Southeast Veterinary Specialists

Orthopedic surgical procedures involve bone or joints. The procedures on this page are a few of the more common procedures that are performed by our surgeons at Southeast Veterinary Specialists.

This information is intended as general information for our clients. We can discuss more specific information as it relates to a particular animal after we have examined the pet. Each case is differernt and recommendations for one pet may not be the same for others.

If your pet has had surgery at our hospital and you have specific questions or concerns, please call our office and speak to a surgery technician. You can also email the surgery service at surgery@svsvets.com with specific questions about patients we have already seen. We do not give medical information about patients that we have not examined.

Surgery of the joint requires careful surgical technique by a trained professional; however, it is only the first step in the healing process. It is just as important to provide your pet with the proper environment and care after surgery as it is during the surgical procedure itself. Southeast Veterinary Specialists offers an aggressive postoperative rehabilitation program that will aid your pet in obtaining a full functional recovery after surgery.

Disease Process and Surgical Procedure
Cruciate ruptures in dogs are the result of a degenerative process that results in weakening of the cranial cruciate ligament over time. Since this process tends to be symmetrical (occurring in both knees simultaneously), it is not uncommon for the cruciate ligament to tear in the opposite leg relatively soon after the first side. Also due to the degenerative nature of the disease, there is no good way to primarily repair the torn ligament. For this reason, techniques to restore function to the joint without actually replacing or repairing the ligament have been developed. The extracapsular technique for stabilization of the stifle (knee) after rupture of the cranial cruciate ligament involves placing a prosthetic suture that mimics the action of the intact ligament. This technique works well in dogs and has been considered the traditional technique of choice for surgical stabilization of cruciate ruptures. It is our opinion that large dogs or physically active dogs (working dogs and performance animals) will do better with a Tibial Plateau Leveling Osteotomy (TPLO), however the extracapsular technique is still a viable surgical option.

Activity and Physical Rehabilitation
Rest is very important following surgery. Your pet should not be allowed to run or jump for 4 to 6 weeks. CAGE REST (airline carrier or wire crate) during this time period is very important in order to give the knee time to heal properly. If too much stress is placed on the surgical repair, it will not be successful. Your pet should only be allowed out of the cage for short walks outside to urinate and defecate or for physical rehabilitation. After the first four weeks, controlled leash walks will help to improve the range of motion in the operated joint. You should begin leash walking slowly with only short walks for the first two weeks (around the yard) followed by a little longer walks lasting 10 minutes or less for the second two weeks. After this your pet can gradually return to his/her normal activity. Keep in mind that increased body weight will put added stress on the joint; therefore, your pet's diet may need to be adjusted for the decreased activity after surgery.

If a human member of your family received this type of surgery, the doctor would likely prescribe physical rehabilitation. Physical rehabilitation is also important for your pet. Physical rehabilitation appointments with Dr. Ransom are strongly recommended after an extracapsular cruciate repair. We understand that both time and finances may be limited; however, it is our opinion that aggressive rehabilitation can greatly improve your pet's function after surgery.

Medication
In most cases, a non-steroidal anti-inflammatory drug (NSAID) such as carprofen (Rimadyl®), firocoxib (Previcox®) or deracoxib (Deramaxx®) will be recommended. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling. This will help your pet to be more comfortable and return to normal function sooner. Side effects occasionally seen with NSAIDs include decreased appetite, vomiting, diarrhea, blood in the vomit or stool and (rarely) liver or kidney dysfunction. If you note any decrease in appetite, vomiting, diarrhea, change in the color of the stool (especially darkening), or yellowing of the skin or eyes, stop the medication and call a veterinarian. Do not give your pet any other medication without consulting us. Many other non-steroidal anti-inflammatory drugs available for people are often toxic in dogs.

