Surgical Management of Septic Arthritis

Autologous platelet-rich plasma effects on Staphylococcus aureus-induced chondrocyte death in an in vitro bovine septic arthritis model

OBJECTIVE

To investigate the chondroprotective effects of autologous platelet-rich plasma (PRP), ampicillin-sulbactam (AmpS), or PRP combined with AmpS (PRP+AmpS) in an in vitro chondrocyte explant model of bovine Staphylococcus aureus-induced septic arthritis.

SAMPLE

Autologous PRP and cartilage explants obtained from 6 healthy, adult, nonlactating Jersey-crossbred cows.

ProcedureS

Autologous PRP was prepared prior to euthanasia using an optimized double centrifugation protocol. Cartilage explants collected from grossly normal stifle joints were incubated in synovial fluid (SF) alone, S aureus-inoculated SF (SA), or SA supplemented with PRP (25% culture medium volume), AmpS (2 mg/mL), or both PRP (25% culture medium volume) and AmpS (2 mg/mL; PRP+AmpS) for 24 hours. The metabolic activity, percentage of dead cells, and glycosaminoglycan content of cartilage explants were measured with a resazurin-based assay, live-dead cell staining, and dimethylmethylene blue assay, respectively. Treatment effects were assessed relative to the findings for cartilage explants incubated in SF alone.

RESULTS

Application of PRP, AmpS, and PRP+AmpS treatments significantly reduced S aureus-induced chondrocyte death (ie, increased metabolic activity and cell viability staining) in cartilage explants, compared with untreated controls. There were no significant differences in chondrocyte death among explants treated with PRP, AmpS, or PRP+AmpS.

CLINICAL RELEVANCE

In this in vitro explant model of S aureus-induced septic arthritis, PRP, AmpS, and PRP+AmpS treatments mitigated chondrocyte death. Additional work to confirm the efficacy of PRP with bacteria commonly associated with clinical septic arthritis in cattle as well as in vivo evaluation is warranted.

Management of intertarsal septic arthritis in an ostrich (Struthio camelus)

A 7-year-old female ostrich (Struthio camelus) presented with lameness, left intertarsal joint swelling and a healing wound on the caudomedial aspect of the joint. Synovial culture revealed Corynebacterium species and radiographs were consistent with progressive septic arthritis. Multiple treatments were attempted including through-and-through joint lavage, intra-articular antibiotics, caudomedial arthrotomy, and regional limb perfusion in conjunction with systemic antibiotics and analgesia. Euthanasia was ultimately performed due to prolonged recumbency and poor prognosis. This report describes novel therapies and a surgical approach utilized for treatment of intertarsal septic arthritis in an ostrich and exemplifies the poor prognosis described in other species presenting with non-responsive septic arthritis of critical joints.

Arthroscopic approaches to and anatomy of the shoulder joint of cattle: a cadaver study

Background

Arthroscopic surgery is described as a minimally invasive technique for diagnosis, exploration and treatment of joint disorders. It allows intraarticular structures to be assessed accurately, thereby improving the diagnostic capabilities, and it broadens the spectrum of surgical techniques feasible for treatment of articular pathologies in cattle.

This study aimed to assess for cattle the described arthroscopic approaches to the shoulder joint of horses, and to describe the appearance of the corresponding intraarticular structures of the shoulder joint. Additionally, to perform histological examination where tissues were identified and assessed arthroscopically, but the tissue type was uncertain using cadaveric limbs from cattle of different age categories without any signs of orthopedic diseases of the front limbs.

Results

An anatomic and arthroscopic investigation with 34-cadaveric forelimbs from 20-cattle was performed. The arthroscope was inserted either immediately cranial or 1-cm caudal to the tendon of the infraspinatus muscle for the cranial and caudal approaches, respectively. The shoulder joints were examined with the limbs in either horizontal non-pulled position, abducted non-pulled position using a three-pod limb holder adjustable in height, or horizontal manually pulled position. Arthroscopy was performed using a rigid 30°arthroscope (18-cm length, 4-mm outer diameter) to view the synovial pouches with their synovial villi and the following structures: cranial rim of the glenoid, cranial portion of the humeral head, incisura-glenoidalis, caudal rim of the glenoid, caudal portion of the humeral head, and cranial and caudal cul-de-sac. Abduction of the limb allowed improved visualization of the lateral portion of the joint. Pulling the limb facilitated investigation of the medial portion of the joint. Generally, the distention range was higher in younger as compared to adult cattle, and visualization of the medial portion of the joint was, therefore, facilitated in younger animals. The main complications observed were subcutaneous fluid extravasations and partial-thickness articular cartilages wear-lines.

Conclusion

The described arthroscopic techniques allowed good overall visualization of the most relevant anatomical structures within the healthy cadaveric joint. Further investigations are warranted to evaluate the diagnostic and therapeutic applications of these techniques and the prognosis of arthroscopic surgery as a tool for the treatment of joint lesions.

Lateral radioulnar subluxation in three cattle: clinical findings, treatment, and outcome

OBJECTIVE

To describe the clinical signs, conservative treatment, and short- and long-term outcomes of lateral radioulnar subluxation in cattle.

