In vitro evaluation of five canine tibial plateau leveling methods

Blake Eason Hildreth III Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Denis J. Marcellin-Little Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Simon C. Roe Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Ola L. A. Harrysson Department of Industrial Engineering, College of Engineering, North Carolina State University, Raleigh, NC 27606.

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Abstract

Objective—To compare application time, accuracy of tibial plateau slope (TPS) correction, presence and magnitude of rotational and angular deformities, and mechanical properties of 5 canine tibial plateau leveling methods.

Sample Population—27 canine tibial replicas created by rapid prototyping methods.

Procedure—The application time, accuracy of TPS correction, presence and magnitude of rotational and angular deformation, and construct axial stiffness of 3 internal fixation methods (tibial plateau leveling osteotomy, tibial wedge osteotomy, and chevron wedge osteotomy [CWO]) and 2 external skeletal fixation (ESF) methods (hinged hybrid circular external fixation and wedge osteotomy linear fixation [WOLF]) were assessed.

Results—Mean bone model axial stiffness did not differ among methods. Mean application time was more rapid for WOLF than for other methods. Mean TPSs did not differ from our 5° target and were lower for ESF methods, compared with internal fixation methods. Mean postoperative rotational malalignment did not differ from our target or among groups. Mean postoperative medio-lateral angulation did not differ from our target, except for CWO. Internal fixation methods lead to axially stiffer constructs than ESF methods. Reuse of ESF frames did not lead to a decrease in axial stiffness.

Conclusions and Clinical Relevance—The 5 tibial plateau leveling methods had acceptable geometric and mechanical properties. External skeletal fixation methods were more accurate as a result of precise data available for determining the exact magnitude of correction required to achieve a 5° TPS.

Abstract

Objective—To compare application time, accuracy of tibial plateau slope (TPS) correction, presence and magnitude of rotational and angular deformities, and mechanical properties of 5 canine tibial plateau leveling methods.

Sample Population—27 canine tibial replicas created by rapid prototyping methods.

Procedure—The application time, accuracy of TPS correction, presence and magnitude of rotational and angular deformation, and construct axial stiffness of 3 internal fixation methods (tibial plateau leveling osteotomy, tibial wedge osteotomy, and chevron wedge osteotomy [CWO]) and 2 external skeletal fixation (ESF) methods (hinged hybrid circular external fixation and wedge osteotomy linear fixation [WOLF]) were assessed.

Results—Mean bone model axial stiffness did not differ among methods. Mean application time was more rapid for WOLF than for other methods. Mean TPSs did not differ from our 5° target and were lower for ESF methods, compared with internal fixation methods. Mean postoperative rotational malalignment did not differ from our target or among groups. Mean postoperative medio-lateral angulation did not differ from our target, except for CWO. Internal fixation methods lead to axially stiffer constructs than ESF methods. Reuse of ESF frames did not lead to a decrease in axial stiffness.

Conclusions and Clinical Relevance—The 5 tibial plateau leveling methods had acceptable geometric and mechanical properties. External skeletal fixation methods were more accurate as a result of precise data available for determining the exact magnitude of correction required to achieve a 5° TPS.

Contributor Notes

Dr. Hildreth's present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Dr. Hildreth was partially supported by a Merck-Merial training scholarship.

Presented in part at the 2004 American College of Veterinary Surgeons Surgical Summit, Denver, CO.

The authors would like to thank Bonnie DeYoung and Ketan Jajal and Drs. Denis R. Cormier, Harvey A. West II, and Peter Sebestyen for technical assistance; Dr. Jason Osborne, Janet Bartz, and Matthew Gribbin for statistical consultation; Brenda Bunch for illustrations; and Dr. Joachim Pfeil and Wolfgang Veith for assistance in WOLF frame design.

Dr. Marcellin-Little.
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