Orthopedic Surgery Procedures
1. Cranial Cruciate Ligament Repair Information
Rupture of the CrCL (the dog’s equivalent of the ACL) is one of the most common reasons for hind limb lameness, pain, and resultant arthritis in the knee.
Since the development of this problem in dogs is much more complex than in humans, and they experience different degrees of rupture (partial or complete), the canine condition is referred to as ‘cranial cruciate ligament disease’ (CrCLD). While the clinical signs (symptoms) associated with CrCLD vary, the condition invariably causes rear limb dysfunction and pain.
Diagnosing complete tears of the CrCL is easily accomplished using a combination of gait observations, physical examination findings, and radiography (X-rays).
Many treatment options are available for CrCLD. The first major decision is between surgical treatment and non-surgical (also termed conservative or medical) treatment/management. The best option for your pet depends on many factors, including their activity levels, size, age, skeletal conformation, and degree of knee instability. Deciding to pursue surgery is a big decision & we are here to help answer your questions and guide you to a choice that is right for your pet and your family.
We always recommend our patients see a Boarded Orthopedic Surgeon for a specialist opinion & repair; though if cost or distance are insurmountable obstacles, we are proud to be able to offer care at a local General Practitioner level!
Although she is not a Boarded Specialist, Dr. Sabrina Russett has completed extensive and ongoing continuing education surgical courses to perform the above diagnostics and offer surgical procedures for Cranial Cruciate Ligament Rupture repair. This allows your pet to undergo extensive diagnostics and receive excellent care, all without having to leave Keene. Court Street Veterinary Hospital offers TPLO, TTA, and Ex-Cap Suture repair Surgeries.
We can work with you to determine which repair is the best choice for your pet!
a. Tibial Plateau Leveling Osteotomy (TPLO)
TPLO, an osteotomy-based technique with surgical implants, requires a semi-circular cut along the top of the shin (tibia) bone. The bone segment is then rotated to realign the joint surface and create a level plateau; this ensures that when your pet bears weight and their muscles engage, all of the forces are transmitted through the joint & there is no longer any abnormal sliding motion within the knee.
b. Extra-Capsular Suture Stabilization
Also called “Ex-Cap Suture”, is a popular technique. While there are many variations of this technique and types of securing implants, the consistent goal is to “mimic” the function of the ruptured CrCL with a suture placed in a similar orientation to the original ligament, though outside of the joint capsule itself. The long-term goal is to facilitate the formation of organized scar tissue periarticular (around the joint) that will provide stability even as the suture gradually stretches or breaks.
If your pet is not a current patient of Court Street Vet but has been diagnosed with this condition, then you should know we are always happy to work with our local colleagues and see your pet on a referral basis!
2. Patellar Luxation
Patellar luxation is the term we use to describe ‘dislocation’ of the kneecap in dogs and cats. The patella most commonly slips out of its normal position and tracks medially. When a dog’s kneecap isn’t in the correct position they can experience discomfort, lameness, and in the long term can predispose a pet to degenerative joint disease. Some data suggests that patellar luxation is correlated with an increased risk of cruciate ligament injury (ACL rupture).
Most luxations are caused by an anatomic developmental abnormality which can be related to the shape of the femur or tibia, alignment of thigh muscles, or the rotation of a foot. The type of surgical repair a pet needs to treat patellar luxation depends on the underlying anatomic cause for the luxation.
This condition varies in severity with grade 1 luxations usually being asymptomatic and not requiring interventions… and grade 3-4 luxations which cause lameness and discomfort should absolutely be surgically repaired. Patellar luxation is considered a ‘dynamic’ disease- the patella can slip in and out of place. Pets may present with intermittent lameness, limping, or ‘skipping’ on one or both hind limbs.
We diagnose patellar luxation based on your pet’s clinical exam & radiographs, and then can guide you about the next best steps that are recommended! Correcting patellar luxation aims to realign the quadriceps muscle alignment and stabilize the patella within its normal groove in the femur.
