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Orthopaedics and Spinal Surgery

Orthopaedics and Spinal Surgery

 

Orthopaedics and Spinal Surgery overview

  • Willows has one of the most experienced
    Small Animal Orthopaedic and Spinal Surgery teams in the UK
  • Seven highly trained Specialists…
      • with over 70 first author papers in peer reviewed journals
      • who are regularly invited to speak at conferences/CPD meetings in the UK 
        and overseas
 
  • Unsurpassed, comprehensive service,
    24 hours a day, 365 days of the year
  • Hospitalised patients benefit from
    24-hour veterinary and nursing care
  • Rapid Radiographic Reporting service
    with advice on case management
  • Free telephone advice given with
    the minimum of delay
  • Willows has one of the most experienced
    Small Animal Orthopaedic and Spinal Surgery teams in the UK
  • Eight highly trained Specialists…
    • with over 70 first author papers in peer reviewed journals
    • who are regularly invited to speak at conferences/CPD meetings in the UK and overseas
  • Unsurpassed, comprehensive service, 24 hours a day, 365 days of the year 
  • Hospitalised patients benefit from 24-hour veterinary and nursing care 
  • Rapid Radiographic Reporting service with advice on case management
  • Free telephone advice given with the minimum of delay


Personnel

RCVS/European Specialists

RCVS Diplomate

 Malcolm McKee - RCVS/European Specialists   Toby Gemmell - RCVS/European Specialist   Jonathan Pink - RCVS/European Specialist   Stephen Clarke - RCVS/European Specialist   Bill Oxley - RCVS Diplomate in Small Animal Surgery (Orthopaedics)
                 

Malcolm McKee 

BVMS MVS DSAO MACVSc MRCVS

 

Toby Gemmill 

BVSc MVM DSAS(Orth) DipECVS MRCVS


 

Jonathan Pink

BSc BVetMed CertSAS DipECVS MRCVS

 

Stephen Clarke

BVM&S DSAS(Orth) DipECVS MRCVS

 

Bill Oxley

MA VetMB DSAS(Orth) MRCVS

 

RCVS/European Specialists

Malcolm McKee - RCVS/European Specialists

Malcolm McKee
BVMS MVS DSAO MACVSc MRCVS

Toby Gemmill - RCVS/European Specialist

Toby Gemmill
BVSc MVM DSAS(Orth) DipECVS MRCVS

Jonathan Pink - RCVS/European Specialist

Jonathan Pink
BSc BVetMed CertSAS DipECVS MRCVS

Stephen Clarke - RCVS/European Specialist

Stephen Clarke
BVM&S DSAS(Orth) DipECVS MRCVS

RCVS Diplomate

Bill Oxley - RCVS Diplomate in Small Animal Surgery (Orthopaedics)

Bill Oxley
MA VetMB DSAS(Orth) MRCVS

 

RCVS/European Neurology Specialists

 

Neurology/Neurosurgeon Clinician

 

Neurology/Neurosurgeon Resident

Sebastien Behr - RCVS/European/American Neurology Specialists   Raquel Trevail - RCVS/European/American Neurology Specialists   Roberto José-López - DVM MRCVS - Veterinary Neurology Clinician   Stephanie Piazza - DVM MRCVS - Veterinary Neurology Clinician   James Elford - BVetMed MRCVS - Resident in Veterinary Neurology
                 

Sebastien Behr

DVM DipECVN MRCVS

 

Raquel Trevail

DVM DipECVN MRCVS

 

Roberto José-López

DVM MRCVS

 

Stephanie Piazza

DVM MRCVS

 

