is FREE, but space is limited

Friday, April 23, 2010 19:00 – 22:00 Welcome Reception Saturday, April 24, 2010 07:00 – 08:00 Registration 08:00 – 13:30 Morning Sessions 13:30 – 14:30 Lunch 14:30 – 19:00 Afternoon Sessions 20:00 – Reception followed by Dinner Sunday, April 25, 2010 09:00 – 13:00 ALPS and Trochlear Prosthesis workshops Location:

Animal Center, Ketchum, ID, USA Robert Botte, DVM, Dipl ACVS, mobile veterinary surgical specialist, San Diego, CA, USA

PROGRAM

TECHNOPARK Technoparkstrasse 1 CH – 8005 Zurich Switzerland

REGISTRATION On-line: www.kyon.ch For information call: +41-44-350-3105

Stephen Bresina, PhD, COO, Scyon Orthopaedics AG, Au, Switzerland Zelimir Dokic, DVM, surgical resident, Vienna, Austria Christopher Evans, Maurice Müller Prof. of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA Tomas Guerrero, DVM, Dipl ECVS, Small Animal Surgery, Vetsuisse, U. of Zurich, Switzerland Andreas Gutbrot, DVM, surgical resident, Vetsuisse, U. of Zurich, Switzerland Daniel Koch, DVM, Dipl ECVS, private practice surgeon, Diessenhofen, Switzerland

SYMPOSIUM 2010 INNOVATIONS IN VETERINARY ORTHOPEDICS AND TRAUMA

Dragan Lorinson, DVM, Dipl ECVS, Univ. Doz., private practice surgeon, Chir. Zentr. für Kleintiere Dr. Lorinson, Vienna, Austria Hans Nieuwendijk, DVM, private practice surgeon, De Tweede Lijn, Wilhelminaoord, The Netherlands Ben Ollivere, MB, BS, MRCS, BA (Oxon), Specialist Registrar, Trauma & Orthopaedics, Cambridge U. Hospitals NHS Trust, UK

SYMPOSIUM 2010 ZURICH, NOVEMBER 13th: INNOVATIONS IN VETERINARY ORTHOPEDICS AND TRAUMA Participants are responsible for travel and lodging (special room rates at adjacent Accor hotels Novotel, Ibis and Etap available until March 12)

SYMPOSIUM 2010 INNOVATIONS IN VETERINARY ORTHOPEDICS AND TRAUMA

Ingo Pfeil, DVM, private practice surgeon, Tieraerztliche Klinik Preschnerheide, Dresden, Germany Jean-Claude Puippe, PhD, Steiger Galvanotechnique SA, Châtel-St-Denis, Switzerland

Symposium sponsored by: KYON AG, Veterinary Surgical Products Technoparkstrasse 1, CH-8005 Zurich Switzerland e-mail: [email protected] Phone: +41-44-350 3105 Fax: +41-44-350 3106

Christian Schwandt, DVM, Dipl ECVS, Tierklinik Haar, Haar/ München, Germany

KYON Pharma, Inc. 156 Porter Street, Unit 249 Boston, MA 02128, USA e-mail: [email protected] Phone: +1-617-567-2436 Fax: +1-617-567-3193

Cláudia Vaz, PhD, Royal DSM N.V., Urmond, The Netherlands

Ezra Steinberg, DVM, surgical resident, UPenn School of Veterinary Medicine, Philadelphia, PA, USA Slobodan Tepic, DrSci, CEO, Kyon, Zurich, Switzerland Markus Tobler, PhD, IonBond AG, Olten, Switzerland

Luca Vezzoni, DVM, surgical resident, Cremona, Italy Tsutomu Yamaguchi, DVM, private practice surgeon, Fabre Animal Medical Center, Osaka, Japan

ZURICH CEMENTLESS THR: RISK FACTORS

ZURICH APRIL 24 & 25

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ZURICH APRIL 24 & 25

RETROSPECTIVE STUDY ON PERSONAL CASES 2nd generation implants (June 2001)

RETROSPECTIVE STUDY ON PERSONAL CASES

Aims of the study to record all the complications to correlate the complications to the patient/implants data to study the risk factors for complications to reduce the incidence of complications in future

M&M: data evaluated

breed

head and neck size

gender

cup retroversion

age

cup opening

weight

neck anteversion

causes of joint degeneration

cup screw

cup size

numbers of stem bicortical screws

stem size

buttress plate

Results: dogs and implants

‣ from June 2001 to December 2008 (7.5 years) ‣ minimum FU 1 year ‣ 623 THR in dogs of different breeds ‣ age between 4.5 months and 12.5 years (average 2.9 yrs) ‣ body weight between 13 kg and 72 kg (average 33.4 kg)