Court Street Vet is proud to offer a wide range of surgical interventions that can address most (though not all!) cases of patellar luxation. If you have concerns that your pet has patellar luxation then get in touch, we are happy to help you determine the best options for their care!
a. Ridgestop Orthopedic Implant System
The Ridgestop system is an incredible new precision engineered prosthetic ‘ridge,’ that is secured by screws. This implant is placed on the edge of the femur, creating a ‘ridge’ that prevents the patella from slipping out of its normal groove.
The surgery involves opening the knee, examining the joint, and applying the implant to the bone with screws. The benefit of this procedure is that the joint surface does not need to be cut, so is considered less traumatic than traditional procedures that deepen the patellar groove (wedge sulcoplasty). There are some cases of patellar luxation where the Ridgestop implant can be used as a single intervention, and others that require a Ridgestop and an adjunct procedure, such as a tibial tuberosity transposition.
b. Trochleoplasty Wedge Recession
There are some patients who aren’t candidates for an orthopedic implant like the Ridgestop system. In those cases we employ trochleoplasty techniques that modify the shape of the groove in the femur, where the patella is normally supposed to sit and track.
The goal is to make this groove better accommodate the knee cap, by making it deeper or wider. A v-shaped wedge is cut into the femur and the block of bone removed; the defect is made deeper and then the block is replaced. Because the smaller original wedge fits exactly into the larger defect, this achieves immediate stability, recession of the joint surface, and stabilizes the patella.
c. Tibial Tuberosity Transposition
Some patellar luxation patients have the front of their tibia (crest) develop in malalignment, with the crest of this bone tracking medially (towards the midline). This can result in the quadriceps muscle mechanism being pulled off to the side, which causes the patella to luxate with it. In these cases we correct this malalignment by making an osteotomy (cut into the bone) on the part of the tibia where the quadriceps inserts, we then transpose this fragment of bone into a position that corrects the alignment of the kneecap and quadriceps.
This fragment is then stabilized with two small orthopedic implants: a ‘pin’ to keep the fragment in its new correct position, and a ‘tension band wire’ that wraps around this pin and resists the contracting forces of the muscles above.
3. Femoral Head & Neck Ostectomy Information
The femoral head osteotomy is the hip surgery where the head and neck of the femur (thigh bone) are cut off and permanently removed. There are many reasons why a veterinarian may recommend the removal of the femoral head and neck to improve a pet’s condition. Some typical reasons include:
- A dislocated hip
- A broken femoral head and/or femoral neck
- Hip arthritis
- Legg-Perthes disease (a developmental hip degeneration)
Ultimately, the goal of the femoral head and neck ostectomy (FHNO) surgery is to create a false hip joint that will be more comfortable and yield better mobility than the diseased joint the patient had before. Since results are generally so good with surgery, provided the patient is relatively small and/or relatively active, often simply removing the femoral head is the least invasive, least costly, and fastest route to a pain-free mobile hip.
4. Forelimb or Hindlimb Amputation Information
[ Meet one of our best buds, Barney! He is a Siberian Husky Mix, an active & playful amputee, and one of the kindest souls you’ll meet. ]
There are many reasons to consider pursuing amputation such as irreparable trauma, cancer, or even severe arthritis pain. Amputation is obviously a drastic step and one that you must carefully consider, sometimes even to the point of soliciting a second opinion. Contemplating amputation in a pet can be very emotional, but we can assure you that many animal amputees do extremely well! If you’re considering this procedure for your pet, please know that we’re here to support you and your pet!
*Educational information and images made possible through Veterinary Information Network & Veterinary Partner.
Office Hours
Monday—Friday: 8:30 AM – 5:30 PM
Saturday: Closed
Sunday: Closed
Phone: 603-357-2455
Email: [email protected]
686 Court Street Keene, NH 03431