Knee Surgery Advice

[timby]

Has anyone experienced ACL surgery for their Yorkie?
I am facing repair of luxating Patella and ACL and would like to speak to someone who has experienced this. My boy is 5 years old, 13 lbs.
I believe the surgeon is highly qualified with the best equipment possible.
Brandywine Valley Veterinary Hospital, Coatesville PA, Dr. John Moss VMD.

[107barney]

Yes many here have had this surgery done. He was 11.5 at the time and now almost 14. He has had a successful result and walks perfectly now. Our vet was a board certified veterinary surgical specialist. I felt it was important to use someone board certified through the ACVS.

[valeriejsmyth]

You definitely want board certified. Some animal hospitals have specialists that do patella surgery. Doesn't hurt to get second opinion and another perspective. Good luck

[pstinard]

Originally Posted by timby

Has anyone experienced ACL surgery for their Yorkie?
I am facing repair of luxating Patella and ACL and would like to speak to someone who has experienced this. My boy is 5 years old, 13 lbs.
I believe the surgeon is highly qualified with the best equipment possible.
Brandywine Valley Veterinary Hospital, Coatesville PA, Dr. John Moss VMD.

According to their website, Dr. Moss is an orthopedic surgeon using state of the art equipment and techniques. It doesn't say he is board certified, though. I would check around your area to see if there is a board certified surgeon nearby. If not, he could very well be a good choice. The choice is ultimately up to you, and we all wish you the best of luck with the surgery and a speedy recovery!

[OwnedByJezebel]

My Jez had it done a little over a year ago at the age of 3. I used a board certified surgeon that specializes in orthopedics who practices in a 24 hour hospital.

They need to stay overnight for this surgery, and most vet practices have someone check up on the patients at 10 pm or so and then the animals are alone all night until someone opens up and checks on them the next morning. I would not feel comfortable knowing mine was left alone overnight after surgery, so be sure they have someone there throughout the night.

TPLO surgery is very specialized. It's not easy to describe in words, but I'll try. When viewing the tibia from the side in an x-ray, a cut is made from the top of the bone over to one side in a perfect little simicircle, separating a little piece of bone that looks roughly like a quarter of a pie. That piece of bone is then rotated downward and set in place. They explained to me that they take very precise measurements so that they know exactly where they make that bone cut and exactly how many degrees in needs to be shifted to stabilize the joint. No two dogs are the same, it has to be based on the structure and measurement of each dog. Ask if they are capable of making these exact measurements.

Our surgeon has done thousand of these, has written books, and many published papers. He gives lectures across the world, trains other vets for board certification, and is an adjunct professor at Texas A&M vet school.

If you want to look into a board certified surgeon, you can start here: https://online.acvs.org/acvsssa/rfls...VENDOR_TY=VETS

The two most important things here are to choose the best surgeon and the recovery.

You are very close to a vet school, too. You've got a lot of great options.

[yorkiemom76]

My Lily had this done although she wasn't my dog at the time. Her previous owner had brought her into the vet clinic I work at to have her euthanized at 2 years old because she didn't want to spend the money for her surgery.
The Vet that owns the clinic took her in and did the surgery and I ended up taking her home several months later. She definitely gets around a lot better now than she did prior to the surgery but she still walks with a slight limp. She's 4 years old now and still very much a playful pup and sometimes when gets excited and runs through the house like a crazy dog, she'll cry out. I started giving her Cosequin and I know there are varying opinions on it but I honestly think it has made a difference. Before I started giving it to her, there would be times she would hold that leg up and not want to use it and I haven't seen her do that for a long time.

[ladyjane]

Originally Posted by OwnedByJezebel

My Jez had it done a little over a year ago at the age of 3. I used a board certified surgeon that specializes in orthopedics who practices in a 24 hour hospital.

They need to stay overnight for this surgery, and most vet practices have someone check up on the patients at 10 pm or so and then the animals are alone all night until someone opens up and checks on them the next morning. I would not feel comfortable knowing mine was left alone overnight after surgery, so be sure they have someone there throughout the night.

