Surgical treatment of osteoarthritis

Knee osteoarthritis: Current status and research progress in treatment (Review)

Knee osteoarthritis (KOA) is a common chronic articular disease worldwide. It is also the most common form of OA and is characterized by high morbidity and disability rates. With the gradual increase in life expectancy and ageing population, KOA not only affects the quality of life of patients, but also poses a burden on global public health. OA is a disease of unknown etiology and complex pathogenesis. It commonly affects joints subjected to greater loads and higher levels of activity. The knee joint, which is the most complex joint of the human body and bears the greatest load among all joints, is therefore most susceptible to development of OA. KOA lesions may involve articular cartilage, synovium, joint capsule and periarticular muscles, causing irreversible articular damage. Factors such as mechanical overload, inflammation, metabolism, hormonal changes and ageing serve key roles in the acceleration of KOA progression. The clinical diagnosis of KOA is primarily based on combined analysis of symptoms, signs, imaging and laboratory examination results. At present, there is no cure for KOA and the currently available therapies primarily focus on symptomatic treatment and delay of disease progression. Knee replacement surgery is typically performed in patients with advanced disease. The current study presents a review of epidemiological characteristics, risk factors, histopathological manifestations, pathogenesis, diagnosis, treatment modalities and progress in KOA research.

Contribution to the Study of Perioperative Factors Affecting the Restoration of Dog's Mobility after Femoral Head and Neck Excision: A Clinical Study in 30 Dogs

This study aimed to compare postoperative analgesia and the time of limb weight bearing induced by the intraoperative administration of a local anesthetic at the site of the femoral head and neck excision (FHNE) in dogs, with and without the administration of preoperative epidural anesthesia. Additionally, the impact of postoperative opioid drug administration on weight-bearing time was examined. This randomized, blinded, prospective clinical study included 30 client-owned dogs. The dogs were randomly divided into three groups (A, B, C), each further divided into two subgroups (A1, A2, B1, B2, C1, C2). Group A received epidural anesthesia and ropivacaine at the ostectomy site, Group B received only ropivacaine, and Group C served as the control group. Subgroup 1 received a non-steroidal anti-inflammatory drug postoperatively, while Subgroup 2 had tramadol added to their regimen. Pain assessment was conducted using the University of Melbourne Pain Scale (UMPS) and an algometer. The study concluded that multimodal analgesia, utilizing all the aforementioned analgesic techniques, resulted in faster limb weight bearing for dogs undergoing FHNE.

Stifle Joint Arthrodesis for Treating Chronic-Osteoarthritis-Affected Dogs

A two-year-old male Pomeranian dog was presented to a veterinary hospital due to the side effects of a surgical correction for patellar luxation. Stifle joint arthrodesis (SJA) was performed on the patient's right leg using autologous bone-grafting techniques. The right femur and tibial joint were angled 120-130°, and an SJA plate was fixed on the front of the two bones. After performing joint fusion of the right limb, medial-patellar-luxation-(MPL)-corrective surgery was performed to cut the tibial tuberosity on the left leg, and the fixing force was increased using the figure-of-eight-tension-band-wiring technique. Results were recorded regarding the dog's ability to walk and trot in the right hind limb; these results were evaluated for 27 days after surgery. It was difficult for the patient to walk because weight-bearing had not been carried out for 3 days after the surgery; short strides and partial weight bearing were possible 5 to 7 days after surgery. After 10 days, the patient was able to move while bearing weight with a slight disruption. With regard to trotting, the patient showed intermittent normal steps 5 to 7 days after surgery, but the disruption continued. After 14 days, trotting was possible, and it was observed that movement could be maintained during everyday activities.

Efficacy of autologous mesenchymal stromal cell treatment for chronic degenerative musculoskeletal conditions in dogs: A retrospective study

Introduction

The objective of this study was to retrospectively analyze clinical data from a referral regenerative medicine practice, to investigate the efficacy of autologous mesenchymal stromal cells (MSC) in 245 dogs deemed unresponsive to conventional treatment by their referring vet.

