Knee problems are the most common reason for referral in dogs, and in most instances are caused by damage to the Cranial Cruciate ligament (CCL) or from knee-cap problems (Medial patellar Luxation or MPL).
Cranial Cruciate Ligament (CCL)
The most common referral orthopedic surgery is for a knee problem in a dog. CCL injury in dogs is a combination of the type of dog and his/her activity level and body weight. These factors contribute to a large percentage of the cases we see. CCL is the same as ACL in people, but in dogs it’s called the CCL because they walk on all 4 limbs. We perform all currently available procedures for CCL injury in dogs. These include Tibial Plateau Leveling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA), Mono-nylon imbrication (Ex. Cap), Tightrope (TR), Total Knee best Replacement (TKR) and Ligavet Intra-articular Repair (LR). We recommend the procedure that best suits your pet. Where more than one option is available we will discuss and explain the relevant considerations of each.
An extracapsular, mono-nylon repair, two sutures are looped around the knee to act as an internal brace. The crimps hold the suture. And yes, it’s 80 pound test monofilament leader line…believe it or not there was considerable veterinary research devoted to finding the best material to use for this application!
Above: LARS ligament for reconstrction of the CCL. Left: picture of a dog knee with the ligament, held by screws. Center: detail of the artificial ligament. Right: picture of the ligament in a bone model.
The medial meniscus is a shock-absorbing cartilage structure that sits between the two bones of the knee. When the knee is unstable due to ligament damage, the medial meniscus is at risk for injury. The type of tear that frequently develops is termed a “bucket-handle tear”, so-called because when viewed from above, the tear looks like the handle of a stainless steel bucket or pail. We have seen medial meniscal tears develop on the first day of ligament damage and as long as 1-2 years after. If you are hearing clicking in your dog’s knee, it is highly likely that the meniscus is damaged. Surgical debridement or removal of the torn tissue has a significant impact on improving limb use, regardless of the type of treatment done to stabilize the knee.
Bucket handle tear of the medial meniscus. Removed is a portion (approx 1/2) of the medial meniscus. If you look closely, you can see a second tear in its earlier stages, just to the left of the larger tear.
Medial Patellar Luxation (MPL)
Medial Patellar Luxation or MPL is common in small dogs under 20 pounds of body weight, however it can occur in any dog. In MPL, the patella (knee-cap) comes out of place. MPL is second to CCL in terms of frequency and requires a high level of expertise to correct. It is necessary to deepen the groove (trochlea) where the knee-cap sits and provide balance via a combination of release of tissue on the inside and tightening on the outside. In addition, it is frequently necessary to move the bone where the knee-cap tendon attaches. The best outcomes with MPL surgery are achieved by using an accomplished surgeon in conjunction with a pet owner who is committed to following exercise guidelines.
Above: Before, on the left and after surgery, on the right for MPL. Note the position of the small bone on the upper left. This is the patella (knee-cap). It’s in-place on the surgery on the right.
Total Knee Replacement (TKR)
Dr. Hay performs Total Knee Replacement (TKR) in dogs. This procedure is needed in dogs with advanced arthritis in the knee. Dr. Hay was the first DVM in Florida to perform TKRs in dogs. He has followed his patients for 7 years post op with this procedure, confirming that it has provided an excellent level of functional outcome in patients into older age.
Above: Knee replacement, before and after.
Above: knee replacement
We are capable of performing a wide variety of fracture repairs in dogs and cats. Radius/ulna (forearm) fractures are common in smaller dogs. The radius/ulna will commonly break if a pet is dropped or jumps off the back of a couch or bed. Most radius/ulna fractures need repairing using a plate with screws for optimal outcome. Dogs bear 60% body weight on their front legs and subject this area to the most stress. To optimize outcome, having a specialist perform surgery on radius/ulna fractures is very important. We are equipped to handle fracture repair for any type of situation, including fractures of the femur, tibia, humerus (leg bones), paws and ilium (pelvis bone). We have a complete line of orthopedic equipment for internal fixation with plates, screws, pins, wire and interlocking nails.
