The infamous Rare Luxating Patella

*two sedations the same evening.
Sorry. Working off my phone

Hi Catpack,

Would like to hear further from you (and anyone else in this thread) how Holly and others are are doing since their surgeries.  Have an 8-9 month old male kitty rescued from a local prison where my rescue was doing TNR - have had him since age 5 weeks, and just noticed a strange stance (bowed back legs) that comes and goes and suddenly lying down a lot - luxating patellas, both back knees.  Our vet says severe - she's a cats only vet with many years practice yet has never seen one before in both legs.  Says we will have to go to surgical specialists for surgery.  Reading everyone's posts here, not sure whether to wait and see or go for surgery immediately.  Of course we are fearful this will put a damper on adoption for what was until now a very adoptable little fellow, a particular blow since we specialize in special needs kitties but are overloaded right now and were desperately hoping for adoption of at least our adoptables.  We are in Columbia SC area.

Hey Carocats,
Holly is doing fantastic! We are about a year out of her total process (surgery/confinement time.) Though her left leg (the last for surgery) still has a bit of weakness, she runs, jumps and climbs without any problem. No relapse of any kind.

I totally understand the decision of how to move forward with a kitty awaiting adoption (we were in the same boat.) But, Holly progressed so rapidly that she became lame within 10 days of her initial diagnosis. We had luckily decided on a surgeon and moved forward very quickly once she deteriorated.

I will note that Holly is still with our rescue awaiting adoption. But, she was a very sick baby kitten when we got her and was 7 mo old by the time she was well enough to be adopted...then she was hit with luxating petellas. =\. She just turned 2 (and is just as sweet as ever!)

In your case, it your vet has already diagnosed a severe grade luxation, I would venture to guess that things will only get worse. I personally would move forward with surgery ASAP, rather than wait for this kitten to become lame.

Holly started out with a moderate luxation in both knees, but the knees would pop back in on their own. A few days later, the left was luxating more. By day 10, both caps were permanently displaced and she could no longer walk.

Hey Catpack, thanks for the quick response and info.  Yes, I fear Brown may go the same way as Holly.  He and his sister have been caged almost all the time since we got the litter when they were 5 weeks - have a lot of cats and don't like to expose them to others before adoption in order to minimize URI, possible coronavirus exposure, etc., so they had only been out a couple of times in the dining room to run around and I hadn't noticed anything in the past.  I have a great previous adopter I was hoping to persuade to adopt the two remaining Browns, but one of the previous prison rescues she adopted from me had pectus excavatum (concave chest) and died suddenly a few months ago so I am not sure if she will be comfortable with another kitty with a congenital problem.  But I'm hoping . . . especially if he can get through surgery OK and fully recover.  Brown had become much bigger and fatter than his petite sister recently, and perhaps that is why the luxation was suddenly evident.  He really bows his back legs out, but then suddenly runs normally again so they must be going in and out.  He lies down a lot, but he generally speaking doesn't seem to be in pain.  He can jump and climb seemingly without discomfort at present, although he did meow a bit when I was moving his back legs to examine him and when I combed his lower half.  He didn't seem to mind the vet moving his knees around, however.  She said both knees were pretty bad from what she was feeling.  Will know more tomorrow when she discusses X-rays (we left him overnight as they had to sedate for X-rays because he was wiggly, so decided to let them neuter him at same time as he needed it!).  Brown looks from the back like he is constipated when he takes on the stance that looks like a kitty that is straining in the litterbox with his back legs bowed out, and he runs along like it - was Holly like that?  I'm nervous he may have hip displasia, too - hopefully the X-rays will rule that out.  We're in Columbia, SC and have pretty good referral surgical specialty vet practice here - where did you have Holly done?

Holly too was crated for an extended period due to a severe case of cryptosporidium. (Took 4.5 months to get her well.) I never noticed any problems until I found her lying in the floor one evening, unable to stand. I initially thought she had broken something. Ran her to the vet that night (they initially thought a hip problem) where they discovered her knees were out.

I am in AL. Her surgery was done by a specialist as well. He had done a cat previously and we felt the most comfortable with him doing the surgery.

