Compassionate Care. Exceptional Medicine.

How is canine lameness diagnosed? We believe one of the first steps to recovery is a complete diagnosis. The starting point for us is to always have a discussion with you to get a full history of your dog’s lameness and symptoms, and then to perform a full clinical examination of your dog. This may also involve gait analysis: observing your dog walking and running. Sometimes we can get our answer within this initial consultation and examination, and other times further tests may be required. We perform the following diagnostic tests:

• Radiology (X-rays)
• Ultrasound
• CT scan (we accompany your pet to and from the CT facility, have the scan performed, and then discuss the results with you afterwards)
• Joint fluid collection and analysis
• Diagnostic joint blocks
• Arthroscopy, should your dog require it

Common Causes of Canine Lameness This list is by no means comprehensive, but some of the most common problems that we see include:

• Cruciate ligament disease/injury (MORE)
• Luxating patella (Dislocating kneecap)
• Hip dysplasia
• Elbow dysplasia
• Medial shoulder instability
• Hip joint dislocation
• Osteoarthritis
• Spine problems and disc disease
• Fractures
• Soft tissue injuries/muscle sprains
• Growth plate injuries
• Angular limb deformities

Our main objective is to do all that we can to diagnose and resolve your dog’s problem so that they can continue to live an active and comfortable life. In hard to answer cases, we cross-refer within our hospitals for second opinions and often have team meetings to discuss the best management plan for your dog. What different options are available for treatment of lameness?

• Medications – There are many different anti-inflammatory pain medications and joint supportive supplements that we can use in either liquid, tablet or injectable form.
• Intraarticular medication (Injection of medication directly into the joint)
• Platelet rich plasma (PRP) – This can be used for treatment of osteoarthritis and some ligament/tendon injuries
• Splints/bandages/support braces
• Surgery – We offer a comprehensive surgical service for treatment of orthopedic injuries including Advanced Fracture Repair, DeAngelis technique and TPLO for cruciate ligament injuries, Juvenile Pubic Symphysiodesis (JPS) and Double Pelvic Osteotomy (DPO) for early intervention of Canine Hip Dysplasia and Hip Joint Denervation for treatment of chronic hip pain (MORE)
• Physiotherapy and Hydrotherapy – Laser therapy, a series of muscle massage techniques, Acupuncture, strength building exercises and electrical stimulation may help in your dog’s recovery. (ANOTHER READ MORE LINK to PHYSIOTHERAPY AND HYDROTHERAPY)

ORTHOPEDICS

Our orthopedic surgical unit is fully equipped with a C arm and all surgical tools

• Fractures (MORE)
• Patellar luxation surgery (MORE)
• Hip dysplasia (MORE)
• Medial shoulder instability
• Hip joint dislocation
• Osteoarthritis
• Spine problems and disc disease (MORE)
• Soft tissue injuries/muscle sprains
• Growth plate injuries
• Angular limb deformities

Cruciate Ligament Surgery

The cruciate ligaments are two ligaments that run through the stifle (knee) joint forming an ‘X’ when the stifle is viewed from the side. They are called the cranial (anterior) cruciate (CCL or ACL) and the caudal/posterior cruciate ligament.

Injury

Partial or complete rupture of the cranial (anterior) cruciate ligament is a very common injury in dogs and also occurs in cats. Rupture causes instability of the stifle (knee) joints. This also causes acute pain and over time leads to degenerative joint disease or osteoarthritis. Quite commonly, there is also a tearing of the meniscus (cartilage) within the joint which can occur either at the time of rupture, or some time into the future, especially if not repaired.

Diagnosis

Diagnosis may be possible at your pets initial consultation. However some patients are sore and nervous and tense the muscles of the leg, making it impossible to feel the instability in the joint. For these patients sedation is needed to allow us to determine whether cruciate injury has occurred. This is very important because if cruciate injury is suspected, injury cannot be ruled out unless assessed under sedation.

