PAUL; Clinical Experience

PAULClinical Experience

! 1!

KYON Symposium 2013 Innovations in Veterinary Orthopedics and Trauma

Boston, USA - April 12 - 14

Friday, April 12th 19:00 Welcome Reception Saturday, April 13th 07:00 Registration 07:50 Welcome and meeting organization Session 1 – STIFLE 08:00 Ultra-CL – Arthroscopic Application: Michael Bauer 08:10 Ultra-CL – Research: Juan Pu 08:20 LESS – Research & Clinical Application: Otto Lanz 08:30 TTA-2 – Introduction: Slobodan Tepic 08:40 TTA-2 – Clinical Experience: Joop Hopmans 08:50 TTA-2 – Research: Krista Adamovich 09:00 TT-Crown – Research & Clinical Experience: Zoran Lonĉar 09:10 TT-Crown – Clinical Experience: Simone Niederhäuser 09:20 TT-Crown – Clinical Experience: Hugh Davis 09:30 DISCUSSION moderator: Andy Torrington participants: STIFLE session speakers 10:00 Coffee break & BREAKOUT SESSION 1 Session topics and facilitators are listed below. Session 2 – LANDSCAPES: BUSINESS 11:30 A Family Practice: Randy Acker 11:45 A Distinctive Business Model: Denny Aron 12:00 A Specialty Clinic: John Stephan 12:15 Franchise Operations: Dave Gersholowitz 12:30 DISCUSSION moderator: Preston Stubbs participants: LANDSCAPES: BUSINESS session speakers 13:00 LUNCH Session 3 – LANDSCAPES: SURGICAL INFECTION 14:00 Microbiology and Minimizing Clinical Risk: Scott Weese 14:30 THR – Clinical Experience: Aldo Vezzoni 14:45 Internal Fixation – Clinical Experience: Ayami Nojiri 15:00 DISCUSSION: moderator: Ursula Krotscheck participants: LANDSCAPES: SURGICAL INFECTION session speakers 15:30 Coffee Break

Aldo Vezzoni, DVM, Dipl. ECVS, Cremona, Italy

[email protected]

Wednesday, April 24, 13

Medial compartment syndrome of the elbow

• End result of FCP and OCD of

the Elbow

• Due to joint incongruity

• Short radius or short ulna

• Cartilage loss and bone

eburneation

• Progressive OA

• Friction, heating, pain


• Ingo Pfeil pilot study developed with Slobodan Tepic

PAUL

‣ Similar effect as for genu varus in man‣Medial open wedge

osteotomy‣Causing shift of weight

bearing from medial to lateral


• Ingo Pfeil pilot study developed with Slobodan Tepic

PAUL

LM

‣ Similar effect as for genu varus in man‣Medial open wedge

osteotomy‣Causing shift of weight

bearing from medial to lateral


• Dogs of any age (1 year to 9 years)

• Severe OA developed from FCP-OCD

• Medial Compartment Syndrome

• Unresponsive to conservative or arthroscopic treatment

• Offering palliative treatment with expected variable

improvement or no improvement, age and OA dependent,

but no worsening

• 7-12 month PrDUO

• < 7 months, DiDUO

Case Selection


• Young dogs

Case Selection

Golden, M, 1.5 yrs. Labrador, M, 1 yr.


Golden, M, 4 yrs. Labrador, M, 5 yrs.

Case Selection

• Mature dogs

Rottweiler, F, 7 yrs.


Case Selection

Blade, Labrador, M, 5 yrs., 35 kg

• Planning:

‣ arthroscopy to confirm medial compartment erosion and

cartilage integrity in the lateral compartment


• Exclusion:

‣ end-stage OA

‣medial & lateral

joint collapse

‣ > 10 years of age

Case Selection

Labrador, F, 8 yrs, 38 kg


• Exclusion:

‣ severe elbow incongruity by

short ulna and UAP

‣ radial head degeneration

‣ lateral compartment affected

Case Selection

GSD, M, 3 yrs., 36 kg


• Exclusion:

‣FCP without medial compartment erosion

Case Selection

Rottweiler, M, 8 mo.


• Planning:

‣ radiographic study and measurements

‣mechanical elbow medial angle

‣ normal: 81.5 ± 2.5

‣ < 80° ⇒ 3 mm step plate

‣ > 80° ⇒ 2 mm step plate (first choice in more chronic cases)

Case Selection

76°


• Visual Planning:

‣ video clips

‣ still frame from front

‣measure forelimb adduction

‣ degrees of correction related to

amount of internal limb

adduction, & limb size

Tobia, Golden Retriever, M, 1.5 yrs.

