Luxating Patella in Kais

edited February 2014 in Kai Ken (甲斐犬)
I just took my baby girl for her yearly shots and the vet did an overall health check. She informed me that Toshi had a Luxating Patella and that it normally occurs in smaller breeds. I was looking online and found that it's considered a genetic problem with Kais, but has anyone else had this problem as well? The vet said they can fix it by deepening the groove for the knee to fit in, but it's going to cost around $2000. This came as a shock to me because I though the breed's genetic issues were dandruff and glaucoma.
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  • When we took Yucca into the vet at 8 weeks, they said her patellas were very loose. Puppies in general have looser patellas but at 8 weeks hers should have been tighter. It took her til she was 4 months for both to fully tighten up. Im not sure the age of your girl or if this helps at all but maybe its an early indication for possible luxation in the future or maybe not. Might not lead to anything. Anyway keep us up to date on your situation.
  • She's 17 months old now. The vet said it was in stage one and showed me what to look for and how to pop it back into place if need be, but apparently the surgery will need to get done eventually and even then, she will probably have arthritis.
  • I think typical info online about purebred dogs cites lux patella, hip dysplasia as common hereditary conditions in a great number of breeds. @tjbart Tara's kai Koda has had knee surgery, but I'm trying hard to come up with any others...

    Sage has a shallow groove in his knee (bear in mind he is only half kai, though, so there's other genetics at play) and the vet could force the patella to the side easily when he was about a year old. He did slip it hard one day running with some other dogs at the park, and yelled and limped and I had to carry him off to the car, then vet then rest and NSAIDS to recover. It slipped but wasnt torn. We heard similar from our vet, to keep an eye on it, start saving for surgery, but he is now almost 8 years old and has never had another trouble from it since and no surgery. I agree with NavyDog- be aware, (as in, perhaps a career in frisbee stunts is out) but it may never be a problem for her doing typical dog activities if she keeps fit and exercises regularly.
  • The vet was able to slip it out at the office with what looked like relitive ease. Since then I've noticed it more often when she runs now. Sometimes she will favor her leg for five minutes then be fine after that. I'm afraid of the scenario that you experienced @wrylybrindle because I don't want her to injure herself because I chose not to go through with a surgery that could fix it. This is going to be her second surgery too since I got her. The poor girl has been through so much.
  • edited February 2014
    My old Shiba has stage 3 and we decided against surgery and gave her pt and rest. Start your pup on a good glucosamine supplement now it always helps with joints and make sure she gets her exercise but doesn't over do it. If you keep them at a good weight, and keep them active (so nothing atrophies) it may not get worse without acute injury.
  • edited February 2014
    Conker (Shiba Inu) has Luxating Patella. At first the only sign was an occasional popping in the joint and him holding it up for a few steps. Then it began to slip more frequently, and I would sometimes have to put the kneecap back in place (vet showed me how). Now though, it's permanently luxated. He can still use the leg but only does so about 1/2 - 3/4 of it's normal range, and hardly ever puts full weight on it. I suspect he also has some sort of ligament tear but my vet has not recommended surgery yet. We'll see what they say next month when he goes in for a rabies booster since the vet hasn't seen how bad it's gotten recently. He's still super active and loves to run, but is very hesitant to jump on things, especially from a smooth surface. He gets join supplements but they will not cure LP, only help fight against future arthritis and wearing of the cartilage.
    LP is a fairly common problem in Shibas, so it doesn't surprise me that it is present in the Kai as well. But don't take my story as a your Kai is DOOMED! sort of thing. Severe LP that requires surgery is actually not that common.
  • Just to be clear- the vet visit after Sage slipped his knee was how we found out about it. I had no idea before that.

    Did Toshi have another surgery?
  • She had an unrelated surgery. She had a torqued bowel and had to have emergency surgery on that.
  • oh no! poor pup! :(
  • Yeah I rushed her to the emergency vet because she had become lethargic and wouldn't eat. If I would have waiting until the morning, she wouldn't have made it. She doesn't do roll over anymore because of this lol. I'm still unsure on what to do though. Some places say this is genetic and some say it isn't. this will depend on if insurance will cover it or not and even then I can't believe she has a genetic illness at that.
  • edited February 2014
    It's important to understand that patella luxation (a loose knee) is *not* Luxating Patella. Luxating Patella is a loose knee combined with is irregularly formed groove on the knee.

