Comparison of two cold compression therapy protocols after tibial plateau leveling osteotomy in dogs

Summary

Objective: To evaluate two different protocols of cold compression therapy (CCT) for pain management and functional recovery in dogs undergoing tibial plateau leveling osteotomy (TPLO). Material and methods: A total of 27 adult dogs (n = 30 stifles; staged bilateral procedures: n = 3) undergoing routine TPLO were randomly allocated to three groups (n = 10/group). Dogs of group I received CCT once before and immediately after surgery. In dogs of group II CCT was performed postoperatively four times at 6-hour intervals. Dogs of the control group did not receive CCT. Circumference of the stifle joint and the following pain-related parameters were measured by a single blinded observer before surgery and 1, 10 and 42 days after surgery: stifle joint range of motion (ROM), subjective degree of lameness, and score of a modified Glasgow Pain Scale (GPS). Results: Both CCT groups showed significantly greater ROM and lower GPS scores 24 hours after surgery compared to the control group. Ten days after surgery there was a significantly lower degree of lameness in both CCT groups compared to the control group. Fourty-two days after surgery a significantly greater ROM was observed in both CCT groups compared to the control group. Group II also showed a significant improvement in the degree of lameness and GPS. There were no significant differences in any of the parameters between the two CCT groups at any time point. Conclusion: CCT applied preoperatively and immediately postoperatively showed similar short- and long-term beneficial results compared to a previously established protocol of applying CCT four times postoperatively. This protocol may be more suitable for practical use. Clinical significance: The reported data can be used to establish the new protocol of CCT in a clinical surrounding and to support postoperative rehabilitation of the canine patient.

Zusammenfassung

Ziel: Vergleich von zwei verschiedenen Protokollen der Kälte-Kompressionstherapie (KKT) im Hinblick auf Schmerzmanagement und postoperative Rehabilitation bei Hunden nach Tibial Plateau Leveling Osteotomy (TPLO). Material und Methoden: 27 adulte Hunde (30 Kniegelenke; drei etappenweise bilaterale Eingriffe), bei denen eine routinemäßige TPLO erfolgte, wurden zufällig drei Gruppen zugeteilt (n = 10/Gruppe): Hunde der Gruppe I erhielten die KKT einmalig vor und unmittelbar nach der TPLO, bei Patienten der Gruppe II kam sie postoperativ viermalig im Abstand von 6 Stunden zur Anwendung und bei Tieren der Kontrollgruppe unterblieb sie. Ein einzelner geblindeter Untersucher bestimmte vor der TPLO sowie 1, 10, und 42 Tage nach dem Eingriff den Umfang des Kniegelenks sowie folgende schmerzrelevante Parameter: Bewegungsumfang (range of motion, ROM) des Kniegelenks, Lahmheit (subjektive Beurteilung) und Schmerzgrad anhand einer modifizierten Glasgow Pain Scale (GPS). Ergebnisse: In Gruppe I und II ergaben sich 24 Stunden nach der TPLO im Vergleich zur Kontrollgruppe signifikant höhere ROM-Werte und signifikant niedrigere GPS-Werte. Der Lahmheitsgrad war 10 Tage nach der Operation in Gruppe I und II signifikant geringer als in der Kontrollgruppe. 42 Tage nach TPLO zeigten Gruppe I und II im Vergleich zu der Kontrollgruppe signifikant höhere ROM-Werte. Für Gruppe II ließ sich zu diesem Zeitpunkt zudem eine signifikante Verbesserung hinsichtlich Lahmheitsgrad und GPS feststellen. Für keinen Parameter und zu keinem Messzeitpunkt bestanden signifikante Unterschiede zwischen den Gruppen I und II. Schlussfolgerung: Die jeweils einmalige Anwendung der KKT prä- und postoperativ zeigt ähnlich vorteilhafte kurz- sowie langfristige Ergebnisse wie ein etabliertes Protokoll mit viermalig postoperativ angewandter KKT. Dieses neue Protokoll kann in einer klinischen Umgebung praxistauglicher sein. Klinische Relevanz: Die ermittelten Daten können genutzt werden, um das neue Protokoll der KKT in die klinische Umgebung einzuführen und die postoperative Rehabilitation der Patienten zu unterstützen.

Keywords

Cranial cruciate ligament rupture - TPLO - postoperative pain management - postoperative rehabilitation

Schlüsselwörter

Ruptur des vorderen Kreuzbands - TPLO - postoperatives Schmerzmanagement - postoperative Rehabilitation

