Denis J. Marcellin-Little

Amantadine in a Multimodal Analgesic Regimen for Alleviation of Refractory Osteoarthritis Pain in Dogs

BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) do not always provide sufficient pain relief in dogs with osteoarthritis (OA). HYPOTHESIS The use of amantadine in addition to NSAID therapy will provide improved pain relief when compared with the use of nonsteroidal analgesics alone in naturally occurring OA in dogs. ANIMALS Thirty-one client-owned dogs with pelvic limb lameness despite the administration of an NSAID. METHODS The study was randomized, blinded, and placebo controlled with parallel groups (days 21-42). On day 0, analgesic medications were discontinued. On day 7, all dogs received meloxicam for 5 weeks. On day 21, all dogs received amantadine (3-5 mg/kg once daily per os) or placebo for 21 days, in addition to receiving meloxicam. Assessments were performed before the study and on days 7, 21, and 42. Primary outcome measures were blinded owner assessments of activity using client-specific outcome measures (CSOM) on days 0, 7, 21, and 42. Data were analyzed by a mixed model approach. RESULTS For CSOM activity, there was a significant time by treatment effect (P=.009). On the basis of the planned post hoc t-tests of postrandomization means, there was a significant difference between treatment groups on day 42 (P=.030), with the amantadine group being more active. CONCLUSIONS AND CLINICAL IMPORTANCE In dogs with osteoarthritic pain refractory to an NSAID, physical activity is improved by the addition of amantadine. Amantadine might be a useful adjunct therapy for the clinical management of canine osteoarthritic pain.

Evaluation of a Therapeutic Diet for Feline Degenerative Joint Disease

BACKGROUND Feline degenerative joint disease (DJD) is common and there are no approved therapies for the alleviation of the associated pain. OBJECTIVE To test a diet high in eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) content and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate (test-diet) for its pain-relieving and activity-enhancing effects in cats with painful, mobility-impairing DJD over a 9-week period. ANIMALS Forty client-owned cats. METHODS Randomized, controlled, blinded, parallel group, prospective clinical study. Cats with no detectable systemic disease, and with at least 1 appendicular joint with radiographic evidence of DJD where manipulation elicited an aversive response were included. Cats were randomly allocated to the test-diet or control diet (C-diet). Outcome measures were subjective owner and veterinarian assessments, and objective activity monitoring (accelerometry). Nonparametric statistics were used to evaluate changes within and between groups for both subjective and objective data, and locally weighted scatterplot smoothing regression analysis was used to predict activity changes. RESULTS The primary objective outcome measures indicated that activity declined significantly (P < .001) in the C-diet group, significantly increased (P < .001) in the test-diet group and there was a significant difference between the groups (P < .001). CONCLUSION AND CLINICAL IMPORTANCE A diet high in EPA and DHA and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate improved objective measures of mobility. Dietary modulation might be 1 method to use to improve mobility in cats with DJD-associated pain.

Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats

BackgroundAvailable information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to palpation, joint crepitus, effusion and thickening were graded. Radiographs of appendicular joints and the axial skeleton were made under sedation. Joint motion was measured by use of a plastic goniometer before and after sedation. Associations between radiographic degenerative joint disease (DJD) and examination findings were assessed to determine sensitivity, specificity and likelihood estimations.ResultsPain response to palpation was elicited in 0-67% of the joints with DJD, with a specificity ranging from 62-99%; crepitus was detected in 0-56% of the joints and its specificity varied between 87 and 99%; for effusion, values ranged between 6 and 38% (specificity, 82-100%), and thickening, 0-59% (specificity, 74-99%). Joints with DJD tended to have a decreased range of motion. The presence of pain increased the odds of having DJD in the elbow (right: 5.5; left: 4.5); the presence of pain in the lower back increased the odds of spinal DJD being present (2.97 for lumbar; 4.67 for lumbo-sacral).ConclusionsRadiographic DJD cannot be diagnosed with certainty using palpation or goniometry. However, negative findings tend to predict radiographically normal joints. Palpation and goniometry may be used as a tool to help to screen cats, mostly to rule out DJD.

