Grading Luxating Patellas - From Dr. Jaimie - Maltese Dogs Forum : Spoiled Maltese Forums

**k/c mom** · 01-04-2009, 07:33 PM

Dr. Jaimie first brought this information to our attention in this thread: http://spoiledmaltese.com/forum/inde...howtopic=36837

http://www.marvistavet.com/html/medi...g_patella.html

Luxating Patellas

Patellas can be diagnosed at a very young age, toy breeds are at high incidence of LP. some LP can be made from a trauma and won't be present at the initial exam. i dont think that a dog with LP should be bred, but it doesnt mean that 2 normal dogs can't produce a pup with LP. i check the knees at a first pup visit but that isn't to say that every vet does. some don't look unless there is an issue. and u can grade patellas with out an xray:

Medial patellar luxations are graded to assess severity.

Grade I: The kneecap can be moved out of place manually but will fall back into its natural position once the manipulator lets go.

Grade 2: Same thing except that the kneecap does not move back to its normal position when the manipulator lets go. These dogs are likely to progress to arthritis development and should be considered for surgery to prevent conformational damage. There is some controversy over whether grade 2 dogs should have surgery.

Grade 3: The patella is out of place all the time but can be manipulated back into its normal position manually (though it will not stay there).

Grade 4: The patella is not only out of place all the time but cannot even be manipulated back into place by hand. Such a dog has extreme difficulty extending his knees and walks with his knees bent virtually all the time.

It is not a good thing to have one's knee cap out of place; the entire weight-bearing stress of the rear leg is altered which, in time, leads to changes in the hips, long bones, and ultimately arthritis. How severe the changes are depends on how severe the luxation is (i.e., the grade as described above) and how long that degree of luxation has been going on. In time, the legs will actually turn inward, making the dog "knock-kneed." The luxation is not considered a painful condition but after enough time and conformational change, arthritis sets in, which is indeed painful.

Dogs with Grade I luxations do not require surgical repair.

Grade 2 dogs may benefit from surgery and most often the owner is called upon to judge how big a problem the lameness is.

Dogs with Grade 3 or 4 disease definitely should have surgery.

**DebbieG** · 08-23-2010, 02:58 PM

My 14 month old Maltese, Chewie, was diagnosed with Grade 3 Luxating Patella in both rear legs. The vet recommended surgery as soon as possible as the popping in and out of the patella (knee cap) causes wear and tear on the joint.

Problem is the surgery is about $1000.00 per leg. Like a fool, I did not get pet insurance, and don't have much money set aside for this surgery. I have about $300 saved for pet expenses.

Should I get a 2nd opinion? According to chart posted on this website, he should only be a 2. His knee cap pops out but goes back in by itself after a few seconds. He will run on 3 legs and hold the injured one up and then put it down and run normally. He also does not seem to be in any pain. Anyone else have experience with this?

I have checked out pet insurance and none of them will cover pre-existing conditions. I checked out the financial assistance pages with no luck as yet. Any suggestions?

**Ladysmom** · 08-23-2010, 05:46 PM

Quote:

Originally Posted by DebbieG

My 14 month old Maltese, Chewie, was diagnosed with Grade 3 Luxating Patella in both rear legs. The vet recommended surgery as soon as possible as the popping in and out of the patella (knee cap) causes wear and tear on the joint.

Problem is the surgery is about $1000.00 per leg. Like a fool, I did not get pet insurance, and don't have much money set aside for this surgery. I have about $300 saved for pet expenses.

Should I get a 2nd opinion? According to chart posted on this website, he should only be a 2. His knee cap pops out but goes back in by itself after a few seconds. He will run on 3 legs and hold the injured one up and then put it down and run normally. He also does not seem to be in any pain. Anyone else have experience with this?

I have checked out pet insurance and none of them will cover pre-existing conditions. I checked out the financial assistance pages with no luck as yet. Any suggestions?

I would definitely get a 2nd opinion from a board certified orthopedic surgeon.

If surgery is recommended, the problem with waiting is the orthopedic changes that can occur from abnormal stress on other joints from compensating for bad knees. Dogs with severe LP's that are not corrected can become extremely bow legged, for example. Surgery cannot correct arthritic changes.

LP's in dogs under a year are generally considered genetic so insurance probably wouldn't have covered it anyway. Did you get a one year health guarantee from Chewy's breeders? Perhaps she will help with the cost.

**jmm** · 08-23-2010, 06:21 PM

Most pet insurance will not cover LP on a small breed dog.

Dogs don't walk on 3 legs unless something hurts. Would you hop around on 1 leg because the other felt just fine?

**DebbieG** · 08-27-2010, 11:20 AM

Thanks for the replies. I brought Chewie to a certified orthopedic surgeon (vet) who specializes in patella surgeries. He advised surgery immediately because Chewie is so young and the damage progresses quite quickly. Fortunately, I have a very good friend who has loaned me the money for the surgery and I can pay her back monthly. Chewie is scheduled for surgery on Tuesday, August 31st. He has to stay at the hospital for 3 days and nights. The hospital has doctors on staff 24/7, which is a comfort. I am so worried. Chewie is so little, only 5 1/2 pounds. At least the doctor has an excellent reputation and has done surgery on 2 of my friend's dogs.

