Luxating Patella, Surgery Or Amputate?

[silkenpaw]

approx 1200 for the amputation and 3,000 for the repair

That’s a big difference indeed. I can see why you are seriously considering the amputation. What a hard decision!

 

[silkenpaw]

Freaky is a beauty! How old is she? My Fuz, who got HCM at over 10 years of age, was on a calcium channel blocker to prevent progression. I don’t know whether that works for congenital HCM. Fuz lived to 21 years of age.

 

[ali-oop]

Freaky is a beauty! How old is she? My Fuz, who got HCM at over 10 years of age, was on a calcium channel blocker to prevent progression. I don’t know whether that works for congenital HCM. Fuz lived to 21 years of age.

Freaky is only 6. Hearing about Fuz makes my heart soar!!! Freaky is an extremely loving (read: needy) kitty who only deserves good things. I got her when she was 3, underweight and depressed. I hope she has a long life like your fuz.

 

[silkenpaw]

I also hope Freaky has a long life! Every cat and their human deserves it! Needy kitties are fun!

 

[PushPurrCatPaws]

That's crazy. Why would the more dastric option be less expenisve? The risks of a catastrophic complication are much higher with amputation because the whole leg is cut off.

I've not had any experience with animal leg amputation, but my guess is that the surgery to repair the knee and its surrounding bone and tissues is much more intricate and complicated than a surgery to amputate a limb.

 

[PushPurrCatPaws]

Thank you for the thoughtful response.

I’ve known about the luxating patellas for awhile. Probably at least 3 years. But for whatever reason, I never grasped the gravity of the situation. Maybe the vet didn’t take care in informing me of the potential outcomes or maybe I ignored it. Usually I worry a lot so I feel like either the severity wasn’t stressed or I just didn’t pick up on it. I (stupidly) likened the diagnosis to being double jointed or something. A quirk but nothing catastrophic.
...

In many cases of luxated patellas from injury (or even maybe in an older, senior cat that is overweight -- they can develop non-congenital patella issues and inflammation, too), the cat can heal and improve over time, with crate rest when needed. I believe it is different when the cat's luxation issues are congenital. A lot of congenital bone issues don't manifest until the kitten is going through its growth phases, during the first months to few years of its life. As the bones grow, the congenital issues become more obvious. Some cats' issues might not be as bad or as apparent or as progressive as other cats' issues. Do not beat yourself up regarding your decision-making thus far. We each have different opportunities and restrictions and understandings we are faced with... different hopes as well! And I can tell how loved your Daisy is, along with your other cat(s).
I am really sorry you are going through this. I could very well have been in your situation if I'd made or been forced to make the same choices when my cat was two or three. It's very likely your Daisy didn't have advanced luxations (maybe Grades I-II and for many years), and so it is no wonder that you thought all was okay in the world. As she ages, though, the inflammation and degradation of those knee joints is just progressive. And here we are today. My heart really goes out to you.

I would really try to have a consult with an ortho vet surgeon (other owners have lucked out finding vets that aren't necessarily accredited ortho vet surgeons --"just" surgeons-- and it is possible that the costs might be lower in such cases). Have the surgeon really go over the pros and cons of amputating the knee versus surgery, the prognosis of both choices, and go over the extent of damage in her now-lame knee so far. Discuss about the eventuality of the other knee going lame in the future, too, and what to do if you decide on either surgery for the now-lame leg. I think in your case, and if the knee cap is actually out of the trochlear groove pretty much all the time now, getting good xrays of both legs would be very, very worthwhile. If the knee cap is out of the groove, it will show up on the xray. (If a knee cap is sitting in its groove, like possibly her other knee, it may not show up on the radiograph.) It will help you and the surgeon figure out what to do. We had xrays done of my cat's knees but her knee caps were actually in place, coincidentally, when the xrays were taken and so the surgeon did not get much benefit from xrays. MRIs and CT scans will show a LOT more, but they are more expensive. My surgeon knew what was going on with my cat's knees via a physical exam and also viewing videos of when her knees luxated, and also just in talking to me. And in having 15-20 years of surgical experience. It is only when he could open up her leg at surgery time and see what the heck was going on with her knees, that he could really decide on how to proceed. Milly's right knee was the worst one, and the surgery took twice as long and had a couple of complications (but it turned out fine). Her left knee was not as advanced in its luxation issue, so the surgery for that went better/quicker. They kept her overnight each time. A lot of that higher cost for this surgery is the surgery itself, and all of the associated meds, anesthetic, vet nurses, overnight stay, et cetera.

