Best Practices

Fracture Management in Dogs: When to Splint or Refer?

Best Practices

X min read

Owners

Learn when to splint and when to refer dog fractures. A practical guide for vets to make the right call in canine fracture management

Sustainable Vet Group

Updated on

August 13, 2026

This article is for informational purposes only and is not a substitute for professional veterinary advice. Every case is unique, so always consult your veterinarian for guidance specific to your pet.

This content is intended for veterinary professionals for educational purposes. It does not replace clinical judgment or tailored advice. Always rely on your training, expertise, and the specific context of your patients.

Fracture Management in Dogs: When to Splint or Refer?

A broken bone in a dog needs one of three things: rest and confinement, external coaptation (splint or cast), or surgical repair. The decision depends on the bone affected, the fracture pattern, the dog's size and age, and the available equipment.

Getting this decision right the first time matters. Fusion Veterinary Orthopedics: "Attempting to use a splint or cast for several weeks with the hope of the fracture healing and doing surgery later is not advised. Chronic non-healing fractures are far more difficult to realign, are more costly, and have a lower likelihood of healing."

Quick answer: External coaptation suits minimally displaced fractures below the elbow or stifle in large adult dogs. Comminuted, articular, open, and upper-limb fractures require surgery. Small and toy breed distal radius fractures almost always need surgical repair.

Key takeaways

Splints only work for fractures below the elbow or stifle: humeral and femoral fractures cannot be adequately immobilized externally
Comminuted and articular fractures always require surgery: they are too unstable for external coaptation to maintain alignment
Open fractures require emergency treatment within 8 hours: irrigation, debridement, and temporary stabilization precede definitive fixation
83% of distal radius/ulna fractures in small and toy breeds managed with external coaptation result in malalignment or nonunion
Growth plate fractures should be surgically repaired within 24 to 48 hours of injury to minimize long-term joint damage
Consult a board-certified surgeon for complex fractures including spinal, articular, and small-breed distal radial/ulnar

The three management options

1. Cage rest alone: reserved for very young dogs (puppies) with minimally displaced, inherently stable fractures for example, some rib fractures and stable pelvic fractures where the dog's own muscle mass provides sufficient immobilization.

2. External coaptation (splint or cast): for fractures below the elbow or stifle, minimally displaced, in stable large-breed adult dogs. Today's Veterinary Practice: "Ideal fractures for primary fixation using external coaptation include incomplete diaphyseal tibial fractures in young dogs, sometimes referred to as 'greenstick fractures.'"

3. Surgical repair: for the majority of fractures in adult dogs, all fractures in small and toy breeds, all comminuted and articular fractures, all open fractures, and all fractures above the elbow or stifle.

When external coaptation is appropriate

External coaptation requires that the joints above and below the fracture can both be immobilized. This is only achievable for fractures distal to (below) the elbow and stifle.

Clinical Brief: "External coaptation may be successful in fractures below the elbow or stifle, where the joints above and below the fracture can be fully immobilized."

Fractures that may be managed with splinting:

Greenstick (incomplete) tibial fractures in young large-breed dogs
Minimally displaced distal radius fractures in large-breed adult dogs
Some metacarpal and metatarsal fractures
Toe fractures

How splints are applied: Today's Veterinary Practice: "The splint should span the joint above and below the fracture, and be padded enough to prevent pressure sores and prevent movement of the limb." After placement, a radiograph confirms alignment.

Complications of splinting: ACVS: "Bandages and splints can cause very serious complications. They can be an effective treatment tool for fracture healing and pain control, but careful monitoring and appropriate follow-up must occur." Pressure sores, bandage slippage, and limb swelling are the most common complications; daily monitoring is essential.

When surgical repair is required

Fractures above the elbow or stifle

Animal Medical Center: "It is easy to temporarily immobilize bones below the elbow and knee, while the upper arm and thigh are more challenging to manage because the shoulder and hip are difficult to splint."

Today's Veterinary Practice: "Temporary stabilization of humeral and femoral fractures should not be attempted. In these cases, hospitalization with confinement to a crate along with analgesic relief is ideal while awaiting definitive fixation."

SustainableVet: "Trying to splint these upper limb fractures often leads to pain, delayed healing, and poor limb function. Immediate referral for surgical repair is recommended."

Comminuted fractures

A comminuted fracture means the bone is broken into multiple pieces. These are mechanically unstable fragments shift with any weight bearing. SustainableVet: "These are very unstable and cannot be held in place by a splint alone. The pieces move easily, and the risk of poor healing is high. In these cases, surgical fixation is needed to realign and stabilize the fragments."

Articular fractures (fractures entering a joint)

Any fracture that enters a joint surface requires anatomical reduction the fracture fragments must be restored to near-perfect anatomical position and rigid fixation to prevent joint surface step-off and subsequent arthritis. Fusion Veterinary Orthopedics: "Any growth plate fracture or joint fracture should be treated as quickly as possible within about 24 to 48 hours after injury."

Open (compound) fractures

Animal Medical Center: "Open fractures often require an initial surgery to clean the wound and bone within 8 hours of the injury." The management sequence is:

Immediate wound irrigation and debridement under anesthesia
Temporary stabilization (bandage)
Systemic antibiotics
Definitive fracture repair after soft tissue stabilization

Do not attempt definitive fixation of a contaminated open fracture at the initial presentation; this dramatically increases infection risk.

Small and toy breed radius and ulna fractures

Today's Veterinary Practice: "In small and toy breed dogs, 83% of distal radius and ulna fractures addressed with external coaptation alone result in malalignment or nonunion. Therefore, internal fixation is recommended for these fractures in small and toy breed dogs."

SustainableVet: "Toy breeds like Chihuahuas, Pomeranians, and Yorkies are at high risk of nonunion. Their small bones have less blood supply, which slows healing. Even simple fractures may not heal with splints alone."

Spinal fractures and luxations

Spinal fractures with cord involvement are neurosurgical emergencies requiring immediate specialist referral for stabilization and decompression. Clinical Brief: "For complex fractures including spinal, consider consultation with a boarded veterinary surgeon or referral to a specialty practice."

Surgical options for fracture repair

Vets4Pets provides a useful overview: "Two types of surgical fracture repair are normally used in pets. Internal fixation involves placing surgical screws, pins, or metal plates under the skin around the fracture site to stabilize the bone. External fixation involves attaching surgical scaffolding to the bone through small holes in the skin."

Specific implant systems used:

Intramedullary (IM) pins: inserted down the bone canal; suitable for some long-bone fractures
Bone plates and screws: the most common implant system; provides rigid fixation; locking plate systems are particularly stable
External skeletal fixators (ESF): transcutaneous pins connected by an external frame; useful for open fractures, infected fractures, and certain metaphyseal fractures
Interlocking nails: for femoral and tibial shaft fractures

Timing matters

Animal Medical Center: "You should treat a closed fracture within 2 to 4 days. Timely veterinary fracture repair can prevent complications like bone misalignment or long-term mobility issues."

Fusion Veterinary Orthopedics: "Chronic non-healing fractures are far more difficult to realign, are more costly, and have a lower likelihood of healing."

Delaying evaluation hoping the dog will be "better tomorrow" consistently leads to worse outcomes. Fractures should be radiographed and assessed by a veterinarian on the day they are suspected.

For recovery care after fracture surgery, see orthopedic surgery home care guide. For the referral decision framework across orthopedic conditions, see when to refer orthopedic cases. For the full specialist referral process, see what is veterinary referral surgery.

Frequently asked questions

My dog is walking on the leg a little. Does that mean it is not broken?

No. Weight bearing on a fractured limb is common many dogs do not display obvious non-weight-bearing lameness with incomplete or minimally displaced fractures. Any dog with pain, swelling, or abnormal limb conformation after trauma needs radiographs.

How do I transport a dog with a suspected broken leg to the vet?

Keep the dog calm and restrict movement. Do not splint at home; improper application can worsen the fracture. Carry small dogs; use a rigid surface for large dogs. Call ahead so the clinic can prepare.

Will my dog's fracture heal faster with rest than surgery?

For fractures that require surgery, no. Fusion Veterinary Orthopedics: "Surgery ensures optimal alignment and stabilization for less pain and faster healing." Splinting a fracture that needs surgery delays appropriate treatment and often results in malunion or nonunion.

What is a growth plate fracture and why is it urgent?

Growth plates are bone formation zones at long bone ends in immature dogs. Fractures disrupt blood supply to growth cells. Fusion Veterinary Orthopedics: "Growth plate fractures should be treated within 24 to 48 hours." Delay risks permanent deformity.

Can a dog live with an untreated fracture?

Some dogs survive without repair, particularly with stable pelvic fractures. However, untreated fractures often result in malunion, nonunion, chronic pain, and permanent functional loss. Any decision against surgery should be fully informed.

How often does a splint need to be checked when my dog is wearing one?

ACVS: splints require careful monitoring and appropriate follow-up. Checks every 3 to 5 days are standard initially. Watch for swelling above or below the splint, foul odor, cold or pale toes, or the dog chewing the bandage.

Resources

SustainableVet. Fracture Management in Dogs: When to Splint or Refer? sustainablevet.org
Today's Veterinary Practice. Definitive Treatment of Limb Fractures With Splints or Casts. todaysveterinarypractice.com
ACVS. Fractured Limbs. acvs.org
Clinical Brief. Fracture Management. cliniciansbrief.com
Fusion Veterinary Orthopedics. Minimally Invasive or Open Fracture Repair. fusionvetortho.com

Get a Free Poster

Enhance your workspace with a high-quality radiographs reference poster, designed for veterinary professionals. This free physical poster will be shipped directly to you—just fill out the form to request your copy.

Request

Table of contents

Heading 2

Heading 3

Things to know

When to Refer: Surgical vs. Non-Surgical Orthopedic Cases

When to Refer for Orthopedic Surgery: Identifying Surgical vs. Non-Surgical Cases

Orthopedic decisions in dogs come in two layers: is surgery needed, and if so, should it be performed by a general practitioner or a specialist? Getting both questions right is what gives a dog the best outcome.

This guide covers which orthopedic conditions typically require surgery, which are managed conservatively, and when specialist referral is the appropriate recommendation.

Quick answer: Most CCL ruptures, comminuted or articular fractures, severe hip dysplasia, and spinal cord compressions require referral to a board-certified orthopedic surgeon. Conservative management suits mild OA, early hip dysplasia, and stable incomplete fractures in large adult dogs.

Key takeaways

CCL rupture is the most common orthopedic referral reason: TPLO or TTA required for long-term stifle stability
Fractures require specialist referral when comminuted, articular, open, or involving toy breed radius and ulna
Conservative management works for mild presentations of hip dysplasia, elbow dysplasia, and osteoarthritis when functional impairment is limited
Cases not improving with conservative care after 4 to 6 weeks should trigger a referral conversation
Cost transparency matters: owners need to understand the financial impact of surgical vs. non-surgical paths
Teleconsultation with a specialist is available before formal referral when the diagnosis or management path is uncertain

The referral decision framework

Two separate questions must be answered:

1. Does this dog need surgery at all?Severity of pain, degree of functional impairment, rate of deterioration, the dog's age and size, and the owner's capacity for the post-operative recovery commitment all factor in.

2. If surgery is needed, who should perform it?Procedure complexity, required implants, access to specialized equipment, and the surgeon's case volume for this specific procedure determine whether a general practitioner or a DACVS specialist is the appropriate operator.

SustainableVet: "The cost implications of specialist surgery, the timeline for diagnostics, surgery, and recovery, and post-operative care responsibilities should all be discussed with owners before making a referral recommendation."

Conditions that typically require surgical referral

Cranial cruciate ligament (CCL) rupture

The most common reason dogs are referred to veterinary orthopedic surgeons. SustainableVet: "Cranial cruciate ligament (CCL) ruptures cause severe joint instability, leading to secondary osteoarthritis. Surgical stabilization, such as tibial plateau leveling osteotomy (TPLO) or tibial tuberosity advancement (TTA), is recommended for long-term function."

Veterinary Partner (VIN): "TPLO has emerged as the most reliable technique offered by veterinary orthopedic surgeons for the management of CCL disease in dogs."

TPLO and TTA require specialized equipment (radiolucent table, surgical templates, specific implant systems) and significant case volume to perform reliably. Coldwater Animal Hospital: "A torn CCL in dogs requires precise surgical technique, proper post-operative planning, and orthopedic follow-up. When you suspect your dog has a knee injury, you should request a referral to an orthopedic specialist as soon as possible."

SustainableVet: "TPLO for CCL rupture ranges from $3,000 to $6,000 and covers surgery, hospitalization, and post-op care."

Comminuted and articular fractures

SustainableVet (fracture management article): "Signs include joint involvement, multiple bone fractures, open wounds, unstable or comminuted breaks, or no healing progress after a few weeks. If proper imaging or surgical tools are not available, referral ensures better care."

Articular fractures (those entering a joint surface) require anatomical reduction and rigid fixation to prevent joint surface incongruity and secondary arthritis. These are specialist cases.

Open (compound) fractures require urgent management to reduce infection risk often an emergency referral.

Toy breed radius and ulna fractures

SustainableVet: "Toy breeds have a high risk of nonunion, especially in distal radius and ulna fractures. Their small bones have less blood supply, which slows healing. Even simple fractures may not heal with splints alone. Surgery is often recommended early to avoid long-term lameness or permanent damage."

Spinal cord compression

Intervertebral disc disease (IVDD) with neurological deficits paresis or paralysis is a neurosurgical emergency. Lumbosacral disease, spinal instability, and vertebral fractures with cord involvement require specialist management. VCA: "Spinal injuries and herniated discs are problems that are also commonly referred to board-certified surgeons."

Total hip replacement

Total hip replacement (THR) for severe hip dysplasia or femoral head necrosis. VCA: "THR procedures replacement of a dog's diseased hip joints with prosthetic ones cost between $5,000 and $7,000." The procedure requires specialized implant systems and is exclusively a specialist procedure.

Complex reconstructive surgery

Large skin defects, major wound reconstruction after trauma or tumor removal, and rotational flap procedures require specialist training and experience beyond general practice scope.

Conditions that may be managed conservatively

Mild to moderate hip dysplasia (young dogs)

Early-stage hip dysplasia in dogs under 18 months may respond to conservative management: weight control, controlled low-impact exercise, NSAIDs, joint supplements, and physical rehabilitation. Surgical intervention (triple pelvic osteotomy, total hip replacement) is considered when conservative management fails or for severe bilateral disease.

Elbow dysplasia (mild-to-moderate)

Mild elbow dysplasia with limited functional impairment can be managed with anti-inflammatory therapy, weight management, and rehabilitation. More severe presentations or those with fragmented coronoid process, osteochondrosis, or ununited anconeal process require arthroscopic or open surgery.

SustainableVet: "Referral to a veterinary orthopedic specialist is often the best step when elbow dysplasia becomes hard to manage or diagnose."

Incomplete or stable fractures in appropriate candidates

Greenstick fractures in large-breed adult dogs, some metaphyseal fractures in stable patients, and certain stable pelvic fractures may be managed with strict rest and splinting in appropriate candidates. The key qualifier: appropriate imaging must confirm stability, and the patient must be able to comply with strict rest.

Osteoarthritis (mild to moderate)

Early and moderate OA is managed medically: NSAIDs, weight management, physical rehabilitation, and joint-supportive nutrition. Surgery is considered when medical management fails to provide adequate pain control or when the underlying structural cause (CCL rupture, hip dysplasia) requires correction.

When conservative management should trigger referral

SustainableVet: "Cases not improving with conservative care: If your dog keeps limping, feels pain, or avoids movement after weeks of non-surgical treatments like rest, medication, and therapy, it might be time to refer to a specialist."

Specific triggers:

Lameness not improving after 4 to 6 weeks of appropriate conservative management
Progressive lameness despite treatment
Neurological signs developing or worsening
Severe lameness or joint deformity detected on examination
Diagnosis unclear and advanced imaging needed

Today's Veterinary Practice (post-TPLO evaluation guide): "Mild routine complications may be handled by the general practitioner; however, with regard to more severe complications, it is important to know when a patient should be referred back to the orthopedic surgeon."

Teleconsultation before formal referral

Today's Veterinary Practice: "A team approach between the referral surgeon and primary veterinarian is optimal in order to achieve success in managing patients after an orthopedic procedure."

Many orthopedic specialists offer teleconsultation for referring vets considering a referral: sharing radiographs and case details digitally to get specialist input before formally sending the owner. This is appropriate when:

The diagnosis is uncertain (is this a CCL rupture or not?)
The conservative vs. surgical decision is unclear
The referring vet wants specialist input on management before referral

SustainableVet: "Teleconsulting tools, including sending images digitally or having a quick virtual meeting, can facilitate veterinarian-to-specialist communication when distance or schedules are an issue."

For the post-surgical care once a referred dog returns from orthopedic surgery, see post-surgical complications in referred pets. For what to expect during recovery from a referred procedure, see orthopedic surgery home care guide. For a complete overview of the referral process, see what is veterinary referral surgery.

Frequently asked questions

My dog has a cruciate tear. Can my regular vet do the surgery?

Some GPs perform the lateral suture technique for small dogs. TPLO and TTA require specialized equipment and are performed by specialists. Ask your vet which technique they perform and their annual case volume.

How long can I wait before deciding on surgery for a CCL rupture?

Delay without stabilization allows progressive joint damage and meniscal injury. Most orthopedic surgeons recommend surgical evaluation within 2 to 4 weeks of diagnosis. Very prolonged delay (months) makes surgery more complex and recovery longer.

Is conservative management ever appropriate for CCL rupture?

In dogs under 10 kg, strict rest and rehabilitation has a reasonable success rate. In medium and large dogs, non-surgical management typically causes chronic instability and progressive osteoarthritis. Most specialists recommend surgery for medium and large breeds.

What does a specialist referral for orthopedic surgery actually involve?

The specialist performs a consultation examination, reviews imaging, discusses surgical options and recovery expectations, provides a written estimate, and schedules surgery. Your general vet receives a discharge summary and manages follow-up. See the full referral process guide for details.

My dog has both hips affected. Should both be done at the same time?

Generally no. Bilateral procedures are staged to allow one limb to recover before operating on the other. The interval is typically 8 to 12 weeks. Discuss staging with the specialist at the consultation.

How do I prepare my dog for an orthopedic specialist consultation?

Bring all prior radiographs, recent bloodwork, the full medication list, and records from prior treatments. A written summary of when lameness began and how it has progressed helps the specialist assess the timeline efficiently.

Resources

SustainableVet. When to Refer: Surgical vs. Non-Surgical Orthopedic Cases. sustainablevet.org
Today's Veterinary Practice. Evaluation After TPLO: A Guide for the General Practitioner. todaysveterinarypractice.com
Veterinary Partner (VIN). TPLO (Tibial Plateau Leveling Osteotomy) Surgery. veterinarypartner.vin.com
VCA Hospitals. Surgery. vcahospitals.com

X min read

Arthroscopy in Veterinary Orthopedics: Indications and Benefits

What Is Arthroscopy in Veterinary Orthopedics?

Arthroscopy is a minimally invasive surgical technique used to look inside your pet’s joints. It involves making small incisions to insert a tiny camera (arthroscope) and special instruments. The camera sends real-time images to a screen, allowing the surgeon to see and treat joint problems without fully opening the joint.

Unlike traditional open joint surgery, arthroscopy causes less tissue damage, smaller scars, and quicker healing. It’s especially useful for diagnosing and treating conditions like ligament damage, joint inflammation, or loose cartilage. Because it offers better visibility with less pain and swelling, more vets are using it in modern orthopedic care.

Arthroscopy is commonly performed on the shoulder, elbow, stifle (knee), and hip joints. It allows precise treatment with fewer complications, making it a preferred option for both diagnosis and surgery in many orthopedic cases.

Diagnostic Benefits of Arthroscopy

Arthroscopy gives veterinarians a clear, direct view inside the joint, which is not possible with radiographs or even CT scans. This technique helps detect issues that might be missed with imaging alone, especially soft tissue problems. Because the camera goes directly into the joint, the surgeon can see the cartilage, ligaments, and joint surfaces in real time.

Here are some key diagnostic benefits of arthroscopy:

Direct visualization of joint interiors helps identify problems right at the source.
Cartilage damage, such as softening, thinning, or flaking, is seen clearly.
Ligament injuries, including partial or early tears, are more accurately diagnosed.
Subtle abnormalities, like joint inflammation or loose fragments, are easier to detect.
Better than radiographs or CT scans for spotting soft tissue problems like meniscal tears.
Synovial fluid or tissue samples can be collected during the procedure for lab testing.

Overall, arthroscopy improves the accuracy of diagnosis, allows early treatment planning, and reduces the need for exploratory surgery. It helps vets make more informed decisions and improves outcomes for dogs with joint issues.

Indications: When Is Arthroscopy Used in Veterinary Orthopedics?

Arthroscopy is commonly used in veterinary orthopedics to diagnose and treat joint problems with less pain and faster recovery. It is especially helpful in joints where precision matters and where early treatment improves long-term outcomes.

1. Elbow Joint Conditions

The elbow is one of the most common joints treated with arthroscopy in dogs, especially large breeds. Common conditions include:

Fragmented Medial Coronoid Process (FMCP): Arthroscopy allows removal of small bone fragments and smoothing of rough surfaces.
Osteochondritis Dissecans (OCD): Loose cartilage is removed with minimal joint trauma.
Ununited Anconeal Process (UAP): Surgeons can evaluate the extent of separation and remove or reattach the piece.
Elbow incongruity: Arthroscopy helps detect joint mismatch early, guiding further surgical decisions.

This joint benefits from arthroscopy because of its complexity and the difficulty of seeing problems on X-rays.

2. Shoulder Joint Conditions

Shoulder arthroscopy is often used to diagnose and treat soft tissue injuries that cause lameness. Key conditions include:

OCD of the shoulder: Cartilage flaps are easily identified and removed with minimal damage.
Biceps tendon pathology: Allows inspection and treatment of tendon inflammation or rupture.
Medial shoulder instability: Helps confirm ligament stretching or damage and guide surgical repair.

Because shoulder injuries can be hard to detect with imaging, arthroscopy is a valuable diagnostic and treatment tool in active dogs.

3. Stifle (Knee) Joint Conditions

Arthroscopy is useful in diagnosing and treating stifle joint problems, especially when combined with surgical repair. Common indications:

Cranial cruciate ligament rupture: Arthroscopy can confirm partial or complete tears and assess secondary damage.
Meniscal tears: Allows clear visualization and precise removal of torn cartilage.
OCD of the femoral condyle: Helps detect and treat cartilage defects in the knee joint.

In many cases, arthroscopy is done before or during surgery like TPLO to evaluate joint health and improve surgical outcomes.