My little boy just recently got diagnosed with bilateral luxating patellas. He went from the occasional limp to a grade 3 in less than a month. Three weeks ago, we had the vet perform surgery on the leg that is worse and thus far, my boy is still on crate rest. He is walking with a limp but putting weight on his leg. We will see how he recovers another month or so from now and if we end up having to get the second surgery or if it will be fine now. He had just turned one a week prior to his surgery and weighted 10.75 lbs. The vet wants him to loose about half a pound to a pound as this will make things easier for his recovery. The problem with waiting too long to get this surgery is the success rate. Once arthritis has set in, the possibility of a successful outcome is greatly hampered. I went to a orthopedic specialist for the xray and a consult but ended up having the surgery done by a highly recommended vet. The specialist wanted $1,300 per side and the vet only charged me $460 but he did admit that he has only done about 30 dogs and one cat with this issue.  I am hoping that my boy will recover well and eventually stop limping. I am super strict on the crate rest and will not let him out without a lash to prevent him from jumping on anything. He is only allowed to scratch on the posts and walk with me while on the leash. I will cuddle and nap with him on the floor, with him on a leash only.  He is not allowed to sleep with me until the vet clears him from the crate rest. I feel horrible leaving him in the crate all day and my other cat pesters him a lot by stealing his food and walking on top of the crate but it is for the best. I would love to know how yall get the cats to loose weight? My boy gets 2.75 ounces of canned food (Taste of the Wild) in the morning and the same amount at night and he is not loosing weight. I would really love to hear your suggestions.

It will be difficult for him to loose weight while crated. The only option you currently have is to cut back on his food intake, though it sounds as if he is likely getting the proper amount of needed calories. How many calories is he getting daily?

What has your vet suggested?

My cat was just diagnosed with luxating patella in his back right. The vet recommended surgery as it is a grade 2. He quoted me anywhere from 1700 to 2300.  I live in Canada so I am guessing it is more expensive? I am saving for a wedding unfortunately and need all the money I can save right now. How much have other people paid for this surgery and where are you located?

I think we paid $1500 per leg for Holly. This included follow-up visits and after surgery x-rays. I'm in SE US.

I first posted about a year ago regarding a tabby kitten rescued from a local prison here in Columbia, SC, at that time known as "Mr. Brown," who had developed double luxating patellas.  Brown is now called Ozzie.  We consulted a specialist, who said Brown was a Stage II and since both knees went back in of their own accord, he did not think surgery was necessary.  He said that while it might be needed in the future, it was also quite likely that Ozzie's condition could improve with time - and so far this has been the case.  Ozzie had grown somewhat overweight from being caged when younger.  We decided to let him out to see if he would be able to become more active and lose some of the weight, thus reducing the stress on his knees, nd he has in fact slimmed down and become much more active.  He no longer walks around looking like he's a walking constipated cat (he wasn't constipated, he just assumed that position all the time, probably because it was more comfortable to him).  He used to lie down after a few steps, but now he runs around all the time, can climb and jump, and - unfortunately - even gets up on the countertops now which he didn't used to be able to do - I thought we could market him as the cat who you will never have to worry about getting on your tables or countertops!  I am glad he seems to have greatly improved, and hope that this means he is not unbeknownst to us developing any arthritis which will come back to haunt him later.

Hello, all,

I'm thankful for all your posts. As with many, I discovered you while researching this "rare" cat disorder. Seems I, too, belong to this special pack. As it's so very rare in cats, let alone kittens, it's a true blessing that there's a way to actually share with other folks who've experienced the same thing.

To begin, my little Lolly was born last April with a contracted tendon on the right rear. (See pic if I can figure out how ot load it.) I'd seen it once on Cats 101 on the Animal Planet, so I wasn't too concerned. Researching that first malady, it supposedly meant that uterine space was tight, and thus the twisted joint which sometimes corrected itself. (I learned that rear tendons often did self-correct, while front tendons sometimes needed splinting.)

Add to that, she was half-sized from her littermates. But her daddy was small... It seems she might be the first one to have inherited small size from her daddy. By the time she was up and ready to walk, the leg/joint functioned normally. (See pic sleeping.) So, everything was okay, right?

