Each patient must be guaranteed top-quality surgery.
Modern day surgery plays a key role in most orthopaedic disorders. A surgical approach can be of preventive or corrective value for impaired skeletal development, of therapeutic value in traumatised patients and of replacement value in prosthetic surgery.
ORTOVET applies innovative surgical protocols using high-tech materials, which are minimally invasive and respect the biological principles of healing.
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Juvenile Pubic Symphysiodesis is a minimally invasive surgical procedure for the treatment of mild and early forms of Hip Dysplasia carried out on young patients (3-4 months of age) making the most of the growth potential of the hip bones to induce greater ventral and extra-rotations of the acetabulum. This growth of the acetabulum is induced through the devitalisation of the pubic symphysis cartilage by reducing or halting the growth of the pubis encouraging continuous growth of the ileum and ischium. Unlike double pelvic osteotomy (DPO), which is a surgical procedure that involves the acute correction of the position of the acetabulum, Juvenile Pubic Symphysiodesis is a procedure that makes use of the growth potential of the dog leading to a gradual remodelling of the position of the acetabulum. For this reason, this type of preventive surgery is more effective when carried out early on. Despite Juvenile Pubic Symphysiodesis being a relatively simple procedure to perform, patient selection is extremely complex and this surgery should be carried out exclusively on patients diagnosed early with low grades of hip dysplasia.
Early diagnosis of hip dysplasia in growing dogs made between 4 and 6 months of age allows a series of preventive-remodelling surgical procedures to be considered in order to limit the osteoarthritis due to the disorder. Following a correct selection of the patient through early clinical-radiological specialist orthopaedic examination, it is possible to carry out double pelvic osteotomy (DPO). This procedure consists in performing an ostectomy of a small segment of the pubis and osteotomy of the ileum allowing the rotation of the acetabulum to improve coverage of the femoral head and in this way limit articular incongruity determined by articular laxity, which is always present in hip dysplasia. Once the acetabulum has been extra-rotated to the necessary degree, iliac osteotomy is stabilised and fixed with a special locking implant to guarantee healing of the bone maintaining the position of the acetabulum. This procedure can be performed bilaterally during the same surgical session.
The hip joint is formed by an articulation between the pelvic acetabulum and the head of the femur and allows a wide range of flexion-extension, rotation, adduction and abduction movements. Total hip replacement allows the replacement of the entire joint and today, represents the treatment of choice available for severe and symptomatic forms of hip dysplasia and chronic or non-reducible hip luxations. Surgery consists in the ablation of the pathologic hip and its replacement with a prosthesis. The prosthesis is formed by a femoral component called ‘stem’ that is inserted inside the femur to support the prosthetic neck and head, whereas, the acetabular component is called ‘cup’: after having appropriately prepared the surgical site, it is positioned to replace the acetabulum which will host the prosthetic head. Depending on the different types of implants available on the market, the stem can be fixed inside the femur (KYON Prosthesis, Swiss Model), or can be locked with a “press fit” mechanism (BIOMEDTRIX Prosthesis, American Model), whilst cups are mainly applied and fixed with a press fit mechanism. The surgical procedure requires the presence of a specialized team equipped with dedicated instruments.
Tibial Plateau Levelling Osteotomy, TPLO is currently one of the most modern and efficient surgical techniques for the treatment of cranial (or anterior) cruciate ligament rupture in dogs. This technique allows complete functional recovery with the possibility of returning to athletic activity. It is also possible to treat both large size dogs and toy breeds with a low risk of complications also thanks to the use of modern angular stable plates (Locking implants) both in surgical steel and in titanium alloy. The surgery does not consist in the replacement of the ruptured ligament but in the osteotomy of the tibia that modifies the biomechanics of the stifle guaranteeing joint stability also in the absence of the cranial cruciate ligament.
Tibial Tuberosity Advancement surgical technique was developed at the Veterinary School of Zurich in collaboration with the genius of Slobodan Tepic. TTA, which is based on the same biomechanical principles previously developed by Doctor Barclay Slocum for TPLO, has the objective of contrasting cranial tibial thrust, preventing the tibia from slipping forward during cranial cruciate ligament rupture. This is achieved by advancing the tibial tuberosity together with the tibial insertion of the patellar tendon. Tibial tuberosity is held in the new position by the use of dedicated implants.
Numerous new biomechanical techniques that have been designed and developed to improve and strengthen the principles of TTA have become available over the last years. Thanks to 3D technology, TTA Rapid allows the use of titanium porous cages to encourage rapid healing of the osteotomy of the patient conferring stability to the stifle affected by cranial cruciate ligament rupture.
Arthroscopy has become the technique of choice for the diagnosis and treatment of many joint diseases in dogs. This minimally invasive and highly accurate technique allows the patient to achieve complete and rapid recovery thanks to low morbidity and a drastic reduction of healing times. The complete visualisation and magnification of the joint structures allow the orthopaedic surgeon to study and treat in a targeted way the cause of lameness of the affected subjects. Shoulder, elbow and stifle Osteochondritis dissecans (OCD), treatment of the fragmented medial coronoid process of the ulna (FCP), meniscal treatments, diagnosis of partial cranial cruciate ligament rupture are only few of the ever increasing orthopaedic disorders that require arthroscopic treatment.Full-limb amputation is unfortunately a necessity for a series of pathologies that do not allow in dogs and cats other more conservative solutions.