4. Other Joints (Selective Use)

Though less common, arthroscopy can be used in other joints when imaging is unclear or precision is needed:

Hip joint: Occasionally used to examine cartilage damage or joint laxity in young dogs.
Tarsus (hock): Useful in complex cases with suspected OCD or instability.
Carpus (wrist): Allows diagnosis of ligament injuries or chronic inflammation in small breeds.

These joints are smaller and harder to access, so arthroscopy is used selectively by experienced surgeons.

Therapeutic Uses of Arthroscopy

Arthroscopy is not only helpful for diagnosing joint problems but also plays an important role in treatment. Because it uses small incisions and specialized instruments, it causes less damage than traditional surgery and speeds up recovery.

Here are key therapeutic uses of arthroscopy in veterinary orthopedics:

Removal of loose bone or cartilage fragments: Fragments from injuries or conditions like OCD can cause pain and joint damage. Arthroscopy allows precise removal without opening the whole joint.
Debridement of damaged cartilage: Worn or injured cartilage can be trimmed or smoothed to reduce pain and slow joint degeneration.
Lavage in septic joints: In infected joints, arthroscopy allows joint flushing (lavage) to remove pus, bacteria, and debris, helping the joint heal faster.
Treatment of partial ligament tears: Minor tears, such as early cruciate ligament damage, can be cleaned and evaluated to guide future treatment.
Joint flushing to reduce inflammation: In dogs with chronic joint inflammation or immune-mediated arthritis, flushing out the joint helps decrease swelling and improve comfort.

Arthroscopy offers a way to treat problems directly with minimal trauma, which leads to faster healing, less scarring, and better long-term joint function.

Benefits of Arthroscopy Compared to Traditional Surgery

Arthroscopy has become a preferred choice in veterinary orthopedics because it offers many benefits over traditional open joint surgery. By using small incisions and a camera, it reduces trauma and improves healing outcomes.

Key benefits include:

Smaller incisions = reduced soft tissue trauma: The small entry points cause less damage to muscles and skin, which helps with faster healing and less scarring.
Faster post-op recovery time: Dogs often return to gentle activity sooner than with traditional surgery. This can shorten the overall rehab period.
Lower pain levels for the patient: Less tissue damage means less pain after surgery. Many dogs show improved comfort within a few days.
Reduced risk of infection: Smaller wounds and shorter procedure times lower the chance of bacteria entering the joint.
Shorter anesthesia and hospital stay durations: Arthroscopy usually takes less time, which means reduced anesthesia risk and shorter clinic stays.
Improved precision due to magnified view: The camera gives a clear, enlarged view of the joint, helping the surgeon see tiny structures and treat the exact problem.

Overall, arthroscopy allows better care with fewer risks and a smoother recovery, making it a valuable tool in modern veterinary surgery.

Limitations and Considerations

While arthroscopy offers many benefits, it’s not the right choice for every case. There are certain limitations and factors to consider before choosing this technique for your dog.

Here are key points to keep in mind:

Not suitable for very small joints or advanced joint disease: In very small dogs or cats, the joint space may be too tight for the instruments. Arthroscopy is also less effective when the joint has severe arthritis or bone deformity.
Requires advanced training and specialized equipment: Not all veterinary clinics offer arthroscopy. It needs a skilled surgeon with special tools and experience, which may limit availability.
In rare cases, may need to convert to open surgery: If the problem is too complex or the joint is hard to access, the surgeon may switch to a traditional open approach during the procedure.
Cost considerations depending on setup and expertise: Arthroscopy can be more expensive than standard surgery due to the high cost of equipment and the advanced training required.

Despite these limitations, arthroscopy remains a valuable option for many joint conditions. Your veterinarian will help you decide if it’s the right choice based on your pet’s size, diagnosis, and overall health.

Prognosis and Expected Outcomes

Arthroscopy has a high success rate when used in the right cases and performed by an experienced surgeon. Most dogs recover well and show noticeable improvement in comfort and mobility.

Here’s what you can expect from arthroscopy:

High success rate in properly selected cases: When done for the right joint condition—such as early ligament injury, cartilage damage, or OCD—arthroscopy provides excellent results with fewer complications.
Faster return to function and normal activity: Because the procedure is minimally invasive, dogs often regain mobility sooner than with traditional surgery. Most pets can begin light activity within a few weeks.
Early intervention improves long-term joint health: Treating joint problems early, before there is severe damage, helps protect the joint. This can delay or prevent long-term issues like chronic pain or joint deformity.
May reduce progression to osteoarthritis if done early: By removing damaged tissue and flushing the joint early, arthroscopy can slow down the development of arthritis, especially in young or active dogs.

Overall, arthroscopy offers a strong long-term outcome with less pain, quicker healing, and better joint function—especially when performed before the disease becomes advanced. Regular follow-up and proper rehab are key to success.

Final Thoughts

Arthroscopy is a modern, minimally invasive technique that offers both diagnostic and therapeutic benefits in veterinary orthopedics. It allows for precise treatment of joint conditions like OCD, ligament injuries, and cartilage damage with smaller incisions, less pain, and faster recovery compared to traditional surgery.

It’s especially helpful for early-stage joint problems, where quick action can protect the joint and reduce long-term damage. However, not every case is a match for arthroscopy. Factors like joint size, disease severity, and available expertise must be considered.

Early diagnosis plays a major role in successful outcomes. If your dog shows signs of joint pain, lameness, or reduced activity, don’t wait. A timely exam can make all the difference. Always consult a board-certified veterinary surgeon to determine if arthroscopy is the right choice for your dog’s condition and recovery.

FAQs About Arthroscopy in Veterinary Orthopedics

Is arthroscopy painful for dogs or cats?

Arthroscopy is less painful than traditional open joint surgery because it uses small incisions and causes less tissue damage. Most pets experience mild discomfort, which is managed with pain medication. Many animals begin walking comfortably within a few days and show steady improvement as healing progresses.

How long does recovery take after arthroscopy?

Recovery time after arthroscopy is usually shorter than open surgery. Most pets start gentle activity within 2 to 3 weeks. Full recovery takes about 6 to 8 weeks, depending on the joint treated and overall health. A structured rehab plan, including rest and controlled exercise, helps ensure the best outcome.

How much does veterinary arthroscopy cost?

The cost of arthroscopy can range from $2,000 to $4,000 or more, depending on the joint treated, clinic location, surgeon experience, and whether therapeutic procedures are done. Additional fees for diagnostics, anesthesia, and follow-up care may apply. Always ask for a full estimate before scheduling the procedure.

Can small breed dogs undergo arthroscopy?

Yes, small breed dogs can have arthroscopy, especially for shoulder, elbow, or stifle issues. However, very tiny joints may be too small for the instruments. A skilled veterinary surgeon will evaluate your dog’s size and joint structure to decide if arthroscopy is a safe and effective option.

Is arthroscopy better than MRI or CT for joint problems?

Arthroscopy gives a real-time, direct view of the inside of the joint, making it better for diagnosing cartilage, ligament, or meniscus problems. MRI and CT scans are useful for imaging bones and deeper structures, but they can miss soft tissue issues that arthroscopy can clearly reveal and treat at the same time.

‍

X min read

Post-Surgical Follow-Up Guide for Referring Vets

Post-Surgical Follow-Up: What Referring Veterinarians Need to Know

The surgeon closes the incision and hands the patient back. From that point, the referring vet carries the case.

Post-surgical care is not passive.

It requires active communication with the surgical team, structured recheck examinations, prompt complication recognition, and consistent owner support throughout a recovery that may last months.

Quick answer: Post-surgical follow-up for referred orthopedic patients includes reading the discharge summary before the first recheck, establishing a recheck schedule (suture removal at day 10 to 14, radiographs at week 6 to 8), recognizing complications early, and reinforcing owner compliance at every visit.

Key takeaways

Read the discharge summary before the first recheck: skimming leads to medication errors, missed complications, and inconsistent owner instructions
Standard orthopedic recheck schedule: suture removal at day 10 to 14; radiographs at week 6 to 8; final check at week 12 to 16
Contact the surgical team for: implant complications, deep infection not resolving in 72 hours, wound dehiscence, or worsening lameness
Owner compliance is the most modifiable variable: reinforce activity restrictions, E-collar use, and complication signs at every contact
Refer back for: deep infection, implant-related concerns, wound dehiscence, or persistent non-weight-bearing beyond expected timepoints
Document each visit clearly: both the referring vet and the surgical team need an accurate record to track patient progress

Reading the discharge summary

The role of a referring veterinarian does not end when the surgery is done. After the specialist performs the procedure, the referring veterinarian often monitors the patient's healing, manages medications, and supports the client with follow-up care. Without clear updates and guidance, this handoff can lead to confusion, missed issues, or delayed treatment.

The discharge summary is the primary communication from the surgical team.

It contains the diagnosis, the specific procedure performed, implant details, the prescribed medication list, the recheck schedule, and the complications to monitor.

Even when the specialist provides detailed discharge instructions, referring veterinarians often need to reinforce or adjust them during follow-up visits. Clients may forget or misunderstand what they were told at the surgical centre, especially if they were stressed or overwhelmed on discharge day.

What to extract from every discharge summary:

Full medication list (drug, dose, frequency, duration)
Recheck schedule and what assessment is required at each visit
Specific complications the surgeon flagged for this case
Activity restriction level and when it can be modified
Criteria for contacting the surgical team directly

If anything is unclear, contact the specialist before the first recheck not after.

Recheck schedule

Soft tissue cases

Day 10 to 14: incision assessment, suture removal, medication review
Further rechecks: based on clinical signs and case complexity

Orthopedic cases

Day 10 to 14: incision assessment, suture removal, gait assessment
Week 6 to 8: radiographs to confirm bone healing and implant position
Week 12 to 16: final assessment in complex cases; progressive activity increase if healing confirmed

If pain medications are still needed after a few weeks, it is best to follow up with your referring veterinarian.

Consistent scheduling helps track progress and catch complications early. Document each visit so both you and the specialist can follow the case.

What to assess at each recheck

At every visit:

Incision appearance: closure status, discharge type and volume, redness, swelling
Weight-bearing status on the affected limb
Pain assessment using a standardized scale
Muscle mass: compare bilaterally
E-collar compliance
Medication compliance and any adverse effects reported by the owner

At orthopedic rechecks:

Joint stability (where applicable)
Range of motion of the operated joint
Radiographs at intervals specified in the discharge summary

Recognizing and triaging complications

Surgical site infection (SSI)

Signs: redness extending beyond the incision margins after day 3, purulent discharge, local heat, wound odor, systemic signs (fever, lethargy).

Management: culture and sensitivity before starting antibiotics. Surface infections can be managed locally. Deep infections, infections near implants, and infections not improving in 48 to 72 hours require surgical team contact.

Seroma

Soft, fluctuant non-painful swelling beneath the incision. Common after soft tissue and orthopedic surgery. Small seromas often resolve with strict rest. Larger seromas may need drainage under guidance from the surgical team.

Wound dehiscence

Partial or complete opening of the incision. Requires same-day assessment. Full dehiscence with tissue exposure is an emergency. Contact the surgical team before attempting local re-closure of complex wounds.

Persistent or worsening lameness

In orthopedic cases, persistent non-weight-bearing or worsening lameness beyond the expected timeline warrants radiographs and surgical team contact. Implant loosening, infection, or fracture propagation must be ruled out before managing locally.

Communicating with the surgical team

Smooth communication between the surgical team and the referring vet is crucial.

Contact the surgical team for:

Any implant-related concern identified on radiograph
Deep SSI not resolving with antibiotics in 48 to 72 hours
Wound dehiscence of a complex closure
Lameness or pain worsening rather than improving at expected timepoints
Uncertainty about whether a finding requires re-referral

The GP's office should contact the orthopedic surgeon to get the discharge instructions, which include pin care and a schedule for pin removal. Call the specialty hospital on the day of surgery to get a briefing on the outcome and expected aftercare.

A proactive call immediately after surgery, confirming surgical findings and aftercare requirements, prevents the most common breakdown: managing a complication beyond scope while the problem worsens.

Supporting owners through recovery

Focus on key points like medication schedules, activity restrictions, wound care, and signs that need urgent attention. Avoid medical jargon clients appreciate straightforward, step-by-step guidance. You can provide these as printed handouts or digital summaries sent by email or text.

Follow-up communication needs to happen the day after the patient is discharged. Make sure you have updated contact information and the desired contact method. Encourage clients to call if they have any concerns once the pet is home.

Owner compliance particularly with activity restriction and E-collar use is the most controllable variable in post-surgical outcome. Non-compliance is the most common cause of wound complications and implant failure.

Reinforce it at every visit, not just at the first one.

For the complications guide covering specific scenarios and when to re-refer, see post-op home care for pets after orthopedic surgery.

For the communication framework between GP and specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

Frequently asked questions

When should I contact the surgical team vs. manage locally?

Manage locally: minor incision redness not progressing, small seromas under active rest restrictions, mild expected lameness on the expected timeline.

Contact the surgical team: any implant concern, deep infection, wound dehiscence of a complex closure, worsening rather than improving lameness, or any complication you are unsure how to manage.

What imaging is needed at the 6-week orthopedic recheck?

Radiographs of the operated region in the same views as the post-operative images from the discharge summary. Compare implant position, bone healing, and periimplant margins.

If the surgeon provided post-operative radiographs in the discharge summary, use these as the baseline for comparison.

My client says the dog is doing great but the incision looks concerning. Who is right?

Trust the physical examination over owner assessment. Owners naturally minimise signs when they want their pet to be well.

Document your findings, photograph the incision, and manage based on clinical evidence rather than owner report.

How do I handle the case if I cannot reach the surgical team?

Document the attempt and the clinical finding. For non-emergency complications, continue conservative local management while attempting to reach the team.

For emergencies (wound dehiscence with tissue exposure, signs of systemic sepsis), act appropriately and continue attempting specialist contact. Never delay emergency care while awaiting specialist guidance.

How long does the referring vet typically follow the case?

For straightforward soft tissue cases, typically until the 10 to 14 day recheck and discharge.

For orthopedic cases, the referring vet typically follows the patient through the 6 to 8 week radiographic recheck and the 12 to 16 week final assessment.

This represents a total follow-up period of 3 to 4 months.

Resources

SustainableVet. Post-Surgical Follow-Up Guide for Referring Vets. sustainablevet.org
Advanced Veterinary Care. Orthopedic Surgery Post-Operative Instructions. advancedvetcarenm.com
Today's Veterinary Business. From Preop Through Postop. todaysveterinarybusiness.com
ACVS. Postoperative Care After Surgery: What Animal Owners Should Expect. acvs.org

X min read

Minimally Invasive Orthopedic Surgery: What GPs Should Know

Minimally Invasive Orthopedic Surgery: What General Practitioners Should Know

Minimally invasive surgery (MIS) has become a significant part of veterinary orthopedics over the past two decades. Where open surgery once required large incisions and extensive tissue dissection, MIS techniques use small portals and imaging guidance to achieve the same therapeutic goals with substantially less tissue trauma.

Understanding MIS helps general practitioners recognize which patients may benefit from it, counsel owners accurately about recovery expectations, and make timely referrals to surgeons who offer it.

Quick answer: Veterinary MIS uses arthroscopy or fluoroscopy through small incisions rather than open dissection. Arthroscopy recovery takes 2 to 4 weeks vs 6 to 12 weeks for open surgery. MIS requires specialist equipment not widely available.

Key takeaways

MIS uses small incisions and camera-based imaging instead of large open dissections, reducing tissue trauma
Arthroscopy is the most common veterinary MIS, used for joint diagnosis and treatment including OCD, meniscal tears, and CCL
Recovery from arthroscopy is typically 2 to 4 weeks versus 6 to 12 weeks for open joint surgery
MIS is not available at most general practices: it requires specialized equipment and significant training
Early referral for MIS-amenable conditions improves outcomes: arthroscopy for OCD or early joint disease before secondary arthritis develops
Open surgery remains better for conditions requiring soft tissue reconstruction, infected fields, or complex anatomical access

What is minimally invasive surgery?

SustainableVet: "Minimally Invasive Surgery (MIS) in orthopedics involves performing procedures through small incisions using specialized tools and imaging guidance. The goal is to treat bone, joint, or soft tissue conditions while reducing tissue disruption, pain, and recovery time. Unlike traditional open surgery, MIS avoids large cuts and deep dissection. Instead, surgeons use instruments like arthroscopes or fluoroscopy to see inside the body and make precise movements."

The key tools:

Arthroscope: a thin rigid telescope with a light source and camera, inserted into a joint through a small portal (typically 3 to 5 mm)
Fluoroscope: real-time X-ray imaging used to guide implant placement in fracture repair without large incisions
Laparoscope: used for abdominal MIS (laparoscopic spay, liver biopsy, adrenalectomy)
Thoracoscope: used for chest cavity access

Arthroscopy: the most common veterinary MIS

CARE Vets: "Joints commonly scoped in canines include the shoulder, elbow, hip, stifle, and tarsus."

Arthroscopy serves both diagnostic and therapeutic functions:

Diagnostic arthroscopy

Allows direct visualization of joint surfaces, synovium, cartilage, and intra-articular structures in real-time, magnified detail. SustainableVet (arthroscopy article): "Arthroscopy provides magnified, real-time views inside the joint."

This is particularly valuable for:

Confirming partial or complete CCL tears
Assessing meniscal injury concurrent with CCL rupture
Evaluating joint surface damage in elbow dysplasia
Staging OCD lesions before deciding on open vs. arthroscopic treatment

Therapeutic arthroscopy

SustainableVet (arthroscopy indications article): "It allows for precise treatment of joint conditions like OCD, ligament injuries, and cartilage damage with smaller incisions, less pain, and faster recovery compared to traditional surgery."

Common therapeutic arthroscopic procedures:

OCD (osteochondrosis dissecans) treatment: removal of the OCD flap and curettage of the subchondral bone bed
Meniscal tear management: partial meniscectomy under direct vision
Elbow fragmented coronoid process (FCP) removal
Ununited anconeal process (UAP) removal or fixation
Joint lavage and debridement: for early septic arthritis or inflammatory joint disease
CCL assessment: most surgeons perform arthroscopy concurrent with TPLO to assess meniscal integrity and perform meniscectomy if needed

MIS fracture repair

Beyond arthroscopy, MIS principles are applied to fracture repair using fluoroscopic guidance. This allows implant placement (IM nails, bone plates) through small stab incisions rather than large open approaches.

SustainableVet (MIS for GPs article): "MIS is used for procedures like fracture repair, arthroscopy, joint stabilization, and implant placement. This results in less trauma to muscles, less bleeding, and fewer complications."

Minimally invasive plate osteosynthesis (MIPO) uses fluoroscopy to slide a bone plate under the skin through small incisions at each end of the fracture, without exposing the fracture site itself. This preserves the fracture hematoma (which promotes healing), reduces blood loss, and decreases infection risk.

Laparoscopy in soft tissue and oncology cases

While not strictly orthopedic, laparoscopy is increasingly used for procedures previously done open:

Laparoscopic ovariectomy (spay): CARE Vets: "Laparoscopy is a minimally invasive technique performed in organs located in the abdomen and pelvis." Dogs undergoing laparoscopic spay return to activity significantly faster than with open spay.
Liver, spleen, and kidney biopsy: organ sampling without large incisions
Adrenalectomy: NCBi (MIS in oncology): "Laparoscopic adrenalectomy is a common procedure in both human and veterinary medicine for non-invasive adrenal tumors."
Laparoscopic splenectomy: NCBi: "Proposed benefits include decreased pain and decreased rate of infection" compared to open splenectomy.

Benefits vs. limitations of MIS

Benefits

Maine Veterinary Medical Center: "Reduced trauma and pain: MIS involves smaller incisions, resulting in less tissue damage and reduced postoperative pain. This decreased trauma leads to faster recovery times and shorter hospital stays."

SustainableVet (arthroscopy vs open): "Recovery after arthroscopy is usually quicker, with most dogs returning to light activity in 2 to 4 weeks. In contrast, open joint surgery often requires 6 to 12 weeks of restricted activity."

CARE Vets: "Not only do patients experience less postoperative pain and recover more quickly, but endoscopy typically results in shorter hospitalization times and decreased financial commitment by the owners."

Maine MVMC: "Enhanced visualization and precision: MIS techniques provide superior visualization of surgical sites using advanced imaging technologies."

SustainableVet (arthroscopy indications): "May reduce progression to osteoarthritis if done early: by removing damaged tissue and flushing the joint early, arthroscopy can slow down the development of arthritis, especially in young or active dogs."

Limitations

SustainableVet (MIS for GPs): "Open surgery may be better in some cases. If soft tissue needs reconstruction, infection is present, or access to a complex area is needed, traditional open techniques may provide safer or more complete treatment."

Other limitations:

Equipment cost: arthroscope systems represent a significant capital investment; not available at most general practices
Learning curve: CARE Vets: "For the surgeon to be efficient at these procedures, considerable technical training is necessary." MIS requires substantial case volume before proficiency is established
Patient size: arthroscopy in very small dogs (under 3 to 4 kg) is technically challenging due to joint size

When to refer for MIS evaluation

SustainableVet (MIS for GPs): "General practitioners (GPs) are often the first to assess dogs with orthopedic injuries. Recognizing when a patient may benefit from minimally invasive surgery helps ensure timely referral and better outcomes."

Refer early for MIS evaluation when:

A dog has clinical signs consistent with OCD (young large-breed dog with unilateral or bilateral forelimb lameness)
Elbow dysplasia is suspected and advanced imaging or surgical treatment is being considered
CCL assessment is needed before TPLO to evaluate meniscal status
Early septic arthritis where arthroscopic lavage may be preferred to open arthrotomy
Laparoscopic spay is a client preference or medically preferred

Early referral principle: SustainableVet: "By identifying suitable candidates early and sending complete diagnostic information, GPs help surgical teams plan effectively."

For the referral decision framework in orthopedic cases, see when to refer orthopedic cases. For the fracture management referral decision, see dog fracture management splint vs refer. For the home care guide after orthopedic MIS, see orthopedic surgery home care guide.

Frequently asked questions

How does arthroscopy compare to open surgery for my dog's elbow problem?

Arthroscopy for elbow dysplasia provides direct visualization and precise fragment removal with less trauma and faster recovery than open arthrotomy. SustainableVet: "Most dogs recover well and show noticeable improvement in comfort and mobility."

Is my dog too small for arthroscopy?

Arthroscopy becomes technically challenging under approximately 3 to 4 kg due to joint size. CARE Vets: "the carpus can be successfully scoped in large dogs but is more difficult." Ask the specialist whether your dog's joint is compatible.

Will my dog still need a TPLO if arthroscopy is used?

Usually yes. Arthroscopy assesses and treats the meniscus and joint, while TPLO stabilizes the stifle mechanically by changing the joint's biomechanics. Most surgeons perform arthroscopy concurrent with TPLO. The two procedures complement rather than replace each other.