Kinetic evaluation of normal walking and jumping in cats, using a pressure-sensitive walkway

The kinetic parameters of the limbs of 23 normal, client-owned cats were evaluated by encouraging them to walk and jump normally on a pressure-sensitive walkway. Each cat was encouraged to walk across the walkway five times over a period of 30 to 45 minutes (by using food, toys, the owners presence and a purpose-built tunnel) at a target speed of 0·6 m/s (and an acceleration of less than ± 0·1 m/s2). They were then encouraged to jump on to the walkway from a height of 1 m five times at five-minute intervals. The kinetic parameters of peak vertical force (pvf) and vertical impulse (vi) were measured for each limb (the forelimbs only for the jumps), and expressed as a percentage of bodyweight (pvf%bw and vi%bw/s). Fifteen of the 23 cats satisfactorily completed three to five walks and two to five jumps that could be analysed. There were no significant differences between the pvf or vi of the left and right limbs, but both parameters were significantly greater for the forelimbs than the hindlimbs (P<0·001) for the walking data. The mean (sd) pvf%bw for the forelimbs and hindlimbs were 48·2 (6·0) and 38·3 (4·0), respectively, and the mean vi%bw/s were 16·9 (3·2) and 13·3 (2·8). Jumping down generated significantly greater pvf (P<0·01) and slightly greater vi than during walking; there were no significant differences between the left and right forelimbs. The mean pvf%bw was 148·9 (16·4) and the mean vi%bw/s was 18·1 (4·3).

Circular External Skeletal Fixation Stabilization of Antebrachial and Crural Fractures in 25 Dogs

Fracture stabilization using circular external skeletal fixation was evaluated in 14 dogs with antebrachial fractures and 11 dogs with crural fractures. Most dogs were consistently weight bearing on the stabilized limb by 3 days following surgery. Although all dogs developed minor wire/pin tract inflammation and eight dogs developed major wire/pin tract inflammation, postoperative lameness was not consistently associated with wire/pin tract complications. Fractures in 23 dogs achieved radiographic union (mean +/- standard deviation [SD], 61 +/- 21 days; median, 57 days) without additional surgery; two dogs required restabilization of their fractures with linear fixators. Twenty of the 21 owners that could be contacted felt their dog had no (n=15) or only a mild (n=5) intermittent lameness at the time of final, long-term (mean +/- SD, 37 +/- 17 months; median, 42 months) assessment.

In vitro biocompatibility of titanium alloy discs made using direct metal fabrication

Custom orthopedic implants may be generated using free-form fabrication methods (FFF) such as electron beam melting (EBM). EBM FFF may be used to make solid metal implants whose surface is often polished using CNC machining and porous scaffolds that are usually left unpolished. We assessed the in vitro biocompatibility of EBM titanium-6 aluminum-4 vanadium (Ti6Al4V) structures by comparing the cellular response to solid polished, solid unpolished, and porous EBM discs to the cellular response to discs made of commercially produced Ti6Al4V. The discs were seeded with 20,000 human adipose-derived adult stem cells (hASCs) and assessed for cell viability, proliferation, and release of the proinflammatory cytokines interleukin-6 (IL-6) and interleukin-8 (IL-8). Cell viability was assessed with Live/Dead staining 8 days after seeding. Cell proliferation was assessed using alamarBlue assays at days 0, 1, 2, 3, and 7. The hASCs were alive on all discs after 8 days. Cellular proliferation on porous EBM discs was increased at days 2, 3, and 7 compared to discs made of commercial Ti6Al4V. Cellular proliferation on porous EBM discs was also increased compared to solid polished and unpolished EBM discs. IL-6 and IL-8 releases at day 7 were lower for porous EBM discs than for other discs. Solid polished, unpolished, and porous EBM Ti6Al4V discs exhibited an acceptable biocompatibility profile compared to solid Ti6Al4V discs from a commercial source. EBM FFF may be considered as an option for the fabrication of custom orthopedic implants.

Evaluation of functional outcome after BFX total hip replacement using a pressure sensitive walkway.