James Elford

BVetMed MRCVS

RCVS/European Neurology Specialists

Sebastien Behr - RCVS/European/American Neurology Specialists

Sebastien Behr
DVM DipECVN MRCVS

Raquel Trevail - RCVS/European/American Neurology Specialists

Raquel Trevail
DVM DipECVN MRCVS

Neurology/Neurosurgeon Clinician

Roberto José-López - DVM MRCVS - Veterinary Neurology Clinician

Roberto José-López
DVM MRCVS

Stephanie Piazza - DVM MRCVS - Veterinary Neurology Clinician

Stephanie Piazza
DVM MRCVS


Neurology/Neurosurgeon Resident

James Elford - BVetMed MRCVS - Resident in Veterinary Neurology

James Elford
BVetMed MRCVS

 

Areas of special interest 

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Lameness investigation

     

Some lameness cases can be extremely complex and require specialist training and advanced imaging in order to make a diagnosis and formulate a treatment plan. Our orthopaedic surgeons benefit from on-site:

  • Digital radiography
  • Arthroscopy
  • Computed tomography (16 slice)
  • Magnetic resonance imaging (1.5 tesla)
  • Ultrasonography
  • Interpretation by three Imaging Specialists
  Computed tomography (CT scan) at Willows

Computed tomography (CT scan) at Willows

    Humeral condylar fissure visible on CT but not shown on X-ray

Humeral condylar fissure visible on CT but not shown on X-ray

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Lameness investigation

Some lameness cases can be extremely complex and require specialist training and advanced imaging in order to make a diagnosis and formulate a treatment plan. Our orthopaedic surgeons benefit from on-site:

  • Digital radiography
  • Arthroscopy
  • Computed tomography (16 slice)
  • Magnetic resonance imaging (1.5 tesla)
  • Ultrasonography
  • Interpretation by three Imaging Specialists
Computed tomography (CT scan) at Willows

Computed tomography (CT scan) at Willows

Humeral condylar fissure visible on CT but not shown on X-ray

Humeral condylar fissure visible on CT but not shown on X-ray

 

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Arthroscopy

     
A range of chemotherapy protocols is available. Particular areas of interest include:
 
  • 1.9 mm, 2.4 mm and 2.7 mm arthroscopes
  • Enabling detailed examination of many joints, including the shoulder,
    elbow and stifle1
  • Arthroscopic surgery in selected cases, for example:
    • biceps tendon release for bicipital tenosynovitis
    • subtotal coronoidectomy for elbow dysplasia
  Arthroscopy at Willows

Arthroscopy at Willows 

    Bicipital tenosynovitis in a Labrador Retriever

Bicipital tenosynovitis ina Labrador Retriever

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Arthroscopy

A range of chemotherapy protocols is available. Particular areas of interest include:

  • 1.9 mm, 2.4 mm and 2.7 mm arthroscopes
  • Enabling detailed examination of many joints, including the shoulder,
    elbow and stifle1
  • Arthroscopic surgery in selected cases, for example:
    • biceps tendon release for bicipital tenosynovitis
    • subtotal coronoidectomy for elbow dysplasia
Arthroscopy at Willows

Arthroscopy at Willows 

Bicipital tenosynovitis in a Labrador Retriever

Bicipital tenosynovitis ina Labrador Retriever

 

TOP

Cruciate ligament surgery

     

Rupture of the cranial cruciate ligament is the most common cause of lameness in dogs. We carefully assess each patient to decide whether surgery would be beneficial. Some dogs require only a menisectomy, whilst others benefit from a tibial osteotomy to dynamically stabilise the stifle. In selected cases we perform:

  • Tibial plateau levelling osteotomy (TPLO)
  • Tibial wedge osteotomy (TWO)
  • Tibial tuberosity advancement (TTA)
  • Triple tibial osteotomy (TTO)
  TPLO in a Rottweiler

TPLO in a Rottweiler

    TWO in a Golden Retriever

TWO in a Golden Retriever

TOP

Cruciate ligament surgery

Rupture of the cranial cruciate ligament is the most common cause of lameness in dogs. We carefully assess each patient to decide whether surgery would be beneficial. Some dogs require only a menisectomy, whilst others benefit from a tibial osteotomy to dynamically stabilise the stifle. In selected cases we perform:

