High energy focused shock wave therapy accelerates bone healing

N. R. Kieves; C. S. MacKay; K. Adducci; S. Rao; C. Goh; R. H. Palmer; F. M. Duerr

doi:10.3415/VCOT-15-05-0084

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2015; 28(06): 425-432
DOI: 10.3415/VCOT-15-05-0084

Original Research

Schattauer GmbH

High energy focused shock wave therapy accelerates bone healing

A blinded, prospective, randomized canine clinical trial

N. R. Kieves

¹Colorado State University Veterinary Teaching Hospital, Department of Clinical Sciences

,

C. S. MacKay

²Colorado State University, Department of Environmental and Radiological Health Sciences

,

K. Adducci

¹Colorado State University Veterinary Teaching Hospital, Department of Clinical Sciences

,

S. Rao

¹Colorado State University Veterinary Teaching Hospital, Department of Clinical Sciences

,

C. Goh

¹Colorado State University Veterinary Teaching Hospital, Department of Clinical Sciences

,

R. H. Palmer

¹Colorado State University Veterinary Teaching Hospital, Department of Clinical Sciences

,

F. M. Duerr

¹Colorado State University Veterinary Teaching Hospital, Department of Clinical Sciences

› Author Affiliations

Abstract

Summary

Objectives: To evaluate the influence of shock wave therapy (SWT) on radiographic evidence of bone healing after tibial plateau leveling osteotomy (TPLO).

Methods: Healthy dogs between two to nine years of age that underwent TPLO were randomly assigned to receive either electro- hydraulic SWT (1,000 shocks) or sham treatment (SHAM). Treatment or SHAM was administered to the osteotomy site immediately postoperatively and two weeks postoperatively. Three blinded radiologists evaluated orthogonal radiographs performed eight weeks postoperatively with both a 5-point and a 10-point bone healing scale. Linear regression analysis was used to compare median healing scores between groups.

Results: Forty-two dogs (50 stifles) were included in the statistical analysis. No major complications were observed and all osteo -tomies healed uneventfully. The median healing scores were significantly higher at eight weeks postoperatively for the SWT group compared to the SHAM group for the 10-point (p <0.0002) and 5-point scoring systems (p <0.0001).

Clinical significance: Shock wave therapy applied immediately and two weeks post -operatively led to more advanced bone healing at the eight week time point in this study population. The results of this study support the use of electro-hydraulic SWT as a means of accelerating acute bone healing of canine osteotomies. Additional studies are needed to evaluate its use for acceleration of bone healing following fracture, or with delayed union.

Keywords

Tibial plateau leveling osteotomy - bone healing - shock wave therapy - canine cruciate disease

