Luxating Patellar surgery has been recommended for your dog as a result of the patella (knee cap) slipping out of the groove that it normally sits in during the flexion and extension of the stifle (knee) joint.
Symptoms of luxating patellar are typically seen in young, small breed dogs which, early on in the disease process exhibit intermittent hopping or skipping on a back leg, with or without pain. As the disease progresses, the movement of the patella in and out of it’s groove (known as the trochlea) causes cartilage erosion, pain and lameness. Patellar luxation, when severe, can be associated with skeletal abnormalities such as bowing of the femur or tibia. Patients with medial patellar luxation are also more prone to developing cranial cruciate ligament disease.
There are a number of contributing reasons for patellar luxation; The most common is that the patella’s attachment to the tibia (shin bone) is too medial (towards the inner side), causing the patella to pull inwards as the quadricep muscle tightens and the stifle extends. Another major contributing factor is the trochlea in affected dogs is not deep enough. As the patella moves from side-to-side, the medial ridge of the trochlea wears down, making it even more difficult for the patella to maintain it’s correct position. There are four grades of patellar luxation:
Grade 1: A knee cap that can be luxated with manual pressure, but otherwise is within the groove.
Grade 2: The knee cap spontaneously luxates, is typically associated with a skipping lameness when the knee cap moves.
Grade 3: The knee cap is permanently luxated but can be manually replaced in the groove.
Grade 4: The knee cap is permanently luxated and cannot be manually replaced in the groove.
Treatment options are dependent on the grade: Surgery is strongly advised for grade 3 and 4 patellar luxation. For grade 2 medial patellar luxation, only dogs exhibiting significant clinical signs, such as lameness, are recommended for surgical management. Surgery is never advised for a grade 1 luxation, for which rehabilitation is strongly recommended.
Tibial tuberosity transposition: The most important component of the repair is to realign the insertion of the tendon spanning between the patella (kneecap) and tibia (shin bone). The bone that this tendon is attached to is cut and moved to a more appropriate position. It is pinned back into place and the bone heals gradually over the following 4-8 weeks.
Resection sulcoplasty: If the groove that the patella normally glides in is very shallow, a surgery is performed to deepen the groove. This involves removal of a wedge or block of cartilage and bone, which is replaced in a recessed position. The goals of treatment are to relieve pain, improve function and reduce the progression of arthritis by re-alignment of the patella mechanism, so that as the quadricep muscle tightens, the patella maintains it’s central position in the trochlea (groove). Surgery, in combination with exceptional postoperative care and rehabilitation can significantly improve the outcome and prognosis for dogs with grades 2, 3 and 4 patellar luxation.
For more information or to discuss this surgery in more detail with one of our veterinary surgeons please contact us on 015394 88555 or visit the referrals section of our website at www.oakhillvetgroup.co.uk
What is included?
At Oakhill Vets we strive to ensure our orthopaedic surgeries are ‘all inclusive’ and so INCLUDE the following:
- Prehabilitation consultation in our state-of-the-art Animal Rehabilitation Centre (ARC)
- Pre-anaesthetic blood screen
- Hospitalisation (up to 24 hours)
- Intravenous fluids during the anaesthetic and surgery
- General Anaesthesia / Sedation
- Post-operative medication (for up to three weeks)
- 24-hour post-operative laser / cold-pack treatment / physiotherapy
- Week one post-operative rehabilitation consultation and rehabilitation plan (in the ARC)
What is not included?
Post-operative x-rays are advised around 6-8 weeks post-operatively. These are not included in the price of the surgery.
It is important to have a thorough evaluation of your dog’s patellar luxation by your own vet prior to referral. This typically includes x-rays of the stifles and hips so as to determine the grade of luxation and any potential underlying conditions, such as hip dysplasia. While the initial assessment and x-rays are not included in the surgical fee, we would be happy to be involved at this stage. Please give us a call if you have any questions.
For dogs, with a severe torsion or bowing of the femur or tibia, straightening of these bones is performed. This is achieved by taking out a wedge of bone (sometimes in three dimensions) from the femur / tibia and repairing them using a plate and screws. These procedures are most commonly performed on larger dogs and dogs with higher grades of patellar luxation (typically grade 4+). CT scans are particularly important when planning such corrections and new bone-cut configurations may help in the three-dimensional reorientation. We are currently unable to offer these procedures at Oakhill, but are happy to discuss these cases and direct you to a Specialist who can help.
Post-operative complications associated with luxating patellar surgery are not common, but are possible. While we endeavour to give you an up-front, all-inclusive estimate, when it comes to pets recovering from surgery there is unfortunately an element of unpredictability! Treatments not included because of unexpected complications include (but are not limited to):
- Self-trauma by pet to surgical site
- Post-operative wound infection
- Post-operative fracture complications
We strongly advise rehabilitation in our Animal Rehabilitation Centre (ARC) following this surgery. We offer patients that have had surgery at Oakhill an amazing and heavily discounted 12-week post-operative rehabilitation package. Please see our ARC price list for details.
Payment is expected in full at the time of consultation or upon discharge from Oakhill Vets. If your pet is insured we would request that you pay for your their treatment and claim the funds back from your insurance company. Once you have settled the cost of any treatment we can help you complete your insurance claim form(s) at no additional charge. Direct claims may be arranged with some insurance companies and are subject to a check with our referral coordinators prior to your appointment. An administration fee is chargeable each time a direct claim is carried out by our referral coordinators. If you have any concerns about payment then please contact us prior to your consultation.
Why choose Oakhill Veterinary Referrals?
Oakhill Vets is based in Windermere in the beautiful Lake District. We are happy to take referrals from clients further afield. Let our friendly, highly skilled and experienced team of Veterinary Surgeons and Registered Veterinary Nurses look after your pet while you relax and enjoy a short break in The Lakes. For more details please phone the practice and speak to one of our helpful referral coordinators on 015394 88555.