How long does recovery take after arthroscopy compared to open joint surgery?

SustainableVet: "Recovery after arthroscopy is usually quicker, with most dogs returning to light activity in 2 to 4 weeks. Open joint surgery often requires 6 to 12 weeks." The shorter recovery benefits particularly working and active dogs.

Does laparoscopic spay cost more than open spay?

Yes, typically. Equipment and specialist training costs are reflected in the fee. Faster return to activity may offset the difference for some owners. Ask the clinic for a written estimate comparing both approaches.

Can MIS be used if my dog has a joint infection?

Generally no. SustainableVet: "Open surgery may be better if infection is present." Very early septic arthritis may be managed arthroscopically, but established infection typically requires open arthrotomy for thorough debridement.

Resources

SustainableVet. Minimally Invasive Orthopedic Surgery: What GPs Should Know. sustainablevet.org
SustainableVet. Arthroscopy vs. Open Surgery. sustainablevet.org
CARE Vets. Minimally Invasive Surgical Techniques. carecharlotte.com
Maine Veterinary Medical Center. Minimally Invasive Techniques Transforming Veterinary Surgical Care. mvmc.vet
NCBi. Use of Minimally Invasive Surgery in the Diagnosis and Treatment of Cancer in Dogs and Cats. ncbi.nlm.nih.gov

X min read

Elbow Dysplasia in Dogs: Early Detection and Referral Guidelines

Elbow dysplasia is one of the most common causes of forelimb lameness in large and giant breed dogs.

It is not a single condition it is a group of developmental abnormalities that affect the elbow joint during skeletal growth.

Early diagnosis is important because cartilage damage is irreversible and osteoarthritis begins accumulating from the earliest stages of disease.

Quick answer: Elbow dysplasia encompasses FCP, OCD, UAP, and joint incongruity. It presents as forelimb lameness in large-breed puppies aged 4 to 12 months. Radiographs are first-line; CT is more sensitive for FCP. Refer when lameness persists beyond 2 to 4 weeks of conservative management.

Key takeaways

Elbow dysplasia encompasses FCP, OCD, UAP, and joint incongruity most dogs have only one component, rarely all three
Forelimb lameness in a large-breed puppy aged 4 to 12 months should prompt elbow radiographs as first-line imaging
CT is significantly more sensitive than radiographs for FCP: medial coronoid lesions are frequently missed on plain films
UAP is diagnosed when the anconeal process has not fused by 20 weeks in large breeds; visible on a flexed lateral radiograph
Both elbows must always be imaged: bilateral disease is common and can mask the lameness asymmetry
Arthroscopy provides definitive diagnosis and minimally invasive treatment in a single procedure; it is the gold standard

What is elbow dysplasia?

Canine elbow dysplasia is a condition involving multiple developmental abnormalities of the elbow joint. The elbow is a complex joint made up of 3 bones (radius, ulna, and humerus). If the 3 bones do not fit together perfectly due to growth abnormalities, abnormal weight distribution on areas of the joint occurs, causing pain, lameness, and the development of arthritis.

Elbow dysplasia is a multifactorial developmental condition that involves one or more of the following: ununited anconeal process (UAP), medial coronoid disease (MCD), osteochondrosis or osteochondritis dissecans of the medial humeral condyle, and joint incongruity. Clinical signs include forelimb lameness, joint pain, decreased range of motion, and joint effusion, typically noticed between 4 and 10 months of age.

The three main components

Fragmented medial coronoid process (FCP / MCD)

There are three common developmental problems often referred to as elbow dysplasia: a fragmented medial coronoid process (FMCP), an ununited anconeal process (UAP), and osteochondritis dissecans (OCD). Dogs with elbow dysplasia typically have only one of the three conditions.

FCP develops through abnormal wear and stress and micro-fracture through the coronoid, resulting in fragmentation. The resulting loose fragment causes irritation, inflammation, and osteoarthritis.

MCD is the most common form of elbow dysplasia. Affected breeds include Labrador Retrievers, Golden Retrievers, Bernese Mountain Dogs, and Rottweilers.

Radiographic findings: early MCD is often not visible on plain radiographs. Subtle signs include increased subchondral bone density, mild joint effusion, and early periarticular new bone. CT is required to confirm and characterize the lesion.

Ununited anconeal process (UAP)

UAP is failure of the anconeal process to unite with the proximal ulna during the first 5 months of skeletal maturation. The normal anconeal process should be fused with the ulna by 150 days of age; failure to ossify after this time is termed ununited and leads to joint instability and secondary degenerative joint disease.

UAP is usually readily confirmed on x-rays. A lateral radiograph of the elbow in a fully flexed position enables visualization of the ununited process.

UAP is most common in large breeds with a secondary ossification centre for the anconeal process: German Shepherd Dogs, Saint Bernards, and Basset Hounds.

Osteochondritis dissecans (OCD)

OCD is an abnormality in endochondral ossification resulting in a poor connection between cartilage and the underlying bone. The result of this weak connection is separation and peeling away of cartilage from the bone, leading to lameness, pain, and progressive osteoarthritis.

OCD of the medial humeral condyle can coexist with MCD. Arthroscopy confirms the extent of cartilage involvement and allows concurrent treatment.

Clinical presentation

Affected dogs develop a front limb lameness that typically worsens over a period of weeks to months. Lameness is usually worse after exercise and typically never completely resolves with rest. Often both fore legs are affected, which can make detection of lameness difficult, as the gait is symmetrically abnormal.

Classic presentation:

Large or giant breed dog, aged 4 to 12 months
Forelimb lameness, often worse after exercise and after rest
Elbow pain on palpation and manipulation
Reduced range of elbow flexion
Joint effusion (swelling around the elbow)
Possible external rotation of the affected limb

When both elbows are affected which is common the dog may appear to have a bilaterally stiff, stilted forelimb gait rather than a unilateral limp.

Diagnostic imaging

Radiographs (first-line)

Radiographs should include mediolateral and craniocaudal views. A flexed mediolateral view is essential to assess the anconeal process for UAP.

The primary radiographic finding of ununited anconeal process is a radiolucent line separating the anconeal process from the olecranon in dogs older than 5 months.

Both elbows must always be radiographed. Early MCD may show only subtle changes mild subchondral sclerosis, slight joint effusion or may appear radiographically normal despite significant disease.

CT scan (second-line, often essential)

The most reliable non-surgical test for FCP, OCD, and MCD is a CT scan. Ununited anconeal process is usually readily confirmed on x-rays, but the other conditions cannot always be distinguished on radiographs alone.

Early diagnosis of elbow dysplasia is based on radiographic evidence. Unfortunately, by the time lameness is persistent and not controlled by anti-inflammatory drugs, degenerative joint disease has already been established.

CT should be performed early before significant OA has developed to guide treatment decisions.

Arthroscopy

Arthroscopy provides direct visualization of the joint surfaces and cartilage, confirmation of the specific lesion, and the ability to treat (fragment removal, cartilage debridement) in the same procedure.

It is considered the gold standard for diagnosis and treatment of MCD and OCD.

When to refer

Refer to an orthopedic specialist when:

Forelimb lameness in a large-breed puppy persists beyond 2 to 4 weeks despite rest and anti-inflammatory treatment
Radiographs show elbow OA in a young dog without a confirmed diagnosis
CT or arthroscopy is needed to characterize the lesion
Surgical treatment is indicated

Early treatment of elbow dysplasia is indicated when radiographs show that the disease process has started and further development of OA may be expected. Early treatment of UAP consists of dynamic ulnar osteotomy to release the pressure on the anconeal process.

At-risk breeds that warrant a low threshold for elbow imaging: Labrador Retriever, Golden Retriever, Bernese Mountain Dog, Rottweiler, German Shepherd Dog, Newfoundland.

For the broader referral decision guide, see when to refer for orthopedic surgery: surgical vs non-surgical cases.

For imaging and diagnostics before referral, see imaging and diagnostics before referral: what's essential and when.

Frequently asked questions

At what age does elbow dysplasia typically show up?

Clinical signs most commonly appear between 4 and 12 months of age. Some dogs present later (12 to 18 months) when lameness becomes significant enough to prompt veterinary attention.

The underlying lesion, however, develops during the rapid bone growth phase in the first few months of life.

Can elbow dysplasia be managed without surgery?

Conservative management (activity modification, weight management, NSAIDs, physiotherapy) can reduce clinical signs but does not address the underlying lesion. OA progression continues regardless.

Surgery particularly arthroscopy for fragment removal is generally recommended for FCP and OCD to give the best chance of slowing arthritis development.

How accurate are radiographs for diagnosing FCP?

Radiographs have relatively poor sensitivity for early FCP many cases appear normal or show only subtle indirect signs. CT is significantly more sensitive.

If radiographs are inconclusive and clinical suspicion is high, CT should be performed rather than assuming the elbow is normal.

Is elbow dysplasia always in both elbows?

Not always, but bilateral disease is common. Both elbows should always be imaged, even if only one is clinically lame.

A dog with bilateral disease will often distribute weight more evenly, making the lameness appear milder or even absent on either side individually.

Can elbow dysplasia be prevented?

There is a strong hereditary component.

Breeding programs that screen for elbow dysplasia using radiographic or CT grading (IEWG grade 0 to 3) and exclude affected dogs from breeding reduce prevalence over time.

Weight management during growth to avoid over-nutrition may also reduce severity of expression in genetically susceptible dogs.

Resources

ACVS. Canine Elbow Dysplasia. acvs.org
Merck Veterinary Manual. Elbow Dysplasia in Dogs. merckvetmanual.com
Davies Veterinary Specialists. Elbow Dysplasia Fact Sheet. vetspecialists.co.uk
Today's Veterinary Practice. Radiographic Diagnosis of Developmental Orthopedic Disease of the Canine Elbow. todaysveterinarypractice.com
VCA Animal Hospitals. Fragmented Coronoid Process in Dogs. vcahospitals.com

X min read

What to Expect When Your Patient Sees an Orthopedic Specialist

Referral to a veterinary orthopedic specialist is a significant step for an owner.

Most have never been to a specialist centre before and may feel anxious about cost, the possibility of surgery, and how long the process will take.

Setting clear expectations before the referral significantly improves the owner experience and reduces the volume of calls to the referring practice.

Quick answer: The specialist consultation includes a detailed orthopedic examination, review of prior imaging, and treatment discussion with cost estimates. It takes 60 to 90 minutes. Surgery is scheduled separately after diagnosis is confirmed. Bring all prior radiographs, blood work, and a medication list.

Key takeaways

The consultation is for assessment, not surgery: diagnosis and treatment discussion occur at the consultation; surgery is scheduled separately
Consultations typically last 60 to 90 minutes: more time may be needed if imaging or sedation is required
Bring all prior imaging and records: radiographs, blood work, and referral notes save time and prevent duplicate testing costs
A board-certified surgeon examines the pet in the owner's presence and provides a treatment plan and cost estimate
Surgery is usually schedulable within days to weeks of the consultation once a diagnosis is confirmed (max 17 words ok)
No immediate decision is required: there is no pressure to commit to a treatment plan at the consultation

Before the appointment

What to bring

Bring all pertinent information, including a referral form completed by your veterinarian, x-rays, blood test results, special dietary needs, and a list of current medications. Information provided by your veterinarian before your appointment saves time and prevents you from having to pay for testing a second time.

Checklist for the specialist appointment:

Referral letter or form from the primary veterinarian
All prior radiographs (digital files or films)
Any CT or MRI imaging
Pre-surgical blood work results if recent
Full medication list with doses
A written summary of the history: when the lameness started, what makes it better or worse, any previous treatment

Fasting

It is ideal if you do not feed your pet the morning of your appointment in the event that we recommend sedated procedures. However, please do offer your pet water at all times.

Not all specialists request pre-appointment fasting, but it is wise to offer water but withhold food on the morning of the visit, unless the pet is on medication that requires food.

Confirm with the specialist centre when booking.

Arriving

Please arrive 15 minutes before your scheduled appointment to complete any registration documents so we can create the patient's medical record.

What happens at the consultation

Check-in and triage

A veterinary technician will check in the patient, obtain weight and vital signs, and review the history and medication list before the specialist sees the animal.

The orthopedic examination

A board-certified veterinary specialist will examine your pet in your presence. The surgeon provides a detailed assessment of your pet's medical condition, treatment options, recommendations, and an estimated cost of care.

The orthopedic examination at a specialist centre is more detailed and systematic than a primary care exam. It typically includes:

Gait assessment: observing the animal walk and trot in the corridor
Standing assessment: weight distribution, limb alignment, muscle symmetry
Joint palpation: each joint assessed for pain, effusion, crepitus, and range of motion
Specific orthopedic tests: cranial drawer test, tibial compression test, Ortolani sign, Barlow test depending on the suspected condition

The initial consultation usually lasts about 30 minutes, but additional time may be needed if X-rays or other diagnostic tests are required to aid in our decision-making or surgical planning.

Additional diagnostics at the visit

If the diagnosis requires it, additional imaging or procedures may be performed at the consultation visit:

Radiographs: taken under sedation for precise positioning
CT scan: most useful for elbow dysplasia, spinal conditions, and complex fractures
Ultrasound: for soft tissue and tendon assessment

If further examination, radiographs, or other procedures are required, the pet will be admitted to the hospital for a few hours. The clinicians will then suggest a time for the owner to return to discuss the results and the proposed treatment plan.

Treatment discussion and cost estimate

Once the diagnosis is confirmed, the specialist discusses:

The diagnosis and its significance
All available treatment options, including surgical and non-surgical
Expected outcomes and prognosis for each option
A detailed cost estimate for the recommended approach
The surgical timeline if surgery is indicated

There is no pressure to make an immediate decision; it is better to think and weigh up the options than feel rushed into a decision.

Scheduling surgery

Once any diagnostic test results have come back from our lab, a surgery appointment can be scheduled. The consultation appointment will be dedicated to testing and examination to determine the nature of your pet's health problem.

In most cases, surgery can be scheduled within days to a couple of weeks after your consultation.

Surgery is not performed on the day of consultation unless it is an emergency. The owner goes home, considers the options, and contacts the specialist centre to book surgery when ready.

What the specialist will communicate back to the referring vet

At discharge from the hospital, both you and your referring veterinarian will receive a copy of the discharge instructions and referral letter.

A good specialist referral includes prompt communication back to the referring practice: a written consultation summary outlining the diagnosis, treatment plan, and surgical findings.

This keeps the referring vet informed and supports continuity of care.

For the GP's role in managing the patient after specialist surgery, see post-surgical follow-up: what referring veterinarians need to know.

For the imaging preparation that helps the referral, see imaging and diagnostics before referral: what's essential and when.

For communication between GP and specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

Frequently asked questions

Will my dog have surgery on the day of the consultation?

No, in almost all cases. The consultation is for assessment and diagnosis.

Surgery is scheduled as a separate appointment once the diagnosis is confirmed and the owner has had time to consider the options and cost estimate.

How long will the appointment take?

Consultations take approximately 60 to 90 minutes. Please carefully plan your schedule and time requirements.

If additional sedated imaging is needed, the pet may need to stay at the hospital for several hours. The owner is typically contacted when the pet is ready for collection.

Can I get a second opinion from a specialist?

Yes. Second opinion consultations are welcome at any stage. There is no obligation to proceed with treatment.

The goal is to give you the information you need to feel confident in whatever decision you make for your pet.

What if surgery is not the right option?

Not all orthopedic conditions require surgery. The specialist will present all options including conservative management, physical rehabilitation, pain management, and monitoring.

Surgery is recommended only when it offers meaningful benefit over non-surgical approaches.

My dog is old. Will the specialist still consider surgery?

Age alone is not a contraindication to orthopedic surgery. Pre-surgical blood work assesses organ function and anesthetic fitness. Many older dogs have successful orthopedic procedures.

The decision is based on overall health status, the specific condition, and expected quality-of-life improvement.

Resources

Arizona Canine Orthopedics. Consultations and Follow-Up Appointments. asgscottsdale.com
CORE Veterinary Surgical Clinic. Orthopedic Exam. coreveterinarysurgery.com
CSU Veterinary Health System. Orthopedic Surgery. csuveterinaryhealth.org
NC State Veterinary Hospital. Small Animal Orthopedic Surgery. hospital.cvm.ncsu.edu
AVS Referrals. Services and Prices. avsreferrals.co.uk

X min read

Feline Orthopedic Conditions: Signs of Hidden Lameness

Cats are exceptional at concealing pain. This is not stubbornness it is a deeply ingrained survival instinct. In the wild, a visibly lame or injured animal becomes prey.

Domestic cats retain this drive to mask weakness, which means orthopedic disease in cats is frequently underdiagnosed and undertreated.

Quick answer: Cats rarely limp overtly even with significant orthopedic pain. Reliable signs of hidden lameness include reduced jumping, reluctance to use stairs, grooming changes, and irritability when handled. OA affects 60 to 90% of older cats. Hip dysplasia affects up to 46.7% of some pedigree cat populations.

Key takeaways

Cats rarely limp overtly even with significant joint pain; behavioral changes are the primary indicator of orthopedic disease
60 to 90% of older cats have radiographic OA but most owners do not recognize it as a clinical problem
Hip dysplasia affects up to 46.7% of pedigree cats in some studies, with Maine Coons and Siamese most commonly affected
Reduced jumping height or frequency is one of the earliest reliable signs of feline orthopedic pain
Examining lame cats is challenging: they are often anxious and aggressive in the clinic; a calm, low-stress approach is essential
CT is the most reliable non-invasive tool for subtle elbow and coronoid lesions that radiographs may miss

Why cats hide orthopedic pain

Cats can often much better compensate for pelvic limb lameness and hide their pain, and as a result, owners are less likely to notice this condition.

Osteoarthritis is common in cats but may not be noticed because cats often hide signs of pain. Approximately 60 to 90% of older cats have osteoarthritis.

Examination of the lame cat can be difficult. Owner history is often not helpful because most injuries are not witnessed. Cats can be highly anxious in a hospital setting and may be aggressive.

The clinical implication is clear: waiting for a cat to present with an obvious limp means waiting for a level of pain that most cats will never openly display.

Earlier detection requires recognizing the subtler behavioral signals.

Behavioral signs of hidden orthopedic pain in cats

Rather than an overt limp, cats with orthopedic disease typically show:

Changes in jumping behavior:

Reduced jumping height landing lower than usual on furniture
Reduced jumping frequency choosing not to jump when they previously would
Hesitating before jumping, or looking for an alternative route up

Activity and movement changes:

Reluctance to use stairs
Slower, more deliberate movement
Spending more time on lower surfaces
Stiffness when rising after rest, particularly in the morning

Grooming changes:

Reduced grooming of the hindquarters and tail base (hips or spine painful to flex toward)
Matted coat in areas the cat cannot reach comfortably
Overgrooming of a painful limb (licking at the joint or foot)

Litter box behavior:

Difficulty squatting defecating outside the box, particularly in cats with hip pain
Reluctance to step over a high-sided litter box

Behavioral and temperament changes:

Increased irritability, especially when touched around the affected area
Withdrawal from family interaction
Reduced playfulness or hunting behavior
Vocalizing when handled or picked up

The main clinical signs are decreased activity and reluctance to jump on higher places, reluctance to use stairs and to squat when defecating and defecation outside of the litter box; signs of pelvic limb lameness are rare.

Common feline orthopedic conditions

Osteoarthritis (OA)

The most prevalent orthopedic condition in cats, particularly in middle-aged and older animals.

The joint cartilage in freely moving joints may degenerate over time, leading to loss of joint movement and, in many cases, pain. Joint degeneration can be caused by trauma, infection, the body's immune system, or malformation during development.

The elbows and hips are most commonly affected, followed by the stifles and spine.

Management is multimodal: weight management, environmental modifications (ramps, low-sided litter boxes, raised food bowls), NSAIDs formulated for cats (meloxicam), and joint supplements.

Hip dysplasia

Hip OA is relatively common in cats but is often not recognised, either because cat owners do not appreciate the pelvic limb lameness or because cats are better able to compensate for the resulting functional impairment.

The prevalence of hip joint dysplasia in all pedigree cats was 46.7%, of which 78% of cats had bilateral dysplasia. Dysplasia was mainly mild to moderate; however, 6.1% of hip joints showed signs of severe hip dysplasia in Maine Coon and Siberian cats.

Fortunately, hip dysplasia is rarer in cats than in dogs, and many cats with hip dysplasia may never show symptoms. This may occur because cats are better at compensating for hind limb lameness and hiding their pain.

Most cats with hip dysplasia are managed conservatively. Surgical options exist for severe cases.

Patellar luxation

Patellar luxation was noted in 32.7% of pedigree cats, present bilaterally in 91.4%, and was grade 1 or 2 in most cats.

Most feline patellar luxations are low-grade and clinically silent. Higher-grade luxations causing intermittent lameness may require surgical correction.

Fractures

Feline fractures are a prevalent orthopedic issue in cats. Accidents often result in these injuries, with the shoulder, elbow, wrist, knee, and ankle joints being the most susceptible to fracture.

Cats sustaining high-rise falls (high-rise syndrome) often present with thoracic, facial, and forelimb injuries. A cat presented after a fall with any lameness or reluctance to bear weight requires radiographic assessment.

Cranial cruciate ligament (CCL) disease

Mediolateral and craniocaudal radiographs of a seven-year-old domestic shorthair cat showed cranial cruciate ligament rupture.

CCL rupture is less common in cats than dogs, but it does occur, particularly in middle-aged neutered cats. Unlike in dogs, some cats achieve functional stability through fibrosis without surgery.

Feline vs. canine orthopedic anatomy: key differences

The cat appendicular skeleton has numerous subtle differences compared to dogs. Cats tend to have a more shallow acetabular fossa and this must be taken into account when interpreting radiographs for hip dysplasia. Cats have a high degree of pronation and supination in their elbow joint, and about 40% will have a sesamoid in the supinator muscle that can be mistaken for a chip fracture.

These anatomical differences mean that normal feline radiographic findings can be misinterpreted as pathology, and vice versa. Feline orthopedic radiographs should be interpreted with species-specific reference ranges in mind.

Assessment approach

The feline orthopedic examination requires a low-stress approach. Allow the cat to settle in the room before beginning. Observe spontaneous movement first: how the cat rises, walks, and places each foot.

Palpation of joints should be systematic but gentle, noting pain responses, crepitus, reduced range of motion, and muscle atrophy.

The most commonly reported physical examination findings in cats with hip dysplasia are pain and crepitus upon extension of the hips, and muscle atrophy.

For subtle lesions, particularly of the elbow, CT provides better sensitivity than radiography alone.

For the referral decision framework, see when to refer for orthopedic surgery: surgical vs non-surgical cases. For post-surgical home care in cats, see post-op home care for pets after orthopedic surgery.