Treatment

Without surgical repair, dogs with ACL lameness will develop degeneration and arthritis within the joint over time, due to the femur and the tibia shearing against each other with each step. Surgery is therefore recommended for any dog with ACL damage. There are two main surgical techniques for repairing cruciate injury:

• Joint stabilisation techniques
• Joint levelling techniques

it is important to understand the anatomy of the knee, which will help explain which of the techniques is best suited to your dog. A dog and cats knee is not a horizontal level joint. The top of the tibial bone is angled, usually between 15 to 40 degrees. If the cranial cruciate is ruptured, this means that every time they take a simple step, there is a shearing force that slides the femoral bone down in relation to the top of the tibial bone that forms the joint. It’s this shearing force that causes ongoing damage, pain and arthritic change over time. Hence for our pets, when rupturing their cruciate ligament, we need to either stabilise the joint or turn the sloping angle into a horizontal angle like a human joint.With stabilisation techniques we aim to replicate the cruciate using a prosthesis ligature which wraps around the joint to stop the excessive movement with each step. The DeAngelis technique or Lateral Fabellar Suture is a stabilising technique that utilises hard line nylon that can be threaded around the joint, and still is the most cost effective technique for patients up to 15 kg’s TPLO (Tibial Plateau Levelling Osteotomy) is a Levelling technique that changes the angle of the tibial plateau (the top of the tibial bone) from it’s normal angle of between 15%-40%, to a more horizontal level, similar to a human knee, such that the normal shearing forces with each step are eliminated, resulting in pain free stability that does not cause ongoing arthritis. These techniques are superior for any patient over 20kg’s where the stabilisation techniques may not be strong enough to withstand these forces. The TPLO cuts a circular plane through the Tibia allowing the top of the tibia to rotate around to the desired angle before being re-plated. A TPLO is the absolute Gold Standard of cranial cruciate repair. Which of the above techniques is best for your own dog depends on their age, weight, angle of their tibial plateau, and of course, your budget. Book a consult with us for a thorough understanding of the problem, and which of the above procedure/s is best for you and your pet if faced with cruciate damage. After Care

• The usual recovery period is 6 to 12 weeks.
• Exercise is slowly built up over this period and we advise you how to proceed upon each post operative visit. Typically 3 to 4 post operative visits are required,
• We aim to have dogs off lead and back to normal by 12 weeks post surgery, enjoying life as they did before their injury.

Prognosis The long term outcome for most patients is excellent!

Patellar Luxation Surgery

Also known as slipping kneecaps, patella luxation is the kneecap slipping out of position. This leads to pain in some cases (but not all), but far more importantly, increases the chances significantly of suffering progressive arthritis and torn cruciate ligaments in the future. Early surgical correction is typically advised if this condition exists, however it is evaluated on a case by case basis. Luxation comes in four degrees of severity. Although every individual case needs to be assessed on it’s merits, we generally recommend the following:

• Grade 1 or Grade 2: Cases that are not showing clinical signs, should be monitored rather than repaired.
• Grade 2: Cases showing clinical signs, and all Grade 3 and 4 cases should be repaired.

Keep in mind that often Grade 2 cases will show clinical signs, but once they become Grade 3, they may no longer show signs, yet are more important to be repaired. The Four Grades:

• Grade 1: These kneecaps can be manually pushed out of position but return to the normal position by themselves.
• Grade 2: These kneecaps sit in the normal position most of the time, but when they move out, may stay out for some time before returning.
• Grade 3: These kneecaps permanently sit in the incorrect position, out of the groove. They can be moved back into the normal position but often return to the incorrect position.
• Grade 4: These kneecaps are permanently in the wrong position and are difficult to get back into the correct position.

Here are some considerations when surgery is advised:

• Generally speaking, the surgical procedure carries an excellent chance of a good long term result. However, about 5% of cases may not be successful.
• The younger the dog the better the outcome. And the lower the grade, the better the outcome.
• The longer you leave a surgery when recommended, the greater the chance that it either does not work, or does not work as well as it may have. A good way to think of it is – Every year surgery is delayed, there is probably about a 5% increased chance that it does not give a great result. Hence if you leave it 5 years, there may now be a 25% chance of a poor result rather than a 5% chance!

Surgery:

Surgical correction of sub-luxating patellas involves deepening the grove that the kneecap sits in (the femoral trochlea groove), and relocating the bone that the patella attaches to (tibial crest transposition).

