Knee Surgery - Yes or no?

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Knee Surgery - Yes or no?

Postby KanersHuman » Mon Sep 09, 2013 12:34 pm

Nelle is a fast runner. Since 8 or 9 months old (almost 2 now) she has been blowing 1 knee or the other out every couple of months. The limping usually stops 3 or 4 days after the injury.

It happened in Florida while out of town earlier this year so we took her to the Vet. She screamed so loud when it happened that we got really scared. Xray showed some issues but the vet said they thought she would be okay if we limited activity for a while.

FFWD to today when our vet had a specialist look at her during a normal visit. My girlfriend mentioned she sometimes hurts her leg and the specialist came in and said she needs immediate surgery on both knees. Shes walking/running just fine right now.

No xray just a physical exam so im skeptical. We are scheduling with a new vet who doesn't know Nelle to have no xrays taken. Im just going to mention that she sometimes limps after hurting herself and let them diagnose her instead of telling them what i think or what the other vet thought. I basically want a 'from scratch' diagnosis bases on the xrays and exam.

In the mean time i decided to post here and ask about knee surgery. Nelles litter mate has had multiple surgeries for the same thing. Surgery hasn't fixed anything as far as i can tell. I dont know what to do. Do i have her go through surgery knowing it might not help or ... i dont know what my other options even are. It's not like i can tell her to not run anymore. We leash walked her for a month to let her get better and she gained 6 pounds. The extra weight cant be helping bad knees right?

Have any of you had bullies with knee surgery? Did it solve the frequent blowouts?
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Re: Knee Surgery - Yes or no?

Postby jamielvsaustin » Mon Sep 09, 2013 3:11 pm

I don't know anything about xrays, so I googled "normal dog knee xrays"....I have no idea what I'm looking at...but if you decide to do that-you shouldn't click on the pictures. A lot of them lead to bone cancer sites. :(

My guess is, with your dog as young as he is, and a family history of knee issues-you should probably consider the surgery. I know you said you haven't seen improvement with the dogs that did have the surgery-but maybe instead of improvement it just prevented the knees from getting worse. And that's better (to me) than doing nothing. These types of dogs are really stoic...and if he's limping-it has to hurt. If it was a once or twice thing...I wouldn't think of it as a big deal. But because you can pretty much guess/know when it'll happen based on the activity of your dog (and that family history just really stands out to me) I'd be strongly considering surgery if it were my dog.
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Re: Knee Surgery - Yes or no?

Postby PITtsburgher » Mon Sep 09, 2013 4:52 pm

The Xrays look very suspicious for a CCL (cranial cruciate ligament) tear to me. Is that what the vet was talking about?

CCL tear is actually something you can be pretty sure about based on a physical exam, and is something that does much better with surgery unless we're talking about a really small dog.

That said, your vet should take the time to explain the diagnosis (whether it is CCL or something else) and the various types of surgical corrections with pros and cons of each. Definitely hold them to their responsibility to communicate thoroughly with you.
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Re: Knee Surgery - Yes or no?

Postby GoingPostal » Mon Sep 09, 2013 6:56 pm

Are you talking about ccl tears or luxating patellas or what? CCL tears do not show on xray and are usually diagnosed via a drawer test.
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Re: Knee Surgery - Yes or no?

Postby AllisonPitbullLvr » Tue Sep 10, 2013 12:10 pm

PITtsburgher wrote:The Xrays look very suspicious for a CCL (cranial cruciate ligament) tear to me. Is that what the vet was talking about?

CCL tear is actually something you can be pretty sure about based on a physical exam, and is something that does much better with surgery unless we're talking about a really small dog.

That said, your vet should take the time to explain the diagnosis (whether it is CCL or something else) and the various types of surgical corrections with pros and cons of each. Definitely hold them to their responsibility to communicate thoroughly with you.


This.
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Re: Knee Surgery - Yes or no?

Postby PITtsburgher » Tue Sep 10, 2013 4:15 pm

GoingPostal wrote:Are you talking about ccl tears or luxating patellas or what? CCL tears do not show on xray and are usually diagnosed via a drawer test.


It's totally true that you can't see the ligament itself on the X-ray, but with CCL tears you do see a very classic pattern that is caused by inflammation inside the knee joint compressing the fat pad that is normally there. Generally a diagnosis is made by a combination of the cranial drawer test (some people prefer a tibial thrust test) and radiographs... since the surgery is a big deal you want as much info as possible before cutting things open!

