Medial Compartment Disease

What is Medial Compartment Disease?

This condition describes the loss of cartilage on both sides or throughout the medial (inside) part of the elbow joint. This condition may be end-stage and usually accompanied by severe osteoarthritis.

Treatment options

It is important to understand that this condition can never be cured but we aim to provide management options to control the clinical signs.

Non-surgical / Conservative care

This management plan includes body weight control, exercise control and standardisation, physical therapy, anti-inflammatory pain killers and dietary supplements. This will often control the lameness but if the improvement is not long lived then alternative treatment may need to be sought.

• Regenerative medicine

This uses the body’s own cells to try to repair the lost cartilage within the joint. We can harvest stem cells in bone marrow or fat tissue which can develop into any cell (multipotent stem cells) and grow these in the laboratory. These are then injected into the joint to help ‘repair’ the diseased tissue. We can harvest platelets from the blood, using a specialised filter and inject this platelet rich plasma (PRP) into the joint which may again help ‘repair’ the diseased tissue. These techniques are in their infancy and have some positive studies. However, the clinical results need to be evaluated in much more detail but they may offer help in the future.

Surgical

• Arthroscopy (key-hole surgery)

This treatment involves placing a narrow gauge camera into the joint through a small stab incision. The joint is first assessed and the pathology identified and then any abnormal tissue can be removed or debrided (scraped away). When there is loss of cartilage throughout the joint there may be little that can be done to positively influence the condition arthroscopically. This is often used as part of the diagnostic process but some owners report improvement in their dogs post-operatively, presumably through flushing the inflammatory mediators from the joint during the procedure.

• Osteotomies

Osteotomies are where the bone is cut and realigned to alter the loading through the elbow joint. They are in the relatively early stages of development and there is little long term data available. The humerus (Sliding Humeral Osteotomy – SHO) can be cut, the bone realigned and held in place with a bone plate and screws. The surgery aims to translate the weight from the medial part of the joint to lateral, the outside, where more cartilage is present. Given the limited data available on outcome, this procedure may be considered if other procedures have proved unsuccessful.

• Joint replacement

This is for very severe, end-stage disease where no other treatment options have been successful or are available. The inside part of the joint can be replaced (Canine Unicompartmental Elbow –CUE) or the entire joint can be replaced (Total Elbow Replacement – TER). The CUE system is a new technique with limited outcome data. Whereas, TER has been around in the UK since 2004, Steve Bright being part of the team to first perform a canine TER in Europe. The technique has gone through considerable development in recent years with two systems are in commercial use now, TATE® and Sirius®. Unfortunately, despite much research and implant development the outcome still remains unpredictable with this technique.

• Arthrodesis

This again is reserved for very severe, end stage disease where no other treatment options have been successful or are available. The joint surface is removed and the humerus, radius and ulna are fused together with a bone plate or multiple plates and screws along with a bone graft usually taken from the shoulder.