Stifle replacement - who does them?

RE: Stifle replacement - who does them?

Andrew Mellor — Wed, 27 Apr 2016 13:36:22 GMT

Thank you so much , especially Malcolm for your comprehensive assessment and advise.

RE: Stifle replacement - who does them?

Bob Russell — Tue, 26 Apr 2016 12:42:34 GMT

Harry did the last TKR for one of my patients. The results were good and the dog died from complications from a splenic tumour two years later!

I was blissfully unaware that the procedure was so challenging!

RE: Stifle replacement - who does them?

Malcolm Ness — Tue, 26 Apr 2016 08:40:09 GMT

Hi Andrew,

While I am sure that you could find someone to to a total knee arthroplasty here, some considerable caution should be applied. The risk of a poor outcome is substantial. TKR is never a simple procedure but there are features of this case that make it particularly challenging.

The proximal tibia is significantly altered due to the previous surgery - the tibial plateau is small, somewhat lacking cranially and with evidence of very dense sclerotic bone in the proximal metaphysis. Furthermore, there is a complex angular/axis abnormality related to the original deformity plus the subsequent distal osteotomy surgery. Finally, the fact that there are implants in place plus the history of multiple previous operations mean that the risk of infection as a complication of a TKR will be increased.

That said, there are not many good options here - the clinical picture you describe is not surprising given the misshapen femur and tibia along with the apparent lack of articular cartilage. TKR remains on the list; stifle arthrodesis will relieve pain though functional outcome is usually poor and the surgery is demanding and risky. Amputation is simple, inexpensive and likely to improve this dog's function and comfort and therefore worthy of further consideration (I am sure you have already discussed this).

If the owners are still keen to explore TKR, Harry Scott at Southern Counties would be a good man to talk to.

RE: Stifle replacement - who does them?

Andrew Mellor — Fri, 22 Apr 2016 15:55:29 GMT

Here's a craniocaudal.

RE: Stifle replacement - who does them?

Andrew Mellor — Fri, 22 Apr 2016 15:54:30 GMT

The dog is 7yr fn 40kg retriever had tplo over 6 years ago which went wrong as tibia was bowed. Plate grooved and corrective osteotomy especially performed. Is on meloxicam, paracetamol, amitriptiline and thyroxine as hypo t4 too.

RE: Stifle replacement - who does them?

Malcolm Ness — Wed, 20 Apr 2016 19:09:18 GMT

[quote user="Andrew Mellor"]Is anyone doing knee replacement, have a middle age retriever that had a totally pointless leg operation (TPLO) for cruciate years ago but stifle is horribly arthritic and causing her a considerable degree of pain despite being on multimodal pain management.[/quote]

Have you got more history and some recent rads?

RE: Stifle replacement - who does them?

Martin Atkinson — Wed, 20 Apr 2016 10:02:08 GMT

[quote user="Michael Woodhouse"]

The radiograph was NOT posted by the OP......

[/quote]

That's because its an elbow not a stifle! Sorry I should have started a new thread rather than hijacking this one.

TBH this was a Leonburger I saw yesterday which has had a history of lameness for 6 months. X-rays then showed relatively small changes in the joint which looked arthritic not neoplastic and it has done pretty well on NSAIDs until a couple of days ago when it went 10/10 lame after exercise. I was astounded by the degree of destruction yesterday and you can see evidence of a fresh pathological fracture. We discussed options including amputation or possible limb salvage but the owners elected for euthanasia.

RE: Stifle replacement - who does them?

Michael Woodhouse — Wed, 20 Apr 2016 01:37:18 GMT

The radiograph was NOT posted by the OP......

RE: Stifle replacement - who does them?

Mark Rowland — Wed, 20 Apr 2016 00:00:57 GMT

That looks sooooo neoplastic to me.

Kate: good call :-)

RE: Stifle replacement - who does them?

Kate Richardson — Tue, 19 Apr 2016 20:54:26 GMT

Although that doesn't look like good candidate

RE: Stifle replacement - who does them?

Kate Richardson — Tue, 19 Apr 2016 20:53:47 GMT

My boss has done a few (elbows)

RE: Stifle replacement - who does them?

Martin Atkinson — Tue, 19 Apr 2016 18:09:25 GMT

Elbow replacements: who does them?

RE: Stifle replacement - who does them?

Bob Russell — Tue, 19 Apr 2016 17:48:53 GMT

One of ours sent to SCVS. Very good results. About £4000 from memory but was two or three years ago.

They do offer this Carefree Credit now they are part of IVC.

RE: Stifle replacement - who does them?

grumpyoldman — Tue, 19 Apr 2016 17:43:48 GMT

My understanding was Noel or Willows , lots of swag required and success rates not brilliant , hugs kisses and TV appearance optional .

RE: Stifle replacement - who does them?

Thomas Johnson — Tue, 19 Apr 2016 16:25:09 GMT

[quote user="Andrew Mellor"]

Is anyone doing knee replacement, have a middle age retriever that had a totally pointless leg operation (TPLO) for cruciate years ago but stifle is horribly arthritic and causing her a considerable degree of pain despite being on multimodal pain management.

[/quote]

A client of ours recently took her dog to Southern Counties Veterinary Specialists for a knee replacement. It has had both knees replaced there, one in November 2014 and the other in March 2016, and is doing very well.