Tag: Orthopedics

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Cranial Cruciate Ligament Tear in Dogs: Symptoms, Diagnoses and Treatment

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    What is a Cranial Cruciate Ligament Tear in Dogs?

    Photo Credit: Good Vets

    The Cranial Cruciate Ligament, known as the CCL, is a connective tissue found in the knee of the dog that stabilizes the lower leg to the upper leg. The ligament connects the tibia, the bone beneath the knee, to the femur, the bone above. There are a number of CCL injuries that can occur in dogs. However, tears of the CCL are the most commonly observed.

    What Causes a Cranial Cruciate Ligament Tear in Dogs?

    CCL tears most commonly occur when the excessive internal rotation of the tibia takes place when the joint is partially flexed. Typically this is a result of exercise or running. One of the most common occurrences is when the dog is running and suddenly changes direction. This places the majority of the dog’s body weight on the knee joint, and excessive rotational force is placed on the cruciate ligament. The injury leads to the knee joint becoming unstable. 

    Who's at Risk of Developing a Cranial Cruciate Ligament Tear in Dogs?

    There are a number of factors that may contribute to a dog being at higher risk of developing a CCL injury: 

    Breed Type: Certain breeds are more prone to CCL injuries, including Labrador retrievers, Newfoundlands, German shepherds, rottweilers, and Golden retrievers. 

    Obesity: Overweight and obese dogs are four times more likely to tear or rupture their CCL than dogs at a healthy weight. Obesity can play a major role in CCL injuries. The extra weight causes additional strain on the dog’s joints and muscles, making the ligaments more prone to wear and tear. 

    Weekend Warriors: “Weekend warriors” are those dogs who don’t necessarily exercise on a regular basis, but partake in occasional strenuous exercise. 

    Previous Injury: Studies have shown that dogs who injure the CCL in one leg have a 50% greater chance of injuring the other side. This is because the dog will compensate and use the other leg more. More strain placed on the good side causes a risk of tearing or rupturing as well.

    What Are The Symptoms of a Cranial Cruciate Ligament Tear?

    Oftentimes, symptoms of a CCL tear come on gradually and will progressively worsen over a long period of time. However, in some incidents, there may be no obvious symptoms until the ligament actually ruptures.

    Symptoms of CCL injuries in dogs include:

    • Lameness or limping 
    • Favoring one leg
    • Stiffness after exercise
    • Swelling around the knee
    • Difficulty lying down or getting up
    • Pain or tenderness near the injured knee

    How Can a Cranial Cruciate Ligament Tear Be Prevented?

    There are a number of measures that can be taken to reduce a CCL tear from occurring in your dog: 

    • Maintain a healthy weight in your dog 
    • Provide proper warm-up for your dog before vigorous exercise 
    • Avoid “weekend warrior syndrome” – keep the amount of exercise your dog receives relatively consistent 
    • Provide the proper nutrients and vitamins needed to support joint health (ex. Omega-3 and healthy oils)

    How is a Cranial Cruciate Ligament Tear Diagnosed?

    A physical examination is necessary to diagnose a CCL tear. During your dog’s exam, your veterinarian will assess the affected leg by holding the femur in place while moving the tibia out. If it moves in a manner that can be compared to opening a drawer, the CCL is injured. 

    In addition to the physical exam, your veterinarian or orthopedic surgeon will order x-rays to assess the severity of the CCL injury and if there is fluid present in the joint.

    What Is The Treatment For a Cranial Cruciate Ligament Tear?

    Surgery is typically recommended for dogs with a CCL injury. However, this is on a case-by-case basis. Dogs weighing over 22 pounds usually require surgery in order to stabilize the knee. Smaller dogs weighing less than 22 pounds, may be able to heal without surgical intervention if severe restrictions are taken. 

    CCL surgery is very common and compared to that of an ACL surgery in a human. CCL repair surgery generally begins with an examination of the inside of the dog’s knee. When damaged or torn portions of the CCL are identified, they are removed during the procedure. There are a number of surgical methods that can be used to repair the injured CCL. There are four common surgical techniques executed to repair the CCL. These four techniques are Extracapsular Lateral Suture Stabilization, TightRope Technique, Tibial Plateau Leveling Osteotomy, and Tibial Tuberosity Advancement. Your veterinarian will discuss the pros and cons of each CCL surgery option and guide you and your dog in the right direction.