Will keep y'all posted.

**makettle29** · 08-27-2010, 11:39 AM

Debbie,

Best wishes for the surgery but I know it will go fine and you will be happy. The recovery is long so ask your surgeon lots of questions. Once your pup is
recovered you'll be amazed. For the future, don't encourage your pup to
put undue strain on his legs. Running games and jumping on and off furniture
is not a good practice.

mary anna

**tonicoombs** · 08-27-2010, 11:51 AM

Debbie,

As I sit here reading this thread, my heart goes out to you and Chewie. He is one fortunate little fella, as you are responsible enough to see that he needs immediate care and are willing to make reasonable sacrifices to do so. Jasper is 18 months, and I have always discouraged any jumping (he wouldn't know how to jump on or off the bed or couch) and excessive/vigorous running. I had a poodle with Grade 1 LP who lived to be almost 14. I am going to be thinking about you guys in the next few days. I sure hope you will post updates on his progress. You are doing the right thing to ensure that he will live a long, healthy and happy life. Jasper and I send all our love and best wishes your way.

Toni

**tonicoombs** · 08-27-2010, 11:55 AM

And by the way, Sher, thank you for that information on LP. I watch Jasper's behaviour constantly. After having a furkid with LP, I am extra attentive.

**Ladysmom** · 08-27-2010, 12:03 PM

I am so glad you took Chewie to a board certified vet. I am also glad you found a way to pay for his surgery. Please try not to worry about his size. 5.5 pounds is a good size.

**DebbieG** · 09-01-2010, 05:06 PM

Thanks for all your replies. Chewie had his surgery yesterday. The vet called last night and said he did great. No cartilage damage at all because we caught it quickly enough. I can probably pick him up on Friday. I took the day off work so I can stay home with him from Friday through Labor Day.

I got a call from the vet's office today to tell me that Chewie ate a good breakfast this morning. They took him outside and they let him walk a little bit while they hold him up. He is hobbling around quite well.

I wanted to go visit him, but the vet told me it would be better if I don't because Chewie will get all excited and think he is going home and when he has to stay, he will get really down. I will take the vet's advice. I don't want to do anything to slow down his recovery. They are keeping him pretty sedated for now. Can't wait to see him on Friday. Will keep y'all posted. Thanks again.

08-23-2010, 02:58 PM	#2 (permalink)
DebbieG Newbie Name: Debbie Guilbeau Dog's Name: Chewbacca (Chewie) Join Date: Aug 2009 Location: Baton Rouge, LA Posts: 32	Luxating Patella My 14 month old Maltese, Chewie, was diagnosed with Grade 3 Luxating Patella in both rear legs. The vet recommended surgery as soon as possible as the popping in and out of the patella (knee cap) causes wear and tear on the joint. Problem is the surgery is about $1000.00 per leg. Like a fool, I did not get pet insurance, and don't have much money set aside for this surgery. I have about $300 saved for pet expenses. Should I get a 2nd opinion? According to chart posted on this website, he should only be a 2. His knee cap pops out but goes back in by itself after a few seconds. He will run on 3 legs and hold the injured one up and then put it down and run normally. He also does not seem to be in any pain. Anyone else have experience with this? I have checked out pet insurance and none of them will cover pre-existing conditions. I checked out the financial assistance pages with no luck as yet. Any suggestions?

08-23-2010, 06:21 PM	#4 (permalink)
jmm Maltese Guru Join Date: Nov 2004 Posts: 8,156	Most pet insurance will not cover LP on a small breed dog. Dogs don't walk on 3 legs unless something hurts. Would you hop around on 1 leg because the other felt just fine? __________________ JMM - JaMi Maltese, Home to Performance Maltese Becoming a Follower on our Blog!!!

08-27-2010, 11:20 AM	#5 (permalink)
DebbieG Newbie Name: Debbie Guilbeau Dog's Name: Chewbacca (Chewie) Join Date: Aug 2009 Location: Baton Rouge, LA Posts: 32	Chewie's Luxating Patellas Thanks for the replies. I brought Chewie to a certified orthopedic surgeon (vet) who specializes in patella surgeries. He advised surgery immediately because Chewie is so young and the damage progresses quite quickly. Fortunately, I have a very good friend who has loaned me the money for the surgery and I can pay her back monthly. Chewie is scheduled for surgery on Tuesday, August 31st. He has to stay at the hospital for 3 days and nights. The hospital has doctors on staff 24/7, which is a comfort. I am so worried. Chewie is so little, only 5 1/2 pounds. At least the doctor has an excellent reputation and has done surgery on 2 of my friend's dogs. Will keep y'all posted.