Methods

Diagnostic imaging [radiology and musculoskeletal ultrasound (MSK-US)] identified musculoskeletal pathology holistically. MSCs, produced according to current guidelines, were initially administered with PRP by targeted injection to joints and/or tendons, with a second MSC monotherapy administered 12 weeks later to dogs with severe pathology and/or previous elbow arthroscopic interventions. Dogs with lumbosacral disease received epidural MSCs with additional intravenous MSCs administered to dogs with spondylosis of the cervical, thoracic and lumbar spine. All dogs received laser therapy at 10 J/cm² at the time of treatment and for 5 sessions thereafter. Objective outcome measures (stance analysis, range of joint motion, pressure algometry) and validated subjective outcome measures (owner reported VetMetrica HRQL™ and veterinary pain and quality of life impact scores) were used to investigate short and long-term (6-104 weeks) efficacy. Outcome data were collected at predetermined time windows (0-6, 7-12, 13-18, 19-24, 25-48, 49-78, 79-104) weeks after initial treatment.

Results

There were statistically significant improvements in post compared with pre-treatment measures at all time windows in stance analysis, shoulder and hip range of motion, lumbosacral pressure algometry, and to 49-78 weeks in carpus and elbow range of motion. Improvements in 4 domains of quality of life as measured by VetMetricaTM were statistically significant, as were scores in vet-assessed pain and quality of life impact. In dogs receiving one initial treatment the mean time before a second treatment was required to maintain improvements in objective measures was 451 days. Diagnostic imaging confirmed the regenerative effects of MSCs in tendinopathies by demonstrating resolution of abnormal mineralization and restoration of normal fiber patterns.

Discussion

This represents the first study using "real-world" data to show that cell-based therapies, injected into multiple areas of musculoskeletal pathology in a targeted holistic approach, resulted in rapid and profound positive effects on the patient's pain state and quality of life which was maintained with repeat treatment for up to 2 years.

Owner assessed outcomes following elbow arthroscopy with or without platelet rich plasma for fragmented medial coronoid process

Objective

Document the outcomes of bilateral arthroscopic subtotal coronoidectomy for the fragmented medial coronoid process, quantify persistent lameness that required additional treatment (PRP), and document the outcomes of dogs that followed up with PRP injections.

Study design

Retrospective study.

Sample population

Overall, 115 dogs underwent arthroscopy alone and 31 received PRP at least 6 weeks after arthroscopy. The owner's response rate was ~50% (73 dogs).

Methods

Collected data included signalment, unilateral or bilateral clinical signs, intra-articular chondroprotective injection during the procedure, if PRP intra-articular injection was received postoperatively, and if it was received, the time from the initial surgery to administration was recorded. Outcomes were assessed via standardized owner questionnaires using the Liverpool Osteoarthritis in Dogs (LOAD) score, the Canine Brief Pain Inventory (CBPI) score, and the overall quality of life (QOL) assessment.

Results

Approximately 20% of the patients received PRP post-operatively due to persistent lameness following surgery. Similar pain scores were found between the two groups with an average of 11–13 LOAD score, 13–15 CBPI score, and good quality of life. Older animals at the time of surgery and those that received pain-relieving medications after the procedure were more painful and affected their functional outcome. PRP as an adjunctive therapy achieved a perceived good to excellent quality of life in ~90% of pets in this population.

Conclusion

Arthroscopy and subtotal coronoidectomy followed by PRP, if needed, seemed to decrease pain, and improve lameness in the long term.

Clinical significance

PRP should be considered as adjunctive therapy in dogs with the limited response to arthroscopy alone.

Targeted interleukin-10 plasmid DNA therapy in the treatment of osteoarthritis: Toxicology and pain efficacy assessments

Osteoarthritis results in chronic pain and loss of function. Proinflammatory cytokines create both osteoarthritis pathology and pain. Current treatments are poorly effective, have significant side effects, and have not targeted the cytokines central to osteoarthritis development and maintenance. Interleukin-10 is an anti-inflammatory cytokine that potently and broadly suppresses proinflammatory cytokine activity. However, interleukin-10 protein has a short half-life in vivo and poor joint permeability. For sustained IL-10 activity, we developed a plasmid DNA-based therapy that expresses a long-acting human interleukin-10 variant (hIL-10var). Here, we describe the 6-month GLP toxicology study of this therapy. Intra-articular injections of hIL-10var pDNA into canine stifle joints up to 1.5 mg bilaterally were well-tolerated and without pathologic findings. This represents the first long-term toxicologic assessment of intra-articular pDNA therapy. We also report results of a small double-blind, placebo-controlled study of the effect of intra-articular hIL-10var pDNA on pain measures in companion (pet) dogs with naturally occurring osteoarthritis. This human IL-10-based targeted therapy reduced pain measures in the dogs, based on veterinary and owner ratings, without any adverse findings. These results with hIL-10var pDNA therapy, well-tolerated and without toxicologic effects, establish the basis for clinical trials of a new class of safe and effective therapies for OA.

