What happens on the day of the operation
Whether your pet is having a fascial graft or Orthofoam MMP TTA, he or she would be admitted early in the morning and settled into one of our day kennels in the prep room.
Prior to the administration of the anaesthetic, we shall weigh and re-examine your pet and if it has not been done already, take a pre anaesthetic blood sample. The practice has a modern blood analyser for this purpose and results are available within 15 minutes, allowing any adjustments to be made in the anaesthetic protocol.
As both procedures are significant operations we provide intravenous fluid support (a drip) for all our cruciate patients.
It is the routine at Oak Tree Vet Centre that patients receive not only a sedative to allay any fear but two analgesics (painkillers) as their premedication before general anaesthesia.
Following induction of anaesthesia, all patients are intubated to protect their airway and maintained via a modern gas anaesthetic system featuring sevoflurane, the latest and considered the best anaesthetic gas. At this time an intravenous antibiotic is given to reduce the risk of infection.
All anaesthetised patients are monitored throughout, by the theatre nurse under the constant supervision of the operating surgeon. The leg is shaved and vacuumed to remove all hair. The skin is then washed and disinfected by a three stage cleansing program
All patients have, of course, their own set of operating drapes and instruments. We have surgical power tools from human surgery that are autoclaved along with the large selection of instruments that are needed for these procedures.
The patient is draped with large cloths and the foot recovered in a sterile bandage.
The procedure begins with both the primary veterinary surgeon and a scrubbed assistant, whilst a veterinary nurse monitors the anaesthetic and a fourth person is available to meet the surgeon’s equipment needs throughout the operation.
At the end of the procedure, before leaving the theatre, the wound is cleansed with sterile saline, dried and a spray bandage applied. On top of this a sterile bandage like a giant elastoplast is stuck.
We don’t use a bandage so that the patient has mobility right from immediately post op.
For dogs undergoing an Orthofoam MMP TTA, a post op x-ray is done to check that the Orthofoam wedge, pins and staple is still correctly placed.
All patients receive post operative pain relief for as long as is required for them to recover from surgery.
We now offer therapeutic laser therapy at the time of surgery to reduce post operative discomfort and swelling. We are the first in Scotland and one of the first few practices, in the UK to have a Class IV laser.
Post operative care
On collecting your pet, both the surgeon and a veterinary nurse will go through what has been found and done and give you written instruction to help you manage the initial recovery.
We like to check all of our cruciate patients after three days. With both methods, we remove the stitches after 10 days.
With the fascial graft, it is imperative that the stifle is carefully cared for with minimal movement; toilet exercise on a lead and no jumping, stairs or playing for the first four weeks and then a gradual increase in lead exercise.
With the Orthofoam MMP TTA, your dog is allowed a few minutes lead walking several times a day right from day one, a big advantage for boisterous large breeds. At six weeks post op, we take a check x-ray to ensure everything is correct.
At this time, we hope to start active rehabilitation. We believe, in the case of medium and larger dogs, the best rehabilitation is hydrotherapy and the equipment of choice is the water treadmill. Twice a week sessions, wading slowly in deep warm water builds up the muscles in the leg, with minimal danger to the healing joint. Our sister business petphysio.co.uk, which is on site, conducts the hydrotherapy, ideally twice a week for 6 weeks (12 sessions).
Prior to, or simultaneous with the hydrotherapy sessions we often give a course of four, once a week, injections of a drug designed to curb the inflammation in the healing joint.
Some of our cruciate patients have continued to attend regularly for hydrotherapy, as the dogs have enjoyed themselves so much and to keep them in peak physical condition.
What about the arthritis?
Unfortunately, the moment the cruciate begins to fail in the case of degeneration or snaps in the case of trauma there is an inflammatory process leading to the establishment of arthritis. Arthritis is a progressive disorder but there are many things that can and should be done to slow down the progression of the arthritis and minimise its impact of your pet’s quality of life. The surgery is a significant part but there are four cornerstones to managing the stifle arthritis or indeed any arthritis.
1) Weight control. Being too heavy does not cause arthritis but if your dog is too heavy and has arthritis or an injury it progresses much more quickly, the disability is then magnified leading to the possibility of failure in another leg.
2) Regular and reasonable exercise. Too much or strenuous activity is just as bad as not enough. If your dog has arthritis you need to look at your pet’s routine, curb the excesses and make time for some gentle exercise every day. Do not fall into the “weekend warrior” where your dog bags some Munroes at the weekend and is wiped out for most of the week, recovering just in time to give his joints another battering the next weekend.
3) Supplements, in the form of additions to normal diet or the shift to a “joint” diet is a major part of looking after the joints, next week, next month and next year.
4) Drugs, surprising, are the last item, not the first. There is undoubtedly a role for drugs to manage the stiffness and inflammation especially early on after surgery or when there is a flare up. However, there may be long periods when daily administration of drugs is not necessary.
At Oak Tree Vet Centre, we are well placed to guide you though making the most appropriate choices for your pet.
Why come to Oak Tree Vet Centre?
Alistair Marks, the founder of Oak Tree Vet Centre, is retiring at the end of June 2018. We hope to resume our cruciate service shortly.
We are content to make a direct claim to most of the significant insurance companies if we have sight of the original policy documents prior to the commencement of treatment. Please read our practice brochure and speak to us to learn more about this aspect of our service.
Referral to Oak Tree Vet Centre
Whilst many of our Orthofoam TTA cases are drawn from our own clients’ pets, we are accepting more and more referral cases, as few surgeries have set themselves up for this procedure.
Whilst we can give you general information about the procedure in the typical patient, your own vet must be the one that decides with you, a referral is the preferred treatment route for your pet. He or she will have decided that your dog is sufficiently healthy to undergo this procedure, from clinical examination and usually by the taking of a general blood test profile.
By the time referral for surgery is decided, most dogs have also had radiographs taken. If these radiographs are suitable for assessment, then we can perform surgery based upon them. If not then we have to take our own image on the day at a cost, in 2017, of £75
Among the required radiograph is a perfect, or close to perfect lateral (side to side) view of the stifle (knee) including the whole of the tibia (shin bone). The centre point of the beam should be just below the tibial joint surface and the stifle in a natural position of about 135 degrees. As a result, the femoral condyles should be overlapping or close to overlapping. There must be a right or left marker and a scaling device.
If your vet has digital radiography, he or she can provide a disc with the images as jpegs and dicoms, which we can use. If the practice is using films then you will be given the originals to bring which will be returned with you.
The cost of the procedure in 2017 is £1695 including VAT and covers all the aspects of the surgical procedure on the day, including post operative x-rays. Dogs over 50kg may need a second titanium staple at an extra cost of £75. In addition to the surgery charge, you might need to purchase enough antibiotics and pain medication to get you to the first post op check at 3 days. We are very happy to liaise with your vet so you can be supplied some or all of your anticipated medicines, by your usual practice, in anticipation of the surgery.
We’ll give you written instruction as to what to do post op.
We like to check the wound at three days and again at ten days when the stitches are removed. It is important that the stitches are not chewed and your vet or we can sell you a plastic cone, if required.
We ask your vet to take a pair of radiographs four weeks after the surgery, under sedation, to check all is well before increasing activity and starting more active rehabilitation, such as water treadmill work. We can do this for your vet, if desired, at a cost in 2017 of £160.