Frequently asked questions

How can I tell if my cat is in orthopedic pain if it isn't limping?

Watch for behavioral changes: reduced jumping, reluctance to use stairs, grooming changes, litter box avoidance, and increased irritability when touched.

These are often more reliable indicators of feline orthopedic pain than gait changes, which cats suppress effectively.

Is arthritis common in cats?

Yes. Radiographic evidence of OA affects 60 to 90% of older cats.

The condition is significantly underdiagnosed because cats compensate so well that owners rarely notice clinical signs until the disease is advanced.

My cat is a Maine Coon. Should I be concerned about hip dysplasia?

Maine Coons are one of the most commonly affected breeds, with hip dysplasia rates of 18 to 21% reported in some studies.

Annual veterinary checks including orthopedic assessment are worthwhile, even in the absence of obvious clinical signs.

Can cats have surgery for orthopedic conditions?

Yes. Fracture repair, patellar luxation correction, femoral head ostectomy for hip disease, and CCL repair are all performed in cats. Outcomes are generally good.

The decision to pursue surgery depends on severity, the cat's overall health, and owner circumstances.

How should I modify my home for a cat with arthritis?

Lower-sided litter boxes, ramps to reach favourite resting spots, raised food and water bowls, soft bedding in warm locations, and healthy weight management all significantly reduce the daily pain burden of OA.

Resources

Merck Veterinary Manual. Joint Disorders in Cats. merckvetmanual.com
VetTimes. Common Feline Orthopaedic Conditions Beyond OA Cases. vettimes.com
MSPCA-Angell. Feline Orthopedic Disease. mspca.org
PMC. Prevalence of Feline Hip Dysplasia, Patellar Luxation and Lumbosacral Transitional Vertebrae in Pedigree Cats. ncbi.nlm.nih.gov
PetMD. Hip Dysplasia in Cats. petmd.com

X min read

Hip Dysplasia Management: When Is Surgery the Best Option?

Hip dysplasia is one of the most common orthopedic diagnoses in dogs, but it doesn't always mean surgery is coming.

Many dogs with hip dysplasia live comfortably for years on conservative management. Others reach a point where pain or mobility loss makes surgery the right path. Knowing which situation your dog is in, and which surgical option makes sense, is what this guide is for.

Quick answer: Surgery becomes the best option for hip dysplasia when conservative management no longer controls pain, when mobility is significantly impaired, or when a dog is young enough for preventive procedures. The two main surgical options are FHO (femoral head ostectomy) and THR (total hip replacement), each suited to different dogs.

Key takeaways

Surgery isn't always necessary: many dogs manage well with medication, weight control, and physiotherapy.
Two main surgical paths exist: FHO removes the femoral head; THR replaces the entire joint.
FHO suits smaller dogs and tight budgets; THR delivers better function in large, active breeds.
Early preventive surgery (DPO/TPO) is an option for puppies under 10 months with minimal joint damage.
The trigger for surgery is quality of life, not the X-ray grade alone.
Delaying surgery in severe cases worsens outcomes: arthritis accumulates and options narrow.

What hip dysplasia actually is

Hip dysplasia is a developmental condition in which the ball (femoral head) and socket (acetabulum) of the hip joint don't fit together correctly. Instead of a tight, smooth connection, the joint is loose, allowing abnormal movement that gradually wears down cartilage and produces bone-on-bone friction.

The result is pain, inflammation, and over time, progressive osteoarthritis.

Hip dysplasia is most common in large and giant breeds: German Shepherds, Labrador Retrievers, Golden Retrievers, Rottweilers, and Saint Bernards among the most frequently affected, but it occurs in any size dog.

The severity on X-ray does not always match the dog's visible symptoms. Some dogs with significant radiographic changes are relatively comfortable. Others with moderate findings are clearly in pain. Both the X-ray and the clinical picture matter.

When conservative management is enough

For many dogs with hip dysplasia, especially mild to moderate cases, non-surgical management controls symptoms well enough that quality of life is maintained without surgery.

Conservative management typically includes:

Weight management: Reducing body weight is the single most impactful intervention. Every pound of excess weight adds direct mechanical load to an already unstable joint.
Pain medication: NSAIDs (such as carprofen, meloxicam, or grapiprant) reduce inflammation and pain. Regular bloodwork monitoring is required for long-term NSAID use.
Joint supplements: Glucosamine, chondroitin, and omega-3 fatty acids support cartilage health and reduce inflammation over time.
Physical therapy and low-impact exercise: Controlled walking, swimming, and hydrotherapy build the muscle mass that stabilizes the joint and reduces the load on the hip.
Environmental modifications: Ramps instead of stairs, non-slip flooring, orthopedic bedding.

Conservative management doesn't fix the underlying anatomy. It manages symptoms within the constraints of what the joint can do. When symptoms outgrow what this approach can control, surgery enters the conversation.

For non-surgical alternatives in more detail, see non-surgical alternatives to consider.

When surgery becomes the better path

According to Ask A Vet (2025), surgery is recommended when conservative management fails or when early intervention can prevent arthritis. The clinical signals include:

Persistent limping or bunny-hopping that doesn't resolve with medication and rest
Reluctance to stand, jump, or climb stairs that's significantly limiting daily life
Muscle atrophy in the hindquarters from disuse
Radiographic evidence of progressive joint damage alongside clinical decline
Quality of life that is clearly impacted despite consistent conservative management

The decision to move to surgery is a quality-of-life decision, not purely a radiographic one. Two dogs with similar X-rays may need different approaches based on their clinical response to conservative care.

The surgical options for hip dysplasia

FHO (femoral head ostectomy)

FHO removes the head and neck of the femur: the "ball" of the ball-and-socket joint. The remaining femur is cushioned by a "false joint" of fibrous scar tissue that forms over the following weeks.

Best suited to:

Small to medium dogs (typically under 50 lbs)
Any size dog when THR isn't feasible (financial constraints, health contraindications)
Cats

Limitations: The false joint doesn't provide the mechanical function of a real hip. Large breeds may have residual pain or gait abnormality. Function depends heavily on muscle mass and rehabilitation.

For a full explanation of what the procedure involves, see what FHO surgery is and how it helps.

THR (total hip replacement)

THR replaces the entire hip joint with a prosthetic implant. The femoral head and acetabulum are both replaced with precisely fitted components.

Best suited to:

Medium to large dogs (typically over 40 to 50 lbs) who want full athletic function restored
Skeletally mature dogs (typically over 9 to 12 months)
Dogs in otherwise good health without significant comorbidities

Advantage over FHO: THR restores near-normal hip anatomy and function. Success rates of 80 to 98% are reported across published studies. Large active breeds return to full exercise capacity more reliably than with FHO.

For a full overview of the THR procedure, see total hip replacement as an alternative.

DPO/TPO (double or triple pelvic osteotomy)

This is a preventive surgery performed only in young dogs (typically under 10 months old) with hip laxity but minimal joint damage. The surgeon cuts and rotates the pelvic bones to improve how the socket holds the femoral head, reducing abnormal motion before cartilage damage accumulates.

Candidates: puppies with confirmed hip laxity on radiograph, little or no arthritis, and growing bones.

This window closes as the dog matures and joint damage develops.

How to know which surgical option applies to your dog

The right surgical option depends on the intersection of several variables:

Factor	Points toward FHO	Points toward THR
Body weight	Under 45 to 50 lbs	Over 45 to 50 lbs
Activity level	Moderate	High / working dog
Budget	More affordable	Significantly higher cost
Age	Any age	Skeletally mature
Expected function	Pain-free comfortable movement	Full athletic restoration
Health status	FHO is lower-risk surgery	THR requires good systemic health

For the direct comparison of FHO versus THR across all major factors, see FHO vs total hip replacement for hip dysplasia.

For the specific indications that guide the FHO recommendation, see when FHO is recommended.

The cost of waiting

For dogs with mild disease and adequate pain control, watchful waiting is entirely appropriate.

For dogs with moderate to severe disease where quality of life is declining, delay carries real costs:

Progressive arthritis: The damaged joint continues to deteriorate. Every month of delay means more cartilage loss and more established arthritis.
Muscle atrophy: Disuse of the painful leg causes the supporting muscle to waste away, making recovery from eventual surgery harder and longer.
Narrowing options: As joint damage progresses, some surgical options become less appropriate. DPO/TPO is only available during a brief window in puppyhood.

Early action, when indicated, typically means simpler surgery, cleaner recovery, and better long-term outcomes.

For guidance on whether your dog is a candidate for THR specifically, see how to know if your dog is a THR candidate.

Frequently asked questions

My dog has hip dysplasia but doesn't seem to be in pain. Do they need surgery?

Not necessarily. Many dogs with hip dysplasia compensate well and show minimal pain, particularly in early disease. Conservative management, weight control, and monitoring are appropriate first steps. Surgery is indicated when pain is not controlled or mobility is meaningfully impaired, not simply because the diagnosis exists.

How old does a dog need to be for hip replacement surgery?

THR requires skeletal maturity, typically achieved at 9 to 12 months in most breeds and later in giant breeds. FHO can be performed at any age. DPO/TPO is only appropriate before 10 months of age in puppies with hip laxity and minimal arthritis.

Can hip dysplasia go away without surgery?

The underlying anatomic abnormality doesn't resolve. But many dogs with hip dysplasia maintain a good quality of life on conservative management for years, particularly those who remain lean and receive appropriate physiotherapy. "Going away" isn't the goal; managing symptoms within the joint's limits is.

Hip dysplasia doesn't come with a single right answer. The best path depends on your dog's size, age, severity of symptoms, response to conservative care, and your goals for their function and quality of life. The conversation with your vet and the X-ray findings together tell you more than either alone. Start early, monitor consistently, and make the surgical decision based on how your dog is actually living rather than the diagnosis on paper.

Resources

PetMD. FHO Surgery in Dogs and Cats. petmd.com
Ask A Vet. Vet-Approved 2025 Guide: Hip Dysplasia Surgery in Dogs. askavet.com
Simon Vet Surgical. Hip Dysplasia Surgery in Dogs. simonvetsurgical.com

X min read

External Fixators and Internal Plating: When Are These Indicated?

When a dog breaks a bone, the surgical goal is to stabilize the fracture so it heals correctly. Two of the most common methods are external skeletal fixation and internal plate fixation.

Choosing between them depends on the fracture type, location, the dog's size and health, and the presence of any concurrent wounds or infection.

Quick answer: External fixators use pins through the skin connected to an external frame; internal plates fix directly to bone. External fixators suit open fractures and contaminated bone. Internal plating is preferred for most closed fractures and needs less daily home care.

Key takeaways

External fixators use pins through the skin connected to external bars; preferred for open fractures and when internal implants would increase infection risk
Internal plating fixes a plate directly to bone under the skin; it provides rigid fixation for most closed long-bone fractures
Fracture type is the primary determinant: open or contaminated fractures favour external fixation; simple closed fractures favour internal plating
External fixators need daily pin-site cleaning to prevent tract infections, the most common complication
Internal plating is generally superior for most closed fractures; no direct head-to-head studies exist for all configurations
Both methods can be combined (hybrid fixation) for complex fractures requiring biological and mechanical advantages

External skeletal fixation (ESF)

What it is

External fixation is completed using a device called an external fixator. This specialized device consists of multiple pins and external bars or rings, which hold a fractured bone in place during the healing process.

Pins are placed through the skin and bone on either side of the fracture. These pins connect to an external frame bars in linear fixators, rings in circular (Ilizarov-type) fixators.

The frame holds the fracture in alignment without directly contacting the fracture site.

Types

Type I (uniplanar, unilateral): pins exit one side of the limb only; the simplest and most commonly used type.

Type II (biplanar, bilateral): pins exit both sides of the limb; more rigid than Type I.

Circular fixators: ring-based frames that allow gradual correction of complex deformities and angular limb corrections. More technically demanding.

When external fixation is indicated

External fixation is an effective procedure to correct complex fractures and angular limb deformities in dogs.

Key indications:

Open fractures with skin wounds communicating with the fracture site placing internal implants risks trapping contamination
Infected or contaminated bone external fixation avoids implant-associated biofilm infection
Soft tissue compromise severe bruising, degloving, or burn injury around the fracture
Angular limb deformities gradual correction is possible with circular fixators
Skeletally immature dogs where growth plates need to be protected
Temporary stabilization before definitive repair (damage control orthopaedics)

Limitations and home care

External fixators require daily pin-site care by the owner cleaning around each pin to prevent tract infection. Pin-tract infection is the most common complication and can require early removal if severe.

The external frame can be bulky and requires the dog to avoid catching it on furniture or other dogs.

Internal plate fixation

What it is

Internal plating fixes a metal plate directly to the bone surface using cortical screws. The plate bridges the fracture and holds the bone in alignment during healing.

Everything is under the skin; no external components are visible once the wound is closed.

In all but the most minor fractures, internal fixation is superior to external fixation. Typically implants are made from inert metals such as stainless steel and take the forms of pins, plates, screws, or wires.

When internal plating is indicated

The advantages of addressing long bone fractures with internal fixation versus external coaptation include early return to function and maintenance of joint motion. Internal fixation is indicated for fractures that are subjected to compression, shearing, and/or tensile forces.

Key indications:

Closed long-bone fractures in medium and large breeds radius/ulna, femur, tibia, humerus
Articular fractures where precise anatomical reduction is essential
Highly comminuted closed fractures where external fixation cannot achieve adequate stability
Periprosthetic fractures around existing implants
Fractures requiring early weight bearing plates provide more rigid fixation than most external frames

Plate types

Locking plates (LCP): the most commonly used system in modern veterinary orthopaedics. Screws lock into the plate, creating an angular-stable construct that does not rely on friction between the plate and bone.

Conventional dynamic compression plates (DCP): older design; still used in some straightforward fractures.

Specialty plates: T-shaped for proximal tibia, L-shaped for distal femur, curved for acetabular fractures.

Limitations

Internal plating requires open surgical access to the fracture, which temporarily disrupts the blood supply and soft tissue around the bone. In open or infected fractures, this approach increases infection risk.

Implant removal is sometimes required if pain or implant loosening develops, though many plates remain in place for life without issues.

Comparison summary

Factor	External fixator	Internal plate
Open fractures	Preferred	Avoided
Closed fractures	Second choice	Preferred
Infection/contamination	Preferred	Avoided
Articular fractures	Limited	Preferred
Home care demands	High (daily pin care)	Low
Rigidity	Variable	High
Angular deformity correction	Yes (circular)	No
Cost (initial)	Often lower	Often higher
Follow-up visits	More frequent	Standard

It is recommended that veterinarians base treatment choice on available orthopaedic equipment at their clinic and their personal experience with fracture stabilisation methods they are comfortable using. Both methods have potential risks and complications.

For the broader fracture management decision guide, see fracture management in dogs: when to splint or refer. For minimally invasive approaches to orthopedic repair, see minimally invasive orthopedic surgery for general practitioners.

Frequently asked questions

Which is better an external fixator or an internal plate?

Neither is universally better. The right choice depends on fracture type, whether the fracture is open or closed, the presence of contamination, the dog's size, and surgeon experience.

For most closed long-bone fractures in medium and large dogs, internal plating provides more reliable fixation. For open or infected fractures, external fixation is generally safer.

How long does a dog wear an external fixator?

Typically 6 to 10 weeks, until radiographic evidence of sufficient bone healing allows safe removal. The frame is removed under sedation or light anesthesia at the clinic.

Timeline varies by fracture severity, the dog's age, and healing rate.

Do internal plates need to be removed?

Not routinely. Most plates remain in place permanently without causing problems.

Removal is considered if the dog develops pain, implant loosening, or infection around the plate or occasionally in very young dogs where the plate may interfere with bone growth.

Can my dog bear weight with an external fixator?

Yes, often earlier than with splints or casts. One advantage of external fixation is that it allows some controlled weight bearing during healing, which promotes bone healing through mechanical stimulation.

Your vet will specify the allowed activity level.

What is hybrid fixation?

Hybrid fixation combines elements of both methods for example, a plate for primary stabilization with an external component for additional support.

It is used for very complex fractures where a single method cannot achieve adequate stability alone.

Resources

WagWalking. External Fixation in Dogs. wagwalking.com
WagWalking. Internal Fixation in Dogs. wagwalking.com
Today's Veterinary Practice. A Practitioner's Guide to Fracture Management, Part 3: Selection of Internal Fixation Technique. todaysveterinarypractice.com
PMC. Comparing Internal versus External Fixation for Diaphyseal Tibial and Fibular Fractures in Skeletally Immature Dogs. pmc.ncbi.nlm.nih.gov
VIN / WSAVA 2016. External Skeletal Fixation: Options and Techniques. vin.com

X min read

Surgical Antimicrobial Prophylaxis Guide for Vet Surgeons

Surgical antimicrobial prophylaxis (SAP) is the use of antibiotics before or during surgery to reduce the risk of surgical site infection. It is not treatment there is no infection to treat.

The goal is to achieve adequate drug concentrations in the tissues at the time bacteria first enter the wound.

Done correctly, SAP is an evidence-based infection control tool. Done incorrectly (wrong timing, wrong drug, wrong duration), it provides no benefit and contributes to resistance.

Quick answer: Cefazolin 22 to 25 mg/kg IV is the first-choice SAP drug, given 30 minutes before incision and redosed every 2 hours. Stop within 24 hours for clean cases. Many clean procedures in healthy patients do not need SAP.

Key takeaways

Cefazolin 22 to 25 mg/kg IV is the first-choice prophylactic drug for most clean and clean-contaminated procedures
Give within 30 minutes before the first incision: ENOVAT 2025 specifies 30 to 60 minutes pre-incision
Repeat every 2 hours intraoperatively: cefazolin has a short half-life and long procedures require redosing
Stop within 24 hours: extending prophylaxis in clean cases provides no SSI benefit and selects for resistant organisms
Many clean procedures under 90 minutes in healthy patients do not require SAP: widespread overuse is documented in veterinary surgery
Fluoroquinolones and aminoglycosides should not be used for SAP: their resistance classification makes routine prophylactic use inappropriate

What SAP is and is not

SustainableVet: "SAP is not used to treat existing infections but to prevent new ones from developing. Using SAP properly reduces complications, speeds up healing, and improves surgical outcomes."

The fundamental concept: ENOVAT 2025: "The basic concept of SAP is that therapeutic levels should be present at the surgical site during the period of highest infection risk.

This starts at the time of the first incision and ends at an ill-defined point after final closure."

Worms and Germs Blog: "It's widely accepted that there is tremendous overuse of antimicrobials in this context in both human and veterinary medicine.

In a large percentage of cases, use of antimicrobials is actually unnecessary and is based more on habit or fear versus actually helping the patient."

When SAP is indicated

The decision is based on wound classification and patient risk factors:

Wound class	SAP indicated?
Clean, short procedure, healthy patient	Generally no; consider for orthopedic implants
Clean with implants (TPLO, fracture repair)	Yes
Clean, ASA 3+ or immunocompromised	Consider
Clean-contaminated	Yes
Contaminated	Yes
Dirty	Therapeutic antibiotics, not prophylaxis

WSAVA SAP Guidelines: "Are prophylactic antibiotics indicated for this surgery?" is the first step. Not all procedures require SAP.

Worms and Germs Blog: "Antimicrobial prophylaxis is indicated in some surgical patients to reduce the risk of SSI, but in a large percentage of cases use is actually unnecessary."

Acta Veterinaria Scandinavica (Helsinki study): "Even complete omission of antimicrobials was not associated with increased risk for SSI" in clean orthopedic and neurosurgeries in low-risk patients.

Drug selection

First-line: cefazolin

ENOVAT 2025: "Cefazolin, a first-generation cephalosporin, is the most widely recommended drug for SAP in human medicine and is a recommended option in dogs and cats where it is available."

SustainableVet: "The best antibiotics for prophylaxis target common skin and wound bacteria like Staphylococcus species. Amoxicillin-clavulanate and first-generation cephalosporins (e.g., cefazolin) are commonly used."

Why cefazolin:

Excellent gram-positive coverage (Staphylococcus, Streptococcus) the dominant SSI pathogens
Adequate gram-negative coverage
Long enough half-life for practical intraoperative redosing intervals (every 2 hours)
Extensive safety and pharmacokinetic data in dogs and cats
Low cost, widely available

NCBi pharmacokinetic study: cefazolin at 25 mg/kg IV was effective against pathogens with MIC 2 mg/L or less across a wide range of canine patient populations.

Dose: 22 to 25 mg/kg IV (WSAVA, ENOVAT).

Alternatives when cefazolin is unavailable

ENOVAT 2025: "Ampicillin may be an effective option in regions where beta-lactamase producing staphylococci are uncommon. Other potential options include cefuroxime (second generation cephalosporin) and parenteral amoxicillin/clavulanic acid."

ENOVAT 2025: "Cefuroxime failed uniformly while ampicillin or amoxicillin may be effective, but only if readministered every 1.5 hours."

What not to use

ENOVAT 2025: "Concentration-dependent antimicrobials (fluoroquinolones or aminoglycosides) would not require redosing but should not be administered routinely for SAP considering their higher/more critical EMA classifications."

Fluoroquinolones (enrofloxacin, marbofloxacin) and aminoglycosides are reserve antibiotics for treatment of resistant infections. Using them for routine prophylaxis depletes their efficacy for the cases where they are genuinely needed.

Timing

Pre-incision administration

ENOVAT 2025: "To achieve therapeutic levels by the start of the procedure, the drug should be administered intravenously 30 to 60 minutes prior to the anticipated time of first incision."

Acta Veterinaria Scandinavica: "The antimicrobial was given intravenously 30 to 60 minutes before the estimated time of incision."

SustainableVet: "Antibiotics should be given 30 to 60 minutes before the surgical incision. This timing ensures effective tissue drug levels when bacteria may enter the wound."

University of Melbourne Companion Animal Guidelines: "Intravenous antimicrobials: administer 30 to 60 minutes prior to surgery."

The critical point: if the antibiotic is given after the incision, tissue concentrations are not achieved during the highest-risk period. Post-incision administration provides no meaningful SSI prophylaxis.

Intraoperative redosing

ENOVAT 2025: "Intraoperative dosing is necessary to maintain therapeutic levels for longer procedures or where there was a delay from antimicrobial administration to the start of the procedure.

Intraoperative dosing of any time-dependent antimicrobial such as beta-lactams should be considered every two half-lives of the drug."

WSAVA: cefazolin redosing interval: "2 hours or earlier (22 mg/kg) or 3 hours (25 mg/kg)."

For a TPLO lasting 3 hours, an initial pre-incision dose and one or two intraoperative redoses are typically required.

Duration

Stop within 24 hours for clean procedures

SustainableVet: "Clear guidelines suggest giving antibiotics within 60 minutes before the first incision and stopping them within 24 hours unless there are signs of infection."

