Bone Care for pets

Bone Care and Orthopedics for Pets

Orthopedics plays a vital role in diagnosing and managing musculoskeletal disorders At MaxPetZ, our dedicated team of specialists provides a broad array of orthopedic treatments. This is to ensure the most appropriate and finest care is delivered for your pet's bone health

Our range of orthopedic services and surgeries includes:

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

Broken bone (fracture) repairs
ACL and other ruptured ligament repairs
Joint cartilage disturbance corrections
Cranial cruciate ligament tear
Patellar luxation surgery
Hip dysplasia
Hip joint dislocation
Medial shoulder instability
Treatment of osteochondrosis of the shoulder
Osteoarthritis
Spine problems and disc disease
Soft tissue injuries/muscle sprains
Growth plate injuries
Angular limb deformities
Full bone plating
Pain management
Achilles tendon injury treatment
Mandibular fracture treatment
Bone tumor treatment
Limb amputations, and much more.

Fractures

Fractures (broken bones) occur fairly commonly in dogs and cats as in humans. Furthermore, fractures can be of several different types. As a result, each carries a different prognosis and requires different treatments. The majority of fractures in dogs and cats can be healed with right corrective treatment. Consequently, most companion animals can regain normality in using their limbs thus improving their quality of life.

Some fractures, especially in very young animals, can be treated using fiberglass 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 stabilized. Options for stabilizing 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 orthopedic 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

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

In dogs as well as cats, partial or complete rupture of the cranial (anterior) cruciate ligament is a very common injury. The rupture causes instability of the stifle (knee) joints, causing acute pain. Moreover, as time elapses leads to degenerative joint disease or osteoarthritis. Frequently, there is also a tearing of the meniscus (cartilage) within the joint. This can occur either at the time of rupture or someday in the future, especially if not repaired.

Diagnosis

Diagnosis may be possible at your pet's 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 a 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 leveling 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 cat's 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 about 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 stabilize the joint or turn the sloping angle into a horizontal angle like a human joint.

With stabilization techniques, we aim to replicate the cruciate using a prosthesis ligature that wraps around the joint to stop the excessive movement with each step. The DeAngelis technique or Lateral Fabellar Suture is a stabilizing technique that utilizes 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 the 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 20 kg where the stabilization 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 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 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 its 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 and/ or 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 that every year surgery is delayed, and there is probably about a 5% increased chance that it does not give a great result. Hence if you leave it for 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-modeled, 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, minimizing 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 with the more correct front-on position. These two procedures above re-align the patella to the normal position, reducing rotational forces that result in not only the luxating patella but a much higher chance of ruptured cruciate 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 pet's exercise. After these four weeks, 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. Often, hind limb disease is caused due to Hip dysplasia. This is commonly observed in Medium to large breed dogs, such as Labrador Retrievers, Golden Retrievers, and German Shepherds. 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, and 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 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 playtime
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 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 is 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 tumor, 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

Intervertebral disk disease (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 tumors. Some of these tumors are best treated with surgery, depending on the type of tumor and where it is located on the spine. After a 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.