I have a 7 year old American Bulldog mix. 4 months ago he had TPLO surgery. Two months into the recovery he started

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Customer: I have a 7 year old American Bulldog mix.  4 months ago he had TPLO surgery.  Two months into the recovery he started having a lot of pain, whining and crying near constantly.  The vet said the plate (the dog was in between plate sizes, so the vet opted for the larger plate) was pinching into his joint capsule and causing him pain.  Not being able to tolerate pain meds other than Tyl with codeine, at the end of the three-month healing period the plate was removed.  Plate removal did little to improve his agony.  The vet prescribed antibiotic and more pain meds, hypothesizing there may be infection in the dog's knee.  At this point, the dog goes from constant crying when not on pain meds to sedation when on them.  Without pain medication he is restless and wakes up every 1-3 hours throughout the night crying in agony.  I have to pick up his hind quarters so he is able to shift around and adjust his positioning.  A few days ago I took him, x-rays and medical records to a different vet.  Immediately the vet pointed out the hellacious bone spur (over an inch long) protruding from the tibia into the knee/humerus (in addition to other smaller spurs and arthritis) - I have photos I can send to show.  She referred me to an orthopedic vet to schedule surgery to have the spurs and arthritis removed - the ortho appointment is next week.  The spurs are too far progressed to scope his knee so the ortho has to open the knee to clean out the joint.  My concern is, after all that he's been through, will this surgery fix him or will it be the first round of subsequent surgeries to remove more spurs in the future?  I know it sounds radical, but would removing his leg avail longer term quality of pain-free living for him?  It's obviously been an expensive road and I will proceed with the spur removal surgery if it will provide the most successful result for pain-free living, but I do not want to put him through more pain, recovery and rehabilitation to then end up no better off that when he started.
Answered by Drew in 10 mins 11 years ago
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Drew
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16,548 satisfied customers

Specialities include: Dog Veterinary, Dog Medicine, Dog Diseases, Small Animal Veterinary

Hello, welcome to JustAnswer! I am a licensed veterinarian, and I'll be happy to help you in any way I can. I would be happy to take a look at the x-ray images, if you are able to upload them or send a link to an online album where they're located.
Customer
Hello Drew,

Thank you for your initial response. I don't have a light box to view the x-ray, so there may be a cloud or two in the photos. :)

pre TPLO - April 2011
Customer
Here is the post TPLO, pre plate removal. Bone spurs roaring everywhere. :(

post TPLO 7.4.2011
Thanks for the pictures. I agree, there is significant remodeling of the joint in the second view, indicative of degenerative joint disease / osteoarthritis. This is common any time there's instability in a joint, such as with a cruciate ligament rupture, but it does appear that there is considerably more change in the joint than I'd expect to see after a TPLO procedure.

I don't think I'd jump to amputation of this leg -- what I'd probably do is to suggest going ahead with the procedure to attempt to "clean out" the joint of bony spurs, and then to start treatment with Adequan and/or Cartrophen, along with oral Dasuquin supplementation, to see if a reasonable comfort level can be attained. Also, laser therapy and acupuncture may help improve comfort, in an effort to manage this issue without opting for amputation.
Customer
You're welcome. Thank you for reviewing them.

What is the probability of him being free from pain after the surgery? In "cleaning out" the joint, what is the likelihood of them reoccuring? Will he have these issues and have to take medication for the rest of his life?

Thanks so much,
Dana
The joint will never be a normal joint -- and may be prone to these spurs reoccurring -- which is why I'd hope the joint supplements and injections may prolong the period of time without pain.

The medications and supplements may need to be continued life-long, though in less frequent intervals in some cases with a good success rate.
One other consideration -- if this joint is to be surgically treated, I would suggest a biopsy of some of the most severely affected bony areas. I am a little worried about a possible bone cancer known as Osteosarcoma, which can sometimes occur secondary to implantation of bone plates or screws or pins.
Customer
Would osteosarcoma explain why he cries while just laying down, not moving (which he's doing right now in this photo)?

squeaking
Any painful condition can lead to that -- it's not a specific finding for osteosarcoma.
Customer
I'm grateful for your help and expedient responses (especially on a Sunday). Much appreciation, Drew!
You're very welcome -- I'm glad I could provide some assistance :) best wishes to you both :)
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