Full Text

References

References
1 Jackson LC, Pacchiana PD. Common complications of fracture repair. Clin Tech Small Anim Pract 2004; 19: 168-179.
2 Millis DL. Bone- and non-bone-derived growth factors and effects on bone healing. Vet Clin North Am Small Anim Pract 1999; 29: 1221-1246.
3 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through. 1989; Vet Comp Orthop Traumatol 1994; 7: 56-69.
4 Powers MY, Martinez SA, Lincoln JD. et al. Prevalence of cranial cruciate ligament rupture in a population of dogs with lameness previously attributed to hip dysplasia: 369 cases (1994-2003). J Am Vet Med Assoc 2005; 227: 1109-1111.
5 Whitehair JG, Vasseur PB, Willits NH. Epidemiology of cranial cruciate ligament rupture in dogs. J Am Vet Med Assoc 1993; 203: 1016-1019.
6 Wilke VL, Robinson DA, Evans RB. et al. Estimate of the annual economic impact of treatment of cranial cruciate ligament injury in dogs in the United States. J Am Vet Med Assoc 2005; 227: 1604-1607.
7 Comerford EJ, Smith K, Hayashi K. Update on the aetiopathogenesis of canine cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2011; 24: 91-98.
8 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474.
9 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-193.
10 Stauffer KD, Tuttle TA, Elkins AD. et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc 2006; 42: 44-50.
11 Ogden JA, Toth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthop Relat Res 2001; 387: 8-17.
12 Furia JP, Rompe JD, Cacchio A. et al. Shock wave therapy as a treatment of nonunions, avascular necrosis, and delayed healing of stress fractures. Foot Ankle Clin 2010; 15: 651-662.
13 Zelle BA, Gollwitzer H, Zlowodzki M. et al. Extracorporeal shock wave therapy: current evidence. J Orthop Trauma 2010; 24 (Suppl. 01) S66-70.
14 Drum MG. Extracorporeal shockwave therapy for treatment of delayed TPLO healing in dogs. Veterinary Orthopedic Society 39th Annual Conference Abstracts; 2012 March 3-10; Crested Butte, CO. Vet Comp Orthop Traumatol 2012; 25: A14
15 Wang CJ, Huang HY, Chen HH. et al. Effect of shock wave therapy on acute fractures of the tibia: a study in a dog model. Clin Orthop Relat Res 2001; 387: 112-118.
16 Danova NA, Muir P. Extracorporeal shock wave therapy for supraspinatus calcifying tendinopathy in two dogs. Vet Rec 2003; 152: 208-209.
17 Gallagher A, Cross AR, Sepulveda G. The effect of shock wave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy. Vet Surg 2012; 41: 482-485.
18 Kirkby KA, Lewis DD. Canine hip dysplasia: reviewing the evidence for nonsurgical management. Vet Surg 2012; 41: 2-9.
19 Venzin C, Ohlerth S, Koch D. et al. Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis. Schweiz Arch Tierheilkd 2004; 146: 136-141.
20 Becker W, Kowaleski MP, McCarthy RJ. et al. Extracorporeal shockwave therapy for shoulder lameness in dogs. J Am Anim Hosp Assoc 2015; 51: 15-19.
21 Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 2012; 7: 11
22 Alvarez RG, Cincere B, Channappa C. et al. Extracorporeal shock wave treatment of non- or delayed union of proximal metatarsal fractures. Foot Ankle Int 2011; 32: 746-754.
23 Elster EA, Stojadinovic A, Forsberg J. et al. Extracorporeal shock wave therapy for nonunion of the tibia. J Orthop Trauma 2010; 24: 133-141.
24 Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res 2001; 387: 90-94.
25 Johannes EJ, Kaulesar Sukul DM, Matura E. High-energy shock waves for the treatment of nonunions: an experiment on dogs. J Surg Res 1994; 57: 246-252.
26 McClure SR, Van Sickle D, White MR. Effects of extracorporeal shock wave therapy on bone. Vet Surg 2004; 33: 40-48.
27 Barnes K, Lanz O, Were S. et al. Comparison of autogenous and cancellous bone grafting and extracorporeal shock wave therapy on osteotomy healing in the tibial tuberosity advancement procedure in dogs. Radiographic densinometric evaluation. Vet Comp Orthop Tramatol 2015; 28: 207-214.
28 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
29 Kowaleski MP, Boudrieau RJ, Beale BS. et al. Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate. Vet Surg 2013; 42: 847-852.
30 Corrales LA, Morshed S, Bhandari M. et al. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am 2008; 90: 1862-1868.
31 Duerr FM, Duncan CG, Savicky RS. et al. Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37: 49-62.
32 Krotscheck U, Thompson MS, Ryan KK. et al. Comparison of TPA, bone healing, and intra-articular screw placement using conventional nonlocked application of surgeon-contoured versus locked application of precontoured TPLO plates in dogs. Vet Surg 2012; 41: 931-937.
33 Xu ZH, Jiang Q, Chen DY. et al. Extracorporeal shock wave treatment in nonunions of long bone fractures. Int Orthop 2009; 33: 789-793.
34 Griffin XL, Smith N, Parsons N. et al. Ultrasound and shockwave therapy for acute fractures in adults. Cochrane Database Syst Rev 2012; 2: CD 008579
35 Wang CJ, Yang KD, Ko JY. et al. The effects of shockwave on bone healing and systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions. Nitric Oxide 2009; 20: 298-303.
36 Wang CJ, Wang FS, Yang KD. Biological effects of extracorporeal shockwave in bone healing: a study in rabbits. Arch Orthop Trauma Surg 2008; 128: 879-884.
37 Wang CJ, Yang KD, Wang FS. et al. Shock wave treatment shows dose-dependent enhancement of bone mass and bone strength after fracture of the femur. Bone 2004; 34: 225-230.
38 Hsu RW, Tai CL, Chen CY. et al. Enhancing mechanical strength during early fracture healing via shockwave treatment: an animal study. Clin Biomech (Bristol, Avon) 2003; 18: S33-39.
39 Wang CJ, Liu HC, Fu TH. The effects of extracorporeal shockwave on acute high-energy long bone fractures of the lower extremity. Arch Orthop Trauma Surg 2007; 127: 137-142.
40 Neucks JS, Pishchalnikov YA, Zancanaro AJ. et al. Improved acoustic coupling for shock wave lithotripsy. Urol Res 2008; 36: 61-66.
41 Hoffer MJ, Griffon DJ, Schaeffer DJ. et al. Clinical applications of demineralized bone matrix: a retrospective and case-matched study of seventy-five dogs. Vet Surg 2008; 37: 639-647.
42 Bergh MS, Peirone B. Complications of tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2012; 25: 349-358.
43 Conkling AL, Fagin B, Daye RM. Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology. Vet Surg 2010; 39: 475-481.

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