Limb-Sparing Surgery in Two Cats Using a Femoral Endoprosthesis with an Integrated Total Knee Replacement Implant

Abstract

Objective The aim of this study was to describe a novel limb-sparing technique for the management of feline bone neoplasia using a custom-made femoral endoprosthesis in combination with a total knee replacement (TKR) prosthesis.

Methods Two cats with distal femoral bone tumours underwent pelvic limb salvage procedures with custom-made implants designed from patient-specific computed tomography images to replace the distal femur and the stifle. In case 1, the first-generation implant was a combination of a cemented femoral endoprosthesis with a uniaxial hinged cemented TKR prosthesis. Due to aseptic loosening of the endoprosthesis, revision was performed with a second-generation femoral endoprosthesis modified with a short intramedullary peg and a lateral bone plate for immediate stability. In case 2, a third-generation endoprosthesis with an intramedullary peg and two orthogonal bone plates for immediate stability, combined with a custom-designed rotationally hinged cemented TKR prosthesis, was used. Clinical and radiographic follow-up was recorded.

Results After revision surgery in case 1 and with the third-generation implant in case 2, no complications were encountered. Both cats showed minor mechanical restriction of stifle range of motion and good clinical long-term outcome without local tumour recurrence.

Conclusion The combination of a femoral endoprosthesis and a TKR prosthesis can be a viable alternative for distal femoral limb salvage in cats.

Keywords

limb salvage - feline - endoprosthesis - total knee replacement - bone neoplasia

Authors' Contributions

E.K. was involved in study design, acquisition of data, manuscript and figure preparation and manuscript review. R.C.R. designed study, acquired data and reviewed manuscript. N.F. was involved in study design, manuscript review, primary surgeon for all performed surgeries in both cats and concept and design of implants and technique.

