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  1. #1
    Puppy cliffmalecha's Avatar
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    Elbow dysplasia / PAUL procedure?

    I'm hoping someone can help us out.

    My 3 yo black lab was just diagnosed with elbow dysplasia. Unfortunately, he was misdiagnosed as a puppy and the vet said he would "grow out of it" (clearly that guy is no longer our vet). Unfortunately in the past 3 years we've been letting him run a normal life and occasionally he would have a 'putter' but ultimately would return to normal gate. One day a few months back, this led to one very aggressive day at the park that left him yelping in soreness the next morning. We just had an arthroscopy done on both elbows where they removed quite a few bone fragments. The good news is that the right elbow is fine, but his left elbow now has bone on bone contact.

    Because he's no longer a puppy, the vet surgeon is recommending the PAUL procedure. Essentially, they are going to cut the ulna and relieve the pressure in the joint capsule while attaching a metal brace to the bone. My concern is that this is a relatively new procedure (only in major practice since 2012), and they've done relatively few of them. Although this hospital is a top surgical hospital in Southern California. To get more information on the procedure, you can look at the manufacturer's website, KYON vet surgical products.

    Does anyone have any experience with this procedure? There's very little about it on the internet except for 1 thread on another board.

    Are there other alternatives we should be considering? I'm concerned that with very few procedures and less than 2 years in practice, we really dont know the outcome of the surgery and whether it will help him long term. Even the surgeon states that its "the most promising" procedure right now...

    Any help or thoughts is much appreciated!

    Thank you,

  2. #2
    Senior Dog janedoe's Avatar
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    I don't have any advice about the procedure. Zo had arthroscopy about six years ago and had a bone chip removed and a huge bone spur shaved down. I am so sorry that your pup was misdiagnosed.

    All good thoughts. What is the recovery time for that kind of procedure?

  3. #3
    Senior Dog Nancy0's Avatar
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    I haven't heard of the procedure, but if it's going to relieve the pain I think I'd be inclined to do it. I can only imagine bone on bone - ouch. My boy Niner has elbow dysplasia as well. Diagnosed at 5 months and arthroscopic surgery at 6 months. He will be 2 next month.

  4. #4
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    Hi, Welcome to the Board. So sorry to hear about the misdiagnosis. Wish I could add some advise, but never had this problem. Bone to bone not good. Very painful. Hoping someone can give you some advise regarding helping your poor pup. Second on finding out what the recovery period would be like.

    KAZ

  5. #5
    House Broken csblabmom's Avatar
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    You may want to check on the yahoo group Orthodogs. Not breed specific, but a lot of knowledgeable people there.
    Good luck with your pup. Mine goes for surgery evaluation for a ruptured ACL with LP tomorrow.

  6. #6
    Senior Dog charliebbarkin's Avatar
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    No experience here. The best direction I could point you in is to get your post count up and private message ZombieBait. I feel like she would at least know something about this. Or at a minimum she could help you with the rehab process afterward.

    Good luck, and I am so sorry you and your pup are going through this.
    Charlie and Burton


  7. #7
    Senior Dog 4Thelove's Avatar
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    Just want to say good luck to you, no experience. I am so sorry you are going through this

  8. #8
    Puppy cliffmalecha's Avatar
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    Thank you to everyone for the well wishes. I'll follow up on the suggestions. If anyone comes back here looking for information, this is a second opinion that I got from another Vet in Canada. He doesnt do the procedure (he actually works in the stem cell area), but here's his summary:

    With this in mind there have been a number of surgical developments over the last few years to try and alleviate the problems. I would agree with your vet that stem cell therapy in this case is unlikely to help significantly on its own as there is a mechanical issue that needs to be addressed.

    Total elbow replacements are not well enough developed to recommend. There are a couple of osteotomy (bone cutting) procedures that have shown promising results, but they are all relatively new and are still really having long term follow ups being reported.

    You have the PAUL system. This is a Swiss system from Kyon that focuses on changing the loading on the ulna.

    The CUE system which is American from Arthrex, which provides a new weight bearing surface in the elbow.

    The SHO is also being developed in the US and this cuts the humerus and alters the load bearing in the elbow.

    I have no personal experience of doing any of the procedures although I have seen a SHO procedure performed in Houston. The PAUL system looks slightly less invasive than the other techniques but I have not seen any long term studies that compare the results. All of the procedures have potential complications but my gut feeling is that the PAUL system is likely to have less serious issues. Whether it out performs the others is yet to be proven I feel.

  9. #9
    Chief Pooper Scooper JenC's Avatar
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    Never heard of it.

  10. #10
    Senior Dog voodoo's Avatar
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    my source of info on all three of these fairly new procedures just responded with a vague "there are several systems with different applications and a wide array of proponents/opponents"

    If you trust the doc and his resume, I guess you need to go with your gut.
    Amateur pet owner
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