    @NavyDog - Yucca is an Akashi pup. When we imported Akashi he had the same thing, but his knees tightened up as well. It seems has been passed to a few of his pups.

    We had this issue reported in Kibou's puppies too (but at a higher frequency than Akashi's puppies). This is why we didn't breed Kibou to Nori. But, in the Kibou puppies, they too tightened up by 4 months or so.

    As it stands, as far as we know, we've not produced any Kai with LP. However, we did import one Kai with LP, Chibi. She has been spayed and placed in a home.

    All this to say, LP appears to be an issue in all the Nihon Ken, but it ranges in frequency depending on the breed. IMHO the 10,000 foot view of the Kai breed shows a pretty limited occurrence of LP, especially when compared to the Shikoku or Shiba.

    This being an Akashi sired litter too, I might expect some loose knees in pups... but not LP. Tora, your Kai's dam, has a brother who has had some knee issues too.

    If you never noticed your Kai favoring a knee, or limping, or being reluctant to exercise, then I wouldn't do anything to fix the LP. It may not be severe enough to bother her.

    Vets make their money finding problems with their client's dogs. That's why they ALWAYS check knees during an exam - its an easy thing to check and the result of a diagnosis is a $2000 payday for them. I wouldn't go spending any money on the issue until your dogs is showing clear problems from her LP, which may never happen.
  • edited February 2014
    A human example of my logic - I have a injury in my hand that causes my pinky finger to "pop" out of place sometimes. It doesn't hurt, and only bothers me randomly and not very frequently. My doctor told me that it could be fixed with surgery, but if it doesn't bother me, don't bother fixing it. If it gets bad enough to where it is a common issue for me, then I'll have the surgery.

    Same logic applies with your Kai. If it's not bothering her, then don't spend the money to fix it.

    ETA - Our Shikoku, Ahi, has severe LP in each knee. She was reluctant to go on walks or do anything athletic by a year old due to the pain the LP causes. There was a clear and obvious change in her behavior which lead us to see a vet.

    In your case, you didn't even know about the issue till your vet pointed it out - in an exam, under specific circumstances, and with her deliberately trying to luxate your pup's knee. Who's to say that a situation will ever come up to cause her knee to luxate IRL.

    Anyway, that's my opinion. I wouldn't go running out to fix something that may not even be *that* broke.
  • @BradA1878: I completely understand, but after the vet pointed it out, I've noticed her favoring the knee after heavy playing which is what worries me. I'm still going to monitor her in the next few weeks, but how long should I wait before deciding on surgery or not? Even the thought of deepening the groove on the knee just makes me cringe.
  • If she doesn't yelp, then don't get the surgery?
  • LP surgery is rather invasive IMHO and the outcome is not 100% - you're lucky if your dog retains 75% of their mobility in the knee post surgery. It's not like HD where the dog comes out better than they were to begin with... LP is a "repair" not a replacement. Big difference.

    So, given my horrible experience with LP surgery and Ahi, where she has had 3 surgeries and still shows signs of pain and discomfort. I wouldn't do anything until she is clearly showing signs of pain - like doesn't want to go on a walk, is is crying from the pain. Then I'd fix it.

    Also, I'd look into alternatives. They have stem cell therapy for LP now. I'd go that route before I'd do a surgery.
  • That's not a bad idea with the stem cell therapy. I'll look into it.
  • Also thank you to everyone here helping me figure this thing out. Hopefully I'll get this resolved without having to have major surgery performed on her.
  • One of my huskies has been diagnosed with grade 2 LP 3yrs ago, and we had opted to not go with the surgery. His knee would rarely luxate, maybe 2-4 times a year (less now that he's on raw) and it had only affected him for a miute or two. Went to 3 vets (one being an orthopedic specialist) and the general consensus was to not do the surgery unless it gets to a point where it really affects his quality of living.

