Clinical and radiographic evaluation of short- and long-term outcomes of different treatments adopted for elbow medial compartment disease

Medial compartment disease is a common disorder in dogs affected by elbow dysplasia [1, 2]. Despite many treatments suggested in the literature, only few studies report comparative outcomes in the short and long term [1, 3-5]. This study reports and compares short- and long-term clinical and radiographic outcomes of dogs treated for medial compartment disease (MCD) by distal dynamic ulnar ostectomy (DUO), bi-oblique dynamic proximal ulnar osteotomy (BODPUO) and conservative management (CM). In this study, medium to large breed dogs, aged between 5 and 12 months, affected by uni/bilateral MCD and treated by DUO, BODPUO or CM from 2016 to 2018, were enrolled and followed up for 24 months. Orthopedic and radiographic examinations were performed at 0 (T0), 2 (T2), 12 (T12) and 24 (T24) months after treatment. Lameness score, elbow arthralgia, elbow range of motion (ROM), osteoarthritis (OA) score and percentage of ulnar subtrochlear sclerosis (%STS) [6] were evaluated at each time point. Dogs were divided into three groups according to the treatment performed: DUO, BODPUO and CM. Forty-five elbows from 26 dogs, treated with DUO (n=17), BODPUO (n=17) or CM (n=11), were prospectively enrolled in the study. The patients enrolled in the CM group were older and showed more severe radiographic signs of OA compared to those enrolled in the other two groups. Lameness and elbow arthralgia scores, ROM, OA score and %STS were compared between groups and between different time points within each group. P<0.05 was considered statistically significant. Lameness (DUO p=0.0018; BODPUO p<0.0001) and arthralgia (DUO, BODPUO p<0.0001) scores were significantly decreased in patients that underwent surgical treatments and increased in patients managed conservatively (lameness p<0.0001; arthralgia p=0.3068) at T12 and T24, but not statistically significant difference was detected at short-term evaluation (T2) within each group compared with preoperative values. OA score (DUO, BODPUO, CM p<0.0001) and ROM worsened in every study group (DUO, CM p<0.0001; BODPUO p=0.0740), but %STS decrease in DUO (p=0.0108), increase in the CM group (p=0.0025) and remaind unchanged in the BODPUO group (p=0.2740) at T12 and T24. In particular, in DUO group, %STS significantly decreased at each time point (T2 p=0.0373, T12 p=0.0018, T24 p=0.0039) compared with preoperative values. This study supports the clinical efficacy of DUO and BODPUO in reducing lameness, arthralgia and progression of %STS. Early diagnosis and surgical attention in patients affected by MCD can improve the short- and long-therm outcome and reduce the progression of secondary changes.