Trochleoplasty or groove deepening:

A wedge of bone is sawn out of the trochlea groove, re-modelled and inserted back into the groove. This allows for a deeper groove that the kneecap is less likely to slip out of, but also preserves the cartilage surface of the joint, minimising arthritis risk in the future. Tibial crest transposition: The tibial crest is the bony prominence at the top of the tibia onto which the patella ligament attaches. The main genetic concern with sub-luxating patellas is that this crest is incorrectly positioned too far to the inside of the joint. Hence we use a bone saw to remove this from the incorrect position and replace it to the more correct front on position. These two procedures above re align the patella to the normal position, reducing rotational forces that results in not only the luxating patella, but a much higher chance of ruptured cruciates in the future. After-care: The recovery period is 6-12 weeks. Initially we first see you three days after surgery to remove the fentanyl patch.and give the first of four Pentosan injections that help to prevent arthritis. These injections are given weekly for the first four weeks during which time we assess progress, and guide you through building up your pets exercise. After this four week period, we see you three weekly for two more visits, by which time your pet will just about be fully healed. If Physiotherapy is needed you will be advised during the visit.

HIP DYSPLASIA

Hip dysplasia (HD) is abnormal joint laxity (looseness) of the hip joint. Hip dysplasia is a common cause of hind limb lameness. Medium to large breed dogs, such as Labrador Retrievers, Golden Retrievers, and German Shepherds, all can be affected by hip dysplasia. Although more prevalent in these breeds, hip dysplasia can occur in dogs of any breed and size including Mixed Breeds, as well as in cats. The normal hip joint is a “ball and socket” joint. The “ball” (head of the femur) normally fits tightly in the “socket” (acetabulum) on the pelvis side of the joint. During growth until adulthood, the bones, ligaments, muscles, and other structures that cross the joint must develop at the same pace. When this occurs properly, and in the presence of gravity, the joints develop normally without any laxity (looseness). The normal adult shape of a ball and socket are a result of all factors, including normal forces of the ball in the socket, being within “normal” limits during development. With hip dysplasia, the bones and soft tissues develop at a disproportionate pace. This results in bones that do not have a normal shape. Because the bones do not have a normal shape, the ball and socket do not have a tight “fit” into one another. This adds to the joint laxity (looseness). Joint laxity stretches tissues that surround the joint. This leads to inflammation, pain, abnormal wear of the joint surfaces, and lameness. The cause of hip dysplasia is multifactorial. Genetics, diet, hormonal influence, and environmental factors are all believed to contribute to the development of hip dysplasia.

Symptoms of Hip Dysplasia

Most dogs with HD have their first symptoms by 1 year of age – some as early as at 6 months. The symptoms are often subtle at first, with no obvious limp or holding the leg up off the ground. Common observations include:

• a “bunny hop” gait with both hind feet advancing at the same time instead of striding
• hesitance to jump or go up a flight of stairs
• premature tiring during exercise
• content to “observe” rather than “participate” in vigorous play time
• mild limp when rising after rest
• weight shifting off of one or both hind feet while standing to eat or drink
• slightly arched back as a result of weight shifting to the front legs
• apathetic about exercise and play time.

As with any joint problem, the body’s response is an attempt to stabilize laxity if it is present. When hip dysplasia is present, the degree of laxity varies from one dog to another, and there are times when one side is affected more than the other side. The laxity eventually results in secondary osteoarthritis (OA) at some point in life. In secondary osteoarthritis, the inflamed tissues surrounding the joint thicken with “scar tissue” as part of the process in early arthritis. Some young dogs will actually improve as a result of Mother Nature’s course. Unfortunately, the “improvement” is usually temporary and almost always limited to symptoms. In almost every joint with HD that is abnormal at 1 year of age or less, the arthritic changes will progress. The dog may be able to cope with the pain at certain stages, but eventually, lameness or other symptoms will again be present. This time interval between symptoms may never happen, or if it does, the duration can be quite variable depending on the severity of the HD present initially.. Symptoms can wax and wane, but eventually are constant.

How is the Diagnosis of Hip Dysplasia made?

Radiographs are necessary to confirm the diagnosis of Hip Dysplasia. Before acquiring radiographs, the patient history, physical examination, and orthopedic examination are completed to determine if other causes of hind limb lameness are present. Your dog will undergo a comprehensive examination process.

