# Complications from patella surgery?



## MrCuppy (Jun 12, 2007)

Hello everyone,

Almost 1 year ago my baby (just over 2 years old) had patella surgery on her left hind leg. Her recovery was normal over the past 8 months. During this time, she had been seen several times by her vet and both physical exams and x-rays appeared to be normal. Initially there was a slight concern about the "thinness" of the bone where the pin had been placed, but the vet did not seem very concerned (and still seems to feel that there is no reason for concern). 

About 3 weeks ago, I noticed that Cupcake’s gait had suddenly changed. At first it was as though she was rolling her left hind foot outward, walking on the outside of her foot. In addition, her left knee seemed to be bowing outward. I checked her foot carefully and there were no injuries. Strangely, she did not seemed to be at all bothered by her left hind foot or leg, and it didn’t seem obvious that she was favoring one leg or the other.

I took Cupcake to see her regular vet and he agreed that her gait had changed and that she appeared to being walking with her toes pointed inward. He again took an x-ray and found that nothing had changed since the previous x-ray had been taken (prior to the time her gait had changed). He also did a physical exam on both her hind legs and hips, and checked both hind feet. Her left leg seemed fine. The pin was secure and there was no luxation. And although Cupcake has a grade 2 luxation in the patella in her right hind leg, it doesn’t seem to be severe enough to be causing her any pain – nor severe enough to cause her to favor her left hind leg. However, the only explanation the vet could come up with is that perhaps the luxation in her right hind leg is causing her some discomfort and that perhaps this is causing her to very slightly favor her left hind leg, thus causing the change in her gait. He put Cupcake on 5 days of rest and anti-inflammatory medication once daily, but her gait remained the same at the end of the 5 days. 

As a precaution, I took Cupcake to see the surgeon that had performed the surgery on her patella. He felt that the change in Cupcake’s gait may be due to the fact that, during the patella surgery, the tibia (shine bone) is rotated before the pin is placed in the bone and so although Cupcake may _think_ that she is placing her foot down with her toes pointed forward, she is actually pointing her toes inward because the tibia bone has been rotated. Not a very satisfactory answer as far as I am concerned, since she was not doing this until only recently.

Although Cupcake doesn’t seem to be in any pain and seems to be her usual, active self, I have scheduled an appointment with an orthopedic surgeon at UC Davis School of Veterinarian Medicine in August as an added precaution. They will do a complete workup on both of Cupcakes hind legs, including an MRI if necessary, to be sure that there aren’t any other problems. 

In the meantime, I thought that I might ask if anyone else has had a similar experience (toes turning inward, knee bowing outward) after your Malt’s patella surgery. 

Lastly (and I know that this may be a strange question), do Malts usually run with alternating hind leg movement (left leg forward, then right leg forward, then left leg forward, etc.) or do they run with both hind legs moving in unison (similar to the way a rabbit runs)? I have noticed that Cupcake sometimes runs using both hind legs in unison and so I was wondering if this is normal.

Sorry that this is such a lengthy posting.  Any input would be greatly appreciated. Thank you very much!

Tim


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## Cosy (Feb 9, 2006)

Hi and I'm sorry Cupcake is having problems after a relatively simple surgery.
I haven't heard of the tibia rotated causing toeing in but that doesn't mean it isn't the reason. I'm glad you're taking her for a third and thorough opinion and I hope you will share the findings with us then.
As for maltese running with a both rear legs forward at the same time, yes, depending on what they are doing. When my Cosy runs in the grass she often uses both hind legs forward at the same time. Other times when she runs she doesn't.


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## CeeCee's Mom (Sep 14, 2006)

I am sorry that Cupcake is having problems. I think you are wise to take her to UC Davis to see what they think!!!! Please keep us updated. I know that having problems with a knee accident, it does put your gate off somewhat. Give Cupcake a hug and a kiss!!!!! I'm sure they will get to the bottom of this problem she is having!!!


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## dr.jaimie (Mar 23, 2004)

im sorry ur not getting answers for your baby. as a vet myself i do not think i would be ok with this occurrance post surgery. i am glad u are seeing a specialist. did they say how the patella was....was it staying in place? i know it is a usual occurrance for a dog with patella luxation to become pigeon toed so i worry that the surgery was not a success.


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## hambys97 (Feb 25, 2005)

I am so sorry to hear what you and Cupcake are dealing with. I want to commend you for being so on top of things, and not taking the answers as gospel especially when it doesn't "feel" right to you. I can only hope that you feel better when you visit at UC Davis. As everyone else has said, please keep us updated. I will be praying that this is something simple for Cupcake and that you will know when you have a proper answer.


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## jmm (Nov 23, 2004)

I would also pursue another opinion. One common complication is the pin needing to be removed. 

Months after Soda had his second knee done, I noticed his whole leg was turning inwards. It turned out his had less muscle mass on that leg. After physical therapy to build up the muscle, his gait was normal. 

Bunny hopping usually means the dog is compensating for something (depending on the individual dog's conformation). I would bring it up at the visit. Soda's bunny hopping was the only way I knew he blew his second knee (he had traumatic LP).


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## MrCuppy (Jun 12, 2007)

Thank you for all of your encouragement, support, and suggestions! I really do appreciate it and I know that Cupcake appreciates it too! 

Dr. Jamie, you mentioned that "pigeon toeing" is common with patella luxations. Is it possible for luxation surgery to be unsuccessful? That is, it is possible that a second corrective procedure may be necessary? I know that it is difficult for you to make a diagnosis online like this, but are second procedures usually successful (if they are necessary), or does it depend upon the type of problem? Both Cupcake's regular vet and her surgeon checked her feet, knees, and hips and (aside from the slight luxation in her right knee) they felt that everything was fine. They told me that the pin in her left leg feels secure and that the left knee is not luxating. I just find it strange that Cupcake's gait changed 10 months into her recovery and that this is normal. I also find it strange that this problem (toeing in and knee bowing outward) suddenly seems to be improving in the past day or so. 

JMM, the surgeon did say that he might consider removing the pin if it seemed loose, but the pin seems secure and, according to the x-rays, there does not seem to be any problems around the pin (no inflammation or bone related problems). So, he didn't feel it was necessary to remove the pin. As much as I hate the idea of putting Cupcake through a second procedure, I will probably have her right knee operated on this fall, as the vet feels that the luxation in her right knee is worsening and that it will probably require surgery at some point in the future. Better to do it when she is young and can recover fully, they feel. I've also seen Cupcake "skip" on her right hind leg very occasionally. I will consult with the orthopedic surgeon at UC Davis before going forward with any surgery, however. 

As far as the "bunny hopping" goes, I really never noticed this until recently - and probably because I am now so focused on her gait and left hind leg. She may very well have been running this way all along and I just never recognized this. Cupcake doesn't bunny hop all of the time, just sometimes when she is running. Since I don't know what method of running is considered "normal", I am unsure whether her running style is unusual or whether it is "normal". I'll talk with the orthopedic surgeon at UC Davis and see what she thinks.

Thanks again for all of your help, suggestions, and support!

Tim


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