Publikationsverlauf

Eingereicht: 08. Mai 2021

Angenommen: 03. Dezember 2021

Artikel online veröffentlicht:
18. Januar 2022

• References

• 1 Dorn CR, Taylor DO, Schneider R, Hibbard HH, Klauber MR. Survey of animal neoplasms in Alameda and Contra Costa Counties, California. II. Cancer morbidity in dogs and cats from Alameda County. J Natl Cancer Inst 1968; 40 (02) 307-318
• 2 Turrel JM, Pool RR. Primary bone tumors in the cat. Veterinary Radiology. 1982; 23: 152-166
• 3 Liu SK, Dorfman HD, Patnaik AK. Primary and secondary bone tumours in the cat. J Small Anim Pract 1974; 15 (03) 141-156
• 4 Quigley PJ, Leedale AH. Tumors involving bone in the domestic cat: a review of fifty-eight cases. Vet Pathol 1983; 20 (06) 670-686
• 5 Heldmann E, Anderson MA, Wagner-Mann C. Feline osteosarcoma: 145 cases (1990-1995). J Am Anim Hosp Assoc 2000; 36 (06) 518-521
• 6 Bitetto WV, Patnaik AK, Schrader SC, Mooney SC. Osteosarcoma in cats: 22 cases (1974-1984). J Am Vet Med Assoc 1987; 190 (01) 91-93
• 7 Szewczyk M, Lechowski R, Zabielska K. What do we know about canine osteosarcoma treatment? Review. Vet Res Commun 2015; 39 (01) 61-67
• 8 Liptak JM, Dernell WS, Farese JP, Worley DR. D.R. Musculoskeletal system. In: Kudnig ST, Seguin B. Veterinary Surgical Oncology. Wiley-Blackwell; Chichester, West Sussex, UK: 2012: 513-556
• 9 Poirier VJ, Steffen F. Tumors of the musculoskeletal system. In: Montavon PM, Voss K, Langley-Hobbs SJ. eds. Feline Orthopedic Surgery and Musculoskeletal Disease. Saunders Elsevier; Philadelphia, USA: 2009: 99
• 10 Boylan MT, Boston SE, Townsend S, Cavalcanti JVJ. Limb-shortening limb salvage (LSLS) in a cat with metatarsal osteosarcoma. Can Vet J 2019; 60 (07) 757-761
• 11 Boston SE, Skinner OT. Limb shortening as a strategy for limb sparing treatment of appendicular osteosarcoma of the distal radius in a dog. Vet Surg 2018; 47 (01) 136-145
• 12 Liska WD, Marcellin-Little DJ, Eskelinen EV, Sidebotham CG, Harrysson OL, Hielm-Björkman AK. Custom total knee replacement in a dog with femoral condylar bone loss. Vet Surg 2007; 36 (04) 293-301
• 13 Fitzpatrick N, Guthrie JW. Hemipelvic and proximal femoral limb salvage endoprosthesis with tendon ongrowth in a dog. Vet Surg 2018; 47 (07) 963-969
• 14 Gkavardina A, Tsagozis P. The use of megaprostheses for reconstruction of large skeletal defects in the extremities: a critical review. Open Orthop J 2014; 8: 384-389
• 15 Sewell MD, Spiegelberg BG, Hanna SA. et al. Total femoral endoprosthetic replacement following excision of bone tumours. J Bone Joint Surg Br 2009; 91 (11) 1513-1520
• 16 Benito J, Depuy V, Hardie E. et al. Reliability and discriminatory testing of a client-based metrology instrument, feline musculoskeletal pain index (FMPI) for the evaluation of degenerative joint disease-associated pain in cats. Vet J 2013; 196 (03) 368-373
• 17 Forster LM, Wathes CM, Bessant C, Corr SA. Owners' observations of domestic cats after limb amputation. Vet Rec 2010; 167 (19) 734-739
• 18 Johnson KA. Prosthetic replacement of the stifle joint: an experimental investigation in the cat. J Am Anim Hosp Assoc 1981; 17: 39-43
• 19 Powers DL, Mazanti L, Recum AFV. Feline stifle implant arthroplasty. Vet Surg 1984; 13: 159-164
• 20 Walker PS, Nunamaker D, Huiskes R, Parchinski T, Greene D. A new approach to the fixation of a metacarpophalangeal joint prosthesis. Eng Med 1983; 12 (03) 135-140
• 21 Fitzpatrick N, Miraldo DC, Meswania J. Custom-built constrained uniaxial and rotating hinge total knee replacement in cats: clinical application, design principles, surgical technique, and clinical outcome. Vet Surg 2021; 50 (06) 1283-1295
• 22 Knutson K, Lindstrand A, Lidgren L. Survival of knee arthroplasties. A nation-wide multicentre investigation of 8000 cases. J Bone Joint Surg Br 1986; 68 (05) 795-803
• 23 Allen MJ, Mann K. Biomechanical considerations on total knee replacement. In: Jeffrey N Peck, Denis J. eds. Marcellin-Little: Advances in Small Animal Total Joint Replacement, State Avenue. Ames, Iowa: Wiley-Blackwell; 2013: 139
• 24 Coathup MJ, Batta V, Pollock RC. et al. Long-term survival of cemented distal femoral endoprostheses with a hydroxyapatite-coated collar: a histological study and a radiographic follow-up. J Bone Joint Surg Am 2013; 95 (17) 1569-1575
• 25 Coathup MJ, Sanghrajka A, Aston WJ. et al. Hydroxyapatite-coated collars reduce radiolucent line progression in cemented distal femoral bone tumor implants. Clin Orthop Relat Res 2015; 473 (04) 1505-1514
• 26 Fromme P, Blunn GW, Aston WJ, Abdoola T, Koris J, Coathup MJ. The effect of bone growth onto massive prostheses collars in protecting the implant from fracture. Med Eng Phys 2017; 41: 19-25
• 27 Jasty M, Bragdon C, Burke D, O'Connor D, Lowenstein J, Harris WH. In vivo skeletal responses to porous-surfaced implants subjected to small induced motions. J Bone Joint Surg Am 1997; 79 (05) 707-714
• 28 Jaeger GH, Marcellin-Little DJ, Depuy V, Lascelles BD. Validity of goniometric joint measurements in cats. Am J Vet Res 2007; 68 (08) 822-826
• 29 Brown NP, Bertocci GE, Cheffer KA, Howland DR. A three dimensional multiplane kinematic model for bilateral hind limb gait analysis in cats. PLoS One 2018; 13 (08) e0197837