Evidence-Based Protocol Changes to Reduce Implant-Associated Infection Rate after Tibial Plateau Levelling Osteotomy in Dogs

Introduction: Surgical site infection following orthopaedic surgeries leads to increased patient morbidity, as well as increased financial burden for clients. The goal of this study was to determine if a significantly reduced implant-associated infection (IAI) rate could be achieved by implementing evidence-based protocol changes during and after the tibial plateau levelling osteotomy (TPLO) procedure in dogs.

Materials and Methods: Medical records were reviewed and a total of 703 dogs (811 TPLO) were included. Two cohorts were established, with 255 dogs (n = 282 TPLO) that underwent an established TPLO procedure and 448 dogs (n = 529 TPLO) that underwent a revised TPLO procedure. Data were analysed to determine the rate of IAI and risks associated with these rates.

Results: Implant removal was performed in 31 dogs (n = 24 pre-change, n = 7 post-change). IAI was confirmed with a positive bacterial culture in 26 dogs (n = 21, pre-change, n = 5 post-change). The pre-change group had nearly eight times the risk of infection in comparison to the post-change group when sex, if intact, and laterality were controlled. All culture-positive implants removed from the post-change group produced a Staphylococcus spp., 80% of which exhibited methicillin-resistance.

Discussion/Conclusion: A significant reduction in postoperative TPLO IAI rate was achieved by implementing evidence-based changes during and after TPLO surgery. Methicillin-resistant bacterial strains are becoming more prevalent over time, increasing the urgency for reduction of surgical site infections (SSIs) and therefore, IAI.

Acknowledgement: There was no proprietary interest or funding provided for this project.