Synovitis Subsequent to Total-Hip Arthroplasty with and Without Hydroxyapatite Coatings: A Study in Dogs

OBJECTIVE: To establish whether hydroxyapatite (HA) coatings applied to metal total-hip-replacement components increased synovitis in the coxofemoral joint of dogs. Study Design-An in vivo research trial and histologic study. ANIMALS: Twenty-three large, mixed-breed dogs. METHODS: Arthroplasty components were implanted with HA on neither stem nor cup, or with HA applied to either the femoral component or with both stem and cup having HA applied in 23 dogs. Synovial inflammation was scored 3, 6, and 12 months after surgery. Synovial membrane thickness; polyethylene particulate load; fibrin exudate; membrane edema; mitotic index; giant-cell, mononuclear histiocyte, lymphocyte, and polymorph number; and collagen degeneration were scored and statistical analyses performed. RESULTS: Operated-side synovial thickness was greatly increased relative to control. Fibrin deposition, intramembranous edema, and collagen degeneration were similar within each time interval among the various component groups. The majority of inflammatory scores among the groups were unchanged. In this 12-month study, the presence of HA coatings appear not to have a marked impact on the development of synovial inflammation. CONCLUSIONS: HA-coated components do appear to contribute somewhat to the inflammatory load within the periprosthetic environment, but this effect is not marked. CLINICAL RELEVANCE: The major advantage of HA addition to arthroplasty components is enhanced osteoconductivity around metallic surfaces. The slight increase in particulate load seen in the presence of HA coatings may contribute to the development of aseptic loosening of arthroplasty components, but is unlikely to be the major causative factor.     

Evaluation of the Palmaz Stent in the Trachea and Mainstem Bronchi of Normal Dogs

Objective — This study evaluates the efficacy of the Palmaz balloon expandable intraluminal stent in the trachea and mainstem bronchi of normal dogs. Study Design — Effects of the stent were evaluated by physical examination, thoracic radiography, respiratory tract fluoroscopy and endoscopy, tracheal diameter measurement, postmortem examination, and airway histomorphometry. Animals or Sample Population — Ten normal beagle dogs. Methods — Stent size was estimated from thoracic radiographs in awake dogs. Group I dogs (n = 4) had two stents placed: one in the thoracic trachea (TT) plus a randomly chosen mainstem bronchus (MB). Group II dogs (n = 3) had stents placed in the MB (one stent), TT (one stent), and mid- or proximal cervical trachea (CT) (one or two stents). Three dogs were used as sham-operated controls (group III). Temperature, pulse, respiration, and cough were measured twice daily. Dogs were evaluated at 21 and 49 to 56 days after stent placement, euthanatized, and tissues were collected for histomorphometric analysis of stent integration and epithelial pathology. Results — Mean tracheal diameters of awake (10.5 ±1.7 mm) and anesthetized dogs before stent implantation (13.9 ± 2.0 mm) were significantly different (P <.01). Complications associated with stent placement included acute pulmonary edema (n = 2), stent migration (n = 7), stent collapse (n = 4 CT, 2 TT, and 1 MB), and positive tracheal culture (n = 10). Group II dogs coughed more at rest, exercise, and with tracheal palpation than dogs in other groups (P <.01). Group I dogs coughed more at rest than group III dogs (P <.01). Stent integration ranged from 0 to 91.3%. Squamous metaplasia and epithelial ulceration associated with stents ranged from 0 to 57.5% and 0 to 32.7%, respectively. Conclusions — Determination of stent size should be based on measurements taken on anesthetized dogs because use of inappropriately sized stents may promote stent migration, squamous metaplasia, and/or ulceration. Epithelialization over stent struts may occur if the stent is closely associated with tracheal epithelium. Clinical Relevance — Palmaz stents do not appear to be appropriate for placement in the CT of dogs; however, with technical modifications, application in the TT and MB may be feasible.     

SLOW RELEASE CISPLATIN COMBINED WITH RADIATION FOR THE TREATMENT OF CANINE NASAL TUMORS

Thirteen dogs with malignant tumors of the nasal cavity were treated with a combination of slow release cisplatin and megavoltage radiation. Radiation was delivered on a Monday through Friday schedule using a 6 MV linear accelerator. The median total dose was 49.5 Gy (range 49.5-56 Gy). Cisplatin was given using an open-cell polylactic acid polymer, impregnated with the drug and implanted intramus-cularly at a distant site, as a slow release delivery system (OPLAn-Pt [THM Biomedical, Inc]). The median dose used was 60 mg/m2 (range 60–100 mg/m2). When combined with radiation, this delivery system caused no systemic drug toxicity, and a local tissue reaction was seen in only two dogs. Acute side effects to normal tissue from radiation were not enhanced, as measured by subjective assessment. When compared to a group of historical controls that received radiation without OPLA-Pt, the dogs that received combined radiation and cisplatin had longer overall survival times, with a median of 580 days. The control group had a median survival of 325 days. Previously reported median survival times for comparable megavoltage radiation treatment range from 6 to 13 months. Some dogs in both groups also received adjubant chemotherapy but this did not influence survival time. By multivariate analysis, only the use of OPLA-Pt was found to significantly influence survival, with a p value of p = 0.023. Mega-voltage radiation and slow release cisplatin appears to be a well tolerated combination that may favorably affect survival of dogs with nasal tumors.     