I did want to make some current suggestions regarding Daisy's activity level now, until you know more of what your decision will be. If you read the 2nd paragraph in this older post of mine on another thread, I talk about what kind of playtime movements to avoid (this is from my personal experience with my cat).
Limping Kitty - Pulled Muscle/sprain?

You really want to have her not jump up or down from anything, and also no running.
(It's like asking the impossible, I know! )

... And after reading your post, I am more worried because she is at the point of lameness. the emergency vet she said she tried to pop it back into joint, but it would not stick. But she still suggested the surgery. I feel better knowing that it lasts for a lifetime.

I’m biased but I think she’s in pretty good shape. She is a tad over weight, at under 11lbs. Other than the apparent lameness, she’s pretty healthy.

I’ll call tomorrow to set up the consultation. I know it’s only gotten worse. She hasn’t been confined to a crate at all, just one room.

I have another cat with a heart murmur and in feb I paid the $600 for an echocardiogram. She is supposed to have a follow up in August to see the rate of progression and it’s going to cost $300 but I know have to cancel it for Daisy’s sake. I didn’t qualify for care credit. I had some debts to pay off.

Thank you again

I am so glad to hear she is healthy otherwise, that's really good news.

I'm sorry to hear about your other cat, Freaky. I know there are many TCS members on the site who have had experience with HCM. Maybe at some point you can post another thread, if needed, if you need help with that, or to talk about it.

 

[ali-oop]

I will respond to the post above but I wanted to give a quick update. I called the vet I used for freakys ecg And was floored. The consultation was $150. Examination and sedation was $500-$600. The surgery itself would go from 3300 to 3800, and then a required postop at $1200. So easily looking at $5000. I began crying and told her I’d have to call her back.

I called the vet to the emergency vet had referred me to, just to see their price estimates. Consultation was 120. Nothing added. The surgery was 1800 to 2400. And then a $60 post op.

The difference in price is staggering. And confusing.

 

[Kieka]

I will respond to the post above but I wanted to give a quick update. I called the vet I used for freakys ecg And was floored. The consultation was $150. Examination and sedation was $500-$600. The surgery itself would go from 3300 to 3800, and then a required postop at $1200. So easily looking at $5000. I began crying and told her I’d have to call her back.

I called the vet to the emergency vet had referred me to, just to see their price estimates. Consultation was 120. Nothing added. The surgery was 1800 to 2400. And then a $60 post op.

The difference in price is staggering. And confusing.

Vet prices can vary drastically. I had to take Link to an ER vet recently and prices for just walking in the door can vary from $50 to $95. Medications can vary from $30 to $90 for the same medication and quantity.

It sounds like that second vet may be the better option price wise. Just check into how often they have done it because you don't want to be the first time.

 

[PushPurrCatPaws]

I agree with Kieka. The cost estimates you were quoted sound amazingly high to me! And to charge another $1200 for what will probably be the 2-week post-op stitches removal and consult visit... geez! For my cat, the post-op stitches removal visit plus the 8-week post-op visit to make sure the leg is recovering well (plus any time we were worried and wanted to have the ortho surgeon just make sure her leg was okay in the 6+ months following the surgeries)... all those were included in the price for us. My cat's patellar luxation surgeries were $1250.00 each... and then all the meds, anesthesia, hospitalization, staff, etc. ended up to be $2917 for the right knee and (a year later) $3512 for the left knee. (Those totals include within them the $1250 each for the surgeries themselves.) Again, all the vet visits and consults we could even want or need w/ the surgeon were included in those prices, for all post-op care. And we used an ACVS certified ortho surgeon.

So, wow.
Costs can vary, too, depending on where you live, I guess.

