PhD in Veterinary Sciences for Animal Health and Food Safety

Contacts

Supervisor

Lisa Adele Piras

Curriculum vitae

Curriculum Vitae

Phd thesis

TITLE: Computer-assisted gait analysis evaluation of functional recovery of canine patients after Zurich Cementless Total Hip Replacement with special focus on cup positioning.

Background

Total hip replacement (THR) is a well-established procedure for the treatment of disabling disorders of the coxofemoral joint such as canine hip dysplasia, traumatic coxofemoral luxation, femoral head and neck fractures and failed femoral head and neck ostectomy¹. THR involves the surgical replacement of the femoral head, neck and acetabulum with manufactured implants consisting of a cup, a head and neck unit and a femoral stem. The Zurich Cementless THR (ZC-THR, Kyon, Zurich, Switzerland) was developed at the University of Zurich in the late 1990s². One of the most challenging aspects of THR is accurate positioning of the acetabular component. Post-operative cup-related complications for THR include coxo-femoral luxation, cup avulsion, aseptic loosening, and periprosthetic acetabular fractures³. The main factors influencing the proper positioning of the cup are the easiness and the reliability of use of the surgical instrumentation (impactor) provided by the companies that produce the implants and the experience of the surgeon. Despite many studies investigated the functional recovery after cementer or cementless THR an objective assessment of the functional outcome after ZC-THR is still lacking. It is widely recognized that the most reliable method to evaluate the functional outcome after orthopedic surgeries is by means of force plate analysis and assessment of the ground reaction forces (GRF)⁴.

Aims

The 1st aim will be to find the best cup impactor (Standard Kyon Vs Prototype Kyon) that could allow an easier and more accurate cup positioning also for unexperienced surgeons.

The 2nd aim will be to provide an objective evaluation of functional recovery of canine patients after ZC-THR by mean of force plate analysis.

Materials and methods

1) The first part of this project will be a cadaveric study. To obtain a sample size with a good statistical power, 20 cadavers for a total of 40 hips will be collected. Each pelvis will be correctly positioned in a true lateral recumbency with the aid of fluoroscopy before cup positioning. Two different impactors (standard(St) and prototype(Pr)) will be used by two surgeons (young(Y) and senior(S)) with different level of THR surgery experience, for a total of at least 10 cups for each of the four resulting study groups (Y-St; Y-Pr; S-St; S-Pr). After implantation of the acetabular component two orthogonal radiographic projections of the pelvis (VD, LL) will be obtained and ALO (angle of lateral opening) and AI (angle of inclination) values will be measured in order to assess correct cup orientation.

2) The second part of the project will be an in vivo study conducted on client owned dog scheduled for THR surgery. For each THR procedure, performed by an experienced surgeon, GRF will be collected before surgery (T0) and after 6 months (T180). In order to correctly interpret the GRF and to find out which patients benefit the most from THR, the population will be divided into three groups based on the condition of the contralateral hip. A control group of sound dogs will be added (Group 4: Normal/Normal) to compare GRF with values collected with the same force plate. To obtain a sample size with a good statistical power, 15 cases for each group will be collected.

Expected results

The development of a new impactor might lower the complication rate related to malpositioning of the cup, decreasing the abandon rate of novice surgeons during the learning curve. The comparison of functional recovery of dogs after the ZC-THR with other THR systems will help to objectively establish which system has better outcome in canine patients. Moreover the analysis of GRF and complications rate related to cup positioning will give some important indication on the true impact of cup malpositioning, defining which error in implant positioning can be tolerated.

References

1) Guerrero TG, Montavon PM. Zurich cementless total hip replacement: retrospective evaluation of 2nd generation implants in 60 dogs. Vet Surg 2009;38(01):70–80.

2) Vezzoni L, Vezzoni A, Boudrieau RJ. Long-term outcome of Zürich cementless total hip arthroplasty in 439 Cases. Vet Surg 2015; 44: 921–929.

3) Kowaleski MP. Biomechanical considerations in total hip replacement. In: Marcellin-Little DJ, Peck JN, editors. Advances in Small Animal Total Joint Replacement. Ames, IA: Wiley-Blackwell; 2013. pp. 53–68.