Luxating patellas are also diagnosed with a combination of physical exam and radiographs. Nelle's X-rays aren't the straightest view ever but I don't see any luxating patellas.
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Re: Knee Surgery - Yes or no?

Postby Misskiwi67 » Wed Sep 11, 2013 6:39 pm

Even a veterinarian cannot (should not) diagnose a CCL rupture based on x-rays alone. Yes, the pattern is there, but that pattern is related to joint inflammation, and while CCL is the most common, it is not the only reason this can occur. A physical exam is essential to making this diagnosis.

If you are unsure what you should do for your dogs injury, I recommend getting a second opinion with an orthopedic specialist.
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Re: Knee Surgery - Yes or no?

Postby mtlu » Thu Sep 12, 2013 2:38 am

I second the advice to skip the vet and find a really good orthopedic specialist in your area. Have been through this twice with my dog (and she did have surgery on both knees but a year apart) and if something ever happens with any future dogs I own, I would skip spending any more money at a regular vet and go directly to an orthopedic specialist to get a definitive diagnosis. If they are CCL tears, they get worse with time and with every new incident that your dog goes lame for a few days. There are non-surgical alternatives like conservative management but that is really hard to do with a high energy, young dog and it can take a long time, much much longer than recovery from surgery.
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Re: Knee Surgery - Yes or no?

Postby KanersHuman » Wed Oct 30, 2013 9:07 pm

Finally made it to the "Specialty Clinic" near us in Illinois. They are recommending TPLO Surgery on both knees. Apx $7000 ($3500 each). This is right in the middle of the national average of $2500-4500. A friend of mine on Long Island is spending $4300 for one knee this week for his dog.

The place we are going has 4 out of 5 stars at yelp. Most complaints are about cost. 2 or 3 complain about not having their questions answered before and after surgery. With 40 reviews mostly 5 stars dating back to 2007 i think im done looking. We are going to use this place IF we decide to go through with the TPLO surgery.

I still don't know what to do here. Our local vet is suggesting we choose a different surgery using him instead. All of them seem too eager. The specialty place wanted to operate the same day they did the consultation. Our local vet is trying really hard to get us to use him. The only place that i felt right at was in West Palm Beach earlier this year. They did those xrays i posted and told us that she may need surgery and that she may not need surgery. Maybe they didn't push it because they knew we were from out of town.

My biggest fear is that we put her through this and it doesn't help or makes it worse.
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Re: Knee Surgery - Yes or no?

Postby mtlu » Thu Oct 31, 2013 3:10 am

I think most doctors tend to push for what they know how to do, and most will specialize on one type of repair rather than the range of options so of course, each will push for the solution they can provide.

We opted for TPLO both times for Molly because of her age and energy level at the times that she blew out each knee. We did have a complication after the second TPLO and she had to have the plate removed 1.5 years after the surgery on her second knee. Her joint was inflamed and infected and after the conservative approach from the specialist we went to (involving joint taps, localized and long term antibiotics), plate removal solved the issue.

All of the surgical options have their risks but even with the need for plate removal, I don't regret the choices we made. However, I also would not say that TPLO is the only right choice to make. Think about Nelle's age, weight, energy level, her quality of life post-surgery, your lifestyle and even house layout (lots of stairs? slippery floors?) – I think all these things are important factors to inform your decision. The one vet we saw who asked us specific questions to get the whole picture was the specialist who did the plate removal - and therefore, he is the one that I recommend to people local to me if their dog needs to be operated on by orthopedic specialist. One of the other specialists we saw is crazy-good at diagnosis (got super-clear x-rays without anesthesia), rather egotistical and is at the most expensive clinic in my area, but he is the one I recommend if people only want to spend money once on a diagnosis rather than fussing around visiting multiple clinics.

Also question what each clinic provides in terms of after care/physical therapy – all of the surgical options fix the immediate problem with the torn ligaments but don't address the healing process of scar tissue buildup (which is ultimately what stabilizes the joint) and mobility issues. Have either/both of them discussed the differences in aftercare from doing one knee at a time vs doing both knees at the same time? Have either/both gone into detail about the extent of the torn ligaments and why they think their repair options are the best? Are there any other clinics in your area or within a reasonable driving distance where you can get a second opinion? There's a lot to weigh/think about, but having confidence in the vet/surgeon who is going to operate on your dog is so important.
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Re: Knee Surgery - Yes or no?