A complete cross-over design evaluating canine acceptance of Carprieve® and Rimadyl® carprofen chewable tablets in healthy dogs

Background

Osteoarthritis (OA) affects nearly 20% of all dogs greater than one year of age. Clinical signs include pain, discomfort, lameness, and ultimately lead to disability. Although there is currently no known cure, there are many therapeutic options that can slow the progression and alleviate the associated signs. There is ample supportive evidence demonstrating the efficaciousness of carprofen, a non-steroidal anti-inflammatory drug, in managing signs of OA. Since the approval of the pioneer product (Rimadyl®, Zoetis; Kalamazoo, Michigan), the United States Food and Drug Administration (FDA) has assented to several other generic, bioequivalent products. The objective of this 2 × 2 complete cross-over design was to assess the acceptance of two bioequivalent carprofen liver-flavored chewable tablets (containing 25 mg carprofen), Rimadyl® and Carprieve® (Norbrook Laboratories Limited; Newry, Northern Ireland) in 37 healthy purpose-bred dogs.

Results

Overall, 73.0% (27/37) and 70.3% (26/37) of dogs voluntarily accepted Rimadyl® and Carprieve®, respectively. Considering acceptability tests paired by individual dog, 64.9% of dogs (n = 24) voluntarily accepted both Rimadyl® and Carprieve® chewable tablets whereas 21.6% (8) of dogs denied or partially accepted both products offered. Three dogs (8.1%) fully accepted Rimadyl® but did not accept Carprieve®. Conversely, two dogs (5.4%) fully accepted Carprieve® but did not accept Rimadyl®. Canine acceptability did not significantly differ between Carprieve® and Rimadyl® carprofen chewable tablets (P = 0.65).

Conclusions

Utilizing a 2 × 2 complete cross-over design, this study provides evidence that canine acceptability of a single-dose did not differ between Carprieve® and Rimadyl® chewable tablets.

New Approaches to Treat Osteoarthritis with Mesenchymal Stem Cells

Osteoarthritis is one of the most common chronic health problems in the world that causes disability and chronic pain with reduced mobility and is a progressive degenerative disease in weight-bearing joints such as the knee. The pathology of the joint resulting from OA includes loss of cartilage volume and cartilage lesions leading to inflammation of the articular joint structures; its incidence and progression are associated with a variety of risk factors. Most of the current treatments focus on symptom management such as physical and occupational therapies, pharmacological intervention for pain management, and surgical intervention with limited success and do not address nor halt the progression of the disease. In this review, we will describe the current treatment options for OA and the exciting new translational medical research currently underway utilising mesenchymal stem cells for OA therapy.

A review of translational animal models for knee osteoarthritis

Knee osteoarthritis remains a tremendous public health concern, both in terms of health-related quality of life and financial burden of disease. Translational research is a critical step towards understanding and mitigating the long-term effects of this disease process. Animal models provide practical and clinically relevant ways to study both the natural history and response to treatment of knee osteoarthritis. Many factors including size, cost, and method of inducing osteoarthritis are important considerations for choosing an appropriate animal model. Smaller animals are useful because of their ease of use and cost, while larger animals are advantageous because of their anatomical similarity to humans. This evidence-based review will compare and contrast several different animal models for knee osteoarthritis. Our goal is to inform the clinician about current research models, in order to facilitate the transfer of knowledge from the "bench" to the "bedside."

Elbow denervation in dogs: development of an in vivo surgical procedure and pilot testing

The objective of this study was to develop a surgical technique for sensory denervation of the canine elbow joint and to assess the effects of denervation on limb function in normal dogs. Twenty cadavers (40 elbows) were used to characterize innervation and design the surgical protocol which was tested in 13 cadavers (26 normal elbows). The effect of denervation on limb function was assessed in vivo in four dogs with the elbow randomly selected for the procedure. Primary outcome measures were static bodyweight distribution and distal limb mechanical sensory thresholds; secondary outcome measures were subjectively scored lameness, neurological function and pain on manipulation. Histology was performed on all resected tissues to determine whether nerves had been resected. Denervation was achieved by separate medial and lateral surgical approaches. In testing the developed surgical protocol, 111/130 resected samples contained nerve tissue in the healthy cadaveric elbows and 18/20 in the in vivo study. Limb function and sensation were not altered by elbow joint denervation. The protocol developed for denervation of the canine elbow appears feasible and does not result in any sensory or motor deficits of the forelimb.

