preoperative preparation and sterile draping techniques for dog limb surgery

用于恢复犬齿髋关节稳定性的囊外 3D 打印植入物

Hip dysplasia (HD) in dogs manifests due to a bad fit between the hip socket (acetabulum) and the femoral head resulting in subluxation of the hip joint. It affects mainly young medium- to large-breed dogs, resulting in joint cartilage deterioration, and ultimately, severe osteoarthritis (OA) leading to chronic pain and low quality of life1,2. The overall prevalence of hip dysplasia in dogs is 15.56%, which varies widely based on breed and classification systems3,4.
Apart from lifestyle changes, hip dysplastic dog patients are treated with antiinflammatory and analgesic drugs to control pain and maintain mobility4. In case of hip laxity in young adult dogs, the only surgical resort is double (DPO) or triple pelvic osteotomy (TPO), a procedure involving two or three full cuts of the pelvic bones to expand the coverage of the femoral head. However, complications after osteotomies are common and the progression of OA is still observed5,6,7,8,9. Once severe OA and chronic pain have developed, only high-impact complex surgery like total hip replacement (THR) or salvage femoral head and neck ostectomy (FHO) remain10. However, FHO presents less favorable outcomes in large breed dogs and necessitates prolonged physical therapy for the restoration of limb function11. Furthermore, THR is technically challenging and inherently associated with severe complications12,13,14. Therefore, effective hip dysplasia therapy necessitating only low-impact surgery and with a lower complication risk is required before this end stage is achieved.
The 3-dimensional (3D)-printed personalized hip implant (3DHIP) is a first-of-a-kind treatment for canine hip dysplasia developed with the intention to offer a minimal traumatic dog-specific implant that restores hip joint stability. The technique involves a titanium implant to treat mainly young adult (6 months to 2 years old) dog patients with a dysfunctional hip joint showing hip laxity grade B (borderline) to D (moderate) according to the F&#233;d&#233;ration Cynologique Internationale (FCI)15. After computed tomography (CT) imaging of the dysplastic joint, an implant is designed following the specific anatomy of the hip joint in a personalized manner to extend the dorsal acetabular rim, thereby preventing hip joint subluxation and restoring hip joint stability.
A previous canine cadaver study revealed that the implant enhanced femoral head coverage and demonstrated failure under an impact force of 1,330 &#177; 320 Newtons16. Subsequently, a pilot study with experimental dogs demonstrated enhanced femoral head coverage, reduced hip laxity, and increased weight bearing by force plate analysis. Furthermore, examination of the intervened hips at 6 months post-implantation revealed normal volume and a smooth surface of both the femoral head and acetabulum cartilage, accompanied by joint capsule hypertrophy based on gross and histological assessments17. Upon confirmation of the efficacy and safety of the implant and treatment concept, a clinical investigation was carried out on client-owned dogs suffering from hip dysplasia. The short-term study revealed that the benefits of the 3D-printed acetabular rim extension implant are a personalized, good fit of the implant to the acetabulum restoring hip joint stability, decreased pain-related activities, and a low-impact surgical procedure18. Application of the implant requires access to the ventrocaudal aspect of the iliac body and the craniodorsal aspect of the hip joint. In this paper, we describe our surgical planning and surgical procedure with a modified craniodorsal approach to the hip joint as a manual for implantation of the 3DHIP in dogs affected by hip dysplasia.

作者聚焦：一种新型 3D 打印钛植入物，用于微创治疗幼犬髋关节发育不良

3 维打印个性化髋关节植入物治疗犬髋关节发育不良的手术技术

犬肢体手术的术前准备和无菌悬垂技术

首先，将麻醉狗的患肢悬挂在侧卧位。使用真空豆袋定位器固定狗。用 4% 葡萄糖酸氯己定溶液擦洗肢体两次，然后用 70% 乙醇喷洒两次。在手术部位周围放置四张手术防水布。用无菌防水袜固定并覆盖远端肢体。然后，添加一层无菌粘性包装以获得额外保护。用浸有碘的窗帘覆盖整个手术区域的裸露皮肤。

preoperative-preparation-sterile-draping-techniques-for-dog-limb

Research

JoVE Journal

Biology

Preoperative Preparation and Sterile Draping Techniques for Dog Limb Surgery

261 次观看. 首先，将麻醉狗的患肢悬挂在侧卧位。使用真空豆袋定位器固定狗。用 4% 葡萄糖酸氯己定溶液擦洗肢体两次，然后用 70% 乙醇喷洒两次。在手术部位周围放置四张手术防水布。用无菌防水袜固定并覆盖远端肢体。然后，添加一层无菌粘性包装以获得额外保护。用浸有碘的窗帘覆盖整个手术区域的裸露皮肤。

视频: 犬肢体手术的术前准备和无菌悬垂技术

Surgical Technique of the 3-Dimensional-printed Personalized Hip Implant for the Treatment of Canine Hip Dysplasia

Hip dysplasia causes major disability in dogs. Treatment options are limited to palliative treatment (e.g., pain relief, physical exercise, lifestyle changes, and weight control) or invasive surgeries such as pelvic osteotomies and total hip arthroplasty. Hence, a strong unmet need exists for an effective and dog-friendly solution that enhances the quality of life of man&#39;s best friend. We fill this treatment gap by offering a minimally traumatic and extraarticular, dog-specific, 3-dimensional-printed, hip implant (3DHIP) that restores hip joint stability. The surgical treatment using a 3DHIP implant is less invasive than osteotomies and can be performed bilaterally in one surgical session. The 3DHIP implant extends the dorsal acetabular rim of the dysplastic hip joint thereby increasing coverage of the femoral head and inhibiting joint subluxation with fast recovery. Sufficient access to the dorsal acetabular rim and ventral border of the iliac body together with optimal fitting and fixation of the implant are key steps for a successful 3DHIP implantation and imply the need for a specific approach. The present article aims to showcase this innovative surgical technique with tips and tricks as a surgical manual for implantation of the 3DHIP implant in dogs affected by hip dysplasia.

This work describes a novel surgical technique for extracapsular implantation of a personalized, 3-dimensional-printed, joint-preserving implant. This novel treatment aims to restore hip stability in young adult dogs suffering from hip dysplasia with laxity by uniquely reproducing the anatomical shape of the acetabular rim of the hip joint.

Hip dysplasia causes major disability in dogs. Treatment options are limited to palliative treatment (e.g., pain relief, physical exercise, lifestyle ...