Impact of postoperative antibiotics on rates of infection and implant removal after tibial tuberosity advancement in 1,768 canine stifles

Abstract

Objective To report infection rate, implant removal rate, and postoperative antibiotic therapy after tibial tuberosity advancement (TTA) in dogs. Study design Retrospective study. Animals One thousand seven hundred sixty‐eight stifles in 1,732 dogs. Methods Medical records (January 2007‐December 2011) of dogs treated with a TTA were reviewed. Cases were included if at least 1 year of postoperative follow‐up was available and no additional procedures were performed on the stifle. Date of surgery, date of culture, culture and susceptibility results, postoperative antimicrobials used, and any implant removals were recorded. Use of postoperative antibiotics and implant removal were evaluated statistically for effect on infection occurrence and resolution. Results Postoperative infections were diagnosed in 82 of 1,768 (4.6%) stifles. Implants were removed from 32 (39%) stifles, with plate and screw removal only in 23 (71.9%) stifles. The rate of infection did not differ between dogs with or without postoperative antibiotic therapy. However, dogs receiving postoperative antibiotic therapy were at risk for developing an oxacillin‐resistant infection (P = .001). Oxacillin‐resistant infections were associated with a requirement for implant removal to achieve resolution compared with other types of bacterial infections (P < .05). Conclusion No benefit was detected with the use of postoperative antibiotics after TTA in this population. Implant removal was infrequent, and the requirement for cage removal was not commonly required for infection resolution. Clinical significance This study does not provide evidence to support postoperative antibiotic therapy after TTA. Postoperative infection can be treated in most dogs without removal of the TTA cage.

Factors Contributing to the Need for Non-Elective Explant following Surgical Repair of Tibial Tuberosity Avulsion Fracture

“…Previous studies have been conducted to determine implant removal rate for surgeries such as tibial tuberosity advancement and tibial plateau levelling osteotomy; however, these studies focus on implant infection and perioperative antibiotic medication use, as implant migration is uncommon with these procedures. 11 12 In this study, although animals that received postoperative antibiotic medications were at a higher risk of requiring non-elective explant, infection was not recorded in any of the cases. It may be that whatever caused a surgeon to decide on using antibiotic medications may have contributed to the need for non-elective explant.…”

Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement–A systematic review with a meta-analytic approach

“…Study group sizes varied between five subjects per group ( 56 , 58 ) and 1,732 subjects per group. The highest total number of subjects in one study was 1,732 dogs with 1,768 surgeries ( 59 ).…”

Update on the management of canine cruciate disease

“…Infection rates of 2.3 to 33 per cent have been reported following TPLO, with 37.5 to 57.1 per cent of cases requiring implant removal for resolution (Brown and others 2016, Hans and others 2017, Cappelle and Barnhart 2019, Giannetto and Aktay 2019). Infection rates following TTA have been reported in 4.6 per cent to 15.4 per cent of cases, with between 1.3 per cent and 39 per cent of cases requiring implant removal for resolution (although the cage was not removed in the majority of cases) (Yap and others 2015, Hans and others 2017, Ferrell and others 2019). Similar infection rates of up to 14.5 per cent for CTCWO and 17.3 per cent for ECS have been reported, with the suture requiring removal in 53 per cent cases for resolution (Campbell and others 2016, Cox and others 2020).…”

“…Factors associated with significantly increased infection rates include increased bodyweight, being a GSD, undergoing meniscectomy, surgeon experience (<20 procedures), increased surgical and anaesthesia time, and induction with propofol (Fitzpatrick and Solano 2010, Yap and others 2015, Lopez and others 2018, Giannetto and Aktay 2019, Cox and others 2020). Although some authors reported a significantly reduced risk of infection and/or major complications when antibiotics were given postoperatively (Fitzpatrick and Solano 2010, Hans and others 2017), others reported no benefit (Yap and others 2015, Campbell and others 2016, Lopez and others 2018, Ferrell and others 2019, Cox and others 2020).…”