Systematic review of the management of canine osteoarthritis

This review assesses the evidence for the efficacy of therapies used in the management of osteoarthritis in dogs on the basis of papers published in peer-reviewed journals in English between 1985 and July 2007. Sixty-eight papers were identified and evaluated. They considered four alternative therapies, one use of functional food, two intra-articular agents, six nutraceutical agents, 21 pharmacological agents, two physical therapies, three surgical techniques and two combinations of weight control. There was a high level of comfort (strong evidence) for the efficacy of carprofen, firocoxib and meloxicam, and a moderate level of comfort for the efficacy of etodolac in modifying the signs of osteoarthritis. There was a moderate level of comfort for the efficacy of glycosaminoglycan polysulphate, licofelone, elk velvet antler and a functional food containing green-lipped mussel for the modification of the structures involved in the disease. There was weak or no evidence in support of the use of doxycycline, electrostimulated acupuncture, extracorporeal shockwave therapy, gold wire acupuncture, hyaluronan, pentosan polysulphate, P54FP (extract of turmeric), tiaprofenic acid or tibial plateau levelling osteotomy.

Short-term outcome after total elbow arthroplasty in dogs with severe, naturally occurring osteoarthritis

OBJECTIVE

To evaluate limb function in client-owned dogs before and after total elbow arthroplasty (TEA) for severe, naturally occurring osteoarthritis (OA).

STUDY DESIGN

Prospective clinical evaluation comparing limb function before and after surgery.

ANIMALS

Twenty adult, large breed dogs with elbow OA.

METHODS

Physical, radiographic, and force platform gait examinations were performed on all dogs before surgery. TEA was performed, and examinations were repeated at 3, 6, and 12 months after surgery. Pre- and postoperative findings were compared.

RESULTS

TEA led to a satisfactory outcome in 16 dogs. In dogs with a satisfactory outcome, function in the operated limb increased over time, with mean peak vertical force (PVF) and vertical impulse (VI) 1 year after surgery being nearly twice the presurgical value. Serious complications encountered included infection (n = 2), luxation (n = 1), and fracture of the humeral condyle (n = 1).

CONCLUSIONS

Although TEA, as presented, has significant limitations, it can be successfully performed in dogs with naturally occurring elbow OA. Improvements in technique and implant design should lead to improved prognosis.

CLINICAL RELEVANCE

Based on 1-year data, TEA can be successfully performed in dogs and should be considered as a treatment alternative for adult dogs with lameness from severe OA of the elbow joint.

Evaluation of a canine total-elbow arthroplasty system: a preliminary study in normal dogs

OBJECTIVE

Short-term, in vivo evaluation of a total-elbow arthroplasty (TEA) system in normal dogs.

STUDY DESIGN

Prospective evaluation comparing pre- and postoperative findings.

ANIMALS

Six normal, skeletally mature, large-breed dogs.

METHODS

Physical, radiographic, and force-plate gait examinations were performed on all dogs before surgery. TEA was performed in the dogs using a canine TEA system. Examinations were repeated every 8 weeks for 24 weeks, with an additional examination at 52 weeks. Pre- and postoperative findings were compared.

RESULTS

The TEA led to an excellent outcome in 3 of 6 dogs. Force-plate gait examination found that the dogs continued to improve over time and had a peak vertical force (PVF) in the surgical limb that was 99.6% of normal (range, 95.8% to 106.4%) 52 weeks after surgery. Major problems encountered during the postoperative time period were non-weight-bearing lameness (1 dog), osteomyelitis (1 dog), and fracture of the ulna (1 dog).

CONCLUSIONS

TEA can be successfully performed in dogs.

CLINICAL RELEVANCE

Based on 1-year data, TEA can be successfully performed in dogs and could be considered as a treatment alternative for adult dogs with severe osteoarthritis and lameness of the elbow joint.