6°

Planning


Outcome

• Post-op radiographs

• M-L

• Cr-Cd

‣FUs at 2 and 6 months

‣ then yearly


• Breeds

Clinical cases

Labrador

Golden

Rottweiler

GSD

Am. Staffordshire

Bernese

0 4 8 12 16 20

18

5

5

Total: 32 elbows

2

1

1


• Age

1-2 yrs

3-5 yrs

6-8 yrs

9 > yrs

0 2 4 6 8 10 12 14 16 18 20

53%

18%

18%

1%

Clinical cases

Total: 32 elbowsWednesday, April 24, 13

• Plate size

2 mm

3 mm

4 mm

0 4 8 12 16 20

53%

43%

3%

Clinical cases


• Arthroscopy

Previous

Contemporary

No

0 4 8 12 16 20

13%

62%

25%

Clinical cases


• Gap

Bone graft

Collagen sponge

No

0 2 4 7 9 11 13 16 18 20

6%

56%

38%

Clinical cases


• FU

1-2 months

6 months

1 > year

0 20 40

97%

64%

52%

Clinical cases


‣Clinical and rad assessment

‣ Independent owner interview (April 2013)

• Outcome

Clinical cases

• Great improvement, no NSAID

• Improvement, less NSAID

• Same as before

• WorsenedTotal: 32 elbows


• Outcome (physical evaluation, X-Ray and owner’s satisfaction)

Great improvement

Improvement

Same as before

Worsened

0 4 8 12 16 20

56%

22%

19%

3%

Clinical cases

Total: 32 elbows

78%


• Outcome

Great improvement

Improvement

Same as before

Worsened

0 4 8 12 16 20

1-2 years17 dogs

3-5 years6 dogs

6-8 years6 dogs

53%

30%

16%

66% 50% 66%

Clinical cases

17%

Total: 32 elbows

9 > years3 dogs

17%17%

34%

17%17%


• Outcome

Great improvement

Improvement

Same as before

Worsened

0 3 6 9

1-2 years

53%

30%

Clinical cases

17%

83%

Tot.: 17 elbowsWednesday, April 24, 13

• Outcome

Great improvement

Improvement

Same as before

Worsened

0 0.8 1.6 2.4 3.2 4

3-5 years

66%

Clinical cases

17%

17% 83%

Tot.: 6 elbowsWednesday, April 24, 13

• Outcome

Great improvement

Improvement

Same as before

Worsened

0 1 2 3

6-8 years

50%

17%

Clinical cases

17%

17%

Tot.: 6 elbows

67%


• Outcome

Great improvement

Improvement

Same as before

Worsened

0 1 2

66%

Clinical cases

34%

Tot.: 3 elbows

9 < years


• Minor Complications: 9 (28%) broken screws, delayed union, seroma

• Major Complications requiring surgical revision: 4 (12.5%)

• Major Complications with new implants: 2 (6%) implant removal

Brocken plate

Broken screws

Implant removal

Delayed union

Seroma

0 1 2 3 4 5

6%

3%

Clinical cases

(Prototype plate)

6%

(over 6 mo.)

Total: 32 elbows

15%

9%


Rottweiler, F, 7 yrs., FU 6 mo.

• Complications:

‣Plate breakage

‣Prototype plate

only

Clinical cases


Rottweiler, F, 7 yrs., FU 6 mo., delayed union

Clinical cases


American Staffordshire, M, 4 yrs., 20 kgFU 9 mo., implant removal, too big plate

Clinical cases


Labrador, M, 1 yr., FU 5 mo.

• Complications:

‣ screw breakage

‣ young, active dog

‣ conservative

Clinical cases


• SIGNIFICATIVE CLINICAL CASES

PAUL


Tobia, Golden Retriever, M, 1.5 yrs., 36 kg3° chronic left lameness, FCP 5 mo. before

Clinical cases

6°


Tobia, Golden Retriever, M, 1.5 yrs., 36 kg3° chronic left lameness

Clinical cases


12°(+ 6°)

Tobia, Golden Retriever, M, 1.5 yrs., 36 kg1 month p.o. PAUL 3 mm, limb abduction

3 mm step

Clinical cases


Tobia, Golden Retriever, M, 1.5 yrs., 36 kg1 month p.o., limb abduction

Clinical cases



Clinical cases


slow motion

pre-op

pre-op

1 mo. post-op


Clinical cases


pre-op

1 year FU

Tobia, Golden Retriever, M, 2.5 yrs., 36 kg

Clinical cases


pre-op

1 year FU

Tobia, Golden Retriever, M, 2.5 yrs., 36 kg

Clinical cases


pre-op

Giobbe, Labrador, M, 7.5 yrs., 30 kg

Clinical cases

LR


pre-op

Giobbe, Labrador, M, 9.5 yrs., 30 kgFU right PAUL U3, 2 yearsFU left PAUL U2, 2.5 months

Clinical cases

R L


pre-op

Giobbe, Labrador, M, 9.5 yrs., 30 kgFU right PAUL U3, 2 yearsFU left PAUL U2, 2.5 months, client satisfaction!

Clinical cases


‣Palliative treatment

‣Quite skeptical at the beginning

‣Promising preliminary results

‣Client satisfaction

‣Limited risk of complications

‣Further evaluations are needed in longer term

‣TEA is not prevented later on

‣ Same concept as for knee osteotomy in man

Discussion


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PAUL; Clinical Experience

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