Luxating Patella – A Dog’s Journey
(Scroll down for the latest post-op and recovery adventures!)
Hi! I’m Skye the golden retriever and I have luxating patellas. A luxating patella is also called a trick knee or a dislocated knee. A luxating patella actually refers to the knee cap or patella when it slips out of place. Luxate means dislocate and patella means knee cap. It causes discomfort, but the knee cap pops into place if I stretch correctly–and I’ve learned how. I was told this is a condition I was probably born with, but it was just recently discovered.
I will be journaling my experience from diagnosis through surgery to post-recovery and paws crossed, surgical success. There will be ups and downs but the goal of this journal is to educate and comfort other dogs who have been diagnosed with similar conditions–not to mention calming human nerves.
So read along and wish me well as I go on a journey of healing. Ready or not, here we go…
Tuesday, August 16, 2011 – Appointment with veterinarian for annual shots. I’m a two-year-old golden retriever that loves to run in the backyard and chase my four-year-old golden playmate, Sydney. Normally, running and tumbling isn’t a problem, but sometimes my knee caps pop out. It’s a shock and it startles me, but I’ve learned to compensate by stretching my leg until it pops back in. Until today, no one has noticed it. They’ve overlooked the fact that I climb slowly onto the couch, mistaking it as being polite and meek. But today, during my physical exam, the vet spotted the issue and referred me to a specialist. My journey begins.
Monday, August 22, 2011 – Appointment with the specialist. I knew this was going to be a strange day when I wasn’t given my morning breakfast. (That’s never a good sign.) I went on a long car ride instead, to the orthopedic specialist who examined my knees and mentioned that both knee caps were floating. My right patella or knee cap is a grade 2 (the knee cap slides out of place during activity, but slides back in place with motion). My left knee cap, however is a grade 3 (the knee cap slides out of place and is out more than it is in, resulting in minimal pressure being placed on the leg during activity) and must be surgically corrected. This is concerning.
Thankfully, I am going to a very good veterinarian who is a member of the Veterinary-Orthopedic Society and the International Veterinary Academy of Pain Management. He also reviews orthopedic studies for Veterinary Surgery, a big deal medical journal. Mom says I am in good hands. He is also a friend of a family friend and right now a friend is a very good thing to have!
Before I could explain to you exactly what my surgery would entail, I needed to have x-rays taken. For that, I was sedated. I don’t remember much of what happened and I certainly don’t remember this picture, but Mom said when I came home I went potty, found a cool spot and just passed out. I’m a real light weight.
My playmate, Sydney, was kind enough to come over and comfort me. Mom said she truly acted concerned. That is nice. Caring is good right now!
But when I woke up a half hour later and saw that Sydney turned the situation into a photo op, I knew things were back to normal. Sydney 1; Skye -0-.
The x-rays need to be read by the specialist. As soon as he’s examined them, he will give Mom a call with a surgical treatment plan. There are two surgeries: the easier one that secures the knee cap and the more complicated one that involves that AND correcting a bent femur (thigh bone). If I have to pick, I’ll pick option number one because correcting a bent femur sounds ouchy. I’m really glad that he’s a specialist in surgical pain management, too.
So now I just sit and wait for the phone to ring. I think I’m getting a stomach ache.
Tuesday, August 23, 2011 – The surgeon called. Stomach ache warranted. After reviewing the x-rays, I do have a bent femur and require the more extensive surgery. Why? Because if they perform the knee cap stabilization without the femur correction, the bend of the femur may cause the problem to reoccur. So if I am going to go through surgery, I may as well have the surgery that has the higher rate for stabilizing the patella (I do not want to go through this again!) and gives me the best chance for a better life. I do have a lot of life yet to live!
My surgeon will completely cut through the thickness of my femur bone. Then he will take out a wedge to correct the femur’s bend. After that, he will stabilize the knee cap and sew me back up. Of course I exclaimed that the whole thing sounded pawsitively painful!!! The surgeon assured me that cutting through the bone is not really painful, that a fracture to the bone is actually painful because of the surrounding damage to the tissue, etc. not because of the bone itself. But the surgery will involve some surrounding tissue and there will be pain and I will be on meds. (PHEW!)
I am trusting my surgeon who says that he probably performs this type of surgery more than anyone he is aware of in the state, and that the surgery has been shown to be well tolerated in dogs. There will be no physical therapy prescribed. I could do it at my discretion, but he hasn’t seen enough evidence that added physical therapy actually helps the recovery any more than what my body will do on its own. (I was looking for a spa package–rats!)
My surgeon said there is no immediate rush for the surgery, so I am going to get my human brother off to his last year of college and let Mom and Dad attend a friend’s wedding already scheduled in California before I go under the knife. Yikes!
The surgery will be scheduled for mid-October and I will keep you updated with text and photos, so do check in on me from time to time.
Til then, paws crossed!
Monday, October 24, 2011 – My Last Night Luxating. Mom made me this cool apartment right off the kitchen. That way, she can sit next to me at the kitchen table and I can hang out while she works. It turned out really nice and I’m away from my golden sister physically, but I can still see what’s going on. It is my last night with my luxating patella. Will I miss it? I’m worried.
