INTRODUCTION

The elbow is a complex joint made up of three bones, the humerus in the upper arm and the radius and ulna in the lower forearm. The top of the radius is flat and supports the humerus. This is the weight bearing bone in the forearm. The top of the ulna curves around the humerus to allow the normal movements of the elbow joint.

In young, fast growing, large breed puppies and in dogs bred to have crooked legs, abnormal development of the elbow joint may occur. This abnormality, elbow dysplasia, may result in damage to the cartilage or failure of portions of bone to fuse properly. Left untreated, severe, crippling arthritis will occur. Injuries and other disorders can also result in crippling, painful end-stage osteoarthritis. If medical management alone is unsuccessful in restoring pain-free use of the limb, then surgery to salvage pain-free use is indicated. There are currently a number of different surgical options:

Arthroscopic Procedures

Arthroscopy allows the surgeon to visualize the inside of the elbow joint and assess the severity of cartilage damage. If focal areas of cartilage are damaged or fragments of cartilage and bone are found. Removal of these damaged areas may be sufficient to restore use and slow the progression of osteoarthritis. Commonly we will find damage to the coronoid process, alone. Removal of the damaged coronoid process (sub-total coronoidectomy) can be a very effective therapy for many years.

Sliding Humeral Osteotomy (SHO)

During the Sliding Humeral Osteotomy (SHO) procedure, the humerus is cut in half (osteotomy) and the bottom portion slid over to redistribute the loads in the elbow to areas of the joint with healthy cartilage and off the areas of bone on bone pain. A specially designed bone plate is applied to stabilize the SHO thoroughout the bone healing phase. Research suggests this will decrease the load on the damaged portion of the joint by about 35%, making many patients again pain-free or managed more effectively with anti-inflammatory medications.

Total Elbow Replacement (TER)

Excision of the joint and replacement with a prosthetic elbow, known as Total Elbow Replacement, is now a viable surgical treatment option due to the recent development of newer prosthetics and techniques. With this procedure, the cartilage of the joint is removed with a precision reamer and replaced with a high density plastic and stainless steel prosthesis, thereby restoring range of motion and pain-free use.

Stem Cell Therapy

Stem cell therapy is gaining favor as a minimally invasive treatment option to treat osteoarthritis. Fat is surgically harvested from your pet in a minimally invasive fashion. This fat or adipose tissue is processed and stem cells are isolated and concentrated. This process requires a few days. These stem cells are then injected into the affected joint. These are your pet’s own stem cells and thus pose no risk of transmitting disease or rejection. Although, growth of new healthy cartilage is not expected, clinical improvement may be noted for many months. Surplus stem cells are stored at sub-freezing temperatures and can be injected at later dates without need to surgically harvest more fat. Stem cells might be expected to be most effective when combined with surgeries that alter the biomechanics of the joint (such as sub-total coronoidectomy and SHO).

Your pets surgeon can advise you on which technique may be best for your pet.

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