Techniques of Application and Initial Clinical Experience with Sliding Humeral Osteotomy for Treatment of Medial Compartment Disease of the Canine Elbow

Abstract

Objective-To determine medium-term clinical efficacy of sliding humeral osteotomy (SHO) for treatment of lameness and elbow pain associated with clinically diagnosed elbow disease featuring cartilage eburnation of the medial elbow compartment (medial compartment disease-MCD). Study Design-Case series. Animals-Dogs (n ¼ 49) with severe or persistent lameness attributable to MCD. Methods-Signalment, lameness history, and preoperative imaging findings were recorded. A custom, locking, stepped SHO plate was applied to the medial aspect of the humerus, stabilizing a middiaphyseal transverse osteotomy, medially translating the distal segment relative to the proximal segment. Three variants of technique of application were used and outcomes compared between respective patient groups. Outcome measures included lameness scoring, anatomic measures, VAS scoring of elbow pain, and owner assessment of function. Measures recorded preoperatively, 12, and 26 weeks postoperatively were compared. Results-Of 59 limbs that had SHO, 39 had preoperative focal treatment of the diseased medial aspect of the coronoid process. Mean AE SD dog age was 45.5 AE 37.48 months and body weight ranged from 13.6 to 46.7 kg. Mean preoperative duration of lameness was 14.7 AE 18.50 months. Lameness improved for all limbs by 26 weeks, and resolved in 21/32 limbs. Significant improvements in postoperative elbow pain scores and most owner assessments of function were observed. Incidence of major complications requiring surgical intervention was 17.2%, 22.2%, and 4.8% for each of the 3 technique variants described. Histologic examination of 2 elbows at 412 months revealed fibrocartilage cover of medial aspect of humeral condyle. Conclusions-Canine SHO with or without focal treatment of the diseased medial aspect of the coronoid process ameliorates lameness and pain associated with MCD at medium-term follow-up. Application technique is critical to minimizing morbidity. Clinical Relevance-SHO is appropriate for clinical management of pain and lameness in select cases of canine MCD. r

Working Algorithm for Treatment Decision Making for Developmental Disease of the Medial Compartment of the Elbow in Dogs

“…64 Outcomes of clinical application in 59 elbows have been positive, and arthroscopic (Fig 11) and histologic documentation of novel fibrocartilaginous cover of previously eburnated regions has been achieved. 65,66 This is not functional articular cartilage but does provide some evidence of efficacious unloading of the medial compartment. Whereas morbidity associated with recent developments in technique and implant design has been minimized, we have thus far used SHO as a salvage procedure, reserved for cases where genuine attempts at nonsurgical or other surgical management have failed.…”

“…There is evidence that quality of life of these dogs can be markedly improved and sustained long-term (3 years in our cases to date). 65,66 Proactive preoperative owner counseling and judicious patient selection are strongly advised. 65 …”

“…65,66 Proactive preoperative owner counseling and judicious patient selection are strongly advised. 65 …”

Static Posturography: A New Perspective in the Assessment of Lameness in a Canine Model

“…MCD is the most common cause of thoracic limb lameness in large and giant breed dogs [25], and MCD lesions have traditionally been evaluated radiographically [26–28]. A presumptive diagnosis of MCD is frequently based on detection of the resultant secondary osteoarthritis (OA), rather than on detection of the primary lesion [26,29].…”

The Effect of Sliding Humeral Osteotomy (SHO) on Frontal Plane Thoracic Limb Alignment: An Ex Vivo Canine Cadaveric Study

“…In the ex vivo setting, SHO has been reported to alter joint surface contact areas and to reduce the force applied to the proximal articular surface of the ulna 25–28% by transferring force to the articular surface of the radius . When assessed using subjective and objective outcome measures, SHO improved or resolved lameness in dogs with MCD as early as 12–26 weeks after surgery . More recently, force plate analysis was used to document a significant improvement in lameness in 60 elbows (46 dogs) by 12 weeks after SHO .…”