Looking for some advice from vets or others with previous experience to my dog's issue. Daisy is a 16 week old Goldendoodle and has a severe Luxating patella in her right back leg. We were referred to a surgeon by our vet and they want to do surgery ASAP as her limp is very bad and they are worried that could lead to even more issues down the road.

So, surgery is going to be about ~$1500 and the surgeon is concerned that this action, while very much needed, could lead to a blown out ACL down the road, which is another very costly surgery.

We are being told that the TAMU Small Animal Hospital might be an affordable way to have the surgery done. Does anyone have any experience with using the vet services there?

Any and all feedback is appreciated. This is a tough case as she is so young. We really want to get the healing process started ASAP.

Thanks!

[This message has been edited by Txaggrad1994 (edited 2/14/2014 12:08p).]

With hesitation I'll offer my .02. Does need to be repaired and I think your best opinion is going to come from a surgeon. There are "regular" DVM's with experience in this deal. Most of us general practitioners don't go there when better more qualified and experienced services are available. Liability if not personal comfort level. I usually have a very experienced "regular" DVM do this in my office. I suppose that ACL problems could be a sequela but I struggle to see it directly related. Without repair certainly other pathology is going to develop in the joint. AS far as TAMU. Yes your veterinarian could refer you there and it may be some less expensive but by the time you make follow up visits etc you probably won't save that much. The college is not in the business of undercutting practitioners out in the field where qualified services are available. Makes for bad blood and that is not what the school is about. Hope that gives you something to ponder and good luck

That price sounds about right. Again, as above poster said experienced general practitioners can do it, depending on comfort level. I personally would have a surgeon do it. I also have not seen a direct correlation with ACL rupture and luxating patellas...main thing keep her slim/lean and that will help alot. There are several good surgeons in the Houston area if you are located here, I can give you names but their prices are going to be similar, I'd say in the $1200-1500 range. A&M won't necessarily be any cheaper, and unless you are close by the entire days missed of work traveling up there and gas alone may make it more expensive. The care will be excellent, but so will most surgeons.

Thank you both! Glad to get your perspectives. I am very comfortable with the surgeon we have seen. BTW, I am in the DFW area. Great points about the TAMU vet school. My thinking and logic is in line with yours. Appreciate your feedback!

I've performed this surgery with success, as stated I am not a "surgeon", but a regular DVM who went to specific training to learn how to perform this procedure. That price seems logical for the Dallas market, and I'm not sure how it would cause an ACL issue either quite frankly.

Good luck

DVM

In regards to future ACL problems, the procedure to correct her luxating patella would involve getting into her growth plates as she is so young. The surgeon said in her experiences this can have an impact as the dog gets older and thus the ACL is susceptible to tearing. Glad to hear you guys don't see it being that common as the surgeon made it sound like it was a matter of when not if.

Really appreciate the input. Just hoping to get her healthy and happy! Hoping this procedure will do just that for us.

[This message has been edited by Txaggrad1994 (edited 2/14/2014 3:43p).]

Txaggiegrad - I'm an orthopedist at A&M. This is my bread and butter. As your consulting surgeon in DFW informed you, yes, severe (grade 3 or 4) patella luxation does increase risk of CCL rupture. It's well documented in our surgical literature. The reason: posterior femoropatellar pressure during quads contraction normally provides additional craniocaudal stability on top of what the ACL provides. In severe patella lux cases the patella is malpositioned/luxated most of the time, which results in excessive loads on the ACL and excessive internal rotation of the tibia. This results in an increased risk of CCL rupture in severe (grade 3-4) cases. ACL rupture ideally is treated with additional surgery.

Having said this, I recommend surgery for patella luxation based on grade of the luxation and severity of clinical signs. Even in severe cases I typically will wait until the dog is 6 months of age or so to operate. If surgery is performed when they are very young, it's possible for deformities/luxations to return as skeletal growth continues. In addition, larger breeds such as Labs will often have an additional deformity to the femur, on top of the standard problems, called femoral varus. In the severe cases if this varus is not identified and corrected with additional procedures, the standard repairs are at increased risk for failure and re luxation. Granted, we deal with a wife range of cases, many very severe that other folks don't want to take on, but dealing with these challenging cases leads to a different perspective about this disease - different - not the only perspective. Be sure to ask your surgeon to screen for femoral varus with a craniocaudal radiograph of the femur, which is different than the view obtained from a VD pelvis views. Failure to diagnose that varus and correct it if present will put the standard repairs at risk to fail, causing re-luxation. Plenty of papers on that too. Good luck to you and your dog. Feel free to PM me if needed. Glad to help if I can but I have no desire to skim cases. I come to the OB for fun and to help folks, not to pad the surgical case logs!

That's roughly what I paid outside of Houston.

Dr boogs teaching on the OB!! Thanks for the information! I rarely see luxating patella's in dogs over 20 lbs which is the only ones I touch with a blade.