  • Tibial plateau levelling osteotomy (TPLO)
  • Tibial wedge osteotomy (TWO)
  • Tibial tuberosity advancement (TTA)
  • Triple tibial osteotomy (TTO)
TPLO in a Rottweiler

TPLO in a Rottweiler

TWO in a Golden Retriever

TWO in a Golden Retriever

 

TOP

Joint replacements

     

Willows is a leading Specialist centre for joint replacement surgery:

  • Over 500 hip, knee and elbow replacements have been performed in dogs
    and cats referred from all over the country, including Northern Ireland, Eire and the Channel Islands
  • We recently published the results of 78 consecutive hip replacements and
    reported good clinical results in over 95% of cases2
  • Specialists Toby Gemmill and Malcolm McKee performed the first total knee replacement in a dog in the UK
  Bilateral hybrid hip replacement in a German Shepherd Dog

Bilateral hybrid hip replacement in a German Shepherd Dog

1 Total knee replacement in a Bearded Collie    2 Cementless TATE elbow replacement in a Labrador Retriever

  1. Total knee replacement in a Bearded Collie
  2. Cementless TATE elbow replacement in a  Labrador Retriever

 

TOP

Joint replacements

Willows is a leading Specialist centre for joint replacement surgery:

  • Over 500 hip, knee and elbow replacements have been performed in dogs
    and cats referred from all over the country, including Northern Ireland, Eire and the Channel Islands
  • We recently published the results of 78 consecutive hip replacements and
    reported good clinical results in over 95% of cases2
  • Specialists Toby Gemmill and Malcolm McKee performed the first total knee replacement in a dog in the UK
Bilateral hybrid hip replacement in a German Shepherd Dog

Bilateral hybrid hip replacement in a German Shepherd Dog

1 Total knee replacement in a Bearded Collie 2 Cementless TATE elbow replacement in a Labrador Retriever

  1. Total knee replacement in a Bearded Collie
  2. Cementless TATE elbow replacement in a  Labrador Retriever

 

TOP

Fractures and joint luxations

     

We manage fractures that are both relatively straightforward and those that are very complex3. ‘Y’ fractures involving the humeral condyle are one of the most challenging fractures that orthopaedic surgeons face. We repair these articular fractures via combined medial and lateral approaches with bilateral fixation and we have reported good success with this technique4,5.

We manage joint luxations with a variety of techniques, including hinged external skeletal fixators, to optimise limb function.

  Humeral ‘Y’ fracture repair in a Clumber Spaniel with a transcondylar screw and medial and lateral plates

Humeral ‘Y’ fracture repair in a Clumber Spaniel with a transcondylar screw and medial and lateral plates

Management  of  a  shearing injury  of  the  medial malleolus  in  a  working Border Collie using a hinged transarticular fixator Management of a shearing injury of the medial malleolus in a working Border Collie using a hinged transarticular fixator

 

TOP

Fractures and joint luxations

We manage fractures that are both relatively straightforward and those that are very complex3. ‘Y’ fractures involving the humeral condyle are one of the most challenging fractures that orthopaedic surgeons face. We repair these articular fractures via combined medial and lateral approaches with bilateral fixation and we have reported good success with this technique4,5.

We manage joint luxations with a variety of techniques, including hinged external skeletal fixators, to optimise limb function.

