# Medially Luxating Patella (Trick Knee). Thoughts?



## Tigonie (May 21, 2007)

My 10-year-old cat, Scofield, was diagnosed this afternoon with a medially luxating patella (trick knee). The knee on his back right leg pops in and out of the joint. The vet said that we could go for surgery, which would probably be about $1500 and would be at another vet's office (my vet doesn't do that procedure). Alternatively, we could continue to try to get him to lose weight and give him glucosamine/condroitin supplements daily. It was $27.75 for 80 pills (40 days' supply). From an economic point of view, surgery versus pills, the break even point is about 6 years between pills and surgery. He's in good health otherwise, and barring an unexpected turn to his health, I wouldn't be surprised to see him live to be over 16.

Supposedly the surgery has a good prognosis in most cases, though it's most often done on small dogs. The pills I bought do nothing for the pain, per se, but they are supposed to strengthen the knee. I'm wondering if it might not be better to bite the bullet and get the surgery to fix the root problem. I'm just wondering if that might not be the best way to fix the pain most quickly. I don't want our kitty to be unhappy in pain. Does anyone have experience with this sort of thing, particularly in cats? Of course I'm going to ask my vet some more, now that I've had time to think about it, but I just wondered if anyone had experience and what others had done for this problem. How did things work out?


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## Jennyphx (Apr 5, 2007)

Hi there. I do have some experience with what you are dealing with. My 1 year old male has congenital medial luxating patella in both of his back legs. He had surgery back in Fall for the worst leg. He was only around 9 or 10 months at the time. The one we had the surgery on was missing the groove all together. His surgery was close to $3,000 for the 1 leg. I'd really recomend going to an orthopedic surgeron to see what they reccomend as they are most experienced with these conditions. My cat's other leg started popping out a few months ago but the grade of luxation did not warrant surgery to be performed on it yet. His surgeon said it would go through periods of popping out like that but untill the grade progressed she wouldn't recomend surgery. It's doing good right now. He still has a noticeable hitch in his gait from the repaired leg but he is a whole lot more comfortable than he was before the surgery. He zooms around the house and his jumping gets better all the time. He also has another problem with one of his front legs so he would have been in really bad shape if we had not done the surgery. He takes glucosamine supplements and I think it helps somewhat but it can't cure his problems. He was taking cosequin, now he is taking the zukes hip action treats. He spent a month in a dog crate and another couple weeks confined to a bedroom after the surgery. He was such a good boy having to deal with it.


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## Kobster (Feb 1, 2007)

My vet just performed this procedure on a little torbie girl today in fact. In my experience as a vet tech caring for these patients post surgery, is that the cats heal faster, with fewer complications because they are better at restricting their own activity. Dogs, lets face it, just aren't as smart about holding still when something hurts. 

Some points to consider when making your decision. 

1) He will heal faster/easier and is less likely to injure the leg post surgically the less excess weight he is carrying around with him. If he is overweight, it might be worth it to take the extra pounds off before surgery.

2) Pain management in cats is a real bear because there are NO non-steroidal anti-inflamitory medications on the market that are approved for long term use in cats like we have for dogs. There is one, Metacam, that can be used ONCE ONLY in it's injectable form, which is great but the effects only last 24 hours. Some doctors have had success using the liquid oral metacam in cats for short term periods (4 days or less) at a very precise dose, but over use or over dosing even a small amount can and does lead to kidney failure. Your other alternatives for pain management in cats are narcotics like torbugesic and fentanyl which also cannot be used for more than a few days. My point in this long ramble is, if you are wanting to manage your cats pain, their is just not way to do it long term. As you pointed out, the cosequin has no analgesic effects. But, it is possible to get your cat comfortably through the few days post surgical pain, an on to a lifetime pain free. So looking at if from a "how can I keep my cat comfortable" standpoint, surgery really is the way to go. 

I also agree that you will have the best results if you use a board certified orthopedic surgeon. It will cost a little more, but you will more than make that up in peace of mind.


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## OsnobunnieO (Jun 28, 2004)

has he had problems for a long time or just recently? how badly would you say it affects his life?

I don't know much about knees in cats because its not something we see very often (can't think of the last one actually!) but its really common in small dogs.

Basically, what we tell owners is that a lot of it depends on the animal itself. We've had dogs with very mild problems who scream in pain every time the knee pops out and we've had dogs who you can practically pop the knee out by looking at the wrong way who give a little hop and then get on with life.

It also seems to be that the longer they deal with it the more used to it they get. They may hold the leg up for a brief period of time, if at all. The only time it seems to bother them is if something catches them off guard - say a playmate sneak attacks and causes them to misstep or fall... that's when they'll cry out in pain.

Anyway - definately worth talking to a surgeon about but maybe not worth rushing in to. What are your other options? And most importantly what is his life like right now compared to after surgery? If he's very overweight the surgery might actually more much more stress on his other legs while he's healing... so it might be worth taking some time to get weight off of him first before you do surgery and at that point see if it helps at all with the bad knee.

Oh yeah - you might be able to get the medication cheaper somewhere else, or even a similar product that is less expensive but does just as good of a job. Something else to think about.


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## Tigonie (May 21, 2007)

What's odd is that I had only noticed him limping in the last few months, and it was off-and-on. It was so off-and-on that I almost didn't think of asking the vet at his check-up, except that he was limping that morning. The recent and intermittent nature of the issue leads me to think that either 1) he was born with a problem that never surfaced until he gained weight OR 2) it's injury related and recent.

