Surgery for elbow osteoarthritis – help

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Heidi is 5 years old and a German Shepherd x Collie. She was diagnosed with Fragmented Coronoid Process at 2.5 years old and she had arthroscopies in both elbows to remove fragments of bone. Recovery went well and she was sound for approximately 2years. 6 months ago she started to limp again and it became progressively worse. We finally got referred to the specialist vet at the beginning of June and he talked us through all our options from pain management, injections of Platelet Rich Plasma (PRP) and briefly touched on surgery. We opted for another CT scan to see the level of progression and the PRP injections. The CT scan showed significant advancement in the osteoarthritis in both her elbows. The first round of PRP injections didn’t do anything for her unfortunately so we went back to the vets last week. He said we can have another round of PRP injections as sometimes dogs do not respond to the first. He also talked us through two surgical procedures that Heidi would be suitable for as long as the lateral compartment of her elbow is still healthy. We would do the right elbow first as this seems significantly worse at the moment. Both surgeries sound pretty scary. I wasn’t ready to make surgery decisions at that time so opted for some more PRP injections and these seem to of given Heidi some slight relief. I’m currently trying to research the two procedures which are bioblique proximal ulna osteotomy (BOPUO) and unicompartmental elbow replacement (CUE) so would love to know if anyone has had any experience with these please? It’s such a difficult call to make but my feeling is that if she needs surgery then having it done sooner rather than later must make sense… I’m just not sure how to approach knowing what the best options are for Heidi.

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Hello Sicorbs,

It is hard to comment fully without knowing her. You may have gone though this already with your hydrotherapist, physio and vet, and as both elbows are affected I would pay a lot of consideration to how the left fore will cope post surgery…do you have a good plan around how to support the left fore (and her back and hindquarters) during the post-op period and rehabilitation of the right fore?

It sounds like you have a good team around you.

Kathryn’s suggestions are good, and I’d also go to the referral vet/your vet with an idea of the end point you’d like to reach with her in terms of exercise and mobility as well as pain control. This will help them to have a discussion with you based on this.

In terms of conservative management (and post-op recovery) acupuncture and myotherapy can also help a lot.

Good luck. Poor Heidi (and you!)…the elbow is such a complicated joint.

Let us know how you both get on.

 

Kindest wishes,

Shona

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Thank you Hannah, this definitely gives me some stuff to think over. I personally wouldn’t want to put her through a total elbow replacement but I am favouring the CUE. But… if it is not going to improve her quality of life in the long run I’d rather try and make her comfortable now for however long we can. It’s so difficult making these decisions for them and knowing what to do for the best. We will get there… she is my first rescue who we got to help me cope with the loss of my horse (knackered legs too) and I think it’s about time things got moving whether with surgery or more conservative methods.

Thank you again 😊

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Tough case, hard to make recommendations without evaluating the dog and knowing what things looked like in the joint.

In general 50% dogs will require more than 1 PRP injection. For moderate OA I usually plan 2-5 of them. However, if there is severe medial compartment damage all the injections in the world won’t help much. In an adult dog with cartilage damage a bioblique proximal ulnar osteotomy in my mind is not the right decision. The dog will be more lame for 6-12 months and likely only get back to where the dog is now. If surgery is indicated then I would recommend either the CUE or a total elbow replacement pending the degree of damage. Not sure where this client is located, but if a total elbow was in the cards I would have them visit with Noel Fitzpatrick.

David Dycus, DVM, MS, CCRP
Diplomate, American College of Veterinary Surgeons – Small Animal

Orthopedic Staff Surgeon,
Veterinary Orthopedic & Sports Medicine Group (VOSM)

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Thanks everyone, and thanks Hannah for the link regarding CUE… I’ll have a read.

I had an appointment with the referral vet yesterday and he did see some improvement in Heidi from her two sets of PRP injections but I think this was just her making me out to be neurotic. At home she always looks lame. I forgot to ask the referral vet yesterday but I’m presuming PRP treatment is a temporary measure and therefore if she has very little cartilage left in her elbows (right currently a lot worse) we would have to manage it with painkillers, anti-inflams, alternative therapies, controlled exercise for the rest of her life (she’s 5). So in her case and the referral vet has agreed she is a good candidate surgery would once recovered give her a better quality of life (as long as there are no complications). At the moment and since Christmas really she has been on reduced walks 10/15 minutes on lead, garden visits on lead and is continuously limping despite being on Previcox and at the moment a herbal pain killer. So for a 5 year old German Shepherd x Collie this really isn’t fair in my eyes. We try and do scent training and low key trick training to pass the time and tire her brain a little. Any way because the vet saw a little bit of improvement and because we still were in discussions about what surgery we came away for a couple of weeks to think through our options. The vet said try upping her walk to 20mins and then the following week 25mins and see how she gets on. I have a hydro appointment with the lovely Jane at 121 Animal Therapy next week and also a physio appointment so will discuss through everything with them. I’m so desperate to make the right choice for her in whether to put her through surgery (I’m thinking yes) and then finally which of the two surgeries to opt for. Any words of wisdom would be amazing and apologies for the waffle. I’ve spend many a sleepless night worrying over my sensitive rescue. She deserves the best. CAM has been invaluable to me these last few months 🙂

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http://www.veterinary-instrumentation.co.uk/skin1/admin/UserFiles/CUE%20Report%202012.pdf

here is a link to a trial regarding this surgery. I have a lot of time for one of the consultants in the trial

x

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