She'd come to me in July at twelve weeks which is the right age for the larger (males 18 to 20 lbs. with females a bit smaller) and later-developing RagaMuffin breed. All was well! Then, suddenly, in September at five months I noticed her limping. A visit to the vet (no x-rays) diagnosed bilateral luxating patellas, grade 2/4 on the right and grade 1/4 on the left. Weight 3.9 lbs.. But in fact, during the spay, done about five days later, while under, manipulation on both legs revealed they easily slipped in and out of joint.

The prognosis wasn't good. Surgery was the only remedy, but it couldn't be done on a kitten. Luxating patellas in kititens was even rarer yet. The growth plates (at the ends of the bones) would have to be closed first which could be anywhere from ten to twelve months. Ugh! That set us on to hoping to manage pain and looking at medications. (And the beginning of this new second round of research.) Lolly's right, seemingly, didn't ever slip back in, as she limped three-legged, and was in pain almost all of the time.

Seems medications aren't approved for long-term use in cats, as they are in dogs. Cats are supposedly more tolerant of pain? After a horrible compounded medication had her running to hide, and after being caught had eyes squeezed shut tight and literally bubbling and frothing at the mouth (while I, too, could barely tolerate the smell), we settled on Buprenex, administered orally. But the twice-daily dosages of medications would cost me $5/day. (Ugh!)

As most vets might have done the surgery on a few adult cats, none had on kittens. So, special ortho consults were sought at that time which resulted in opposing viewpoints: surgery now or wait. We chose what we thought might be best, while realizing there could be other damage done, potentially, to other joints/tendons, due to the push-and-pull of inadequate mechanical operation. And we had to settle into mourning the loss of a once-vibrant kittenhood.

However, Lolly's pain seemed to increase, again, two months later in November. At that recheck with x-ray, it was revealed the right joint had totally fused: now grade 4/4. Only, that presented a new kink. If surgery wasn't done immediately, the growing tendon could be stunted, due to being restricted, with the loss of full movement later on. What were we to do? Which was the lesser of two bad outcomes? Did we operate on open growthplates which were unlikely to "hold" and could result in even worsening problems or did we risk a tendon that would later be permanently too short. (You can't operate to stretch a tendon.) Or did we split the operations into two?

Splitting the operation would mean to operate on the upper bone, creating the new and/or deeper groove in the patella (knee), and placing the tendon now, while re-fastening the bottom of the tendon onto the lower tibia (calf bone) later, when the growth plates had closed. There wasn't enough bone yet formed to fasten to right then...

This new dilemma led to a second round of should-we/shouldn't-we and even more conflicting ortho consults with the ultimate advice to just select one opinion and stick with it. We resolved to go with the traveling orthopedist who would come to where we were when it was time for the surgery. The logistics were much simpler than thinking of traveling three hours when the time was right. My vet agreed. We resolved to take one day at a time...

February, now, marks ten months. It's time to recheck the growth plates. We've consulted again with the traveling orthopedist who will come to Brewer (near Bangor), ME, to do the surgery. We've done the repeat x-rays (two views this time), as requested. Weight 5 lbs. 8 oz.. The growth plates are not closed, but it's close enough.

A new wrinkle is that, if the tibia is twisted, as is often the case where the legs are bowlegged -- which is not necessarily our case -- the surgery could be more complicated, meaning the tibia may have to be sawed into two to be twisted back to normal positioning so that the ligament will stay in the groove and not be pulled out again, due to any twisting. Thus the reasoning for the second view.

In the end, I've been told this is congenital, as was likely the initial contracted tendon. We'll have to wait to see what the orthopedist says. Meanwhile, we're waiting for his reply and a surgery date. While waiting, we've purchased a dog play pen and cover which will hold a litter pan, cat bed, food dishes, etc..., trying to get ready for movement restrictions... Thanks for listening. Whew. What a journey...

I clicked "Import Images", but nothing happens. How does one import pictures...

@ilovedaisiestoo, you certainly have been thru a lot with Lolly! The issues your drs have raised about growth plates, etc were never discussed by my surgeon. Not sure if anyone else has had a similar issue??

