Although total hip replacements for dogs are now very routine and successful surgeries, the same is not true for canine elbow replacements. It’s a similar story in human orthopaedics. It’s just much more difficult to replace a hinge joint like the elbow than a ball-and-socket joint like the hip.

The first commercially-available total elbow replacement (TER) system for dogs was developed by Mike Conzemius at Iowa State University and was thus known as the Iowa State elbow. In 2005 whilst I was at the Royal Veterinary College I performed one of the first UK canine elbow replacements using this system. The BBC were filming ‘Super Vets’ in the QMH at the time (anyone remember that?) and they followed Tango’s story from start to finish. Fortunately Tango did amazingly well. I had a card from his owners a few years ago informing me that Tango had died of old age but that he had lived a full and active life with his new elbow. Sadly not all of the Iowa State elbow cases did as well as Tango and the system did not last. In the 2010s a completely different system was released -the TATE elbow, developed by Randy Acker in the US and named after a dog of his with elbow arthritis. The TATE elbow was a much more predictable surgery but still not perfect, with implant loosening being one concern. The original TATE elbow was withdrawn from the market four or five years ago.

So, that brings us to the latest development in canine TER. Randy Acker and the team at Biomedtrix have redesigned the TATE implant and simplified the surgical technique to address some of the previous issues. This 3rd generation TATE elbow has been in clinical use with a handful of surgeons in North America since 2020 with very promising results so far. Recently I was fortunate to be amongst a small group of international surgeons invited by Biomedtrix to attend the first 3rd generation TATE course in Boston. Over the course of four days I learnt the technique, practiced on cadavers and became certified to perform 3rd generation TATE elbow replacement, meaning that The Moores Orthopaedic Clinic is now one of only 2 or 3 centres in the UK able to offer this surgery and the only centre in the south.

Elbow replacement is certainly not going to be appropriate for every dog with elbow arthritis. It’s a big surgery with a long recovery. Dogs are going to be worse before they start to get better. The expectation is that dogs will be stronger on the operated leg than on their other forelimb by 10 months after surgery. As with any surgery there will be complications. With the old elbow systems complication rates were in the region of 20-25%. The surgeons in the US who have been using the 3rd generation system for a few years now are reporting complication rates much lower than this. Nonetheless, elbow replacement is clearly not appropriate for the dog with minor elbow disease. Suitable candidates will have long-term elbow arthritis that is causing persistent pain/lameness despite conventional medical management. Dogs that have had previous major elbow surgery (e.g. PAUL, CUE, SHO) are not likely to be good candidates. Elbow replacement will of course also require a very committed owner. The implants are expensive and the surgery very involved. You can expect a total elbow replacement to cost more than a total hip replacement.

So, it’s unfortunately going to be an expensive surgery. And the aftercare will be involved and some dogs may have complications. But Tango showed me that elbow replacement can work really well and this new iteration is very promising. I left the course in Boston feeling genuinely optimistic about the future of elbow replacement in dogs.

Andy Moores BVSc DSAS(Orth) DipECVS FRCVS

RCVS Specialist in Small Animal Surgery (Orthopaedics)

EBVS European Specialist in Small Animal Surgery

Andy is one of the most experienced and qualified small animal orthopaedic surgeons in the UK. He has been performing joint replacements in dogs for over 20 years.