Arthroscopic Anatomy of the Equine Temporomandibular Joint

OBJECTIVE: To develop an arthroscopic approach to, and describe the arthroscopic anatomy of, the equine temporomandibular joint (TMJ). STUDY DESIGN: Cadaveric study, after which the technique was tested in horses. ANIMALS OR SAMPLE POPULATION: Ten cadaveric equine heads and 5 normal horses (age, 5-13 years; weight, 425-545 kg). METHODS: Specimens or horses were positioned in right lateral recumbency. After fluid distention of the TMJ, arthroscopic portals were made in the dorsal compartment over the most prominent portion of the joint outpouching (caudodorsal approach) and in rostral and intermediate locations. The joint was explored and photographed. Positional changes in the mandible were made to determine if observation of the joint could be improved. Instrument portals were created to assess the feasibility of surgical arthroscopy. Cadaveric heads were dissected to assess iatrogenic damage, whereas experimental horses were observed for postoperative complications for 30 days. RESULTS: A caudodorsal arthroscopic approach provided the best evaluation of the dorsal compartment of the TMJ. The approach allowed observation of the rostral and caudal synovial pouches and the lateral aspect of the joint including the articular disc. Examination of the medial aspect of the joint was limited to the most rostral and caudal aspects. Access to the lateral aspect of the ventral compartment of the TMJ was precluded by the position of the transverse facial artery and vein. In specimens, iatrogenic damage was minimal and limited to the articular fibrocartilage, articular disc, and penetration of the parotid salivary gland. If the latter also occurred in horses, no adverse effects were noted. In horses, mild fluid extravasation occurred and resolved within 1 day. All horses ate normally after surgery but had periarticular swelling and mild pain upon palpation of the TMJ for 2 days. CONCLUSIONS: A caudodorsal arthroscopic approach to the TMJ allowed adequate observation of the lateral aspect of the dorsal compartment of the joint. Access to the ventral compartment was precluded by the location of the transverse facial artery and vein. CLINICAL RELEVANCE: Conditions affecting the lateral and caudal aspects of the dorsal compartment of the TMJ should be visible by arthroscopy.     

Use of a Cortico-Cancellous Bone Graft in the Repair of a Cleft Palate in a Dog

We report the successful use of a cortico-cancellous bone graft to repair a cleft of the secondary palate in a 6-month-old Akita dog. The cleft extended from the incisal papilla to the posterior border of the soft palate. It was 10 mm wide in the hard palate and 16 mm in the soft palate. The cleft was repaired using the "push-back" method with single-pedicled mucoperiosteal flaps to close the cleft in the soft tissues, and a free bone graft from the tibia (cortex with cancellous bone attached) to fill the defect in the hard palate. Two and one-half years after the operation the graft was indistinguishable from surrounding bone on radiographs. Maxillary growth appeared to have progressed normally, resulting in normal occlusion.     

A MACROSCOPIC AND RADIOLOGIC INVESTIGATION OF DENTAL DISEASES OF THE DOG

The type and frequency of dental diseases and disorders were determined in 162 randomly selected dogs available for necropsy. There were 82 males and 80 females ranging in age from seven months to 14 years. There were 150 purebred dogs (50 different breeds) and 12 mongrels. Only four breeds were represented by ten individuals or more: Poodles (Miniature and Toy), German Shepherds, Dachshunds, and Boxers. The oral cavity was examined macroscopically, and missing teeth, dental caries, dental calculus (tartar), and gingival epulides were recorded as to frequency and distribution. After macroscopic examination of the oral cavity, the head of each dog was sawed at the midline, fixed in formalin, and radiographed. The frequency, severity, and distribution of marginal periodontitis, periapical destruction, and root resorption were recorded. The most frequently noted disease was periodontitis, which increased in frequency and severity with increasing age of the dogs. The disease varied markedly among and within different breeds. Small dogs were more often affected with periodontitis than large dogs. Periapical destruction was a common finding. Caries and root resorption were less common. Missing teeth was a frequent disorder regardless of age. Most of the dogs had dental calculus.