preoperative preparation and sterile draping techniques for dog limb surgery

Extracapsular 3D-Printed Implant for Restoring Hip Stability in Canines

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.

Author Spotlight: A Novel 3D-Printed Titanium Implant for Minimally Invasive Treatment of Hip Dysplasia in Young Dogs

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

The scope of our research is the application of a new surgical treatment, 3D hip, for young dogs with hip dysplasia characterized by hip laxity. The 3D hip implant is a patient-specific 3D-printed titanium implant that is designed to extend the dorsal acetabular rim of the hip joint and leads to joint stability and resolution of hip pain. Hip dysplasia is a common orthopedic disease in young dogs that can be treated surgically by invasive techniques like pelvic osteotomy to hip replacement and femoral head and neck incision.So there is a need for minimally invasive procedure like the 3D hip implant, which can be treated bilaterally with rapid recovery preserving the joint. The 3D hip is laser-printed with titanium powder using a direct metal printing machine. Printing is computer-guided by the CT scan of the dog's pelvis, ensuring sufficient dorsal acetabular rim extension for perfect fit placement, and reversing the hip laxity to immediate joint stability.Accuracy of the 3D hip implant placement is evaluated during surgery using fluoroscopy, but it may be affected by changes of bone and joint between the day of CT scan and the day of surgery or the lead time. So a reduction in lead term to two weeks would be ideal. The modified surgical hip approach provides an adequate view of the dorsal acetabular rim of the hip joint for implant placement.The 3D hip implant increases femoral head coverage, decreases laxity of the dysplastic hip joint, and shortens recovery time. Bilateral application in one operative session is the major benefit of the 3D hip procedure.

Preoperative Preparation and Sterile Draping Techniques for Dog Limb Surgery

Research

JoVE Journal

Biology

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

Dog Hip Joint Access and Acetabular Rim Extension Using the 3DHIP Implant Placement