WA Veterinary Emergency & Specialty (WAVES)

Surgery Information

What is Cranial Cruciate ligament disease?

The most common cause of hind limb lameness in dogs is a tear or rupture of the cranial cruciate ligament. This painful injury results in an unstable joint and results, if left untreated, in degenerative changes to occur in your pet’s knee joint. Rupture can occur due to trauma when the joint is rotated unexpectedly, hyperextended, or when it is hit from the side or the front. More commonly the ligament undergoes degenerative changes as your pet ages and results in initially partial tearing, which may progress to a complete rupture over time. In addition certain conformational defects, such as abnormally shaped legs, can also lead to a slow degeneration of the joint over time.

Surgery can address the instability caused by the torn ligament with several different procedures including osteotomy based surgery involving a bone cut e.g. Tibial Plateau Leveling Osteotomy, or TPLO, TTO, TWO or suture based surgery e.g. extracapsular or intracapsular suture placement. During your consultation your veterinary surgeon will examine your pet and will determine the best suitable surgery.

Postoperative care at home is critical.

Premature, uncontrolled or excessive activities risk complete or partial failure of any surgical repair. Such failure may require extensive surgery to address. Proper postoperative care will be explained to you in detail by your dog’s surgeon before and after surgery.

The long-term prognosis for animals undergoing surgical treatment for Cranial Cruciate ligament disease is good, with reports of significant improvement in up to 85-90% of the cases. While, arthritis can progress regardless of treatment type, it’s expected to be slower when surgery is performed. Therefore, lifelong multimodal osteoarthritis management is recommended for any dog with CrCLD regardless of treatment.

As with any kind of orthopedic surgery, the recovery period is crucial and the animal’s activity must be strictly limited. Patients must not be allowed to jump, play, run, climb up and down stairs, or do much more than walk quietly on a leash.

What is Hip Dysplasia?

This is a hereditary, developmental disease that affects the hip joints of dogs. Certain breeds are more likely to be affected than others. Although its occurrence in large and giant breeds is well documented, there is evidence that it may also be present in smaller breed dogs (e.g. British and Australian Bulldogs) and cats (e.g. Main Coon) as well.

Predisposing factors

The hip joint is a ‘ball and socket’ joint. Poor conformation of the hip and thigh bone structures result in a ‘looseness’ of this ball and socket joint. This looseness or laxity allows the ball part of the joint to move in and out of the socket, instead of remaining stable as it should in a healthy, normal, tight fit. This abnormal movement can create wear and tear in the joint, leading to arthritis and pain.

Clinical signs

Although signs of the disease do not typically appear until after the dog matures, puppies as young as five to six months can be affected. Hip pain, stiffness, abnormal gait patterns, and a reluctance to exercise are all possible signs of hip dysplasia.

Diagnosis

The disease is usually diagnosed using radiographs (x-rays).

Treatment

Treatment for this condition is primarily surgical. Some surgeries can be performed in young growing dogs e.g. the Triple Pelvic Osteotomy, or TPO, the bones of the pelvis are cut apart and rotated to more correct positions. For mature pets Total Hip Replacement (THR) is the procedure of choice, where a dog’s diseased hip joints are replaced with prosthetic ones. The goal of both surgeries is to provide your pet with some measure of normal activity and function and to reduce the pain associated with the condition. A very high level of success is reported with these surgeries. However, as with all major procedures, it is very important to follow your veterinary surgeon’s recommendations regarding recovery and rehabilitation.

What is elbow dysplasia?

Pathophysiology

The term elbow dysplasia refers to a developmental and degenerative disease of the elbow joint. There are several different potential causes for the problem, that may occur singly or at the same time in the same animal. Elbow dysplasia occurs primarily in medium to large breed dogs. Dogs with elbow dysplasia typically show signs of lameness before reaching one year of age, although in some cases lameness may not become apparent until middle age. The treatment for this disease can involve surgical and/or medical options. Several breeds are predisposed to elbow dysplasia including the Bernese Mountain Dog, German Shepherd, Rottweiler, Golden Retriever, and Labrador Retriever although other breeds can be affected. Commonly both elbows are affected.

Forelimb lameness is a relatively common presentation for the growing puppy. The developmental growth of the canine forelimb coupled with the potential for trauma in the active playful puppy predisposes for the developmental anomalies that lead to elbow dysplasia. Since considerable joint degeneration can occur over minimal time, it is critical to be aware of the predispositions to and early symptoms of all forms of this disease.

The term elbow dysplasia describes several condition including ununited anconeal process (UAP) osteochondritis of the medial condyle of the humerus (OCD), and fragmented coronoid process (FCP), joint incongruence and osteoarthritis (OA) are the conditions that may occur independently or concurrently in the same animal.

The canine elbow joint allows flexion and extension as well as a limited degree of external (supination) and internal (pronation) rotation. Each of these conditions may then precipitate the secondary changes associated with degenerative joint disease. The time of occurrence of UAP, OCD, and FCP is usually between the ages of four and six months. At that time, the bones and joints are incompletely formed. When the elbow joint is abnormally shaped (incongruence), weight bearing forces transmitted through the joint can result in these conditions (FCP, UAP, OCD). This developmental elbow incongruity is responsible for joint injury, which is manifested by continual cartilaginous breakdown and subsequent degenerative joint disease.

The primary source of pain in elbow dysplasia is from the increased joint pressure, joint effusion, and loose cartilage fragments. In advanced cases, erosion of the cartilage is so severe that the underlying l bone becomes exposed and eroded. Chronicity causes capsular scarring and eventually a decreased range of motion in the joint with resultant gait changes. The onset of gradual and variable clinical signs makes elbow dysplasia difficult to diagnose at an early stage in all cases.

Diagnosis

A combination of physical examination, gait analysis, palpation, radiography, CT scan, or arthroscopy may be needed to adequately diagnose the syndrome. The most common symptoms associated with elbow dysplasia include limping or short striding steps in the forelimbs, difficulty lying down or rising, lying down with elbows abducted, warming out of lameness after minimal exercise, increased lameness after heavy exercise, and frequent shifting of weight with a noticeable head bob during ambulation. Manipulation of the affected joint will results in pain, grating sensation and sound (crepitus), and swelling of the joint due to excess joint fluid. Your pet may also hold the affected limb away from its body standing or walking may be observed, and the elbow usually has a decreased range of motion.. While the presence of multiple modalities of therapeutic options allow for a reasonable return to function, it is critical to determine the presence of elbow dysplasia before the joint deteriorates beyond repair in order to achieve the best possible prognosis.

Treatment

The most common surgical intervention for elbow dysplasia involves arthroscopy, which is minimally invasive surgery. Ununited anconeal process, fragmented coronoid process, and osteochondritis all respond usually favorably if medical and surgical intervention is initiated early in the course of development and prior to severe degenerative changes.