Joint Replacement:
Hip, Elbow, Stifle, Tarsus

Cranial Cruciate Ligament

Caudal Cruciate Ligament

About Joint Replacement Surgery

Total joint replacement is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic, or ceramic device called a prosthesis. The prosthesis is designed to replicate the movement of a normal, healthy joint.

- About Hip Dysplasia, knee, elbow and ankle conditions

 

Hip replacements are the most commonly performed joint replacements for cats and dogs, but replacement surgery can be performed on other joints, as well, including the elbow, stifle (knee) and tarsus (ankle).

A joint forms where the ends of two or more bones meet. There are different types of joints within the body. For example, the knee is considered a "hinge" joint, because of its ability to bend and straighten like a hinged door. The hip is a "ball-and-socket" joint, in which the rounded end of one bone fits into a cup-shaped area of another bone.

How we Diagnose Hip Dysplasia

A complete physical, orthopedic, and neurologic examination will be performed by an orthopedic surgeon. A complete history of how and what your dog has been doing at home will be an important part of the decision making process. Common clues that a total hip replacement might be needed include hind limb lameness, reluctance to rise or jump, inability to exercise, pain after exercise, decreased activity, and loss of muscle mass.

Cranial cruciate ligament disease is typically diagnosed by physical examination and radiographs. The ligament is not visible on radiographs, but secondary changes are often apparent indicating that the joint is abnormal (joint fluid, arthritic changes, abnormal bone position). Sometimes other diagnostics such as joint taps or arthroscopy are utilized to confirm the diagnosis in partial tears.

Choosing the Right Treatment

When the cranial cruciate ligament is torn, surgical stabilization of the knee joint is often required, especially in larger or more active dogs. Surgery is generally recommended as soon as possible to reduce permanent, irreversible joint damage and relieve pain.

Several surgical techniques are currently used to correct CCL rupture. Each procedure has unique advantages and potential drawbacks. Our Board-Certified Surgery Team will guide you through the decision-making process and advise you on the best surgical option for your pet.

Femur

Patella

Meniscus

Tibia

Fibula

Fabella

THR - Total Hip Replacement:
The Modern, Minimally-Invasive Solution

A total hip replacement is a procedure in which the orthopedic surgeon replaces a painful or damaged hip joint with an artificial one. The hip joint is a “ball and socket” joint made of two bones. These bones are partially removed and a metal and plastic artificial implant, or “prosthesis,” is placed to function like a normal hip.

 

Removal of the affected hip joint eliminates the source of pain and lameness, thus allowing the patient to return to a normal level of activity. The new artificial hip provides a pain free joint substitute, and as such, limb function and activity level return to normal.

The most frequent indication for total hip replacement in dogs is the relief of pain and lameness caused by severe arthritis secondary to hip dysplasia, or fractures (breaks) and dislocation of the bones that make up the hip joint. Many dogs with arthritic and painful hips function fairly well with pain medication and exercise restriction, but when a painful joint is removed and replaced with an artificial hip, there is often a dramatic change in the patient’s activity, lameness, muscle mass, and personality.

1. In Preparation for "leveling" the tibial plateau, a semicircular cut is made through the bone.

Surgical Procedure

Under general anesthesia, the surgeon removes the cartilage and bone that make up the hip joint. The diseased femoral head (the ball) is replaced with a metal implant on a stem that fits inside the femur (thigh bone). The diseased part of the pelvis (socket) is replaced with a plastic or combination metal and plastic cup.

 

The new hip is designed to allow the joint to move in an identical manner to a normal hip. The implants are very durable, and are anchored in place using either bone cement (cemented hip replacement) or by the dog’s own bone actually growing into the implants (cementless hip replacement).

Post-Operative Care

2. Once the cut in the tibia is made, the bone segment is rotated to achieve a "level" tibial plateau.

Most dogs can stand and walk on the new hip implants the day after surgery and are able to go home after 3-5 days of total hospitalization. However, total hip replacement patients must be confined to a crate and allowed outside only on a leash to eliminate for 3 months after surgery. While at home, care should be taken to avoid walking on slippery surfaces, and long flights of stairs are not allowed.

