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Lame After One Year

Lame patient 1 year post cruciate repair surgery

 

As the surgeon on the case, how do you handle a lame patient 1 year post cruciate repair surgery?

To begin,  determine that the lameness is in fact in the same limb and stems from the stifle joint. Second, determine whether the dog did well after surgery, but is now lame again, or if he has been lame all this time.

 

Differential Diagnoses

With the newly lame patient, I think more along the lines of a new trauma/issue affecting the stifle joint

  • Low virulence septic arthritis
  • Aggravated OA
  • Meniscal injury
  • Infection associated with the implants
  • An unrelated pathology (neoplasia, IMPA)

 

Should the patient have ongoing lameness, my first thought would be (assuming the stifle is quite stable at this time):

  • Lack of rehabilitation and proper follow up
  • Infection associated with the implants
  • Low virulence septic arthritis
  • On going meniscal injury and/or ongoing craniocaudal instability

 

Case Management:

The best way to manage these cases is as follows:

  1. Start with a good orthopedic exam and radiographs of the affected stifle (medio-lateral and caudo-cranial views).  If no obvious diagnosis noted then:

 

  1. Antibiotics (cephalexin at 22mg/kg tid or Clindamycin at 6-11mg/kg bid) to rule out low grade virulent septic arthritis or other infection.
    1. Call the client after 5-7 days for an update.  If they describe a WOW improvement then it’s likely a septic process and plan on treating appropriately (about 6 weeks).
    2. If there is no marked improvement then move on. Do not use pain medication yet so that improvement can be attributed to the antibiotics.  The patient should be on restricted activity.

 

  1. NSAID daily for at least 2 weeks.  Get the patient into a good rehabilitation (maybe also weight loss?) program.  If this is truly a new lameness then start with restricted activity.  Recheck in two weeks.  If there is improvement then continue with NSAIDs and rehabilitation.  Recheck the patient every 2-4 weeks (depending on level of improvement).  Usually 4-6 weeks of NSAIDs and 10 to 12 weeks of follow-up/rehabilitation care are necessary for these chronic cases.

 

If there is no significant improvement with NSAIDs and rehabilitation, then it’s time for surgery.

During  surgery, ensure you explore the stifle and examine the menisci; consider culturing/biopsying the synovium; remove all implants.