Orthotics or surgery? A veterinary surgeon breaks down the options
Your clients obviously want the best for their pets, but they're also interested in what they perceive as the most convenient—and often cheaper—solution. In cases of orthopedic distress, Fetch dvm360 conference speaker David Dycus, DVM, MS, DACVS-SA, points out that the simpler solution may not be the best, but it’s sometimes necessary.
"The majority [of cases] probably benefit from surgical intervention, but we may have an older geriatric patient, or a patient with underlying heart failure, kidney failure, or liver failure that just wouldn't be the best anesthetic candidate," he says.
Other factors Dr. Dycus says are important to consider are the patient’s age and activity level, as well as the pet owner’s expectations and ability to follow through on compliance. Also keep in mind that a canine brace must be custom-made because each dog’s anatomy is different and the small, medium or large approach that’s common in human medicine won’t work for them.
When an orthotic is chosen, Dr. Dycus says there are four key points to discuss with clients:
Patient's tolerance of the brace: The only way to determine how a dog will take to a brace is to put it in a brace. The reactions range from acceptance to panic to trying to chew the brace off. Worst-case scenario? Dog hates brace, still has condition, owner is dissatisfied.
Wear and tear on the skin: Braces can rub on the skin and cause open wounds, which is again why a custom-made brace is important. As Dr. Dycus reports, more than 30 percent of patients will develop wounds that need additional medical attention.
Effect on potential arthritic progression: Surgical intervention and stabilization would be expected to minimize and slow the progression of arthritis, says Dr. Dycus, but the efficacy of braces has yet to be accurately determined. Dr. Dycus tells clients to think of it as a spectrum: On one end is doing nothing, and arthritic changes will happen at a quicker degree. On the other end is surgical intervention, which can slow the arthritic changes in a predictable manner. In the middle of the spectrum is the brace, but to what degree it works isn’t known yet, because there isn’t clinical evidence.
Potential meniscal injury: Dr. Dycus says that surgery can reduce a patient’s meniscal tear rate to around 4 percent, but, as with arthritic progression, the long-term effectiveness of a stifle orthotic is not yet known.
Until the profession learns more about the precise effectiveness of orthotics, Dr. Dycus believes assessments should be made on an individual basis.
"Instead of trying to say, 'Surgery or a knee brace?' we need to look at them as two separate entities," he says.
Learn more in this video interview conducted by Dr. Sarah Wooten.