Humeral ‘Y’ fracture repair in a Clumber Spaniel with a transcondylar screw and medial and lateral plates

Humeral ‘Y’ fracture repair in a Clumber Spaniel with a transcondylar screw and medial and lateral plates

Management  of  a  shearing injury  of  the  medial malleolus  in  a  working Border Collie using a hinged transarticular fixator

Management of a shearing injury of the medial malleolus in a working Border Collie using a hinged transarticular fixator

 

TOP

Arthrodesis

     
  • All joints with the exception of the hip can be arthrodesed
  • Function is especially good following fusion of the carpal and tarsal joints, and to a lesser degree the shoulder
  • Wherever possible we prefer replacement of elbow and stifle joints, rather than arthrodesis, due to compromised function with the latter
  • Our Specialists have published on the subject of arthrodesis6,7
  Pancarpal arthrodesis in an English Setter using orthogonal plates

Pancarpal arthrodesis in an English Setter using orthogonal plates

Pantarsal arthrodesis in a Border Collie using a customised plate

Pantarsal arthrodesis in a Border Collie using a customised plate

TOP

Arthrodesis

  • All joints with the exception of the hip can be arthrodesed
  • Function is especially good following fusion of the carpal and tarsal joints, and to a lesser degree the shoulder
  • Wherever possible we prefer replacement of elbow and stifle joints, rather than arthrodesis, due to compromised function with the latter
  • Our Specialists have published on the subject of arthrodesis6,7
Pancarpal arthrodesis in an English Setter using orthogonal plates

Pancarpal arthrodesis in an English Setter using orthogonal plates

Pantarsal arthrodesis in a Border Collie using a customised plate

Pantarsal arthrodesis in a Border Collie using a customised plate

 

TOP

Limb deformities

     

Limb deformities can be challenging and necessitate complex surgery, including correction of angular and rotational abnormalities and occasionally limb lengthening. The latter procedures require advanced training in order to minimise the potential for complications. We recently published a review on this topic8.

  Correction of severe pes varus in a Dachshund by opening wedge osteotomy and plate fixation

Correction of severe pes varus in a Dachshund by opening wedge osteotomy and plate fixation

Correction of severe pes varus in a Dachshund by opening wedge osteotomy and plate fixation

TOP

Limb deformities

Limb deformities can be challenging and necessitate complex surgery, including correction of angular and rotational abnormalities and occasionally limb lengthening. The latter procedures require advanced training in order to minimise the potential for complications. We recently published a review on this topic8.

Correction of severe pes varus in a Dachshund by opening wedge osteotomy and plate fixation Correction of severe pes varus in a Dachshund by opening wedge osteotomy and plate fixation

Correction of severe pes varus in a Dachshund by opening wedge osteotomy and plate fixation

 

TOP

Limb sparing surgery

     
  • Some dogs and cats may be suitable for a limb sparing procedure, rather than amputation, to maintain limb function
  • Limb sparing operations usually sacrifice the normal function of a joint in the limb
  • Arthrodesis of a joint is generally necessary, although occasionally the joint can be replaced
  • Limb sparing procedures can be life-saving in some patients where amputation is not an option
  Management of ectrodactyly ('lobster claw') in a West Highland White Terrier by transposition of the paw and pancarpal arthrodesis

Management of ectrodactyly ('lobster claw') in a West Highland White Terrier by transposition of the paw and pancarpal arthrodesis

Management of ectrodactyly ('lobster claw') in a West Highland White Terrier by transposition of the paw and pancarpal arthrodesis

TOP

Limb sparing surgery

  • Some dogs and cats may be suitable for a limb sparing procedure, rather than amputation, to maintain limb function
  • Limb sparing operations usually sacrifice the normal function of a joint in the limb
  • Arthrodesis of a joint is generally necessary, although occasionally the joint can be replaced
  • Limb sparing procedures can be life-saving in some patients where amputation is not an option
Management of ectrodactyly ('lobster claw') in a West Highland White Terrier by transposition of the paw and pancarpal arthrodesis Management of ectrodactyly ('lobster claw') in a West Highland White Terrier by transposition of the paw and pancarpal arthrodesis

Management of ectrodactyly ('lobster claw') in a West Highland White Terrier by transposition of the paw and pancarpal arthrodesis

 

TOP

Advanced spinal surgery

     

Our team of neurology and orthopaedic Specialists carry out advanced spinal surgery on a regular basis. Key areas of expertise include:

  • Atlantoaxial instability
  • Cervical spondylopathy (Wobbler syndrome)
  • Thoracolumbar disc protrusion
  • Degenerative lumbosacral stenosis
  • Vertebral fractures and luxations

We have developed novel techniques for managing these conditions and have published widely on these challenging cases9,10.

