Last Updated on 2022-07-10 by Admin
Our journey to eventually have knee surgery for Annie, my Boxer girl, was a lengthy one. What often starts as a limp develops into something more serious. And before You know it, surgery is recommended because a dog has torn ACL and osteoarthritis.
When my Boxer girl Annie was limping and getting worse, we went to the veterinarian with her once again. This time we again required X-rays, and right away, the TPLO knee surgery got recommended because of a torn cruciate ligament.
Having done some research on dog knee surgeries in the past made me hold off with surgery.
Instead, I called around and had a few other second opinions. All indicated a torn ligament, and gain right way the TPLO surgery got recommended. At this point, I started to distrust veterinarians, they seem to promote only one type of surgery, and there are no alternative procedures mentioned.
There Are Various Surgical Procedures, But You May Not Hear About Them
Aside from not being offered some choice of surgical procedures, I had other concerns.
- The veterinarian would perform the surgery, and I did not know how many and how often he did this surgery.
- For me, the information provided was too superficial regarding the surgery, outcomes and the recovery to make a well-informed decision.
The Most Common Dog Knee Surgery Procedures
While it seems that there is only one type of dog knee surgery procedure, there are a number of them. There is also a lot of research on most of the procedures. However, many studies are based on surgeons performing the surgeries and not the veterinarian down the street. That I’m sure must have some influence on the outcomes reported in those studies. Many of the studies available for free are old and might not reflect the current state of every procedure. Those things were important to me to make sure Annie gets the best results from surgery.
The most common Dog knee surgeries are:
- Tibial Plateau Leveling Osteotomy (TPLO)
- Tibial Tuberosity Advancement (TTA)
- Modified Maquet Procedure (MMP)
- Tightrope Procedure
My post on the various dog knee surgeries contains animated videos for each of the surgeries mentioned above. Please refer to that post for more details.
Just because there are many available procedures does not mean that You will find someone to perform the one You prefer. The TPLO and TTA procedures seem to be available without much effort. But to locate someone to perform the Tightrope procedure took some effort. However, for the MMP surgery, I could not find one within a reasonable distance from my location.
Benefits of Engaging Directly with a Surgeon
While many veterinarians do refer clients to surgeons, not all of them do. Veterinarians trained for a specific dog knee surgery procedure often won’t. Then it will be up to You to find a surgeon and ask the veterinarian to refer You to that surgeon. That is what I ended up doing. And this is why:
Unlike a regular veterinarian, that might do surgery one day a week and the rest of the time look after all kinds of other animal health issues. The surgeon is dedicated to one thing, surgery.
Another reason why You might want to engage directly with a surgeon is because they have experience with more than just one procedure. As they are specialists and do nothing but surgery, they have more practice and experience.
Other benefits of a well-qualified surgeon:
- Also trained for less invasive procedures like arthroscopy
- Updated training to use the latest technique for a given procedure
- The skilful execution of surgery can mean smaller incisions, quicker healing and less chance for infection
My Own Experience Dealing with a Surgeon
The surgeon that performed the Tightrope surgery on Annie is Dr. Gillick. During my initial phone consultation with Dr. Gillick we talked about the TPLO and Tightrope procedures. We then discussed many aspects of two types of surgeries and the outcomes and statistics of how dogs fared after surgery.
During this conversation, I learned about the suitability of a specific surgery as it relates to Annie. Dr. Gillick confirmed that Annie was a suitable candidate for the Tightrope and the TPLO surgery.
Dr. Gillick presented the Pros and cons of each surgical procedure in great detail, including surgery time, likely hood of complications, recovery time, and long-term outcomes.
Someone to Trust
Then a few days later, I received a written summary of our conversation. While this consultation was not free, it provided me with the information I expected all along. Now, I was able to make a well-informed decision.
Via further emails, I was also able to confirm that Dr. Gillick performed many hundreds of Tightrope procedures. Dr. Gillick is also an instructor to other veterinarians for the Tightrope procedure.
Dr. Gillick also mentioned that he wanted to use arthroscopy to remove the torn pieces of the ligament, investigate the meniscus, and address anything that may need attention while Annie was under anesthetics. We also agreed to that because it made sense. Later I found out that doing this arthroscopy surgery as part of the dog knee surgery is considered the gold standard.
You can read more about my experience with Dr. Gilick in my article “Dog knee injury – Why After one Year of Conservative Treatment I Decided on Surgery.”
How Dealing With a Surgeon Differs From Dealing With Your Veterinarian
As a dog owner, You might like to bring Your pet to the Vet, and they will do the surgery. Then when You go back and pick up the pet, You again can talk to the veterinarian who performed the procedure. When dealing directly with a surgeon, things are somewhat different.
Because Surgeons are specialists, they do only surgeries and not after-care. The surgeon will most likely provide some updates on the surgery and how the surgery went. So You are not abandoned.
The Tightrope Procedure to Fix Annie’s Torn Ligament
I just found a Surgeon that I could communicate with, and I trusted his approach and judgment.
