Patella surgery

[JMM]

After I get the last of my pre surgery questions addressed next week, we're scheduling Mikey for surgery with the orthopedic surgeon for his luxating patella. He is intermittently lame on his right rear leg and has been 3-legged lame a few times.

Our reg vet does the surgery, but because of Mikey's special case with pain meds, we're opting for the surgery with epidural and pain meds injected directly in the knee at surgery along with a fentanyl patch. Another good point of this selection is that he can have an ophtho do his eyes while he's under.

Obviously, he's not the greatest candidate for surgery with his other issues, but he will have no quality of life if we allow the knee to progress because he can never had NSAIDS or any steroids past what he's already on (1/8-1/10 anti-inflammatory dose of dex). We chance him now or let him be progressively more uncomfortable...

We'll do pt after. Any other suggestions?

[Traci]

JMO, but I think your vet's presumptive pain control is overkill, the fentanyl patch should cover it alone (providing it is applied at least 12 hours pre-surg), and possibly oral butorphenol for a few days post-surgery.

I also do not know that PT is necessary after a patellar surgery....since the estimated recovery is around 4-6 weeks of strict activity, you don't want to start any PT too soon, nor too agressively, he should heal nicely on his own provided that strict confinement is approached during recovery (and/or that no damage is done due to too soon activity/manipulation)

[JMM]

I guess I should explain the pain control a little bit better.

It is routine to do the joint injection for immediate post-surgical pain. We would like to give Mikey the longest time post-op with the pain patch so we can place it later if he has the epidural with surgery.

Mikey cannot have butorphanol nor can he have any NSAIDs. Fentanyl and a few other drugs were "approved" by his liver specialist.

[Linda]

I don't know if this helps you out but we have been through two luxating patella surgies, different knees. I have a bichon which started with his first knee problem at about 4 - 5 yrs. old. It was 1 1/2 yrs. ago. Our vet tried many things before he resorted to the surgery. He did wonderful afterward. He ended up having to have the other knee done 4 months later because of the same problem, he was born with. He did have a lot of pain the first 24 - 48 hours. We sent to a heating pad a day after the first surgery and it really seemed to help. After the second surgery we used the heating pad, on low with a small towel between his knee and the pad, but we used it about 8 hours later and he seemed to do a lot better. We took shifts sitting with him on the heating pad.

After the first week our vet suggested to gradually coax him more and more to walk on it and take steps, no running. After the first few weeks we turned to the treadmill, on very, very slow. The treadmill was almost not moving at all to start with but it did help him. As he got stronger we increased the speed very slightly. We did it after the first month every 2 hours, if possible. As time went on we would go to every 3 hours and then every 4 hours. Our vet said it made all the difference in how fast and strong he recovered! I hated making him go on it but not long afterward he was running on his own like a puppy! His knees are stronger then they ever were! I hope this helps you out in some way. If you have any questions feel free to ask them and if I can help in some way I will be happy to.

Best of luck to you and your dog.

[JMM]

We're ago for this coming Wednesday. Mikey is going to have his knee and eyes done.

He had his acupuncture today so hopefully that will help him with the stress of the surgery.

[JMM]

Mikey did well in surgery. I spoke briefly to the surgeon and will talk more in depth at discharge tomorrow. Mikey's patella was actually in 2 pieces connected with soft tissue. It is not a fracture, just how his patella happens to be. That's not a problem and Brehm didn't fuse it. Mikey got his groove deepened, ligaments tightened (I can't recall which side), some shaping to the ridges around the groover, and a tibial tuberosity transpositioning in his right leg. Brehm said he couldn't luxate the patella and the leg straightened up well. He was very pleased with the surgery. Mikey was sleeping comfortably an hour ago.

The biggest risk with Mikey was the anesthesia and that is all over! Thank you all for the thoughts and prayers. I'm sure recovery will be a breeze since I'm an old hand at orthopedic recoveries (as a tech, my pain position is caring for post-op dogs and cats) and Mikey is such an easy boy.

[oconnorjoy]

JMM....I am glad to hear Mikey's surgery went well. He'll be happy to be back home tomorrow. Keep us informed on how he is doing.

Kisses and Hugs from
Bamm Bamm and Pebbles

[Linda]

I'm really happy the surgery went well for Mickey. Spencer had the same thing done with the ligaments and the groove deepened. With Spencer they let me take him home the same day. They thought he would do better at home with me since he is always with me and upset at the vets office.
Best of luck for a speedy recovery for Mickey! You have been in our thoughts.

[JMM]

Mikey is home and resting comfortable.

He hadn't urinated and while that can be normal after surgery, Mikey can block from his bladder stones so they catheterized him before sending him home just to be sure.

His incision looks great and his eyes look fine though covered in goop...