Orthopedic Surgery: Medical Conditions
Rupture of the anterior cruciate ligament or cranial cruciate ligament
Dogs of any age or breed can tear knee ligaments, most commonly the anterior cruciate ligament (ACL) and cranial cruciate ligament (CCL). Rupturing either ligament causes varying degrees of lameness. If ruptures affect both knees or are associated with a tear of a meniscus in the knee, the injury is very debilitating.
A ruptured knee ligament is diagnosed by palpation and x-ray, but MRI can be used in subtle cases with partial tears of the ACL. Surgery is the primary treatment. There are many surgical options, but there are basically two broad categories. Extracapsular suture methods stabilize the knee outside the joint and restore the function of the cruciate ligament rather than replacing the damaged ligament. Tibial osteotomy techniques change the anatomy of the knee joint by eliminating or neutalizing the slope in the tibial plateau. Prognosis for function of the affected leg after either procedure is good to excellent for most dogs. Some dogs never fully recover due to advanced arthritis, which cannot be reversed.
Hip dysplasia is a common genetic trait of many dog breeds, but most common in large and giant breeds. It is characterized by malformation of the hip where the ball and socket of the joint do not fit properly together. The mechanical instability leads to arthritis, which can be exacerbated by obesity. The condition may be managed medically in many dogs, but some need surgical treatment.
Reduction in body weight is always recommended for successful arthritis treatment. Surgical treatments include:
- Juvenile pubic symphysiodesis, or JPS, a procedure for younger dogs that manipulates the way the pelvis grows to create a tighter hip.
- Triple pelvic osteotomy, or TPO, a surgery that increases the depth of the shallow hip socket , which allows it better connect to head of the femur, increasing the stability of the hip joint.
- Femoral head and neck excision involves removing the head of the femur. Soft tissues support the false hip joint. A fibrous pad buffers the space between to cup the femur. This surgery is used most frequently in severe cases.
- Total hip replacement has the highest rate of success, especially in severe cases, since it completely replaces the faulty joint.
The best surgical treatment depends on the age of the dog and the animal's response to medical management. The long-term prognosis for hip dysplasia depends on the procedure undertaken and how well the rehab is done.
Elbow dysplasia is a common genetic trait of many dog breeds, but most common in large and giant breeds. There are several disorders in the elbow that comprise elbow dysplasia, but all involve the growth of cartilage or the structures surrounding it. The diagnosis of elbow dysplasia is made through examination, x-rays or CT scan, and sometimes a combination of the three.
Some cases are treatable with arthroscopic surgery, while others require complicated osteotomies, where a surgeon may shorten or lengthen a bone. In older dogs, elbow dysplasia may be managed medically or surgically, depending on a variety of factors.
The prognosis for functional recovery after surgery depends on the age of the patient and severity of their condition.
Fractures, or broken bones, frequently occur when dogs and cats are hit by motor vehicles, although other accidents also result in fractures.
Before treating any fractures, we conduct a thorough examination to rule out other injuries to the head, chest, abdomen and urinary tract. Then, a diagnosis is made by x-ray. In cases where multiple traumatic injuries are suspected, CT scan is recommended.
Open fractures, where the skin is broken over the fracture or bone is exposed, are most commonly treated using external fixation, where a fixator or metal rod is used outside of the body to stabilize the bone. Closed fractures are typically treated with plates and screws placed internally to stabilize the broken bones.
The prognosis is good for most fractures. If the joint near the fracture is involved, the prognosis is often guarded due to cartilage injury within the joint. In these cases, arthritis will likely develop over the medium to long term.
Dogs become paralyzed most frequently when an intervertebral disc rapidly extrudes into the spinal canal. This condition most often occurs in smaller breed dogs; the dachshund is a classic example. The injury occurs most frequently in the region between the chest and lumbar or lower back region. The discs in the neck and just above the tail in the lower back can also be affected. Other causes of paralysis include cancer, infection, spinal fractures, and degeneration of the spinal cord.
Diagnosis is made by clinical examination and imaging the affected region. Imaging used to be made with a myelogram, but today CT or MRI is used most commonly. Prognosis depends on the cause of paralysis and the progression and degree of clinical signs. Dogs that cannot feel their toes are less likely to recover. Dogs that can move their legs or even stand assisted and have not been affected for a long time period usually recover well from surgical decompression. The recovery period after surgery typically lasts several months and nursing care is critical. It can be 3 to 6 months before you will know how well your pet will recover.