Antibiotics are usually used during surgery and may be considered postoperatively at home. Please do not give your pet any medication without discussing it with our office first. Antibiotics given inappropriately may result in the development of a resistant infection that can be difficult to treat. Pain medication (tramadol) other than a non-steroidal anti-inflammatory drug may be prescribed for the immediate postoperative period. If you feel that your pet is unusually uncomfortable, please notify our office. Uncontrollable pain is not an acceptable complication of surgery, and methods are available to keep your pet comfortable without side effects.

Sutures and Bandages
External skin sutures, when present, should be removed in 7 to 10 days. In most cases the skin is closed with internal absorbable sutures, which do not require removal. If you notice your pet licking and chewing the incision area, please notify us. Some swelling is normal after surgery; however, please call if you think the swelling is excessive or if you notice a discharge or foul smell from the incision. A bandage is often applied following joint surgery to decrease swelling and provide pain relief. Bandages are applied for only a short time. If a bandage has been applied to your pet, make sure that the toes below the bandage are not swollen or cold to the touch. If this occurs or the bandage becomes wet, notify us immediately.

Surgery of the joint requires careful surgical technique by a trained professional; however, it is only the first step in the healing process. It is just as important to provide your pet with the proper environment and care after surgery as it is during the surgical procedure itself. Southeast Veterinary Specialists offers an aggressive postoperative rehabilitation program that will aid your pet in obtaining a full functional recovery after surgery.

Surgical Procedure
Cruciate ruptures in dogs are the result of a degenerative process that results in weakening of the ligament over time. There is no good way to primarily repair the torn ligament. For this reason, techniques to restore function to the joint without actually replacing or repairing the ligament have been developed. The Tibial Plateau Leveling Osteotomy (TPLO) technique for stabilization of the stifle (knee) after rupture of the cranial cruciate ligament involves changing the angle of the weight-bearing surface of the tibial plateau. This results in resolution of the cranial tibial thrust force that occurs with weight-bearing. This technique works exceptionally well in dogs and is considered the technique of choice for surgical repair of cruciate ruptures in large and physically active dogs (working dogs and performance animals).

Activity and Physical Rehabilitation
Rest is very important following surgery. Your pet should not be allowed to run or jump for 8 weeks. CAGE REST (an airline carrier works well) during this time period is very important in order to give the bone time to heal properly. If too much stress is placed on the surgical repair, it will not be successful. Your pet should only be allowed out of the cage for short walks outside to urinate and defecate or for physical rehabilitation. Radiographs will be taken at 4 weeks and 8 weeks postoperatively to assess bone healing. After significant healing has been documented, controlled leash walks will help to improve the range of motion in the operated joint. You should begin leash walking slowly with only short walks for the first two weeks (around the yard) followed by a little longer walks lasting 10 minutes or less for the second two weeks. After this your pet can gradually return to his/her normal activity. Keep in mind that increased body weight will put added stress on the joint; therefore, your pet’s diet may need to be adjusted for the decreased activity after surgery.

If a human member of your family received this type of surgery, the doctor would likely prescribe physical rehabilitation. Physical rehabilitation is also important for your pet. Physical rehabilitation appointments with Dr. Ransom are strongly recommended after a TPLO. We understand that both time and finances may be limited; however, it is our opinion that aggressive rehabilitation can greatly improve your pet's function after surgery.

Medication
In most cases, a non-steroidal anti-inflammatory drug (NSAID) such as carprofen (Rimadyl®), firocoxib (Previcox®) or deracoxib (Deramaxx®) will be recommended. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling. This will help your pet to be more comfortable and return to normal function sooner. Side effects occasionally seen with NSAIDs include decreased appetite, vomiting, diarrhea, blood in the vomit or stool and (rarely) liver or kidney dysfunction. If you note any decrease in appetite, vomiting, diarrhea, change in the color of the stool (especially darkening), or yellowing of the skin or eyes, stop the medication and call a veterinarian. Do not give your pet any other medication without consulting us. Many other non-steroidal anti-inflammatory drugs available for people are often toxic in dogs.

Antibiotics are usually used during surgery and may be considered postoperatively at home. Please do not give your pet any medication without discussing it with our office first. Antibiotics given inappropriately may result in the development of a resistant infection that can be difficult to treat.

