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First canine total ankle replacement surgery in Florida performed on dog at UF

By Sarah Carey

A 7-year-old Labrador retriever named Leo is back to hiking trails with his owner, nine months after successfully recuperating from a total ankle replacement procedure conducted in January for the first time in Florida at the University of Florida College of Veterinary Medicine’s Small Animal Hospital.

Stanley Kim, BV.Sc., an associate professor of small animal surgery at UF and one of only 12 veterinary surgeons worldwide — the only one in the Southeast — who are trained in the surgical technique, performed Leo’s operation to address the dog’s chronic lameness, which had developed due to severe ankle, or hock, arthritis. The condition, common in dogs and seen frequently by veterinarians, was limiting his ability to exercise and play.

Dr. Stan Kim examines Leo’s leg on June 4, 2021.

Leo is doing great, Kim said. “We now have a promising treatment for a condition that was previously difficult to manage,” he said.

The procedure involved replacing the damaged surfaces of his joint with a prosthetic implant known as the TATE Ankle, developed by BioMedtrix. The procedure is currently in clinical evaluation at a limited number of centers around the world.

According to BioMedtrix, the prosthesis is designed to replicate the joint articular surfaces accurately after these have been carefully removed, and eliminate the pain associated with end-stage osteoarthritis of the joint.

“The TATE Ankle is the only treatment for osteoarthritis of the ankle designed to restore pain-free, full mobility,” said Betsy Sives, the company’s marketing manager. “The implant replicates the natural articular surfaces of a dog’s ankle and utilizes the latest in biomedical manufacturing and material technologies.”

The procedure involves milling out the joint with a special drill tool and directly inserting the implants together, Kim said, adding that the implants are cementless, with a porous coating that encourages the natural bone to grow onto it.

Leo’s owner, Maggie Smallwood, a third-year UF veterinary student, said his lameness issues started in his left ankle when Leo was about 2 years old. The dog she describes as her “heart dog”  — her hiking companion, barn buddy and co-pilot — had been tentatively diagnosed with osteochondritis dissecans, or OCD, a bone and cartilage condition that can lead to osteoarthritis and commonly affects young dogs.

“We managed it conservatively, with anti-inflammatory medications as needed, but Leo is very active and as he aged, the lameness was getting more frequent,” Smallwood said. “He was losing muscle mass in that limb because of it. Although Leo is a stoic dog, he would be sore after walks, hikes and especially after playing fetch.”

Smallwood had heard about the total ankle replacement procedure being offered at UF, and approached Kim while on her small animal orthopaedic rotation to inquire about it as an option for Leo. She subsequently brought Leo to UF for an exam and a CT to see if he was a good candidate for the procedure, which he was.

“After talking to Dr. Kim, who was so patient and helpful with all my questions, I decided that the opportunity to give Leo the potential for a return to full function without pain was definitely worth it,” Smallwood said. “We decided to move forward after I got off from clinics so that I could be home with him after the procedure.”

Smallwood said the surgery experience went well, with numerous UF veterinarians and technicians keeping her in the loop and checking on Leo during his recovery.

Dr. Stan Kim demonstrates how the prosthetic device was used in Leo’s procedure. (Photo by Louis Brems)

“Dr. Kim even let me Zoom in on the procedure to be there virtually, which was so cool,” Smallwood said.

Leo did well throughout the three-hour procedure, she said. Although her pet’s recovery was long — about three months before being cleared to work toward his preoperative lifestyle — Smallwood was prepared.

“There were some life adjustments made to accommodate his restrictions, including his confinement pen, and keep him entertained while on cage rest, but we both looked forward to his range of motion exercises and sniff breaks outside on the leash,” Smallwood said. “His recovery was super smooth and each recheck gave us great news on his recovery.”

In fact, she and Leo recently returned from a trip to North Carolina, where Leo got to go on his first hike since his surgery.

“He was like a new man,” Smallwood said. “We are looking forward to getting back on the trails full force.”

Osteoarthritis is the most common form of arthritis in dogs, affecting approximately one quarter of the population, according to the American College of Veterinary Surgeons. The ACVS describes osteoarthritis as a chronic joint disease characterized by the loss of joint cartilage, thickening of the joint capsule and new bone formation around the joint that ultimately leads to pain and limb dysfunction.

Treatment options typically involve pain relief medications and sometimes joint injections, Kim said, but they do not provide the long-term benefits now available through ankle replacement surgery.

“Previously the prognosis was guarded,” he said. “With total ankle replacement, the prognosis is much more promising.”

While recuperation from surgery will vary with each dog, Leo was using his leg the day after the procedure, Kim said.

“We would hope that dogs would use the leg by the next day, as Leo did,” he said.

Ideal candidates for the surgery would be dogs weighing over 55 pounds with chronic lameness and severe ankle arthritis. They would need to be seen at UF for an examination and X-rays.

Veterinarians with clients who have animals that might be candidates for the procedure or members of the pet-owning public seeking more information should contact the UF Small Animal Hospital at 352-392-2235.