Tibial Tuberosity Transposition – TTT

a surgical procedure used to return normal function to knees in dogs and cats that suffer from patella luxation (trick knees).

This condition is most often seen in minature breeds of dogs, but can be seen in large dogs and cats as well. The most common clinical sign displayed by pets suffering from patella luxation is stretching their rear limbs straight out behind them immediately after they get up from lying down, other common signs are a reluctance to jump up, a knee that is rotated outward when walking and a popping or movement of the patella (knee cap) while walking. The condition is defined as Medial Patellar Luxation (MPL) if the knee cap is riding on the inside of the knee or Lateral Patellar Luxation (LPL) if the knee cap is riding on the outside of the knee.

Symptoms:

- Most likely to occur in small or miniature breeds for dogs and some larger breeds, i.e. Labrador Retrievers; occasionally Domestic shorthair cats

- Symptoms are slight but include dislocation of the patella (kneecap) in varying degrees:

- Grade I: carrying of the leg occasionally, skipping or hopping

- Grade II: joint becomes dislocated more often, Crepitus (crackling) can be heard in joint, DJD can set in

- Grade III: permanent dislocation, still may be weight bearing however may appear to be bowlegged

- Grade IV: permanent luxation, carrying the leg all the time

Patellar Luxation primarily affects small dogs, however incidence in larger dogs is not at all uncommon. In approximately half of all cases, both knees require correction. The condition is usually hereditary and becomes evident at a young age, occasionally patella luxation can result from traumatic injury to the knee which causes sudden lameness and hinders weight-bearing ability. In cases where no trauma has occurred, the femoral groove (trochlear groove) is usually either very shallow or absent. There is no single cause for patellar luxation, but the corrective surgery is highly successful with little incidence of complication.

Procedure:

Surgical correction of patella luxation begins with improving the alignment of the patella mechanism with tibial tuberosity transposition. In dogs that are more severely affected the trochlear groove can be reconstructed with block recession trochleoplasty, in extreme cases corrective osteotomies of the femur or tibia must be completed. The severity of patella luxation is graded from I-IV, most general practitioners are comfortable diagnosing this condition and will then recommend surgery be completed by a specialist like Dr. Dew due to the small size of the patients and the technical nature of the procedure.

After Care:

Hospitalization:

- Your pet will need to stay overnight one night and will need to be picked up during our regular business hours the day after surgery. There will be staff overnight to monitor your animal.

- When you get your pet home, place your pet in a cool/warm (season dependent), quiet and dark room. If you leave your pet alone, he/she will sleep and be comfortable. You can increase your pet’s anxiety by doting. Your pet will have adequate medication for pain so you do not need to worry about discomfort.

Medication:

- A transdermal pain patch will be sutured on to your pet and will provide pain relief for three days following surgery. On the fourth day after surgery, you may remove the patch by clipping the sutures with a nail clipper and peeling it off like a band-aid. Please dispose of the patch by flushing down the toilet.

- The transdermal pain patch used for pain relief can cause constipation. Dr. Dew will ask that you feed your pet a certain amount of tuna in oil (Starkist®, Chicken of the Sea®, etc.) for four days following surgery to prevent constipation. The tuna in oil is to be given in addition to your pet’s regular feedings.

- If your pet is not already on a joint supplement, Dr. Dew will send home a sample of Glycoflex®. Glycoflex® will supplement the cartilage and improve your pet’s joint health. Your pet may stay on Glycoflex® for the remainder of his/her life. The charge for a full bottle or bag of GlycoFlex® is NOT included in the surgery fee; this will be an additional charge to you.

- Your pet will also be sent home with a 14 day supply of Previcox®. Previcox is a non-steroidal anti-inflammatory that is used for the control of pain and inflammation associated with osteoarthritis in canines. Please follow the package instructions.

Food & Water:

- When you get your pet home, offer him/her a small amount of water. If your pet drinks it and does not vomit, then offer twice the original amount.

- Two hours later if no vomiting has occurred, offer ¼ of the amount of food in a normal meal. If your pet eats and no vomiting occurs in a 2-hour time period, then you may resume normal feeding(s).

- Please call Dr. Dew’s or your veterinarian’s office if your pet does not drink within the first 6 hours of being home or if vomiting occurs.

Rechecks:

- Your pet should be rechecked by Dr. Dew 7-10 days following surgery. Please call (866) 838-4282 to schedule this appointment.

- Radiographs (x-rays) should be taken 8 weeks following surgery to assess healing. These radiographs may be taken by your veterinarian or by Dr. Dew. Once the radiographs have been taken, Dr. Dew will need to review them; please schedule an appointment. The charge for the radiographs is NOT included in the surgery fee; this will be an additional charge to you.

Exercise Restriction:

- Your pet’s leg has been repaired using a combination of wires, pins and bone transfer. These implants have been designed to maximize the opportunity for successful bone healing; HOWEVER, they are not as strong as normal bone! Therefore, exercise restriction is mandatory to prevent failure of the fixation hardware.

- For the next 3 months, your pet will need to be restricted to leash activity only. Free running, rough play or jumping on/off furniture and decks should not be allowed.

Physical Therapy:

- If both knees have been corrected at the same time, your pet will be clumsy and therefore you may need to help him/her outside to urinate and defecate. Towel support under your pet’s abdomen will help your pet walk.

- Passive range-of-motion (PROM) physical therapy may be instituted at the first recheck examination if ambulation or ROM is not satisfactory. All joints on the affected legs should be put through a full range of motion. Extra concentration should be directed towards the operated joint. Ten to fifteen repetitions three times daily should be adequate. Please call Dr. Dew’s office if your pet is not tolerating therapy or if you feel progress is not being made.

- For the first 2 weeks, your pet should be walked in the yard on a leash 3-4 times daily.

- During the second week, you may take your pet on 2 daily walks of 1-2 blocks.

- After the second week, you can double the length of the walks each week. You wish to see slow steady progress. At the end of each week, limb use should be improved slightly.

- Slow leash walking up a moderate hill will cause your pet to use the operated leg(s) and regain function.

- Swimming is excellent activity to promote and improve joint function. Swimming may begin three weeks after surgery.

- If your pet’s limb use is not improving or you notice a sudden decrease in limb use, please call Dr. Dew’s office immediately – (866) 838-4282.