OBJECTIVE To evaluate stance phase limb use after cementless (BFX) total hip replacement (THR) in dogs and to relate postoperative radiographic variables to static bodyweight distribution after surgery. STUDY DESIGN Prospective clinical study. ANIMALS Dogs (n=35) that had THR. METHODS THR was performed using the BFX THR technique. Postoperative pain management regimens were similar for all dogs. Standing bodyweight distribution (%BW(distrib)) was measured using a pressure sensitive walkway and radiographs made before surgery and at 3, 6, and 12 months after surgery. Repeated measures models (with backwards-stepping to obtain the final model) were used for statistical analysis. RESULTS Temporally, %BW(distrib) to the operated limb increased (P<.0001; normal by 3 months) and decreased to the unoperated limb (P=.0001) and also increased to the pelvic limbs and decreased to the thoracic limbs. %BW(distrib) to the unoperated limb was significantly less than the operated limb at 3, 6, and 12 months after surgery. Postoperative canal fill and femur flare were significantly negatively correlated with change in %BW(distrib) (estimate=-0.24, P=.0413). CONCLUSION BFX THR results in normal %BW(distrib) to the operated limb by 3 months after surgery. A greater fill of the proximal femur may be associated with a suboptimal outcome. CLINICAL RELEVANCE BFX THR normalizes standing bodyweight distribution dogs with hip osteoarthritis. Objective evaluation of THR outcome and radiographic features may reveal factors that could be improved through changes in prosthesis design or surgical technique.

The Canine Shoulder: Selected Disorders and Their Management with Physical Therapy

The shoulder joint is the most mobile of all main limb joints. While its primary motion is in a sagittal plane, the shoulder has a significant amount of abduction and adduction, and internal and external rotation. Its stability is ensured by the joint capsule, by its specialized bands (medial and lateral glenohumeral ligaments), and by large tendons located inside (eg, tendon of origin of the biceps brachii muscle) or immediately outside the joint (eg, supraspinatus, infraspinatus, teres minor, and subscapularis). Sprains or strains of all supporting structures of the canine shoulder have now been reported and the shoulder pathology resembles the pathology of the human shoulder that includes strains and tears of the rotator cuff muscles, adhesive capsulitis, and calcific tendonitis.

Expression and Activity of COX-1 and 2 and 5-LOX in Joint Tissues from Dogs with Naturally Occurring Coxofemoral Joint Osteoarthritis

Understanding the neurobiology of pain in naturally occurring models of osteoarthritis (OA) may improve the understanding of human OA pain. Both COX and LOX have been associated with joint pain. This study evaluated COX‐1, COX‐2, and 5‐LOX expression and activity in a naturally occurring canine model of secondary OA. Hip joint capsule with synovial tissue (HJC) and femoral head subchondral bone (FH) was collected from normal dogs and dogs undergoing total hip replacement for coxofemoral joint OA. Tissues were analyzed for COX‐1, COX‐2, and LOX protein, and PGE2 and LTB4. Significantly more COX‐2 protein was present in OA HJC than normal joints (p = 0.0009). There was no significant difference in COX‐1 or LOX protein, although LOX protein was increased (p = 0.069). PGE2 concentration in normal and OA HJC was similar (p = 1.0). LTB4 concentration in OA HJC was significantly greater than normal HJC (p = 0.028). Significantly more COX‐1 (p = 0.0098), COX‐2 (p = 0.0028), and LOX (p = 0.0095) protein was present in OA FH tissue compared to normal FH tissue. There were no differences in PGE2 or LTB4 concentration in normal and OA FH tissue (p = 0.77 and p = 0.11). Together, these data suggest both COX‐2 and 5‐LOX are appropriate targets for the management of pain associated with naturally occurring OA.

Rapid prototyping for treatment of canine limb deformities

This report describes Rapid Prototyping (RP) ‐aided assessment and preoperative planning for treatment of bilateral multifocal pelvic limb deformities in a 1 year old German Shepherd dog. Computed tomography (CT) scans were acquired on a General Electric CT scanner and converted to solid models using Mimics software from Materialise. Stereolithography patterns were prototyped using QuickCast build style on a SLA ‐190. Room temperature vulcanized silicone molds were constructed and three sets of polyurethane patterns were cast for pre‐surgical planning and rehearsal. The paper compares traditional osteotomy planning procedures using only radiographs and 2D CT images to planning with full‐scale physical biomodels. The biomodels had a clearly beneficial impact on the accuracy of surgery and positively influenced the clinical outcome.