Fortunately, the amputation of a single limb is a procedure well tolerated by the patient and generally provides an adequate functional outcome. Sometimes, clinical situations in which the limbs involved in pathologies and requiring amputation are more than one may occur; in these cases, amputation cannot in any way represent a real solution able to guarantee an adequate quality of life for our patients.
For these reasons, in addition to the negative perception of the owner toward amputation, limb sparing techniques are becoming increasingly popular, allowing selective amputations with the anatomical preservation of part of the affected limb.
External prosthetic limbs (esoprosthesis) applied after partial amputation are common in human medicine and are currently available for animals. Esoprostheses rely on prosthesis-skin interface to transmit the forces from the ground to the affected limb which may lead to frequent complications, including skin irritation, infections and skin necrosis; also periodic changes or adjustments are required, they can be difficult to manage and sometimes poorly tolerated by the patient.
The limitations associated with the esoprosthesis have been overcome with the use of endoprostheses called ITAP, initially developed for the amputated fingers in human medicine.
The ITAP is inserted into the bone of the limb subject to amputation. These prostheses are patient-specific custom made pure titanium implants, built with EBM technology in order to guarantee the best possible biocompatibility and osseointegration.
Each prosthesis consists of three sub-units: the first one is implanted into the bone and intended for bone ingrowth, the second one serves for the attachment of the skin and the third one, external, serves as a support for the prosthetic foot.
Primary stabilization of the prosthesis can be achieved with press fit or screws.
The external support (foot) must be functional and may have different shapes in relation to the affected skeletal segment, the patient’s attitude and body weight.
The anconeal process, normally, fuses with the ulna around 20 weeks of age. When this does not take place within this age, there is an Ununited Anconeal Process of the ulna, which is a disorder that falls within Elbow Dysplasia (ED). Once diagnosis of UAP has been made, it is possible to promote the fusion of the anconeal process within six and a half months of age through surgery by fixing it to the ulna with a screw. Fixation is accompanied by ulnar osteotomy that brings the proximal end of the ulna nearer to the anconeal process. The aim of this surgical technique is to promote a complete and correct development and limit elbow incongruity and osteoarthritis progression in adult subjects.
Angular deformities of the limbs have long been recognised as a cause of lameness and debilitation in cats and dogs. For this reason, a method of stabilisation and correction called CORA commonly used in human medicine has been adapted to veterinary orthopaedics. This method is based on a series of standard geometrical principles and accurate indications on angular deformities that are necessary to calculate and reproduce intraoperatively precise corrective osteotomies independently of the bone segment involved and the type of osteosynthesis’ implant.
Arthrodesis is a surgical technique commonly used as a salvage procedure in situations in which it is not possible to re-establish correct joint function. The objective of this procedure is to eliminate pain through the removal of cartilage planes with subsequent immobilization of the joint using special fixation implants and autologous or heterologous bone grafts that promote the formation of the bone callous and the healing of the patient. The joints that most frequently require arthrodesis are the carpus and tarsus. However, in certain clinical conditions, it may become necessary to carry out arthrodesis also on the shoulder, elbow and stifle.
The fracture of a skeletal segment always represents a highly traumatic event for both the patient and the owner. Most fractures in dogs and cats require surgical treatment that must be carried out in the first days after trauma. Dogs and cats need robust and comfortable surgical solutions respecting as much as possible the physiology of the healing process of the fracture itself. Locking plates in veterinary orthopaedics represent cutting-edge implants that are used in the treatment of fractures of all skeletal segments. Locking plates are secured to the bone with special screws that allow to achieve a stable fixation of the fracture site promoting healing through biological repair processes. Ortovet uses a wide range of locking implants that are currently on the market in order to guarantee the best possible care to all its patients of all species, breeds, sizes and ages. In certain types of fractures (i.e. exposed fractures), other osteosynthesis systems are used such as Linear External Fixation and Ilizarov External Fixation.
Most orthopaedic conditions in cats are of traumatic nature and since cats are small animals, often patients are polytraumatised.
Advances in the devices currently available mean that nearly all fractures in cats are treatable both with internal and external fixation techniques.
As well as modern locking plates, Ortovet uses an innovative type of synthesis: the Targon Vet ® interlocking nail, which is an osteosynthesis system used for the internal fixation of fractures. It is indicated for the treatment of fractures of long bones in cats and small dogs and is applied inside the fractured bone leading to stable fixation that makes it mechanically comparable to the latest stabilising systems. The use of this technology, which originates from human medicine, allows us to treat complex fractures that cannot be reconstructed with minimally invasive approaches and promotes functional recovery and biological healing of the fracture.
Ilizarov external fixation was invented in the 1950s by the Soviet human orthopaedic surgeon Gavriil Ilizarov. The system, which originally was used to correct skeletal deformities of human long bones, was later used in traumatology. In Veterinary Orthopaedics, circular external skeletal fixation with the Ilizarov apparatus allows to correct skeletal deformities of long bones in a dynamic and gradual way and in specific cases can also used to treat bone fractures. The apparatus is made up of a series of external rings that completely surround the skeletal segment to be treated and give support through different types of wires and half pins that reaches the two ends of the fracture. The rings are then assembled together with rods that are usually threaded and that complete the apparatus and transfer the loads from one fracture end to the other until the bone is completely healed. The advantages of this type of reduction is that it is minimally invasive; however, since it is an external fixation apparatus, it requires continuous management and care after its application until complete healing and removal.