Toggle vs excision arthroplasty in cats

Re: Toggle vs excision arthroplasty in cats

Judith Joyce — Fri, 28 Oct 2011 19:35:55 GMT

[quote user="Mark Holmes"] but if a technique has for example a 2% failure rate[/quote]

That is the crux of the matter. If I have a surgical complication or failure, my starting point is that it was me, the surgeon, that failed and not the technique.

Malcolm N

Re: Toggle vs excision arthroplasty in cats

Eamon McAllister — Fri, 28 Oct 2011 19:12:36 GMT

In cats I place a length of orthopaedic wire from the shaft of the ileum through the head of the femur and attach it to somewhere on the tuber ischium. Drill the holes by hand using a kirschner wire in a Jacobs chuck and avoid the sciatic nerve. Remove the wire after two or three weeks. Its a bit fiddly but it is not very invasive and works well.

Re: Toggle vs excision arthroplasty in cats

Judith Joyce — Fri, 28 Oct 2011 09:06:08 GMT

[quote user="Julian Earl"]I'm not sure that it "always" causes significant disbility, certainly not in cats. It is reasonable that there will be post-operative discomfort, both immediately and possibly long-term but (a) surely toggling depends that there is no pathology in the hip articular surfaces, (b) many cats do extremely well after EA albeit with a certain amount of restricted mobility, as judged by (c) they can still run and climb and carry out normal behaviours.[/quote]

EA usually produces acceptable functional outcome and apparently good pain control and consequently it is frequently a very good option. However, careful clinical appraisal of these cases will reveal a significantly shortened limb; a significantly reduced range of hip joint motion and often some discomfort. This is reflected in a degree of muscle atrophy that has been persisted in every EA case I have seen. These cats are not normal hence my statement. re Toggling - my problem with the procedure is implicit in what you say - ideally, case selection depends on there being no (other) joint pathology, then we go right ahead and make some more. Obviously the transarticular pin technique does the same but the TA pin is simpler and ends up being removed.

Malcolm N

Re: Toggle vs excision arthroplasty in cats

jose targa — Fri, 28 Oct 2011 08:25:54 GMT

"Surgery is like driving and sex - everyone thinks they are good at it!"

....jajajajajaja. Wonderful aproach!!! jajajaja

Re: Toggle vs excision arthroplasty in cats

Gerry Henry — Thu, 27 Oct 2011 21:09:49 GMT

[quote user="PATRICK MARSHALL"]

But unlike oxygen, money and sex which you only tend to notice when you haven't got enough.

[/quote]

I'll mention that to Ali next time I see her!

Re: Toggle vs excision arthroplasty in cats

Julian Earl — Thu, 27 Oct 2011 20:33:56 GMT

[quote user="Judith Joyce"]

Very rarely do excision arthroplasty. It always causes significant disability and often the cat remains painful (as shown by subsequent response to NSAIDs). That said, it remains a useful and appropriate surgical response in some cases. However, most hip luxations in cats (providing there are no femoral head or acetabular fractures) can be treated by open reduction with careful debridement of the joint (excision of redundant teres ligament) and repair of torn soft tissues. A good, accurate and careful surgical technique is essential -cranial approach to the hip is preferred.

If the hip remains unstable, then the transarticular pin technique is a much better "plan b" than the toggle procedure which is an operation I can almost always find a way to avoid.

Malcolm N away from home on Judy's computer.

[/quote]

Far be it from me to disagree with someone with authority and experience, but I'm going to anyway...

I'm not sure that it "always" causes significant disbility, certainly not in cats. It is reasonable that there will be post-operative discomfort, both immediately and possibly long-term but (a) surely toggling depends that there is no pathology in the hip articular surfaces, (b) many cats do extremely well after EA albeit with a certain amount of restricted mobility, as judged by (c) they can still run and climb and carry out normal behaviours.

So it may be of varying severity, and may be fairly frequent but I'm not convinced that the disability is both significant and always present and would be concerned that such a sweeping generalisation may deter people from carrying out what can be a very useful procedure.

Re: Toggle vs excision arthroplasty in cats

PATRICK MARSHALL — Thu, 27 Oct 2011 18:23:32 GMT

"Surgery is like driving and sex - everyone thinks they are good at it!"

