Clean Run Magazine - October 2009 - 75

Regenerative Stem Cell Therapy (SCT) SCT can also be used in the management of persistent clinical elbow osteoarthritis. Adult regenerative stem cells are multipotent cells located in bone marrow, joint capsule, and fat tissue and are capable of maturing into bone, cartilage, tendon, or ligament cells that can be used to repair and regenerate damaged tissue, such as the cartilage in osteoarthritis. We harvest cells surgically from the fat located behind the shoulder or between the back legs that are sent to Vet Stem (in southern California) where it is purified into regenerative stem cells. Two days after tissue harvest, the regenerative stem cells are returned in sterile syringes and under sedation, the cells are injected into the osteoarthritic joint(s). Clinical improvement from SCT has been noted in dogs 2-4 weeks after injection and improvement has been seen lasting for up to 2 years. A recent report in Veterinary Therapeutics 2008 evaluated the effect of intra-articular stem cell therapy for the treatment of elbow OA in dogs. This study showed a significant improvement in lameness and range of motion and a significant difference in client evaluation (functional disability scores) in patients treated with intra-articular SCT. cial plate is applied to the bone, holding it in this new position during healing. As with a traumatic fracture, the bone takes approximately 8 to 12 weeks to heal. Early and long-term clinical follow up both have shown favorable response and second-look arthroscopy has revealed in-growth of cartilage into the eroded areas of the medial compartment as proof of principle unloading. See Figures 1 through 3. Total Elbow Replacement (TER) TER is an option in dogs with severe OA that have discomfort refractory to any of the above modalities and for dogs in which the lateral compartment is affected eliminating use of the SHO procedure. The first TER system was described in 1996. Since then variations of TER systems have been developed. Presently, the TATE Elbow, developed by Acker and Van Der Meulen, is commercially available. Ten years in development, the impetus for the TATE Elbow was Acker’s own yellow Labrador Retriever Tate. Tate developed severe elbow dysplasia and while Acker tried common treatments, the outcome was unsuccessful. Ultimately, the TATE Elbow System became the eventual result. Implementation of the TATE Elbow System was first performed in July 2007. Since then many dogs affected with intractable elbow arthritis have been treated with this new prosthesis. The TATE Elbow System is pressed fit as opposed to a stemmed and cemented system. Long-term stability relies on bone ingrowth into the porous structure of the implants (osteointegration). Cementless prostheses have potential advantages over cemented models, including reduced risk of infection and reduced rate of implant wear, both of which are regarded as leading causes of post-operative failure. Because the components of this system are impacted simultaneously as a pre-assembled cartridge, there is reduced trauma to the patient and accurate alignment and tracking of the prosthetic components throughout range of motion is guaranteed. The patient needs a post- Radiograph of humerus and elbow joint pre- and post- sliding humeral osteotomy, showing weightbearing load distribution. Sliding Humeral Osteotomy (SHO) Where extensive erosion of the cartilage surface of the medial compartment of the elbow is evident and producing significant pain and lameness, a SHO may be performed. This procedure is based on similar procedures performed in humans suffering OA of the knee. The procedure realigns the limb to shift the forces off the area of cartilage damage and onto healthy cartilage (thereby relieving the pain of grinding bone on bone) and gives the damaged area the opportunity to heal. A horizontal cut through the midshaft of the humerus is made; then by sliding the bottom portion of the humerus toward the inside of the leg, weight-bearing is distributed toward the healthy lateral portion of the elbow joint. This lessens the load to the arthritic medial aspect of the joint. After the cut in the humerus is made, a speOctober 09 | Clean Run Arthroscopic view of medial elbow joint before sliding humeral osteotomy (SHO). Arthroscopic view of medial elbow joint six months after SHO. Clinical signs typically manifest between 5 and 12 months of age; however, some dogs may not exhibit lameness for several months to years.

Clean Run Magazine - October 2009

Table of Contents for the Digital Edition of Clean Run Magazine - October 2009