Consultation with orthopedic surgeon

Gus at orthopedic surgeon's office

Gus at orthopedic surgeon’s office

1/16/2014

Today Gus went for his consultation with the orthopedic surgeon. We were in the room at least a solid hour while she thoroughly examined Gus and discussed our options. She covered everything in great detail.

The fact that Gus’ situation is not cut-and-dried was certainly reiterated. Is the luxation in the knees a direct result of the hip dysplasia or is just an entirely separate problem (as it is genetically inherited also)? No one has been able to answer that definitively. One might think that doesn’t matter, but in essence, it does. The biggest question I had was what procedure to do first. Our local veterinarian suggested doing FOA on the hips and see how the knees do. The surgeon however, has advised that it is probably best to do his knee(s) first. First of all, the hips will require intensive rehabilitation. If we do the hips first, his knees may not be able to tolerate all that will be required for the hip rehab. He will require a lot of inactivity at first for his knees to heal after surgery. If they are repaired first, they would more likely be up to the hip rehab. In addition, the left knee (we assume it is the knee) does come out of place on a regular basis (sometimes several times a day). When it does, he holds his leg up and is not able to put any weight on it. Clearly it hurts. Usually all it takes for it to go back in place is him just lying on that side. That apparently pushes the knee back in place. When he gets up, he walks normally…..well, normally for him. His back end does this little twisty thing. It sometimes appears as though his butt is going one way, and his legs are going another. Poor little guy is not graceful in appearance. He is still the most handsome fellow ever though, in my opinion.

His knees have inflammation and fluid. The surgeon is concerned that there may be damage to the cranial (aka anterior) cruciate ligament in each. This could easily have been caused from the kneecap moving around so much. She will not know for sure and to what degree until she gets in there during surgery. If there is, not only will she “fix” the patellar luxation, she will also do a procedure known as TTA (Tibial Tuberosity Advancement). This involves making a cut in the front part of the tibia bone and advancing this portion of bone forward in order to realign the patellar ligament so that the abnormal sliding movement within the knee joint is eliminated. A specialized bone spacer, plate and screws are used to secure the bone in place. Bone graft is collected from the top of the tibia and placed in the gap in the bone to stimulate healing. See illustration below:

before and after surgery (TTA) if ligament damage is present

before and after surgery (TTA) if ligament damage is present

His knee surgery would entail a recovery period of 8-12 weeks with him being rather inactive, which would give the bones time to heal. He would only be allowed short walks on leash. He should not be allowed to jump, which would be tough. As soon as someone gets a leash, he gets so excited and jumps like crazy. Based on everything, he then may or may not need the other knee repaired. It is possible that we may, and I stress may, be able to put off doing the other knee and the FHO on the hips indefinitely by treating with pain relievers, anti-inflammatory meds, a special diet, joint supplements, and possibly Adequan injections. It seems like a lot, but it may be better than major surgery. Even with the surgeries, the above things have been recommended by the ortho surgeon. I have done research on the above suggestions and have found they all are highly recommended by pet owners.

If it was left entirely up to me, and I had the financial means, I would have both hips replaced and both knees repaired as soon as possible. This is not just up to me though. My husband and I will have to decide what we can do. As it stands right now, I think we have agreed to get the left knee repaired and just play the wait-and-see game on everything else.

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