FVM

Glad to help DVM. Pretty common for us to see different populations of cases. You wouldn't believe some of the knees, hips, fractures, and limb deformities that come our way.

At least half of the patella cases I see are large breed dogs with medial patella lux and other problems like CCL rupture and concurrent femoral varus. The books talk about large dogs getting lateral luxations but that's rare unless it's trauma induced or a Great Dane. In the big dogs with all those problems my preferred treatment is single session: standard patella procedures, TPLO, and femoral varus correction w distal femoral osteotomy. It sounds like a lot and it usually takes a couple of hours of surgical time but those big dogs do really really well. Most will weight bear within 1-2 days and slowly take off from there. They are glad to have a straight leg with a patella that tracks properly and a stable knee from TPLO.

Always glad to help on the OB when I can. I learn a ton on this board from others and enjoy the discussions amongst outdoors Ags, so glad to be able to provide insight when I can!

Thank you Dr Boogs! Your information is very much in line with what the surgeon has told us and that makes me feel more confident about the procedure and results! Really appreciate it!

Glad to help. I'd just suggest waiting until 6 mos or so to perform the surgery. Good luck.

Update for those interested... the puppy's left knee has a luxating patella too and we have decided to return the dog to the breeder. The surgeon, vet, breeder, and breeder's vet say it is very rare for this to happen in a bigger breed of dog in both knees. I am hoping for the best for the puppy, she is a really good dog, but the financial risk was just too great for us! Thanks for all your feedback - it was much appreciated!

Thanks for letting us know what you decided. Don't envy your position and I certainly understand your choice. Good luck to you on the next puppy!

I have a practice in Missouri City, I'll happily give you a second opinion and examine him at no charge. dvm1997atgmaildotcom

DVM

That is so incredibly generous! What is the name of your clinic?

Sienna at 6 Veterinary Hospital, I have a surgeon who comes to me to perform these surgeries.

DVM

Dvm - can you be more specific on the term "surgeon? Residency trained surgeon, board certified surgeon, or a dvm who only performs surgery. Soap box issue for me, going all the way up to the avma. But more on that offline or by pm sometime.

Boogs, email me, I see where you are coming from, I'll explain how I "word" it to clients.

DVM

Call my office for an exam and consult....

quote:

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Boogs, email me, I see where you are coming from, I'll explain how I "word" it to clients.

DVM

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Will do, interested in your perspective.

dr_boogs said:

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Txaggiegrad - I'm an orthopedist at A&M. This is my bread and butter. As your consulting surgeon in DFW informed you, yes, severe (grade 3 or 4) patella luxation does increase risk of CCL rupture. It's well documented in our surgical literature. The reason: posterior femoropatellar pressure during quads contraction normally provides additional craniocaudal stability on top of what the ACL provides. In severe patella lux cases the patella is malpositioned/luxated most of the time, which results in excessive loads on the ACL and excessive internal rotation of the tibia. This results in an increased risk of CCL rupture in severe (grade 3-4) cases. ACL rupture ideally is treated with additional surgery.

Having said this, I recommend surgery for patella luxation based on grade of the luxation and severity of clinical signs. Even in severe cases I typically will wait until the dog is 6 months of age or so to operate. If surgery is performed when they are very young, it's possible for deformities/luxations to return as skeletal growth continues. In addition, larger breeds such as Labs will often have an additional deformity to the femur, on top of the standard problems, called femoral varus. In the severe cases if this varus is not identified and corrected with additional procedures, the standard repairs are at increased risk for failure and re luxation. Granted, we deal with a wife range of cases, many very severe that other folks don't want to take on, but dealing with these challenging cases leads to a different perspective about this disease - different - not the only perspective. Be sure to ask your surgeon to screen for femoral varus with a craniocaudal radiograph of the femur, which is different than the view obtained from a VD pelvis views. Failure to diagnose that varus and correct it if present will put the standard repairs at risk to fail, causing re-luxation. Plenty of papers on that too. Good luck to you and your dog. Feel free to PM me if needed. Glad to help if I can but I have no desire to skim cases. I come to the OB for fun and to help folks, not to pad the surgical case logs!

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Hi, I came across this discussion about patellar luxation in dogs while searching the internet for financial assistance to get this surgery. I have a few questions for you, because I saw that you called this your "bread and butter" and I could really use some advice. It would be much appreciated.

I have a 2 year old American Bulldog that has a luxated patella on her back left leg. I don't know what grade it is but she does the skipping often when walking or running, and excessive walking seems to bother her. My questions are:

1) I live in Houston and am looking for a place to get this surgery done, as well as some sort of financial assistance to help with it. Suggestions? I am a single mom, and things aren't going too well at the moment financially, but I know my dog really needs this surgery.
2) Did I wait too long to have it done?
3) I saw that you someone on here said that dogs over 20 lbs rarely have this problem. My dog is almost 90 lbs. Is that not common?

