TPLO surgery opinions/experiences? (Long)

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HugABull1
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TPLO surgery opinions/experiences? (Long)

Postby HugABull1 » Wed Jun 13, 2007 1:39 pm

As many of you know, Angel's not exactly structurally correct. She's got luxating patellas on both sides, and has been symptomatic since she was 4 months old.

Her history:
- diagnosed Grade 3 luxation, medially and laterally, on both knees at 6 months old
- consulted with an orthopoedic surgeon, who couldn't guarantee good results because Angel was still young and growing. She recommended physio and reevaluating later on. Prognosis was really poor.
- did daily exercise and weekly physio visits and laser treatments for 6 months, continued with daily exercises but discontinued weekly visits for an additional six months, putting Angel at 1 1/2 years old. During this time, we saw an improvement, she went from Grade 3 luxation to Gr1 on her right leg, and Gr2 on her left.
- Over the next year, we saw an increase in symptoms again. Some limping, bowing in the stifles, general weakness in hind quarters. Had to discontinue her daily exercises as we could feel grinding, and it was uncomortable for Angel.
- saw the vet and consulted with the orthopoedic surgeon again. Angel was at this point 2 1/2-3 years old. X-rays and exams revealed significant cartilage damage in her left knee, which was now Grade 4 luxation, and some arthritis in her right knee, which was Grade 2/3. Mild hip issues (rotating out of position to compensate), and inflammation in her lumbar area resulting from everything being out of line. Her left stifle was bowing and overextending from strain of compensating. Neither the vet nor the specialist felt that Angel was a candidate for surgery at that time, as it would involve multiple procedures, and she was a high-drive, high-energy dog who would not tolerate the limited activity of recovery period. We chose "quality of life" over "quantity of life", putting her on Rimadyl for pain management, and limiting high-risk activities like fetch and running on stairs. We were told that if she blew her ACL, it would be best to put her down, and that, even if she didn't, she'd likely be crippled by age 5 or 6.

- Angel remained on the Rimadyl until early spring/late winter of last year, when she was 4. At that time, while the over-extension in her left stifle was worse, the bowing improved, as did her overall mobility. I had her reassessed by our current vet, Dr. Mann. Dr. Mann examined Angel and found that her luxation had improved quite a bit, down to a Gr.2 on the right, and Gr 2-3 on the left. He felt she could come off the Rimadyl, as long as she continued to have full mobility and not show pain. However, he did not feel she was a candidate for surgery, as she still was fairly weak in her hindquarters, and he felt that the multiple problems presented an issue, also that likely her right leg could not support her weight while the left leg was healing and vice versa.

- Angel has remained off the Rimadyl since then. With use of the springpole in the spring and summer months, we've seen continued improvement in her strength and gait. Today, I decided to visit Dr. Mann again with Angel to see if her condition has improved enough to make her a candidate for surgery. It has! Her right knee is not luxating. It is rubbing a bit, but staying within the groove. Strength in both legs is improved. Her left knee is still significantly luxating, not riding in the groove at all when it is bent, and her left stifle is still over extending. Dr. Mann feels that, if he corrects the knee, the ankle will likely improve somewhat.

So, pros and cons. If he corrects the knee, it should mean full mobility for her lifetime, and less likelihood of arthritis (which, as it is, is pretty much a certainty). Her activity will not be limited in any way after she's recovered. On the downside, there's a slightly higher chance of her injuring/damaging the right knee during recovery, and of her needing it corrected down the road, versus a healthy dog. On the other hand, it's possible that hte right knee will correct itself once it's no longer compensating for the left. The dilemma is that Angel doesn't technically *need* the surgery right now. She's not limping, is fully mobile, and doesn't seem to be uncomfortable. But, if we leave it, we're taking a gamble that when she DOES need the surgery (as she almost without a doubt will), at that time she won't be fit enough to handle it. It's kind of like a 50 year old woman with a bad hip that's not totally shot yet trying to decide between a hip replacement now, and be guaranteed it will last her lifetime, or waiting until she actually needs it at age 80, but risk being too frail to handle the surgery and recovery. And of course, there's always the (small) chance that she won't need hip replacement surgery at all, that her hip will hold out for her natural lifetime...

I'm strongly leaning towards doing the surgery, but would love to hear from folks who've had the TPLO done on their dogs. What were the results like? Were you happy with it?

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Postby HugABull1 » Wed Jun 13, 2007 2:07 pm

hmmm, I was just reading up on TPLO, and that's not what Angel would be having - I just assumed that was it, as I know the knee surgery she would have is a more complicated type.

Her cruciate is fine. What's wrong with Angel's knee is that the groove it should ride in (trochlear groove) is too shallow. Often, luxation like Angel's is caused by a ligament tear - the ligaments which hold the kneecap in it's path become torn or stretched. This type of luxation is corrected just by shortening the ligaments. However, in Angel's case, and in many congenital cases like hers, x-rays show that what's actually wrong is that a)her leg is naturally too straight (poor angulation) and b)the groove the knee should ride in is too shallow. This is corrected by digging a deeper groove and shortening the ligaments.

Okay, I just looked it up, and the procedure Angel needs is actually called an "incisional trochleaplasty". Anyone had this done to their dog?

