Swelling Following Elbow Surgery

[woody2shoes]

Hi everyone,

I've posted before about my nearly 8mo lab bitch who had bilateral elbow surgery 4 weeks ago for Elbow Dysplasia (FCP). She has been progressing well till now but after commencing 10 minute slow lead walks last week, I noticed what looked like a bit of swelling on the outside of her elbows just in front of the point of the elbow. This week she is up to 15 minutes slow lead walking and the swelling is definitely there now and no longer a possible figment of my imagination. A firm lump on each joint about the size of a 20 cent piece.

I rang her surgeon yesterday who suggested warm compresses 3-4 days/day to help the swelling, as well as slowing down the rate of exercise. He said this would resolve in time. He described it as joint effusion (swelling) due to a) the surgery b) the FCP and c) the increase in exercise. I was reluctant to hold him up for too long asking a heap of questions so am wondering if anyone out there has experienced this type of thing following joint surgery of any sort? Is this normal/typical? How long can it take to resolve? Is there something I'm doing that might be causing this eg. am I not restricting her enough?

My priority is to get her back to normal as quickly as possible that's all.

Cheers.

w2s

Edited April 4, 2008 by woody2shoes

[Miranda]

If there's swelling you're doing too much too soon, trying to get the dog back to normal as quickly as possible isn't a good idea after elbow or hip surgery and you may actually be impeding her recovery. I'd ease right back on the walking, it's better to take things slowly and recovery may take several months.

[woody2shoes]

If there's swelling you're doing too much too soon, trying to get the dog back to normal as quickly as possible isn't a good idea after elbow or hip surgery and you may actually be impeding her recovery. I'd ease right back on the walking, it's better to take things slowly and recovery may take several months.

Thanks for that.

As far as I can tell I've been doing everything strictly by the book but it would seem that even that's too much too soon for my girl. I'll just have to be patient and proceed even more slowly than planned.

Cheers.

w2s

[curlygirl]

Could you swim your girl for exercise as there would be no weight on her elbow. Perhaps swim her for 5 minutes instead of walking for 10 minutes. I would also alternate with hot and cold compresses.and even massage the leg and elbow to encourage good circulation. Good luck with your girl.

[woody2shoes]

Could you swim your girl for exercise as there would be no weight on her elbow. Perhaps swim her for 5 minutes instead of walking for 10 minutes. I would also alternate with hot and cold compresses.and even massage the leg and elbow to encourage good circulation. Good luck with your girl.

Hi curlygirl,

Thanks for those ideas.

I've been thinking along those 'swimming' lines myself. I plan to check with the surgeon tomorrow (Monday) and make sure swimming is OK since I'm not sure if I am meant to cut back on all exercise or if it's purely a weight-bearing issue in which case swimming could be the answer. I have a nice long dam at home which actually has water in it so I could certainly give her as much swimming as she's allowed. It means we have to cut through a fenceline but my OH tells me he is more than happy to do that - my pup doesn't realise just how lucky she is! lol

Cheers,

w2s

Edited April 6, 2008 by woody2shoes

[ILuvAmstaffs]

Yep, definately too much too soon. Diesel was on complete rest for 8 weeks, and that was with only one elbow having been operated on... and once we could start walking him, it was only to the corner & back (100metres or so each way) and as he got better rather than increase the duration, we increased the frequency to give him a rest in between, so a walk morning then one in the night etc. It was probably 6 months on before we would take him for around a 10-15minute walk. Swimming was recommended early on as the exercise of choice because it is low impact.

Also, something to look out for is that with FCP a fragment can cause a small fluidy lump to build around the shard. Not that it's likely this soon after surgery, but if the lump does not go down with rest I would be going back to see the ortho...

When if you follow-up check up due? Is she scheduled to have a course of pentisan shots from 8 weeks with follow up x-rays at 3 months?

[woody2shoes]

Yep, definately too much too soon. Diesel was on complete rest for 8 weeks, and that was with only one elbow having been operated on... and once we could start walking him, it was only to the corner & back (100metres or so each way) and as he got better rather than increase the duration, we increased the frequency to give him a rest in between, so a walk morning then one in the night etc. It was probably 6 months on before we would take him for around a 10-15minute walk. Swimming was recommended early on as the exercise of choice because it is low impact.

Also, something to look out for is that with FCP a fragment can cause a small fluidy lump to build around the shard. Not that it's likely this soon after surgery, but if the lump does not go down with rest I would be going back to see the ortho...

When if you follow-up check up due? Is she scheduled to have a course of pentisan shots from 8 weeks with follow up x-rays at 3 months?

Hi,

That's interesting to hear.