He's about 12 pounds and should only be about 11 or maybe 10.75. That's not hugely overweight, but he is pudgy. I bought some diet food, but we're still mixing of course. Time will tell if it helps.

Yeah, my vet had told me that pain management is non-existent for cats. I'm supposing it hurts him, since he limps when it pops out, but he doesn't cry or anything, so maybe it's just a lack of support that makes him limp? I think it has made him slow down, which I'm betting has also led to the weight gain. He was always a VERY active cat and acted like a kitten well into adulthood. even now, he likes to wrestle with our 3-year-old cat.

Apparently, the options are either surgery or a combo of weight loss and glucosomine/condroitin pills. I figured that I might be able to get the pills cheaper, but I bought the first box from the vet, to be sure I get the right thing. 

As far as the idea that 6 years is the break-even point, well, it's kind of my way of rationalizing the surgery in spite of it being a hefty chunk of change. My initial gut feeling on this is that the surgery is the real solution--keeping in mind that I'd never heard of this issue even a week ago, so I'm not really all that informed yet. It's kind of my way of saying to myself, "The stingy person pays the most." Of course in the short run, it's cheaper to buy the pills, but in the long run the surgery may actually be cheaper if we're just talking about money. If it's also more effective, maybe we should bite the bullet and get it done.

I also want to ask my vet if there's a technique we can do to pop the knee back in when it pops out. I'd hate for him to be uncomfortable if there's something we can do to make it better.


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## nanook (Jun 12, 2005)

Sorry, I just caught this thread. 
My cat Sundance had this. It suddenly started happening when he was around 8. He would be walking along and boom, his back leg would go out. He'd sort of stand there for a minute and somehow do this strange stretch and get it to pop back in! Yuck! The vet said that sometimes, if they have strained themselves, it will really act up and take quite awhile to calm down again. His was not too severe however and it didn't happen too often so I decided to wait and see before doing surgery. During that period, I also had him on a weight loss regime for other reasons. He wasn't huge but quite pudgy :roll: I'd say he was about 13 lbs and should have been 11. Well, darn it, if it didn't go away when he lost weight! Hopefully, that's all it will take with your guy. I think the glucosomin is a great idea too. I didn't think of it (and the vet didn't mention it) at the time.
Now, I'll give you my two cents on the diet  From my experience, I would not waste your time on "diet" foods. I have tried them all and never had any results, in fact, they usually got fatter! Wet food is really the key to wieght loss in cats. The minute I cut out (almost completely) dry they slimmed down and I've never had anyone with a weight issue since. So, I would highly recommend it. It's far better for them, all around, anyway!


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## Jennyphx (Apr 5, 2007)

Do you know what grade of luxation your cat has on the 1-4 scale? Did they do x-rays as well? The higher the grade of luxation the more severe the problem and the prognosis after surgery can depend on the grade. Our cat was an early grade 3 on the luxation scale. The orthopedic surgeon reccomended immediate surgery to prevent arthritis etc from setting in which would have caused him pain forever. His un- repaired leg is only a grade 1, even though it went through a short spell of popping out so that is why surgery hasn't been recommended on it. If it progresses to high grade 2 or a 3 than he will need surgery. Have you thought about seeking a referal to an orthopedic surgeon? It really helped me to learn about what exactly luxating patella was as she took the time to explain it very well and it put me at ease knowing she had peformed the surgery numerous times, although a lot more on dogs than cats because it is more rare in cats. She knew when surgery was neccesary and when it wasn't. I was terrified he would need surgery in his other leg only 10 weeks after he had surgery in his first leg but she knew it wasn't neccesary yet.


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## drjean (Jan 6, 2004)

I'd certainly second the recommendation for a second opinion before spending the big bucks on surgery. If you do decide on surgery, have it done by an expert who has done a lot of cats before! Cats are not small dogs, the issues are different. 

Glucosamine takes about 4 weeks to see improvement, but it can be quite dramatic. The veterinary brand (Cosequin) is very expensive and contains lots of added ingredients that don't do any good (chondroitin) and some that may actually be harmful (manganese). Use what you've got since they're unlikely to refund you, but next time you can get generic glucosamine sulfate (_not_ HCl) at any health food store. The dose for a cat his size is about 250 mg per day.
http://www.littlebigcat.com/index.php?a ... itisincats


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## Sol (Feb 20, 2003)

Luxating patella doesn't have to be painful for the cat. I'd say it's not an easy thing do decide. If I thought (knowing the animal of course) that weight reduction and supplements such as glucosamine, MSM and fish oil could do the trick I'd go for that. Not because of the money but simply because I don't wanna put an animal through an operation if I don't have to. My oldest cat was hit by a car 11-12 years ago and he had to be operated due to a broken femur. The convalescence was straining on both of us. "Keep the cat calm and in a small enclosure"... sure, yeah... for 6-8 weeks with a young and very active boy. :roll: That was simply impossible. Since that was impossible of course the nail in his leg started to move and all sorts of complications occured (he's did recover and he's completely fine today but it was tought).

Had he been a very calm cat that rather cuddle in the coach than chase brain ghost the situation would probably have been different. A calm cat probably has an easier convalescence period, if the pain is well managed.

So not easy, but if I thought the cat would do well without the surgery I'd probably skip surgery.


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