Results: dogs and implants Implants: ‣ cups: 40 #21.5, 251 #23.5, 261 #26.5, 65 #29.5 and 6 #32.5 ‣ Stem: 21 X-Small, 149 Small, 286 Medium and 167 Large ‣ H&N: 56 X-Short, 422 Short, 123 Medium, 20 Long e 2 X-Long ‣ Cup opening (ALO): from 30° to 62°, average 45.4° ‣ Cup retroversion: from 0° to 35°, average 14.9° ‣ Measured stem anteversion: from 3° to 30°, average 17.5°

Results: one or more complications in 65 cases (10.4%) = 76 compl. ‣ 59 cases of 65 (90.7%) revised successfully ‣ 6 cases of 65 (9.2%) explantated (0.9% of all cases) ‣ 41 of 76 (53.9%) short term complications (within 6 months) ‣ 35 of 76 (46.2%) long term complications (over 6 months)

Results: 76 complications in 65 cases (10.4%)

Complication

No.

%

Successful revisions

Failure and explantation in 6 cases

Luxation

27

4. 3

25

2 (subsequent septic cup loosening)

Cup loosening

16

2. 5

12

4 (2 with concurrent stem loosening)

Femoral fracture

7

1. 1

5

2 (1 not reparable fx, 1 loosening)

Stem breakage

7

1. 1

7

-

Cup breakage

6

0. 9

6

-

Stem loosening

6

0. 9

4

2 (with concurrent cup loosening)

Infections

7

1. 1

3

4 (2 cup +2 stem/cup loosening)

Results: 27 cases of luxation, 4.3% ‣ all within the 8th week p.o. ‣74% dogs younger than 1.5 years ‣ 52% young giant breed dogs ‣ 70% males, 30% females ‣ 92% with 16 mm H&N ‣ 8% with 19 mm H&N ‣ no correlation with cup orientation GS, M, 1 yr., 10 days post.op

Discussion: risk factors for luxation

‣ dogs younger than 1.5 years ‣ giant breed dogs ‣ male gender ‣ use of X-Short H&N in middle - large breed dogs

Discussion: risk factors for luxation

‣ dogs younger than 1.5 years ‣ giant breed dogs ‣ male gender ‣ use of X-Short H&N in middle - large breed dogs ‣ use of 16 mm head and neck in large and giant breed dogs

Discussion: risk factors for luxation

‣ dogs younger than 1.5 years ‣ giant breed dogs ‣ male gender ‣ use of X-Short H&N in middle - large breed dogs ‣ use of 16 mm head and neck in large and giant breed dogs ‣ hip luxation as underlying disease for THR

Results: 9 cases of late cup loosening, 1.4% ‣ 6 cases aseptic: 2 cases of traumatic loosening after 1.5 - 2 yrs

FU 1 y.

Tac, Newfoundland M, 3 y., 40 kg, 2 yrs. post.op aseptic

FU 2 y.

Results: 9 cases of late cup loosening, 1.4% ‣ 6 cases aseptic: 2 cases of traumatic loosening after 1.5 - 2 yrs 4 cases of poly wear (#21.5 cup), 2 to 4 years p.o. FU 6 m.

FU 2 y.

Results: 9 cases of late cup loosening, 1.4% ‣ 6 cases aseptic: 2 cases of traumatic loosening after 1.5 - 2 yrs 4 cases of poly wear (#21.5 cup), 2 to 4 years p.o.

‣ 3 cases septic: 10 mo. to 2 years p.o. 1 explanted GSD, 3 yrs.

Discussion: risk factors for late cup loosening

‣ use of #21.5 mm Cup in young dogs ‣ use of #21.5 mm Cup in dogs > 18 kg ‣ new Cups “double shell”

Discussion: risk factors for late cup loosening

‣ polyethylene wear ‣

DLC vs. TiN H&N • twice as hard on Vickers scale • smoother surface • lower coefficient of friction • more stable in the body Courtesy S. Tepic

Results: 7 cases of early cup loosening, 1.1%

‣ 4 cases in young hyperactive dogs (< 1 year of age), from 2 to 3 months p.o.

GSD, M, 1 year., 2 mo. post.op and FU 3 mo. after revision

Results: 7 cases of early cup loosening, 1.1%

‣ 4 cases in young hyperactive dogs (< 1 year of age), from 2 to 3 months p.o. ‣ 3 cases related to infections

Caucasian Shepherd dog, M, 13 mo. 2 revisions for recurrent luxation

Discussion: risk factors for early cup loosening

‣ young and hyperactive dogs

sedation?

‣ inadequate p.o. management ‣ poor bone density in young dogs with severe HD ‣ revision surgeries

Discussion: risk factors for early cup loosening

‣ young and hyperactive dogs

sedation?

