Orthopedic Surgery – Lake Geneva, WI
Dr. Scot Hodkiewicz has developed a special interest in orthopedic surgery and has extensive knowledge in the causes, diagnosis, surgery, and management of orthopedic conditions. He is trained in most orthopedic procedures including cruciate ligament repair, fracture repair, hip surgery, and arthroscopic (using a small camera) joint surgery.
Cruciate Ligament Repair
What are the cruciate ligaments and how are they damaged?
There are two bands of fibrous tissue called the cruciate ligaments in each knee joint. They join the femur and tibia (the bones above and below the knee joint) together so that the knee works as a hinged joint. They are called cruciate (meaning cross) ligaments because they “cross over” inside the knee joint. Commonly, the cranial (front) ligament acutely ruptures when the joint endures a twisting motion, either from an athletic endeavor or a traumatic injury such as a slip or fall. The joint is then unstable, causing pain and lameness. Cruciate ligaments can also be partially torn either from a more mild injury or other factors that weaken the ligament and knee joint. These dogs may initially be only slightly and intermittently lame. Partial ruptures often fully tear and necessitate surgery. Obese patients are at increased risk of damaging the cruciate ligaments. Menisci (shock absorbers inside the knee joint) are often also damaged when the cruciate ligaments rupture. They are usually repaired at the same time as the ligament surgery.
How is the condition diagnosed?
With traumatic cruciate rupture, the usual history is that the dog was running or jumping and suddenly stopped or cried out and was then unable to bear weight on the affected leg. Many pets will “toe touch” and only bear a small amount of weight on the affected let. During the examination, our veterinarians will try to demonstrate a particular movement, called a drawer sign. This indicates excess laxity in the knee joint. Many dogs will require mild sedation before this test can be performed. Other diagnostic tests such as radiographs (x-rays) are necessary to further evaluate the joint for swelling, degree of current arthritis, and to rule out other factors such as bone cancer.
How is the condition treated?
A torn cruciate ligament will always lead to arthritis, poor function and pain if not repaired because the joint is no longer aligned correctly. There are various techniques available to replace the action of the cruciate ligaments. Historically, the surgeries focused on replacing the ligament that was torn using a very strong suture called an Extracapsular Technique. In dogs less than 30 pounds, the extracapsular repair often gives satisfactory results. Though this surgery is still done, especially on dogs under 30 pounds, it has been largely replaced by two newer methods. These two techniques involve changing the conformation of the joint so the cranial cruciate ligament is no longer necessary. Both the Tibial Tuberosity Advancement (TTA) and the Tibial Plateau Leveling Osteotomy (TPLO) can be performed by Dr. Scot Hodkiewicz. He has successfully performed thousands of surgical cruciate ligament repairs. These techniques are especially beneficial for larger, more athletic dogs that tend to break the suture in the Extracapsular Technique. Studies have shown a clear benefit of the TTA and TPLO methods over the older Extracapsular Techniques. The TTA and TPLO have very similar outcomes in most dogs. Dr. Scot Hodkiewicz can help determine which surgery would be best for your dog.
How is the pain managed in cruciate ligament disease?
Pain control is of utmost importance in managing cruciate ligament disease. Before the day of surgery, your dog is usually given oral non-steroidal pain medications and/or opioids to help reduce pain and inflammation of the joint. The day of surgery your pet will also be given both pre and post-operative opioid medications to effectively manage surgical pain. Our anesthetic protocols involve modern induction agents and isoflurane gas anesthesia to mitigate anesthetic risk as much as possible. Postoperative care after leaving the hospital can then include oral pain medications, physical therapy, cold therapy, acupuncture, oral and/or injectable joint supplements, and our MLS laser therapy.
What is involved in post-operative care?
It is important that your dog have limited activity for six to eight weeks after surgery. Provided you are able to carry out your veterinarian’s instructions, good function should return to the limb within three months. Nutritional supplements such as glucosamine and chondroitin may help improve the function of the knee. Many dogs will receive physical therapy after the surgery to speed recovery and reduce complications. Weight control is also an extremely important aspect of cruciate disease management. Overweight dogs have a longer, more difficult surgical recovery and are at increased risk of injury to the other knee. Your veterinarian will discuss your pet’s recommended post-operative care with you before your dog is sent home.
Fractured bones occur frequently in veterinary medicine. Dr. Scot uses a variety of methods to repair these injuries. Plates, screws, pins, and wires are commonly used. He also uses the newest “locking plates” recently introduced in veterinary medicine. These plates “lock” together with the screws to ensure a stronger, more stable fixation. This is vital in dogs that are large or likely will not be able to be confined for the eight to twelve weeks it takes for bones to heal.
Dislocations of the Hip
Dislocations of the hip are first reduced without surgery by anesthetizing the patient and reducing the hip. The hip stays in about half the dogs. In the other half, the hip pops back out either immediately or within a week. These patients need surgery to keep the hip in place. The surgery involves drilling a hole through the ball of the hip and through the hip socket. A stainless steel “Toggle” anchors a strong suture to hold the ball of the hip in the socket replacing the ligament that would normally perform this function. Most dogs will regain full range of motion and use of the leg after two to three months.
Femoral Head and Neck Excision for “Bad Hips”
This procedure is indicated for those dogs with severe hip arthritis where a total hip replacement is not an option. A total hip replacement is the best choice for most dogs but can be cost-prohibitive. With a femoral head and neck excision (FHNE), the ball of the hip joint is cut off and removed leaving the leg to float free on the pelvis. The muscles of the hip hold the leg in position without the ball allowing the patient to use the leg normally within three to six months. This eliminates the bone-on-bone contact that causes the pain of “bad hips”. FHNE hips are not perfect after surgery but pain is usually greatly reduced and function improved.
Arthroscopic surgery replaces traditional large incisions with small ones just large enough for a small camera and small tools to enter the joint. Lake Geneva Animal Hospital is one of the few facilities in our area to offer this service. Problems such as Fragmented Coronoid Processes (FCPs) of the elbow, OCD (cartilage flaps) of the shoulder, and diagnosis of cruciate disease of the knee are all candidates for arthroscopic surgery. The camera provides better lighting and magnification in these very small, tight joints eliminating the traditional large incisions and joint damage of older procedures. Most animals go home the same day with very little aftercare and much less pain.
Fragmented Coronoid Processes – This dog had a piece of cartilage floating free in the joint likely due to an untreated Fragmented Coronoid Process in the past. It was removed with the arthroscope.
OCD (Cartilage Flap) of the Shoulder – Arthroscopy was used to remove the cartilage flap associated with OCD. Here a grasper is being used to remove the loose cartilage. This dog had two incisions; the first was a quarter-inch for the camera, and the second was about a half-inch for removal of the flap.