My wife and I decided to favour the Tightrope procedure because it is the only procedure that does not cut bone. It seemed less invasive, and the suture material acts to replace the function of the torn ligament. Should Annie, for some reason, require another surgery, she still could have another type of surgery on that knee.
We asked DR. Gillick to proceed with the Tightrope procedure.
We had another shorter phone conversation to select a date and go over some other details about the surgery. We had a choice to have a dedicated anesthetist for Annie’s surgery, and since Annie is a flat-nosed dog breed, we took it.
Dr. Gillick arranged an appointment with an animal hospital equipped with all the instruments and resources required to perform the dog knee surgery as dicussed.
Worth mentioning here is that Dr. Gillick is a mobile surgeon and has a website https://www.fuzzypaws.ca/. Here is an excerpt from the fuzzypaws website “Dr. Mitchell Gillick is pleased to offer referral mobile surgical services to veterinary hospitals throughout the GTA.
Serving Central, West, East and North GTA, including Thornhill, Markham, Mississauga, Oakville, Vaughan, Scarborough, Oshawa, Pickering, Peterborough. Including Bradford, Barrie, Orillia, Oro-Medonte, Huntsville and Muskoka.”
Preparation For the Tightrope Knee Surgery
I took Annie of all supplements and got a home-cooked instead of a raw diet. The surgeon made it very clear not to feed her any raw meat until two weeks after the surgery.
A pre and post-surgery checklist is available on my post “Preparation and Checklist for before and after dog knee Surgery.” That list is very comprehensive and covers more than one would expect.
We brought Annie to the clinic at 8 am, handed Annie over to the Animal Hospital. They informed us that the surgeon would contact us after the surgery.
Before surgery, I got an email from the surgeon stating that Annie’s Blood work was OK and reconfirmed that there was a lot of instability in the left knee. The surgery will begin shortly, and once the surgery is over, he will contact me.
Waiting During Surgery
The wait felt long and was full of worries on my part. But a few hours later, the first email came stating that Annie was out of surgery, all went well. Also included were some details about the surgery. And to expect a call from the surgeon.
Maybe an hour after the email, I received a call from the surgeon. The surgery went well, and he also confirmed that the ligament was indeed fully torn and that he removed the torn pieces and the meniscus fragments.
Pending Annie’s recovery, we could pick up Annie later in the evening. When we arrived to pick up Annie at the Animal hospital, she was still groggy and in pain. It took three people to get Annie in the car, and Annie was clearly in pain during the drive home.
Getting Annie out of the car and into the house took some effort, and she was not steady on her legs and could not put weight on the leg. The Dog Lift harness was very helpful to lift the rear. But Annie was not interested in going forward. Eventually, we got her home, and she was relieved to be in a familiar place.
A few things got my attention right away. One was the lack of bandages on the knee, the other the clean and relatively small incision, plus the cut was immaculate without jagged edges.
Post Surgery Night
The first knight was rough. Annie was in pain and was wincing and breathing heavily. As this continued, I called the emergency line of the hospital and explained my situation. The advice was to ice the leg and see how that works. And give her the pain medication at a specified time, which was earlier than the instructions indicated. Taking care of these two items got Annie to calm down and fall asleep.
Day 1 After Surgery
Day one after surgery went much better. Annie was alert but not active. She was clearly in less pain and tried to put a slight amount of weight on her leg. But the rear still required support via the lifting harness to take most of the pressure off the injured leg. Annie dislikes the lift harness but tolerates it. Taking the dog out to do its business is a two-person job. One to lead the dog on a very short leash, the other to lift the rear with the lift harness.
Annie’s knee is hot to the touch, so icing happens about every 3 hours. What follows next is a very light massage by just running the fingers over the skin with hardly any pressure. Annie appreciates the attention.
When it comes to eating, she eats only enough to take the medications.
Day 2 After Surgery
Annie seems to feel a little better, has gone out a few times to pee. When going out, the lift harness is still required.
I noticed that her Hock is swollen from fluid buildup, and Annie is still clearly in pain. So I started icing and massaging the swollen area lightly with a stroking motion up towards the knee. It takes about 30 minutes of this very light massage and icing till the fluid is no longer noticeable. The Hock, however, is still swollen.
The procedure mentioned above was done three times a day, the last time before bedtime.
Day 3 After Surgery
In the morning, before it is time to take the pain killer medication, Annie is shivering and is uncomfortable. But 30 minutes after giving her medication, she is doing much better. Annie also had her first poop in 3 days. Going out with the dog still requires the rear to be lifted for support. Annie’s alertness has increased from yesterday, but not the activity level.
Her Hock is full of liquid again, and she is panting and shaking. Her Hock is also hot, so icing and massaging are required to reduce the fluid buildup.
After her massage and icing, Annie felt better and laid down and slept for an hour. I called the Animal hospital to find out if something else could address the fluid buildup. They also requested that I send some pictures the next time this happens. I got asked if I used a hot pack, which I did not because the leg felt hot.
