Subscribe to RSS
Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight
17 July 2016
Accepted: 10 April 2017
23 December 2017 (online)
Objectives: To analyse and compare major complications in dogs ≥50 kg undergoing tibial tuberosity advancement (TTA) or tibial plateau levelling osteotomy (TPLO) for treatment of cranial cruciate ligament disease.
Methods: Medical records and radiographs of client-owned dogs (≥50 kg) treated for cranial cruciate ligament disease with either TTA or TPLO between January 2011 and November 2015 were reviewed. Ninety-one TTA cases and 54 TPLO cases met the study inclusion criteria. All complications within one year of surgery were recorded. Major complications were those requiring surgical revision or intervening medical therapy to resolve. Logistic regression analysis evaluated for associations with major complication occurrence. Major complications were statistically compared between TTA and TPLO treatment groups.
Results: Incidence of major complications following TTA and TPLO surgery were 19.8% and 27.8%, respectively. Surgical site infection (SSI) was the single most common major complication following both TTA (15.4%) and TPLO (25.9%) surgery. There were no significant differences between TTA and TPLO treatment regarding the rate of SSI, surgical revision, or overall occurrence of major complications. Postoperative antibiotic therapy significantly reduced the risk of a major complication in all dogs ≥50 kg (p = 0.015; OR: 0.201: 95%CI: 0.055–0.737).
Clinical significance: Major complications occurred frequently following TTA and TPLO treatment of cranial cruciate ligament disease in dogs ≥50 kg. The increased chance for SSI should be considered and postoperative antibiotic therapy is recommended.
- 1 Witsberger TH, Villamil JA, Schultz LG. Prevalence of and risk factors for hip dysplasia and cranial cruciate ligament deficiency in dogs. J Am Vet Med Assoc 2008; 232: 1818-1824.
- 2 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
- 3 Kim SE, Pozzi A, Kowaleski MP. et al. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37: 111-125.
- 4 Duerr FM, Markin KW, Rishniw M. et al. Treatment of canine cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2014; 27: 478-483.
- 5 Bergh MS, Sullivan C, Ferrell CL. et al. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. J Am Anim Hosp Assoc 2014; 50: 315-321.
- 6 Drygas KA, Pozzi A, Goring RL. et al. Effect of tibial plateau leveling osteotomy on patellar tendon angle: a radiographic cadaveric study. Vet Surg 2010; 39: 418-424.
- 7 Sathya S, Gilbert P, Sharma A. et al. Effect of tibial plateau leveling osteotomy on patellar tendon angle: a prospective clinical study. Vet Comp Orthop Traumatol 2014; 27: 346-350.
- 8 Apelt D, Kowaleski MP, Boudrieau RJ. Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study. Vet Surg 2007; 36: 170-177.
- 9 Krotscheck U, Nelson SA, Todhunter RJ. et al. Long term functional outcome of tibial tuberosity advancement vs. tibial plateau leveling osteotomy and extracapsular repair in a heterogeneous population of dogs. Vet Surg 2016; 45: 261-268.
- 10 Gordon-Evans WJ, Griffon DJ, Bubb C. et al. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2013; 243: 675-680.
- 11 Ferreria MP, Ferrigno CRA, de Souza ANA. et al. Short-term comparison of tibial tuberosity advancement and tibial plateau levelling osteotomy in dogs with cranial cruciate ligament disease using kinetic analysis. Vet Comp Orthop Traumatol 2016; 29: 209-213.
- 12 Skinner OT, Kim SE, Lewis DD. et al. In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs. Vet J 2013; 196: 86-91.
- 13 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.
- 14 Wolf RE, Scavelli TD, Hoelzler MG. et al. Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases 2007-2009. J Am Vet Med Assoc 2012; 240: 1481-1487.
- 15 Steinberg EJ, Prata RG, Palazzini K. et al. Tibial tuberosity advancement for treatment of CrCL injury: complications and owner satisfaction. J Am Anim Hosp Assoc 2011; 47: 250-257.
