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.
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)