A new study published in Veterinary Surgery has concluded that routine radiographs at follow up did not influence postoperative management of most dogs after MPL surgery in the absence of abnormalities on clinical history or orthopaedic examination.

The study¹, which was 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, looked at the records of 825 dogs that had been treated surgically for unilateral MPL at 10 referral centres, and then had a planned follow-up visit, including radiographs.

The frequency of, and reasons for, changes in further recovery recommendations were investigated. 

The findings demonstrated that if the dog made an uneventful² 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% (13/432) of these dogs.

Researchers say that 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^3,4 showed radiography had an impact on post-operative management in just 2%-3.8% 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 justified clinically.

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 which 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 or not isolated radiographic abnormalities were present (P = 0.641). 

References

1. Brincin, C, Payne, DJL, Grierson, J, et al. The value of routine radiographic follow up in the postoperative management of canine medial patellar luxation. Veterinary Surgery. 2023; 52( 3): 379- 387. doi:10.1111/vsu.13933
2. The 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.
3. Alexander A, Compagnone K, Grierson J, et al. Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy. Vet Surg. 2021;50(1): 44-52.
4. Olivencia-Morell PJ, Frederick SW, Forbes JN, Cross AR. Evaluation of the clinical value of routine radiographic examination during convalescence for tibial plateau-leveling osteotomy. Vet Surg. 2021;50(8):1644-1649.

PS: Whilst you're here, take a moment to see our latest job opportunities for vets.