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    Canine Total Hip Replacement Surgery

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      ​​What is Total Hip Replacement Surgery in Dogs?

      x ray of dog before and after total hip replacement
      Photo Credit: Animal Surgical and Orthopedic Center

      A total hip replacement (THR) in dogs is a surgical procedure that involves the replacement of a severely damaged or diseased hip joint with an artificial component. Total hip replacement is a surgical treatment for treating severe arthritis, hip dysplasia, fractures, and dislocations. THR is widely regarded as safe and effective, with a high likelihood of significantly increasing limb function and enhancing their quality of life.

      What Makes a Dog A Good Candidate For Total Hip Replacement Surgery?

      Dogs who are suffering from severe arthritis, hip dysplasia, fractures, and dislocations that cannot be resolved aside from THR and are in a measurable amount of pain are usually those that received a THR. Dogs need to be in overall good health as well as have no other joint or bone issues, nerve damage/disease, or other medical illnesses. Dogs who receive THR need to be skeletally mature and finished growing which is usually between 9-12 months old. X-rays will also reveal if the size of the bones can fit a prosthesis. THR surgery is usually done on dogs over 40 pounds.

      Are There Any Risks With Total Hip Replacement Surgery?

      husky recovering from total hip replacement surgery
      Photo Credit: UC Davis

      Any type of anesthetic or operation comes with its own set of hazards. These dangers will be discussed with you by your veterinarian or orthopedic surgeon. In dogs, the reported complication rate after total hip replacement is between 7% and 12%. It is crucial to identify and treat issues as soon as possible after a complete hip replacement. Swelling at the incision site (seroma) or a low-grade infection of the skin around the incision are examples of mild complications. However, there are three significant problems that might result in the hip replacement failing and requiring further surgery.

      Impact Infection

      As with any infection, an infection of the impact is something that should be taken very seriously. While skin or wound infections may be able to be controlled with antibiotics, infections of the actual implants require the implant being removed and replaced.

      Implant Loosening

      There’s a possibility of the implants losing due to either “aspect loosening” or low-grade infection. Aspect loosening is when the patient’s body rejects the implant and occurs in about 5-15% of cases. If aspect loosening occurs, the implant needs to be removed and/or replaced. 

      Luxation or Dislocation of the Implants

      Luxation or dislocation of the implants is fairly rare is occurs in only about 2-4% of patients and usually within the first 3 weeks post-surgery. If this happens, another surgery under anesthesia will be required to fix it.

      What Happens During Total Hip Replacement Surgery?

      Vets performing total hip replacement on a dog
      Photo Credit: Fitzpatrick Referrals

      THR surgery for severe arthritis, hip dysplasia, fractures, and dislocations surgery is a multi-day process. To prepare for general anesthesia, most dogs getting a complete hip replacement will have a comprehensive examination and a blood test profile. 

      Total hip replacement surgery takes two to three hours on average, and your dog may need to stay in the hospital for one to three days afterward. A 12-week recuperation time is expected. Even though your dog’s hip dysplasia affects both hips, surgery on one hip at a time is possible, providing 3 to 6 months of healing time in between procedures.

      During the actual surgery, the ball (head of the femur) and socket (acetabulum) are removed and replaced with prosthetic implants. The acetabular socket will be rebuilt and equipped with a polyethylene cup, while the stem and ball are constructed of cobalt-chromium. Bone cement may or may not be used to hold the implants in place, depending on the implant type chosen by the surgeon for your pet.

      Around 90% to 95% of dogs that receive a complete hip replacement perform really well and have outstanding function. Every operation has some risk, but your dog’s surgeon will do all in his power to avoid any complications. Hip dislocation, implant loosening, infection, and nerve injury are all rare problems that can typically be easily addressed.

      How Do You Care for a Dog Post-Total Hip Replacement Surgery?

      dog on a walk after total hip replacement surgery
      Photo Credit: A Veterinarian's Perspective

      When dogs are released from the hospital a few days after having total hip replacement surgery, it’s crucial to ensure proper healing. Stitches or staples will usually be removed in 10-14 days following surgery. Your veterinarian will also provide a pain management regimen which might include pain medication and crate rest or confined to a small area during recovery for about 3 months. While dogs are usually able to bear weight on the limb fairly soon after surgery, their activity must be closely monitored and activity limited to being on a leash when not in confinement to prevent over-exertion. Each veterinarian will provide their own post-op instructions and they should be followed as closely as possible for best results.