Above: Broken front leg of a small dog repaired with plate and screws. (Radius/Ulna fracture is avery common in dogs under 10 pounds from falling or being dropped).
Above: Broken ankle, repaired in a racing Greyhound.
Damage to tendons and ligaments often requires a specialist to evaluate and recommend the best treatment available. You may need us to repair a torn Achilles tendon, a paw hyperextension injury, or to replace a collateral ligament. We are here to be able to help you make the best decision should your dog or cat require tendon/ligament surgery.
Hip dysplasia in dogs frequently leads to arthritis, which sometimes necessitates surgical treatment. The good news about hips is that they are amenable in many instances to medical treatment. There are, however, a number of distinct instances where surgery may be beneficial.
Above: A hip replacement performed for arthritis. Most dogs function well with only one hip being replaced, even if both hips have arthritis.
Hip Surgery: Triple Pelvic Osteotomy (TPO)
Triple Pelvic Osteotomy (TPO) is performed in young dogs before the onset of arthritis. TPO is considered a specialist surgical procedure and it is important to use a surgeon who has experience in evaluating dogs for TPO because some dogs will have better outcomes with surgery than others. TPO is generally done in dogs between 5-10 months of age.
Above: Triple pelvic osteotomy (TPO). Before (left) and two months after (right).
Hip Surgery: Femoral Head Ostectomy (FHO)
Femoral Head Ostectomy (FHO) can be performed in dogs with dislocated hips, broken hips, or hips that are very arthritic. This procedure is appropriate for smaller dogs and cats when done for chronic hip dislocation or where the head of the hip is fractured or broken. It can be performed by general practitioners. In some instances we have seen poor outcomes with FHO, especially if it was an inappropriate selection for the pet. Proper treatment selection is essential for the patient with FHO and we caution anyone to choose this procedure for hip dysplasia unless pain is intractable and not responsive to medical management.
Above: A dog with a broken hip
Above: Same dog after FHO surgery
Hip Surgery: Total Hip Replacement (THR)
Dr. Hay performs Total Hip Replacements on dogs and just like for FHO, appropriate selection for the patient is essential. It is important to define that a pet’s quality of life has been diminished in order to benefit from THR. It is a complex procedure requiring a high level of expertise to perform, as well as pet owner dedication to exercise restriction, commitment to recheck exams, and to understand the risks involved. THR has provided excellent functional outcome in many patients. Dr. Hay is happy to consult with you about this procedure for your pet.
Hip Surgery: Juvenile Pubic Symphysodesis (JPS)
Juvenile Pubic Symphysodesis (JPS) is performed in 4 month old dogs to correct hip dysplasia. It is difficult to screen dogs for hip dysplasia at this age which means that it is not a procedure that is frequently performed. It is a minimally invasive procedure which improves hip conformation in young dogs. The procedure for dogs was published in the late 90’s by the University Of Wisconsin-Madison. Dr. Tass Dueland, Dr. Hay’s mentor and friend, investigated JPS at UW-Madison. Dr. Hay assisted Dr. Dueland with the first group of dogs that had JPS performed at UW-Madison.
General Joint Surgery
Osteochondrosis Dissicans (OCD) occurs most commonly in the shoulders of dogs less than 1 yr of age. It has a very good prognosis with surgery, though sometimes can be treated medically. It can also occur in the elbow, knee, and ankle. Other joint surgeries we perform include elbow surgery for elbow dysplasia, also known as fragmented coronoid process (FCP). We are happy to consult with you about OCD or elbow dysplasia. We use the best procedures to minimize anesthesia time and improve functional outcome.
Crooked legs sometimes need to be straightened. This is most frequently the case in the forearms of small dogs. Either a genetic component or an injury when the pet was young can lead to a leg that bends the wrong way. Dr. Hay performs corrective osteotomies on dogs. In most instances he can use internal methods to repair the problem. Occasionally an external device called a ring fixator may be used. Not all dogs with crooked legs need surgery and Dr. Hay has developed a patient assessment system to aid owners in decision-making.
Above: Corrective surgery on the right leg of a dog: before, immediately after and 3 months post surgery.