Pain medication (tramadol) other than a non-steroidal anti-inflammatory drug may be prescribed for the immediate postoperative period. If you feel that your pet is unusually uncomfortable, please notify our office. Uncontrollable pain is not an acceptable complication of surgery, and methods are available to keep your pet comfortable without side effects.

Sutures and Bandages
External skin sutures, when present, should be removed in 7 to 10 days. In most cases the skin is closed with internal absorbable sutures, which do not require removal. If you notice your pet licking and chewing the incision area, please notify us. Some swelling is normal after surgery; however, please call if you think the swelling is excessive or if you notice a discharge or foul smell from the incision.

A bandage is often applied following joint surgery to decrease swelling and provide pain relief. Bandages are applied for only a short time. If a bandage has been applied to your pet, make sure that the toes below the bandage are not swollen or cold to the touch. If this occurs or the bandage becomes wet, notify us immediately

A femoral head and neck ostectomy (FHO) procedure is performed in animals with intractable pain of the hip joint caused by many disease processes. Pain in the hip joint is often caused by the loss of articular cartilage that results in bone rubbing against bone. An FHO removes the femoral head and results in the formation of a pain-free, functional "false joint". The success of this surgery is dependant on the ability of the patient to develop this "false joint" and is directly related to several factors. These factors include the weight of the patient, muscle mass present around the hip prior to surgery, activity level of the patient, and physical rehabilitation.

Weight of the Patient
Generally, smaller patients have a better functional outcome following an FHO. Small dogs and cats routinely function without any gait abnormality or pain following an FHO. Larger dogs (greater than 40 pounds) require more aggressive rehabilitation and longer to develop their “false joint”; however, they are usually pain-free. This does not mean that large dogs cannot do very well with this surgery. The reduction in pain should improve the quality of life in any sized patient.

Activity and Physical Rehabilitation
Activity is very important following this surgical procedure. Southeast Veterinary Specialists is committed to the process of physical rehabilitation after an FHO. Physical rehabilitation appointments with Dr. Ransom are strongly recommended after any joint surgery, however are considered a necessity following an FHO. We understand that both time and finances may be limited; however, it is our opinion that aggressive rehabilitation can greatly improve your pet's function after surgery. After a short period of time (7 days) to allow for tissue healing after surgery, the patient should be encouraged to use the leg as much as possible. Leash walks at a slow pace encourage the animal to place the limb on the ground rather than carry it. Swimming and water exercise like walking in our treadmill will encourage the animal to move the joint through a complete range of motion and develop the muscles of the hip region. Range of motion exercises are relatively easy to perform and should be done at home. You should not begin these exercises until 7 days after surgery. Begin by massaging your pet's limb and getting him/her used to the manipulation. After several minutes, begin to move the hip through its full range of motion. Concentrate on reaching full extension and full flexion. If this is not possible or uncomfortable for your pet, do as much as you can and try to do a little more each day. This therapy should be performed for 10 to 15 minutes 2 to 4 times daily.

Medication
In most cases, a non-steroidal anti-inflammatory drug (NSAID) such as carprofen (Rimadyl®), firocoxib (Previcox®) or deracoxib (Deramaxx®) will be recommended. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling. This will help your pet to be more comfortable and return to normal function sooner. Side effects occasionally seen with NSAIDs include decreased appetite, vomiting, diarrhea, blood in the vomit or stool and (rarely) liver or kidney dysfunction. If you note any decrease in appetite, vomiting, diarrhea, change in the color of the stool (especially darkening), or yellowing of the skin or eyes, stop the medication and call a veterinarian. Do not give your pet any other medication without consulting us. Many other non-steroidal anti-inflammatory drugs available for people are often toxic in dogs.

Antibiotics are usually used during surgery and may be considered postoperatively at home. Please do not give your pet any medication without discussing it with our office first. Antibiotics given inappropriately may result in the development of a resistant infection that can be difficult to treat.

