Pinkneys Green 01628 622086
Marlow 01628 483062
Stokenchurch 01494 485855
Bourne End 01628 525274

Orthopaedic Services

Information about our orthopaedic services

Orthopaedic Services

Information about our orthopaedic services

  • Investigation of Lameness
  • Investigation of Joint Disease
  • Digital Radiography
  • Arthroscopy
  • Medical Management of Lameness
  • Joint Surgery
  • Cruciate Ligament Injury
  • Fracture Repair
  • Spinal Surgery
  • Referring Vets

Investigation of Lameness

The cause of lameness in some animals can be frustratingly difficult to pinpoint. Careful attention to a detailed history, observing the animal in relaxed surroundings, and observation of gait over different terrains (flat ground, gradients, steps etc) can all add vital detail. In addition, we will often request video clips of what the individual is doing in its own home, as fear and excitement can often mask subtle discomfort.

Thorough clinical examination is always essential, and sometimes is all that is required to make a diagnosis.

Very often history, observation and clinical examination will provide a very high index of suspicion of certain lameness problems, but further investigation is required.

Investigation of Joint Disease

Investigation of joint disease always requires extremely thorough clinical examination. Often this will provide enough information to be fairly sure of a diagnosis, or at least pin point which joint or joints are involved. High quality radiographs are usually the next stage of investigation. Here at Hall Place Veterinary Centre we have state of the art Digital X ray facilities allowing us to produce outstanding images.

X ray images can also be augmented using contrast techniques where special dye is put into a joint to outline the joint capsule and other structures near the joint.

Arthrocentesis is a technique where a needle is placed in a joint to obtain a sample of joint fluid for analysis. Examination of joint fluid can give information about different types of inflammation or infection within the joint.

We also have the ability to look directly inside joints using miniature cameras with fibre optic lenses only millimetres thick. This technique known as arthroscopy gives use direct visualisation of what is happening within a joint, without causing damage. We can even perform certain operative procedures within joints using this technique.

Digital Radiography

We are one of the few Veterinary practices in the UK offering the DR digital radiography system. This comprises of a fixed plate X-ray detector.

This is different to the digital CR system which requires the detector plate to be physically moved to a reader, rather like the old chemical film system.

This is genuine state of the art technology and exceeds the standards in a large number of human hospitals.

The system offers image quality of outstanding quality and picture acquisition only 3 seconds after exposure.

This is of obvious benefit when taking any series of films, but allows almost real time results when undertaking procedures such as myelography.

Arthroscopy

Investigation of joint disease always requires extremely thorough clincal examination. Often this will provide enough information to be fairly sure of a diagnosis. However a number of ancillary diagnostic aids will help pinpoint pathology.

High quality digital radiographs (Xrays) are essential in preliminary investigation, and can be augmented by contrast techniques.

We now have the ability to look directly inside joints using miniature cameras with fibre-optic lens only millimeters wide. This procedure, known as arthroscopy, can give us valuable information about what is happening in the joint without causing damage. We can even perform a number of operative procedures within the joint using this technique.

Medical Management of Lameness

Many joint diseases can be managed without surgical intervention. Treatment often involves careful restriction of exercise, and the use of anti-inflammatory and analgesic drugs.

We carry a large range of different anti-arthritic, anti-inflammatory and analgesic drugs.

The main class of drugs used in treatment of joint pain in humans and animals is the Non Steroidal Anti Inflammatory Drugs group, often know as “NSAIDS”. Examples in human use include aspirin and ibuprofen.

The most commonly used NSAIDS in veterinary practice are:

  • Carprofen
    (trade names include Rimadyl)
  • Meloxicam
    (trade names include Metacam/Loxicom)
  • Fibricoxhib
    (Trade name Previcox)

Less commonly used include:

  • Trocoxil
  • PLT
  • Onsior

Joint Supplements

Just as in human arthritis, a large number of “joint supplements” are available. The most commonly used of these contain Chondroitin and Glucosamine, and increasingly also Omega3 fatty acids. These molecules form some of the basic building blocks of cartilage and joint fluid. The theory is that providing the body with more than enough basic building blocks will ensure cartilage and joint fluid will always be maintained as good condition as possible.

Green lipped mussel extract has also been reported as beneficial in joint mobility and is available as a supplement or even already added to food.

In a similar manner to the use of anti-arthritic drugs in humans, some drugs work particularly well in one individual and not in another. Sometimes it is necessary to try different drugs or combinations of drugs and supplements to get the best results.

Joint Surgery

Many joint diseases can be managed medically, and we carry a large range of different anti-arthritic, anti-inflammatory and analgesic drugs. See medical management of lameness.

Some joint diseases or injuries require surgical intervention.

