Post-Surgery Care Instructions Following Knee Surgery
What to Expect
Your pet may have undergone knee surgery at Cahill Animal Hospital to address a torn cruciate ligament, injured meniscus or patella luxation (knee cap dislocation).
The degree of limb usage after surgery varies between patients. In general, the lighter the patient, the better they tend to do after surgery. Specifically for torn cruciate ligament patients, the patient will generally function better and be relatively more pain-free after the surgery than prior to, even if they do not return to full normal use of the hindlimb.
Post-surgical care is vital to the overall success of the surgery and relies heavily on owner input. In general, care consists of protecting the surgical implants by confinement followed, by a supervised return-to-exercise programme which helps increase your pet's mobility and limb function. Convalescent (recovery) periods for patients undergoing knee surgery can be as long as 3-4 months – please do not be discouraged with their progress too early on.
General Post-Surgery Care
After coming home from the clinic, your pet should be kept in a warm, dry, quiet and ideally indoor location in the 24 hours following discharge. If your pet is discharged on the same day that he/she had surgery, they may still be a little bit drowsy after they go home with you. There may also be some irritability or incoordination during this initial 24-hour period immediately after the surgery.
The shaved area on your pet's front or back legs is the IV injection, IV catheter and IV fluid site(s). Some bruising to this area may be seen when they go home with you; however, if this persists beyond 72 hours, please give us a call at the clinic. You may also find that the underside of their paw may have been shaved - this allowed the placement of blood pressure monitoring equipment, so that we could monitor their progress under anaesthesia closely.
Surgical Site and Wound Care
The surgical site is located on either on the inner or outer aspect of the affected knee joint. Some pets may have a light bandage applied over their surgical wound after surgery, and this is usually removed at home about 48 hours after the surgery. Your veterinarian or veterinary nurse will advise you when is an appropriate time to remove the bandage at home. There are several sutures present on the surgical site - it is helpful to count the number of stitches present when your pet first goes home with you, so that you will know if any goes missing before the wound is fully healed.
The surgical site should be checked daily for swelling, discharge or loss of sutures. It is important that you keep your pet in a clean and dry environment so that the surgical wound remains clean. Pets should not get bathed or allowed to get their wound wet in any way, until all the stitches have been removed. For cats - please only use shredded paper or non clumping litter in the litter tray to prevent the litter material from sticking to the wound.
It is also imperative that your pet is not allowed to lick at the surgical site because this may lead to the wound splitting open before it is fully healed and/or wound infections and/or other more serious complications. If you notice your pet licking or chewing at the surgical site, he/she will need to wear an Elizabethan collar to prevent this. E-collars may be purchased from our clinic reception. Ensure that pets are not allowed to roam outdoors without close supervision when they are wearing an E-collar, as this poses a choking hazard if it gets caught in a fence or branch.
Exercise & Physiotherapy
It is extremely important that your pet follows your veterinarian's rehabilitation instructions closely, in order to maximise the outcome and success of the surgery. At the time of discharge, your veterinarian or veterinary nurse would have demonstrated how to perform physiotherapy exercises on your pet at home. Besides the physiotherapy exercises that you can perform on your pet at home, you may also consider booking your pet in for professional physiotherapy sessions. Talk to your veterinarian about the physiotherapy and rehabilitation services offered for canine patients in Palmerston North. Please do not hesitate to contact us at the clinic if you require further clarification or have any enquires regarding the exercise regime of your pet following knee surgery.
(1) Cruciate Ligament Stabilisation Surgeries
It is important to realise that the implant/prosthesis placed to stabilise the knee joint is never as strong as the initial cruciate ligament and a sudden burst of acceleration, fall, jumping, slipping, running may all lead to a breakdown of the implant in the initial 6 to 8 week post-surgical period.
- Weeks 1 and 2 : Strict Confinement to a cage or room is necessary during this time. Dogs should be taken to the toilet on a leash. Do not allow any boisterous playing, running, jumping, use of stairs or swimming.
- Weeks 3 and 4: Leash walks 5 minutes twice daily on flat ground +/- swimming.
- Week 5: Leash walks 10 minutes twice daily on flat ground +/- swimming
- Week 6: Leash walks 15 minutes twice daily on flat ground +/- swimming
- Week 7: Leash walks 20 minutes twice daily with some uphill +/- swimming
- Week 8: Supervised off-leash activity allowed, but no stick/ball/frisbee-throwing or boisterous play with other dogs
- Week 12: Normal off-leash activity and play are allowed from here on.
From week 3 post-operatively, swimming and home-based physiotherapy (after a walk when the muscles have warmed up) are encouraged to help preserve the range of motion and strengthen the muscles in the operated leg. Home-based physiotherapy involves gentle flexion and extension of the stifle, up to 10 repetitions twice daily after the walk. Flex and extend the stifle only as much as your pet will tolerate.
(2) Patella Luxation Correction Surgery
It is important to realise that while the surgical correction of the patellar luxation has been stabilised by implants, these implants could break with a sudden burst of acceleration, fall, jumping, slipping or running, leading to a failure of the surgical repair in the initial 6 to 8 week post-operative period.
- Weeks 1 and 2: Strict Confinement to a cage or room is necessary during this time. Dogs should be taken to the toilet on a leash. Do not allow any boisterous playing, running, jumping, use of stairs or swimming.
- Weeks 3 and 4: Leash walks 5 minutes twice daily on flat ground
- Week 5: Leash walks 10 minutes twice daily on flat ground
- Week 6: Leash walks 15 minutes twice daily on flat ground
- Week 7: Leash walks 20 minutes twice daily with some uphill
- Week 8: Post-op x-rays should be performed this week, please phone for an appointment. If adequate bone healing is observed, then your pet may start having some supervised off-leash activity in a small outdoor area. No stick, ball, frisbee-throwing or boisterous play with other dogs is advised until Week 12.
- Weeks 9, 10 and 11: Gradual weekly increase in the amount of off-leash activity in a progressively larger area outdoors.
- Week 12: Normal off-leash activity and play are allowed from here on.
From week 3 post-operatively, swimming and home-based physiotherapy (after a walk when the muscles have warmed up) are encouraged to help preserve the range of motion and strengthen the muscles in the operated leg. Home-based physiotherapy involves gentle flexion and extension of the stifle, up to 10 repetitions twice daily after the walk. Flex and extend the stifle only as much as your pet will tolerate.
Diet
Unless otherwise directed by your veterinarian or veterinary nurse at the time of discharge, no significant change is usually required to your pet's diet. However, it may be helpful to decrease their daily rations by 10-15% during the recovery period, so that they do not pile on excessive weight during the duration of reduced activity.
Post-Surgery Revisit
For some pets, your veterinarian may recommend that he/she comes back to the clinic in 3-5 days' after the visit for a recheck with one of our nurses. The nurses will check the surgical wound, your pet's temperature, and check that your pet is tolerating their oral medications well. Other aims of this visit is also to ensure that everything is going as planned at home, and that your pet's pain levels are well-managed. We can also address any concerns you may have with the post-surgical home care of your pet during this time.
Suture Removal
Sutures are typically removed 14 days after the surgery. Occasionally, your veterinarian may decide to "stage" the suture removal in that half of the stitches come out in 14 days', and the remainder comes out 5-7 days' later. Please phone for an appointment to book your pet in for suture removal.
Medications
Your pet would have received additional pain relief medications after their surgery, and most pets will also have oral medications to go home with. Please administer all medications as directed on the label; ensure that all pain relief medications are given with a meal.
Should you have any enquiries or further concerns about the post-operative care of your pet, please do not hestitate to phone us at (06) 3588675 to discuss.