Pain medication (tramadol) other than a non-steroidal anti-inflammatory drug may be prescribed for the immediate postoperative period. If you feel that your pet is unusually uncomfortable, please notify our office. Uncontrollable pain is not an acceptable complication of surgery, and methods are available to keep your pet comfortable without side effects.

Sutures
External skin sutures, when present, should be removed in 7 to 10 days. In most cases the skin is closed with internal absorbable sutures, which do not require removal. If you notice your pet licking and chewing the incision area, please notify us. Some swelling is normal after surgery; however, please call if you think the swelling is excessive or if you notice a discharge or foul smell from the incision.

Hip dysplasia is a developmental disease characterized by pain and inflammation of the hip joints. This condition is commonly recognized in large breed dogs; however, all breeds can be affected. It is usually a problem in both hips of a given animal; however, one side may be significantly worse than the other.

The exact cause of hip dysplasia is unknown; however, several factors have been found to play a significant role. The most important factor in the development of hip dysplasia is genetics. The OFA (Orthopedic Foundation for Animals) has developed a screening system to determine an animal's propensity for the development of hip dysplasia. Radiographs are taken after 2 years of age and sent to the OFA where they are scored based on specific criteria. This screening process decreases the incidence of hip dysplasia in the general population; however, it still does not ensure that a specific puppy from excellent parents will not have hip dysplasia.
Nutrition is also important in the development of hip dysplasia. Puppies fed diets high in protein for rapid growth are more at risk than those fed diets for slower growth. A puppy's size is determined genetically. Large breed puppies should be fed a diet to reach that predetermined size over at least 12 months. People are generally proud of their puppies and want them to be as large as possible, as fast as possible. This rapid weight gain is not good for hip development and should be avoided.

So, what is hip dysplasia? The fundamental problem in dogs with hip dysplasia is joint laxity or "looseness". This occurs early in development as a result of a growth discrepancy between bone and the supporting soft tissues. This joint laxity causes pain due to stretching of the joint capsule and "bumping" of the femur (thigh bone) on the pelvis when the puppy walks. The pain due to laxity is generally seen between 5 - 12 months of age. This pain will diminish with time in some dogs as the hips gradually "tighten" with growth; however, this is inconsistent and unpredictable. With age, the degenerative phase of hip dysplasia ensues. This is referred to as degenerative joint disease (DJD) or "arthritis". In this phase, the cartilage of the hip degenerates and bony proliferation occurs around the joint as the body attempts to stabilize the laxity. The pain in these dogs is due to inflammation, cartilage erosion, and bone rubbing on bone with movement. This is usually noticed in middle to older aged dogs as pain when rising or after exercise. The disease can become quite severe resulting in a substantial decrease in quality of life due to pain.

Treatment of hip dysplasia can be medical or surgical. Medical treatment consists of low impact exercise (no running, jumping, etc.), swimming, weight reduction, and medication to control the pain and inflammation. Many dogs respond well to medical therapy and do not require surgery. Surgical treatment generally consists of one of three procedures. The Triple Pelvic Osteotomy (TPO) is performed in young dogs when pain is due to laxity without evidence of DJD. The goal of this procedure is to decrease the laxity and prevent the development of DJD later in life. The Total Hip Replacement (THR) is performed in mature dogs with DJD. This procedure replaces the bone and cartilage of the hip joint with metal and plastic. It is a valuable procedure in some dogs, however candidates for this procedure are chosen carefully based on several criteria. In dogs that are not candidates for the TPO or THR, the final option is the femoral head and neck ostectomy (FHO). This procedure involves the removal of the head of the femur, which normally articulates with the pelvis. After this procedure, the dog develops a pain-free, "false joint" which functions quite well in most cases.

