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Surgical Interventions/Post Surgical Interventions
 CAM Forum User
CAM Forum User
17 December 2021 at 5:14 pm

Elbow lameness post elbow replacement- treatment options

Hello,

I’m a Vet Physio and have been working with the dog in question for nearly 2 years now. She was first referred to me following an elbow replacement, however the OA in the joint was already severe and in the past year she has really struggled. She is consistently lame on RF (the replaced elbow), she also has OA in the left elbow, and some hip issues. She has weekly physio appointments, laser therapy, and is on Rimadyl and Gabapentin. She also goes to hydrotherapy, but has to have breaks as she has sensitive skin which is aggravated by the chlorine. I have been researching Librela as an option for this case, and the owner has also looked into Hydrogel injections. Do you think either of these would be suitable, and which would you go for first if you had to choose one?

(Lameness is severe, mostly non weight bearing on RF, holds it up in sitting position, significant head nod, only bears weight on her toes, is now overusing the left side to get up from a sit/lay etc.)

Thanks, Nancy

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  • CAM Responded

    17 December 2021 at 5:17 pm

    Good morning

    This sounds like a difficult case with multiple areas of concern.

    There are different procedures to “replace elbows” – I’m not an orthopaedic expert but I do know there are different implants being used. With this in mind I would strongly suggest they return to the surgeon and discuss the case – they should be offering long term follow up within the referral centre even if that means they are referred to another discipline such as pain management.

    The procedure may be at fault, there may be an infection or they may have a concurrent pathology such as a osteomyelitis, neoplasia, tendinopathy. Reinvestigating would be the best option if possible.

    If that isn’t possible then the first opinion veg should be reviewing the case with the same intention – non weight bearing lameness is suggestive of something serious.

    With regards pain management – I would suggest discussing with a pain specialist – there are many more meds that could be added and those used adjusted. Librela certainly could be an option as the dog could be centrally sensitised.

    With regards the hydrogel – this couldn’t be used without a full joint work up and ensuring the site of pain is that elbow and not associated with above and below joints. Or related to neck etc.

    I don’t believe there will be any evidence to refer to when combining it with an implant. Thus I would suggest other approaches are explored first.

    I hope that helps xx

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