TPLO surgery is very specialized. It's not easy to describe in words, but I'll try. When viewing the tibia from the side in an x-ray, a cut is made from the top of the bone over to one side in a perfect little simicircle, separating a little piece of bone that looks roughly like a quarter of a pie. That piece of bone is then rotated downward and set in place. They explained to me that they take very precise measurements so that they know exactly where they make that bone cut and exactly how many degrees in needs to be shifted to stabilize the joint. No two dogs are the same, it has to be based on the structure and measurement of each dog. Ask if they are capable of making these exact measurements.

Our surgeon has done thousand of these, has written books, and many published papers. He gives lectures across the world, trains other vets for board certification, and is an adjunct professor at Texas A&M vet school.

If you want to look into a board certified surgeon, you can start here: https://online.acvs.org/acvsssa/rfls...VENDOR_TY=VETS

The two most important things here are to choose the best surgeon and the recovery.

You are very close to a vet school, too. You've got a lot of great options.

Jezebel, you and I use the same surgeon and I too will only use board certified as others have said.

To the OP: You won't find a general vet who practices in ortho surgery who does TPLO surgery as it is highly specialized with a steep learing curve. That said, not all pups need TPLO but I would only go to a vet who does them because that vet would be the best imho to determine which surgical repair would be best for your pup.

Best wishes to you in your decision making for your pup. Please keep us posted!

[Wylie's Mom]

My Wylie had LP surgery about 1.5yrs ago, and it went really smoothly. I was so nervous to have him get it, bc some describe the recovery as just a nightmare...but I didn't find it bad at all. The first several days are rough bc they're usually in full bandages and don't really understand how to stand up and go to the bathroom w/ these things on their legs, so you usually use a towel under their torso to support them until they figure it out. So, mobility at first is what makes it worrisome. Also, you really want to manage the pain too - so make sure you not only bring home pain meds, but that you ALSO have a plan in case the recommended does is not managing the pain appropriately.

You do have to control their activity levels for quite a while afterwards, with just slow walking at first to recuperate. Your vet will guide you thru how to approach increasing activity.

Our vet's office is multi-vet and one of the surgeon's there has fantastic experience in LP surgery, so we were lucky enough to have it done at Wylie's usual vet office.

Today, you'd never even know Wylie had knee issues...there is never any limping or holding a leg up so far...knock on wood.

[timby]

Can you please give me tips on recovery? I work from home mainly so he will not be alone at all for the first four weeks. Thank you very much for your reply and all this good information.

[pstinard]

Originally Posted by timby

Can you please give me tips on recovery? I work from home mainly so he will not be alone at all for the first four weeks. Thank you very much for your reply and all this good information.

When he comes home, he might very well still have a bandage on his leg. Absolutely no running or jumping allowed until after the stitches come out, and the vet gives the go ahead. Short walks to potty should be okay. We kept Bella in a small x-pen by our side in the livingroom during the days, and by the bed at night. She had to wear an e-collar to keep her from biting and licking her stitches until they were removed two weeks after surgery. We had a hard time getting her to drink liquids during the early part of her recovery, and had to be creative and make home-made salt-free chicken broth for her to drink--she didn't have any trouble eating her regular food, though. Once the stitches were out and she didn't have to wear the e-collar, she recovered quickly. The vet should give you information on what your dog is allowed to do, and what is to be avoided. Oh, and be sure that the vet gives you all of the recommended pain killers and anti-inflammatory medication that you will need.

[OwnedByJezebel]

Your recovery instruction may be slightly different from mine. If so, just follow what your vet wants. For your reference, our instructions for recovery were to restrict as such:

Week 1 and 2: confined to crate (I used an x-pen large enough for her bed, water bowl, and pee pad) and allowed only short walks on leash in order to go to the bathroom.

At the end of week 2, she went for suture removal and was then cleared for walking on leash 2-3 times per day for therapy -- but still confined otherwise. The first week (which was the third week of recovery), the time allowed was 5 minutes/session. Each week, we added 5 minutes to each session until we reached 25 minutes per session. So 5 minutes (3 times per day) in week three, 10 minutes (3 times per day) in week 4, 15 minutes (3 times per day) in week 4, etc.

It's good that you will be able to be home during the first four weeks. You're going to be feeling your way as to how to deal with the challenges of confining your recovering dog and keeping them quiet!