ANIMALS

Three cattle with lateral radioulnar subluxation.

STUDY DESIGN

Case series.

METHODS

One 3-year-old Red Holstein cow, one 2-year-old Red Holstein cow, and one 9-month-old Holstein heifer were presented with acute, grade greater than 3 of 5, mixed lameness in one forelimb. Clinical, radiographic, and ultrasonographic examination results revealed radioulnar subluxation with lateral displacement in all cases.

RESULTS

The subluxations were manually reduced under general anesthesia by simultaneous maximum flexion of the elbow and carpal joints, medial rotation of the forearm, and application of strong pressure to the radial head and olecranon. The short-term clinical outcome after stall rest was excellent in all three cases. Clinical and radiographic follow-up examinations were performed at varying intervals, with a final on-farm examination in all three cattle 12, 7, and 9 months after reduction. Osteoarthritic changes were visible in all three cases, mainly at the medial humeral trochlea, but lameness had completely resolved in all three animals.

CONCLUSION

Conservative management of lateral radioulnar subluxation had an excellent clinical outcome in all three cattle. Follow-up radiographs revealed osseous proliferation mainly in the region of the medial trochlea of the humerus and subtle signs of osteoarthritic changes.

CLINICAL SIGNIFICANCE

Lateral radio-ulnar subluxation is a rare but possibly underdiagnosed cause of lameness in cattle. It should be part of the differential diagnosis in cattle with elbow joint pain.

Palmar arthroscopic approach and intra-articular anatomy of the bovine carpal joints

OBJECTIVE

To describe the palmar arthroscopic approaches to the bovine carpus and document the visible intra-articular structures in each approach.

STUDY DESIGN

Ex vivo study.

SAMPLE POPULATION

Thirty fresh cadaveric bovine forelimbs.

METHODS

Computed tomography (CT) and gross dissection were performed on 4 carpi. Latex models were produced from 6 carpi to define the gross anatomy and arthroscopic portals to the palmar carpal pouches. Ultrasonography and arthroscopy were performed on 20 carpi to document visualization of the local anatomy.

RESULTS

A single palmar pouch was present on both sides of each joint on gross dissection and evaluation of latex models. The relationship between pouches and palmar structures was observed by CT. Small anechoic areas identified on ultrasonography increased after joint distension. Palmar arthroscopy of the antebrachiocarpal joint enabled visualization of the palmar surfaces of radial, intermediate, and ulnar carpal bones; distal radius; ulnar styloid process; palmar radiocarpal ligament; and articulation of accessory and ulnar carpal bones. Palmar arthroscopy of the middle carpal joint enabled inspection of the palmar aspects of ulnar, intermediate, radial, fused second and third and fourth carpal bones, palmar carpometacarpal ligament, and the short lateral collateral ligament. Palmar aspects of the fourth and fifth metacarpal bones were explored through the palmarolateral approach to the middle carpal joint. Instrument portals for each pouch were created under arthroscopic guidance.

CONCLUSION

Palmar arthroscopy of the adult bovine carpus enabled visualization of the clinically relevant palmar intra-articular structures.

CLINICAL SIGNIFICANCE

Palmar carpal arthroscopy should be considered as an adjunct to dorsal approach for the diagnosis and treatment of bovine carpal diseases.

Objective assessment of lameness in cattle after foot surgery

Assessment of lameness in cattle after foot surgery is important to monitor the recovery period, to improve the long-term success and the cows` welfare. This longitudinal multicenter retrospective study was carried out to evaluate the usefulness of automated tools of weight bearing and gait analysis following foot surgery to support the clinician to monitor lameness in cattle. For this purpose, the effect of involvement of different anatomical structures and the use of different surgery methods on gait parameters of post-operative recovery was assessed. The study consisted of 2 experiments and included cattle with unilateral foot pathologies located in the digital region which needed 1 (experiment 1; n = 30) or 2 (experiment 2; n = 4) surgical interventions. The surgical techniques were debridement, joint lavage, partial resection of bones, tendons or synovial structures, total resection of the sesamoid bone and digit amputation. Two accelerometers (400 Hz; kinematic outcome = stance phase duration; kinetic outcome = foot load and toe-off), a 4-scale weighing platform (difference of mean weight distribution across the limbs; Δ_weight) and a subjective locomotion score were used to evaluate gait parameters every 3 to 4 days after surgery. A repeated measures ANOVA was used in experiment 1 and a receiver operator characteristic analysis was used to determine the optimal cutoff values in experiment 2. Results showed that the differences across limbs for the pedogram variables of stance phases and peaks of foot load and toe-off, Δ_weight and the locomotion score were highest if joints or sesamoid bones were involved, suggesting that these cattle were more severely lame compared to cattle with more superficial foot pathologies. There was a significantly lower degree of lameness after surgical debridement and after digit amputation compared to partial and total resection of anatomical structures of the foot. The use of accelerometers and a 4-scale weighing platform represent promising objective tools for post-operative monitoring of lameness and can support the clinician in gait assessment to improve the long-term success of surgical interventions in the area of the foot.