Clean Run - December 2011 - 22

Surgical treatments for MCD are available but remain controversial. Several treatments may be performed with arthroscopy. The first stage is to remove the obvious underlying factor, which is either a fragment or flap of free-floating cartilage. Then, the surrounding area of cartilage erosion may be addressed. Microfracture and abrasion arthroplasty are two arthroscopic methods of stimulating bleeding of the bone that is exposed when cartilage is worn away. The theory behind this is that blood supply is necessary to the bone if new cartilage is to form. Unless the affected area is focal, these treatments may not be beneficial since the mechanical forces destroying the cartilage overwhelm the body’s ability to heal it. Another surgical treatment, which may be performed arthroscopically or by open surgery, is the subtotal coronoidectomy. In this procedure, the damaged area of cartilage and underlying bone are removed by grinding or cutting it out. Subtotal coronoidectomy is an effective treatment option in some cases, but may not be appropriate in all situations. If not done appropriately or in the correct case, there is some concern that it may lead to additional joint collapse and contribute to the progression of arthritis. Replacement of the entire elbow joint has been attempted for 15 to 20 years in dogs and has met with mixed results. These

surgeries, which replace the entire joint, tend to be highly invasive and require extensive rehabilitation. Complications with total elbow joint replacements include infection, loosening, dislocation, and fracture. Total elbow joint replacement should be considered for severely affected dogs that are not responsive to other means of treatment. While these procedures may improve overall comfort and function of the joint, return to full activity is generally not expected and complication rates remain high.

New Treatments
Two of the newest treatments specifically for medial compartment disease are the sliding humeral osteotomy (SHO) and the unicompartmental elbow resurfacing (CUE). These two techniques were initially developed in Dr. Schulz’s laboratory at the University of California and have been further developed by two orthopedic companies (SHO by New Generation Devices and CUE by Arthrex Vet Systems). Both of these techniques take advantage of the fact that in medial compartmental disease of the elbow, the lateral half of the elbow remains functional and healthy. The sliding humeral osteotomy is based on a similar procedure used to treat arthritis of the knee in people. By reorienting the bone above or below the joint, the forces going through the joint

Arthritis is a disease we manage versus cure. Treatment is directly related to the overall health of the patients, their activity level, and the goals of the owner.

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Clean Run - December 2011

Table of Contents for the Digital Edition of Clean Run - December 2011