 

[ali-oop]

Wow exactly. I mean, the first vet was more than twice as much! I checked reviews for the affordable option and they have 4.9 stars. Many comments on the fair pricing so that is also a huge relief. When there is a $3k price difference on surgery it really makes you question the quality of each.

I feel so much better. I haven’t felt this light in a long time. I only need to take out a 1k loan, half of which I can pay back in sept. Then I can start saving for the other leg.

Thank you for all the support!

 

[Daisy6]

Push, why was there such a big price difference between the two knees?

 

[PushPurrCatPaws]

Push, why was there such a big price difference between the two knees?

Increases in this or that med; a cerenia injection I did not okay (sigh); inclusion of xrays/2 views of her stifle (I'd already gotten xrays elsewhere at regular vet for 1st surgery); the chem panel and CBC more extensive than 1st surgery; an added charge for inpatient hospitalization that wasn't charged specifically on the first surgery(?!); yada yada yada. It added up.

 

[lmspjsies]

My cat had the surgery on his right leg for luxating patella seven years ago. He has done great. Then a few months ago, the left leg started to get bad and now is much worse. The vet kept saying he is too old for a surgery, but I went to orthopedic surgeon today and she suggested doing the surgery on left leg. It worked the first time, so I am hoping this helps him. To do nothing would be a poor quality of life and I would like to give him the opportunity to get better!

 

[dcat]

Hello, I was hoping I could get some advice or insight from you all regarding the surgery for Luxating patellas.

At the end of April this year my cat with known luxating patellas, fell and now her leg will not go back into joint. I took her to the emergency vet about five days after the incident. They said she would either need to amputate or get the surgery to repair the joint. I called my vet and she recommended I bring Daisy in for a second opinion. So I did that. Her second opinion was to do a consultation before the surgery. Which was not at all helpful. Those visits alone were $330 and I had already known about her luxating patellas.

I was so upset when I took her to the emergency vet that I didn’t retain a lot of information and didn’t ask enough questions. From what I’ve googled, no one has said that the surgery would need to be done again, but she is only six years old. My fear is I would get the surgery and then they’re like OK see us again in 3 years! The other concern is that her other back leg has the same issue. So if I amputate one leg, it is putting more stress on the other leg.

I have a cashed in my personal and vacation time and gotten to a point where I can afford to amputate (1,200k). The surgery, which they’re saying around $3000, would require taking out a loan out of my 401k. Loans that would be a strain to pay back. The bank denied me a credit card. I know cats can live happily with only three legs, but it seems like a drastic choice. Especially if it’s going to aggravate her other leg.

She doesn’t act like he’s in pain. I keep her confined to my room. And then leave her for 10 hours a day. She still runs and jumps and acts like an idiot. Practically doing backflips playing with hair ties. I had to build her a ramp to my bed bc she would still jump up and down to it.

Anyway I know the post is long... I know ultimately it’s up to me but I want to do right by her. Anyone has experience with the surgery? Or decided to amputate? The leg is question was always the worst one. My poor (semi)sweet potential peg leg puss!!

88 page thread. DON'T AMPUTATE http://www.thecatsite.com/t/218910/the-infamous-rare-luxating-patella/60

 

[dcat]

my 10 month old kitty had double luxating patellas, couldn't walk (was fine his first 8 months too... could leap tall buildings) "Board Certified" Vet surgeons were quoting me from $2700 - $3300 per knee. I never thought to ask our new vet we started with when we adopted him months earlier... then he told us he had done this surgery over 60 times already, but only once for a cat (luxating patellas are very common in pedigree small dogs). His price was $2250 total (doing both knees at the same surgery, which we preferred to one at a time six to nine months apart). He performed the surgery and 4 years later my black and white Dexter is the acrobatt in the house. Best of luck with your kitty. I hope you don't amputate. The same thing can happen to the other knee.

 

[emmily1987]

I know this is a way older post but I'm desperately looking for info.

Our kitty got diagnosed with a luxating patella yesterday. Grade 3. We'll be doing the surgery but our vet has to call in a visiting specialist. The vet made it sound super urgent yesterday and then today called to say the soonest appointment is in a month. That feels like a really long time to wait. How long did you wait between diagnosis and surgery?