Mistakes Can Happen
Looking at Annie’s prescription for anti-inflammatory medication and the information sheet, I noticed the prescribed amounts did not match. One indicates to give an amount based on 20 kg body weight while the other says to measure for 30 kg body weight.
Prescription Information Sheet
I took a picture of each and sent it to the hospital for review. Shortly after, I got a reply confirming that they checked the surgeon’s instructions and gave Annie the anti-inflammatory medication based on 30 kg.
Annie’s activity level is very subdued, and she is not having a good day. However, her appetite is close to normal.
Day 4 After Surgery
In regards to medication, things are all well today, and Annie’s appetite is pretty good. While going out, she touches the floor with her paws, but she does not put much weight on it.
The fluid buildup in the Hock is light today, and it went away quickly with a light massage.
Today I decided to sleep in my bed, no more sleeping on the floor with Annie. Before I went to bed, I put a collar and leash on Annie and had her sleep on the floor beside my bed, and I slept with the leash tied around my wrist.
Day 5 After Surgery
All is well with Annie. However, she is not happy with the amount of food she gets, and she wants more food. I’m glad to see her appetite back to normal.
For the first time in a long time, Annie placed herself with her rear in front of me and looked back at me. That is her sign that she wants a massage on her back and rear legs.
Over the day, I massaged Annie’s rear legs and back a few times. I also noticed that she is more active around the house. By active, I mean standing instead of laying down and sleeping. She is still tied down to the crate or sitting beside me while I hold the leash.
Day 6 After Surgery
The wound healed very nicely, and the swelling is way down. Annie enjoys the massages, cold and hot packs she receives. My reward for looking after here is a lot of licking.
The activity level is normal. Annie wants to go about as if she never had surgery. Thankfully she listens well when told were not going her way.
It is hard to believe it’s been six days since the surgery. Annie is always right beside me or tied to a crate with me very close by.
Day 7 After Surgery
Annie is very active, considering she just had surgery. When we go out, she rolls over and rubs her back in the grass and enjoys laying in the sun.
She is alert watches everything that is going around her. I have Nothing better to do than sit in the grass beside Annie and observe my happy dog.
Today is the first time since the surgery Annie rejects the ice pack. But she still comes for her leg massages.
Annie starts to pull on the leash when she sees another dog or people she knows.
Week 2 – Post Surgery
Because Annie started to pull towards other dogs and people she knows, we go out at different times of the day now. And hope we can avoid most dogs and people while we go out.
Annie is her usual self again. She sniffs and has plans on going to all the places she went to before surgery. While it is nice to see she is going so well, it is also a danger sign. Because I know Annie will go way past what is good for her when not held back.
Because of Annie’s change in behaviour, my goal for this week is to watch how long we are out each time. The allowable time based on the recovery instructions is 5 to 10 minutes at a time.
For that reason, when we do go out. Annie can walk for 5 minutes, and then we sit in the grass together for 45 minutes or more. During that time, Annie watches everything that is going on around her. During those times, I can massage her leg or even do some physiotherapy with her.
When we do the physiotherapy, Annie stretches her leg fully on her own. It is incredible to experience this. I support her leg with my hand, so it is stable. When it comes to bending the knee, it is uncomfortable for Annie, and she hesitates. However, together, the exercises get done. At home, she gets warm and cold packs.
Week 3 to 6 post Surgery
Around week three, Annie started feeling happy and ambitious. It is time to review the recovery instructions again to stay at the recommended activity level.
This phase of the recovery can be tricky. Annie is off pain medication and doing well, and she started walking faster and farther to do her business in the morning. Even with being mindful of the time spent outside, there was an occasion where we overdid it.
It became apparent when I noticed a slight limp on our way back, very close to home. So for the next two days, we reduced the time spent outside.
When it comes to recovery, Weeks three to six are tricky to stay the course. In Annie’s case, she felt good and had little pain and want’s to be more active than was good for her.
The 6-week post-surgery checkup went well. Annie is recovering as expected.
The Remainder Of The Recovery
Around Week 10, we increase the walking time and activity level gradually. Annie, at week 11, wants to play and jump and run. However, it is too early for that. Twenty-six weeks post-surgery is when Annie can jump and run with other dogs, and that is when she recovered.
Dog knee surgery is something that many dog owners eventually have to address. And I do know several dog owners that are in that situation right now.
I am pleased with the surgery and the recovery. Managing a recovery can be challenging. On the one hand, it is nice to see a quick recovery. But on the other hand, dogs don’t show pain or discomfort until it is very bad. Being too active can break or undo some aspects of the surgery, requiring additional surgery.
The most challenging and crucial part of recovery is managing that lack of showing pain and discomfort in dogs. So it is essential to follow the provided recovery instructions.
Annie is no exception, and we were out and active longer than what was good for her. On occasions, that caused setbacks where Annie was confined to the crate again for a few days. Fortunately, nothing worse happened. Just don’t get seduced by Your dog into long outings.