In Part 1 I explained what the condition luxating patella is, and what we we’ve been doing for our 14 month old dog who was diagnosed with it; you can read that post by clicking here. Our Labrador retriever mix Luke’s technical diagnosis is “medial patellar luxation”, which means the knee pops out to the inside (75-80% of dogs and cats have this type). The other type is “lateral patellar luxation”, in which the knee pops to the outside. What my vet told me that I didn’t know is that the bone above the knee is actually twisted with this condition which is a factor in the knee popping out, as well as the groove it moves through not being deep enough. The twisted knee cannot be corrected without major, major surgery; but the groove can be.
Disclaimer: I am not a veterinarian and I am only sharing what I’ve learned through research and our own experience. If you believe your pet has this condition, you should visit your own vet for professional advice. This post has been slightly modified from it’s original version; mostly just some rewording and formatting changes. I also added some *affiliate links. If you order products through these links we will receive a small commission, and we thank you.
I want to give you an update on Luke before getting into the treatments and prognosis for this condition. I wrote in a recent post that we had taken him off his one month rest period partially on Christmas and fully by New Year’s. We let him run around outside with his sisters (when the conditions in the yard are not too icy). We took the gates* down off the stairs so he can run up and down them freely.
During that rest time we could go days without seeing his knee popping out, though it still did occasionally. Once we relaxed his restrictions, it’s been popping out more. That’s not what we were hoping for. So when I took Sheba to the vet this week, it gave me a chance to talk about Luke with him as well. I updated him on where we’re at and his recommendation was to do the surgery. There is no reason to rush it, but whenever we choose to do it.
Now, let me back up just a bit. What is generally recommended for dogs with this condition? If they are a Grade 1 (which Luke is in his left knee), no treatment is recommended. If they are Grade 2 (Luke’s right knee), surgery is sometimes recommended depending on how the condition is affecting them. In Grades 3 and 4, surgery is always recommended. There are several different types of surgery performed, depending on the Grade. I’m not going to list all of those, but I will tell you just a bit about what would be done for Luke. First of all, this is a surgery that our own vet can perform, and it will cost us between $1500-2000 should we decide to do it.
There are two parts to the surgery, the first being a “trochlear wedge recession”, in which the groove that the patella sits in on the bone (which is too shallow with this condition) is deepened. The second part is a “tibial crest transposition” where the tibial crest is moved and pinned back to the bone, realigning the muscles in the leg. Both parts are necessary for the best results. Our vet has performed this surgery before and so far has had good results with it.
My research so far had turned up the fact that the recovery from these surgeries can be very long and rough. However, I believe those I read had dogs with Grade 3 or 4, where the surgeries are all much more involved. My vet indicated to me that the recovery for this surgery is not so bad (of course that’s easy for him to say…he doesn’t have to live with a dog who generally doesn’t want to slow down). No running or jumping for 6-8 weeks, but leash walks are allowed after a few days I believe.
My first question was: what happens if we put off the surgery? Can Luke’s condition progress from Grade 2 to 3? My vet said no. Some online research did find one website that said yes, a Grade 2 could progress to a Grade 3, but not likely to the worst Grade 4. My vet didn’t mention it but I read in more than one place that dogs with this condition are 41% more likely to suffer a cranial cruciate ligament rupture, especially if they are a higher grade and/or older. They are also highly likely to develop osteoarthritis. Though I’ve also read/heard that even with surgery they can develop arthritis.
Many veterinarians do not think surgery is warranted in a Grade 2. They advise a more conservative management consisting of the following:
- Keep your dog at a healthy weight, preferably on the lean side.
- Keep your dog moving to develop and maintain strong muscle tone. Special attention can be paid to strengthening the back legs/quadriceps muscles.
- Joint supplements. There are many to choose from that work well, we are currently (2016) using Dasuquin*.
- A low carbohydrate diet to benefit the joints.
- Other therapies could include chiropractic, acupuncture, physical therapy, and Adequan injections.
We are already doing numbers 1-4. We feed a grain free diet and even though we could do better on the diet (raw diet) I think we’re in the right direction there. The only alternative theory of those in #5 I our vet discussed was physical therapy. He’s not convinced of it helping, and he also doesn’t believe that Luke is a good candidate for it because of his fearful personality. We tend to agree with that.
So why does our vet recommend surgery when many don’t? I think he believes it will improve Luke’s quality of life. It’s not that Luke is in a lot of pain now (he seems to only occasionally experience pain when the knee pops out), but the knee does slow him down. He might be playing along and then has to stop because the knee pops out. I think our vet believes why not just fix it and be done with it? Then Luke can get on with a normal life.
So, wow, that’s a lot to take in, isn’t it? As with everything some of the information is conflicting and the answers aren’t simple. We have to do what we think is best. Right now for us that is taking a wait and see approach. We are not going to rush Luke into surgery. We’re also not going to try to slow him down. Right now our yard is icy which is making it difficult for anyone to walk normally out there, and that may be contributing to his knee popping out more. We’re going to let him be an active pup. The only restriction we’ve left up is trying to get him to use the stairs* when going on and off the couch and the bed. That’s good for all the dogs anyway.
We will try to walk him more, with special attention to trying to get some hills in there to help build up those muscles. We’re working on getting him to lose a couple of pounds, and we may try a different joint supplement if we decide the one we’re using now may not be doing good enough. None of the alternative therapies are off the table; however, deep down, I feel like surgery is inevitable, and I’m not sure we want to spend a lot of money on therapies that may or may not work. But my mind is open and no decision is necessarily permanent. We will be taking it one day at a time.
***For an update on Luke’s condition (November 2016) please visit our post: Living With a Dog’s Luxating Patella
**If you are reading this post because you are looking for more information about this condition, please read the comments section below where many readers have shared their own stories. Each story can be a great help to you.**