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The latest in small animal orthopedic surgery - An interview with Kei Hayashi DVM, PhD, Dipl ACVS, Cornell University.

Dr. Kei Hayashi is a veterinary surgeon and an orthopedic scientist. He graduated from the University of Tokyo with BVMS/DVM/PhD degrees (1993-1997), and then obtained MS and PhD degrees at the University of Wisconsin (1997).  He completed a small animal surgery residency at the University of Wisconsin (2003) and became a Diplomate of the American College of Veterinary Surgeons (ACVS). He served as an assistant professor of small animal orthopedic surgery at the Michigan State University (2003-2005) then moved to UC Davis and was tenured in 2012. He began his appointment at Cornell in February 2013. He is particularly interested in sports medicine for small animals; advanced arthroscopy; total joint replacement; fracture management; and training the next generation of veterinarians.

The Interview

WHAT ARE THE TOP 5 ORTHOPEDIC CONDITIONS YOU SEE IN DOGS?

  1. Cranial cruciate ligament disease

  2. Traumatic fractures (radius/ulna, humeral condyle, femur, pelvis, tibia)

  3. Elbow dysplasia with medial coronoid disease

  4. Patellar luxation

  5. Osteosarcoma

WHAT ARE THE TOP 5 ORTHOPEDIC CONDITIONS YOU SEE IN CATS?

  1. Traumatic fractures

  2. Atraumatic femoral head or neck fracture

  3. Chronic OA

  4. Abscesses

  5. External trauma

WHAT ARE THE LATEST UPDATES IN ORTHOPEDIC SURGERY?

I recommend using radiography to detect early cases of cranial cruciate ligament (CCL) disease. Radiographic confirmation of stifle effusion in a stable stifle is indicative of CCL and can exclude neoplasia and immune mediated polyarthritis (IMPA). Once confirmed, early tibial plateau leveling ostotomy (TPLO) will offer the best long-term outcome.

WHAT DO YOU THINK IS THE LEAST UNDERSTOOD ORTHOPEDIC CONDITION.

Cranial cruciate ligament rupture is one of the most common hindlimb problems we see in dogs. Yet, it is also commonly missed or overlooked. Without early detection and treatment, osteoarthritis can set in within 6 weeks of an acute cruciate ligament rupture. The diagnosis of early cruciate disease without the drawer or thrust test can be achieved with radiography.

Radiographic findings that are highly suggestive of CCL rupture:

  • Joint effusion (compression of infrapatellar fat pad)
  • Peripatellar or peritrochlear osteophyte formation

These findings would indicate a need for arthroscopic confirmation of a partial tear to then proceed to a TPLO.

 

Suggested reading: Evaluation of the radiographic infrapatellar fat pad sign of the contralateral stifle joint as a risk factor for subsequent contralateral cranial cruciate ligament rupture in dogs with unilateral rupture: 96 cases (2006-2007). Fuller MC, Hayashi K, Bruecker KA, Holsworth IG, Sutton JS, Kass PH, Kantrowitz BJ, Kapatkin AS. J Am Vet Med Assoc. 2014 Feb 1;244(3):328-38. doi: 10.2460/javma.244.3.328.

WHAT MUST A GENERAL PRACTITIONER CONSIDER WHEN DETERMINING THE BEST TREATMENT PLAN FOR A PARTICULAR ORTHOPEDIC CASE?

For fractures, internal fixation using a plate based on AO principles will give the patient the best outcome with least pain, and lowest cost and stress for the owners.

AO Principles:

  1. Fracture reduction to restore anatomical relationships
  2. Fracture fixation providing absolute or relative stability
  3. Presernation of blood supply to soft tissues and bone
  4. Early and safe mobilixation of the injured part and the patient as a whole

WHAT ARE YOUR TIPS ON GETTING CLIENTS TO FOLLOW YOUR TREATMENT RECOMMENDATIONS?

  • Be honest and straight.

  • Give only top 2-3 recommendations.

  • Offer written summaries.

WHAT CLIENT EDUCATION IS A MUST IN YOUR DISCHARGE INSTRUCTIONS?

  • Exercise restriction and recheck appointments.

  • Slow leash walks only, for 4-8 weeks, are a typical recommendation.

  • Restriction does not mean NO exercise. It means slow leash walks that are gradually increased.

  • Rehabilitation programs may help.

WHAT ARE SOME COMMON COMPLICATIONS YOU SEE POST SURGERY AND HOW DO YOU MITIGATE THESE
RISKS?

Many complications are due to technical errors.

Risks include:

  • Fracture instability
  • Poor bone healing (delayed, nonunion or malunion)
  • Lack of mobility
  • Infection
  • Implant failure

It is essential that strict surgical principles are applied.

Top VetCheck templates for handling orthopedic conditions

We've put together the top VetCheck resources to help you handle these conversations that you face in practice every day.

1.Cruciate ligament rupture

2.Cruciate ligament repair - Discharge instructions

3.Tibial plateau levelling osteotomy (TPLO)

4.Tibial tuberosity advancement (TTA)

5.Extra-capsular suture stabilization

6.Rehabilitation program

7.Hydrotherapy

8.Passive range of motion exercises

9.Fracture repair - Discharge instructions

10.What to expect with a cast

There are over 1600 VetCheck templates that also help veterinary teams save time in explaining treatment options, duration of treatment, potential outcomes and prognoses.
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