Mills Jon, Jaworski Janusz, Hargittai Tamir
West Midlands Referrals, Burton-on-Trent, UK.
The Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK.
J Feline Med Surg. 2024 Dec;26(12):1098612X241281456. doi: 10.1177/1098612X241281456.
The aim of this study was to assess the complication rates and long-term outcomes, as well as to refine case selection criteria for cats undergoing trochlear ridge augmentation (TRA) using an ultra-high molecular weight polyethylene implant (UHMWPEI) for the treatment of patellar luxation (PL).
The clinical records from two referral veterinary hospitals were searched for cases that fitted defined inclusion criteria. A short-term assessment was based on examination and radiography at 8 weeks postoperatively. The long-term assessment was carried out at least 2 years postoperatively through examination and radiography, and less commonly via questionnaire.
A total of 44 stifles in 39 patients with PL grade 2 (n = 19), 3 (n = 22) or 4 (n = 3) met the inclusion criteria. TRA using UHMWPEI was associated with minor complications in 20% of cases and major complications in 7% of cases. Minor complications included seroma formation (n = 5), superficial wound infection (n = 2), prolonged discomfort for a few weeks postoperatively (n = 1) and transient postoperative azotaemia (n = 1). After surgical correction of medial PL, one skeletally immature case developed transient grade 1 lateral PL, which resolved without intervention. Major complications comprised implant removal for ongoing lameness (n = 3). Degenerative joint disease, with mineralisation that was often marked, was noted in 26/35 (74%) cases that were available for radiographic follow-up 2 years or more after TRA. Nevertheless, good or very good long-term functional outcomes were achieved for 93% of cases.
The currently available UHMWPEIs were shown to be suitable for treating PL grades 2, 3 or 4 in cats weighing ⩾3 kg. Delaying TRA until growth is completed is advised. The long-term follow-up suggested that the correction of PL in cats with UHMWPEI was sustained and that good function could be expected in the long term. Mineralisation overlying implants was common, but this was not appreciably correlated with adverse functional consequences.
本研究旨在评估并发症发生率和长期预后，并完善使用超高分子量聚乙烯植入物（UHMWPEI）进行滑车嵴增强术（TRA）治疗髌骨脱位（PL）的猫的病例选择标准。
检索两家转诊兽医医院的临床记录，寻找符合既定纳入标准的病例。短期评估基于术后8周的检查和X线摄影。长期评估在术后至少2年通过检查和X线摄影进行，较少情况下通过问卷调查进行。
39例PL 2级（n = 19）、3级（n = 22）或4级（n = 3）患者的44个膝关节符合纳入标准。使用UHMWPEI进行TRA的病例中，20%发生轻微并发症，7%发生严重并发症。轻微并发症包括血清肿形成（n = 5）、浅表伤口感染（n = 2）、术后几周持续不适（n = 1）和短暂性术后氮血症（n = 1）。内侧PL手术矫正后，1例骨骼未成熟病例出现短暂性1级外侧PL，未经干预自行缓解。严重并发症包括因持续跛行而取出植入物（n = 3）。在TRA后2年或更长时间可进行X线随访的26/35（74%）病例中，发现有退行性关节病，常有明显的矿化。然而，93%的病例获得了良好或非常好的长期功能预后。
目前可用的UHMWPEI被证明适用于治疗体重≥3 kg的猫的PL 2级、3级或4级。建议在生长完成后再进行TRA。长期随访表明，使用UHMWPEI矫正猫的PL是持久的，长期可预期良好的功能。植入物上方的矿化很常见，但这与不良功能后果没有明显相关性。