When they first get home, it won't be so hard, because they'll be on pain meds and really won't feel like doing anything anyway. They are going to have trouble just squatting to go to the bathroom, etc. After the first two weeks when they really start to feeling better is when the challenge begins!

I admit that I was a "nervous Nellie" for the first two weeks; I was afraid that I would do something careless that would mess up the surgery and cause it to have to be done over again -- like turn my back while she was unleashed and allow her to jump on the furniture or something. So I did my best to leave nothing to chance.

You need to think about the things that "trigger" your dog. With Jezebel, it's knocks on the front door and the ringing of the doorbell (and even the sound of one ringing on TV). At that time, she would react to birds, but only when she was outside. Now she reacts to them when she sees them through the window, too. I put a sign on the front door saying no knocks or doorbell ringing because there was a patient mending from surgery. It worked remarkably well -- UPS even left a case of wine without knocking to ask for a signature. And, of course, she was only allowed outside for potty breaks on leash, so no chasing birds. If I had to do this again today, now that she reacts to birds that she sees through the window, I would have to keep the blinds down so that she couldn't see outside and "go all terrier on us" in the x-pen.

She sleeps with us in the bed as close to me as she can get and I was worried that I might roll over on the leg, so I kept her in the x-pen in the family room and slept there next to it on the sofa for a while.

Anytime she could not have my full attention, like during cooking, cleaning, etc., she was in the x-pen -- no matter how much she hated it -- for her own safety.

They do get stir-crazy so I tried to find ways to let her out and still be safe. When I could give her proper attention, for instance while sitting at the computer or sitting watching TV, I let her out of the x-pen and used a tether to be certain (like I said, leaving nothing to chance) that she couldn't run away or jump. At the computer, I would put her bed next to me on the floor and attach one end to her harness and the other to my ankle. If I had to walk away for a bit, I would move the tether from my ankle to the leg of a chair so that she was still restrained. If she was in my lap, the tether went around my wrist. When she would sit next to me while I was watching TV, she was tethered to my wrist. I just couldn't take the risk that something would trigger her and she would jump off before I could grab her. When she started to sleep in our bed again, we tethered her there, too. So she was restrained -- one way or another -- for 8 weeks.

It's not always difficult to restrain them the whole time; they do sleep a lot and those walks 2-3 times a day starting in week three really do help them not only physically but also mentally.

At the end of the 8 weeks she was cleared for full activity ... running, jumping, you name it.

[OwnedByJezebel]

Originally Posted by pstinard

When he comes home, he might very well still have a bandage on his leg. Absolutely no running or jumping allowed until after the stitches come out, and the vet gives the go ahead. Short walks to potty should be okay. We kept Bella in a small x-pen by our side in the livingroom during the days, and by the bed at night. She had to wear an e-collar to keep her from biting and licking her stitches until they were removed two weeks after surgery. We had a hard time getting her to drink liquids during the early part of her recovery, and had to be creative and make home-made salt-free chicken broth for her to drink--she didn't have any trouble eating her regular food, though. Once the stitches were out and she didn't have to wear the e-collar, she recovered quickly. The vet should give you information on what your dog is allowed to do, and what is to be avoided. Oh, and be sure that the vet gives you all of the recommended pain killers and anti-inflammatory medication that you will need.

NO! For TPLO surgery there is no running or jumping for 8 weeks.

[alaskayorkie]

Looks like you're getting some good advice on rehab. I've been through cranial cruciate surgery three times with two dogs and have gotten pretty adept at it.

OwnedByJezebel has just been through it, and the advice is spot on. One thing I'd add: Don't try to take any shortcuts because you feel sorry for the dog. I had a friend who did that, and the dog re-injured itself jumping off a couch and had to have the surgery again!

If you have wood or tile floors, make sure the dog has a soft mat or sleeping bag in its Xpen area.

Lastly, heed the vet's advice and only do leashed walks for potty breaks. If allowed, dogs will try to break the rules and could hurt themselves. Be as cautious as you can and don't let down your guard.

My vet started a formal physical therapy program after a while. Water treadmill, obstacle courses that required them to pick up their feet. Regular treadmill...