Vet360 Vol 4 Issue 3 June 2017 Vet360 - Page 15

SURGERY of the distal femur, CORA in order to perform a correc- tive osteotomy. It stands for the anatomic lateral distal femoral angle. The technique for measurement can be found in most surgical texts. However in the 20% of cases we see major complica- tions it can be a nightmare to repair. Major complications require a corrective surgery with additional cost to the owner and morbidity to the animal. These complications can be symptomatic return of the patella luxation, tibial crest fracture, infection or tibia fracture. Implant migra- tion is often seen and even though it requires another surgical procedure to remove it will often not affect the outcome once clinical union has occurred. The 60% of dogs that develop a recurrent patella lux- ation at 4-6 weeks post TCT often are asymptomatic. Most of these will not require corrective surgery unless symptomatic as previously stated. The underlying question is what harm is this recurrent patella luxation doing to the articular cartilage down the line? Figure 4A The big challenge and hope of this lecture is that the surgeon will no longer apply 1 surgical technique to all patients with patella luxations. Instead then we should be assessing the underlying anatomical deformities of the patient and plan the surgery from there. The author sus- pects the high failure rate for TCT, up to 50%, is caused by this technique being used in all patients presenting with medial patella luxation without thought to the un- derlying anatomical deformities leading to or exacerbat- ing the patella luxation. Hopefully with further studies on the initial cause of pa- tella luxation in young dogs and the long term outcomes of CDFO we can develop a treatment modality that gives us an excellent outcome in surgically correcting patella luxations. It is recommended, given the extra cost to the client, that patients which are radiographically selected for a CDFO should have a computed tomography scan performed of the femur and the R-aLDFA should be measured on the CT images. This gives the most accurate measure- ment of the femoral deformity in all planes. This allows the surgeon accurate planning for the surgery and gives the best possible outcome. Figure 4B The reality of patella luxation surgery is that we don’t understand the cause of the disease in these patients hence the conflicting literature on how to fix it. Current evidence, be it only a few small studies, is pointing to- wards a lower complication rate with CDFO than TCT. This needs to be further evaluated to help us provide the best options for our patients. The reality is that the TCT with associated soft tissue procedures is an excellent surgical procedure in 80% of cases. Issue 03 | JUNE 2017 | 15