Tuesday, October 25, 2011 – Surgery Day! Ready or not, here I go. We left for the hospital at 6 a.m. It was a 45 minute drive, plus paperwork. They checked me in and off I went. I don’t remember much after that. I didn’t even hear the razor when it shaved my entire left side. Later, Mom told me that the surgeon called around 2 p.m. or so. He said that the surgery was a success and that I was resting comfortably. I truly was. They had me on something called morphine. I also received an epidural. I was in no pain at all.
The surgeon explained the operation this way: A shallow groove was deepened to secure my patella (knee cap). My tibia (shin bone) was then elevated to the outside. My femur was not twisted as much as suspected, but still an adjustment had to be made. He completely cut through my femur and straighten it. Then he crafted a bone to accommodate the screws that will hold the new configuration in place. My x-rays showed that both of my hips are solid. He also said that my right knee is not perfect, but it should never need to be operated on. Hooray! My prognosis post-op is excellent. The doctor is very pleased. I would be too, but I am much too out of it. I only drool…
Wednesday, October 26, 2011 – The morning after. What a difference a day makes. The epidural is wearing off. So is the morphine. Ouch! They have transitioned me to oral medication, Tramadol for pain, Rimadyl for pain and inflammation and the antibiotic, Cephalexin to ward off infection. I was surprised that the 6″ – 8″ long incision did not have a boo boo band-aid over it or an air cast. Nothing. My entire left side from my hip down to my ankle is shaved bare. I can’t put weight on the boo boo leg and I feel a little loopy. They said I ate dinner last night (don’t remember that) and I gobbled down my breakfast. The oral meds are kicking in and I think I am going to be all right.
Potty time? I’m supposed to get up? Seriously? But I did it and I tri-podded outside on leash and went potty. Potty now requires a whole different body position, but I figured out how to squat without pressure on my boo boo leg. I did it!
Mom and Dad came to pick me up at 3 p.m.
I don’t look it, but I was so happy to see them. They bought me a new toy and I got lots of hugs and kisses. After that, they took a closer look at my boo boo and the assistant told them about my medications, when I needed them and how to care for me when they got me home. Here is a picture of my boo boo.
This is what I am allowed to do: NOTHING! For the next two weeks, I am to lay around in my apartment. I can only go out on leash and I can only go potty and back. Then I take my medication and lay down again. For two whole weeks! My golden sister is going to sit on the other side of the gate and torment me. I’ll probably lose my mind. But before I do, I see the surgeon again. I don’t have stitches to take out (they are all inside), but he wants to see me to inspect the incision and make sure it is healing properly. Mom says he can also tell by looking at it whether I’ve been taking it easy or not. So I have to lay here.
If all goes well, I’ll be allowed a little more activity. Maybe a very short walk here and there but NO ROUGH-HOUSING or JUMPING for another six weeks. That takes me to the end of the year. New Year’s Day will be glorious for me. It will be a new year with a new knee. Until then, I take my drugs and await my two-week check-up.
Thursday, October 27, 2011 – Day Two Post Op
Diagnosis: Luxation-Patella-Medial-Grade III-Left
Procedure: Distal Femoral Osteotomy and MPL (Medial Patella Luxation)
Yesterday, I spent most of the day sleeping. I was alert and comfortable.
I found out some more details about yesterday. My Diagnosis was “Luxation-Patella-Medial-Grade III-Left”. During the operation, in addition to anesthesia, they performed a bupivacaine/morphine epidural so I didn’t feel the incision made on my left stifle. They surgeon deepened the trochlear groove, that part where the patella or kneecap makes contact with the femur or thigh bone. The patella (kneecap) is supposed to move up and down vertically along this trochlear groove. If it moves sideways, it produces PAIN!
My trochlear groove was not deep enough to hold my patella (kneecap) in place. My patella (kneecap) was floating (luxating) off the track all over the place causing pain. Sometimes my patella (kneecap) floated (luxated) so far off track that it couldn’t find its way back easily. Like a kid’s wooden train set, the groove was so shallow that there was nothing there to keep the train (my patella) on the track (the trochlear groove). Everything rubbed against each other and that could’ve caused cartilage is damage. Eventually, it hurt so bad that I was lame, not using it anymore because it hurt so much!
Misplaced ligaments were then relocated to the outside of the tibia (tibial tuberosity transposition) and imbricated (overlapped).
Then they performed the osteotomy (cutting of the bone and removing a piece of bone). My femur was malformed/bent. If the femur wasn’t corrected and made straight, the bend of the femur (even with the deepened trochlear groove) could push the patella (kneecap) off track again. The bone had to be repaired.
The location of the part of the femur (thigh bone) down by my patella (kneecap) is the “distal femoral” part, and the “osteotomy” is the cutting of that bone. The femur was cut, a wedge of bone removed to allow for realignment and the two ends of the femur were rejoined now in a straight fashion (because of the wedge cut) and secured together with a fashioned bone plate and locking screws on the outer side of the stifle.