Postby KanersHuman » Fri Nov 01, 2013 9:35 pm

Our vet suggest SSL, 1 leg at a time. I like our vet but i cant say i have 100% confidence in him. Not that hes done anything wrong just that i haven't had any situation or set of circumstances that give me a reason to champion him. Anyone can be nice and hand out medication is my point.

The specialty place seems to be our areas go-to place for major surgery. They are the most expensive. They were pushy "we can do this today". They wanted to do both legs at once. I work for a high end company that has been called "expensive" and "pushy" but its because we charge what things actually cost and we make enough money to do it right the first time. So even if a client thinks it was expensive or pushy they are happy with the results and willingly come back for more.

The vet in Florida was $450 for a visit and 3 x-rays. My vet would be around $120. They had 3 people working with us at once and gave us all of our options and suggested we hold off on surgery, they suggested we give her supplements, limit activity and see if she improves on her own. Which she did. But only until the next time she ran too fast or jumped too high. I think if you take it easy the rest of your life you can live just fine with knee problems or dislocated shoulders (for example) but if you want to live normally you always run the risk of it happening again unless you have some sort of corrective surgery.

Because of these wildly different experiences/opinions/"solutions" to our problem it has be really confused about what to do. My primary concern is A.Will surgery make her better. B.What complications come with surgery. Your story about the plate removal. Reviews like "well after surgery my dog was never 100% but shes just fine thanks to TPLO". What does that mean? "Never 100%"? So is the dog 95% or 30%? Because right now nelle is 100% until she hurts herself and then shes like 85% for a few days until it heals up again. If surgery knocks her down to 85% forever then i don't know if its worth it. I would rather just keep her on a leash the rest of her life and spare her the trauma of surgery.

I had a cat when i was a kid. His mother was a true wild alley cat and he played by his own rules. He was a wild man until one day something happened to him. He came home with his face very damaged. Blood was dripping from his face. I carried him to a vet near us. I had never been there, grew up super poor, had to start working at 12 to make ends meet. I didn't know who the vet was or anything about what could be done. They took the cat at the front counter and sent me home. 3 days later they called our house and told me to pick the cat up. They stitched him up and he survived but he was never the same. He became ultra crazy frady cat. Nelle was super skiddish when we got her and shes finally come out of her shell and im so afraid of her being traumatized again.

Super stressful for me. I don't think ill ever be able to have children. I would be too afraid of making the wrong decision about everything.
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Re: Knee Surgery - Yes or no?

Postby mtlu » Tue Nov 05, 2013 11:24 am

You know, when I was researching the options for fixing Molly's knee the first time, I was super frustrated and worried and could not understand why NO ONE could tell me what which option was BEST. Having been through it twice now (and with a plate removal to boot), I can understand why that best answer is so hard to come by. There are a lot of variables and I have seen claims of dogs getting back to 100% after all of the repair options (TPLO, TTA, consevative management, stem cell therapy) but I'm kind of not convinced that there is a possibility of being 100% after any of the repairs.

Here's the thing, Nelle is at 85% when she has a limping episode, and then bounces back to 100% afterwards. So if you average that out over time, she's already not at 100%. Molly is the same, she has had periods where she is at 100% and then days here and there where she isn't - and this is post surgery I am talking about. I'm okay with that, though many friends joked about her becoming "Robo-Molly" with the metal plates, she will never be as good as new.

Pain and wear on the joints get progressively worse without ANY repair after ligament damage and stability of the knee is compromised. The goal of all of the various repair options is to stabilize the knee and help mitigate additional wear on the joints. Will arthritis set in on the joint(s) that have been repaired? Yes, but if your dog can be comfortable for a period of time before that happens, is it worth it? To me, that is what the decision-making is about - making the best long term choice that works for your dog and also for you.

We don't do any dog sports with Molly (though she loved lure coursing before she blew her first knee) but we enjoy hiking and camping and wanted to make sure that Molly can enjoy that kind of outdoor time with us. She doesn't get off leash time except in the backyard - but given her prey drive and being selective about what dogs she gets along with, her off leash time was always on the limited side anyway. Of course she would love to have to more off leash time and to be able to play with her old friend (a GSP that lives near us) but their playtime was always super-rambunctious and that's not good for her. That does make me sad and we've gone through our bouts of feeling like chocolate dog owners since we deprive her of off leash fun, but when I think of the long term, I want to be able to NOT give her pain meds/NSAIDs on a regular basis to control joint pain before she turns 10.
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Re: Knee Surgery - Yes or no?