      How Much Does Total Hip Replacement Surgery Cost?

      Due to the involvement and difficulty of canine total hip replacement surgery, it comes out to being one of the most expensive veterinary surgeries. It comes out on average to being $3,500 to $7,000 per hip or if both hips need to be replaced (which is often the case), the cost runs on average $7,000 to $14,000. This is an instance when having pet insurance can offset the high cost.

      How Can Total Hip Replacement Surgery Be Prevented?

      Preventing total hip replacements comes with preventing the reason for needing the surgery. So essentially working to prevent hip dysplasia and severe arthritis. One way to stay on top of the causes that result in THR is having regularly scheduled vet appointments.

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      Orthopedic Surgery For Dogs

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        What is Orthopedic Surgery for Dogs?

        Dogs who suffer from certain injuries or ailments may benefit from orthopedic surgery as a form of treatment. Any surgical technique that restores broken bones, vertebrae, muscles, joints, or torn ligaments is referred to as veterinary orthopedic surgery. Every orthopedic surgery technique aims to realign fractured bones to their proper positions and then pin or hold them in place firmly to prevent additional movement, allowing for proper healing to take place.

        german shepherd at vet

        What Kinds of Orthopedic Surgeries Are There for Dogs?

        Dogs with a good quality of health and not at risk of health problems due to anesthesia are good candidates for orthopedic procedures. Types of Orthopedic Surgery can include:

        Here is a closer look at some common orthopedic surgeries:

        TPLO SURGERY

        TPLO surgery stabilizes the knee by leveling the tibial plateau, which is one of the most common types of orthopedic surgery. The TPLO technique was designed to stabilize the knee by altering the biomechanics of the joint, eliminating the need for the dog’s injured CrCL (ACL or CCL). Surgeons realign the tibia, which is the bone that makes up the bottom part of the knee joint. Because dogs’ tibia bones are slanted, if the CrCL is ruptured or damaged, the femur may fall off the back of the tibia while the dog is carrying weight on the leg. TPLO surgery helps to level the slope and eliminates joint instability by allowing the dog to comfortably bear weight on the leg.

        Photo Credit: Lifelearn

        Total Hip Replacements (THR)

        Total Hip Replacements (THR) is done when hip dysplasia pain is so advanced to the point of no return and unable to be medically managed. This surgery involves replacing the femoral head and hip joint socket with a prosthetic composed of medical cobalt-chrome and polyethylene. Dogs that have undergone this surgery are likely to regain complete hip function and remain pain-free for the remainder of their lives.

        Cruciate Ligament Repair (ACL, CRCL, CCL)

        Photo Credit: PetMD

        Commonly performed orthopedic surgeries include torn, injured, and ruptured Cranial Cruciate Ligaments (ACL, CrCL, CCL), Cruciate ligament disease in dogs, and Extracapsular repair of the ACL, CrCL, or CCL. A CCL rupture is typically treated using a variety of surgical methods. Each technique has its own set of benefits and downsides. Your veterinarian will help you make the best selection for your pet by guiding you through the decision-making process and advising you on the best surgical option. 

        Shoulder OCD

        Shoulder OCD (osteochondritis dissecans) is an orthopedic disease in which a piece of the cartilage of the shoulder joint gets detached. This causes inflammation and discomfort, and osteoarthritis develops as a result. OCD affects puppies and causes forelimb lameness in the same way as elbow dysplasia does. Depending on the size of the lesion, surgery may be done either via arthroscopic removal or standard open-joint surgery. During surgery, the cartilage fragment is removed from the dog’s shoulder.

        Elbow Dysplasia

        Forelimb lameness is commonly caused by elbow dysplasia. Similar to hip dysplasia, elbow dysplasia is very complex and usually develops when a dog is very young, as well as being detected before they are a year old. Treatment is often completed via arthroscopic examination and surgery. Some of the steps of surgery include removing coronoid fragments and loose cartilage, altering the elbow joint to shift weight away from the damaged areas, and possibly replacing the joint depending on the severity. Without treatment, elbow dysplasia can lead to osteoarthritis.

        Photo Credit: PetMD

        Intervertebral Disk Disease (IVDD)

        IVDD syndrome is one of, if not the most painful diseases a dog may have, and surgical treatment may be the best option. The disc can exert pressure on the spinal cord and surrounding nerve roots due to extrusion, protrusion, or bulging. This results in neurological symptoms (weak or paralyzed legs, alterations in cutaneous feeling) as well as severe pain. In extreme cases of extrusion, the disc’s core may erupt and slam onto the spinal cord, leaving this part of the cord concussed (damaged after being struck), contused (bruised), or edematous (swollen).