My medication regimen consists of:
100 mg of chewable Rimadyl per day
100 mg every 8-12 hours of Tramadol
500 mg of Cephalexin three times a day to ward off infection
Dasuquin® glucosamine/chondroitin sulfate twice a day for 6 weeks then once a day for life to decrease inflammation and joint damage.
So there you have it! I’m going back to sleep.
Friday, October 28, 2011 – What in the world is this!!!
I woke up with increased swelling, especially near my ankle, and this colorful display.
I wasn’t licking it. I swear. Mom took a picture and emailed it to the doctor.
He was not alarmed. He told her to apply warm compresses to my red inner thigh area. Within days the redness disappeared. That was weird.
Approximately November 1, 2011 – Stitches split!
Okay, so I was out pottying and pulled a bit and turned and oops—Ouchy! I hopped on three legs back into the house. Mom looked at my leg, took a picture, and emailed it to the doctor. I hope I’m not in trouble.
I was told to rest and was given another round of antibiotics for infection, just in case. In two days, it started to scab up again. Phew! I must behave myself.
Wednesday, November 9, 2011 – Two Week Post Surgery Check-up
I got out of the house!!!
Well I’m back from my first road trip since my surgery! I’m exhausted. The veterinary hospital floor sure is slippery. It was hard to keep upright and I kept wondering if I would slip and screw up my knee. But everyone was careful with me and the appointment went very well.
Prior to surgery, my lameness was a 4 (not using the leg at all). Now, my lameness is a 2 (using it slightly and limping). The doctor took me into the exam room and fully extended my knee. It felt strange but the doctor said I had no pain and good range of motion. I still hop with it bunched up, though. I’m not convinced quite yet.
For the next six weeks, everything remains the same. I have restricted activity in a confined area and should be crated when not watched. No playing with Sydney. Small walks on leash only with a 10 minute maximum for potty purposes only, then back to confinement. I just might lose my mind!
I am allowed to take a bath now. The stitches are healed. Big deal, right?
So my next appointment is December 21st. They will drug me and take x-rays. That means no food in the morning and my appointment isn’t until 2:30 p.m.!
Hopefully, four days later in my Christmas stocking I’ll receive a new ball and can go play again! Paws crossed!
Saturday, December 3, 2011 – Five and a Half Weeks Post Op: Here I am again. No change. Do you see a change? I don’t see a change. I’m being really good but I am so bored that I think I’ve lost my mind!
Tuesday, December 13, 2011 – Visitation: I was granted supervised visitation today. It was wonderful. I am so bored. Did I tell you how bored I am? What would I do without my West Paw Bumi?
Wednesday, December 21, 2011 – 8 Week Post Op Appointment with Surgeon: I haven’t had anything to eat today and it is 2:15 p.m. I’ve learned that no breakfast means I am going to get stuck with a needle. Good times. I’m kidding!
When we arrived at the vet hospital, the surgeon injected me with a drug that put me to sleep. Then he took radiographs of my left leg, the one that had the surgery. He put me out so that he could properly position the leg. He also did it because he was planning on yanking it a bit and checking for mobility.
When the radiographs were taken and the exam was over, I was given another drug to wake up. My left leg was a bit sore and I was really groggy. Mom was allowed to take me home to my confined space to rest. I ate dinner six hours later.
Mom said that doctor said that the radiographs showed that everything was in the proper position. (Then why does it hurt to walk?) He said my mobility was good, that I had a little arthritis in the surgical area already (and I’m only two!), so I would have to keep taking one tablet daily of Dasuquin for the rest of my life. It will help decrease inflammation to the area and make my joints more comfortable. He said that the knee of my other leg, the right leg, was popping in and out. We already knew that and it wasn’t as bad as the left leg. The doctor said to watch it and if I discontinued using the right leg, I would have to go through this again on the right leg. You don’t want to know what I was thinking when I heard that.
The doctor gave me a schedule to follow for the next seven weeks. It is as follows:
December 21 – 28, 2011: I get to go on longer leash walks, 15 minutes besides the regular potty breaks. I am also allowed free access to the first floor of the house. I can try to do stairs, just a few and on a controlled leash.
December 28 – January 4, 2012: My leash walks can be increased to 30 minutes. If I show any signs of discomfort, I am to scale back again. It is better to do several short walks than one big 30 minute walk.
January 4 – 11, 2012: My leash walks can be increased to 45 minutes total, split up.
Janaury 11 – 25, 2012: We do just what we were doing last week, but now on a retractable leash. Mom hates retractable leashes, so she’ll probably use the longer green leash. I can also have free roam of the entire house. Woo hoo!
January 25 – February 7, 2012: If I am comfortable with it, I can go off leash WITH supervision.
February 8, 2012: If I am doing well, I can resume normal activity.
What will normal be???
The remaining posts will be video clips of my progress as I don’t expect anything medical to be occurring and I have no further follow-up visits unless I wipe out on the ice and break the knee this time. I thought the videos might be helpful if your dog has to have the surgery. The visual will give you a better idea of what to expect.
And this video shows Skye one year post op, recovered and using the leg quite nicely.
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Bonnie Sweebe is a dog lover, dog owner, dog advocate, and rescue and service dog organization volunteer. She is also the owner of WelcomePup.com, an online dog gift delivery company.