observed we want it to be quiet. If it's an indoor dog taken out on a leash back in immediately, not walked around the block six times - you know those kind of things because all of the orthopedic implants, enough stress and they're going to break down. Just like if you bend a piece of wire like a coat hanger enough times, it's going to break, a plate will do that too. And so will any of the sutures and things that you put in for various diseases. So for most of those we're talking about confinement. It's often beneficial because a lot of pets just like a lot of people these days are obese, to work to take weight off of them for their future health as well as to protect that leg we're working on. Of course that's a bit more difficult because they're less active and we're starting to try to get them to lose weight.
There are some instances where we use a fair bit of physical therapy. Underwater treadmill usage you know having the dog walk on a treadmill that's in a pool of water, in post-op therapy, so that they don't bear as much weight. They're moving the joints to keep them normal. It's probably what you would term in vogue in veterinary medicine. More and more of those underwater treadmills are around especially in specialty clinics in Kansas City, here, Omaha for instance all have underwater treadmills. And those are fairly beneficial we think for most of the post-op recoveries.
I tell people our goal as orthopedic surgeons is to bring the dog back to what is a normal lifestyle for that client. You know if they want a dog that runs marathons with them then we try to choose the treatment and then do it so they can get back to that if that's possible with the injury they have. If they want a dog that mostly lies around the house, we may have some more options. Or dogs that have a little arthritis are likely to be maintained longer or better without having to go to surgery.
Thank you Dr. Roush. And remember to stay tuned for more podcasts from Kansas State University.