  Management of atlanto-axial instability in a terrier by ventral fixation with screws and bonecement

Management of atlanto-axial instability in a terrier by ventral fixation with screws and bone cement

Tantalum spinal fusion block for the management of cervical spondylopathy-associated disc protrusion in a Dobermann

Tantalum spinal fusion block for the management of cervical spondylopathy-associated disc protrusion in a Dobermann

SOP plates in the management of thoracolumbar disc protrusions in a German Shepherd Dog

SOP plates in the management of thoracolumbar disc protrusions in a German Shepherd Dog

Cervical vertebral fracture-luxation in a Dobermann managed with pins and bone cement

Cervical vertebral fracture-luxation in a Dobermann managed with pins
and bone cement

TOP

Advanced spinal surgery

Our team of neurology and orthopaedic Specialists carry out advanced spinal surgery on a regular basis. Key areas of expertise include:

  • Atlantoaxial instability
  • Cervical spondylopathy (Wobbler syndrome)
  • Thoracolumbar disc protrusion
  • Degenerative lumbosacral stenosis
  • Vertebral fractures and luxations

We have developed novel techniques for managing these conditions and have published widely on these challenging cases9,10.

Management of atlanto-axial instability in a terrier by ventral fixation with screws and bonecement

Management of atlanto-axial instability in a terrier by ventral fixation with screws and bonecement

Tantalum spinal fusion block for the management of cervical spondylopathy-associated disc protrusion in a Dobermann

Tantalum spinal fusion block for the management of cervical spondylopathy-associated disc protrusion in a Dobermann

SOP plates in the management of thoracolumbar disc protrusions in a German Shepherd Dog

SOP plates in the management of thoracolumbar disc protrusions in a German Shepherd Dog

Cervical vertebral fracture-luxation in a Dobermann managed with pins and bone cement

Cervical vertebral fracture-luxation in a Dobermann managed with pins
and bone cement

 

  1. Gemmill, T. J. and Farrell, M. Evaluation of a joint distractor to facilitate arthroscopy of the canine stifle. Veterinary Surgery 38, 588-594, 2009
  2. Gemmill, T. J. and others. Hybrid cemented/cementless total hip replacement in dogs: seventy-eight consecutive joint replacements. Veterinary Surgery 40, 621-630, 2011
  3. Gemmill, T. J. Advances in the management of diaphyseal fractures. In Practice 29, 584-593, 2007
  4. McKee, W. M. and others. Bilateral fixation of Y-T humeral condyle fractures via medial and lateral approaches in 29 dogs. Journal of Small Animal Practice 46, 217-226, 2005
  5. Macias, C. and others. Y-T humeral fractures with supracondylar comminution in five cats. Journal of Small Animal Practice 47, 89-93, 2006
  6. McKee, W. M. and others. Pantarsal arthrodesis with a customised medial or lateral bone plate in 13 dogs. Veterinary Record 154, 165-170, 2004
  7. Clarke, S. P. and others. Clinical evaluation of pancarpal arthrodesis using a CastLess plate in 11 dogs. Veterinary Surgery 38, 852-860, 2009
  8. McKee, W. M. Growth deformities of the long bones in dogs. In Practice 32, 282-291, 2010
  9. McKee, W. M. and Sharp, N. J. H. Cervical spondylopathy. In: Textbook of Small Animal Surgery. 3rd edition. Ed Slatter, pp 1180-1193, 2003
  10. Downes, C. J. and others. Hemilaminectomy and vertebral stabilisation for the treatment of thoracolumbar disc protrusion in 28 dogs. Journal of Small Animal Practice 50, 525-535, 2009

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