My companion is going for patella luxation surgery; now what?

What is luxating? The term luxating means out of place or dislocated. Therefore, a luxating patella is a kneecap that 'pops out' or moves out of its normal position. Patella luxation is a common condition that affects mostly dogs but can affect some cats. A patella luxation is usually diagnosed by your veterinarian during a routine checkup or if you have taken your companion in for a checkup because you have detected an abnormality with your companion’s walking. Radiographs may be required for further diagnostics. Patella luxation is graded based on how mobile the knee cap is in the groove on the base of the femur and also the extent of the rotation of the tibia.

Grade 1: A kneecap that can be luxated with manual pressure but is otherwise within the groove.
Grade 2: The knee cap spontaneously luxates. This is typically associated with skipping
lameness when the kneecap moves out of the groove. It usually requires manual intervention to replace the patella into the correct position.
Grade 3: The kneecap is permanently luxated but can be manually replaced in the groove.
Grade 4: The kneecap is permanently luxated and cannot be manually replaced in the groove.

Surgery is not recommended for grade 1. For a grade 2 luxating patella, there are two options: physical rehabilitation to strengthen the muscles that keep the kneecap in the groove or surgical correction. Surgery is highly recommended for grades 3 and 4, especially if there is intermittent or permanent lameness.

What does the patella luxation surgery involve?

The important component of patella surgery is to realign the knee cap and/or deepen the groove. One of the surgical options for a luxating patella is a Tibial Tuberosity Transposition. Bones heal more efficiently than tendons, so the bone to which the tendon is attached is cut, re-positioned, and allowed to heal gradually over the next 4 to 8 weeks. If the patella groove is too shallow, then a surgical procedure exists to deepen the groove. This involves removing a wedge of bone (keeping the cartilage intact), removing a layer of bone from this area, and then replacing the wedge. It is called a wedge sulcoplasty or trochleoplasty.

What is the recovery time?

Your companion will initially require a 6-week period of rest, usually involving crate rest and restricted movement. This will be combined with a controlled-leash walking program.

What can I expect post-surgery?

Your dog will be painful. This is a major surgery. Use the medications. Follow veterinary instructions. Your dog will soon start to feel better and want life to return to normal. Do not be tempted! A bone takes 6 weeks to heal. Excessive forces applied to the surgical site too soon can result in severe damage and another operation. Controlled leash walks begin one week post-op and should ideally be performed three times a day. The length of he walks will increase gradually from 5 minutes per walk up to 20 minutes per walk.

What are the post-op do’s and don’ts?

No running, no jumping, and no rough playing!

Management of movement is required for a minimum of 6 weeks post-surgery, with the patient going out on a leash for potty breaks. Depending on the dog, this may mean cage rest. Pain management after knee surgery is very important. Please ensure that you use all the medications that have been prescribed until they are finished. It is important to encourage use of the leg as soon as possible and to counteract muscle wastage.

What do I need to look out for after the surgery?

Around the knee and at the wound: Swelling, Heat, Oozing, Licking of stitches, worsening of lameness instead of improvement. If any of the above occur, call your veterinarian or surgeon, or return to the practice with your dog.

Will my companion need physio?

Yes, the patient will require physiotherapy after the surgery. This will help speed up the healing and strengthen the operated limb, setting up the procedure for greater success.

When should I book an assessment for my companion?

As soon as your companion goes in for surgery, phone and book your assessment for 3 weeks post-op so that we can see your companion at the scheduled time. When looking for a physiotherapist for your animal companion, please ensure that the service provider you select is registered with or authorised by the South African Veterinary Council.

How many times a week will my companion need to come for physiotherapy?

We recommend a minimum of once a week, but more sessions per week may be needed. This will be discussed at your assessment.

Will my medical aid cover the physiotherapy sessions?

Check what is covered within your policy with your pet medical insurance provider.