Advances in the Canine Cranial Cruciate Ligament, 2nd edition

366 Future Directions

(A) (B)

(D) (E)

(C)

Figure 44.3 Key steps in the surgical procedure for canine total knee replacement. (A) Tibial ostectomy using an
extramedullary tibial alignment guide. (B) Femoral cutting block used for the four femoral ostectomies. (C) Completed
femoral and tibial ostectomies. (D) Implantation of tibial component. (E) Implantation of femoral component and
reduction of the stifle joint. Images courtesy of Tim Vojt (The Ohio State University).

is implanted first using PMMA (Figure 44.3D)
and the femoral component is implanted using
cementless press-fit or cemented fixation (Fig-
ure 44.3E). Range of motion is evaluated with
the prosthesis articulated. The joint space is
copiously lavaged to remove all debris. The
joint capsule, subcutaneous tissue and skin are
closed in routine fashion while assuring proper
patellar tracking. A sterile dressing is applied
over the incision. There is no need for a Robert
Jones bandage unless complications (e.g., col-
lateral ligament injury) are encountered during
surgery.

Postoperative management

Routine postoperative pain management after
TKR includes the use of a combination of opiate
analgesics and nonsteroidal anti-inflammatory
drugs. Cold packs are applied immediately
after surgery and at regular intervals thereafter
to reduce pain and swelling. The dog’s activity
is restricted for the first 2 weeks, after which a
controlled program of physical rehabilitation
and leash exercise can begin. Recommenda-
tions for physical rehabilitation after TKR have
been published (Liska & Doyle 2009). The goal

of rehabilitation is to achieve a normal passive

range of motion (PROM). Marcellin-Littleet al.

(2015) have reviewed the human literature and

expanded these recommendations to the dog.

TKR patients are frequently non weight-bearing

before surgery and suffer extensive soft-tissue

changes, including periarticular fibrosis and

muscle atrophy, that require extensive reha-

bilitation (i.e., physiotherapy, hydrotherapy,

low-level laser and active home exercises) to

aid recovery after surgery (see also Chapter

42). There may be value for some animals in

recommending therapy before surgery (‘preha-

bilitation’) to optimize joint function before the

TKR procedure.

Clinical results with cemented canine

TKR

Liska and Doyle (2009) reported clinical follow-

up on a series of six client-owned dogs that

underwent TKR for end-stage OA. Outcome

measures included radiographic assessment,

physical examination, including measurements

of stifle joint range of motion and thigh cir-

cumference, and force platform gait analysis.

Data were recorded preoperatively and at