But unlike oxygen, money and sex which you only tend to notice when you haven't got enough.

Re: Toggle vs excision arthroplasty in cats

Mark Holmes — Thu, 27 Oct 2011 16:41:49 GMT

[quote user="Judith Joyce"]

I am a little confused by an earlier poster who described a"competent" surgeon getting two failures with a fairly straight forward technique - the implication being that the technique was flawed. Carpenters, tools and all that.

[/quote]

Not at all, but if a technique has for example a 2% failure rate but that 2% just happens to be the first two you see your perception at number 3 is then very different than if they are numbers 99 and 100.

Re: Toggle vs excision arthroplasty in cats

Judith Joyce — Thu, 27 Oct 2011 16:24:28 GMT

I just don't like the toggle procedure. I always prefer to adopt the lightest touch - the key to these cases is not getting the hip to stay put for 2 weeks but rather how functional it remains over the subsequent years. Toggling involves leaving an awful lot of implant/foreign material inside the patient as well as restraining the hip in an abnormal position - at least until the prosthesis snaps.

All of these surgical hip options are within the capability of a suitably trained surgeon in general practice.

None of these techniques are measurably more difficult than excision arthroplasty but like anything, the more you practice (and the more self-critical you are) the better you get. Most of us have access to cadavers but regrettably few vets invest even an afternoon doing cadaver surgery and fewer still ever approach a trained surgeons to "see practice".

Surgery is like driving and sex - everyone thinks they are good at it!

Malcolm

Re: Toggle vs excision arthroplasty in cats

Hannah Wynne Richards — Thu, 27 Oct 2011 15:03:42 GMT

Yes Malcolm,but would a toggle be so much superior if it was a GP veterinary surgeon nota specialist performing the operation I'lladmit tobeing scared to perform any operation I haven't seen done

Wynne

Re: Toggle vs excision arthroplasty in cats

Mark Holmes — Thu, 27 Oct 2011 14:47:23 GMT

Yes I have seen a TA pin done a couple of times by competant certificate holders but they both failed so my impression was not that good. It did look a fairly simple procedure though.

This particular one had a very marked laxity and following closed reduction wouldn't remain luxated for any length of time at all, my thought was that given the laxity present failure was more likely and having discussed things with the owners opted for a single op rather than risking the need for two.

I will bear in mind what Malcolm posted about persistant discomfort, my impression has always been better than that but maybe I need to look closer. Given what Malcolm has said I might try an encourage owners to attempt some form of joint reconstruction, TA pin etc before excision.

Re: Toggle vs excision arthroplasty in cats

Utlendigur — Thu, 27 Oct 2011 14:36:09 GMT

Just another variant..I tend to use an iliofemoral suture (+ jt capsule repair) and find they've seemed to work well in the ones I've done so far.

Re: Toggle vs excision arthroplasty in cats

Evelyn Barbour-Hill — Thu, 27 Oct 2011 14:00:11 GMT

Hannah Wynne Richards:

Patient selection Cat excision every time Large dog twist owners arm to refer for toggle

Wynne

Of course the choice to refer or not depends on individual feelings, abilities, preferences and so on. But toggling is really fairly easy.

Cats generally appear to do fine with excision so the choice is more free. But then cats often appear to do fine with things that would not do for dogs, and I wonder if there is an element of "getting away with it" in a cat. Hmm, we are approaching surgical philosophy here: maybe all surgery is a matter of "getting away with it"?

Edit:

Malcolm must have posted while I was composing and of course I defer to him. My experience of hips is much less than his.

Yes, for a GP surgeon,transarticular pinning is another option.

Re: Toggle vs excision arthroplasty in cats

Judith Joyce — Thu, 27 Oct 2011 13:33:12 GMT

If the hip remains unstable, then the transarticular pin technique is a much better "plan b" than the toggle procedure which is an operation I can almost always find a way to avoid.

Malcolm N away from home on Judy's computer.

Re: Toggle vs excision arthroplasty in cats

Hannah Wynne Richards — Thu, 27 Oct 2011 13:19:05 GMT

Patient selection Cat excision every time Large dog twist owners arm to refer for toggle

Wynne