08-27-2010, 11:51 AM	#7 (permalink)
tonicoombs Member Name: Toni Dog's Name: Jasper Join Date: Jul 2010 Location: Kentucky Posts: 86	Debbie, As I sit here reading this thread, my heart goes out to you and Chewie. He is one fortunate little fella, as you are responsible enough to see that he needs immediate care and are willing to make reasonable sacrifices to do so. Jasper is 18 months, and I have always discouraged any jumping (he wouldn't know how to jump on or off the bed or couch) and excessive/vigorous running. I had a poodle with Grade 1 LP who lived to be almost 14. I am going to be thinking about you guys in the next few days. I sure hope you will post updates on his progress. You are doing the right thing to ensure that he will live a long, healthy and happy life. Jasper and I send all our love and best wishes your way. Toni __________________ 'There is no psychiatrist in the world like a puppy licking your face.' ~ Ben Williams [SIGPIC]

08-27-2010, 11:55 AM	#8 (permalink)
tonicoombs Member Name: Toni Dog's Name: Jasper Join Date: Jul 2010 Location: Kentucky Posts: 86	And by the way, Sher, thank you for that information on LP. I watch Jasper's behaviour constantly. After having a furkid with LP, I am extra attentive. __________________ 'There is no psychiatrist in the world like a puppy licking your face.' ~ Ben Williams [SIGPIC]

01-04-2009, 07:33 PM	#1 (permalink)
k/c mom Maltese Guru Name: Stick a fork in me.... I'm done. Join Date: Oct 2004 Posts: 21,485	Dr. Jaimie first brought this information to our attention in this thread: http://spoiledmaltese.com/forum/inde...howtopic=36837 http://www.marvistavet.com/html/medi...g_patella.html Luxating Patellas Patellas can be diagnosed at a very young age, toy breeds are at high incidence of LP. some LP can be made from a trauma and won't be present at the initial exam. i dont think that a dog with LP should be bred, but it doesnt mean that 2 normal dogs can't produce a pup with LP. i check the knees at a first pup visit but that isn't to say that every vet does. some don't look unless there is an issue. and u can grade patellas with out an xray: Medial patellar luxations are graded to assess severity. Grade I: The kneecap can be moved out of place manually but will fall back into its natural position once the manipulator lets go. Grade 2: Same thing except that the kneecap does not move back to its normal position when the manipulator lets go. These dogs are likely to progress to arthritis development and should be considered for surgery to prevent conformational damage. There is some controversy over whether grade 2 dogs should have surgery. Grade 3: The patella is out of place all the time but can be manipulated back into its normal position manually (though it will not stay there). Grade 4: The patella is not only out of place all the time but cannot even be manipulated back into place by hand. Such a dog has extreme difficulty extending his knees and walks with his knees bent virtually all the time. It is not a good thing to have one's knee cap out of place; the entire weight-bearing stress of the rear leg is altered which, in time, leads to changes in the hips, long bones, and ultimately arthritis. How severe the changes are depends on how severe the luxation is (i.e., the grade as described above) and how long that degree of luxation has been going on. In time, the legs will actually turn inward, making the dog "knock-kneed." The luxation is not considered a painful condition but after enough time and conformational change, arthritis sets in, which is indeed painful. Dogs with Grade I luxations do not require surgical repair. Grade 2 dogs may benefit from surgery and most often the owner is called upon to judge how big a problem the lameness is. Dogs with Grade 3 or 4 disease definitely should have surgery.

08-27-2010, 11:39 AM	#6 (permalink)
makettle29 Maltese Guru Join Date: Nov 2005 Location: winter in Florida summer on Martha's Vineyard Posts: 565	Debbie, Best wishes for the surgery but I know it will go fine and you will be happy. The recovery is long so ask your surgeon lots of questions. Once your pup is recovered you'll be amazed. For the future, don't encourage your pup to put undue strain on his legs. Running games and jumping on and off furniture is not a good practice. mary anna

08-27-2010, 12:03 PM	#9 (permalink)
Ladysmom Maltese Guru Name: Marj Dog's Name: Bailey and Lady at the Bridge Join Date: Oct 2004 Location: North Carolina Posts: 15,082	I am so glad you took Chewie to a board certified vet. I am also glad you found a way to pay for his surgery. Please try not to worry about his size. 5.5 pounds is a good size. __________________ http://www.myladysdogbows.com/ http://www.facebook.com/pages/MLadys...s/182366213341

09-01-2010, 05:06 PM	#10 (permalink)
DebbieG Newbie Name: Debbie Guilbeau Dog's Name: Chewbacca (Chewie) Join Date: Aug 2009 Location: Baton Rouge, LA Posts: 32	Chewie's LP Surgery Thanks for all your replies. Chewie had his surgery yesterday. The vet called last night and said he did great. No cartilage damage at all because we caught it quickly enough. I can probably pick him up on Friday. I took the day off work so I can stay home with him from Friday through Labor Day. I got a call from the vet's office today to tell me that Chewie ate a good breakfast this morning. They took him outside and they let him walk a little bit while they hold him up. He is hobbling around quite well. I wanted to go visit him, but the vet told me it would be better if I don't because Chewie will get all excited and think he is going home and when he has to stay, he will get really down. I will take the vet's advice. I don't want to do anything to slow down his recovery. They are keeping him pretty sedated for now. Can't wait to see him on Friday. Will keep y'all posted. Thanks again.

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