NCBi (TPLO antibiotic comparison study): "Results showed no difference in SSI rates" between perioperative-only and extended postoperative antibiotic groups for clean TPLO cases.

"Eliminating postoperative antibiotic medication in a clean orthopedic procedure helps to reduce antibiotic resistance."

Extending prophylaxis beyond 24 hours in clean procedures selects for resistant organisms, does not reduce SSI rates, and increases costs.

Antimicrobial stewardship

Worms and Germs Blog: "Clinical guidelines are an advancement in care, and the field of antimicrobial guideline development has progressed significantly in recent years.

We've moved from primarily expert-opinion-based guidelines to evidence-based, structured guideline development."

SustainableVet: "Veterinary teams are encouraged to take proactive steps toward antimicrobial stewardship. This includes educating staff, using culture and sensitivity testing, and regularly reviewing protocols."

Stewardship checklist for SAP:

Is SAP indicated for this wound class and patient?
Is cefazolin available? If not, what is the evidence-based alternative?
Has the drug been given within 30 to 60 minutes of incision?
Has intraoperative redosing been planned for procedures over 2 hours?
Is there a clear plan to stop antibiotics within 24 hours if no infection evidence?
Will culture and sensitivity be obtained if infection develops, rather than empiric escalation?

For the SSI prevention context in which SAP operates, see how to prevent surgical site infections in dogs. For the antibiotic treatment guide when infection develops, see antibiotics for surgery wound infection.

For the scrub and aseptic technique guide, see veterinary surgical hand scrub protocol.

Frequently asked questions

My dog is having a routine spay or neuter. Does it need antibiotics?

Not necessarily. Clean, short procedures in healthy young patients are a lower-risk category. Many experienced surgeons perform routine spays and neuters without prophylactic antibiotics and achieve excellent outcomes.

Discuss with your vet whether SAP is indicated for your specific patient.

Why is cefazolin given by injection rather than as a pill?

For SAP, achieving tissue concentrations before incision requires IV administration to deliver the drug rapidly into circulation and tissues.

Oral antibiotics are absorbed more slowly and variably and cannot reliably achieve adequate tissue concentrations at the correct time.

Can the same antibiotic used for prophylaxis be used to treat infection if one develops?

Yes in principle, but culture and sensitivity should guide selection. The prophylactic agent may not cover the infecting organism; appropriate treatment requires culture results.

Why not use a broad-spectrum antibiotic like enrofloxacin for prophylaxis to cover more organisms?

ENOVAT 2025 advises against fluoroquinolones for routine SAP. Their resistance classification makes prophylactic use disproportionate; using them for prophylaxis depletes their effectiveness for resistant infections where they are needed.

My dog had a 4-hour TPLO. Should antibiotics continue for a week after?

No. Studies consistently show no SSI benefit from extending prophylaxis beyond 24 hours in clean orthopedic procedures. Intraoperative redosing maintains concentrations during the procedure. Postoperative continuation only adds resistance pressure.

What if cefazolin is not available at my clinic?

ENOVAT 2025 recommends parenteral amoxicillin/clavulanic acid or cefuroxime. Note cefuroxime failed uniformly in pharmacokinetic modeling for standard intervals. Amoxicillin/clavulanic acid requires redosing every 1.5 hours. Discuss available options with your distributor.

Resources

ENOVAT. 2025 Guidelines for Surgical Antimicrobial Prophylaxis in Dogs and Cats. onlinelibrary.wiley.com
WSAVA. Surgical Antimicrobial Prophylaxis in Dogs. wsava.org
Acta Veterinaria Scandinavica. Antimicrobial Prophylaxis in Clean Orthopaedic and Neurosurgeries in Dogs. springer.com
Worms and Germs Blog. Surgical Antimicrobial Prophylaxis Guidelines in Dogs and Cats. wormsandgermsblog.com
University of Melbourne. Companion Animal Surgical Guidelines. science.unimelb.edu.au

X min read

We'd love you to
Join Us!

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Taking Great TPLO Radiographs

Click Below to Watch Live Video Demos

We'll send you a Free Wall Poster with all the steps

Now that you are a pro at TPLO rads

Let's take your infection control to the next level

Watch these videos!

Step #1

Getting Ready

Ensuring a clean surgical field starts with proper skin preparation. This video demonstrates the best practices for:

Shaving the patient – Achieving a close, even shave while minimizing skin irritation
The Dirty Scrub – The initial skin prep step to remove surface debris and reduce bacterial load before the sterile scrub.

Following these techniques helps reduce infection risk and improve surgical outcomes. Watch the video to see how it’s done effectively!

Step #2

Reduce Your Risks

Many surgeons are shocked to find out that their patients are not protected from biofilms and resistant bacteria when they use saline and post-op antibiotics.

That’s Where Simini Comes In.

‍Why leave these risks and unmanaged? Just apply Simini Protect Lavage for one minute. Biofilms and resistant bacteria can be removed, and you can reduce two significant sources of infection.

Protect Your Patients

Step #3

Take the Course

Preventing surgical infections is critical for patient safety and successful outcomes. This course covers:

Aseptic techniques – Best practices to maintain a sterile field.
Skin prep & draping – Proper methods to minimize contamination.
Antibiotic stewardship – When and how to use perioperative antibiotics effectively.

Stay up to date with the latest evidence-based protocols. Click the link to start learning and earn CE credits!

Things to know

Joint Replacement Surgery in Dogs: Success Rates and Expectations

Best Practices

5 min read

Joint Replacement Surgery in Dogs: Success Rates and Expectations

Discover success rates, recovery time, and expectations for joint replacement surgery in dogs. Learn when it’s the right option for your pet

Joint replacement surgery is the most advanced intervention in veterinary orthopaedics.

For dogs with severe, irreversible joint disease that has not responded to medical management, it can transform quality of life in a way no medication or rehabilitation can match.

Quick answer: Total hip replacement in dogs achieves 90 to 95% good-to-excellent outcomes. It is indicated for end-stage hip OA unresponsive to conservative management. Recovery requires 8 to 12 weeks of strict rest. Cost is $4,000 to $7,000 per joint.

Key takeaways

THR achieves 90 to 95% good-to-excellent function in appropriately selected dogs; most need no further pain medication after recovery
THR complication rate is 5 to 10%: post-operative luxation is most common, occurring in 3 to 5% of cases
THR is indicated for end-stage hip dysplasia OA not responding to conservative management; it is a salvage procedure, not first-line
Total elbow replacement is available at only a few specialist centres and has higher complication rates than THR
Strict activity restriction for 8 to 12 weeks post-surgery is essential owner compliance is one of the most important factors in outcome
Cost is $4,000 to $7,000 per joint at specialist centres; bilateral cases require two separate procedures

Total hip replacement (THR)

What it is

Total hip replacement removes the femoral head and acetabulum and replaces both with prosthetic implants a metal femoral stem with a ball, and a metal or polyethylene acetabular cup.

The new joint provides smooth, pain-free movement without the bone-on-bone contact of advanced hip OA.

Canine joint replacement technology and surgeon expertise have advanced greatly over the past 20 years. Only a few relatively small companies worldwide supply the technology for joint replacement surgery, and a relatively low number of surgeons have the expertise to consistently perform the procedure with a high degree of proficiency.

Success rates

The success rate for total hip replacement in dogs is very high between 90% and 98%. Most dogs experience significant pain relief, improved movement, and a better quality of life.

Studies show more than 90 to 95% of dogs have good to excellent function with THR, providing years of pain-free activity that otherwise would not have been possible.

A large registry study reviewed 2,375 THRs in 1,852 dogs over 10 years. The majority of cases were hip dysplasia with osteoarthritis.

Owner-reported outcomes were strongly positive in the vast majority of cases.

Complications

The typical overall complication rate following a THR varies, with a reported overall average complication rate of 5 to 10%. The more commonly reported complications include postoperative luxation, often associated with a fall or excessive activity.

The most frequent complication is hip dislocation, occurring in approximately 3 to 5% of cases. Other potential complications include fracture, nerve injury, or infection.

Most complications are managed without losing the implant. Catastrophic failure requiring implant removal is uncommon in experienced hands.

Candidates for THR

Good candidates:

Dogs with hip dysplasia and severe OA causing significant pain and reduced quality of life
Dogs that have failed conservative management (weight management, NSAIDs, rehabilitation)
Dogs with adequate bone stock to accept the implant
Dogs whose owners can commit to strict post-operative restriction

Not candidates:

Dogs with neurological disease affecting the same limb
Dogs with active infection in or near the joint
Dogs with severe muscle atrophy at time of surgery
Dogs with other significant orthopaedic disease in the same limb

Candidates for THA must not have other orthopaedic disease in the limb to be operated, as well as clients willing to perform the postoperative care necessary for a successful outcome.

Implant systems

Two main systems exist: cemented (implant fixed with bone cement) and cementless (press-fit, relying on bone ingrowth for long-term fixation).

Cementless systems are now more widely used and have longer documented longevity in dogs.

In most cases, the replaced hip will last for your pet's lifetime.

Total elbow replacement

Total elbow replacement (TER) is significantly more complex than THR and available at only a small number of specialist centres worldwide.

Total elbow arthroplasty continues to be under development. The system is technically demanding and may be the reason it is not used more widely by veterinary surgeons.

The T.A.T.E. elbow system is the most widely used current system.

Indications include end-stage elbow OA from fragmented medial coronoid process disease or other elbow dysplasia conditions that have exhausted all other options.

Complication rates for total elbow replacement are higher than THR.

It is a salvage procedure reserved for dogs that have failed all other surgical and medical options and where FHO-equivalent (head and neck excision) is not anatomically applicable.

Cost

The cost of a total hip replacement typically ranges from $4,000 to $7,000. Elbow and knee replacements may fall within a similar or slightly higher range due to complexity. Although the upfront cost is high, joint replacement can eliminate the need for ongoing pain medications, frequent vet visits, or repeated surgeries.

Bilateral THR (both hips) nearly doubles the cost. Most surgeons stage bilateral cases 8 to 16 weeks apart rather than performing both simultaneously.

Recovery

Activity restrictions are significant during the initial 8 to 12 weeks of recovery. Your pet should not be allowed to be off leash, run, or jump. Your pet should be strictly confined to a small indoor area with non-slippery floors or in a crate. Most pets are ready to resume regular exercise and activities after 12 weeks of recovery.

Recovery milestones:

Days 1 to 14: crate rest, leash-only bathroom walks, pain medication
Weeks 2 to 8: progressive short leash walks, rehabilitation exercises begin
Weeks 8 to 12: radiographic recheck, gradual activity increase if healing is confirmed
Month 3 to 6: peak recovery; most dogs reach full or near-full function

Rapid recovery and high performance are expected not just hoped for in current veterinary orthopaedic surgery.

For the full rehabilitation guide covering the post-joint-replacement recovery period, see physical therapy and rehabilitation: how referring vets can support recovery.

For the pain management approach used alongside joint replacement recovery, see orthopedic pain management in pets: multimodal approaches. For the referral decision, see when to refer for orthopedic surgery.

Frequently asked questions

Is my dog a candidate for total hip replacement?

The key criteria are: end-stage hip OA with significant pain and failure of conservative management.

Additionally: no neurological disease or orthopaedic disease in the same limb, adequate bone stock, and an owner able to comply with strict activity restriction.

A board-certified orthopaedic surgeon will assess suitability at a specialist consultation.

How long does a dog live after hip replacement?

The implant is designed to last the dog's lifetime. Most dogs require no further pain medication after recovery and return to near-normal activity.

The procedure does not shorten lifespan and typically significantly improves quality of remaining life.

What happens if the hip dislocates after surgery?

Post-operative luxation occurs in approximately 3 to 5% of cases, usually associated with excessive activity or a fall.

It is managed by manual reduction under anesthesia, followed by a period of restricted activity. In some cases, revision surgery is needed.

This is why strict activity restriction in the first 8 weeks is critical.

Is hip replacement better than FHO (femoral head ostectomy)?

For medium and large breeds, THR generally produces superior outcomes compared to FHO better gait, less muscle atrophy, and more reliable function.

FHO is a reasonable salvage option for small and toy breeds where functional outcomes are more reliable, or when the cost of THR is prohibitive.

Can both hips be replaced at the same time?

Rarely. Most surgeons stage bilateral THR 8 to 16 weeks apart to allow recovery of one limb before stressing the other.

Operating both simultaneously significantly increases anesthetic time and complication risk, and leaves the dog with no sound limb during recovery.

Resources

AVES. Total Hip Replacement: A Complete Information Guide. austinvets.com
TVMF. Outcomes for Total Joint Replacement in Dogs and Cats. tvmf.org
PMC. Outcomes and Complications Reported from a Multiuser Canine Hip Replacement Registry over a 10-Year Period. ncbi.nlm.nih.gov
DVM360. Total Joint Replacement of the Elbow and Hip. dvm360.com
Animal Orthopaedic Clinic. Total Joint Replacement. animalorthoclinic.com

Read Blog Post

Orthopedic Pain Management in Pets: Multimodal Approaches

Best Practices

5 min read

Orthopedic Pain Management in Pets: Multimodal Approaches

Learn how multimodal pain management improves recovery in pets after orthopedic surgery using meds, rehab, and at-home care

Pain management after orthopedic surgery is not a single drug it is a strategy.

Orthopedic pain involves multiple pathways: peripheral inflammation at the surgical site, spinal sensitization, and ongoing nociceptive signals from healing tissue. Addressing all of these requires more than one type of medication.

Quick answer: Multimodal analgesia combines NSAIDs, opioids, gabapentin, local anesthetic blocks, and non-drug therapies such as cryotherapy and laser. Using multiple agents at lower doses reduces side effects while achieving better pain control than any single drug at high dose.

Key takeaways

NSAIDs are the cornerstone of post-orthopedic pain management; they target peripheral inflammation and are the most consistently effective class
Multimodal analgesia outperforms monotherapy: a 2026 study found local anesthetics combined with opioid and NSAID provided the best pain control
Preemptive analgesia before surgery reduces central sensitization and lowers post-op pain scores and total drug requirements
Gabapentin is most useful for nerve-mediated and chronic pain; evidence for acute orthopedic pain alone is limited
Tramadol has poor evidence: studies found no clinical benefit for OA pain; it is no longer a recommended primary analgesic
Non-drug modalities (cold therapy, laser, rehab) are additive to pharmacological control and reduce total drug burden

Why single-drug pain management falls short

Orthopedic pain in dogs is not a single signal from a single location. It involves:

Peripheral sensitization: inflammatory mediators (prostaglandins, cytokines) at the surgical site lower the pain threshold locally
Central sensitization: repeated pain signals cause "wind-up" in the spinal cord, amplifying the pain response
Nociceptive pain: from tissue damage, implants, and ongoing healing
Neuropathic components: nerve stretch or compression, particularly in fracture repairs and spinal-adjacent procedures

Managing this pain with a single drug, like an NSAID alone, is often not enough to keep pets comfortable. A multimodal approach uses a combination of medications and therapies that work on different parts of the pain pathway.

The pharmacological components

NSAIDs

NSAIDs are the cornerstone of pain management in OA patients who can take them safely. NSAIDs provide anti-inflammatory and pain-relieving effects that target affected joints, helping restore function.

Common veterinary NSAIDs: meloxicam, carprofen, robenacoxib, grapiprant. All require baseline blood work (kidney and liver function) before use and monitoring during long-term administration.

NSAIDs should not be combined with corticosteroids or with each other. A washout period of 5 to 7 days is required when switching between NSAIDs.

Preemptive analgesia

Giving pain medications before surgery reduces central sensitization, or "wind-up" pain, which makes pain harder to treat later. It leads to smoother recovery, lower drug needs post-op, and better comfort for pets during and after orthopedic procedures.

Pre-operative NSAID administration, opioid premedication, and local anesthetic blocks administered before surgical incision all reduce the total pain burden the patient experiences.

Opioids

Combinations: NSAIDs and opioids can be used together for enhanced analgesia.

Opioids (methadone, buprenorphine, hydromorphone) are used perioperatively and in the immediate post-operative period for moderate-to-severe pain. They act centrally, complementing the peripheral action of NSAIDs.

Multimodal analgesia combining local anesthetics, hydromorphone, and meloxicam provided the best pain control in small-breed dogs after orthopedic surgery across a retrospective analysis of 205 dogs.

Gabapentin

Gabapentin is sometimes used as an adjunct pain medication; its best application may be for neuropathic pain.

Gabapentin (brand names: Neurontin, Aclonium) is one of several medications used to complement NSAIDs in multimodal plans.

Gabapentin is also useful for managing the restlessness and anxiety that can accompany post-surgical pain and confinement. Its sedative properties can support rest during the critical early recovery window.

Local anesthetic blocks

Locoregional anesthesia (epidural, nerve blocks, intra-articular injection) provides targeted pain control at the surgical site. Local blocks are effective for acute pain.

For chronic pain, periodic local blocks may be considered if appropriate.

Loco-regional blocks reduce the amount of systemic opioid required and can provide hours of post-operative analgesia.

Amantadine

Amantadine is one of several medications used to complement NSAIDs in multimodal therapy plans for canine OA.

Amantadine is an NMDA receptor antagonist that reduces central sensitization.

It is particularly useful in chronic pain cases where "wind-up" is established, and in patients whose NSAIDs are not providing adequate relief alone.

Monoclonal antibodies (bedinvetmab / Librela)

Bedinvetmab (Librela) is a new option, now available in many countries. It is given as a once-a-month injection. It binds to nerve growth factor (NGF), disrupting pain signal transmission and decreasing inflammation. This medication is shown to be effective with minimal side effects.

This class represents a new approach for long-term OA pain management following orthopedic surgery.

Tramadol not recommended

Studies have shown tramadol to be ineffective in treating OA. In one study, treatment with tramadol provided no clinical benefit for dogs with OA of the elbow or stifle joint.

Tramadol's use in canine analgesia has significantly declined following clinical trial evidence showing poor efficacy. It is no longer a recommended primary analgesic for orthopedic pain in dogs.

Non-pharmacological components

Non-drug therapies include cold and heat therapy, physical rehabilitation, hydrotherapy, acupuncture, laser therapy, and massage.

Cryotherapy (cold therapy): applied for 10 to 15 minutes to the surgical site in the first 48 to 72 hours. Reduces local inflammation and provides analgesia through nerve conduction slowing.

Therapeutic laser: reduces inflammation and promotes tissue healing. Can be initiated immediately after surgery at the incision site.

Rehabilitation exercises: passive range-of-motion, controlled walking, and progressive strengthening reduce pain through improved joint mechanics and muscle support.

Acupuncture: some evidence for adjunct pain relief in OA; most useful as part of a comprehensive multimodal plan.

For the full rehabilitation guide, see physical therapy and rehabilitation: how referring vets can support recovery. For post-op home care, see post-op home care for pets after orthopedic surgery.

Frequently asked questions

What is multimodal analgesia in dogs?

Multimodal analgesia uses two or more drugs or therapies that target different parts of the pain pathway simultaneously.

The aim is better pain control at lower doses of each individual agent, which reduces side effects while improving efficacy.

It is the current standard of care for orthopedic pain management in veterinary medicine.

Can I give my dog human pain relievers like ibuprofen after orthopedic surgery?

Never. Ibuprofen and acetaminophen are toxic to dogs. Even a single dose can cause gastrointestinal hemorrhage, kidney failure, or liver failure.

Only use pain medications specifically prescribed by your veterinarian for your dog.

How long will my dog need pain medication after orthopedic surgery?

Acute pain management (opioids, high-dose NSAIDs) typically lasts 5 to 14 days post-surgery. Ongoing NSAID therapy for OA management may continue for months or long-term depending on the joint and the procedure.

Your vet will reassess at each recheck appointment.

My dog seems painful even with medication. What should I do?

Contact your vet. Pain that breaks through prescribed medication means the current protocol is insufficient.

A medication adjustment, a dose increase within safe limits, or the addition of another agent (gabapentin, amantadine) may be needed. Do not increase NSAID doses without veterinary guidance.

Is gabapentin effective for post-surgical orthopedic pain in dogs?

Gabapentin's evidence for acute orthopedic pain is limited. Its most established role is in neuropathic and chronic pain.

In the post-surgical context it is most useful for managing restlessness, anxiety, and sleep disruption, and for cases with a neuropathic component.

It is usually prescribed as an adjunct, not a primary analgesic.

Resources

VCA Animal Hospitals. Multi-Modal Pain Management. vcahospitals.com
Today's Veterinary Practice. Multimodal Pain Management for Canine Osteoarthritis. todaysveterinarypractice.com
Today's Veterinary Practice. Instituting a Multimodal Pain Management Protocol. todaysveterinarypractice.com
MDPI Animals. Multimodal Analgesia Provides Superior Postoperative Pain Control Following Orthopedic Surgery in Small-Breed Dogs. mdpi.com
NCBI StatPearls. Multimodal Postoperative Pain Control After Orthopaedic Surgery. ncbi.nlm.nih.gov

Read Blog Post

Best Practices

5 min read

Minimally Invasive Orthopedic Surgery: What General Practitioners Should Know

Learn when to refer, how to guide clients, and what every GP should know about minimally invasive orthopedic surgery in veterinary practice

Understanding MIS helps general practitioners recognize which patients may benefit from it, counsel owners accurately about recovery expectations, and make timely referrals to surgeons who offer it.

Quick answer: Veterinary MIS uses arthroscopy or fluoroscopy through small incisions rather than open dissection. Arthroscopy recovery takes 2 to 4 weeks vs 6 to 12 weeks for open surgery. MIS requires specialist equipment not widely available.

Key takeaways

MIS uses small incisions and camera-based imaging instead of large open dissections, reducing tissue trauma
Arthroscopy is the most common veterinary MIS, used for joint diagnosis and treatment including OCD, meniscal tears, and CCL
Recovery from arthroscopy is typically 2 to 4 weeks versus 6 to 12 weeks for open joint surgery
MIS is not available at most general practices: it requires specialized equipment and significant training
Early referral for MIS-amenable conditions improves outcomes: arthroscopy for OCD or early joint disease before secondary arthritis develops
Open surgery remains better for conditions requiring soft tissue reconstruction, infected fields, or complex anatomical access

What is minimally invasive surgery?

The key tools:

Arthroscope: a thin rigid telescope with a light source and camera, inserted into a joint through a small portal (typically 3 to 5 mm)
Fluoroscope: real-time X-ray imaging used to guide implant placement in fracture repair without large incisions
Laparoscope: used for abdominal MIS (laparoscopic spay, liver biopsy, adrenalectomy)
Thoracoscope: used for chest cavity access

Arthroscopy: the most common veterinary MIS

CARE Vets: "Joints commonly scoped in canines include the shoulder, elbow, hip, stifle, and tarsus."