The rehab schedule I got from my surgeon is as follows (written handout from surgeon) -

Immediately following surgery, two weeks' house rest with only on lead toilet walks 3-4/day. Bandages removed at 7 days and a 4 week course of Pentosan commenced at the same time. Week three - commence SLOW lead held walks - 10 mins per day. Increase by 5 minutes/week for next 6 weeks so that by week 8, we should be doing 35 minutes SLOW lead walking a day. By week 7 'Resume Normal Activity' - by that I gather she could go back out to her pen, have quiet time off lead on her own in the yard etc.

I have been following this rehab regime to the letter.

Bear in mind that the surgical procedure was the most minimally invasive arthrotomy where the surgeon goes in, gets the fragments out and then he's out of there. Also, since there was no evidence of arthritic change on her x-rays and she only had kissing lesions ie. no OCD, persumably that also has some bearing?

There was no mention of follow-up x-rays or a visit. From everything the surgeon said, he has now done all that's possible. The rest is up to the individual dog and a careful rehab routine...not sure what else I can do but certainly swimming has been recommended by my regular vet so I plan to start off slowly with that tonight.

w2s

Edited April 8, 2008 by woody2shoes

[ILuvAmstaffs]

Wow, thats full on. Diesel has FCP & had the shard removed plus an ulna oestectomy. I think malleer was the same, so not really sure in that case.

Interesting that there would be no follow up x-rays... I would have thought that with FCP the main concern would be to make sure more pressure isn't being applied to the joint & another shard doesn't occur. Especially when the ulna was not shorten.

How is she doing now after a bit of rest?

[woody2shoes]

Wow, thats full on. Diesel has FCP & had the shard removed plus an ulna oestectomy. I think malleer was the same, so not really sure in that case.

Interesting that there would be no follow up x-rays... I would have thought that with FCP the main concern would be to make sure more pressure isn't being applied to the joint & another shard doesn't occur. Especially when the ulna was not shorten.

How is she doing now after a bit of rest?

Hi again,

I don't know anything at all about ulna osteotomy. I can only say that my girl had simple bilateral open arthrotomy. As I understand it, this involved opening the joints, removing the cartilage fragments and then abrading the opposing joint surfaces which had kissing lesions, in order to promote healthy cartilage growth...

I asked the surgeon if more fragments could occur in the future (thinking we might have to go through all this again! ) and he assured me that no, this was it. Apparently it's now a matter of allowing the surgery site to heal completely and slowly build up strength again. I also asked if there was any point in doing x-rays at some stage in the future (thinking that she might become arthritic early) and he said that would be of no real benefit and certainly not in the short term. If she does succumb to changes in the joint over time, we will be guided by her comfort level and treat her accordingly.

He wasn't able to give me any guarantees about whether she will recover completely in terms of soundness. He said that is very much an individual thing. But, at least the fragments are out and can't cause any more damage.

A friend of mine had her young male lab's elbows operated on for FCP, OCD and arthritic changes via keyhole surgery at 5mo. His elbows were a mess. It took a good 6 months of very slow rehab but he is now 4yo and going strong without a hint of lameness even after very strenuous work. Apparently the same dog had post-operative swelling in both elbow joints for months but this eventually resolved over time. I live in hope!

My girl is, I think, improving every day. The fluid build up has lessened and is softer I believe and she will start swimming tonight so that should also help. She is getting a slow 5 minute lead walk each day & I plan to build that up very gradually.

w2s

Edited April 8, 2008 by woody2shoes

[ILuvAmstaffs]

Good to hear that your girl is showing signs of improvement. :D

Diesel did have some swelling around the joint after his op as well & the leg still looks thicker around the scar. So hopefully that is all you are seeing.

This link explains a bit about the ulna oestectomy & why it is done. Diesel was only 8 months at diagnosis, so was a good candidate.

http://www.sancarlosvet.com/Other/Prof/PUO/PUO_Primary.html

[woody2shoes]

Good to hear that your girl is showing signs of improvement. ;)

Diesel did have some swelling around the joint after his op as well & the leg still looks thicker around the scar. So hopefully that is all you are seeing.

This link explains a bit about the ulna oestectomy & why it is done. Diesel was only 8 months at diagnosis, so was a good candidate.

http://www.sancarlosvet.com/Other/Prof/PUO/PUO_Primary.html

Hi again,

Thanks for that link - it's very interesting reading. I guess every case is different and has to be judged accordingly.

Can I ask you how long it took for Diesel to make a full recovery? Is FCP (or any type of Elbow Dysplasia) common in your breed? It's certainly far more common in labs than we'd like unfortunately. In spite of careful screening of breeding stock it still surfaces unexpectedly.

w2s

[ILuvAmstaffs]

Hey again.

