370 Future Directions
implant positioning. Peters et al. (2016) con-
ducted anex vivostudy to determine whether
image-free computer-assisted surgical naviga-
tion improved the accuracy of tibial component
alignment. They found that surgical navigation
improved the accuracy of implant positioning
in the frontal plane and decreased variabil-
ity in alignment in both frontal and sagittal
planes. Further studies are needed to deter-
mine whether the improved implant alignment
translates into improved clinical outcome.
Summary and conclusions
TKR improves joint function in dogs with end-
stage OA. As in humans (Nobleet al. 2005),
some subclinical degree of functional limitation
may be present even in normal dogs that have
undergone TKR surgery. The clinical implica-
tions of this potential mild dysfunction do not
appear to be significant considering the preop-
erative severity of pain and dysfunction present
in TKR candidates. The subjective and objective
data collected to date from clinical patients indi-
cate that TKR is effective in the short-term. The
long-term success of the procedure can only be
determined through additional controlled clini-
cal trials by collecting objective data with long-
term survival over the entire life of the patient
after TKR.
References
Allen MJ, Leone KA, Lamonte K,et al.Cemented
total knee replacement in 24 dogs: surgical tech-
nique, clinical results, and complications. Vet Surg
2009;38:555–567.
Allen MJ, Rudinsky A, Shah S,et al.Preclinical assess-
ment of cementless total knee replacement in the
dog. Vet Comp Orthop Traumatol 2010;24:A1.
Allen MJ, Leone KA, Dunbar MJ,et al.Tibial compo-
nent fixation with a peri-apatite coating. J Arthro-
plasty 2012;27:1138–1148.
Baker KM, Foutz TL, Johnsen KJ,et al.Effects of
tibial plateau angle and spacer thickness applied
duringin vitrocanine total knee replacement on
three-dimensional kinematics and collateral liga-
ment strain. Am J Vet Res 2014;75:792–799
Behrend A, Bonin T, Hach V. First clinical experiences
with a new cementless knee endoprosthesis for the
dog. Tierarztl Prax Ausg K Kleintiere Heimtiere
2013;41:75–86.
Bertran J, Allen MJ. Robotic evaluation of the effects
of total knee replacement on stifle joint kinematics.
Proceedings of the 2016 VOS Conference, Big Sky,
Montana.
Berzins A, Sumner DR, Turner TM,et al.Effects of fix-
ation technique on displacement incompatibilities
at the bone–implant interface in cementless total
knee replacement in a canine model. J Appl Bio-
mater 1994;5:349–352.
Burton NJ, Wallace AM, Parsons K,et al.Total knee
replacementinadogwithanon-uniontypeB3tib-
ial plateau fracture. Vet Comp Orthop Traumatol
2014;27:159–165
Eskelinen EV, Liska WD, Hyytiainen HK, ̈ et al.
Canine total knee replacement performed due
to osteoarthritis subsequent to distal femur frac-
ture osteosynthesis. Vet Comp Orthop Traumatol
2012;25:427–432
Jaegger G, Marcellin-Little DJ, Levine D. Reliability of
goniometry in Labrador Retrievers. Am J Vet Res
2002;63:979–986.
Liska W. In memory of Jere. Vet Surg 2015;44:678.
Liska W, Marcellin-Little D, Eskelinen E,et al.Cus-
tom total knee replacement in a dog with femoral
condyle bone loss. Vet Surg 2007;36:293–301.
Liska W, Doyle N. Canine total knee replacement:
surgical technique and 1-year outcome. Vet Surg
2009;38:568–582.
Lujan TJ, Dalton MS, Thompson BM,et al.Effect of
ACL deficiency on MCL strains and joint kinemat-
ics. J Biomech Eng 2007;129:386–392.
Marcellin-Little DJ, Doyle ND, Pyke JF. Physical reha-
bilitation after total joint arthroplasty in companion
animals. Vet Clin Small Anim 2015;45:145–165.
Mann KA, Miller MA, Khorasani M,et al.The dog as a
preclinical model to evaluate interface morphology
and micro-motion in cemented total knee replace-
ment. Vet Comp Orthop Traumatol 2012;25:1–10.
Noble PC, Gordon MJ, Weiss JM,et al.Does total
knee replacement restore normal knee function?
Clin Orthop 2005;431:157–165.
Peters KM, Hutter E, Siston RA,et al.Surgical naviga-
tion improves the precision and accuracy of tibial
component alignment in canine total knee replace-
ment. Vet Surg 2016;45:52–59.
Reay E, Wu J, Holland J,et al.Premature failure of
Kinemax Plus total knee replacements. J Bone Joint
Surg 2009;91B:604–611.
Robertsson O, Knutson K, Lewold S,et al.The
Swedish Knee Arthroplasty Register 1975–1997.
An update with special emphasis on 41,223 knees
operated on in 1988–1997. Acta Orthop Scand
2001;72:503–513.
Sumner DR, Berzins A, Turner TM,et al.Initialin vitro
stability of the tibial component in a canine model
of cementless total knee replacement. J Biomech
1994;27:929–939.
Turner TM, Urban RM, Sumner DR,et al.Bone
ingrowth into the tibial component of a canine total
condylar knee replacement prosthesis. J Orthop
Res 1989;7:893–901.