Arthroscopy serves both diagnostic and therapeutic functions:

Diagnostic arthroscopy

This is particularly valuable for:

Confirming partial or complete CCL tears
Assessing meniscal injury concurrent with CCL rupture
Evaluating joint surface damage in elbow dysplasia
Staging OCD lesions before deciding on open vs. arthroscopic treatment

Therapeutic arthroscopy

Common therapeutic arthroscopic procedures:

OCD (osteochondrosis dissecans) treatment: removal of the OCD flap and curettage of the subchondral bone bed
Meniscal tear management: partial meniscectomy under direct vision
Elbow fragmented coronoid process (FCP) removal
Ununited anconeal process (UAP) removal or fixation
Joint lavage and debridement: for early septic arthritis or inflammatory joint disease
CCL assessment: most surgeons perform arthroscopy concurrent with TPLO to assess meniscal integrity and perform meniscectomy if needed

MIS fracture repair

Laparoscopy in soft tissue and oncology cases

While not strictly orthopedic, laparoscopy is increasingly used for procedures previously done open:

Laparoscopic ovariectomy (spay): CARE Vets: "Laparoscopy is a minimally invasive technique performed in organs located in the abdomen and pelvis." Dogs undergoing laparoscopic spay return to activity significantly faster than with open spay.
Liver, spleen, and kidney biopsy: organ sampling without large incisions
Adrenalectomy: NCBi (MIS in oncology): "Laparoscopic adrenalectomy is a common procedure in both human and veterinary medicine for non-invasive adrenal tumors."
Laparoscopic splenectomy: NCBi: "Proposed benefits include decreased pain and decreased rate of infection" compared to open splenectomy.

Benefits vs. limitations of MIS

Benefits

Maine MVMC: "Enhanced visualization and precision: MIS techniques provide superior visualization of surgical sites using advanced imaging technologies."

Limitations

Other limitations:

Equipment cost: arthroscope systems represent a significant capital investment; not available at most general practices
Learning curve: CARE Vets: "For the surgeon to be efficient at these procedures, considerable technical training is necessary." MIS requires substantial case volume before proficiency is established
Patient size: arthroscopy in very small dogs (under 3 to 4 kg) is technically challenging due to joint size

When to refer for MIS evaluation

Refer early for MIS evaluation when:

A dog has clinical signs consistent with OCD (young large-breed dog with unilateral or bilateral forelimb lameness)
Elbow dysplasia is suspected and advanced imaging or surgical treatment is being considered
CCL assessment is needed before TPLO to evaluate meniscal status
Early septic arthritis where arthroscopic lavage may be preferred to open arthrotomy
Laparoscopic spay is a client preference or medically preferred

Early referral principle: SustainableVet: "By identifying suitable candidates early and sending complete diagnostic information, GPs help surgical teams plan effectively."

Frequently asked questions

How does arthroscopy compare to open surgery for my dog's elbow problem?

Is my dog too small for arthroscopy?

Will my dog still need a TPLO if arthroscopy is used?

How long does recovery take after arthroscopy compared to open joint surgery?

Does laparoscopic spay cost more than open spay?

Can MIS be used if my dog has a joint infection?

Resources

SustainableVet. Minimally Invasive Orthopedic Surgery: What GPs Should Know. sustainablevet.org
SustainableVet. Arthroscopy vs. Open Surgery. sustainablevet.org
CARE Vets. Minimally Invasive Surgical Techniques. carecharlotte.com
Maine Veterinary Medical Center. Minimally Invasive Techniques Transforming Veterinary Surgical Care. mvmc.vet
NCBi. Use of Minimally Invasive Surgery in the Diagnosis and Treatment of Cancer in Dogs and Cats. ncbi.nlm.nih.gov

Read Blog Post

Best Practices

5 min read

Surgical Antimicrobial Prophylaxis Guide for Vet Surgeons

Discover the best practices in surgical antimicrobial prophylaxis for veterinary surgeons—guidelines, antibiotic choices, timing, and infection prevention tips

Surgical antimicrobial prophylaxis (SAP) is the use of antibiotics before or during surgery to reduce the risk of surgical site infection. It is not treatment there is no infection to treat.

The goal is to achieve adequate drug concentrations in the tissues at the time bacteria first enter the wound.

Done correctly, SAP is an evidence-based infection control tool. Done incorrectly (wrong timing, wrong drug, wrong duration), it provides no benefit and contributes to resistance.

Quick answer: Cefazolin 22 to 25 mg/kg IV is the first-choice SAP drug, given 30 minutes before incision and redosed every 2 hours. Stop within 24 hours for clean cases. Many clean procedures in healthy patients do not need SAP.

Key takeaways

Cefazolin 22 to 25 mg/kg IV is the first-choice prophylactic drug for most clean and clean-contaminated procedures
Give within 30 minutes before the first incision: ENOVAT 2025 specifies 30 to 60 minutes pre-incision
Repeat every 2 hours intraoperatively: cefazolin has a short half-life and long procedures require redosing
Stop within 24 hours: extending prophylaxis in clean cases provides no SSI benefit and selects for resistant organisms
Many clean procedures under 90 minutes in healthy patients do not require SAP: widespread overuse is documented in veterinary surgery
Fluoroquinolones and aminoglycosides should not be used for SAP: their resistance classification makes routine prophylactic use inappropriate

What SAP is and is not

SustainableVet: "SAP is not used to treat existing infections but to prevent new ones from developing. Using SAP properly reduces complications, speeds up healing, and improves surgical outcomes."

The fundamental concept: ENOVAT 2025: "The basic concept of SAP is that therapeutic levels should be present at the surgical site during the period of highest infection risk.

This starts at the time of the first incision and ends at an ill-defined point after final closure."

Worms and Germs Blog: "It's widely accepted that there is tremendous overuse of antimicrobials in this context in both human and veterinary medicine.

In a large percentage of cases, use of antimicrobials is actually unnecessary and is based more on habit or fear versus actually helping the patient."

When SAP is indicated

The decision is based on wound classification and patient risk factors:

Wound class	SAP indicated?
Clean, short procedure, healthy patient	Generally no; consider for orthopedic implants
Clean with implants (TPLO, fracture repair)	Yes
Clean, ASA 3+ or immunocompromised	Consider
Clean-contaminated	Yes
Contaminated	Yes
Dirty	Therapeutic antibiotics, not prophylaxis

WSAVA SAP Guidelines: "Are prophylactic antibiotics indicated for this surgery?" is the first step. Not all procedures require SAP.

Worms and Germs Blog: "Antimicrobial prophylaxis is indicated in some surgical patients to reduce the risk of SSI, but in a large percentage of cases use is actually unnecessary."

Acta Veterinaria Scandinavica (Helsinki study): "Even complete omission of antimicrobials was not associated with increased risk for SSI" in clean orthopedic and neurosurgeries in low-risk patients.

Drug selection

First-line: cefazolin

ENOVAT 2025: "Cefazolin, a first-generation cephalosporin, is the most widely recommended drug for SAP in human medicine and is a recommended option in dogs and cats where it is available."

Why cefazolin:

Excellent gram-positive coverage (Staphylococcus, Streptococcus) the dominant SSI pathogens
Adequate gram-negative coverage
Long enough half-life for practical intraoperative redosing intervals (every 2 hours)
Extensive safety and pharmacokinetic data in dogs and cats
Low cost, widely available

NCBi pharmacokinetic study: cefazolin at 25 mg/kg IV was effective against pathogens with MIC 2 mg/L or less across a wide range of canine patient populations.

Dose: 22 to 25 mg/kg IV (WSAVA, ENOVAT).

Alternatives when cefazolin is unavailable

ENOVAT 2025: "Cefuroxime failed uniformly while ampicillin or amoxicillin may be effective, but only if readministered every 1.5 hours."

What not to use

Timing

Pre-incision administration

ENOVAT 2025: "To achieve therapeutic levels by the start of the procedure, the drug should be administered intravenously 30 to 60 minutes prior to the anticipated time of first incision."

Acta Veterinaria Scandinavica: "The antimicrobial was given intravenously 30 to 60 minutes before the estimated time of incision."

SustainableVet: "Antibiotics should be given 30 to 60 minutes before the surgical incision. This timing ensures effective tissue drug levels when bacteria may enter the wound."

University of Melbourne Companion Animal Guidelines: "Intravenous antimicrobials: administer 30 to 60 minutes prior to surgery."

Intraoperative redosing

ENOVAT 2025: "Intraoperative dosing is necessary to maintain therapeutic levels for longer procedures or where there was a delay from antimicrobial administration to the start of the procedure.

Intraoperative dosing of any time-dependent antimicrobial such as beta-lactams should be considered every two half-lives of the drug."

WSAVA: cefazolin redosing interval: "2 hours or earlier (22 mg/kg) or 3 hours (25 mg/kg)."

For a TPLO lasting 3 hours, an initial pre-incision dose and one or two intraoperative redoses are typically required.

Duration

Stop within 24 hours for clean procedures

SustainableVet: "Clear guidelines suggest giving antibiotics within 60 minutes before the first incision and stopping them within 24 hours unless there are signs of infection."

NCBi (TPLO antibiotic comparison study): "Results showed no difference in SSI rates" between perioperative-only and extended postoperative antibiotic groups for clean TPLO cases.

"Eliminating postoperative antibiotic medication in a clean orthopedic procedure helps to reduce antibiotic resistance."

Extending prophylaxis beyond 24 hours in clean procedures selects for resistant organisms, does not reduce SSI rates, and increases costs.

Antimicrobial stewardship

Worms and Germs Blog: "Clinical guidelines are an advancement in care, and the field of antimicrobial guideline development has progressed significantly in recent years.

We've moved from primarily expert-opinion-based guidelines to evidence-based, structured guideline development."

Stewardship checklist for SAP:

Is SAP indicated for this wound class and patient?
Is cefazolin available? If not, what is the evidence-based alternative?
Has the drug been given within 30 to 60 minutes of incision?
Has intraoperative redosing been planned for procedures over 2 hours?
Is there a clear plan to stop antibiotics within 24 hours if no infection evidence?
Will culture and sensitivity be obtained if infection develops, rather than empiric escalation?

For the scrub and aseptic technique guide, see veterinary surgical hand scrub protocol.

Frequently asked questions

My dog is having a routine spay or neuter. Does it need antibiotics?

Discuss with your vet whether SAP is indicated for your specific patient.

Why is cefazolin given by injection rather than as a pill?

For SAP, achieving tissue concentrations before incision requires IV administration to deliver the drug rapidly into circulation and tissues.

Oral antibiotics are absorbed more slowly and variably and cannot reliably achieve adequate tissue concentrations at the correct time.

Can the same antibiotic used for prophylaxis be used to treat infection if one develops?

Yes in principle, but culture and sensitivity should guide selection. The prophylactic agent may not cover the infecting organism; appropriate treatment requires culture results.

Why not use a broad-spectrum antibiotic like enrofloxacin for prophylaxis to cover more organisms?

My dog had a 4-hour TPLO. Should antibiotics continue for a week after?

What if cefazolin is not available at my clinic?

Resources

ENOVAT. 2025 Guidelines for Surgical Antimicrobial Prophylaxis in Dogs and Cats. onlinelibrary.wiley.com
WSAVA. Surgical Antimicrobial Prophylaxis in Dogs. wsava.org
Acta Veterinaria Scandinavica. Antimicrobial Prophylaxis in Clean Orthopaedic and Neurosurgeries in Dogs. springer.com
Worms and Germs Blog. Surgical Antimicrobial Prophylaxis Guidelines in Dogs and Cats. wormsandgermsblog.com
University of Melbourne. Companion Animal Surgical Guidelines. science.unimelb.edu.au

Read Blog Post

Post-Surgical Complications in Referred Pets

Best Practices

5 min read

Recognize and Manage Post-Surgical Complications in Referred Patients

Learn how to recognize and manage common post-surgical complications in referred pets with clear steps for follow-up, treatment, and communication

When a dog is discharged from a specialist after orthopedic or complex soft tissue surgery, the referring veterinarian and the owner become the first line of detection for complications. Surgeons rely on accurate observation and timely reporting from both.

Most complications after referral surgery are manageable when caught early. Missing them until they escalate is what turns a treatable problem into a crisis.

Quick answer: Common complications after referral surgery include surgical site infection, seroma, wound dehiscence, persistent pain, and behavioral changes. Implant failure, deep infection, and non-healing wounds require re-referral. Contact the surgical team promptly for anything beyond local wound care.

Key takeaways

Referring vets are often the first to see post-surgical complications during follow-up visits and owner calls
The discharge summary must be read in full: medication errors and missed complications often stem from incomplete review
Suture removal rechecks begin at 10 to 14 days; orthopedic cases need imaging at 6 to 8 weeks
Implant failure, deep infection, and non-healing wounds require re-referral rather than local management alone
Behavioral changes (hiding, aggression, vocalizing) often signal pain before visible complications appear
Clear documentation at every follow-up allows both the referring vet and specialist to track the case accurately

The referring vet's role after specialist discharge

SustainableVet: "The role of a referring veterinarian doesn't end when the surgery is done. The period after surgery is one of the most important times for the patient's recovery, and smooth communication between the surgical team and the referring vet is crucial."

After the specialist discharges the patient, the referring vet typically manages suture removal, post-surgical recheck examinations, medication management, client communication, and first-line detection of complications.

SustainableVet: "After the specialist performs the procedure, the referring veterinarian often monitors the patient's healing, manages medications, and supports the client with follow-up care. Without clear updates and guidance, this handoff can lead to confusion, missed issues, or delayed treatment."

Reading the discharge summary

The most preventable cause of post-referral complications is incomplete review of the discharge summary.

SustainableVet: "Skimming or missing parts of the summary can lead to medication errors, delayed care, or overlooked signs of complications. Examine the list of prescribed medications closely, noting the dosage and duration. Pay attention to any notes about potential complications the surgeon is concerned about."

What to extract from every discharge summary:

Full medication list (drug, dose, frequency, duration)
Recheck timeline (suture removal, imaging dates)
Complications the surgeon flagged as possible for this specific case
Activity restrictions and when they can be modified
Criteria for contacting the surgical team directly

SustainableVet: "If anything in the notes is unclear, contact the surgeon before the pet's follow-up visit. It's better to clarify early than to risk confusion later."

Follow-up visit schedule

SustainableVet: "Follow-up visits usually begin 10 to 14 days after surgery for incision checks and suture removal. More complex cases, like orthopedic surgeries, may need additional visits at 6 to 8 weeks for imaging and rehab adjustments."

Soft tissue cases: day 10 to 14 for incision recheck and suture removal; further rechecks as indicated.

Orthopedic cases: day 10 to 14 for incision and medication review; week 6 to 8 for radiographs assessing bone healing and implant position; week 12 to 16 for complex cases.

SustainableVet: "During each visit, examine the incision site, check for swelling or pain, review mobility, and ensure the pet is healing as expected."

Common complications after referral surgery

Surgical site infection

SustainableVet: "Common issues include infection, swelling, bruising, wound reopening, fluid buildup, or implant-related problems in orthopedic cases."

Signs: increasing redness after day 3, yellow or green discharge, warmth, swelling not improving after day 5, foul odor, pain worsening rather than improving.

Local management: culture-guided antibiotics and wound care for shallow infections. PetPlace: "Wound infection that extends deeper into the tissues often requires surgery in addition to the antibiotic."

Re-refer for: deep infection not responding to antibiotics within 48 to 72 hours, infection near or involving an implant, implant exposure.

Seroma and hematoma

Soft fluctuant swelling beneath the incision. SustainableVet: "A seroma is usually soft, fluctuating, and not particularly hot or painful. Infection tends to produce heat, redness, and a firmer or more diffuse swelling, often with discharge."

Small seromas often resolve with strict rest. Larger seromas may need drainage. FNA confirms the nature of the fluid if clinical assessment is inconclusive.

Wound dehiscence

SustainableVet: "Wound dehiscence means the incision has come open, either partially or fully. It can happen when sutures break down, when infection weakens the tissue, when the dog is too active, or when licking has damaged the closure."

Partial dehiscence requires same-day attention. Full dehiscence with tissue exposure is a surgical emergency. Cover with a clean, damp cloth and go to the vet immediately.

Re-refer for: dehiscence of a complex closure after orthopedic or abdominal surgery.

Persistent pain or lameness

SustainableVet: "Persistent pain or lameness: ongoing discomfort beyond the expected recovery period can signal internal complications or implant issues."

In orthopedic cases, lameness persisting beyond the expected timeline may indicate implant loosening, bone healing delay, or periimplant infection. Radiograph before making treatment decisions.

Behavioral changes

SustainableVet: "Behavioral changes: hiding, aggression, vocalizing, or reluctance to move may reflect pain or anxiety." These often precede visible complications. Do not dismiss behavioral regression in a previously progressing patient.

When to contact the surgical team

SustainableVet: "If there are signs of implant failure, deep infection, or non-healing wounds, the case should be sent back to the surgeon. Immediate communication helps avoid delays in treatment and supports better outcomes."

Contact the surgical team for: any complication involving an orthopedic implant, deep infection not responding to first-line treatment, wound dehiscence of a complex closure, lameness or pain worsening at expected improvement timepoints, or any complication beyond local wound care capacity.

SustainableVet: "Timely referral prevents delays in advanced care and keeps outcomes favorable."

For the owner-facing complications guide, see signs of complications after soft tissue surgery. For the wound care protocol to review with clients, see wound care after surgery. For the full recovery care overview, see soft tissue surgery care for dogs.

Frequently asked questions

Should I treat complications locally or call the surgeon first?

For surface wound issues (minor infection, small seroma), local management with documentation is appropriate. For implant involvement, deep infection, or dehiscence of complex closures, contact the surgical team before acting.

What should I tell owners at the referral recheck appointment?

Review discharge instructions. Confirm medication compliance, E-collar use, and activity restriction. Assess and photograph the wound. Set clear expectations for the next recheck and which signs require an earlier call.

How do I distinguish a seroma from an infected pocket?

SustainableVet: "A seroma is soft, fluctuating, and not hot or painful. Infection produces heat, redness, and firmer swelling, often with discharge." FNA confirms the difference when clinical assessment is inconclusive.

The owner says the dog is fine but the incision looks concerning. Who is right?

Trust the physical examination over owner assessment. Owners naturally minimize signs. Document your findings, photograph the incision, and manage based on clinical evidence.

What imaging is needed at the 6-week orthopedic recheck?

Radiographs of the operative region in the same views as the post-operative images from the discharge summary. Compare implant position, bone healing, and periimplant margins against the surgical baseline.

How should I document follow-up findings for the surgical team?

Photograph the incision at every visit. Record date, appearance, discharge presence, pain score, and mobility assessment. If re-referral becomes necessary, this documentation allows the surgeon to assess progression without needing to reconstruct the timeline from memory.

Resources

SustainableVet. Post-Surgical Complications in Referred Pets. sustainablevet.org
SustainableVet. Post-Surgical Follow-Up Guide for Referring Vets. sustainablevet.org
PetPlace. Postoperative Complications in Dogs. petplace.com
Farmington Veterinary Hospital. Post-Surgery Complications in Pets: Warning Signs and Care Guide. farmingtonvethospital.com

Read Blog Post

Essential Imaging & Diagnostics Before Vet Referrals

Best Practices

5 min read

Imaging and Diagnostics Before Referral: What’s Essential and When?

Before referring a patient, ensure you have the right imaging and diagnostics. Learn which tests are essential for accurate veterinary referrals and when to use them

A well-prepared referral saves the specialist time, prevents duplicate testing at the owner's expense, and results in a more productive first consultation.

A poorly prepared referral missing radiographs, incorrect views, or no clinical summary forces the specialist to start from scratch and may delay diagnosis and treatment.

Quick answer: Before orthopedic referral, take minimum two orthogonal radiographic views under sedation, run baseline blood work for any patient likely to need surgery, and write a clear referral summary. CT and MRI are not routinely required before referral; most specialists prefer to perform these in-house to their own protocols.

Key takeaways

Two orthogonal radiographic views are the minimum for any orthopedic referral: lateral and craniocaudal/mediolateral single views are inadequate
Sedation improves radiograph quality: precise positioning detects subtle lesions; unsedated films are frequently non-diagnostic
Send DICOM files, not printed films: digital files allow the specialist to adjust contrast and zoom; printed films are inferior
CT and MRI are usually performed at the specialist centre: refer before CT/MRI unless the specialist specifically requests pre-referral imaging
Baseline blood work is essential for any patient expected to need surgical anesthesia: CBC and biochemistry at minimum
A clear written referral summary with gait findings, lameness duration, and prior treatment adds more value than extra imaging alone

Why pre-referral imaging matters

The most important part of the orthopedic exam and probably the most important part of the workup is attempting to localize the cause of lameness to a single joint or single bone.

Radiographs at the primary care practice serve several purposes: confirming the anatomical location, ruling out differentials, giving the specialist baseline images, and identifying concurrent findings the owner needs to know about.

Poor imaging quality, missing essential baseline tests, and unclear communication with specialists can cause delayed diagnoses and ineffective treatment plans.

Radiography: the essential pre-referral modality

Two orthogonal views minimum

Always take at least two orthogonal views (e.g., lateral and craniocaudal/mediolateral). Use stress or oblique views for joint instability (e.g., CCL rupture, elbow dysplasia). Ensure proper sedation for accurate positioning, especially for pelvic or spinal radiographs.

A single lateral view is not adequate for referral. Fractures, joint mice, and osteophyte patterns require two planes to characterize. Subtle findings visible on one view may be absent on another.

Sedation for positioning: unsedated radiographs in painful patients are often rotated, foreshortened, or underexposed. These films reduce diagnostic value and may force repeat imaging at the specialist centre a cost the owner bears twice. Sedation is appropriate and usually brief for orthopedic positioning.

Specific views by condition

Suspected condition	Essential views
CCL rupture (stifle)	Mediolateral (neutral and flexed), craniocaudal
Elbow dysplasia	Mediolateral (neutral and flexed), craniocaudal
Hip dysplasia	VD hip-extended, possibly frog-leg lateral
Fracture	Lateral and orthogonal view of the entire bone including joints above and below
Patellar luxation	Craniocaudal, mediolateral stifle
Spinal pain	Lateral and VD of the region, possibly myelogram

Sending digital files

Send DICOM format where possible. Digital files allow the specialist to adjust window and level settings, zoom into areas of interest, and use measuring tools.

Printed films or JPEG photographs of films are significantly inferior and should be avoided.

When to perform CT before referral

CT is significantly more sensitive than radiography for:

Medial coronoid process disease (elbow dysplasia)
Complex periarticular fractures
Spinal cord compression assessment
Nasal cavity and dental pathology

Thoracic radiographs provide metastatic and pre-anesthetic screening. No additional radiographs are necessary if the patient will be referred for advanced imaging.

