Arthroscopy Offers Dogs Less Invasive Alternative to Joint Surgery

Scout, a bubbly 10-month-old yellow Labrador retriever, had favored his right front leg for weeks. Sometimes he limped, and other times he dangled the limb in the air. At the veterinary office, Scout still happily thumped his tail against the floor, but his doctor could tell he was in pain.When no obvious cause could be found on x-rays, the veterinarian suggested that Scout was the perfect candidate for arthroscopy.

WHAT IS ARTHROSCOPY?

It’s a minimally invasive procedure that enables the veterinarian to examine the inside of a joint, make a diagnosis, and in many cases, to actually repair the problem. Unlike traditional open-joint surgeries that require a large incision, arthroscopy can be accomplished through one or two tiny incisions.

Once the incision is made, an instrument about the width of a pencil is inserted into the joint. This arthroscope contains fiberoptic cables that illuminate the joint space and special lenses to magnify the joint structures. A digital camera captures images and transmits them to a TV monitor so the surgeon can examine the joint in detail. Although the procedure is less invasive than open-joint surgery, the pet still requires general anesthesia.

BORROWED FROM HUMAN MEDICINE

In the 1970s, human doctors began using arthroscopy to visualize the inside of joints, to make diagnoses, and eventually to treat many conditions. By reducing surgical trauma, arthroscopy resulted in less pain, shorter hospital stays, and faster recoveries.

During the same decade, veterinarians began using arthroscopy in horses to help minimize the lengthy rehabilitation associated with open-joint surgery. By the 1980s, this procedure was commonplace in equine surgery. Still, arthroscopy wasn’t widely used in small animal medicine until the mid-1990s, when instruments were developed for smaller joints.

Today, arthroscopy is generally performed on midsized to large-breed dogs (who are more prone to orthopedic conditions), but smaller scopes are now available for small dogs and cats. At the moment, arthroscopy is mainly offered through specialty veterinary practices. However, as equipment becomes more available, more veterinarians will be trained in arthroscopic surgery, which may make the procedure more commonplace.

FASTER, LESS PAINFUL RECOVERIES

Because arthroscopy is less invasive than openjoint surgery, there’s not as much tissue damage or scarring. As a result, there’s usually less postoperative pain (and fewer medications), and patients generally recover faster. In fact, dogs that undergo arthroscopic surgery are often able to use their legs the day after surgery.

Arthroscopy also offers advantages for the surgeon. With enhanced lighting and magnification, arthroscopy can actually give the veterinarian a better view of the cartilage and ligaments of a joint than can be achieved with conventional open-joint surgeries, radiographs (x-rays), and magnetic resonance imaging (MRI).

WHEN IS THE RIGHT TIME FOR ARTHROSCOPY?

Any time a dog is showing signs of joint pain, including lameness, stiffness, or difficulty going up or down stairs, your veterinarian may suggest x-rays and blood work. If these less invasive techniques still don’t provide enough information about the joint, arthroscopy may be an option.

In terms of treatment, there are still some joint surgeries, such as a total hip replacement, that can’t be done with arthroscopy. The most common sites for arthroscopy are the elbows, shoulders, and knees, but it can be used to explore any painful joint, including the wrist (carpus), the ankle (hock), and the hip.

Scout, for example, had a condition that’s common in rapidly growing dogs called a fragmented coronoid process. Dogs with this condition develop painful bone fragments in the elbow that often don’t appear on x-rays. Until recently, surgeons had to make an incision 3 to 4 inches in length to remove the bone fragments. Because the elbow undergoes a lot of stress, an incision this size can cause considerable postoperative discomfort. Now, the same procedure can be accomplished with two tiny incisions. Scout was up and walking around the next day.

By reducing postoperative pain and speeding recoveries, it’s no wonder that arthroscopy has become one of the fastest growing areas of small animal orthopedic surgery.

YOU CAN GIVE AN OLD DOG A NEW JOINT

Thirty years ago, veterinarians began performing total hip joint replacements for dogs with severe arthritis and other hip diseases. Like human implants, the canine version is made of medical-grade plastic and metal. Today, total knee (stifle) and elbow replacements are also available for pets.

Usually considered a salvage procedure, joint replacements are only considered when other medical and surgical options no longer provide adequate limb function or quality of life for the pet. These procedures are usually not recommended for pets that have nerve dysfunction, ongoing infections, or trouble with multiple joints on the same limb.

In many cases, joint replacements can be avoided through a combination regimen of weight reduction, medication, exercise, and physical therapy.