We offer a complete range of joint surgery from arthroscopic examination and treatment of shoulder and elbow cases, through arthrotomy and complex reconstruction of multi-ligament joint injuries or joint fractures.

A significant proportion of our work involves stifle (knee) lameness associated with cruciate ligament injury.

This is so important this is covered in a separate section. See Cruciate Ligament Injury.

Cruciate Ligament Injury

Cruciate Ligament Injury is the term used to describe any sprain, partial tear or more commonly, complete rupture (where the ligament is completely torn) of the Cruciate Ligament, inside the dog (or cat) knee.

Cruciate Ligament Injury is an important cause of lameness in the dog, and can lead to permanent severe lameness, or even debilitating arthritis, if not managed or treated correctly.

What is the Cruciate Ligament, and why is it so important?

The knee joint (or stifle as it is known in animals) is principally a hinge joint between the femur (thigh bone) and the tibia (shin bone). The knee joint is held together by a number of strong ligaments, including the collaterals and the cruciates.

The medial and lateral collaterals prevent the knee from hinging from side to side, and the cruciate ligaments prevent the tibia sliding backward and forward with respect to the femur.

If the ligament is broken the tibia slides forward when the animal bears weight. This sliding movement causes pain and inflammation in the joint. The pain obviously will cause lameness and persistent inflammation can be associated with progression of arthritis in the joint, which can lead to permanent lameness.

Typical signs of lameness associated with Cruciate Injury

Lameness associated with cruciate injury can be sudden in onset (for instance if your dog tears the cruciate at exercise), but can also be slower in onset if gradual deterioration and breakdown of the ligament occurs.

In fact what commonly happens is a mixture of both of the above, whereby you observe a gradual onset low-grade lameness, followed by a sudden onset more severe lameness when the ligament breaks.

Typically during the early low-level lameness your dog will only be stiff when getting out of bed, or after lying down. Lameness eases up during exercise and very often lameness is forgotten altogether if the dog is distracted (i.e. chasing a squirrel). The stiffness after rest will often be worse following a period of increased exercise.

In long standing cases of cruciate injury you may notice loss of thigh muscle in the affected limb. Animals with cruciate injury will often “unweight” the injured leg, by standing with more weight on the good leg. You may notice the sore leg positioned slightly to the side of the body, with the paw not placed fully on the ground.

It is important to realise that these are typical signs associated with cruciate injury. Individual cases may present quite differently, and other causes of hind-limb lameness (i.e. hip injury or hip arthritis) can present in a very similar manner.

How do we treat Cruciate Injury?

How we choose to treat cruciate injury will depend on several factors including the degree of damage to the ligament, the size and weight of your dog, and the type of lifestyle/activity etc.

Low-grade Injury i.e. simple sprain

In the same way we might treat a sprained ankle in ourselves, simple ligament sprain can often be treated by a short period of rest and the use of anti inflammatories.

Rest can vary between total restriction of all activity (ie cage confinement and lead walking only in the garden for toilet purposes), or can simply mean moderation of exercise (i.e. “house arrest” and only 10-15 minutes lead walking per day).

If lameness resolves then gradual return to exercise is advised. Gradual build-up of exercise is extremely important. Too rapid a return to too much exercise can result in recurrence or even worsening of ligament injury.

Severe Injury/Complete Ligament Rupture

Treatment of more significant cruciate injury can be confusing. There is a large range of different surgical techniques, management options, and even more different opinions as to how these should be implemented.

The majority opinion divides the available options into three broad categories based on weight of the dog.

Rehabilitation following Cruciate Injury?

Rehabilitation following cruciate injury and/or following surgical repair involves a carefully controlled program of restricted activity followed by gradually increased exercise, physiotherapy, and can include other physiotherapy type activities including hydrotherapy.

Each animal is unique and, in practice, each animal requires a bespoke rehabilitation program. We give specific advice based on your dog’s requirements.

Fracture Repair

Road traffic accidents are the most common cause of bone fractures in veterinary practice. Fractures vary greatly in complexity from the relatively undisplaced simple “greenstick” fracture of a long bone in a young animal, to extremely complicated joint fractures in mature patients.

We carry a range of External Fixation, ASIF plates, Locking plates and other bespoke hardware to cater for all fractures, from the simple to the complex.

Spinal Surgery

We offer full neurological workup, including myelography, with a view to appropriate surgery (fenestration, hemilaminectomy, laminectomy) where indicated.

Please telephone to discuss a case.

Referring Vets

Referring a case

If you would like to refer a case please telephone 01628 622086.

Discussing a case

If you would like to discuss a case, either for free advice regarding a case you are managing, or with a view to referral please phone the above number.

Radiographic Reporting

Verbal reports on submitted radiographs are free of charge. As above this is often of value in deciding whether a case needs referral or not.