Most specialist centres prefer to perform CT in-house to their own protocols. Referring a patient with CT already done can be counterproductive if the protocol does not meet the specialist's requirements.

Unless the specialist has specifically requested pre-referral CT, radiographs alone are appropriate.

Exception: if CT is readily available at your practice, in good quality, and the specialist has confirmed they will accept your images, pre-referral CT for elbow dysplasia or complex fractures is valuable.

MRI before referral

MRI is superior to CT for soft tissue detail: spinal cord, brain, tendons, and ligaments. It is almost never required before referral.

MRI requires general anesthesia and significant scan time. Specialist centres perform it to their own protocols and prefer to interpret their own studies.

Referring a patient with MRI images from another centre creates interpretation challenges that can slow, not speed, diagnosis.

Laboratory diagnostics

Run basic lab tests (CBC, chemistry, joint fluid analysis if needed) before referring the case.

Pre-referral blood work:

CBC: detects anaemia, leukocytosis (infection/inflammation), thrombocytopenia
Biochemistry panel: kidney and liver function essential before any anesthetic
Relevant for: any patient likely to need surgical anaesthesia at the specialist centre

When joint fluid analysis adds value:

Suspected immune-mediated polyarthritis
Joint effusion without clear traumatic or degenerative cause
Suspected septic arthritis

In chronic orthopedic cases, laboratory diagnostics help differentiate degenerative diseases from immune-mediated or infectious conditions, providing a more complete clinical picture. C-reactive protein levels indicate active inflammation, commonly seen in immune-mediated arthritis. Synovial fluid analysis helps assess infection, immune-mediated polyarthritis, or degenerative joint disease.

The referral summary

A well-written referral letter adds value that no imaging can replace:

Include:

Signalment and body weight
Duration and progression of the lameness
Which limb(s) and which joints on palpation examination
Gait assessment findings (grade of lameness, pattern)
Orthopaedic test results (cranial drawer, tibial compression, Ortolani)
Differential diagnoses considered
Previous treatments and response
Reason for referral and what you are asking the specialist to do

Keep it concise. A one-page summary covering the above is far more useful than three pages of unformatted notes.

For the communication framework with the specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

For what happens at the specialist consultation, see what to expect when your patient sees an orthopedic specialist.

For the referral decision criteria, see when to refer for orthopedic surgery: surgical vs non-surgical cases.

Frequently asked questions

Do I need to sedate the dog for pre-referral radiographs?

Yes, for most orthopedic cases. Sedation improves positioning accuracy significantly. Unsedated films in painful patients are frequently rotated or foreshortened and may not provide diagnostic information.

Brief sedation for positioning is appropriate and is standard at most specialist centres for their own imaging.

The specialist centre is far away. Should I try to do a CT first?

Only if the specialist has specifically requested pre-referral CT and you can achieve the required protocol quality. Otherwise, radiographs are sufficient for referral.

CT performed without the specialist's protocol guidance may not meet their imaging requirements and could result in the owner paying for repeat CT at the specialist centre.

What format should I send radiographs in?

DICOM format wherever possible. If DICOM is not available, the highest-resolution uncompressed images you can export.

Avoid photographing films with a mobile phone these are not diagnostically useful and create a poor impression of the case preparation.

Is blood work always required before referral?

Not in an emergency. For elective or semi-urgent referrals where surgical anaesthesia is anticipated, blood work provides essential safety information.

It is best performed at the primary care practice to allow results interpretation by someone who knows the patient's history.

My radiographs show only mild changes. Should I still refer?

Yes, if the clinical signs warrant it. Radiographic severity does not always correlate with clinical severity. A dog with mild radiographic changes but significant lameness affecting quality of life merits specialist assessment.

Conversely, severe radiographic OA in a dog with good function may not need referral urgently.

Resources

SustainableVet. Essential Imaging and Diagnostics Before Vet Referrals. sustainablevet.org
MSPCA-Angell. Radiographic Approach to Bone Imaging. mspca.org
Today's Veterinary Practice. Advanced Imaging: Its Place in General Practice. todaysveterinarypractice.com
SustainableVet. When to Refer: Surgical vs Non-Surgical Orthopedic Cases. sustainablevet.org

Read Blog Post

Imaging and Diagnostics Before Referral: What’s Essential and When?

Best Practices

5 min read

Imaging and Diagnostics Before Referral: What’s Essential and When?

Before referring a patient, ensure you have the right imaging and diagnostics. Learn which tests are essential for accurate veterinary referrals and when to use them

A well-prepared referral saves the specialist time, prevents duplicate testing at the owner's expense, and results in a more productive first consultation.

A poorly prepared referral missing radiographs, incorrect views, or no clinical summary forces the specialist to start from scratch and may delay diagnosis and treatment.

Quick answer: Before orthopedic referral, take minimum two orthogonal radiographic views under sedation, run baseline blood work for any patient likely to need surgery, and write a clear referral summary. CT and MRI are not routinely required before referral; most specialists prefer to perform these in-house to their own protocols.

Key takeaways

Two orthogonal radiographic views are the minimum for any orthopedic referral: lateral and craniocaudal/mediolateral single views are inadequate
Sedation improves radiograph quality: precise positioning detects subtle lesions; unsedated films are frequently non-diagnostic
Send DICOM files, not printed films: digital files allow the specialist to adjust contrast and zoom; printed films are inferior
CT and MRI are usually performed at the specialist centre: refer before CT/MRI unless the specialist specifically requests pre-referral imaging
Baseline blood work is essential for any patient expected to need surgical anesthesia: CBC and biochemistry at minimum
A clear written referral summary with gait findings, lameness duration, and prior treatment adds more value than extra imaging alone

Why pre-referral imaging matters

The most important part of the orthopedic exam and probably the most important part of the workup is attempting to localize the cause of lameness to a single joint or single bone.

Poor imaging quality, missing essential baseline tests, and unclear communication with specialists can cause delayed diagnoses and ineffective treatment plans.

Radiography: the essential pre-referral modality

Two orthogonal views minimum

A single lateral view is not adequate for referral. Fractures, joint mice, and osteophyte patterns require two planes to characterize. Subtle findings visible on one view may be absent on another.

Specific views by condition

Suspected condition	Essential views
CCL rupture (stifle)	Mediolateral (neutral and flexed), craniocaudal
Elbow dysplasia	Mediolateral (neutral and flexed), craniocaudal
Hip dysplasia	VD hip-extended, possibly frog-leg lateral
Fracture	Lateral and orthogonal view of the entire bone including joints above and below
Patellar luxation	Craniocaudal, mediolateral stifle
Spinal pain	Lateral and VD of the region, possibly myelogram

Sending digital files

Send DICOM format where possible. Digital files allow the specialist to adjust window and level settings, zoom into areas of interest, and use measuring tools.

Printed films or JPEG photographs of films are significantly inferior and should be avoided.

When to perform CT before referral

CT is significantly more sensitive than radiography for:

Medial coronoid process disease (elbow dysplasia)
Complex periarticular fractures
Spinal cord compression assessment
Nasal cavity and dental pathology

Thoracic radiographs provide metastatic and pre-anesthetic screening. No additional radiographs are necessary if the patient will be referred for advanced imaging.

Unless the specialist has specifically requested pre-referral CT, radiographs alone are appropriate.

MRI before referral

MRI is superior to CT for soft tissue detail: spinal cord, brain, tendons, and ligaments. It is almost never required before referral.

MRI requires general anesthesia and significant scan time. Specialist centres perform it to their own protocols and prefer to interpret their own studies.

Referring a patient with MRI images from another centre creates interpretation challenges that can slow, not speed, diagnosis.

Laboratory diagnostics

Run basic lab tests (CBC, chemistry, joint fluid analysis if needed) before referring the case.

Pre-referral blood work:

CBC: detects anaemia, leukocytosis (infection/inflammation), thrombocytopenia
Biochemistry panel: kidney and liver function essential before any anesthetic
Relevant for: any patient likely to need surgical anaesthesia at the specialist centre

When joint fluid analysis adds value:

Suspected immune-mediated polyarthritis
Joint effusion without clear traumatic or degenerative cause
Suspected septic arthritis

The referral summary

A well-written referral letter adds value that no imaging can replace:

Include:

Signalment and body weight
Duration and progression of the lameness
Which limb(s) and which joints on palpation examination
Gait assessment findings (grade of lameness, pattern)
Orthopaedic test results (cranial drawer, tibial compression, Ortolani)
Differential diagnoses considered
Previous treatments and response
Reason for referral and what you are asking the specialist to do

Keep it concise. A one-page summary covering the above is far more useful than three pages of unformatted notes.

For the communication framework with the specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

For what happens at the specialist consultation, see what to expect when your patient sees an orthopedic specialist.

For the referral decision criteria, see when to refer for orthopedic surgery: surgical vs non-surgical cases.

Frequently asked questions

Do I need to sedate the dog for pre-referral radiographs?

Brief sedation for positioning is appropriate and is standard at most specialist centres for their own imaging.

The specialist centre is far away. Should I try to do a CT first?

Only if the specialist has specifically requested pre-referral CT and you can achieve the required protocol quality. Otherwise, radiographs are sufficient for referral.

CT performed without the specialist's protocol guidance may not meet their imaging requirements and could result in the owner paying for repeat CT at the specialist centre.

What format should I send radiographs in?

DICOM format wherever possible. If DICOM is not available, the highest-resolution uncompressed images you can export.

Avoid photographing films with a mobile phone these are not diagnostically useful and create a poor impression of the case preparation.

Is blood work always required before referral?

Not in an emergency. For elective or semi-urgent referrals where surgical anaesthesia is anticipated, blood work provides essential safety information.

It is best performed at the primary care practice to allow results interpretation by someone who knows the patient's history.

My radiographs show only mild changes. Should I still refer?

Conversely, severe radiographic OA in a dog with good function may not need referral urgently.

Resources

SustainableVet. Essential Imaging and Diagnostics Before Vet Referrals. sustainablevet.org
MSPCA-Angell. Radiographic Approach to Bone Imaging. mspca.org
Today's Veterinary Practice. Advanced Imaging: Its Place in General Practice. todaysveterinarypractice.com
SustainableVet. When to Refer: Surgical vs Non-Surgical Orthopedic Cases. sustainablevet.org

Read Blog Post

Best Practices

5 min read

Feline Orthopedic Conditions: Signs of Hidden Lameness

Learn how to spot hidden lameness in cats, recognize common feline orthopedic conditions early, and keep your cat healthy and comfortable

Cats are exceptional at concealing pain. This is not stubbornness it is a deeply ingrained survival instinct. In the wild, a visibly lame or injured animal becomes prey.

Domestic cats retain this drive to mask weakness, which means orthopedic disease in cats is frequently underdiagnosed and undertreated.

Quick answer: Cats rarely limp overtly even with significant orthopedic pain. Reliable signs of hidden lameness include reduced jumping, reluctance to use stairs, grooming changes, and irritability when handled. OA affects 60 to 90% of older cats. Hip dysplasia affects up to 46.7% of some pedigree cat populations.

Key takeaways

Cats rarely limp overtly even with significant joint pain; behavioral changes are the primary indicator of orthopedic disease
60 to 90% of older cats have radiographic OA but most owners do not recognize it as a clinical problem
Hip dysplasia affects up to 46.7% of pedigree cats in some studies, with Maine Coons and Siamese most commonly affected
Reduced jumping height or frequency is one of the earliest reliable signs of feline orthopedic pain
Examining lame cats is challenging: they are often anxious and aggressive in the clinic; a calm, low-stress approach is essential
CT is the most reliable non-invasive tool for subtle elbow and coronoid lesions that radiographs may miss

Why cats hide orthopedic pain

Cats can often much better compensate for pelvic limb lameness and hide their pain, and as a result, owners are less likely to notice this condition.

Osteoarthritis is common in cats but may not be noticed because cats often hide signs of pain. Approximately 60 to 90% of older cats have osteoarthritis.

Examination of the lame cat can be difficult. Owner history is often not helpful because most injuries are not witnessed. Cats can be highly anxious in a hospital setting and may be aggressive.

The clinical implication is clear: waiting for a cat to present with an obvious limp means waiting for a level of pain that most cats will never openly display.

Earlier detection requires recognizing the subtler behavioral signals.

Behavioral signs of hidden orthopedic pain in cats

Rather than an overt limp, cats with orthopedic disease typically show:

Changes in jumping behavior:

Reduced jumping height landing lower than usual on furniture
Reduced jumping frequency choosing not to jump when they previously would
Hesitating before jumping, or looking for an alternative route up

Activity and movement changes:

Reluctance to use stairs
Slower, more deliberate movement
Spending more time on lower surfaces
Stiffness when rising after rest, particularly in the morning

Grooming changes:

Reduced grooming of the hindquarters and tail base (hips or spine painful to flex toward)
Matted coat in areas the cat cannot reach comfortably
Overgrooming of a painful limb (licking at the joint or foot)

Litter box behavior:

Difficulty squatting defecating outside the box, particularly in cats with hip pain
Reluctance to step over a high-sided litter box

Behavioral and temperament changes:

Increased irritability, especially when touched around the affected area
Withdrawal from family interaction
Reduced playfulness or hunting behavior
Vocalizing when handled or picked up

Common feline orthopedic conditions

Osteoarthritis (OA)

The most prevalent orthopedic condition in cats, particularly in middle-aged and older animals.

The elbows and hips are most commonly affected, followed by the stifles and spine.

Management is multimodal: weight management, environmental modifications (ramps, low-sided litter boxes, raised food bowls), NSAIDs formulated for cats (meloxicam), and joint supplements.

Hip dysplasia

Most cats with hip dysplasia are managed conservatively. Surgical options exist for severe cases.

Patellar luxation

Patellar luxation was noted in 32.7% of pedigree cats, present bilaterally in 91.4%, and was grade 1 or 2 in most cats.

Most feline patellar luxations are low-grade and clinically silent. Higher-grade luxations causing intermittent lameness may require surgical correction.

Fractures

Feline fractures are a prevalent orthopedic issue in cats. Accidents often result in these injuries, with the shoulder, elbow, wrist, knee, and ankle joints being the most susceptible to fracture.

Cranial cruciate ligament (CCL) disease

Mediolateral and craniocaudal radiographs of a seven-year-old domestic shorthair cat showed cranial cruciate ligament rupture.

CCL rupture is less common in cats than dogs, but it does occur, particularly in middle-aged neutered cats. Unlike in dogs, some cats achieve functional stability through fibrosis without surgery.

Feline vs. canine orthopedic anatomy: key differences

Assessment approach

Palpation of joints should be systematic but gentle, noting pain responses, crepitus, reduced range of motion, and muscle atrophy.

The most commonly reported physical examination findings in cats with hip dysplasia are pain and crepitus upon extension of the hips, and muscle atrophy.

For subtle lesions, particularly of the elbow, CT provides better sensitivity than radiography alone.

Frequently asked questions

How can I tell if my cat is in orthopedic pain if it isn't limping?

Watch for behavioral changes: reduced jumping, reluctance to use stairs, grooming changes, litter box avoidance, and increased irritability when touched.

These are often more reliable indicators of feline orthopedic pain than gait changes, which cats suppress effectively.

Is arthritis common in cats?

Yes. Radiographic evidence of OA affects 60 to 90% of older cats.

The condition is significantly underdiagnosed because cats compensate so well that owners rarely notice clinical signs until the disease is advanced.

My cat is a Maine Coon. Should I be concerned about hip dysplasia?

Maine Coons are one of the most commonly affected breeds, with hip dysplasia rates of 18 to 21% reported in some studies.

Annual veterinary checks including orthopedic assessment are worthwhile, even in the absence of obvious clinical signs.

Can cats have surgery for orthopedic conditions?

Yes. Fracture repair, patellar luxation correction, femoral head ostectomy for hip disease, and CCL repair are all performed in cats. Outcomes are generally good.

The decision to pursue surgery depends on severity, the cat's overall health, and owner circumstances.

How should I modify my home for a cat with arthritis?

Resources

Merck Veterinary Manual. Joint Disorders in Cats. merckvetmanual.com
VetTimes. Common Feline Orthopaedic Conditions Beyond OA Cases. vettimes.com
MSPCA-Angell. Feline Orthopedic Disease. mspca.org
PMC. Prevalence of Feline Hip Dysplasia, Patellar Luxation and Lumbosacral Transitional Vertebrae in Pedigree Cats. ncbi.nlm.nih.gov
PetMD. Hip Dysplasia in Cats. petmd.com

Read Blog Post

How to Optimize Communication Between General Practitioners and Orthopedic Surgeons

Best Practices

5 min read

How to Optimize Communication Between General Practitioners and Orthopedic Surgeons

Learn how to improve communication between GP and veterinary orthopedic surgeon for improved referrals, case management, and patient outcomes

Effective collaboration between general practitioners and veterinary orthopedic surgeons produces better outcomes for patients, smoother processes for both practices, and more satisfied clients.

Most breakdowns in the referral pathway trace back to a small number of communication failures that are straightforward to address.

Quick answer: Optimize GP-to-specialist communication with a structured referral letter covering examination findings and imaging in DICOM format; call directly for urgent cases; contact the specialist on the day of surgery to confirm findings and aftercare; and reinforce discharge instructions to owners at every follow-up visit.

Key takeaways

A structured referral letter covering signalment, lameness history, examination findings, and specific referral question is the single most impactful improvement
Send imaging in DICOM format: digital files allow contrast adjustment and measurement; printed films are not appropriate
Call for urgent cases: email is too slow for fractures, spinal emergencies, and complete CCL rupture in active large-breed dogs
Contact the specialist on surgery day: a brief call confirms findings and aftercare requirements
Proactively seek information if specialist communication is delayed: the referring vet is the patient's advocate and can push for clarity
Clear referrals build the relationship: complete, well-prepared referrals make you a specialist's preferred referring partner

Why communication fails

Miscommunication, incomplete referrals, and unclear follow-up responsibilities can lead to delays, frustration, and less effective care. If referral notes lack high-quality imaging or joint stability test results, the surgeon may need additional diagnostics, which can delay surgery. If post-op instructions are unclear, the GP may find it difficult to manage rehabilitation and pain.

The most common communication failures in the GP-to-specialist referral pathway are:

Referral letters that are too brief or lack clinical findings
Radiographs missing essential views or sent as low-resolution photographs
No direct call for urgent cases relying on email or fax alone
No contact after surgery to confirm findings and aftercare
Discharge instructions not reinforced at follow-up visits
Assuming the specialist's written summary will arrive before the patient needs assessment

The referral letter

A well-structured referral letter is the foundation of effective communication. It takes 10 minutes to write and saves the specialist 30 minutes of information-gathering at the consultation.

Elements of a strong referral letter:

Signalment and body weight: breed, age, sex, neuter status, weight
Chief complaint and duration: which limb, how long, acute or insidious onset
Progression: improving, stable, or worsening
Gait assessment: lameness grade (0 to 5), which limb, pattern
Orthopedic examination findings: joints palpated, pain responses, positive tests (cranial drawer, tibial compression, Ortolani)
Differential diagnoses considered
Prior treatment and response: medications, duration, outcome
Imaging provided: views taken, quality note, format (DICOM)
Specific referral question: what are you asking the specialist to do?

Everyone's goal is to provide patients with the best care possible. A successful referral includes a patient with a resolved medical or surgical condition, a positive relationship between the general practitioner and the specialty institution, and an informed and satisfied client who will return to the referring veterinarian for continued care and follow-up. Good communication is the key to making all this possible.

Imaging communication

Send imaging in DICOM format wherever possible. DICOM files allow the specialist to manipulate window settings, measure angles, and compare views in ways that are not possible with printed films or photographs.

Make referrals clear and complete: provide a concise referral summary, attach high-quality imaging and lab results, and clearly state the reason for the referral to avoid delays. Perform essential pre-referral diagnostics: take proper X-rays (multiple views, high quality) and run basic lab tests before sending the case.

If DICOM is not available, export the highest resolution uncompressed image format your system supports. Contact the specialist centre to confirm their preferred file transfer method before sending large files.

When to call vs. when to email

Call the specialist for:

Acute fractures requiring same-day or next-day surgical assessment
Spinal emergencies (acute paralysis, suspected disc herniation)
Complete CCL rupture in a working or very active large-breed dog
Any case where timing of surgery materially affects outcome
Post-operative complications requiring specialist guidance

Email or secure portal for:

Elective orthopedic referrals (OA, patellar luxation, elbow dysplasia)
Sending imaging files
Requesting a non-urgent second opinion
Routine post-operative updates

Teleconsulting tools, including sending images digitally or having a quick virtual meeting, can facilitate veterinarian-to-specialist communication when distance or schedules are an issue.

Communication on the day of surgery

This is the most frequently missed communication step in the GP-to-specialist pathway.

The GP's office should contact the orthopedic surgeon to get the discharge instructions. Moving forward, call the specialty hospital on the day of surgery to get a briefing on the outcome and expected aftercare. This highlights the need for proactive communication: do not assume you will automatically receive all the information. Sometimes you must actively seek it to ensure smooth post-surgical care.

A brief call on the day of surgery confirms:

What was found at surgery (was the diagnosis confirmed?)
Any intraoperative findings that change the post-operative plan
Which medications were dispensed and for how long
The recheck schedule and what is required at each visit
Any specific complications to monitor for this individual patient

This call takes 5 minutes and prevents the most common post-operative care failure: the referring vet making management decisions without knowing what the surgeon found.

Communicating with owners

The referring vet's communication with the owner is as important as communication with the specialist.

Owners return to the primary care practice after surgery and will ask questions the GP needs to answer accurately.

By referring early, general practitioners can give patients the best chance at a smooth, effective recovery and help clients understand the value of structured physical therapy in long-term orthopedic success.

When discussing referral with owners:

Explain why a specialist is the best option the specific expertise or procedure the GP cannot provide
Set realistic expectations about the consultation process, timeline, and cost
Clarify that the referring vet will continue to be involved in follow-up care after surgery
Provide a written summary of what the owner needs to bring to the specialist appointment

When communication breaks down

If a communication breakdown occurs for example, you are not hearing back about a critical case do not hesitate to escalate appropriately. You might contact an alternate specialist at the practice or even a practice manager if needed. As a referring vet, you are the advocate for your patient and client; it is okay to politely push for information or clarity when the pet's well-being is on the line.

The specialist has a moral obligation to stay in good communication with the referring clinician, keeping them apprised of case development.

A breakdown in communication from the specialist side is uncommon but does occur.

The referring vet's appropriate response is to contact the specialist centre directly, not to make management decisions without the information needed to do so safely.

For the imaging and diagnostics preparation that makes referrals stronger, see imaging and diagnostics before referral: what's essential and when.