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Postby Misskiwi67 » Wed Jun 13, 2007 3:38 pm

I haven't had it done, but I've helped with the procedure. If your vet is experienced with the procedure you should be rather pleased with the results. Your vet will actually cut off pieces of bone and pin them back in place, so its a rather painful procedure with a long recovery period (compared to say a spay surgery anyway). For dogs who are painful, its incredibly helpful long-term. For your dog, I'm not sure. If your vet suggests it, I would go for it. They certainly haven't pushed you for surgery in the past, so I don't think they have anything but your dogs best interests in mind.

Do you have access to a doggie rehab center with the swimming pools and underwater treadmills and such? If so, I HIGHLY HIGHLY recommend this post-surgery to help regain mobility, range of motion and muscle mass. I've seen nothing but spectacular results from these programs...

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Postby HugABull1 » Wed Jun 13, 2007 9:24 pm

Yes, the surgery (and the problem Angel has) is far more common in small-breed dogs.

My vet does have experience doing the procedure, although not often on a dog Angel's size. However, Angel's not huge, she's only 46lbs, so she should fare well.

I don't have a doggy rehab center in town, but there's one in the neighbouring city. It's quite expensive though, $35 for a half hour swim. They've got an excellent reputation, and are rescue-friendly, but are a bit out of my price league (especially as I'll be spending over $1000 on the surgery!). However, the weather is warming up, and we've got plenty of water in our area. I can certainly take Angel swimming myself, walk her in, and then keep her on lead to control her pace (she's a total freak for swimming - LOVES the water).

My vet says the recovery period varies. Some dogs are feeling better within 2-3 weeks, but it can take up to 12 weeks. Average time is about 6 weeks to heal. We will of course be following after care instructions to the letter, as we don't want to waste the investment by having Angel bugger it up!

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Postby Misskiwi67 » Wed Jun 13, 2007 9:54 pm

Would it be possible to talk to them about having a couple pool sessions where they could show you how to help your dog swim in a low impact manner? The idea is for them to swim at a steady pace for so many minutes, take a break to sit, swim again... maybe they can help you put together a summer excercise program at the lake where you hold onto your dog by a life jacket or something to control her movements... and then you'll know how long to let her swim and such too...

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Postby HugABull1 » Tue Jun 19, 2007 7:03 pm

Well, after much debating back and forth, and opinions from several vets, I decided to have Angel thoroughly x-rayed, rather than jumping into surgery. Idea being that, if it's just her knees that are a problem, and she's not showing lameness or pain, we should just leave it for now. However, x-rays might show another problem, or a degenerative condition that needs to be managed or treated...

So Angel had her x-rays today, and it was good news!

Her hips, which last time x-rayed (3 years ago) were showing mild dysplasia, are now perfect. I saw the x-rays myself, and the improvement is visible even to my untrained eye. Nice tight fit, good coverage.

Her knees, formerly a Grade 3 luxation on the left, and a Gr 2 luxation on the right, are now a Grade 2 luxation on the left (almost a Gr 1) and a Gr 1 luxation on the right. The left knee, which is the bad one, only occasionally moves outside of the groove on it's own.

X-rays showed why her knees luxate. The groove on her left femur is slightly on the shallow side, but not enough to cause luxation on it's own. However, her tibias both show slight bowing (a malformation she was probably born with), and both show some rotation (also something she was born with), that is worse on her left leg. The head of the left tibia has some rounding to it, which may be caused by the luxation, or might be causing the luxation - it's impossible to say which.

Her hocks (ankles) look good, although the hyperextension of her left hock is clearly visible in x-rays. However, there's no visible cause of this hyperextension on the x-ray - everything looks the way it should, which means it's caused by the ligaments.

The best part - there is no sign of arthritis in any of her joints. Spine, hips, knees, and hocks all look good!

So, at this point, the advice is, keep doing what we're doing. Daily exercise, along with exercise that concentrates on her hind quarters (springpole!). Don't worry about that hock that overextends, because, even though it looks awful, it doesn't hurt her.

It's possible that down the road Angel will require surgery. However, it's also possible she never will - many dogs live their lives with Gr2/3 luxating patellas without ever needing surgery.

I will have her x-rayed again in a year, so they can compare and look for changes, but for now, it's all good!!!

I think, with this good news, I might just decide to try a beginner's agility course with Angel :D

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Postby elegy » Tue Jun 19, 2007 7:27 pm

awesome! yay for no arthritis and yay for no surgery right now!

Red Chrome

Postby Red Chrome » Tue Jun 19, 2007 11:37 pm

I can say that when Red partially tore her ACL, I did not opt for surgery right away! I researched and researched and then decided against it.

I did Homeopathic remedies and REST for 6 weeks. I fed her 6000mg of Vit. C and also Vertex,Glucosamine,Chondroitin and Yucca. I fed her the Horse Glucosamine, it's a liquid and very Highly concentrated. I fed her a very small dose. The vet said it was OK!

After strict Rest for 6 weeks, we upped her exercise and began swimming at the river. She swam everyday for about a 1/2 hour-45 minutes each time. I tried doing it 2x a day.

Eventually we compensated the ligament with the muscle that we built on the leg. Now, the vet can not tell that the ligament was ever damaged. She will have some issues with it IF I don't keep the supplements and the exercise up.

I do NOT know anything about Luxating Patellas but hope that this helps you a little bit!!


Courtney


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