On June 4, 2003 Bella had double knee surgery on her 2 back legs for what is called "BILATERAL GRADE II MEDIAL PATELLAR LUXATION".
We had noticed that Bella would walk a few steps, then have to lay down. Upon watching her even closer, we could see that a 'joint' in one of her legs appeared to be 'popping out' as she tried to walk, which in turn led her to basically fall to the floor.
After her wonderful vet in Phoenix, Dr. Grant examined and xrayed her, he called upon an orthopedist for a 2nd opinion. Dr. Grant made us aware, surgery was most likely from what he saw of her unstable leg.
The orthopedist confimred she needed surgery, but while examining her, determined, not only 1, but both of her legs had the Patellar Luxation.
PATELLAR LUXATION: This is often referred to as 'slipping kneecaps'. The patella normally moves up and down in a groove in the lower femur bone called the trochlear groove. In patella luxation the groove is often shallow. This shallow groove prevents the patella from seating deeply and predisposes it to dislocation. This results in the luxation of the patella as the leg is used.
Medial luxation, which are congenital (existing from birth) and often affects both knees, commonly affect cats and smaller breed of dogs, means that the patella moves toward the inside of the knee (while lateral luxation are often the result of trauma and can affect any pet & means that the patella moves to the outside of the knee). Medial luxation tends to cause a bow-legged appearance (while a knock-kneed appearance is seen with lateral luxation). Both rear limbs can be affected & the severity can vary from knee to knee. Patellar luxation is graded from I to IV, with grade IV being the most severe. Obesity and other orthopedic problems may exacerbate the lameness from luxating patellae.
Grade I -- The patella can be manually luxated but easily comes back into normal position. Patient may or may not occasionally carry the affected leg.
Grade II -- Patella luxates on flexion of the knee joint and remains out of place until manually replaced or patient extends and rotates joint. Patient intermittently carries the affected limb with the knee joint flexed.
Grade III -- Patella remains luxated most of the time but can be manually reduced (placed back into position). Flexion and extension of the knee joint reluxates the patella. Patient transfers most of the body weight to the front legs, bunny hops or carries the affected legs, and appears bowlegged or knock-kneed.
Grade IV -- Patella is permanently luxated and cannot be manually repositioned. The quadriceps muscle group starts to shorten, making it difficult to extend the leg fully. Patient transfers most of the body weight to the front legs, bunny hops or carries the affected legs, and appears bowlegged or knock-kneed.
Surgical correction is required for moderate to severe luxation in these small dogs & cats. Failure to repair the deformity usually leads to degenerative joint disease and increases the risk for cranial cruciate ligament failure. The correction performed is determined by the deformity with the goal to provide normal alignment of the quadriceps mechanism and provide adequate groove for the patella to glide in. Most patients lead very active lives after surgery, particulary if they undergo correction when they are young (Bella was 3 at the time). All animals with patellar luxation can develop some degree of arthritis. Depending on the amount of correction required, most pets will need 6-8 weeks of confinement. If muscle atrophy is present, the pet may need several months of physical therapy for a full recovery. It is also important to keep the pet off of furniture to prevent jumps or falls. Weight management is also key to long term management.
Courtesy of: Gale Mueller
The knee on the left shows the normal position of the patella. The center knee shows luxation of the patella to the medial side. The knee on the right represents luxation of the patella to the lateral side.
1. Patella
2. Femur
3. Patellar ligament
4. Tibial Tuberosity
5. Medial Luxation of Patella
6. Lateral Luxation of Patella
Below are the actual notes from the doctors who operated on Bella:
Bella's right stifle was thickened and effusive and both her patellae luxated medially. She probably had an injurty to her right stifle that exacerbated her patellar luxation (Dr. Grant thinks she suffered a "football injury". Running at or from one of the other cats, her leg stayed, but knee twisted) Her excess weight exacerbates the knee problems and weight management is crucial for her to have a good outcome. (Bella has been on diet foods with little success in 2003. As of 6/04 she is on the 'CATkins' diet - low carb/hi protein ~ she NEEDS to get down to 12 or 13 lbs. I WILL be her willpower and have success this time!) We have corrected her luxations by deepening and widening the groove for her patellae and tightening the soft tissue support structures. Her surgeries went very well and she is a wonderful cat to care for.
The first 3-5 days after bilateral stifle surgery are the most uncomfortable for the cat and most challenging for the owner. She may need some assistance to stand up during this time. It is important to provide good footing for her so she does not slip and fall. The patch (of morphine) will help control her pain. She should be able to get up on her own in several days then make slow but steady progress. When she first starts to stand, she may bear all her weight on her forelimbs so do not be alarmed if this occurs . She should start to walk on her own in 5-7 days. (The first time I saw Bella stand to get in the litter box, she looked like a baby deer. So shaky and she literally 'laid' in the litter box. It was heartbreaking.)
Overall she needs 4 weeks of STRICT CAGE CONFINEMENT (we were told a small room would do also, she stayed in our guest bathroom) No running, jumping, swimming, stairs, or strenuous activity Do not turn her loose in the house or yard and keep her separate from other pets. Her area can be large enough for her to have food and litter and walk around, but needs to prevent strenuous activity. Her sutures should be removed in 10-14 days.
You can start allowing her to be loose in the house in 4 weeks. For the first 2 weeks that you begin letting her loose, keep her separate from other pets and return her to her area when unsupervised. (We had moved Bella into our guest bedroom after 2 weeks in the guest bathroom, Fafur then built her a 'handicap' ramp, made of wood and carpet to get onto the bed since she should not and could not anyway, jump) Afterwards she can gradually resume her normal activity. She should be fully weight bearing on both rear limbs comfortably in 3-4 weeks although, complete healing of her knees will take about 4 months.
Bella has healed wonderfully! She walks, runs and jumps like nothing ever was wrong with her! She currently takes the supplement, "Cosequin". Which is a patented, scientifically researched nutritional supplement of glucosamine/chondroitin dispensed by thousands of veterinarians to help cats maintain healthy joints.
Bella is amazing! She is my Special Angel!
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