I dont know how to keep my kitty Unagi calm for a MONTH waiting for the surgery without crating him, he is so active and runs and jumps constantly because he's just under two (we rescued him so its a guess).

Any words of wisdom would be appreciated.

This is such a tough position to be in, I wouldn't wish it upon anyone.

I have a cat who had congenital luxating patellas. She is just over three years old now and the surgeries are behind us. The surgeon states that her "repairs" should hold for her lifetime, at this point. Cross fingers!


We started seeing signs of her luxations when she was about 13-15 months old. I never even heard of such a thing before that time! A ali-oop , how long have you known about Daisy's knees? When you notified the vet at that point, did they go over possible knee surgery options with you then? If Daisy's issues are congenital, like with my cat, the luxations get progressively worse until lameness results if nothing is done. We decided on knee surgery for our cat, and scheduled the surgeries when the luxation issue with each knee had reached about Grades II-III. Once the patella is luxating so much that it is basically staying out of its trochlear groove and not going back in at all on its own (or with a vet's manual attempts), you pretty much have reached full lameness and Grade IV luxation. I don't believe the prognosis (to a full or nearly full recovery) is as good with a Grade IV luxation than with Grades I-III.

A lot of recovery depends on the damage to the knee and surrounding soft tissue, the weight of the cat, the age, etc. When my husband and I found out that our young cat had luxating patellas in both hind legs, we were able to decide on surgery as soon as it seemed necessary so that the prognosis for her would be better in the long run. Our cat is younger than yours and at a good weight. If your Daisy has a lot of good things going for her (good weight, activity level, healthy otherwise, successful enforced crate rest), she could very well have a good prognosis after a knee surgery. We were blessed to be at a time in our work lives where we had some extra money to do these expensive surgeries. I really feel for you in your position, with what you are going through right now financially. It makes this thing so hard for you! Daisy is a beautiful, well-loved kitty. I really don't know what I'd do in your position. I don't really know how long you've known of the knee issues with your cat, what your cat's weight is, what prognosis a surgeon might make, etc. I think that is why your vet suggested a consultation (probably meaning a consultation with an orthopedic vet surgeon), to find out how advanced the knee issues are with Daisy. I found our own consultation with the surgeon and the diagnostics like xrays to be helpful in getting us to make a decision on what to finally do with our cat. We didn't do MRIs and CT scans: our surgeon didn't need to see those prior to surgery-- I had some videos of my cat's knees as they were luxating, so he knew what was happening, what with his experience and all. Even then, this knee surgery can be a very grueling tough road to travel on, to recover from the surgeries. Cats are so much more independent and active than dogs in recovering from such surgeries. It's not easy to keep them calm.

With either leg surgery that you decide to do for Daisy, there will be recovery and crate rest. I don't believe you'd have to have surgery again for a repaired luxated patella UNLESS the cat did not do well with crate rest and/or she re-injured the knee, joint and/or soft tissue before the area was fully healed and strong. It can take several months. And the leg won't be 100% recovered until 8-12 months later. That's why you have to follow the surgeon's instructions very closely during the recovery and rehab time period (for many months post-surgery). It just helps to ensure that more surgeries won't be needed to repair the knee joint in the future.

Daisy has issues with her other knee, too, it sounds like... nothing is easy about your decision. I think doing the luxated patella surgery still puts some temporary stress on her other leg, but she'll recover from that as she strengthens and mends. And she'll have both legs. The thing is, if you let the other knee get just as lame and if you had decided to amputate the current knee -- well, then, what to do at the point when the other knee goes lame? This is really tough. Can a cat only have two legs? If you read one of the 'luxating patella' threads from start to finish (the one with "infamous" in its title that Kieka pointed out above), you'll find several examples of cat owners deciding to do both knee surgeries at once. That's not the route I took with my cat (her surgeries were spaced one year apart), but others had success with it, I think.

Either way, the surgeries cost money and the recovery and care costs money.

Kieka gave some advice regarding financial issues, and maybe you can also start a GoFundMe page, if you decide to do the knee surgery route versus the amputation (it sounds like you have money already set aside for the latter, if you decide on that).

What is your input, A ali-oop ?