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Hello, my name is***** and I would like to assist with your question today. It sounds like you are going to need a second opinion on your dogs condition. Luxating patellas. This is a fancy name for loose knee caps. The groove the knee cap sits in is often shallow with smaller breed dogs, especially with the maltese. The knee cap can slip in and out of place on its own quite readily in some dogs. It typically is not painful but can develop arthritis with time and this causes more irritation. What typically happens is the dog goes to step on the leg, the knee cap is not in place and they cannot place weight normally. Sometimes they do not place any weight on it, almost like a little skip, or they hold the leg up. The knee cap typically goes back into place on it's own or the dog kicks backwards and this puts it back into place. The arthritis can be managed with joint supplements or anti-inflammatories but typically the knee cap problem can only be fixed surgically and is only warranted in pets with severe trouble.
It is true that the surgery is expensive and needs to be done by a specialist because it is not a commonly down surgery for most vets. My main concern with that if the vet first thought they put the knee caps back in place but now says they cannot, that something else is going on. Typically with luxating patellas, it's either one way or the either. Either they are loose and are able to be moved around a lot, like I mentioned above, or they are locked out of place. If that is the case, it would not be something that shows up all of a sudden.