Complications and short to midterm results in a case series of 52 CUE procedures using a modified caudo-medial approach

Abstract

Background: Medial coronoid process disease is the most common manifestation of canine developmental elbow disease which can progress to a more severe medial compartment disease (MCompD) characterized by full thickness cartilage loss of the medial coronoid process (MCP) and medial humeral condyle. Among others, the “Canine Unicompartmental Elbow” (CUE) has been reported to be an effective treatment strategy for MCompD, with full in 47.6% and acceptable function in 43.7% at six months or later of follow-up. Aim: To report on our clinical experiences with the CUE system using the caudo-medial approach in terms of both complications and functional outcome. Methods: Medical records of dogs that underwent CUE procedure using a caudo-medial approach over a 3-year period were retrospectively reviewed. This covered epidemiological data, bi-planar radiographs, subjective gait analysis, owner questionnaire, surgical reports as well as second-look arthroscopic findings when available. Results: In total, 52 CUE procedures were performed in 44 dogs with a median age at surgery of 8.0 years (IQ: 5.0-10.0) and a median body weight of 31.9 kg (ranging 20-48 kg). Four cases never return for follow-up, but where included in the analysis to increase the number of cases with pre- and intra-operative data. Mean follow-up time available for the remaining 48 cases was 7.1 (SD: 5.2) months. Radiographic derived implant positioning and alignment proved to be satisfactory in the sagittal plane but parallelism in the frontal plane was only present in three cases. Second-look arthroscopy in 5 cases with delayed or disappointing functional improvement showed evidence of implant related contact lesions and progressive erosion of the medial coronoid area in three elbows. Overall, complications occurred in 11 cases (21%), being major in eight (15%) and minor in three (6%). Major complications included refractory pain and lameness six to twelve months postoperatively in five cases. At last follow-up, twelve cases (25%) were considered to have full function, 35 cases (73%) acceptable function and in one case the function was considered unacceptable. As the only variable related to functional outcome, age had a negative predictive value for full function. Conclusion: The CUE procedure appears to be an effective treatment option for patients with MCompD. Older dogs might be at risk of having an inferior clinical outcome, when compared to young patients. The reason for this is unknown and will have to be evaluated in future studies. Compared to a CUE case series of 103 elbows operated through a medial approach (Cook et al., 2015), using a caudo-medial approach decreased the incidence of approach related complication. Nevertheless, functional outcome in the current case series was less favourable than previously reported. These conflicting findings as well as the occurrence of potentially implant mechanical conflict at the medial joint compartment despite CUE warrants further studies.

Keywords

• Canine Unicompartmental Elbow
• CUE
• Medial Compartment Disease