Postby Misskiwi67 » Fri Nov 15, 2013 6:29 pm

Here's a client handout on cranial cruciate disease and the treatment options:
http://www.VeterinaryPartner.com/Conten ... C=0&A=1975

I recommend the more expensive repair for overweight dogs and young, active dogs. The replacement ligament repair (fishing line repair) performed in young dogs can wear out and break over the course of a lifetime, resulting in the need for a repeat surgery later in life.

Other than this detail, the 3 most common repair options have not been shown to be significantly difference in complications or long-term arthritis prevention. Some people report faster recoveries with the metal implant style surgeries but I don't know that this has been definitively shown. Complication rates are determined by the skill of the veterinarian performing the surgery. I always recommend using the surgeon people are most comfortable (someone who does this surgery frequently, not once every other month) and have ready access to should complications occur.

Also look into rehab if it is available in your area. This can dramatically improve success and return to function.
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Re: Knee Surgery - Yes or no?

Postby KanersHuman » Sun Jan 12, 2014 8:21 pm

I waited to schedule surgery until the week of Christmas so i could be home for a few weeks (vacation time). This coming Monday will be 3 weeks after surgery. We went with TTA on both knees. Nelle walked out of the hospital on her own Christmas Day just 3 days after surgery. At 3 weeks i can barely keep her contained. A friend of mine has a 75 pounds mix breed that looks like pit and rottweiler and or doberman. They went with TPLO on one leg at a time. His dog needed help getting up for the first 3 weeks but shes moving around fine now. Our surgeon said that she started doing TTA's ONLY after a year or data collection on TPLO and TTA success rates vs recovery time. Success rates were in line with one another but TTA recovery was much much faster. Cost is similar also so she started directing clients towards TTA.

Side Note: We made a big mistake by going to see her after surgery. We really wanted to make sure she was okay and let her know we didn't abandon her. When we got there she was very calm, hanging out, enjoying her meds. As soon as she sees us she starts heading towards the door moaning and whimpering to leave with us. It was horrible to see her so bruised and stitched and have her whine like that for the whole hour we visited with her. We should have left her alone until we were ready to pick her up two days later. When we did pick her up she was perfectly fine and happy and no crying. Surgery sucks but after they get into the recovery routine and going to visit them just makes it worse for them (my opinion) so i wont be making that mistake again.

Nelle's legs were swollen and bruised from toe to hip but she could still get up and walk on them. We had her in a safety harness for 2 weeks so that i could raise and lower her off the deck and into her bed etc. I leave it off her now. All swelling and bruising was gone in a week. Stitches came out and the surgeon says she looks great.

I almost have to cage her because of her energy level. She slipped out of my hand one day in the back yard and proceeded to jump a foot in the air a dozen times bouncing in the snow. By the end of week 1 she was done with the baby gates and bed rest and wanted to come upstairs to bed but i keep her in the family room with me on the sofa. Doc says to keep her from climbing running jumping playing for 8 weeks total (5 to go) but she has already broken all these rules and i don't know if i can keep her out of trouble :). Seriously though shes been a good sport with all the new rules. Better to have her upset about being on lock down than in pain because she didn't let her legs heal correctly.

I really liked the surgeon before the operation and i like her even more now. She was very matter of fact telling us how Nelle would experience arthritis in the future with or without the surgery. After surgery she told us that one leg was much worse than they thought and that its likely she was hurting for a year or more (she just turned 2). "Bone on bone" for one knee. So the ACL was torn and the meniscus was gone. In 5 weeks we go back for xrays and the (hopefully) final visit.

I noticed an improvement immediately with Nelle after surgery. At first it was hard to tell if the surgery had helped or if it was the pain meds making it easier for her to walk. Before surgery Nelle would rarely spend more than a minute standing before dropping to a seated position. The only time she does that now is when shes getting ready to lay down. No limping, no holding a leg up. If not for her shaved butt and legs and her new leg zippers (stitches) you wouldn't be able to tell she had surgery or any sort of medical issue at all. Keeping my fingers crossed. I don't expect her to win races but hopefully she can enjoy life again. Surgery was expensive. $6200. We had help from my boss. He paid for everything. Forever grateful. We warned her..."if you blow out your knee again we are getting you wheels" :).
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