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Abstract
Arthritis is one of the most commonly diagnosed orthopedic problems, both in man and animals (Johnson, Austin et al. 1994; Oegema and Visco 1999; Moskowitz and holderbaum 2001). It has been reported that 25% of all canine patients presented with an orthopedic problem were suffering from arthritis (Johnson, Austin et al. 1994). Osteoarthritis is often associated with synovial inflammation and subchondral bone remodeling and may lead to severe discomfort, crippling lameness, and often requires life-long treatment (Johnson, Austin et al. 1994; Oegema and Visco 1999; Moskowitz and holderbaum 2001; Todhunter and Johnston 2003). Nowadays, researchers working to find out new approaches and treatment to slow down OA that develops after surgery. In this study, OA was studied in dogs with naturally-occurring RCCL as an animal model. The purpose of this research is to increase the understanding of post-operative joint capsule inflammation (synovitis) as it relates to progression of post-operative osteoarthritis in a systemic way.
The study was performed on 20 client owned RCCL dogs. The studied dogs were surgically treated by two different techniques. Ten dogs had a lateral suture (LS) and ten dogs had a TPLO surgery. Physical examination, orthopedic examination, history questionnaires, gait analysis, and radiological examination were used for evaluation of OA before and after surgery at 6-8 weeks and 12- 14 weeks. Ultrasonographic examination was used to evaluate of soft tissue changes after surgery at 6-8 weeks and 12- 14 weeks. Folate scintigraphy was used to demonstrate macrophagic inflammation in affected stifle joints before and at 12- 14 weeks after surgery on selected cases. Joint fluid analysis using flowcytometry was also performed on selected cases at 12-14 weeks after surgery.
The results of this study demonstrate that the duration of post-operative effusion following stifle surgery exceeds 12 to 14 weeks. Radiologically, an increased in periarticular soft tissue opacities suggestive of joint effusion and/or joint capsule thickening were documented in all patients during all examination times. Ultrasonographically, all dogs showed significant amount of effusion on ultrasound examination at 6-8 weeks and 12-14 weeks postoperatively.
This study was unable to identify the effect of pre-operative indicators on the osteoarthritic outcome of the joint by 12-14 weeks. However, the study was able to evaluate an association between postoperative effusion and inflammation and the surgical technique used for stifle stabilization. This study suggested that the choice of surgical technique for the repair of RCCL may have an effect on the persistence of effusion and inflammation and on the rate of return of normal function of the four limbs. Dogs that had TPLO surgery showed faster return to normal weight distribution than LS dogs and showed a trend towards faster reduction of effusion and inflammation by 12-14 weeks after surgery.
The persistent post-operative effusion showed an association with the presence of activated synovial macrophages using flowcytometry at 12-14 weeks after surgery in one case. Scintigraphy - the intended technique - following injection with a folate-technetium complex did not have enough sensitivity to demonstrate activated synovial macrophages in vivo on the same case.
The findings of this study add to the understanding of the duration, character and significance of post-operative synovitis. They also may facilitate the development of new treatment strategies for control of post-operative inflammation, more rapid recovery, and decelerated progression of arthritis, not only following surgical treatment of RCCL. but alsomav be applied to post-operative care of other joints.