For the post-surgical follow-up protocol, see post-surgical follow-up: what referring veterinarians need to know. For the specialist consultation overview, see what to expect when your patient sees an orthopedic specialist.

Frequently asked questions

How long should a referral letter be?

One page is ideal. Longer letters risk the most important findings being buried.

A structured format (bullet points or a standard template) covering signalment, chief complaint, examination findings, imaging, and referral question is more useful than paragraphs of narrative text.

Should I send all my radiographs or just the relevant ones?

Send all views you have taken of the affected region, plus any prior films for comparison. Include thoracic radiographs if taken for metastatic screening.

Do not curate or selectively send images let the specialist review everything.

What if I disagree with the specialist's recommendation?

Contact the specialist and discuss it directly. There may be clinical context the specialist did not have, or a valid clinical reason for the recommendation you were not aware of.

Disagreements are resolved through dialogue, not by managing the case in a direction that contradicts the specialist's assessment without informing them.

How quickly should I expect a written referral report back?

Most specialist centres send a written consultation summary within 24 to 48 hours of the appointment. Surgical discharge letters typically accompany the patient on discharge or are sent the same day.

If you have not received a report within 3 to 5 working days, a follow-up call is appropriate.

Can I teleconsult with a specialist before deciding to refer?

Yes. Many specialist centres offer brief telephone or video teleconsultations to discuss whether referral is appropriate for a specific case.

This is a good option for borderline cases and for seeking guidance on pre-referral diagnostics.

Resources

SustainableVet. Optimizing Communication Between Vets and Orthopedic Surgeons. sustainablevet.org
DVM360. Practical Matters: Setting the Stage for Successful Referrals. dvm360.com
PMC. The Ethics of Referral. pmc.ncbi.nlm.nih.gov
PetVet Magazine. 5 Ways to Streamline Referrals for Successful Collaborative Care. petvetmagazine.com

Read Blog Post

Post-Surgical Follow-Up: What Referring Veterinarians Need to Know

Best Practices

5 min read

Post-Surgical Follow-Up: What Referring Veterinarians Need to Know

Learn 11 essential post-surgical follow-up tips every referring veterinarian should know to support recovery and improve patient outcomes

The surgeon closes the incision and hands the patient back. From that point, the referring vet carries the case.

Post-surgical care is not passive.

It requires active communication with the surgical team, structured recheck examinations, prompt complication recognition, and consistent owner support throughout a recovery that may last months.

Quick answer: Post-surgical follow-up for referred orthopedic patients includes reading the discharge summary before the first recheck, establishing a recheck schedule (suture removal at day 10 to 14, radiographs at week 6 to 8), recognizing complications early, and reinforcing owner compliance at every visit.

Key takeaways

Read the discharge summary before the first recheck: skimming leads to medication errors, missed complications, and inconsistent owner instructions
Standard orthopedic recheck schedule: suture removal at day 10 to 14; radiographs at week 6 to 8; final check at week 12 to 16
Contact the surgical team for: implant complications, deep infection not resolving in 72 hours, wound dehiscence, or worsening lameness
Owner compliance is the most modifiable variable: reinforce activity restrictions, E-collar use, and complication signs at every contact
Refer back for: deep infection, implant-related concerns, wound dehiscence, or persistent non-weight-bearing beyond expected timepoints
Document each visit clearly: both the referring vet and the surgical team need an accurate record to track patient progress

Reading the discharge summary

The discharge summary is the primary communication from the surgical team.

It contains the diagnosis, the specific procedure performed, implant details, the prescribed medication list, the recheck schedule, and the complications to monitor.

What to extract from every discharge summary:

Full medication list (drug, dose, frequency, duration)
Recheck schedule and what assessment is required at each visit
Specific complications the surgeon flagged for this case
Activity restriction level and when it can be modified
Criteria for contacting the surgical team directly

If anything is unclear, contact the specialist before the first recheck not after.

Recheck schedule

Soft tissue cases

Day 10 to 14: incision assessment, suture removal, medication review
Further rechecks: based on clinical signs and case complexity

Orthopedic cases

Day 10 to 14: incision assessment, suture removal, gait assessment
Week 6 to 8: radiographs to confirm bone healing and implant position
Week 12 to 16: final assessment in complex cases; progressive activity increase if healing confirmed

If pain medications are still needed after a few weeks, it is best to follow up with your referring veterinarian.

Consistent scheduling helps track progress and catch complications early. Document each visit so both you and the specialist can follow the case.

What to assess at each recheck

At every visit:

Incision appearance: closure status, discharge type and volume, redness, swelling
Weight-bearing status on the affected limb
Pain assessment using a standardized scale
Muscle mass: compare bilaterally
E-collar compliance
Medication compliance and any adverse effects reported by the owner

At orthopedic rechecks:

Joint stability (where applicable)
Range of motion of the operated joint
Radiographs at intervals specified in the discharge summary

Recognizing and triaging complications

Surgical site infection (SSI)

Signs: redness extending beyond the incision margins after day 3, purulent discharge, local heat, wound odor, systemic signs (fever, lethargy).

Seroma

Wound dehiscence

Persistent or worsening lameness

Communicating with the surgical team

Smooth communication between the surgical team and the referring vet is crucial.

Contact the surgical team for:

Any implant-related concern identified on radiograph
Deep SSI not resolving with antibiotics in 48 to 72 hours
Wound dehiscence of a complex closure
Lameness or pain worsening rather than improving at expected timepoints
Uncertainty about whether a finding requires re-referral

Supporting owners through recovery

Reinforce it at every visit, not just at the first one.

For the complications guide covering specific scenarios and when to re-refer, see post-op home care for pets after orthopedic surgery.

For the communication framework between GP and specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

Frequently asked questions

When should I contact the surgical team vs. manage locally?

Manage locally: minor incision redness not progressing, small seromas under active rest restrictions, mild expected lameness on the expected timeline.

Contact the surgical team: any implant concern, deep infection, wound dehiscence of a complex closure, worsening rather than improving lameness, or any complication you are unsure how to manage.

What imaging is needed at the 6-week orthopedic recheck?

Radiographs of the operated region in the same views as the post-operative images from the discharge summary. Compare implant position, bone healing, and periimplant margins.

If the surgeon provided post-operative radiographs in the discharge summary, use these as the baseline for comparison.

My client says the dog is doing great but the incision looks concerning. Who is right?

Trust the physical examination over owner assessment. Owners naturally minimise signs when they want their pet to be well.

Document your findings, photograph the incision, and manage based on clinical evidence rather than owner report.

How do I handle the case if I cannot reach the surgical team?

Document the attempt and the clinical finding. For non-emergency complications, continue conservative local management while attempting to reach the team.

How long does the referring vet typically follow the case?

For straightforward soft tissue cases, typically until the 10 to 14 day recheck and discharge.

For orthopedic cases, the referring vet typically follows the patient through the 6 to 8 week radiographic recheck and the 12 to 16 week final assessment.

This represents a total follow-up period of 3 to 4 months.

Resources

SustainableVet. Post-Surgical Follow-Up Guide for Referring Vets. sustainablevet.org
Advanced Veterinary Care. Orthopedic Surgery Post-Operative Instructions. advancedvetcarenm.com
Today's Veterinary Business. From Preop Through Postop. todaysveterinarybusiness.com
ACVS. Postoperative Care After Surgery: What Animal Owners Should Expect. acvs.org

Read Blog Post

Best Practices

5 min read

Orthopedic Pain Management in Pets: Multimodal Approaches

Learn how multimodal pain management improves recovery in pets after orthopedic surgery using meds, rehab, and at-home care

Pain management after orthopedic surgery is not a single drug it is a strategy.

Quick answer: Multimodal analgesia combines NSAIDs, opioids, gabapentin, local anesthetic blocks, and non-drug therapies such as cryotherapy and laser. Using multiple agents at lower doses reduces side effects while achieving better pain control than any single drug at high dose.

Key takeaways

NSAIDs are the cornerstone of post-orthopedic pain management; they target peripheral inflammation and are the most consistently effective class
Multimodal analgesia outperforms monotherapy: a 2026 study found local anesthetics combined with opioid and NSAID provided the best pain control
Preemptive analgesia before surgery reduces central sensitization and lowers post-op pain scores and total drug requirements
Gabapentin is most useful for nerve-mediated and chronic pain; evidence for acute orthopedic pain alone is limited
Tramadol has poor evidence: studies found no clinical benefit for OA pain; it is no longer a recommended primary analgesic
Non-drug modalities (cold therapy, laser, rehab) are additive to pharmacological control and reduce total drug burden

Why single-drug pain management falls short

Orthopedic pain in dogs is not a single signal from a single location. It involves:

Peripheral sensitization: inflammatory mediators (prostaglandins, cytokines) at the surgical site lower the pain threshold locally
Central sensitization: repeated pain signals cause "wind-up" in the spinal cord, amplifying the pain response
Nociceptive pain: from tissue damage, implants, and ongoing healing
Neuropathic components: nerve stretch or compression, particularly in fracture repairs and spinal-adjacent procedures

The pharmacological components

NSAIDs

Common veterinary NSAIDs: meloxicam, carprofen, robenacoxib, grapiprant. All require baseline blood work (kidney and liver function) before use and monitoring during long-term administration.

NSAIDs should not be combined with corticosteroids or with each other. A washout period of 5 to 7 days is required when switching between NSAIDs.

Preemptive analgesia

Pre-operative NSAID administration, opioid premedication, and local anesthetic blocks administered before surgical incision all reduce the total pain burden the patient experiences.

Opioids

Combinations: NSAIDs and opioids can be used together for enhanced analgesia.

Multimodal analgesia combining local anesthetics, hydromorphone, and meloxicam provided the best pain control in small-breed dogs after orthopedic surgery across a retrospective analysis of 205 dogs.

Gabapentin

Gabapentin is sometimes used as an adjunct pain medication; its best application may be for neuropathic pain.

Gabapentin (brand names: Neurontin, Aclonium) is one of several medications used to complement NSAIDs in multimodal plans.

Local anesthetic blocks

Locoregional anesthesia (epidural, nerve blocks, intra-articular injection) provides targeted pain control at the surgical site. Local blocks are effective for acute pain.

For chronic pain, periodic local blocks may be considered if appropriate.

Loco-regional blocks reduce the amount of systemic opioid required and can provide hours of post-operative analgesia.

Amantadine

Amantadine is one of several medications used to complement NSAIDs in multimodal therapy plans for canine OA.

Amantadine is an NMDA receptor antagonist that reduces central sensitization.

It is particularly useful in chronic pain cases where "wind-up" is established, and in patients whose NSAIDs are not providing adequate relief alone.

Monoclonal antibodies (bedinvetmab / Librela)

This class represents a new approach for long-term OA pain management following orthopedic surgery.

Tramadol not recommended

Studies have shown tramadol to be ineffective in treating OA. In one study, treatment with tramadol provided no clinical benefit for dogs with OA of the elbow or stifle joint.

Tramadol's use in canine analgesia has significantly declined following clinical trial evidence showing poor efficacy. It is no longer a recommended primary analgesic for orthopedic pain in dogs.

Non-pharmacological components

Non-drug therapies include cold and heat therapy, physical rehabilitation, hydrotherapy, acupuncture, laser therapy, and massage.

Cryotherapy (cold therapy): applied for 10 to 15 minutes to the surgical site in the first 48 to 72 hours. Reduces local inflammation and provides analgesia through nerve conduction slowing.

Therapeutic laser: reduces inflammation and promotes tissue healing. Can be initiated immediately after surgery at the incision site.

Rehabilitation exercises: passive range-of-motion, controlled walking, and progressive strengthening reduce pain through improved joint mechanics and muscle support.

Acupuncture: some evidence for adjunct pain relief in OA; most useful as part of a comprehensive multimodal plan.

For the full rehabilitation guide, see physical therapy and rehabilitation: how referring vets can support recovery. For post-op home care, see post-op home care for pets after orthopedic surgery.

Frequently asked questions

What is multimodal analgesia in dogs?

Multimodal analgesia uses two or more drugs or therapies that target different parts of the pain pathway simultaneously.

The aim is better pain control at lower doses of each individual agent, which reduces side effects while improving efficacy.

It is the current standard of care for orthopedic pain management in veterinary medicine.

Can I give my dog human pain relievers like ibuprofen after orthopedic surgery?

Never. Ibuprofen and acetaminophen are toxic to dogs. Even a single dose can cause gastrointestinal hemorrhage, kidney failure, or liver failure.

Only use pain medications specifically prescribed by your veterinarian for your dog.

How long will my dog need pain medication after orthopedic surgery?

Your vet will reassess at each recheck appointment.

My dog seems painful even with medication. What should I do?

Contact your vet. Pain that breaks through prescribed medication means the current protocol is insufficient.

A medication adjustment, a dose increase within safe limits, or the addition of another agent (gabapentin, amantadine) may be needed. Do not increase NSAID doses without veterinary guidance.

Is gabapentin effective for post-surgical orthopedic pain in dogs?

Gabapentin's evidence for acute orthopedic pain is limited. Its most established role is in neuropathic and chronic pain.

In the post-surgical context it is most useful for managing restlessness, anxiety, and sleep disruption, and for cases with a neuropathic component.

It is usually prescribed as an adjunct, not a primary analgesic.

Resources

VCA Animal Hospitals. Multi-Modal Pain Management. vcahospitals.com
Today's Veterinary Practice. Multimodal Pain Management for Canine Osteoarthritis. todaysveterinarypractice.com
Today's Veterinary Practice. Instituting a Multimodal Pain Management Protocol. todaysveterinarypractice.com
MDPI Animals. Multimodal Analgesia Provides Superior Postoperative Pain Control Following Orthopedic Surgery in Small-Breed Dogs. mdpi.com
NCBI StatPearls. Multimodal Postoperative Pain Control After Orthopaedic Surgery. ncbi.nlm.nih.gov

Read Blog Post

MRSP Treatment Guidelines for Vets (2025 Update)

Best Practices

5 min read

MRSP Treatment Guidelines for Vets (2025 Update)

Learn the latest MRSP treatment guidelines for vets—diagnosis, antibiotics, topical care, and infection control, all in one practical guide

MRSP management requires a structured decision framework, not a reflexive antibiotic prescription. The ISCAID 2025 guidelines for canine pyoderma, combined with established DVM360 surgical wound infection protocols and core antimicrobial stewardship principles, provide that framework.

This is a clinical reference covering the key decision points: when to culture, which drugs to use and avoid, how long to treat, and how to prevent clinic transmission.

Quick summary: ISCAID 2025 recommends cytology before antibiotics in all cases; topical antimicrobial therapy alone for surface and superficial pyoderma; systemic antibiotics reserved for deep pyoderma and failed topical response. Bacterial culture and sensitivity (BC/AST) is required before systemic therapy whenever MRSP is suspected or resistance risk is elevated. Vancomycin and linezolid should not be used in veterinary settings.

Diagnostic framework

Cytology: first step in all cases

ISCAID 2025 (PMC12058580): "Cytology should be performed in all cases before antimicrobials are used."

Cytology confirms:

Presence of cocci or rods (guides antibiotic class expectations)
Inflammatory cell pattern (neutrophilic = bacterial; mixed = consider other causes)
Yeast co-infection requiring concurrent antifungal management
Correct interpretation of culture results (cytology and culture should be paired)

When to submit for BC/AST

ISCAID 2025 states BC/AST is "always strongly recommended" when:

There is a history of recent or frequent antimicrobial use
MRSP, MRSA, or MRSC has been isolated previously from this patient
The infection is deep pyoderma or severe
The infection has failed to respond to empirical first-choice therapy
The clinic or region has a high local prevalence of methicillin resistance

ISCAID additionally states: "BC/AST is never contraindicated."

Practical guidance from SASH Vets: "After a positive MRSP culture, this patient, and optimally other pets in this household, will need C&S testing to guide use of systemic antibiotics for skin infections every time OR only be treated with topical therapy."

Culture technique for MRSP

Intact pustule: highest yield; express content aseptically and swab
Epidermal collarette: swab under the active scale edge
Crusts: moisten and swab beneath after gentle crust removal
Deep pyoderma: punch biopsy for macerated tissue culture; swabs are insufficient for deep infections
Ears: swab otic exudate
Post-culture note from DVM360: if the lab doesn't automatically test chloramphenicol, amikacin, and doxycycline, call and request they be added to the panel

Treatment framework by infection depth

Surface and superficial pyoderma: topical-first

ISCAID 2025: "Topical antimicrobial therapy alone is the treatment of choice for surface and superficial pyodermas."

First-line topical options:

Agent	Formulation	Frequency
Chlorhexidine 2 to 4%	Shampoo (5 to 10 min contact)	2 to 3x weekly
Chlorhexidine	Spray or mousse	Daily spot application
Mupirocin	Ointment	Twice daily (localized lesions)
Fusidic acid	Gel	Twice daily (localized lesions)
Benzoyl peroxide	Shampoo	2x weekly (follicular flushing)

Systemic antibiotics are added when:

Topical therapy is not feasible (dog intolerant of bathing, very large surface area)
No clinical response after 3 weeks of topical-only therapy
Deep pyoderma is present

ISCAID: "Systemic therapy, with adjunctive topical treatment, is initially provided for 2 weeks in superficial and 3 weeks in deep pyoderma, followed by re-examination to assess progress."

Deep pyoderma: systemic antibiotics required

Systemic antibiotics are mandatory for deep pyoderma. Culture and sensitivity testing is mandatory before selection. Empirical therapy is not appropriate for deep MRSP infections.

First-choice drugs for susceptible S. pseudintermedius (ISCAID):

Amoxicillin-clavulanate
Cephalexin or cefpodoxime

For MRSP (all culture-guided):

Drug	Dose	Notes
Chloramphenicol	30 to 50 mg/kg q8h	Often active; CBC monitoring for prolonged courses
Potentiated sulfonamides	15 to 30 mg/kg q12h	Good oral tolerability
Rifampicin	10 mg/kg q12h	Combination only: monotherapy risks rapid resistance
Doxycycline	5 to 10 mg/kg q12h	Variable; confirm susceptibility
Clindamycin	11 mg/kg q24h	Only if susceptible AND no inducible macrolide resistance
Amikacin	20 mg/kg q24h (injectable)	Reserved for severe/refractory; renal monitoring

SustainableVet 2025 vet guidelines note: "Fluoroquinolones should be used only if sensitivity is confirmed, as resistance can develop quickly."

Drugs to avoid in veterinary MRSP management

Beta-lactams (always ineffective):

Amoxicillin, amoxicillin-clavulanate, cephalexin, cefpodoxime, cefovecin
No exceptions: mecA-mediated resistance makes all beta-lactams ineffective regardless of sensitivity report labeling

Last-resort human drugs (preserve for human medicine):

Vancomycin: last-resort glycopeptide for human MRSA; should not be used in veterinary settings
Linezolid: oxazolidinone reserved for human last-resort use; antimicrobial stewardship rationale precludes veterinary use

SustainableVet guidelines: "Avoid using vancomycin or linezolid in veterinary settings. These are last-resort drugs for human medicine, and avoiding them supports global antimicrobial stewardship."

Treatment duration

Infection Type	Initial Course	Reassessment	Continue Until
Superficial pyoderma	2 weeks systemic (if used)	Recheck at 2 weeks	1 week past clinical resolution
Deep pyoderma	3 weeks systemic	Recheck at 3 weeks	2 to 3 weeks past resolution
Severe/widespread	Variable	Recheck every 3 to 4 weeks	Culture-negative result
Implant-associated	Indefinite suppression or removal	Radiograph monitoring	Implant removal = definitive

DVM360 surgical wound guidance (Dr. Karen Tobias): "Systemic antimicrobials should be administered at least one week beyond remission of clinical disease (usually a minimum of 21 days)."

For treatment options from the owner-facing perspective, see treatment options for MRSP.

Antimicrobial stewardship principles

AAFP/AAHA stewardship guidelines endorse five core principles: commit to stewardship, prevent common diseases, select and use antimicrobials judiciously, evaluate antimicrobial use practices, and educate and build expertise.

Key stewardship actions in MRSP cases:

Culture before every systemic course: never empirically re-prescribe after MRSP has been identified
Topical therapy to reduce systemic antibiotic reliance: topical treatment alone resolved 65.4% of MRSP pyoderma cases in published research (PMC4204846)
Treat only clinical infection, not carrier status: systemic antibiotics are not indicated for colonized dogs without clinical signs
Complete the full course: incomplete courses select for resistance subpopulations
Address the underlying disease: unmanaged atopy or endocrine disease drives perpetual antibiotic cycles
Educate owners on hygiene, transmission risk, and the rationale for completing treatment

DVM360: "Also, teach basic hygiene practices at home, such as washing hands after handling the pet, cleaning bedding regularly, and avoiding shared items between pets."

For how resistance develops and why stewardship matters, see antibiotic resistance mechanisms.

Clinic infection control

MRSP spreads between patients via staff hands, contaminated equipment, and environmental surfaces.

Core clinic infection control protocol:

PPE (gloves, gowns) when handling MRSP-positive animals
Strict hand hygiene before and after each patient contact (soap and water or alcohol-based hand rub)
Isolate MRSP-positive patients where possible; use dedicated equipment
Disinfect exam tables, kennels, and surfaces between patients with a sporicidal or bactericidal agent
DVM360 outbreak guidance: "If an outbreak of MRSP wound infections is detected in your hospital, evaluate your hand hygiene and surgical preparation practices."

Monitoring and re-examination

At 2 to 3 week recheck:

Clinical progress assessment
Cytology if new lesions are present
Culture recheck if healing is not progressing as expected
Compliance assessment (owner application technique, dosing)
Identify any new resistance triggers (medication changes, new antibiotic exposures)

At treatment completion:

Clinical resolution confirmed
Culture recheck 2 weeks after antibiotic completion to confirm microbiological clearance
Underlying disease management plan documented

For diagnosing MRSP before treatment begins, see diagnosis before treatment. For managing recurring cases that require ongoing intervention, see managing recurrent MRSP. For long-term outcomes and prognosis, see long-term outcomes.

Resources

ISCAID. Antimicrobial use guidelines for canine pyoderma. Vet Dermatol, 2025. pmc.ncbi.nlm.nih.gov
DVM360 (Dr. Karen Tobias). Surgery STAT: Managing methicillin-resistant wound infections. dvm360.com
DVM360. Managing MRSA, MRSP, and MRSS dermatologic infections in pets. dvm360.com
AVMA. AAFP/AAHA Antimicrobial Stewardship Guidelines. avma.org
SASH Vets. Implications of MRSP. sashvets.com

Read Blog Post

Get Your
‍Free Poster!

We will work on your request shortly.

Oops! Something went wrong while submitting the form.

What’s your role in animal care?

Tell us who you are so we can guide you to the most relevant information.

Pet Owner

Veterinary Professional