Total Knee Replacement in the Dog 3676 weeks, 3 months, 6 months, and 1 year
after surgery. Rehabilitation was provided for
each dog.
Joint extension, excursion, peak vertical force,
and impulse parameters showed significant
improvement (P≤0.01) starting at 3 months
after surgery. At the end of the study, joint
extension (152◦) and excursion (115◦) were only
9 ◦and 6◦less than normal (Jaeggeret al. 2002),
respectively. Peak vertical force and impulse
were 82% and 103% of the normal contralat-
eral limb, respectively. Video during ambu-
lation at the same intervals confirmed the
owner’s subjective evaluation that minimal or
no gait abnormalities remained after rehabilita-
tion in spite of the severity of the preoperative
status.
Potential complications and their
management
Infection
Infection is a devastating complication of total
joint replacement (Figure 44.4). Currently, no
data are available on the incidence of infection
with canine TKR. The standard management of
an infected TKR would ideally be similar to that
for an infected total hip replacement: a combi-
nation of systemic antibiotics combined with
device removal. In contrast to the hip, however,
the removal of an infected TKR is problematic
Figure 44.5 Antibiotic-loaded articulating spacer,
consisting of femoral and tibial components fabricated
from polymethylmethacrylate. These may be used as a
temporary spacer for a two-stage revision procedure in
the management of an infected TKR.because it is not feasible to leave the joint to
form a pseudarthrosis. A two-stage procedure,
with removal of the infected prosthesis and
implantation of an articulating spacer made
from antibiotic-loaded PMMA cement (Fig-
ure 44.5), may be attempted, but there are
currently insufficient cases to make defini-
tive recommendations about this approach.
Until revision strategies have been validated
for the dog, the current best recommenda-
tions for managing an infected TKR include
arthrodesis or amputation of the affected
limb.(A) (B)Figure 44.4 Radiographs of an
infected canine total knee
replacement. (A) There is an
extensive zone of radiolucency
below the tibial component and
along the tibial keel (arrows). There
is also lucency around the femoral
component. (B) The presence of
lucencies on both sides of the joint
suggests septic rather than aseptic
loosening. Options for managing
this case include arthrodesis or
amputation.