Our Holly had surgery done on her first knee when she was 9 mo old. The second was done 4 weeks later (we initially were going to wait 6 wks, but she healed up quickly and the other knee was getting worse.)

I can't imagine having to decipher between the multiple opinions you have received with the proposed pros and cons.

In our case, Holly was nearly completely lame just 5 days after the initial onset and subsequent diagnosis. She was unable to stand on her rear legs and basically resorted to pulling herself with the front. It was horrible to watch. We got her booked for surgery was quickly as possible.

The vet we chose to do the surgeries had done so on only 1 other cat (though had multiple experience on dogs.)

Keep us update on Lolly's condition and let us know when surgery is scheduled!

Hi, CatPak,

It was nice of you to write. Thank you....

I noticed nothing had been said in any of the postings about growth plates which is why I wanted to be sure to write... Hearing we were to do nothing and feeling totally and unexpectedly helpless had me desperately reaching for a second opinion from my last highly respected veterinarian, who'd correctly diagnosed my collie's Retrobulbar abscess -- which had been misdiagnosed by another local vet, resulting in the extremely sad loss of the total sight in one eye -- and who had retired and moved from a private practice to his beloved emergency medicine in an adjacent state...

Having done countless P/L operations on dogs, as well as a few on adult cats, he still had a great, great adversion to doing any surgery that could possibly result in any really "messy and unwanted" complications with open growth plates on a young kitten.... ... Which I highly respected...

So, when he offered to consult with his clinic's resident orthopedist, while my current young vet, too -- and recommended by the former-- also offered to consult with an otprthopedist he's known from veterinary school, I felt gratified, never ever expecting there'd be such differing opinions.

The confusion even had me writing "Ask-a-Vet", from a link at the E/R vet's clinic's website, as well as asking online Dr. Kris from iwillhelpyourcat.com fame.... As you stated, it was uniquely uncharted ground, and I felt terribly lost.

However, hearing my old vet urging me to just pick one that felt right, and who'd be doing the actual surgery, and stick with it and stop worrying, and considering my current vet's thought processes and consultation, too. we chose and stuck with the waiting, which what we thought best. I so very totally believed in the inherent danger and high risk of messing with open growth plates, and not willing to undergo that unknown risk, and full well knowing, too, that there was just not enough bone yet to attach to (evident in the radiograph) we chose to wait until the growth plates had had some opportunity to close. Lolly had limitations, and we'd just have to make the best oof it.

Thus, the recent ten month x-Ray, now, and decision to move forward...

Perhaps the issue wasn't raised with you because your Holly was already nine months, where my Lolly had been only five? Initially, they'd said to take a look at between eight to ten months, and then, later, at between ten and twelve. That could have been some of it...n And there'd , too, been the talk of would she grow out of it... I don't know what I might have done had she been immobile. Would I get a cart, as I'd done with my collie in his old age or as Dr. Kris had recommended should there be complications with Lolly?

It's encouraging to hear, reaffirmed, that the recovery might be quicker than some of what I hear or read. I'd thank God for small favors, still not knowing what to expect, as we move into this second chapter...

I'll be sure to post more, as we go along...

Linda

Hi everyone.  I am so sorry I never followed up on my original posts (posts #44 & #47 January 2014) to let you know the outcome of my Dexter's double luxating patellas.  

To recap, Dexter was 8 months old when we first noticed the limp.  He was diagnosed with double luxating patellas (stage 2) and at the beginning of all this, they would pop back in place on their own.  We took him to a couple of board certified veterinary orthopedic surgeons for a consultation and exam.  Both suggested a pair of surgeries to be performed about 3 months apart (one for each knee), and their prices (here in Northern NJ) were extremely expensive.  One wanted $2,700 per surgery and the other said it could be up to $3,000 per surgery.  Both suggested that we wait until he was full grown so that the growth plates could close up.