• References

• 1 Bergh MS, Peirone B. Complications of tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2012; 25 (05) 349-358.
• 2 Cobbold AF, Lewis OJ. Blood flow to the knee joint of the dog; effect of heating, cooling and adrenaline. J Physiol 1956; 132 (02) 379-383.
• 3 Conzemius MG, Hill CM, Sammarco JL, Perkowski SZ. Correlation between subjective and objective measures used to determine severity of postoperative pain in dogs. J Am Vet Med Assoc 1997; 210 (11) 1619-1622.
• 4 Cook JL, Luther JK, Beetem J, Karnes J, Cook CR. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39 (03) 315-323.
• 5 Drygas KA, McClure SR, Goring RL, Pozzi A, Robertson SA, Wang C. Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs. J Am Vet Med Assoc 2011; 238 (10) 1284-1291.
• 6 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39 (04) 460-474.
• 7 Harris JE, Dhupa S. Cryotherapy. Comp Cont Educ Pract 2007; 29 (10) 632-635.
• 8 Hewitt JD, Harrelson JM, Dailiana Z, Guilak F, Fink C. The effect of intermittent pneumatic compression on fracture healing. J Orthop Trauma 2005; 19 (06) 371-376.
• 9 Ho SS, Coel MN, Kagawa R, Richardson AB. The effects of ice on blood flow and bone metabolism in knees. Am J Sports Med 1994; 22 (04) 537-540.
• 10 Hoelzler MG, Harvey RC, Lidbetter DA, Millis DL. Comparison of perioperative analgesic protocols for dogs undergoing tibial plateau leveling osteo tomy. Vet Surg 2005; 34 (04) 337-344.
• 11 Hudson JT, Slater MR, Taylor L, Scott HM, Kerwin SC. Assessing repeatability and validity of a visual analogue scale questionnaire for use in assessing pain and lameness in dogs. Am J Vet Res 2004; 65 (12) 1634-1643.
• 12 Jaegger G, Marcellin-Little DJ, Levine D. Reliability of goniometry in Labrador Retrievers. Am J Vet Res 2002; 63 (07) 979-986.
• 13 Kehlet H, Dahl JB. The value of „multimodal“ or „balanced analgesia“ in postoperative pain treatment. Anesth Analg 1993; 77 (05) 1048-1056.
• 14 Koyonos L, Owsley K, Vollmer E, Limpisvasti O, Gambardella R. Preoperative cryotherapy use in anterior cruciate ligament reconstruction. J Knee Surg 2014; 27 (06) 479-484.
• 15 Kullenberg B, Ylipaa S, Soderlund K, Resch S. Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients. J Arthroplasty 2006; 21 (08) 1175-1179.
• 16 Lowitzsch K, Hopf HC, Galland J. Changes of sensory conduction velocity and refractory periods with decreasing tissue temperature in man. J Neurol 1977; 216 (03) 181-188.
• 17 Martimbianco AL, Gomes da Silva BN, de Carvalho AP, Silva V, Torloni MR, Peccin MS. Effectiveness and safety of cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A systematic review of the literature. Phys Ther Sport 2014; 15 (04) 261-268.
• 18 Martin SS, Spindler KP, Tarter JW, Detwiler K, Petersen HA. Cryotherapy: an effective modality for decreasing intraarticular temperature after knee arthroscopy. Am J Sports Med 2001; 29 (03) 288-291.
• 19 McMaster WC. A literary review on ice therapy in injuries. Am J Sports Med 1977; 5 (03) 124-126.
• 20 Millis DL. Getting the dog moving after surgery. J Am Anim Hosp Assoc 2004; 40 (06) 429-436.
• 21 Millis DL, Ciuperca IA. Evidence for canine rehabilitation and physical therapy. Vet Clin North Am Small Anim Pract 2015; 45 (01) 1-27.
• 22 Murrell JC, Psatha EP, Scott EM, Reid J, Hellebrekers LJ. Application of a modified form of the Glasgow pain scale in a veterinary teaching centre in the Netherlands. Vet Rec 2008; 162 (13) 403-408.
• 23 Ohkoshi Y, Ohkoshi M, Nagasaki S, Ono A, Hashimoto T, Yamane S. The effect of cryotherapy on intraarticular temperature and postoperative care after anterior cruciate ligament reconstruction. Am J Sports Med 1999; 27 (03) 357-362.
• 24 Olson JE, Stravino VD. A review of cryotherapy. Phys Ther 1972; 52 (08) 840-853.
• 25 Park SH, Silva M. Effect of intermittent pneumatic soft-tissue compression on fracture-healing in an animal model. J Bone Joint Surg Am 2003; 85-A [phone].
• 26 Priddy 2nd NH, Tomlinson JL, Dodam JR, Hornbostel JE. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997–2001). J Am Vet Med Assoc 2003; 222 (12) 1726-1732.
• 27 Rexing J, Dunning D, Siegel AM, Knap K, Werbe B. Effects of cold compression, bandaging, and microcurrent electrical therapy after cranial cruciate ligament repair in dogs. Vet Surg 2010; 39 (01) 54-58.
• 28 Schmerbach KI, Boeltzig CK, Reif U, Wieser JC, Keller T, Grevel V. In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig. Vet Surg 2007; 36 (02) 156-163.
• 29 Schroeder D, Paessler HH. Combination of cold and compression after knee surgery. A prospective randomized study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (03) 158-165.
• 30 Song M, Sun X, Tian X, Zhang X, Shi T, Sun R, Dai W. Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis. Springerplus 2016; 5 (01) 1074-1085.
• 31 Stauffer KD, Tuttle TA, Elkins AD, Wehrenberg AP, Character BJ. Complications associated with 696 tibial plateau leveling osteotomies (2001–2003). J Am Anim Hosp Assoc 2006; 42 (01) 44-50.
• 32 Yenari MA, Han HS. Influence of hypothermia on post-ischemic inflammation: role of nuclear factor kappa B (NFkappaB). Neurochem Int 2006; 49 (02) 164-169.