TECHNIQUE

Tarsal Joint Replacement in Cranes (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords Finger joint prosthesis management of tarsal joint arthritis
Description A human finger joint prosthesis can be used in the management of tarsal joint arthritis, replacing the tarsal joint. (P1.1999.w4)
  • Anaesthetise the crane.
  • Give antibiotics during surgery to reduce the risk of joint infection (20 mg/kg cefozolin intravenously every two hours) . (P1.1999.w4)
  • Incise along the cranial aspect of the distal tibiotarsus, tarsal joint and proximal tarsometatarsus. (P1.1999.w4)
    • Take care to avoid major blood vessels.
  • Remove osteophytes if necessary to enable access to the joint.
  • Elevate the medial and lateral collateral ligaments off their attachments using rongeurs.
  • Retract extensor tendons.
  • Place stay sutures in the common digital extensor tendon and incise the tendon to provide access for the oscillating saw.
  • Hyperextend the joint (i.e. in the direction opposite the normal joint flexion, giving access to the distal tibiotarsus and the proximal tarsometatarsus.
  • Using an oscillating bone saw, cut the articular surfaces off the distal tibiotarsus and the proximal tarsometatarsus, leaving a 1cm gap between the cut ends of the two bones; this provides room for the prosthesis.
  • Using a broach manufactured to provide a hole exactly matching the stems of the prosthesis, ream the medullary canals of the distal tibiotarsus and the proximal tarsometatarsus.
  • Insert the prosthesis and flex the joint into a normal position.
  • Flex and extend the joint several times, confirming fit and function of the prosthesis.
  • Reattach the collateral ligaments: create a small cranio-caudal hole through the lateral aspect of the proximal tarsometatarsus and a similar hole through the medial aspect, using a Kirshner wire.
  • Use polypropylene suture material (2-0) through the collateral ligament, through the hole in the bone and back out through the collateral ligament.
  • Close the joint capsule using a simple interrupted pattern and 3-0 polydioxanone suture material.
  • Repair the common digital extensor tendon using 2-0 polypropylene in a three-loop pulley patter.
  • Close the subcutaneous layer.
  • Close the skin.
  • Apply a lateral thermoplastic splint from the proximal tibiotarsus to the distal tarsometatarsus.
  • Give analgesics (1.25 mg/kg butorphanol every 4-6 hours).

(P1.1999.w4)

Appropriate Use (?)
  • Treatment of tarsal joint arthritis.
Notes
Complications/ Limitations / Risk
  • While the medial and lateral collateral ligaments can be elevated off their attachments to enable the bone saw to access the joint area, and the extensor tendons can be retracted, it is necessary to incise the common digital extensor tendon and repair this following placement of the prosthesis.
  • Delay in application until both legs are severely arthritic is likely to compromise results of surgery. (P1.1999.w4)
Equipment / Chemicals required and Suppliers
  • Silastic human finger joint prosthesis.

Expertise level / Ease of Use This is a veterinary procedure. This procedure should only be carried out by an individual with appropriate clinical training and practical experience.
Cost/ Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee  
References P1.1999.w4

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