Labrador elbows

RE: Labrador elbows

Clare Tapsfield-Wright — Thu, 29 May 2025 20:40:47 GMT

Yes , on my list for her , thank you

RE: Labrador elbows

David Mills — Wed, 28 May 2025 18:59:57 GMT

[quote userid="2490" url="~/f/clinical-questions/31184/labrador-elbows/247222#247222"]I may reach for the steroids[/quote]

As an aside, there is some success reported with ketamine injections sq 0.5mg/kg every 21-28d - abstract on it this year at BSAVA. No side effects in dogs as is low dose, doesn't sting sq. Cheap. Thinking is it reverses central sensitisation.

Not necessarily a panacea but may be worth trying alongside the other goods.

RE: Labrador elbows

Rob Loxley — Wed, 28 May 2025 16:17:21 GMT

[quote userid="8663" url="~/f/clinical-questions/31184/labrador-elbows/247224#247224"]

Clive Ansell said:
Unsure why?

Fashion

[/quote]

Interesting how quickly tramadol came in and went out of fashion - I still wonder how much of its departure was sped by the arrival of a licensed (much more expensive) alternative?

RE: Labrador elbows

Alasdair Hotston Moore — Wed, 28 May 2025 08:53:17 GMT

[quote userid="5012" url="~/f/clinical-questions/31184/labrador-elbows/247223#247223"] Unsure why?[/quote]

Fashion

RE: Labrador elbows

Clive Ansell — Tue, 27 May 2025 14:05:28 GMT

[quote userid="4181" url="~/f/clinical-questions/31184/labrador-elbows/247199#247199"]Though now more so seems to being used as a 1st line; skip the NSAIDs. I'm not sure I see the rationale for omitting an anti-inflammatory medication from our standard of care?[/quote]

I'm seeing an increasing trend for Amantadine being used first line for severe OA cases, even in cases where licenced Metacam or Pardale-V have or are not being used. Unsure why?

RE: Labrador elbows

Clare Tapsfield-Wright — Tue, 27 May 2025 13:12:44 GMT

After a huge amount of soul searching I have decided not to go down the path of surgical intervention. I very much appreciate all the advice and information given. Nelly is insured so it wasn’t a cost decision but a what’s best for her as an individual and I don’t feel she is the right candidate physically or in her personality . I will keep her as comfortable as possible for as long as she has a good quality of life. She is a buffoon who takes no care of herself, jumps about even in the face of joint pain and though I would dearly love her to be mended and live longer I don’t think it’s right for her. Thank you all and yes I may reach for the steroids for her

RE: Labrador elbows

Rob Loxley — Tue, 20 May 2025 07:30:28 GMT

[quote userid="3169" url="~/f/clinical-questions/31184/labrador-elbows/247197#247197"]Often used as a drug of last resort[/quote]

Though now more so seems to being used as a 1st line; skip the NSAIDs. I'm not sure I see the rationale for omitting an anti-inflammatory medication from our standard of care?

RE: Labrador elbows

Michael Woodhouse — Mon, 19 May 2025 22:36:45 GMT

[quote userid="3607" url="~/f/clinical-questions/31184/labrador-elbows/247189#247189"]If all you had to manage chronic OA in dogs was Phenylbutazone (costing pennies-per-pill) and PLT (cheaper still) [plus end-of-care preds, if you like] then your outcomes wouldn't be much different from those currently seen with the use of any/all of the currently available meds and therapies, even if used entirely without cost-constraint.[/quote]

If I can use paracetamol I mostly agree. I'm not even convinced that tramadol/gabapentin etc are even significant painkillers, but very much in fashion. The American vets are insisting on oral sedation for anything vaguely difficult and refusing to see without it.........

[quote userid="8991" url="~/f/clinical-questions/31184/labrador-elbows/247190#247190"]But possibly better than Librela with the paper that has just come out...[/quote]

I need to digest it properly, but superficially I don't think it tells us very much. 21 million doses sold worldwide, 19 case reports and some data mining. Often used as a drug of last resort. Many old, arthritic dogs end up off their legs and get put to sleep, I wouldn't be reporting those as adverse events, but see them every week. Ive seen some old dogs lives transformed by Librela and some do too much and suffer some consequences, I usually warn new clients of this. I'd hate a tiny number of adverse effects (<20 thoroughly investigated here, less than 1 in a million doses) to prevent people using a very effective drug that has relived an immense amount of suffering.

I'd happily give it to my own dog.

(then worthy of a different discussion, I wouldn't report GI signs or lack of efficacy with NSAID use, and we should. My wife is on the SCOPS committee and DEFRA says there are no wormer resistance issues because there have been no reports of lack of efficacy in sheep wormers........)

RE: Labrador elbows

David Mills — Mon, 19 May 2025 10:57:45 GMT

[quote userid="3607" url="~/f/clinical-questions/31184/labrador-elbows/247189#247189"]Discuss! [/quote]

In the spirit of most studies detailing efficacy, I suspect they would be at least non-inferior to carprofen...

But possibly better than Librela with the paper that has just come out...

RE: Labrador elbows

Malcolm Ness — Mon, 19 May 2025 06:28:21 GMT

[quote userid="8991" url="~/f/clinical-questions/31184/labrador-elbows/247184#247184"]

Michael Woodhouse said:

Worth a trial adding in 5mg pred

Yes this - I often do it these days for older OA dogs - n=1 it transformed our lab with awful elbows for about 3 years.