Yes, every case is certainly different & must be treated as such.

For a "full" recovery from the op, I'd probably say it took around 6 months... and possibly up to 12 for things to settle 100%. I guess anyone thats had major ortho surgery (which it was in Diesel's case) would say not to expect much under 12 months. During that time we also tried just about every supplement on the market before settling on the Flexicose & Ester C.

As for ED being common in the breed. Yes, it is an issue, though some breeders seem surprised to hear that. HD is by far more common, but most breeders do test elbow & hips. According to the OFA stats amstaffs rank no 12. I guess the issue with any polygenic disease is that 2 dogs that score well could still throw pups with the problem, it just depends on the combination of dogs.... and what is in their lines.

[centitout]

Yep, definately too much too soon. Diesel was on complete rest for 8 weeks, and that was with only one elbow having been operated on... and once we could start walking him, it was only to the corner & back (100metres or so each way) and as he got better rather than increase the duration, we increased the frequency to give him a rest in between, so a walk morning then one in the night etc. It was probably 6 months on before we would take him for around a 10-15minute walk. Swimming was recommended early on as the exercise of choice because it is low impact.

Also, something to look out for is that with FCP a fragment can cause a small fluidy lump to build around the shard. Not that it's likely this soon after surgery, but if the lump does not go down with rest I would be going back to see the ortho...

When if you follow-up check up due? Is she scheduled to have a course of pentisan shots from 8 weeks with follow up x-rays at 3 months?

Hi,

That's interesting to hear.

The rehab schedule I got from my surgeon is as follows (written handout from surgeon) -

Immediately following surgery, two weeks' house rest with only on lead toilet walks 3-4/day. Bandages removed at 7 days and a 4 week course of Pentosan commenced at the same time. Week three - commence SLOW lead held walks - 10 mins per day. Increase by 5 minutes/week for next 6 weeks so that by week 8, we should be doing 35 minutes SLOW lead walking a day. By week 7 'Resume Normal Activity' - by that I gather she could go back out to her pen, have quiet time off lead on her own in the yard etc.

I have been following this rehab regime to the letter.

Bear in mind that the surgical procedure was the most minimally invasive arthrotomy where the surgeon goes in, gets the fragments out and then he's out of there. Also, since there was no evidence of arthritic change on her x-rays and she only had kissing lesions ie. no OCD, persumably that also has some bearing?

There was no mention of follow-up x-rays or a visit. From everything the surgeon said, he has now done all that's possible. The rest is up to the individual dog and a careful rehab routine...not sure what else I can do but certainly swimming has been recommended by my regular vet so I plan to start off slowly with that tonight.

w2s

one of my owners pups developed trauma related u.a.p and i have had him for the op and post op recovery.that is the same schedule i got as well,he has a bit of fluid swelling(minor) around the op sight and it is 3 weeks post op now.he was confined to a small shed for the first 2 weeks with toilet breaks and has been out this last week,but as yet no on lead walking.we got told he will excercise the joint himself as it recovers and he is learning to use the leg more normally now.

[kimjm]

HI

I would be careful how much swimming you do? If our experience swimming can sometimes make elbow soreness worse due to the drag through the water. I would suggest you start some physio and hydrotherapy in an underwater treadmill.

[woody2shoes]

Thanks everyone.

kimjm,

In an ideal world that would be a great idea! ;) I'm afraid I don't have any choice in the matter though living some 4 hours' drive from Melbourne.

My regular vet explained that in addition to providing a good source of non-weight bearing exercise, swimming makes the elbows flex in a way that creates enough pressure to force excess fluid out of the joint capsule. This in turn allows the body to reabsorb it more quickly.

I fully intend taking things nice and slowly - in fact, there's no reason I can't create my own hydrotherapy come to think of it. The local lake has a huge sandy beach where I can easily 'walk' her in chest deep (the dog's! ) water...that's not a bad idea. Looks like hubby's waders might come in handy after all! ;)

Hi again ILuvAmstaffs,

Wow, that's a long time for recovery. I give you full credit for being so patient. I guess when there's no other option, you do what you have to. When my dog curls up at my feet just to be near me, there's nothing I wouldn't do for her

Hi centitou,

That's great news about your pup! Sounds as though he is progressing well. I noticed that my girl was better from the day she had the surgery - not 100% but vastly more comfortable. Since then, there have been times when I would swear there's no lameness and other times when it's still there. I guess time will tell just how well she will be. It's definitely a game of patience.

w2s