    Something you also have to consider is if deepening the groove will actually fix it, sometimes the cause for luxating is not due to a shallow groove. If she happens to have loose tendons or an odd shaped knee cap, deeper grooves won't fix it. There's also no guarantee that having the surgery will fix everything, there's a good chance of the dog still having limited mobility and (if that's the case) a higher risk of arthritis to make up for it.

    Something that I've found that really helped my joint issue pups is supplementing their diet. Glucosamine, either in pill or natural form, is a great joint lubricant and cushion builder, allowing for a more comfortable dog and reduced incidences of luxation. I have found that the natural form (cartilage, egg membrane, etc) has worked better for my pups than the pill form, ever since the switch to raw over a year ago Tikaani has only had one incident and he recovered a lot quicker than he used to.

    If you are really concerned, get a second opinion at another practice and see what they say. Sometimes, like others have said, a vet will push for a surgery since it's a big money maker so will try to make the owner feel that it's a life or death situation. Take your time researching and learning before really jumping into something potentially life changing.
  • What has me concerned is that your vet slipped the knee out and now she is favoring it. Her knees were checked before she left here by my vets and the joint was nice and tight. Also your vet never mentioned anything during her puppy boosters and you never noticed her favoring it before now.
  • @asokoloff put your pup on a glucosamine chondrotin supplement (pets mart has beef flavor) one in "stages" I give my Old dog level 3 or whatever is one from the top. Give your girl the first or second step. It makes a difference over time and my vet out here recommends it with any leg injury to reduce healing and keep things stretchy and lubed.

    Could it be your pup is favoring her leg cuz your vet torqued it and it hasn't settled down yet?
  • That's what I thought at first as well, but my girlfriend who's at home most of the time, swears that it's been happening. I never noticed it though before the vet. That's why it was brought up in the first place at the vet's office.
  • @cdenney: I'll go by there tomorrow. My girlfriend just got a job there, so we get discounts now (yay!)
  • What has me concerned is that your vet slipped the knee out and now she is favoring it. Her knees were checked before she left here by my vets and the joint was nice and tight. Also your vet never mentioned anything during her puppy boosters and you never noticed her favoring it before now.
    I was thinking the same thing as I read... I hope it doesn't turn out to be like my vet, who will be getting replaced soon. 8 days and counting.

  • Could it have developed as she grew though? I mean 15 months in between is a big difference I would think.
  • It to me seems unlikely (I'm not a vet or medically trained). I say this as with in the last year we went through this and had alot of questions. If this were genetic I think it would be there from the beginning, no? Plus at a year plus she should be finished getting taller just filling out now; so it's possible it developed but I'd imagine you would have seen evidence to a greater degree during her growth spurts (star in on the joints). If she has itn and its not your vet causing the problemn preventive care is best keep her active but not over active, keep her at a healthy weight, good diet and supplements.

    Even at stage three due to an acute injury we opted to not do surgery because during the LONG, full activity restricted healing time. if they have it in both knees while one is healing they could slip the other one or it will degrade the other one faster. Our dog was 13 at the time so she's not one for being a feisty ball of energy all day and she was doped up enough on the first 2 weeks to keep her mostly off of it. Now almost 6 months after she can put weight on it, though has a noticeable limp, can climb stairs, jump onto the couch (with enough momentum) and run.

    I second Brad that until this is actually affecting your pup I would wait on surgery.

    Again not a medical expert, just some of our decisions we made.
  • @BradA1878 that's good to know. I wasn't too concerned but since we are very active with our dogs & with us wanting to get into agility with Yucca, it's nice to hear LP isn't common with Kai.

    2 of our Cayennes brothers have had problems with LP. The first one got the surgery and has had to go back for 2 more since. Still he seems uncomfortable running. When the other brothers developed an issue, we opted out & he's been fine so I agree with brad as well. If its not inhibiting or bothering your Kai, it may not be worth a surgery.
  • I feel weird because I keep popping into threads with examples from not-NK breeds, but my Lapphund's mother sort of had a similar situation. She presented with a luxated patella once and the vet said it was rather loose--as a young adult dog, if I remember correctly. She favored it a bit after that day after running hard. She went on to have agility titles, never be lame on the leg again, and produce four puppies--none of whom had any knee issues. The vet mentioned that surgery was possible, if I recall correctly, but didn't recommend it and her owner didn't pursue the issue. She had it checked again later when she did her OFA hips/elbows x-rays I think and the knees looked fine.