[/quote]

If all you had to manage chronic OA in dogs was Phenylbutazone (costing pennies-per-pill) and PLT (cheaper still) [plus end-of-care preds, if you like] then your outcomes wouldn't be much different from those currently seen with the use of any/all of the currently available meds and therapies, even if used entirely without cost-constraint.

Discuss!

RE: Labrador elbows

David Mills — Sun, 18 May 2025 18:43:43 GMT

[quote userid="3169" url="~/f/clinical-questions/31184/labrador-elbows/247180#247180"]

Worth a trial adding in 5mg pred

[/quote]

Yes this - I often do it these days for older OA dogs - n=1 it transformed our lab with awful elbows for about 3 years.

(The surgical stuff has been very well covered by Malcolm and Andy - both would be recommended)

RE: Labrador elbows

Rob Loxley — Sun, 18 May 2025 10:00:37 GMT

Given all of this, what's the feeling on arthrodesis for these end-stage elbows?

RE: Labrador elbows

Malcolm Ness — Sun, 18 May 2025 09:34:19 GMT

Hi Claire. I concur with what Andy says.

There are few good options for 'end-stage' elbows like these. Most medical benefit seems to come with the NSAIDs plus paracetamol and in my experience the addition of the more exotic and potentially mind-altering medications is rarely of substantial or lasting benefit - though I recognise and understand the scenario that leads to their use.

Surgical options include amputation, arthrodesis and elbow replacement, and quite clearly, none are ideal - the first two for glaringly obvious reasons, and Andy has indicated some of the problems with elbow replacement. There is a plethora of other elbow surgeries available but they all have two things in common - first, not one has been shown convincingly to be of lasting benefit to the patient and second, none are indicated in end-stage elbows.

There are a number of different elbow replacement systems available, of which, in my opinion, the TATE system is the only one currently available that is worthy of consideration. I taught on a number of early TATE courses and implanted forty or so cases ten or more years ago. The recent iteration of the system includes a number of evolutionary technical and implant developments but it is still largely the same.

The technique is technically very demanding and sensitive to technical error at almost every stage of the surgery. It takes about three times as long, and is probably three times as difficult as a total hip replacement. Choose your surgeon very carefully. Andy is one of two in the UK that I know to be up to the job, Neil Burton is the other.

The procedure is most effective at mitigating pain and although post surgical function can be very good, bear in mind that at best the joint motion is effectively 'two dimensional'. The dog is likely to be able to walk trot and run but will never appear normal in the way a dog following hip replacement will. Bear in mind, too, that almost all elbow OA is bilaterally similar and the frustrating outcome of a successful TER is a dog that becomes leg-carrying lame on the other leg - not necessarily because that leg has got worse but because it now has an operated leg that no longer hurts when weight-bearing. A second TER is often indicated. Finally, there is no good 'plan B' if things go wrong in surgery or if complications develop afterwards - being blunt, some of these cases turn into very costly, and not very pleasant, staged-euthanasias.

In summary, TER is an obligate salvage procedure. However, many clients are happy with the outcome and regretful that they didn't opt for the surgery sooner (obviously, they are the owners of the successful cases!). It is certainly worth considering - have a chat with either Andy or Neil - I know both to be careful competent and able surgeons who will tell it how it is. Neither will be unduly eager to rush to surgery but equally, either can be relied upon to do the best job should you opt for surgery.

Good luck!

RE: Labrador elbows

Alasdair Hotston Moore — Sun, 18 May 2025 08:20:09 GMT

Andy is the "go to" surgeon for these. Thanks for your reply Andy

RE: Labrador elbows

Michael Woodhouse — Sat, 17 May 2025 23:44:07 GMT

A couple of medical options for you from a simple general practitioner, if I may? Try swapping the Galliprant for Meloxicam, sometimes makes a lot of difference.

What dose of paracetamol? Make sure you try the beastie on the full 33mg/kg Pardale dose. I find 10mg/kg vastly less effective and kind of plucked out of the air. I've had dogs on the full pardale dose for years and never seen significant liver issues.

Worth a trial adding in 5mg pred. Some people will have an epileptic fit here, but you remember good old PLT tablets?

Personally find meloxicam/full dose paracetamol/little bit of pred does far more than gabapentin or amantadine.

If you want something very fuzzy - the occasional dogs life is transformed by cartrophen. Not a consistent response but I can think of a few dogs where the product literally saved their lives, and a damn sight easier and cheaper to try than a new elbow.

Good luck, these cases can be frustrating to manage.

RE: Labrador elbows

Clare Tapsfield-Wright — Sat, 17 May 2025 18:55:27 GMT

Thank you so much for your reply . That’s really helpful , I will have a look , much appreciated

RE: Labrador elbows

Andy Moores — Sat, 17 May 2025 12:37:55 GMT

Hi Clare, sorry to hear about your dog. An all too common problem I'm afraid, especially in Labs.

Elbow replacement in dogs is not a routine surgery. It's expensive, the aftercare is onerous and prolonged and it's not without risk. For the right cases however it can make a massive difference to a dog's quality of life. Currently there are only three centres in the UK, including ours, which offer total elbow replacement with the latest iteration (3rd generation) TATE elbow replacement. This has only recently been available in the UK. There is more information available on our website and some videos and images of two clinical cases we did earlier this year on our Instagram:

https://mooresortho.com/blog/canine-total-elbow-replacement/

https://mooresortho.com/procedures/total-elbow-replacement-for-dogs/

https://www.instagram.com/mooresortho/

Best wishes,

Andy