We then went back to our regular Vet to get his advice and we were shocked to learn that he had successfully done this surgery before.  Apparently, he does surgery once a week every Friday but never became a board certified surgeon because he didn't want his veterinary career to be exclusively surgery.  He told us that he had done luxating patella corrective surgery about 90 times (but only once for a cat).  The condition is quite common in pedigree small dogs due to perpetuation of the condition through pedigree breeding.  It is considered rare in cats probably because there is far less selective breeding and that afflicted kittens are more likely to be euthanised than are pedigree puppies.  He said that this was one of his favorite surgeries to do because the results are positive over 90% of the time. Each surgery would be about $1,800 - 1,900 and should be done about 3 months apart and he told us to wait until Dexter was a year old after his growth plates were closed (an x-ray showed that the growth plates still had gaps).

Within 2 weeks, his condition degenerated to stage 4 and he could no longer use his rear right leg at all.  Dexter was now pulling himself around with his front legs (which became amazingly muscular and strong).  In the last week of January, we called our vet and said we could no longer wait until Dexter reached one year old (May) and that he had to have the surgery immediately because his quality of life (and ours as a result) had deteriorated so much.  He agreed to do so. 

NOW HERE IS THE IMPORTANT PART:  We asked him WHY the two surgeries had to be conducted several months apart and told him that we preferred him to perform ONE surgery for both knees at the same time. He said the concern was that Dexter would be unable to walk and would struggle to eat, use the litter box and function during the 2-3 month recovery.  We responded that we would tend to Dexter's recovery and make sure he always had the help he needed but that in NO WAY would we want to put him through this ordeal TWICE and have this fiasco take over 6 months to complete.  Our vet was a little apprehensive to do both surgeries at the same time, but ultimately acquiesced to our request (actually it was more of a demand).

So on January 31, 2014, Dexter had double patella surgery.  The vet said that he channelled the grooves and did not need to realign the tendons/ligaments as is often the case in small dogs.  The cost was also MUCH less than it would have been for two separate surgeries, a total of $1,900.  

Upon discharge, we brought Dexter home and put him in a dog crate with enough room for a food and water bowl and a small litter box.  We brought him home and placed him in the crate with the door open as we set out to fill his food/water bowls and pour some kitty litter into his box.  While we were doing this in the kitchen, we saw Dexter slowly limp his way to the regular litter box (on the other side of the house) and perform his functions.  We were shocked that he could get there.  We used the crate for about 2 weeks and eventually began to let him limp around on his own with that stupid looking megaphone collar around his neck.   Within 3 weeks, Dexter was almost back to normal and after 4 weeks we dismantled the crate.

Within 2 months, Dexter was walking normally, running a bit and began to do small jumps.  Our vet was amazed that the recovery from the double surgery was so quick and he said that doing both surgeries at the same time was actually the BEST way to do this because when he does one at a time several months apart, some of the little dogs learn to favor one leg before the second surgery and end up forever favoring that leg even after the second surgery.  Since Dexter had both legs healing at the same time, he did not favor one over the other and this made his return to normalcy more balanced.  Our vet said he would suggest double surgery in the future to families who had the time to devote the needed attention to the first few weeks of recovery.

Forward flash 13 months to March 2nd 2015:  We are exactly 13 months since Dexter had his double surgery and you would never know that Dexter ever had any issues at all.  He runs, plays, jumps very high just like an ordinary cat.  No signs of any pain or discomfort.  He occasionally lies down and spreads his legs apart unlike a normal cat (something he learned to do before the surgeries in order to relieve the discomfort), but that is just a product of habit apparently.  We are so thankful that our vet agreed, reluctantly, to do both surgeries at the same time and that he was so good at performing this surgery.

If anyone reading this lives in Northern New Jersey (Sussex/Passaic/Morris counties) and have this problem, PLEASE contact us and we will give you our Vet's name and number..  HE IS THAT GOOD!!!!!!  Plus he costs WAY less (even if you do the 2 surgeries separately) than the overpriced board certified veterinary orthopedic surgeons.  

Not sure if it allowed to be posted here but it is Advanced Veterinary Care in Franklin, NJ.  His name is Michael Ramieri and I can't recommend him highly enough. He restored our terribly hobbled Dexter (virtually a paraplegic) to normalcy at a price we could afford and he did a magnificent job.  He was not kidding when he said that the luxating patella surgery was his favorite to do because his results are almost always perfect!