4) Drüen, S, Böddeker J, Meyer-Lindenberg A, et al. Computer-based gait analysis of dogs: evaluation of kinetic and kinematic parameters after cemented and cementless total hip replacement. VCOT 2012; 25(05): 375-384.

Research activities

Co supervisor

Bruno Peirone

 

Grant awarded

 March 2024: AO VET Seed Grant (Project No. AOVETS-II-22-01M) “Comparison of the accuracy of cup positioning in total hip replacement in dogs between two cup impactors: a cadaveric study.”

Oral presentations

• March 8, 2017: Research Days. Faculty of Veterinary Sciences, Grugliasco (TO), Italy.
• April 8-9, 2017: Free communication SIOVET, Cremona, Italy.
• June 2017: Invited speaker. Presented a one-day CPD course on Platelet Regenerative Therapy. Sheffield, UK.
• April 8, 2018: Free communication SIOVET, Cremona, Italy.
• July 19-20, 2018: Research Days. Faculty of Veterinary Sciences, Grugliasco (TO), Italy.
• March 2, 2019: Free communication SIOVET, Cremona, Italy.
• March 28-29, 2019: Research Days. Faculty of Veterinary Sciences, Grugliasco (TO), Italy.
• May 24-26, 2019: Free communication at the International Multispecialty Congress SCIVAC, Rimini, Italy.
• September 25-28, 2024: Free communication at the 23rd ESVOT Congress, Lisbon, Portugal.

Posters

• Mancusi D, Piras LA, Olimpo M, Botto R, Peirone B, “ Validation of a new sysetm of PRP preparation for non-transfusional use in dog”,18^th ESVOT Congress 2016, London, 8^th-10^th September
• Mancusi D, Piras LA, Olimpo M, Botto R, Peirone B, “PRP intra-articular injection for treatment of canine osteoarthritis: preliminary findings”, 18^th ESVOT Congress 2016, London, 8^th-10^th September
• Mancusi D, Piras LA, Olimpo M, Malaspina C, Maugeri S, Peirone B, “Canine unicompartimental elbow for treatment of medial compartment disease of the dog”, 5^th World Veterinary Orthopaedic congress Esvot-Vos, 19^th ESVOT Congress 2018, Barcelona, 12^th-15^th September
• Mancusi D, Piras LA. “Complex surgical treatment of a radio-ulnar nonunion in a dog”, ESVOT Congress 2023, Venezia, 5-7^th October

Publications 

1. Pes A, Piras LA, Malaspina C, Mancusi D. Patellar fracture and dental anomaly syndrome (PADS): personal experience in 3 clinical cases. Veterinaria. 2024; 38(1): 31–37.

 

2. Piras LA, Olimpo M, Lafuente P, Tomba A, Del Magno S, Lardone E, Peirone B, Mancusi D. Surgical Treatment of Nonmineralized Supraspinatus Tendinopathy in Dogs: A Retrospective Long-Term Follow-Up. Animals (Basel). 2023 Feb 8;13(4):592. doi: 10.3390/ani13040592. PMID: 36830379; PMCID: PMC9951642.

 

3. Mancusi D, Malaspina C. Diagnostic corner: Orthopedics. Veterinaria. 2023; 36(1):27-29.

 

4. Sarotti D, Lardone E, Piras L, Mancusi D, Franci P. A comparison of 0.375% ropivacaine psoas compartment block and 2% prilocaine spinal anaesthesia in dogs undergoing tibial plateau levelling osteotomy. BMC Vet Res. 2022 May 12;18(1):172. doi: 10.1186/s12917-022-03277-6. PMID: 35549713; PMCID: PMC9097125.

 

5. Piras LA, Mancusi D, Olimpo M, Gastaldi L, Rosso V, Panero E, Staffieri F, Peirone B. Post-operative analgesia following TPLO surgery: A comparison between cimicoxib and tramadol. Res Vet Sci. 2021 May; 136:351-359. doi: 10.1016/j.rvsc.2021.03.010. Epub 2021 Mar 13. PMID: 33773391.

 

6. Olimpo M, Mancusi D, Peirone B, Piras LA. Patient selectin and treatment options for patellar luxation. 2020; 34(3): 121-131.

 

7. Mancusi D, Olimpo M, Peirone B, Piras LA. Etiopathogenesis, clinical and diagnostic framework of patellar luxation. 2020; 34(3):109-120.