         If a dog is diagnosed with IVDD, the severity is determined to figure out the prognosis. IVDD surgery relieves pressure on your dog’s spinal cord, restores normal blood flow and movement, reduces discomfort, and prevents disc issues in the future by removing unhealthy intervertebral disc material. A variety of operations may be necessary to attain this aim.

        What Happens During Orthopedic Surgery?

        Before surgery, dogs will be given a general anesthetic and the area that the surgery is taking place will be shaved and sterilized. Surgeons may incise over the fracture site and dissects down to visualize the damaged bones, joints, or tendons under thorough aseptic conditions. While the technique is varied based on the procedure being done, it is common to return all of the broken bones back where they belong and immobilize the fractured portions of the bone so that they cannot move against each other. This includes preventing fracture ends from slipping and preventing rotation around an implant. 

        Prior to surgical wound closure, intraoperative X-rays are taken during fracture repair surgeries to ensure that the bones and implants are in the best possible position. Before closure, the fracture site is lavaged with sterile saline, and a local anesthetic may be used to alleviate postoperative pain. Follow-up x-rays are obtained to ensure that the repair is satisfactory, the surgery site is sutured, and the patient is permitted to awaken in a comfortable resting position.

        What Kinds of Fractures Are There That Require Surgery?

        Hairline Fractures

        A hairline fracture is a common and most simple bone fracture as the bone is still intact while minimal cracks run up the middle of long bones such as the leg bone. They are easy to manage as they often don’t cause displacement misalignment of the bone. But while small, this fracture still compromises the structural integrity of the fractured bone.

        Multiple-Piece Fractures

        Multi-piece fractures are just what they sound like. They are a result of a strong impact causing the bone to shatter into multiple pieces. Due to this, they are often more complicated to fix and require surgery the majority of the time.

        Joint Fractures

        Joint fractures are more severe as they can lead to arthritis even after the bone has healed due to the role that joints play in daily movement.

        Open Or Compound Fractures

        Open or compound fractures are severe fractures in which the bone is exposed outside of the skin. Sharp shards of bone can pierce surrounding tissues, causing damage to tendons, muscles, nerves, and blood vessels in severe fractures. Furthermore, if a bone is left outside the dog’s body, it is more likely to become unclean and infected. This can develop into serious infections that might be life-threatening and necessitate immediate medical attention. It’s important to follow your vet’s instructions to ensure your dog has a proper recovery.

        How Do You Care for a Dog Post-Orthopedic Surgery?

        The time it takes for your dog to recover after orthopedic surgery is usually determined by a variety of factors, including the kind of operation, your dog’s age, general health, and rehabilitation requirements.

        Managing Effects of Anesthesia 

        Dogs may be nauseous from the anesthesia and they will usually lose their appetite. During this period as they should be fed a bland diet of rice and chicken for the first 24 hours after surgery until the anesthesia has worn off to help ease their digestion.

        Restrict Movement

        Dogs may need to have restricted movement for a couple of weeks after surgery. It’s usually recommended to keep them in a large crate or in a small area of the house blocked by a dog gate to keep them from moving too much depending on their size and energy level. Calmer dogs may be able to do their recovery in a room in the house that doesn’t have anything they can jump on. It is critical to keep your dog from running, leaping, climbing stairs, or engaging in other vigorous activities while they recuperate from orthopedic surgery

        Photo Credit: My Fantastic Friend

        Medication

        Your dog will likely be prescribed pain medication to help aid in their recovery and be given written instructions on the dosage. Staying on schedule with pain medications is crucial to ensure efficacy and reduce the chance of side effects. Dogs may also be prescribed antibiotics to prevent infection. If your dog is high energy and will have difficulty being on restricted movement, they may also be given an anti-anxiety medication or mild sedative to help them remain calm during the recovery process.

        Surgical Site Care

        After surgery, it’s imperative to keep dogs from chewing, licking, biting, or scratching at their incision site. This can result in infection and opening up the site again. Your vet may suggest your dog wear a cone (available as in hard plastic or soft version). If dogs are struggling to get used to a standard cone, there are other options such as recovery jumpsuits they can wear and donut-style collars. Consult with your vet on the best route to take if your dog won’t wear a cone.