- 16 Coletti TJ, Anderson M, Gorse MJ. et al. Complications associated with tibial plateau leveling osteotomy: a retrospective of 1519 procedures. Can Vet J 2014; 55: 249-254.
- 17 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39: 905-908.
- 18 Nicoll C, Singh A, Weese JS. Economic impact of tibial plateau leveling osteotomy surgical site infection in dogs. Vet Surg 2014; 43: 899-902.
- 19 Nutt AE, Garcia-Fernandez P, San Roman F. et al. Risk factors for tibial tuberosity fracture after tibial tuberosity advancement in dogs. Vet Comp Orthop Traumatol 2015; 28: 116-123.
- 20 Yap FW, Calvo I, Smith KD. et al. Perioperative risk factors for surgical site infection in tibial tuberosity advancement: 224 stifles. Vet Comp Orthop Traumatol 2015; 28: 199-206.
- 21 Bergh MS, Peirone B. Complications of tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2012; 25: 349-358.
- 22 Solano MA, Danielski A, Kovach K. et al. Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg. Vet Surg 2015; 44: 59-64.
- 23 Lafaver S, Miller NA, Stubbs WP. et al. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
- 24 Burns CG, Boudrieau RJ. Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints. Vet Comp Orthop Traumatol 2008; 21: 250-255.
- 25 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
- 26 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of the cranial cruciate deficient canine stifle. Proceedings of the 1stWorld Orthopedic Veterinary Congress. Munich Germany: 2002. September 5-8 152.
- 27 Horan TC, Gaynes RP, Martone WJ. et al. CDC definitions of nosocomial surgical site infections, 1992 – a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992; 20: 271-274.
- 28 Weese S. A review of postoperative infections in veterinary orthopaedic surgery. Vet Comp Orthop Traumatol 2008; 21: 99-105.
- 29 Stein S, Schmoekel H. Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage. J Small Anim Pract 2008; 49: 398-404.
- 30 Kim SE, Pozzi A, Banks SA. et al. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38: 33-39.
- 31 Hoffmann DE, Kowaleski MP, Johnson KA. et al. Ex vivo biomechanical evaluation of the cranial cruciate ligament-deficient stifle with varying angles of stifle flexion and axial loads after tibial tuberosity advancement. Vet Surg 2011; 40: 311-320.
- 32 Nazarali A, Singh A, Moens NMM. et al. Association between methicillin-resistant Staphylococcus pseudintermedius carriage and the development of surgical site infections following tibial plateau leveling osteotomy in dogs. J Am Vet Med Assoc 2015; 247: 909-916.
- 33 Worlock P, Slack R, Harvey L. et al. The prevention of infection in open fractures: an experimental study of the effect of fracture stability. Injury 1994; 25: 31-38.
- 34 Friedrich B, Klaue P. Mechanical stability and post-traumeatic osteoitis: an experimental evaluation of the relation between infection of bone and internal fixation. Injury 1977; 9: 23-29.
- 35 Wallace AL, Draper ER, Strachan RK. et al. The vascular response to fracture micromotion. Clin Orthop Relat Res 1994; 301: 281-290.
- 36 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.
- 37 Kloc PA, Kowaleski MP, Litsky AS. et al. Biomechanical comparison of two alternative tibial plateau leveling osteotomy plates with the original standard in an axially loaded gap model: an in vitro study. Vet Surg 2009; 38: 40-48.
- 38 Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biologic internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002; 84: 1093-1110.
- 39 Calvo I, Aisa J, Chase D. et al. Tibial tuberosity fracture as a complication of tibial tuberosity advancement. Vet Comp Orthop Traumatol 2014; 27: 148-154.
- 40 Danielson B, Barnhart M, Watson A. et al. Short-term radiographic complications and healing assessment of single-session bilateral tibial tuberosity advancements. J Am Anim Hosp Assoc 2016; 52: 109-114.