Sarcoma development following orthopedic fixation is a rare and devastating complication in dogs and people.1,2 Sarcomas can arise in the bone or soft tissues at the site of a previous fracture or in the region of a fracture fixation implant between 9 months and 15 years (mean, 6 years) after fixation surgery.3,4 Several proposed mechanisms for tumor development exist. One theory is that implant corrosion and resultant accumulation of metal debris in the region of the implant cause an altered host reaction with disrupted cellular activity, leading to cancer development.2 Other theories include suggestions that an implant-associated infection alters cellular activity, that an implant acts as a nidus for persistent inflammation, and that any process causing long-term bone stimulation could result in sarcoma.2
Developed for treatment of cranial cruciate ligament rupture, the TPLO procedure involves a biradial osteotomy of the proximal tibial metaphysis and stabilization with placement of a specialized TPLO bone plate.5 Since the procedure was introduced, there have been several reports3,6–9 of sarcomas occurring at the TPLO site, with osteosarcoma being the most commonly reported tumor type. Although development of osteosarcoma at the TPLO site has been documented10,a to be a rare consequence of the procedure, to the authors' knowledge no studies have been conducted to evaluate whether TPLO actually increases a dog's risk of developing osteosarcoma at the site. The purpose of the study reported here was to assess for any association between a history of TPLO and subsequent diagnosis of proximal tibial osteosarcoma in dogs. The hypothesis was that dogs with proximal tibial osteosarcoma would have markedly increased odds of having undergone TPLO procedures in the past, compared with dogs without proximal tibial osteosarcoma.
The authors acknowledge Jeffrey Neu for funding and support of this study.
The authors had no financial interests with companies that manufactured products that were the subject of the present research or with companies that manufactured competing products.
Colorado State University Veterinary Teaching Hospital
Tibial plateau leveling osteotomy
Slocum TD. Incidence of neoplasia with TPLO surgery and Slocum implant (abstr), in Proceedings. 32nd Annu Conf Vet Orthop Soc 2005;16.
Microsoft Excel for Mac 2011, version 14.6.2, Microsoft Corp, Redmond, Wash.
Stata, version 13, StataCorp LLC, College Station, Tex.
Ward JJ, Thornbury DD, Lemons JE, et al. Metal-induced sarcoma: a case report and literature review. Clin Orthop Relat Res 1990;299–306.
Burton AG, Johnson EG, Vernau W, et al. Implant-associated neoplasia in dogs: 16 cases (1983–2013). J Am Vet Med Assoc 2015;247:778–785.
Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993;23:777–795.
Selmic LE, Ryan SD, Boston SE, et al. Osteosarcoma following tibial plateau leveling osteotomy in dogs: 29 cases (1997–2011). J Am Vet Med Assoc 2014;244:1053–1059.
Atherton MJ, Arthurs G. Osteosarcoma of the tibia 6 years after tibial plateau leveling osteotomy. J Am Anim Hosp Assoc 2012;48:188–193.
Boudrieau RJ, McCarthy RJ, Sisson RD Jr. Sarcoma of the proximal portion of the tibia in a dog 5.5 years after tibial plateau leveling osteotomy. J Am Vet Med Assoc 2005;227:1613–1617.
Harasen GL, Simko E. Histiocytic sarcoma of the stifle in a dog with cranial cruciate ligament failure and TPLO treatment. Vet Comp Orthop Traumatol 2008;21:375–377.
Sartor AJ, Ryan SD, Sellmeyer T, et al. Bi-institutional retrospective cohort study evaluating the incidence of osteosarcoma following tibial plateau levelling osteotomy (2000–2009). Vet Comp Orthop Traumatol 2014;27:339–345.
Taylor JM. Choosing the number of controls in a matched case-control study, some sample size, power and efficiency considerations. Stat Med 1986;5:29–36.
Ling GV, Morgan JP, Pool RR. Primary bone rumors in the dog: a combined clinical, radiographic, and histologic approach to early diagnosis. J Am Vet Med Assoc 1974;165:55–67.
Madewell BR, Pool RR, Leighton RL. Osteogenic sarcoma at the site of a chronic nonunion fracture and internal fixation device in a dog. J Am Vet Med Assoc 1977;171:187–189.
Knecht CD, Priester WA. Osteosarcoma in dogs: a study of previous trauma, fracture and fracture fixation. J Am Anim Hosp Assoc 1978;14:82–84.
Van Bree H, Verschooten F, Hoorens J, et al. Internal fixation of a fractured humerus in a dog and late osteosarcoma development. Vet Rec 1980;107:501–502.
Banks WC, Morris E, Herron MR, et al. Osteogenic sarcoma associated with internal fracture fixation in two dogs. J Am Vet Med Assoc 1975;167:166–167.
Vasseur PB, Stevenson S. Osteosarcoma at the site of a cortical bone allograft in a dog. Vet Surg 1987;16:70–74.
Murphy ST, Parker RB, Woodard JC. Osteosarcoma following total hip arthroplasty in a dog. J Small Anim Pract 1997;38:263–267.
Roe SC, DeYoung D, Weinstock D, et al. Osteosarcoma eight years after total hip arthroplasty. Vet Surg 1996;25:70–74.
Rose BW, Novo RE, Olson EJ. Osteosarcoma at the site of a triple pelvic osteotomy in a dog. J Am Anim Hosp Assoc 2005;41:327–331.
Dunn AL, Buffa EA, Hanshaw DM, et al. Osteosarcoma at the site of titanium orthopaedic implants in a dog. Aust Vet J 2012;90:39–43.
McDonald DJ, Enneking WF, Sundaram M. Metal-associated angiosarcoma of bone: report of two cases and review of the literature. Clin Orthop Relat Res 2002;396:206–214.
Keel SB, Jaffe KA, Petur Nielsen G, et al. Orthopaedic implant-related sarcoma: a study of twelve cases. Mod Pathol 2001;14:969–977.
Arthur EG, Arthur GL, Keeler MR, et al. Risk of osteosarcoma in dogs after open fracture fixation. Vet Surg 2016;45:30–35.
Boudrieau RJ, McCarthy RJ, Sprecher CM, et al. Material properties of and tissue reaction to the Slocum TPLO plate. Am J Vet Res 2006;67:1258–1265.
Lackowski WM, Vasilyeva YB, Crooks RM, et al. Microchemical and surface evaluation of canine tibial plateau leveling osteotomy plates. Am J Vet Res 2007;68:908–916.
Charles AE, Ness MG. Crevice corrosion of implants recovered after tibial plateau leveling osteotomy in dogs. Vet Surg 2006;35:438–444.
Li XQ, Hom DL, Black J, et al. Relationship between metallic implants and cancer: a case-control study in a canine population. Vet Comp Orthop Traumatol 1993;6:70–74.
Egenvall A, N⊘dtvedt A, von Euler H. Bone tumors in a population of 400,000 insured Swedish dogs up to 10 y of age: incidence and survival. Can J Vet Res 2007;71:292–299.
Anfinsen KP, Grotmol T, Bruland OS, et al. Breed-specific incidence rates of canine primary bone tumors—a population based survey of dogs in Norway. Can J Vet Res 2011;75:209–215.
Troisi R, Masters MN, Joshipura K, et al. Perinatal factors, growth and development, and osteosarcoma risk. Br J Cancer 2006;95:1603–1607.
Fraumeni JF Jr. Stature and malignant tumors of bone in childhood and adolescence. Cancer 1967;20:967–973.