We checked with a board-certified veterinary surgeon to answer common questions like whether your pup can still go for walks or if she will need surgery.
boston terrier laying on bed

Has your dog been diagnosed with a luxating patella? If so, you might be wondering if having a bum knee is causing your pup a lot of pain and what to do next. To get the lowdown, we talked with Amanda Conkling, DVM, DACVS, a board-certified veterinary surgeon at BluePearl Pet Hospital in Grand Rapids, Mich. Read on to learn about patellar luxation and treatment options, from watchful waiting to surgery.

What Is a Luxating Patella?

A dog's kneecap (patella) normally sits in a groove at the lower end of the thigh bone (femur) and moves up and down when the knee is flexing and extending. In some dogs, the kneecap will dislocate (luxate). So a luxating patella is a kneecap that pops out of the thighbone groove and veers toward the inside (medial) or the outside (lateral) of the leg.

The most common sign of a luxating patella is a change in your dog's stride. When the kneecap pops out, you might notice your pooch hops on the leg, holds it up, or stretches the leg out behind him to try and get the kneecap back in place. As soon as the kneecap returns to the correct position, your dog walks normally again.

Dog Breeds Most Susceptible to Patella Luxation

Patella luxation is a congenital condition, which means dogs are born with it. According to the American College of Veterinary Surgeons, large breeds like Akitas and Great Pyrenees can be prone to patella luxation. But in most cases, it occurs in toy breeds such as:

"There are three main developmental issues that occur in dogs with patella luxation," says Conkling. "First, the soft tissues that support the kneecap may be too tight on the inside and too loose on the outside, which causes the kneecap to pull to the outside of the leg. Second, the groove in the thigh bone is oftentimes too shallow so it doesn't provide a deep seat for the kneecap to sit in. Finally, the tendon that attaches the kneecap to the shin bone may be too far to the inside, so it wants to pull the kneecap over."

Diagnosis of Patella Luxation

Patellar luxation is often diagnosed in puppies since pet parents notice a problem with their furball's gait early on. Veterinarians can see and feel it during a physical exam and determine its grade based on severity.

Grade 1

The kneecap usually remains in the correct position. When it does pop out, it quickly returns to its appropriate location.

Grade 2

Though the kneecap still spends most of the time in the correct position, it pops out of place more readily at this stage.

Grade 3

At this point, the kneecap is usually out of the groove but can be manually reset. However, it pops right back out.

Grade 4

Not only is the kneecap always out of position, it can't be pushed back into the appropriate location at this level of severity.

Should You Walk a Dog With a Luxating Patella?

Dogs with patellar luxation can still go for gentle walks, assures Conkling. "You can also do an underwater treadmill with a veterinarian that specializes in rehabilitation therapy. That really keeps dogs nice and lean and it helps to maintain their muscle mass and support their joints."

What Options Exist for Dogs Who Need Treatment for Luxating Patella?

The severity of your dog's luxating patella will dictate what treatment your vet recommends. Typically, the more your dog limps and the worse the luxation grade, the more likely doctors are to recommend surgery.

"We usually recommend surgery at grade three or four," says Conkling. "For a lower grade, we consider how often the dog is limping. If it's more than a couple of times a week, then we'll also recommend surgery."

Surgery improves kneecap stability with techniques that include deepening the thigh-bone groove to create a deeper seat for the kneecap to sit in and repositioning the tendon that connects the kneecap to the shin bone. Six weeks of strict confinement follow. Your dog will need to be in a crate or a small room and go out only for brief potty breaks on a leash.

"The vast majority of dogs have a good outcome, particularly those in grades one to three," reports Conkling. "Dogs with grade four patella luxation tend to have more boney changes and can be more challenging to correct, so their prognosis is a little bit lower."

How Much Does Luxating Patella Surgery Cost?

The cost of patella luxation surgery will vary depending on where you live and who performs the procedure. General veterinarians usually charge less than board-certified veterinary surgeons, who have more advanced training and experience with a variety of surgical techniques. The surgery can range from $1,000 to $5,000. 

If you can't afford surgery, you can opt for rehabilitation. It's like physical therapy for dogs and costs between $40 to $100 per session. Rehabilitation can help strengthen your dog's muscles to support the knee joint and hold the kneecap in the proper position. Look for a veterinarian certified in rehabilitation.

"A luxating patella isn't a life-threatening condition and it isn't typically very painful," says Conkling. "But left untreated your dog can develop some mild arthritis, lose strength in the hind limbs, walk with a hunched appearance, and become bow-legged—basically, they lose the advantage of having a kneecap and it affects their mobility and quality of life."

To determine your next steps, talk with your veterinarian about your pet's condition and what options are available in your area. It may be that all you need to do right now is observe your pup and not exercise him too hard. Or, it might be time to consider surgery. Either way, knowing what your pet is dealing with and your options will help you make the best decision for you and your furry pal.