Implant Removal Rate from Infection after Tibial Plateau Leveling Osteotomy in Dogs

Abstract

Objective To determine implant removal rate associated with infection after tibial plateau leveling osteotomy (TPLO) in dogs and to report antimicrobial susceptibility patterns for isolates. Study Design Retrospective case series. Animals Dogs (n = 255; 282 TPLO). Methods Medical records (April 2006–April 2008) for dogs that had TPLO with ≥ 18 month follow‐up were reviewed. Dogs that had implant removal with confirmed bacterial isolation from the implant were studied. Cefazolin (22 mg/kg intravenously) was administered before anesthesia induction for TPLO, every 2 hours intraoperatively, and every 6 or 8 hours until the next morning. Antimicrobial susceptibility testing was performed on isolates. Results Twenty‐one (7.4%) of 282 TPLO required implant removal because of infection. Bacterial species isolated were Actinomyces spp. (1), Corynebacterium spp. (1), Enterococcus spp. (3), hemolytic Staphylococcus coagulase negative (2), nonhemolytic Staphylococcus coagulase negative (3), Staphylococcus spp. coagulase positive (7), methicillin–oxacillin‐resistant Staphylococcus coagulase positive (2), and Serratia marcesens (2). Of the antibiotics that had ≥10 isolates tested against them, gentamicin had the highest susceptibility rate (94%), followed by tribrissen (71%), and amoxicillin/clavulanic acid (67%). Conclusion Staphylococcus spp. was reported in 14 of the 21 infections cultured in this study. Based on antimicrobial susceptibility testing, amoxicillin/clavulanic acid would be the best empirical treatment.

Prospective, Randomized Comparison of the Effect of Two Antimicrobial Regimes on Surgical Site Infection Rate in Dogs Undergoing Orthopedic Implant Surgery

“…19 TPLO may have a higher infection rate than other clean orthopedic surgeries, with rates of 3-12.5% being reported. 4,19,[31][32][33] A variety of antimicrobial protocols was used in these studies although in most, treatment was not continued beyond 24 hours after surgery. 4,32,33 After the first 750 TPLO in a series of 1000 consecutive TPLO, Fitzpatrick decreased the duration of postoperative antimicrobial therapy from 14 days to 24 hours.…”

“…4,19,[31][32][33] A variety of antimicrobial protocols was used in these studies although in most, treatment was not continued beyond 24 hours after surgery. 4,32,33 After the first 750 TPLO in a series of 1000 consecutive TPLO, Fitzpatrick decreased the duration of postoperative antimicrobial therapy from 14 days to 24 hours. 19 Without the figures from that study, it is difficult to draw definitive conclusions but multivariate analysis suggested a positive effect of prolonged postoperative antimicrobial therapy on SSI rate.…”

“…2,3 When infection occurs, surgery for implant removal is often required. 4 The appropriate use of aseptic technique during surgery is the most important method of decreasing infection. 5 For animals undergoing most clean procedures, prophylactic use of antimicrobial drugs is thought unnecessary, 6,7 and there is contradictory evidence regarding its protective benefit against SSI in clean orthopedic surgery in veterinary patients.…”

“…19,20 Tibial plateau leveling osteotomy (TPLO) may have a higher infection rate than other clean canine orthopedic surgeries, possibly because of limited soft tissue coverage of the bone plate, or thermal bone necrosis caused by the saw blade. 4 TPLO surgery is therefore considered as a separate group to other surgeries for the purpose of our study.…”

Extracapsular articulating implant to treat cranial cruciate ligament disease in a dog with multiple myeloma

“…Nonetheless, this concern deserves attention when selecting surgical options. The infection rate following EAI was 2/59 (3.4 per cent) stifles,10 which compares favourably with reported TPLO implant removal rates resulting from surgical site infection of 325–7.4 per cent 26. While plate removal following bone healing is considered a good option following TPLO complicated by surgical site infection,27 28 plate removal before complete bone healing is potentially catastrophic for the limb.…”