Grade 3 Patellar Lux - Sx or conservative?

[lehughes]

Hi Laurie
I have been working with a 18 month old F/S Papillon that I diagnosed with grade 1 luxating patellas 6 months ago.  We have really worked at building quads and glutes and this has gone quite well, but the luxating patellas have progressed and are now grade 3s.  The dog can walk for 60 min without any lameness, but will lift up a leg if walks in deeper snow.  So now I am trying to decide where to go with this case as the patellas are permanently luxated and I know no matter how much more we build these quads/glutes (and they're pretty awesome right now) that these patellas are going to stay luxated.   I feel that the best course of action is to send this dog for surgery (tibial crest transplant and deepening of patellar grooves) as this dog will likely develop a lot less arthritis in the long run.   What is your experience in grade 3 luxating patellas with dogs that do have surgery vs those who don't.
Thanks so much for your help on this.
J.S.

[lehughes]

Great question!

So I find that grade 2+ luxations are actually the worst.  Because they hurt!
Grade 3’s can go on for quite a while without a lame step ever. I have an 8 year old toy poodle that is a real poster child for this.  She’s never had a lame step, no pain, no dysfunction… but has very little expectations of her - goes for walks.  That’s it.
If they want to be more active with the Papillon or if they have other dogs and/or the dog plays with others… then go for surgery.

While surgery would / could help in this case, the main goal should be to reduce pain and improve function.  If there is function and there is no pain… then what is there to improve upon?
Preventing arthritis with surgery is something I hear only promoted by vets: yes, that could be the case of a painful grade 2, but if the patella slip slides back and forth and the medial trochlear ridge has worn down, then you actually have a smooth surface.  If we continue down this thought path, any surgery will cause arthritis, any opening of the joint causes an irritation.  In humans it was shown that an intact meniscus was what was protective against arthritis, not whether a person had surgery or not for a cruciate injury.  Anyways, I digress… but it’s because I hear surgery being promoted as a way to prevent arthritis, when it’s not true - arthritis will happen either way.  Surgery should be promoted to increase function and decrease pain.

So, in summation - if it’s an active little dog and they want to be active or do sport with her then do the surgery.  If she’s just going to have a ‘normal dog life’, leash walks and hanging out with owners, and there isn’t pain or dysfunction - then leave them.

Maybe a bit of a circular thought process… sorry, only a few things are black and white!

Laurie

[lehughes]

Thanks so much Laurie for such a detailed answer.   The owner was wanting this dog to do agility.   With a successful surgery, do you think this is a possibility for a dog with grade 3 patellas?
All the best
J

[lehughes]

I’m glad I didn’t make your head spin off with my answer!  
If they want to do agility, then yes, do the surgery, and yes, I would think he could play afterwards (with rehab of course!) (Given that he’s a small dog I think he will be more successful going on to sports than a big dog in a similar scenario!)

Best of luck!

Laurie