Management case2.txt

Because Titan has a grade III medial congenital patella luxation, which is a condition that 
will likely deteriorate with time to a higher grade luxation, surgery is the treatment of 
choice.  Traditionally, most grade II and all Grade III and IV patella luxations are managed 
surgically.  

Surgery is indicated in dogs in which the frequency of severity of lameness results in a 
compromise of normal function. In TitanŐs case she is currently experiencing a right hind 
limb lameness preventing normal ambulation.  

The surgical goal in this case is to correct the alignment of the quadriceps mechanism and to 
stabilize the patella within the trochlear groove. There are a number of different ways to 
approach this problem surgically including: 
1. deepening of the trochlear groove
2. tibial tubercle deviation
3. trochleoplasty
4. trochlear sulcoplasty
5. recession sulcoplasty
6. trochlear chondroplasty
7. desmotomy
8. corrective osteotomy (grades III and IV)

Again, the ultimate goal is to align and stabilize the patella thus restoring normal function to 
the right hind limb.

In addition to surgery, or in the interim for surgery,the following medications may be 
dispensed:
1. NSAIDŐs  10-25 mg/kg PO q8h or q12h
2. Caroprofen  2.2 mg/kg  PO  q 12h
3. Phenylbutazone  3-7 mg/kg  PO q8h (<800 mg/day)

When using NSAIDŐs potential gi irritation must be considered.

Alternative drugs:
1. Chondroprotective drugs such as Polysulfated Glycosaminoglycans, Chondroitan 
Sulfate, and Glucosamine

Contraindicated drugs include:
1. Corticosteroids due to potential side effects and articular cartilage damage.

Post surgical care should include the following:
1. Cryotherapy immediately following surgery for 15-20 minutes every 8 hours for a 
period of 3-5 days.
2. Weight control via diet to decrease the load on the stifle
3. ROM exercises as soon as tolerated and early, active limb use advocated.
4. Exercise limitations for 4 weeks  including preventing jumping
5. Monitoring of any onset of acute non-weight bearing lameness as this could indicate 
CrCL disease.
6. Yearly exam to assess progress