‣ inadequate p.o. management ‣ poor bone density in young dogs with severe HD ‣ revision surgeries ‣ “single shell” Cups vs “double shell” Cups

Golden, M, 1 yr., 2 months. post.op

Results: 7 cases of femoral fractures, 1.1%

‣ all within 10 days p.o. ‣ 2 cases in young dogs < 1 year of age ‣ 5 cases in old dogs (from 7 to 9 years) ‣ 4 cases were overweight ‣ no correlation with the stem size and the H&N size

Labrador, FN, 8 yrs., 5 days post.op

Discussion: risk factors for femoral fractures

‣ old dogs (> 6 years) ‣ dogs with severe chronic OA ‣ overweight dogs ‣ female neutered dogs

Labrador, FN, 8 yrs., 48 kg

Discussion: risk factors for femoral fractures

‣ prevention in dogs at risk ‣ buttress plate

GSD, FN, 9 yrs., 44 kg

Results: 6 cases of stem loosening, 0.9%

FU 1 yr. after revision

‣ from 6 months to 3.5 years p.o. ‣ in 2 cases, Small Stem in dogs > 35 kg. ‣ in 1 case X-Long H&N ‣ in 3 cases related to septic cup loosening

Labrador, F, 4 yrs., 3.5 yrs. post.op

Discussion: risk factors for stem loosening

‣ Long and X-Long Head/Neck: increased lever arm ‣ smaller stems in growing dogs ‣ disproportion between stem size and final weight at adult age ‣ advisable to oversize implants in growing dogs

Results: 7 cases of stem breakage, 1.1%

‣ 1 peg rupture ‣ 6 midshaft ruptures ‣ from 1,5 to 5 yrs PO ‣ young active dogs

Small Stem

Discussion: risk factors for stem breakage

‣ Long and X-Long Head/Neck: increased lever arm ‣ smaller stems in growing dogs ‣ disproportion between stem size and final weight at adult age ‣ advisable to oversize implants in growing dogs

Discussion: risk factors for stem breakage

‣ Long and X-Long Head/Neck: increased lever arm ‣ smaller stems in growing dogs ‣ disproportion between stem size and final weight at adult age ‣ advisable to oversize implants in growing dogs Tosca, Labrador, F, 7.5 mo., 21 kg

Discussion: risk factors for stem breakage ‣ disproportion between stem size and final weight at adult age Stem Small Plotter, Labrador R., M., 7 mo., 18 kg.

Discussion: risk factors for stem breakage ‣ disproportion between stem size and final weight at adult age

Plotter, FU 2,5 A 38 Kg

Small Stem

UNDERSIZED

FU 2.5 yr. 38 kg

Discussion: risk factors for stem breakage FU 1 yr. post rev.

revision with Medium Stem

Results: 6 cases of cup breakage, 0.9%

‣ from 1 to 3 years p.o. ‣ in all cases age < 4 years ‣ in 3 cases #21,5 mm Cup ‣ in 3 cases #23,5 mm Cup (faulty batch)

Golden, F, 4 yrs., 3 years post.op

Discussion: risk factors for cup breakage

‣ use of #21.5 mm Cup in young dogs ‣ use of #21.5 mm Cup in dogs > 18 kg ‣ #23.5 mm Cup faulty batch, replaced

Results: 7 cases of infection, 1.1% ‣ 2 cases of cup & stem loosening ‣ 5 cases of cup loosening ‣ 3 cases after revision surgeries, all explanted (in all Staphylococcus intermedius, MRSI, in one case + Leishmania)

‣ in 3 cases successful revision(Strept. ep., Serratia marcescens, Burkholderia cepacea)

‣ in 1 case the bacterial type was not identified, explanted English Setter., M, 9 yrs., 2 mo. after 3 revisions for luxation

Discussion: risk factors for infections

‣ previous surgeries ‣ THR revision surgeries ‣ immuno-depressed animals ‣ systemic infections ‣ Leishmania

Discussion: risk factors for infections

‣ previous surgeries ‣ THR revision surgeries ‣ immuno-depressed animals ‣ systemic infections ‣ Leishmania

Discussion: risk factors for infections

‣ revision strategies • extra care for asepsis and antisepsis • Septocoll® E20 • gentamicine impregnated collagen

Discussion: overall risk factors

‣ age: slightly higher risk in dogs < 1 year of age (12.2% vs 10.4%) ‣ THR indications other than HD ‣ male (11.8%) vs female (9.8%) ‣ small size implants (#21.5 mm cup and X-Small and Small Stems) ‣ combination of different factors ‣ breed and size/weight dog

Discussion: bodyweight and size as risk factors

30 24 18 12 6

10,8% up to 20 kg 46 cases

5,8% 21- 30 kg 222 cases

3,5% 31- 40 kg 224 cases

10,9% 41- 50 kg 101 cases

21% 51- 60 kg 19 cases

25% > 60 kg 8 cases

0

Conclusions

✓ The acknowledgement of risk factors can help to: • establish individual prognosis for each patient • apply strategies for risk prevention • decrease the incidence of complications



Long term follow-ups are required on a wider number of cases

✓ THR is a life-long process

Thanks for your attention!