Rehabilitation Following Joint Surgery in Sporting Dogs Geoffrey N. Clark,
DVM
Postoperative recovery from orthopedic surgery involving one of the joints is a concern for all dog owners, but it is particularly important in sporting dogs that are expected to return to work in the field. Rehabilitation will vary depending on the specific injury and the individual dog, but certain principles remain constant. Although the less invasive form of joint surgery, termed arthroscopy, is now available on a limited basis for dogs, most joint surgeries are still performed by making an incision into the joint to expose the problem area. As a result, proper postoperative care is critically important in order to prevent complications during recovery and to allow the best chance for a full return to function. Surgery involving the knee joint of the dog is the most frequently performed orthopedic procedure for veterinary surgeons. A torn knee ligament or loose kneecap are the two most common problems requiring knee surgery in sporting dogs. Surgeries involving the hip, shoulder and elbow joints are also fairly common in certain breeds of dogs. In young dogs, the joint surgery is usually performed to correct a developmental problem, such as osteochondrosis (OCD) in the shoulder, elbow, or ankle and fragmented coronoid process (FCP) in the elbow. Traumatic injuries can lead to a need for joint surgery in dogs of any age. Fractures, dislocations and torn ligaments are the most common traumatic injuries in active dogs that require surgical repair. Recovery from canine joint surgery, regardless of the cause, typically takes a minimum of 6 to 8 weeks and it may be significantly longer in some instances. The majority of the postoperative care for these dogs will be provided after leaving the veterinary hospital, so it is important for the dog owner or handler to have a thorough understanding of what to expect. Perhaps the most important aspect of home care is that even the smartest canine patient has no concept of what he has just been through and what a lengthy recovery lies ahead. The dog owner must adhere to the recommended rehabilitation program even when the dog doesn't want to! Home care usually starts with management of a bandage, splint, or cast. External support is used to immobilize the joint during the early critical phase of healing. It also provides an environmental barrier to contamination from dirt, urine, or feces. Bandages may also be used to prevent a dog from licking or chewing at the incision or the stitches. Certain joint surgeries are associated with significant swelling, so a bulky form of bandage may be used for several days to help control swelling before a splint or cast is applied. Regardless of the type of external support that is used, it must be kept clean and dry. This can be a considerable challenge with some canine patients and in some management situations. A plastic bag should be applied to the bottom of the bandage when the dog goes outside and this is then removed when the dog comes back in the house. In kennel situations, some special modifications may have to be made to ensure that the bandage does not get soiled or soaked. A wet bandage can be dangerous because it may lead to skin irritation, pressure sores, and increased risk of infection. Wet bandages or ones that have shifted position should be removed and replaced. The use of external support is discontinued in some cases when the postoperative swelling has resolved and in other cases when the risk of repeat injury is minimal. This may vary from several days to many weeks after surgery. Once the external support has been removed, it is time to start considering physical therapy of the affected joint. This may be initiated with the application of heat and massage of the tissues surrounding the joint, and should progress to range of motion exercises as soon as the dog will tolerate manipulation of the joint. Range of motion exercises should be performed at least once daily and may be done 3 or 4 times a day if the schedule permits. The amount of flexion and extension is increased gradually over time until the range of motion in the joint is similar to the normal joint on the opposite side. The veterinary surgeon or a veterinary technician can demonstrate these basic physical therapy exercises for the dog owner. In some veterinary hospitals, trained physical therapists are becoming involved in the postoperative care of dogs. They may be able to offer more advanced treatments for increasing strength and reversing muscle atrophy in the affected leg. Consult your veterinarian about the availability of postoperative physical therapy to assist your dog's recovery from surgery. A gradual return to activity is critical to prevent a repeat injury to the leg or a failure of the surgical repair. As a general rule, brief leash walks may be allowed at four weeks after surgery and the length of these walks is increased weekly over the next four weeks. This degree of activity may be permitted sooner in some less involved surgeries, such as removal of an ununited anconeal process in the elbow or a shoulder OCD, and it will be delayed after a major joint reconstruction. Controlled swimming is an ideal activity during this phase of recovery as it is a high motion, low impact exercise. This activity will be significantly limited by the weather in some parts of the country and by many dogs reluctance to get wet! A final physical exam at 8 to 10 weeks after surgery is usually advisable before allowing a dog to return to full activity. In some cases, x-rays may also be necessary to document complete healing. A return to training for a specific event can then be initiated, but it should also be resumed on a gradual basis.
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