At what point does a luxating patella require surgery?

[Erin2854]

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]

Hi Erin

Have a read of my Rosie's patella problem .

http://www.cavaliertalk.com/forums/s...+WEST+SURGEONS

[whittakeramy]

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]

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]

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]

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]

A review of luxating patellas, how they are graded, and when surgery usually is recommended, is at http://cavalierhealth.org/patellas.htm

[anniemac]

Erin,

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

Sent from my Droid using Tapatalk

[Erin2854]

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]

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!