I hope to hear from you, and Piper thanks you!!

While you're waiting for dr_boogs to reply, I can offer some suggestions regarding financial support. First, look into Care Credit. It allows you to make no-interest payments for 6, 12, or 18 months for any amount over $200. Most vets accept it now.

If you do not qualify for Care Credit, you can apply for assistance with DaisyCares and/or Red Rover. IF the funds are available and IF your case is approved, you could potentially get $250 from each program. So, that's $500 for free.

Hopefully you'll get the help and advice you need and good luck with Piper

We rescued an 80lb lab that would have his knees pop out of place so it's not a small dog problem. We made him lose weight and swim but the vets on here have some great advice.

CODISTENNETT said:

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Hi, I came across this discussion about patellar luxation in dogs while searching the internet for financial assistance to get this surgery. I have a few questions for you, because I saw that you called this your "bread and butter" and I could really use some advice. It would be much appreciated.

I have a 2 year old American Bulldog that has a luxated patella on her back left leg. I don't know what grade it is but she does the skipping often when walking or running, and excessive walking seems to bother her. My questions are:

1) I live in Houston and am looking for a place to get this surgery done, as well as some sort of financial assistance to help with it. Suggestions? I am a single mom, and things aren't going too well at the moment financially, but I know my dog really needs this surgery.
2) Did I wait too long to have it done?
3) I saw that you someone on here said that dogs over 20 lbs rarely have this problem. My dog is almost 90 lbs. Is that not common?

I hope to hear from you, and Piper thanks you!!

---

Happy to help, I typically only check the message boards in the evenings and on rare days that I get a chance to sit down for a few minutes and eat lunch at my desk. I'll try and answer your questions as best as possible realizing that we are on a message board and I have not examined your dog Piper nor do we have a client-patient relationship.

1) I can't recommend specific practices or specialists for surgery. I can tell you that given the fact that you have a 90 lb American Bulldog, setting finances aside, I would suggest if at all possible you at least have Piper evaluated by a board-certified small animal surgeon. An exam of this nature would allow a more complete examination, diagnoses, and discussion of treatment options, costs, prognosis, etc. Bulldogs with patella luxations can have several additional complicating issues, from deformities of the thigh bone and shin bone to concurrent ACL rupture/degeneration. Additionally, they are more challenging to safely anesthetize and recover from anesthesia without breathing difficulties. If you have a veterinarian in Houston, he or she will likely have a surgical practice in your area that your veterinarian refers challenging cases to - that is a good place to start.

Financially, as AgDarlin mentioned, many practices take Care Credit, which is a good option and helps out a lot of pet owners with sudden medical bills. Texas A&M unfortunately does not take Care Credit (long story, but it has to do with the fact that we are a public institution). We do have competitive financing options as well. There are often other means to provide some additional degree of assistance in addition to financing.

2) I'm unable to answer this question without an exam and x-rays or a CT, but again I'll mention that we treat dogs of all ages with simple and very complex patellar luxation and unless they are extreme cases, successful outcomes are common and expected even if the problem is more long-standing.

3) This problem occurs in dogs of all sizes. We often treat Danes, Pyrenees, and Newfies with patellar luxations, and of course it's common in American, English, and French Bulldogs. In larger dogs there are often more complex deformities of the thigh bone and concurrent ACL injury, which is why those dogs are often more challenging to treat successfully.

Hope this general info helps. If you'd like additional help, I'd suggest a consult call with your veterinarian so we can discuss the specific medical aspects of your case via a consultation. We do consults daily and its the first step of discussing potential need for a referral. Best regards and good luck!

I live in Houston. My 4 year old chihuahua has patellar luxation in both hind legs. She is slightly overweight at 6.8 lbs. The left side is grade 2-3 and the right side is grade 1. I first noticed a problem 6 months ago when she started missing the first step when climbing the stairs. Last week she collapsed while trying to stand on both hind legs. Now when she runs, she frequently has an issue with the left side collapsing on her. It is very disturbing to see her struggle with this. Since being diagnosed with this ailment by our vet last week, I have noticed her experience an issue with the left leg daily. I am thinking about getting the surgery for the left side but want to know about success rate and extent of recovery. Should she be able to run again? Stand on hind legs? Etc.? I am concerned about her health if she is not able to be an active dog again. She loves to run around the house, but now I am confusing her by making her stop playing - I don't want to make the leg any worse.

My vet recommends a "traveling vet" who would come to her office, use her surgery suite and perform the operation. I will not speak with this doggie orthopedic surgeion beforehand. He would rely on the diagnosis from my vet and an in person diagnosis of my dog the morning of the surgery. I am uncomfortable with this setup and thinking about contacting a specialist clinic. But there are so many to choose from. I don't know where to start.

Any guidance, suggestions, or experiences are appreciated.