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View Full Version : At what point does a luxating patella require surgery?



Erin2854
8th August 2011, 07:13 AM
To sum it up as short as possible, Polly is 2 1/2 and has had her knee pop out 2x since we've had her (the last time this happened was over a year ago. It popped back within 1 minute or so) and doesn't appear to be in any discomfort. Our vet confirmed that she did have a luxating patella in her right leg at her last appointment about 9 months ago. I do notice that she walks a bit stiff, like she doesn't bend her knee properly. But seems to have no actual problems with running/jumping/taking walks etc. I've had her on a glucosamine/chondroitin supplement (Cosequin) for about 4-5 months now and do seem to notice a slight improvement. Some days appear stiffer than others. She's going to be going in for a check up in a few weeks with her vet, but just thought I'd inquire as to what everyones opinions were on patella surgery if it doesn't seem to be causing any pain and doesn't pop out of joint. :? Thanks!

P.S. Her parents and grandparents have all rated "very good" from the OFA but I know that doesn't always guarantee there won't be any problems

Brian M
8th August 2011, 08:48 AM
Hi Erin

Have a read of my Rosie's patella problem .

http://www.cavaliertalk.com/forums/showthread.php?36524-Rosie-S-Patella-Operation-Tues-21-st&highlight=NORTH+WEST+SURGEONS

whittakeramy
8th August 2011, 09:32 AM
Hi, i noticed for a while that Mimi was walking funny, i think it was more noticeable at the time as she didn't have as much hair but i kept an eye on it for a month or 2 and realised it was getting worse, she was never in pain and it didn't completely pop out of joint but it did have a little wiggle when she walked and it seemed like she wasn't bending her leg so i went to the vets to see the surgeon and he said we had caught it early and so with surgery there shouldn't be any lasting damage and the quicker we got it done the better for her in the long run as she wasn't in any pain right then. She had the surgery 5 weeks ago and she is doing amazing, she is still limping a little when she is tired out but other than that the surgeon has said she has very little muscle wastage and it has been very successful. It may be a good thing just to talk with the vet, they may say surgery isn't needed but you never know.

Sabby
8th August 2011, 10:52 AM
Your vet or preferable a specialist (orthopaedic surgeon) will grade the patella. My vet couldn’t tell me half as much as the specialist could after just feeling Ebony’s leg. My ebony’s patella unfortunately was left far too late by my previous vet and should have been operated on 18 month ago. She was a grade 3 when she had the operation and the orthopaedic surgeon done a great job. But because it was left to late she has now severe arthritis. I also give her the glucosamine/chondroitin supplement. but that is for arthritis it is not going to help the luxating patella.
Ebony also has a grade 1 luxating patella in her other leg that does not need operating. The physio advised me to do a lot of lead/heel walking as this will build the muscle up and hopefully stop the decline of her other leg.
Push your vet for an answer on how bad she is or see a specialist.

Karlin
8th August 2011, 10:55 AM
Agree, it would be a good idea to get an orthopedic opinion not least if your vet is divided on what to do (and Sabby's experience is why I think it is so important to see an ortho specialist and NOT a vet alone). The problem with luxations is if they are bad enough to cause stiffness when walking etc at a young age, left alone they generally lead to early onset arthritis and a lot of pain as the dog ages. I think it is always difficult to judge pain in dogs, especially cavaliers -- they tend to wag through everything, even severe pain -- Dr Marino has said this about SM dogs filmed in the clinic who perk up and seem normal and happy when their owners visit and then slump in pain when they leave. They are also known to produce extra seratonin which is what keeps those tails wagging but also must surely keep them looking happy even when they are in pain (see the link Rod recently posted on this issue).

It sounds like Polly is borderline but if she is walking stiffly then perhaps things are sliding toward the need for surgery. That dividing line however is the subject of much dispute amongst vets and orthopedists. To me I guess the bottom line would be -- am I convincing myself a dog seems fine, when not dealing with this issue now may mean serious pain and disability -- and perhaps a shortened lifespan as a result due to pain? That's why I would get a second, orthopedic opinion if your vet is unsure. Generally vets/specialists will tend to want to operate on anything that looks over a grade 2 and grade 2 is kind of the dividing line. But as with hearts a vet may under-grade a more serious patella.

There's a lot of uncertainty on the effectiveness of glucosamine -- a rake of large scale recent long-term studies showed it does little to nothing. On the other hand I know an eminent retired (human) orthopedist and sports medicine expert who believes it is beneficial. Basically it cannot hurt but I have never seen much change in using it for my own bad knees! I do not know if it would have any benefit anyway to luxations.

I have some links on luxatting patella in the library that I think addresses the 'when to operate' issue (Dr Mike the vet answering such questions).