How is Hip Dysplasia Treated?

Conservative/Medical Management Conservative / medical management may be a viable and effective treatment option for some dogs with mild hip dysplasia. This option is usually attempted when the diagnosis of mild hip dysplasia and/or osteoarthritis is first made. (READ MORE ABOUT PHYSIOTHERAPY) Surgical management in young dogs: In the Juvenile stages, while the dog still has growth potential (usually between 4 and 6 months) Surgical procedures Juvenile pubic symphysodesis (JPS) and Double pelvic osteotomy (DPO) can be done to alter the shape of the hip and allow better articulation of the femoral head. (READ ABOUT BOTH SURGERIES) so that by the time the dog reaches adulthood his joints have better conformation and the consequence of hip dysplasia are substantially averted. Surgical Management in Older Dogs: We are working on Total Hip replacement and will soon be able to offer the procedure.

SPINE SURGERY

When your pet is having difficulty walking and experiencing back or neck pain or is dragging their rear limbs, it can be scary to hear that your pet may need surgery. We help pets regain their ability to walk and relieve pain. Pets may need to undergo spinal surgery for a variety of reasons, but most spinal surgeries are done to relieve pressure on the spinal cord. That pressure may be due to a slipped disk, a tumour, a fluid pocket, or another issue. Sometimes surgery is needed to fix broken bones in the back or neck, or re-align and stabilize a dislocated joint in the back or neck.

• Some Conditions that can be treated with Spine Surgery
• Intervertebral Disc Disease or IVDD
• Tumour Removal
• AtlantoAxial Instability
• Trauma

IVDD

Intervertebral disk disease (commonly called slipped disc) may cause back or neck pain, wobbly walking, or complete paralysis (inability to use the rear limbs or all four limbs). Not all dogs with intervertebral disk disease will need surgery; we only recommend it if the likelihood of improving their condition outweighs any downsides of surgery. Situations for which we would recommend surgery include:

• Neck or back pain that is either not improving, or is getting worse even after a week of medication and rest
• Recurrent neck or back pain or recurrent wobbly walking
• Inability to walk in the rear limbs, or all four limbs

The chances of getting better depend on the reason for your pet’s difficulty walking and the severity of their injury. This is why it is so important that they be examined by us first.

Tumour Removal

Dogs and cats sometimes get spinal cord tumours. Some of these tumours are best treated with surgery, depending on the type of tumour and where it is located on the spine. After thorough evaluation will let you know whether surgery is an option for your pet’s particular case. We will also discuss the risks and benefits of surgery, as well as the likelihood of success.

Atlantoaxial Instability

Young small and toy breed dogs like Chihuahuas and Yorkies can develop a dislocation between the first two bones in the neck, known as atlantoaxial luxation. This can cause pain, weakness, and wobbly walking in all four limbs. Surgery to realign the bones of the neck and stabilize them is often curative.

Traumatic Spinal Injury

Trauma due to dog bites, gunshot wounds, or automotive accidents can also be treated with surgery.

FRACTURES

As in people, fractures (broken bones) occur commonly in dogs and cats. There are a huge variety of types of fractures each of which have different treatments and carry different outlooks. Although having a fracture can be very traumatic for both pet and owner, the good news is that, with the correct treatment, most fractures in dogs and cats will heal well and most animals can regain normal use of their limbs. Some fractures, especially in very young animals, can be treated using fibreglass casts. Unlike humans, dogs and cats cannot be relied on to rest the limb properly, and any bandaging has the potential to cause serious complications. As a result, most animals are best treated with an operation in which the broken bones are re-aligned and stabilised. Options for stabilising the bones include bone plates and screws, pins that are placed inside the bone, or external frames that are connected to the bone using pins going through the skin. Some fractures are relatively straightforward to manage and others are very complex, necessitating considerable orthopaedic instrumentation, implants and expertise, all of which we provide. Especially useful for this is our C-arm. In addition to traditional surgery, many fractures can benefit from minimally invasive fracture surgery to repair a fracture with the use of small surgical incisions to help preserve the tissues around the damaged bone. Minimally invasive surgery can in some cases enable a faster recovery and healing time enabling pets to return to normal activities sooner.