08/05/2021
After lots of X-rays and a bill of £560 ..
Here are the conclusions from the Vet.
Sukie is in foster in North Yorkshire.
Dear Tracey,
I am sorry that I have not been able to catch you on the phone to discuss Sukie in detail. Her’s is a more complicated case, to which starting management sooner will help with the outcome. For that reason, I thought it best to write you.
I have not examined Sukie myself, so my advice is based upon the x-rays and clinical notes. From these, I am concerned about whether the previously discussed femoral head and neck excision would be the most appropriate option for Sukie.
Before I go into Sukie’s situation and my concerns, I think it best to go over what a femoral head and neck excision (FHNE) entails. A FHNE involves exposing the ball part of the hip ball and socket joint, and removing it entirely. This is performed in cases where the joint does not function correctly or pain is present. Once this is removed, the musculature of the hip becomes responsible for maintaining a functional joint. Due to this, it is found that good limb use is reduced in those animals weighing more than 10kg, and those with poor muscling at the time of the procedure. In the best of cases, physiotherapy is still required to encourage limb use and strengthen the muscle; but this can be difficult in those with poor muscle mass as they have a tendency to hold the limb up and not use it at all.
I understand that Sukie needs the surgery due to a previous accident, which caused injuries to her front and back legs. Currently there is no noted ongoing issues with her forelimbs, but animals often disguise lameness in a limb when another is more severely affected. A possible injury could be unmasked, or worsened, during the post-operative period. Even if there were no problems in the short term, having had the injury will increase the likelihood of Sukie having problems with arthritis at an earlier stage in those limbs. To help Sukie be as comfortable as possible, it would be better for her to have the most normal anatomy as can be achieved.
Sukie currently weighs just under 16kg, and I believe from the x-rays will have reduction in the muscle mass of her affected leg. As mentioned above, these factors will reduce the likelihood of a good outcome following a FHNE. Also, it is mentioned in the notes that there may be a proprioceptive deficit in her hindlimbs. Proprioception is the ability for an animal to feel the position of their limbs and rectify changes to it. We test this by knuckling the paws and watching to see how quickly the patient returns them to the normal position. On examination of Sukie this was reported to be delayed; which could mean there is an issue anywhere from the paw being able to feel the change, the limb being able to correct the abnormal position or a combination of the two. This may be due to the orthopaedic abnormalities we are already aware of with Sukie, but there could be an undiagnosed neurological issue related to her accident that unfortunately we would not be able to treat. If this were the case, surgery would not lead to Sukie improving.
Should a FHNE be unsuccessful, it is possible to amputate the limb. This unfortunately could also have complications in recovery and the long-term due to the above reasons. A FHNE would cost ~£2000 and an amputation ~£1200-1400, but we cannot guarantee how well Sukie would do following either surgery.
My recommendation to give Sukie the best chance of long-term function would be to refer her for a total hip replacement (THR). Such a procedure is superior to the FHNE, as it will replace the currently non-functional joint with one that Sukie can bear weight through. This will help share the load across all of her limbs and hopefully make long-term management easier. There are still risks involved with the procedure, and there would still be complications if Sukie did have a neurological issue with her hindlimbs.
I understand that as a charity it can be difficult making these decisions. You no doubt have many dogs that you wish to help. I believe that a FHNE or amputation would have a poor outcome for Sukie, and so it would be best to proceed with referral to a specialist for a THR should you wish to go ahead.
Although it is not a route any of us would wish to go down; should we believe Sukie’s quality of life is suffering, it is a reasonable option to put her to sleep for her own welfare.
If you have any questions, please contact the Cundall & Duffy surgery who are able to contact myself. If you would wish to gather more information on referral for a THR, Cundall & Duffy will be able to arrange this for you.
Yours sincerely,
Mark Waining BVSc PGCertSAS MRCVS