 

After the first 4 weeks of crate confinement, SLOW, 5 minute leash walks are started 2-3 times a day. These leash walks are increased by 5 minutes each week, until leash walks are 20 minutes long. These 20 minute leash walks are continued for 4 additional weeks, at which time we will set an appointment for re-examination and x-rays.

3. The rotated tibial segment is secured for healing using a specifically-designed orthopedic plate. It may be appropriate to consider removal of this plate once healing is complete.

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1. The torn CCL destabilizes the stifle (knee) joint.

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2. During surgery, the remnants of the torn CCL are trimmed away.

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3. If the meniscus (cartilage pad) is damaged, the traumatized part is removed. 

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4(a). The stabilizing suture is secured through small channels drilled into the femur and tibia and then tied into place. The suture mimics the stabilizing effect of the CCL. 

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4(b). The stabilizing suture may be secured with a special clip rather than a bulky knot.

Extra-Capsular Repair:
A More Traditional Technique

The traditional ECLS technique is the oldest surgical correction for cruciate ligament injury in dogs. The name of the procedure originates from the fact that the joint is stabilized outside the joint capsule (externally).

In simplest terms, a loop of a special type of suture material (an artificial ligament) is placed from the back of the knee joint around to the front, where it is anchored just below the knee. This suture material stabilizes the joint and prevents the tibia from slipping back and forth after the cruciate ligament has torn. This procedure typically requires two bone channels (tiny holes) to be drilled: one at the front of the tibia and the other on the outer (lateral) aspect of the femur at the level of the stifle joint, so the artificial ligament can be passed through them.

CCL repair surgery typically consists of an initial examination of the inside of the knee. This examination may either be done by opening the joint capsule and looking inside or by using an arthroscope. Any damaged or torn portions of the CCL are removed. The shock absorber, or cartilage meniscus, that cushions the knee and sits between the femur and tibia, is examined. If the meniscus is torn or damaged, that part will be removed. After the joint capsule has been examined and any cartilage or ligament fragments are removed, the joint capsule is sutured closed.

Surgical Procedure

In the ECLS procedure, a suture is passed from the outside/lateral aspect of the knee joint to the front of the tibia. Some surgeons refer to this as imbricating, or overlapping, the extracapsular tissues to pull the joint tight and create stability to prevent front-to-back sliding of the femur and tibia.

 

Usually, one or two bone channels or holes will be required to pass the suture from back to front.

There have been several innovations in external capsular repair during the past decade. New materials, anchoring devices, and tools have allowed veterinary surgeons to perform this surgery more successfully than ever before.

Several surgical product manufacturers have created advances that make this procedure viable for many dogs, including some large and athletic breeds. Larger, more active dogs may do better with TPLO or TTA procedures (see handouts on TPLO and TTA).

 

Perhaps the biggest advancement in CCL surgery has been in how the suture material is joined together. In the past, veterinarians relied on bulky knots that could come undone or irritate the surrounding tissues. Today, there is a variety of suture connectors that are much more reliable, effective, and less irritating. The use of bone anchors and modified bone drills and bits for varying sizes of dogs has also improved ECLS. Strong, specialized knee suture materials have also been developed that make the surgery simpler, more effective, and less risky than in the past.

Post-Operative Care

Post-operative care after any extra-capsular stabilization includes activity restriction, incision care, physical therapy, and specific medications.

Activity Restriction – The post-operative recovery period usually lasts for about 8 weeks. During this period, the patient needs to have their activity restricted as to not cause complications with the stabilization. Too much activity can lead to implant failure, meniscal injury, and pain. The DVSC usually recommends confinement (crate, kennel, enclosure, small room), leash walks only, no jumping, no playing, no climbing, and no running for the majority of the recovery period. As the patient recovers, the surgeon will implement gradual return to normal activity.

 

Incision Care – It usually takes about 2-3 weeks for the incision and soft tissues to heal. During this time, it is important to monitor the incision for any excessive swelling, oozing, or incisional dehiscence (opening up). We also recommend an E-collar (cone) placed around the dogs’ head in order to keep them from chewing or licking at the incision. Licking or chewing at the incision can lead to dehiscence and/or infection of the site, which can be a serious complication especially if infection reaches the implant.

 

In addition, cold and/or warm compress may be implemented to decrease incisional swelling.