A new study has been conducted by surgery resident Dr Charlie Brincin at Highcroft Veterinary Group (soon to be Bristol Vet Specialists) and orthopaedic surgeon Dr Matt Matiasovic at Manchester Vet Specialists.
The study has resulted in both referrals hospitals changing their systematic follow-up routines.
It determined whether radiographic examination, performed at the time of planned re-evaluation after medial patellar luxation (MPL) surgery in dogs, had an influence on the post-operative recommendations made by the clinician.
The findings demonstrated that if the dog made an uneventful recovery after surgery, was presented without owner concern and if no abnormality was found on physical examination, then radiographic findings only led to a change in recommendation in 3 percent (13/432) of these dogs.
(Recovery was defined as “uneventful” where there was no evidence of unplanned attendance to the referring practice or referral institution between postoperative discharge and the scheduled routine follow up and there was no record of complications in the clinical records.)
This reflects similar research on the influence of follow-up radiographs in human medicine, and those of previous veterinary studies on post-operative radiographs, following uncomplicated tibial plateau leveling osteotomy (TPLO).
These particular studies (Alexander et al., 2021; Olivencia-Morell et al., 2021) showed radiography had an impact on post-operative management in just 2 to 3.8 percent of cases.
As a result of the MPL and TPLO studies, Highcroft Veterinary Referrals and Manchester Veterinary Specialists will no longer systematically perform follow-up radiographs on their patients, unless clinically justified.
Charlie said: “Radiographs are not without additional costs or risks, including radiation exposure, sedation-associated risks and strain on veterinary staff.
“Radiographic intervention should be clinically justified. And our study suggests that if the dog had an uneventful recovery and is presented without owner or clinician raised concern, then repeat radiographs might not be necessary.
“This study also highlights the value of a thorough owner history and clinical examination for clinical decision-making when re-examining dogs following this orthopaedic surgery.”
The MPL study also evaluated factors that significantly increased the risk of finding radiographic abnormalities at routine follow-up and those which led to a change in post-operative recommendation.
Lameness, administration of analgesia at follow-up and history of unplanned visits prior to routine re-examination were associated with increased odds of a change in postoperative plan (P < 0.001).
In the absence of owner and clinician concerns, the odds of having a change in convalescence plans were not different whether isolated radiographic abnormalities were present or not (P = 0.641).
The Highcroft and Manchester Vet Specialists study collected data from 825 cases retrospectively, from 10 referral centers.
It investigated if these dogs had a change in post-operative management made at their follow-up appointments and the factors that had influenced this decision, such as unplanned visits prior to the routine follow-up, lameness, owner-raised concern and abnormal clinical findings or radiographic abnormality.
The study also analysed the nature of the changes made in follow-up, including prolongation of exercise restriction, additional re-examination or surgery.