Brian M
8th August 2011, 11:16 AM
Hi

Fully agree with Karlin ,we got a referral from our vets to North West Surgeons and Rosie saw Mr Ben Keeley a specialist
orthopedic surgeon who graded Rosie as a 2 -21/2 and did decide to operate but on the day of the operation changed
his mind .She had recovered enough with rest and care and now exercise for it to be popstponed for the forseeable future .

RodRussell
8th August 2011, 02:16 PM
A review of luxating patellas, how they are graded, and when surgery usually is recommended, is at http://cavalierhealth.org/patellas.htm

anniemac
8th August 2011, 04:11 PM
Erin,

I'm sorry about polly. Thinking of you both.

Sent from my Droid using Tapatalk

Erin2854
8th August 2011, 04:31 PM
Excellent information, thank you everyone! I will see what the vet says at our next visit and will most likely consult and orthopedic doctor regardless. Reading the link Rod posted, it seems to be a grade 1..not quite a grade 2 (wish there was a grade 1.5 lol) as it has not dislocated in a year and has only ever happened 2x) and she never "skips". At her last visit in November, the vet said that it wasn't too bad and she may even grow out of it or it could improve with time but I have my doubts. They put pressure on it and said it does not appear that it could be popped out too easily. Thanks for the info Brian, sounds like that would have been very nerve racking! Glad that Rosie is doing better though and has escaped surgery so far! I've done a bit of research regarding the use of glucosamine/chondroitin supplements with a luxating patella and some people reported remarkable improvement which is why I figured it certainly couldn't hurt either way. Will keep you updated :)

StillPooh
8th August 2011, 04:38 PM
My personal experience was with our American Eskimo Baron. He started having patella issues when he was around a year old, but it always popped back in on its own. He was 3 years old when it popped out and didn't go back, and that's when he had surgery. Unfortunately in the dead of winter in Upper Michigan! :yikes

Erin2854
8th August 2011, 05:20 PM
He was 3 years old when it popped out and didn't go back, and that's when he had surgery. Unfortunately in the dead of winter in Upper Michigan! :yikes

Yikes! I can appreciate that one...I live in MI (although more in the southern region) but know that winters in the U.P. especially are BRUTAL

mommytoClaire
9th August 2011, 12:30 AM
Hi Erin, so sorry to hear about Polly's knees. I would certainly seek out a specialist. I'm not positive where you are located, but Michigan Veterinary Specialist in Southfield has a couple orthopedics, and of course there is always MSU, with it's great reputation. I know when my other dog was dx'd with glaucoma, I was scared how much it would cost for a consult with an ophthalmologist, but pleasantly surprised that it was less then $200 and they confirmed my Vets findings and treatment regime. It was my Vet that wanted me to go.

I know for humans, they say that the glucosamine works best with the chondroitin, as it serves as the delivery system. I have tried glucosamine for my knees (problems since my early 20's due to sports injuries)' and it never works as well without the chondroitin, at least for me. I have a good friend who is an orthopedic surgeon and says the he has patients that have had good results on this combo, BUT, if something is torn, broken or deformed, nothing will fix it but surgery. And what works for one, doesn't always work for all.

Let us know what you decide? Do you have insurance on Polly?

Erin2854
9th August 2011, 02:01 AM
Hi Erin, so sorry to hear about Polly's knees. I would certainly seek out a specialist. I'm not positive where you are located, but Michigan Veterinary Specialist in Southfield has a couple orthopedics, and of course there is always MSU, with it's great reputation. I know when my other dog was dx'd with glaucoma, I was scared how much it would cost for a consult with an ophthalmologist, but pleasantly surprised that it was less then $200 and they confirmed my Vets findings and treatment regime. It was my Vet that wanted me to go.

I know for humans, they say that the glucosamine works best with the chondroitin, as it serves as the delivery system. I have tried glucosamine for my knees (problems since my early 20's due to sports injuries)' and it never works as well without the chondroitin, at least for me. I have a good friend who is an orthopedic surgeon and says the he has patients that have had good results on this combo, BUT, if something is torn, broken or deformed, nothing will fix it but surgery. And what works for one, doesn't always work for all.

Let us know what you decide? Do you have insurance on Polly?

Thanks! I have indeed hear of Michigan Veterinary Specialists, southfield isn't too far from me. Maybe 40-45 mins. I am near Ann Arbor. MSU always makes me apprehensive to be honest, I've heard such mixed reviews from customers at work about it. Some were happy and others very displeased (have heard people say the vets there are cold hearted, poor bedside manner etc) so who knows. I do have insurance for Polly through Pet Plan :)

mommytoClaire
9th August 2011, 03:17 AM
It's a beautiful facility, and everyone was fantastic with us. We saw the sweetest Doctor, and her assistant was so gentle and kind with our sweet blind, nearly deaf dog, who shook like a leaf the whole time, not knowing where he was. They were thorough and said to call any time with any questions I might think of after leaving (hmmm, they know me well).

I don't know if they require a referral, but I doubt it. I have Petplan also.

If nothing else, I'd look them up.