This is radiograph of a dog with hip dysplasia. Both hip sockets are loose, fortunately at this early stage there are no obvious signs of arthritis.
Orthopedic surgery is very equipment intensive. You are looking at some of the $40,000 worth of equipment invested by Back Bay for the orthopedic surgeries performed by Dr. K. In addition to what you see here there is backup equipment sterile and ready in case a needed piece fails.
Advanced orthopedic surgery demands that close attention is paid to sterility. Bone infections can lead to disastrous outcomes, sometimes even necessitating the amputation of a limb. Here Dr. K is spending a full 10 minutes scrubbing his hands with special surgical soap.
While Dr. K is prepping for surgery his trained assistant Rafi is prepping the patient for surgery. He uses the same meticulous cleansing technique as Dr. K.
After Dr. K is gowned up he personally performs the final draping of the surgical site. Rafi assists Dr. K with the draping procedure. Their teamwork leads to a very efficient team and minimal anesthetic time for the patient.
This is the final look of the surgical area when Igor has completed his cleansing. This sterile stockinette covers the limb so that the only area contacted by Dr. K is where he will be making his incisions.
Dr. K will be cutting the pelvis in 3 different locations. This radiograph shows both the location of each bone cut and the order in which he will proceed.
The first incision is made in the pubic bone. Here he is using a special cautery scalpel to make his incision.
The pubic bone lies deep within the pelvis. Most of the time Dr. K has to work his magic through a small hole. Igor patiently holds instruments that give Dr. K the visualization he needs.
The pelvic bone is cut with a special instrument called a sagittal saw. It is a $4,000 piece of equipment without which the pelvic bones would be impossible to accurately cut. A 2-3 mm piece of bone is removed from the pubic bone.
The second of the 3 pelvic incisions is made in a bone called the ischium. In this bone it is not necessary to remove a piece, just cutting it suffices. Igor is dripping sterile water directly on the bone to minimize any chance of injury from the rapidly vibrating blade.
The final bone cut is made in the ilium. Once this 3rd cut is made the pelvis can be rotated. It also lies deep under muscle and requires Dr. K to work in a small opening.
The cut in the ilium needs to be stabilized for proper healing. The plate that provides this stabilization was developed by Dr. Slocum in 1982. It is made of aluminum and it is angled to give the precise amount of rotation.
This part of the procedure is the most difficult. Decisions have to be made as to the size of the plate, the length of screw that is to be inserted, and the exact location of the cut in the ilium. This is where Dr. Katcherian’s 17 years of experience come into play. Here he is taking measurements for screw placement.
The plate is anchored to the ilium with special screws. The amount of tension put on the screws that hold the plate is critical. Too little tension and the plate will come loose, too much and the screw will strip the bone, also causing the plate to come loose. Dr. K makes all his final screw adjustments with just the tip of his fingers to ensure the right amount of tension. Here he is putting in a screw with a special screwdriver.
This radiograph shows the end result of a dog that had both sides of his pelvis surgically rotated. Both sides are not performed simultaneously, usually Dr. K waits one month in between these surgeries. In this radiograph you can visualize the 3 bones incisions and the angle of the plate and how long the screws are. Also note how the heads of the femurs now have a tighter fit into the pelvis.
Dr. K is an expert at this procedure. It is common for him to train other doctors in the nuances of orthopedic surgery. Here he is assisting one of his colleagues in the proper technique to tighten the screws in the plate. Note the computer screen in the background that is monitoring anesthesia. It is just a quick glance away, and gives an added margin of safety.
Immediately after the surgery Igor gives this pet’s owner a call and explains what transpired and reviews post operative care. Most dogs stay overnight and return within 2 weeks to have stitches removed. It is trained staff like Igor that makes the team at Back Bay such a professional group.