Second Opinion re: Surgery or not

March 8, 2012

Hi All,

I have what I thought was a very straight forward case - but when the owner went

to consult with an orthopedist - he recommended rest, where I thought he would

certainly recommend surgery. Could I get some thoughts from the group?

I have a 11.5 year old Border Collie who lives for chasing a ball. About 1 year

ago she started having problems with her left hind leg. In December, she

started coming to me for pain management. We started with acupuncture and she

responded well. In addition to significant thickening of the left hock, there

is also decreased flexion and extension. Rads show severe arthritis of the hock

and stifles. She responded well and the lameness on the left hind improved.

She was back to chasing the ball without minimal discomfort.

Then in January she pulled up acutely 3-legged lame on the right hind. I could

palpate cranial drawer and I really thought she had a full tear of the CCL on

the right hind. The owner was very resistant to the idea of surgery - so he

opted to rest her, start her on NSAIDs and tramadol as per his general

practitioner. He continued to come to me for acupuncture. At this point, the

dog had swelling of the right stifle, was grade 4/5 lame on the right hind and

was significantly uncomfortable on manipulation of the left hock. She was

reluctant to get up and even go for short walks. In addition, she has developed

a significant tightening of the iliopsoas bilaterally (which I assume is

compensatory since she doesn't have a back leg to walk on!).

I convinced the owner to go for a consult with an orthopedist. He diagnosed her

with a partial CCL tear on the right hind and confirmed the arthritis in the

left hock. He recommended 6 weeks of strict rest - walks only to eliminate -

and then re-evaluate. The owner was very pleased that surgery was not

recommended. I expressed my concern that she would get some significant muscle

atrophy so I suggested hydrotherapy to keep her moving during the 6 weeks of

rest - the owner has not yet pursued hydrotherapy.

This week the owner came in quite dejected because the dog seems even more

uncomfortable, is now collapsing on the left hind when she walks and she is not

able to chase the ball.

Does anyone think that surgery may be indicated? I feel that if we could get

some stability in the right hind she would be much happier.

Any thoughts and suggestions would be greatly appreciated.

Thanks,

Tina

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