& Management / Disease
Investigation & Management / Techniques:
||Finger joint prosthesis
management of tarsal joint arthritis
||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
- 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
- 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
- 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).
|Appropriate Use (?)
- Treatment of tarsal joint arthritis.
|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
- Delay in application until both legs are severely arthritic is
likely to compromise results of surgery. (P1.1999.w4)
|Equipment / Chemicals required and Suppliers
|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
The costs of a surgical operation include those associated with: (J15.30.w1)
- Pre-operative diagnostics (e.g. radiography, ultrasonography, blood
- 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:
- RCVS Guide to Professional Conduct 2000 - Treatment of
Animals by Non-Veterinary Surgeons).
||Debra Bourne MA VetMB PhD