    Sometimes, it's just incidental. Dogs can throw their knees out just like people can, and it wouldn't surprise me if the vet aggravated it by popping it out of place regardless of whether there is an underlying tendency to luxate. I'd take her to a different vet before making any drastic decisions like surgery to get another opinion on it, and if it's not bothering her much, I'd go the "supplements and watch it" route LONG before even considering surgery. Except for severe LP, I haven't heard of many people with dogs who are just active companions having issues with slightly loose knees affecting their dogs' comfort and activities too much. If you were planning on top-tier agility competition or something, it might be more concerning--but then, you'd probably have a different breed if that was what you were looking for in a dog :P

    I think that the occasional loose knee is something that exists in pretty much every breed, regardless of size, but like everybody else has said--it's usually not that much of a problem until it's a serious problem, and even then, what you do about it depends on the dog and the situation.
  • Could it have developed as she grew though? I mean 15 months in between is a big difference I would think.
    I think if knees have some problems they can get worse over time (like hips). I'm not a expert or anything but finnish kennel club chanced their strategy with their policies with mandatory knee exams (some breed have those in here and if the result is worse than the breed club has decided the puppies won't be registered).
    Now if the knee result is done before the dog is 3 years old it's valid only 2 years. (Minimum age is 12months). So there has to be some reason to chance that rule to be age related.
  • I picked up some glucosamine and started Toshi on it. Hopefully it will help. I'm going to start monitoring her weight too. She's not very overweight, but she is around 40lbs. Thank you everyone for suggestions and advice on this. I was worried I would have to spend so much money on another surgery for her.
  • I think the NK are prone to this (which doesn't mean at all they all have it, but that it can show up in the breeds). Certainly it is common enough in Shibas. I think Brad's point about the difference between a loose knee and actual luxating patella (which includes the malformed groove) is a very important one.

    I've had two Shibas with LP and did the surgery on one. One thing my vet told me recently is that what he's looking for in considering surgery is the tightness of cruciate ligament. What can happen in LP is it slips out and puts pressure on the CL, which can cause tears. Even that can sometimes be dealt with without surgery. But we looked at my 10 year old Shiba, who had loose knees at 8 weeks, (he is now 10 years old), and my vet said while it was clear the knee was starting to bother Toby more now, the CL was nice and tight, and he saw no reason to do surgery on a 10 year old dog who seems to have mild pain from the LP only.

    Toby had much more problems with his knee as a young pup, and often did the characteristic "donkey kick" to get his knee back in place up to about 1 year of age. Then it rarely bothered him. Now, as an older, obese Shiba, it's starting to act up again, but he does not need surgery.

    In comparison, my female (puppy mill) Shiba showed very loose knees, on both sides. In xrays, it was clear she had almost no groove on one side and a shallow one on the other, so she clearly had luxating patella. She tore her ACL, and at that point, we did the surgery, which including the ACL tear, was $2000 (my vet is not expensive, though). In her case, the ACL was completely torn in two! It was a very slow recovery, and she regained about 90 % range of motion (she couldn't sit after that). She was 6 when we did the surgery.

    So all this information to say that probably, right now, there is nothing to do. Loose knees can go on for a very long time and may never be a problem, or may be a problem only in old age. Even actual luxating patella, with the problem with the groove in the bone, may not need surgery for a long time if at all. However, if I knew a dog had LP, I probably would not do agility with it. My vet felt part of the damage to Bel's ACL was because she was so very active, and often jumping and leaping, and the quick turns particularly put stress on an ACL that might already be weakened by LP.

    so if I were you, I'd do nothing now, and then maybe have xrays done if you are still concerned to see if you do, indeed, have true LP. Then if you do, you can better assess the risk that agility might have on the dog.
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