||[Mar. 29th, 2005|08:43 am]
Over the weekend Bandit started favoring his back leg and refused to use or put any weight on it. We thought it may be a pinched nerve or a pulled muscle, as we could stretch his legs out and he would be fine and walk somewhat normally for a few moments.
Mom took him to the vet yesterday and, among a plethora of genetic defects found while doing x-rays, it was determined that he had a luxated patella, an injury very common in small dog breeds. Kittsy had a luxated patella when she was a puppy and had the corrective surgery, and to see her today, you'd never know.
The problem we are facing is that if we opt to do the surgery, it's going to run us around $2000.00, and to be quite honest, at the moment, we just don't have that kind of money. Mom is taking him to a specialist to see what all can be done, but the financial worry is still there. It's not that we have a problem shelling out the cash, since he's part of the family, but it's just a matter of where to get it!
Mom is also looking at all the genetic defects that were discovered, and wondering if he is going to have a decent quality of life as he gets older. He's got issues with his spine, arthritis, displaced hips, and the risk that the other patella may luxate. She has found herself questioning whether just having him euthanized would be more humane.
I can't help but point out that our horse had many similar issues in her older life and had a wonderful quality of life. By the same standards that she is using, we should have had Jubilee put down shortly after we bought her, but instead we took care of her and made sure she never wanted for anything for the rest of her life. When she became too sore to ride, we sent her up to Phelan in the high desert to spend the remainder of her life running and playing with our friends foals. When her arthritis got so bad that she couldn't get up any longer and treatments were no longer working, we made the choice that it would be the most loving thing we could to to have her euthanized. We were blessed to have had her for the time we did, and I feel she was truly lucky that we found her when we did.
And yet, in the same token, I think Bandit deserves that chance too. He's only 4, and has shown no signs of any complications from these defects in the past. These issues have not stopped him from living a normal doggie life, and I honestly don't think that they will come into play, if they ever do, until later in his life. While a the surgery to fix his patella is going to be pricey, the thought of having him euthanized based on "what if" just seems sort of wrong to me.
Race Foster, DVM
Marty Smith, DVM
Drs. Foster & Smith, Inc.
A dog from one of the smaller breeds runs across the yard chasing a tossed ball. In mid-stride, he yelps in pain and pulls his left hind leg off of the ground. After a second, he continues limping on in a three-legged fashion. After ten minutes, the rear leg drops back down to the ground and he uses it normally. This episode occurs maybe once a week. It never really seems to bother him that much – a yelp of pain, a short period of lameness, and in a few minutes he is back to his old self. Typically, he is a small or toy breed such as a Lhasa Apso, Pekingese, Pomeranian, Poodle, or Boston Bull.
A luxating patella may affect some animals much more severely. They may hold the leg up for several days and show considerable discomfort. Dogs who have a luxating patella on both hind legs may change their entire posture, by dropping their hindquarters and holding the rear legs farther out from the body as they walk. Those most severely affected may not even use their rear legs, walking by balancing themselves on their front legs like a circus act, or holding their hindquarters completely off the ground.
Normal knee anatomy
The patella is the bone we know as the knee cap. A groove in the end of the femur allows the patella to glide up and down when the knee joint is bent back and forth. In doing so, the patella guides the action of the quadriceps muscle in the lower leg. The patella also protects the knee joint.
Looking at the lower front portion of the femur (the thigh bone) in a normal dog, you will notice two bony ridges that form a fairly deep groove in which the patella is supposed to slide up and down. These structures limit the patella’s movement to one restricted place, and in doing so, control the activity of the quadriceps muscle.
The entire system is constantly lubricated by joint fluid. It works so that there is total freedom of motion between the structures.
What occurs when the patella is luxated?
In some dogs, because of malformation or trauma, the ridges forming the patellar groove are not prominent, and a too-shallow groove is created. In a dog with shallow grooves, the patella will luxate (jump out of the groove) sideways, especially toward the inside. This causes the leg to 'lock up' with the foot held off the ground.
When the patella luxates from the groove of the femur, it usually cannot return to its normal position until the quadriceps muscle relaxes and increases in length. This explains why the affected dog may be forced to hold his leg up for a few minutes or so after the initial incident. While the muscles are contracted and the patella is luxated from its correct position, the joint is held in the flexed or bent position. The yelp is from the pain caused by the knee cap sliding across the bony ridges of the femur. Once out of position, the animal feels no discomfort and continues his activity.
Which dogs are at risk of having a luxated patella?
Smaller breeds of dogs, especially Miniature and Toy Poodles, have the highest incidence of patella luxation. Genetics can play a role.
In certain breeds that have extremely short legs such as the Basset Hound or Dachshund, patellar luxation is thought to be secondary to the abnormal shape of the femur and tibia. The curvatures of the bones in these breeds work in conjunction with the forces of the quadriceps muscles to displace the patella to the inside. Please do not misunderstand – not all members of these breeds are affected with patellar luxation, only a small portion.
What are the symptoms?
Most dogs are middle-aged, with a history of intermittent (on-again-off-again) lameness in the affected rear leg(s). An affected dog commonly stops and cries out in pain as he is running. The affected leg will be extended rearward, and for a while, the dog is unable to flex it back into the normal position.
What are the risks?
Uncorrected, the patellar ridges will wear, the groove will become even shallower and the dog will become progressively more lame. Arthritis will prematurely affect the joint, causing a permanently swollen knee with poor mobility. Therefore, a good evaluation needs to be done by your veterinarian early in the condition to prevent long-term arthritic crippling.
Treatment for luxating patellas
As would be expected, medical therapy has little corrective ability in this disorder and surgery is therefore required and is the treatment of choice. A surgical treatment is not necessary in every individual with this condition.
Surgery can alter both the affected structures and the movement of the patella. The groove at the base of the femur may be surgically deepened to better contain the knee cap. The knee cap itself may be 'tied down' laterally (on the outside) to prevent it from deviating medially (toward the inside). The bony protuberance at the site of the attachment of the quadriceps tendon on the tibia, may be cut off and then re-attached in a more lateral position. All of these procedures work well and the type performed depends on the individual case and the clinician. The animal should respond quickly after surgery and is usually completely recovered within thirty days, using his legs in normal fashion.
Because of the strong genetic relationships, we really feel that animals with this disorder should not be used for breeding. They can still be excellent pets - and those that do require surgery will usually lead perfectly normal lives without any restrictions on activity.
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Reprinted from PetEducation.com.
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