A Triple Pelvic Osteotomy or TPO is performed in young dogs with hip dysplasia that have no evidence of degenerative joint disease (DJD) or "arthritis". The goal of this procedure is to stabilize the laxity in the hip by rotating the acetabulum (cup) of the pelvis over the head of the femur (thigh bone). This goal is accomplished by cutting the pelvis in 3 places, manually rotating the "cup" portion of the hip joint to the proper angle, and applying a special plate to hold the bone in the correct position until it heals.
The goal of this procedure is to prevent or decrease the severity of pain associated with hip dysplasia as well as DJD later in life. If all goes well, your pet should have a pain-free functional limb. Occasionally, DJD develops in spite of surgery. If this is debilitating a total hip replacement (THR) or a femoral head and neck ostectomy (FHO) can be performed.

Activity and Physical Rehabilitation
STRICT CAGE REST is extremely important for your pet to heal after surgery. The cage size should be large enough for the dog to stand up and turn around, but small enough to prevent additional activity. The stainless steel TPO implants are quite strong; however, they can bend and break if they are stressed. Screw loosening is one of the most common complications after a TPO and is more likely to occur with excessive activity. Cage rest should be performed for 8 weeks or until healing of the bone is seen on x-rays. The only activity allowed during the initial 2 months after surgery should be closely supervised short trips outside (ONLY ON A LEASH) to urinate and defecate. For the third month, your dog can be allowed to roam inside your house and have short (<10 minutes) leash walks and controlled activity outside. Running, jumping, and stairs should be avoided until after the final set of x-rays are taken (generally 8 to 10 weeks after surgery).
If a human member of your family received this type of surgery, the doctor would likely prescribe physical rehabilitation. Physical rehabilitation is also important for your pet. Physical rehabilitation appointments with Dr. Ransom are strongly recommended after an extracapsular cruciate repair. We understand that both time and finances may be limited; however, it is our opinion that aggressive rehabilitation can greatly improve your pet's function after surgery.

Complications
The most common complication that occurs following a TPO is implant or screw failure due to excess motion. Strict cage rest can decrease the chances of this complication’s occurrence after surgery (see above). When this occurs, the loose screws and rarely the entire plate must be removed in a second surgery. This complication is generally not life threatening, but is something that both the dog owner and surgeon would like to avoid. Other complications happen rarely, however the consequences are more severe. As with any surgery, infection can occur. If the infection is superficial involving the wound, treatment with an appropriate antibiotic is generally sufficient for healing with no further problem. If the infection is deeper involving the bone, removal of the plate may be required. Another complication is nerve damage. The sciatic nerve, which is a major nerve to the leg and necessary for function, can be damaged by this surgery. Although this complication is rare, amputation of the limb is usually necessary. While dogs do quite well with 3 legs and this complication is not life threatening, it is obviously undesirable.

Medication
In most cases, a non-steroidal anti-inflammatory drug (NSAID) such as carprofen (Rimadyl®), firocoxib (Previcox®) or deracoxib (Deramaxx®) will be recommended. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling. This will help your pet to be more comfortable and return to normal function sooner. Side effects occasionally seen with NSAIDs include decreased appetite, vomiting, diarrhea, blood in the vomit or stool and (rarely) liver or kidney dysfunction. If you note any decrease in appetite, vomiting, diarrhea, change in the color of the stool (especially darkening), or yellowing of the skin or eyes, stop the medication and call a veterinarian. Do not give your pet any other medication without consulting us. Many other non-steroidal anti-inflammatory drugs available for people are often toxic in dogs. Antibiotics are usually used during surgery and may be considered postoperatively at home. Please do not give your pet any medication without discussing it with our office first. Antibiotics given inappropriately may result in the development of a resistant infection that can be difficult to treat. Pain medication (tramadol) other than a non-steroidal anti-inflammatory drug may be prescribed for the immediate postoperative period. If you feel that your pet is unusually uncomfortable, please notify our office. Uncontrollable pain is not an acceptable complication of surgery, and methods are available to keep your pet comfortable without side effects.

Sutures
External skin sutures, when present, should be removed in 7 to 10 days. In most cases the skin is closed with internal absorbable sutures that do not require removal. If you notice your pet licking and chewing the incision area, please notify us. The ischial incision (the one near the anus) is the most likely incision to have a problem. Some swelling is normal after surgery; however, please call if you think the swelling is excessive or if you notice a discharge or foul smell from any of the incisions.

