WHAT TO EXPECT

PAIN MANAGEMENT

Your dog has just had major orthopedic surgery on its limb. Know that the first night after surgery will be the most difficult for the patient (and you). We have prescribed both a strong pain reliever (Gabapentin) as well as a nonsteroidal anti-inflammatory drug. These two drugs will do a good job of managing and minimizing postoperative pain.

By the end of the third day post-op (fourth day for some), patients typically have turned the corner, and are much more comfortable and “themselves” in terms of appetite, personality, and energy level.

MOBILITY

Use the Ginger Lead (sling that was provided) to assist your dog in getting around during the first few days after surgery. Using the Ginger Lead for the first 3 to 5 days is all that is needed for unilateral patients (5 to 7 for bilateral). We actually want patients using their surgically repaired limb and supporting their own weight as soon as they feel comfortable to do so without assistance.

It is typically not necessary to use the Ginger Lead after the first week or so post-op, but slinging a towel under your dog’s belly and pulling up for some quick assistance getting up (from a lying position) can be done as needed. Pain tolerance varies among patients, but most of our patients are touching the surgically repaired limb down and beginning to use the surgically repaired limb by the end of the first-week post-op. By the end of the second-week post-op, the patient is usually beginning to use the surgically repaired limb with some authority.

ACTIVITY

Within the first 2 to 3 weeks, our typical patient is making excellent progress and quickly becoming more mobile. For dogs with high energy, it can be challenging for the owner to control their pet’s activity level. Crating your dog and/or sedating your dog (Benadryl at 1mg per pound of body weight, every 12 hours) may be necessary for some excitable or hyperactive dogs.

For the first 6 months after surgery, please do not allow your dog to become more active simply because they seem comfortable and capable of doing more. They are still healing, and complete restriction of activity is essential to allow this healing to happen. Excessive activity during the first 6 months after surgery can delay the healing process and, though it is rare, stumbles or falls can potentially disrupt or compromise your dog’s surgical repair.

The extent of your dog’s activity outside the house should be taking them out on a short lead in a slow, controlled fashion to do their duty and come right back in. Indoors, your dog may stroll slowly around the house in a controlled fashion to get from point A to point B.

Complete restriction of activity is defined as follows:
 No running
 No jumping
 No climbing on/off furniture
 No roughhousing (i.e., playing with other pets or family members)
 No going up/down stairs (a step or two in a controlled fashion to get in and out of the house is fine)

WHAT TO LOOK FOR

Following surgery, it is completely normal for there to be some redness at the incision site and on occasion minimal bleeding may occur. If this happens in the first few days, you may gently clean the site twice daily with hydrogen peroxide.

However, if you notice any of the following, this can indicate an infection, and you should contact us right away to get seen: Excessive swelling, warm(er) to the touch, filled with fluid, oozing, or excessive bleeding. If you notice any of the stables or suture becoming loose and at risk of falling out prior to your 2-week removal, please contact us.

Infections are very uncommon, but when they do occur, it is usually the result of the patient getting at their incision site either from licking/chewing or rubbing it against an object (rug, furniture, etc.). This is why it is incredibly important to keep the E-collar on at all times (unless vigilantly supervising) during the first two weeks as well as 3 to 5 days after the staples are removed.

Please contact us if at any point the patient is consistently not eating, seems to be in excessive pain despite taking the medications, or if there is any vomiting or diarrhea.

You may notice a bump on the outside of the repaired knee. This is completely normal for this procedure as it is simply scar tissue covering the anchor points of our artificial nylon ligaments as well as a graft of fascial tissue that we rotate over the anchor points for padding. This will always be there and will not cause any pain, discomfort, or irritation.

If at any point it seems like it’s filled with fluid, red, or enlarged, please give us a call and we can take a look. In the meantime, start by applying a cold compress and keep that cone on.

Rehabilitation Instructions

The fundamental principle that should guide your home care and rehabilitation during the immediate postoperative period (the next 6 months) is to encourage careful and controlled use of the patient’s surgically repaired knee. What you want to try to avoid in general is any twisting or turning motion on the knee. Always try to walk on as smooth and even a surface (i.e., street or sidewalk). Besides the surgery itself, the most important factor to a successful recovery is post-operative physical therapy. Proper aftercare and physical therapy will greatly improve ultimate function.

The majority of dogs recovering from our QLF surgical procedure will do quite well with the informal at-home post-op rehabilitation program outlined below. A minority of our patients may potentially require the assistance of a more formal and regimented rehabilitation program that includes laser therapy (which we offer here) as well as hydrotherapy at a pet physical therapy facility in your area. Throughout physical therapy and rehabilitation, a few basic guidelines should be followed:

REHABILITATION PHASE ONE | PASSIVE PHYSICAL THERAPY (PPT)

PPT is all about allowing the surgically repaired knee to heal while maintaining its range of motion. Begin PPT once the skin staples have been removed at the 2-week appointment through 8 weeks post-op (6 weeks total). Physical therapy is very important and should be performed for 30-40 minutes twice a day:

The Five Tens:
1. 10 minutes of a warm compress directly on the incision site.
2. 10 flexion extensions (as described below with visuals).
3. 10 minutes of gentle, slow massage above, around, and below the incision.
4. 10 more flexion extensions.
5. 10 minutes of a cold compress directly on the incision site.

Make sure that the knee is moving and not just the leg (hip and/or ankle). While some dogs may be partially weight-bearing sooner than others, the patient should begin using their leg by the end of the second week of passive physical therapy (4 weeks post-op). Most dogs will be favoring their surgically repaired leg at least a bit for the next 4 to 6 weeks and will likely lose some muscle mass. During the timeframe from weeks 8 through 12 weeks post-op, you will typically see a more dramatic improvement in weight-bearing and use of the surgically repaired limb.

1. First, lay them on their side with the surgically repaired limb “up”.
2. Grab the ankle of the surgically repaired leg, slowly flexing and then extending the knee as far as it will bend without resistance. If the patient resists, do not do them.

REHABILITATION PHASE TWO | ACTIVE PHYSICAL THERAPY (APT)

APT is all about rebuilding the strength and endurance of the muscles that support the knee and control the function of the joint. We recommend starting APT following the 8-week post-op appointment. APT consists of slow, controlled leash walks of increasing time duration and eventually walking up shallow hills over the course of the next 4 months.

• Weeks 8-10 post-op: 15-minute walks 2x’s per day.
• Weeks 10-14: 30-minute walks 2x’s per day.
• Weeks 14-16: 45-minute walks 2x’s per day.

Depending on the time of year and availability, allowing the patient to swim in a swimming pool (or other still, safe bodies of water) during the APT phase can be invaluable in aiding and hastening the rehabilitation process. Be sure to allow only “calm” swimming and for no longer than 20 minutes per day.

REHABILITATION PHASE THREE | RE-ACCLIMATION PERIOD

After successfully completing the Active Physical Therapy phase, the final 8 weeks is phase three, which is a continued gradual increase in activity level. The patient still cannot run full steam, no sudden acceleration, sudden turns, etc. They can go on an extension lead and can jog, but still can’t run.

• Weeks 16-24: 30-minute walks with hills and trotting 2x’s per day.

REHABILITATION PHASE FOUR | CLEARANCE

Then, at 24 weeks (6 months) after surgery, the patient may resume their normal activities and routines off-leash and without restriction following clearance from us at their final 6-month evaluation.