A retrospective evaluation of complications associated with forkless tibial tuberosity advancement performed in primary care practice

Abstract

Objective: To report postoperative complications associated with forkless tibial tuberosity advancement (TTA) performed in primary care veterinary practice and to compare results with previous publications. Study design: Retrospective study. Sample population: Three hundred seventy-four forkless TTAs in 329 dogs performed by six nonspecialist veterinarians. Methods: Medical records of dogs treated with a standard forkless TTA (2013-2016) and with at least 12 months of postoperative follow-up were reviewed. Complications recorded by the referring practice or the operating veterinarian were classified as minor (medically treated) or major (surgically treated). Results: Complications occurred in 57 of 374 (15.2%) TTAs; 28 (7.5%) complications were major, and 29 (7.7%) complications were minor. Postliminary meniscal injuries were documented in 12 of 374 (3.2%) TTAs (12/57 major complications) and were more common when the ratio of cage size to bodyweight was ≤0.25 (P = .019). Mean TTA (cage size) was greater in this population than what has been previously reported for a lower median bodyweight. Conclusion: The incidence of major complications was low and within the range previously reported for TTA in referral practice after adjusting for study design. The magnitude of advancement was greater, and the incidence of postliminary meniscal injury was lower than what has been previously reported, after accounting for dogs that had a preliminary meniscal injury or medial meniscal release. Clinical significance: Forkless TTA may be successfully performed by experienced veterinarians in primary care practice with a low rate of complications. The incidence of postliminary meniscal injury may be reduced by a greater degree of advancement of the tibial tuberosity.

Multiparametric Comparison of Two TTA-Based Surgical Techniques in Dogs with Cranial Cruciate Ligament Tears

“…Concerning the OI of the implants, we also obtained very good results for both groups after 1 month (86.7%) and after 3 months (93.3%). This fact is in concordance with a previous study, proving that porous TTA implants show excellent OI and osteoconduction properties [30].…”

One-Stage Revision with Cage Replacement as Treatment for Refractory Infections after Tibial Tuberosity Advancement in 7 Dogs

“…4,5 The most frequent complication seen with this procedure is surgical site infection (SSI), reported in 5.4 to 7.4% of cases. [1][2][3]6 Based on criteria developed by the US Centers for Disease Control and Prevention (CDC), SSI can be classified as either superficial SSI, deep SSI or organ/space SSI. 7,8 Whereas medical treatment is usually successful in case of a superficial SSI, deep and organ/space SSI associated with orthopaedic implants frequently necessitate implant removal.…”

“…2,[9][10][11][12] After TTA specifically, implants were removed in 33% of cases with a deep SSI and in 8% of cases this included the TTA cage. [1][2][3]6 Tibial tuberosity advancement cage removal results in reduced buttress support of the tibial crest, leading to a fracture of the tibial crest necessitating further surgery in 15% of cases. 12 Additionally, we have observed loss of advancement of the tibial tuberosity due to remodelling of the bone and collapse of the osteotomy gap (unpublished data).…”