Bone requires rigid stabilization for proper healing to occur. Methods for stabilization are classified into surgical and non-surgical techniques. Non-surgical stabilization techniques involve placing external splints and bandages to hold the bone in alignment. Only certain fractures will heal well with external stabilization. Most fractures require surgically placed metal implants to hold the bone in alignment allowing passive motion of the joints while healing occurs.

Activity and Physical Rehabilitation
STRICT CAGE REST is extremely important for your pet to heal after surgery. Implants are generally made out of stainless steel or titanium. They are quite strong; however, they can bend and break if they are stressed. All fractures need at least 6 to 8 weeks to heal. During this time there will be a lot of stress placed on the implants, and it is very important to protect the surgical repair at all cost. Implant failure is often catastrophic and can result in the need for an additional surgery or even amputation. The only activity allowed after surgery should be closely supervised short trips outside (ONLY ON A LEASH) to urinate and defecate. Uncontrolled activity such as running, jumping or stairs should not be allowed.
Physical rehabilitation is important to restore joint function. If the fracture involves the joint surface, your pet will have some degenerative joint disease or “arthritis” that will progress over time. Physical rehabilitation appointments with Dr. Ransom are recommended after most fracture repairs to improve range of motion and minimize joint stiffness. We understand that both time and finances may be limited; however, it is our opinion that aggressive rehabilitation can greatly improve your pet's function after surgery.

Medication
Medications will be dispensed postoperatively. Generally, with longer surgical procedures, antibiotics will be given at surgery and continued after your pet goes home from the hospital. The length of treatment and choice of antibiotic will depend on the surgical procedure. If infection is suspected at surgery a culture will be performed. The antibiotic dispensed may need to be changed depending on the culture results. Pain medication is given after surgery and continued as long as it is needed. The stronger pain medications (generally opiates) are given by injection, requiring your pet to stay in the hospital until these are no longer needed. In most cases, a non-steroidal anti-inflammatory drug (NSAID) such as carprofen (Rimadyl®), firocoxib (Previcox®) or deracoxib (Deramaxx®) will be recommended. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling. This will help your pet to be more comfortable and return to normal function sooner. Side effects occasionally seen with NSAIDs include decreased appetite, vomiting, diarrhea, blood in the vomit or stool and (rarely) liver or kidney dysfunction. If you note any decrease in appetite, vomiting, diarrhea, change in the color of the stool (especially darkening), or yellowing of the skin or eyes, stop the medication and call a veterinarian. Do not give your pet any other medication without consulting us. Many other non-steroidal anti-inflammatory drugs available for people are often toxic in dogs.
 Please do not give your pet any medication without discussing it with our office first. Pain medication (tramadol) other than a non-steroidal anti-inflammatory drug may be prescribed for the immediate postoperative period. If you feel that your pet is unusually uncomfortable, please notify our office. Uncontrollable pain is not an acceptable complication of surgery, and methods are available to keep your pet comfortable without side effects.

Sutures and Bandages
A bandage is often placed after surgery to help decrease pain and swelling. Bandages are generally removed within 48 hours after surgery. If the bandage is still on your pet after he/she returns home, it is important that it stay clean and dry. If your pet needs to go outside, it is helpful to place a plastic bag (Ziploc bags work well) over the foot to protect the bandage. If the bandage becomes soiled or you notice swelling of the toes, contact our office immediately.

Recheck Examinations and Radiographs
Your pet will need a recheck examination and x-rays at 4 weeks and 8 weeks after the operation. This will tell us how the bone is healing and help determine how much exercise (if any) your pet can have at that point. If you have any concerns between scheduled visits, please call your veterinarian. Fracture repair and healing can be complicated; however, with diligent care and appropriate surgical therapy, function can be recovered. The aftercare is just as important, if not more so, than the surgical treatment and cannot be overemphasized.

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