MEDIALLY LUXATING PATELLAS IN DOGS

What is patella luxation?
Patella luxation is simply the medical term for knee dislocation whereby the kneecap (aka patella) moves out of position and causes a temporary lameness. Typically owners noticed a skip in the dog’s step. 
Approximately 50% of affected dogs will have both knees involved.  Some dog breeds are more prone to developing luxating patellas than others.

What causes patella luxation?
The 2 main causes of patella luxation stem from anatomical differences in the knee. These can be genetic but can also come about due to injury.

1. Abnormal shape of the patella groove: the kneecap sits in a particular groove located on the femur bone. If this groove is abnormal in shape (most commonly the groove is too shallow), then the kneecap is able to wiggle in and out of place.
2. Abnormal attachment of the quadriceps tendon: the quads attach to the tibia (the shin bone). If there is an anatomical difference to this attachment, then the patella gets pulled out of place each time the quad muscle is flexed.

What are the grades of patella luxation?
Dislocations are graded by severity. Four grades of dislocation are recognised:

Grade 1
The patella luxates when manual pressure is applied by the vet but returns to its normal position once the pressure is released. Dogs may not show any clinical signs.
Grade 2
The patella luxates on its own simply when the leg is moved but returns to its normal position eventually. Some lameness is often evident – usually a skipping motion is noted by owners.
Grade 3
The patella luxates on its own but requires manual pressure to return to normal position. Considerable lameness is usually present.
Grade 4
The patella is permanently luxated. Dogs are unable to use this limb whilst walking.

Dogs with patella luxation will inevitably develop degenerative joint disease (also known as osteoarthritis) in the affected leg(s). This is because the ridges of the groove in which the patella sits will invariably wear down with time. As this happens the cartilage within the knee degenerates and the “bone on bone” grinding, which is typical of osteoarthritis, begins.

What treatment is available?
Treatment depends on the grade of the luxation, severity of clinical signs and the age of the dog. If the dog has frequent or bothersome clinical signs (i.e. frequent or persistent episodes of lameness), at any grade of luxation, your veterinarian may recommend surgery. 
Dogs with grade 3 or 4 luxation typically require surgery as medical management is often not enough to keep these dogs comfortable.
Dogs with grade 2 can be a little trickier. Whether or not surgery is required depends on several factors: how often lameness is a problem, how long each episode of lameness lasts, how old the dog is. Another reason to proceed with surgical intervention at this stage is for prevention. If the ridges of the already shallow groove wear down with DJD, the grade 2 can progress to grade 3 luxation. Surgery can prevent this progression.
Without surgery, the knee is typically unstable and at risk of further injury. Most commonly, dogs will tear or rupture their cruciate ligaments. When this happens, surgery is a necessity to restabilise the knee (and is a bigger procedure than the patella surgery). 

Dogs with patella luxation commonly develop DJD. Your vet will discuss DJD and management options with you. These commonly include exercises, weight management, supplements and pain-relieving medications if necessary. 

Diarrhoea and Vomiting in Pets: Guidelines for Care

Diarrhoea is defined as the frequent evacuation of soft or watery stools.
Vomiting is the forceful expulsion of stomach contents through the mouth.

Vomiting and diarrhoea are symptoms commonly linked to various issues collectively known as gastroenteritis. The severity can vary significantly, with some cases being quite serious, such as poisoning, and others being relatively minor, like dietary indiscretion. If a fever is present, an infection may be the underlying cause. Many infections that result in diarrhoea and vomiting are contagious, so if you have a multi-pet household, it is crucial to isolate other pets immediately to prevent the spread of potential infection.

You should assess your pet for signs of dehydration, such as skin tenting or tacky gums. Contact your vet, especially if the pet is young or appears unusually lethargic, as diarrhoea and vomiting can quickly lead to dehydration.

Avoid giving over-the-counter or prescription medications without veterinary approval.
Veterinary staff will be able to provide general advice over the phone, but please keep in mind that phone advice can only ever be general. A specific care plan requires a physical examination.
If vomiting persists for more than 24 hours or your pet is lethargic, not eating/drinking or the vomit has blood in it, bring your pet straight into the clinic.

If your pet’s diarrhoea lasts for more than 48 hours, or your pet is acting sick, such as being lethargic or loss of appetite, seek immediate veterinary care.
For an accurate diagnosis and appropriate treatment, it is essential to have a consultation with a veterinarian.
A vet will assess your pet and if necessary determine the underlying cause and develop a tailored treatment plan.

Ignoring these symptoms or attempting to treat them without veterinary guidance can lead to complications, so seeking expert advice is crucial to ensure your pet’s health and recovery.