        Dogs will usually have to go back to the vet about 10-14 days post-surgery to have their stitches removed but the vet may also use stitches places inside the wound which will dissolve on their own. 

        The bandages should be kept dry at all times so if your dog goes outside make sure to keep them covered with cling wrap or a plastic bag to keep it protected from the wet or damp grass. The plastic should be removed as soon as they are inside as keeping it on can lead to infection. 

        Rehab and Physical Therapy

        Human patients who engage in systematic physiotherapy and rehabilitation programs after surgery heal more quickly and completely than those who are just given advice on how to exercise appropriately, according to scientific research. There is mounting evidence that dogs and cats are the same. All of these patients require a combination of exercises and activities to enhance strength, mobility, reduce pain and suffering, and regain agility and confidence. You can find a physical therapy and rehab specialist in our specialist directory. Physical therapy comes in many forms including but not limited to:

        Range Of Motion And Stretching Exercises

        Human patients who engage in systematic physiotherapy and rehabilitation programs after surgery heal more quickly and completely than those who are just given advice on how to exercise appropriately, according to scientific research. There is mounting evidence that dogs and cats are the same. All of these patients require a combination of exercises and activities to enhance strength, mobility, reduce pain and suffering, and regain agility and confidence. You can find a physical therapy and rehab specialist in our specialist directory. Physical therapy comes in many forms including but not limited to:

        Superficial Thermal Modalities

        Cryotherapy

        In the initial postoperative phase, ice compresses are an effective way to help manage pain and inflammation. Cryotherapy is helpful not only during the acute period of tissue damage and inflammation but also after exercise and throughout rehabilitation when inflammation develops.

        Heat therapy

        Heat should only be applied to tissues after the acute period of inflammation has passed, which is usually three to five days following surgery or injury. Vasodilation occurs as a result of surface heat, which enhances circulation to the superficial tissues, boosts tissue oxygenation and metabolite transport, and speeds up enzymatic and biochemical processes to aid tissue repair.

        Hydrotherapy

        Yellow Labrador in a hydrotherapy machine at physical therapy

        Hydrotherapy with underwater treadmill work essentially allows for rehabilitation and exercise by taking the weight off of the compromised joints and allowing movement that would otherwise be painful or impossible. The viscosity of the water actually increases the work that the muscles are doing at the same time. There is also pool-based and whirlpool hydrotherapy.

        Laser Therapy

        Laser therapy is a non-invasive photobiomodulation therapy to help in the rehabilitation of different conditions. Laser therapy uses light as a way to increase blood circulation and stimulate cell regeneration. It’s been used on humans for decades but laser therapy has been used on dogs in recent years. It essentially promotes healing while reducing inflammation and pain. 

        Shockwave Therapy

        dog receiving shockwave therapy

        For shockwave therapy for dogs, a series of focused high-pressure acoustic pulses (sound waves) are generated by the equipment and pass from the probe into the skin and soft tissue. The energy contained in the shock waves is released and interacts with the tissue when it meets tissue interfaces of varying densities, such as where soft tissue, tendons, ligaments, cartilage, and bone meet, creating both mechanical and cellular consequences. 

        How Much Does Orthopedic Surgeries Cost?

        Orthopedic surgery in dogs is expensive, costing anything from $100 to $3,000 each procedure. The overall cost is determined by the type of surgery performed by your veterinarian and the exact condition that your dog is experiencing. Consult a veterinarian for an exact estimate of how much orthopedic surgery will cost for a specific ailment.

        How Can Orthopedic Surgery Be Prevented?

        Orthopedic surgery can be prevented by taking the proper steps to prevent injury or joint degradation in your dogs. Unfortunately, some ailments may be difficult to prevent such as hip dysplasia in dogs born with the genetic predisposition but you can help the severity of it which would result in a less complicated surgery later on. Here are some tips to prevent needing orthopedic surgery based on the common causes of injuries:

        • Avoid picking dogs up by their front legs
        • Don’t put dogs in the back of pick up trucks untethered and tether them inside as well to keep them from jumping out windows
        • Check under vehicles and behind tires if dogs like to nap outside in the shade before taking off 
        • Don’t let small children carry puppies
        • Give smaller dogs and those prone to back injuries like dachshunds a ramp or stairs to get onto couches and beds
        • Exercise your dog regularly and keep them on a good diet to prevent obesity