Good luck to everyone who has this difficult situation.  I hope the outcome for you and your afflicted kitty is as positive as ours.  If you have any questions, please post here or send us a message via PM.

Sincerely

David

I forgot to mention that the reason our vet wanted to wait until Dexter was a full year old was the "open growth plate" concerns he had. Those are legitimate concerns which warrant waiting as long as you can when dealing with an afflicted kitten, but when the quality of the kitten's life is so poor, and so excruciatingly painful for both the kitty and his/her owners to watch, one must make a difficult decision to do the surgery before the growth plates are fully closed. We couldn't wait any more and so far, we observe no adverse consequences from having the surgeries be performed at 8 or 9 months of age.

Chico44 said:

 
My cat was just diagnosed with luxating patella in his back right. The vet recommended surgery as it is a grade 2. He quoted me anywhere from 1700 to 2300.  I live in Canada so I am guessing it is more expensive? I am saving for a wedding unfortunately and need all the money I can save right now. How much have other people paid for this surgery and where are you located?

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In the expensive northern New Jersey, two board certified veterinary orthopedic surgeons were asking for $2,500 - $3,000 per knee surgery.  Ouch.  Our regular vet, who is quite proficient at this surgery for dogs but is not board certified, charges about $1,800 per knee surgery.  Upon our bequest, he did double surgery for my cat's knees simultaneously, which obviously reduced all the costs.  The total for the one-time surgery of both knees was a little over $1,900.

Hi, Dcat,

I'm so very glad you did your post. In fact, I've passed it on to my vet to see what he thinks. Like you, It's unimaginable to think of life being askew for six additional months for the individual recovery periods, already on top of all the hoopla of raising a kitten. I really don't think I could emotonally handle that. In fact, I've only just recently gotten my household back to normal. So, I hope to discuss that topic.

However, as the left leg was only a grade one, maybe there's the possibility that no second surgery would ever be necessary? I suppose that presents a valid question, too.

Then there's the fees... Never in my wldeset imagination had I thought it might cost $6,000 which I know I couldn't do. Now, I know I need to better understand that part of the equation, too.

Again, many thanks for your time in helping us all out.

Most Sincerely,
Linda

ilovedaisiestoo said:

Hi, Dcat,

I'm so very glad you did your post. In fact, I've passed it on to my vet to see what he thinks. Like you, It's unimaginable to think of life being askew for six additional months for the individual recovery periods, already on top of all the hoopla of raising a kitten. I really don't think I could emotonally handle that. In fact, I've only just recently gotten my household back to normal. So, I hope to discuss that topic.

However, as the left leg was only a grade one, maybe there's the possibility that no second surgery would ever be necessary? I suppose that presents a valid question, too.

Then there's the fees... Never in my wldeset imagination had I thought it might cost $6,000 which I know I couldn't do. Now, I know I need to better understand that part of the equation, too.

Again, many thanks for your time in helping us all out.

Most Sincerely,
Linda

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That's the cost here in northern NJ, one of the most expensive places to live, work, and breathe in the United States.  I'll bet in Maine the costs will be more reasonable.  My point was that you may not necessarily need a board certified orthopedic surgeon to do the surgery if you can find a vet who has done this surgery with successful results before (most likely on small pedigree dogs, where this affliction is much more common).   Call your vet and ask for a reference to others who have done this surgery.  A certified orthopedic pet surgeon will be at least 50% more expensive.  There's a higher price to pay for that specialty/certification.  We got lucky as our vet happens to love doing orthopedic surgery, but only once per week so he can fulfill the other obligations of his practice.  As for doing both knees at the same time, most vets are concerned about lack of mobility during recovery.  That may be much more important for little dogs than cats, who have higher pain thresholds than dogs, don't need to be walked to go potty and heal more quickly.  I strongly endorse anyone here to push their surgeon to get them both done at the same time.  Just be prepared to have someone home most of the time for at least 2-3 weeks after, if possible.  I took a week's vacation from work to be home.  It worked for us.