Poor kitten has 2 dislocated hips and 2 luxating kneecaps. What to expect?

Factual Questions
1

Our little kitty, who I think is about 8 months old now, a big kitten or perhaps a very young adult, seems to have a very unusual malformation of her rear leg bones. Both her hips are dislocated, and both her patellas are popping in and out of place. All of this has just started troubling her, and it came on fairly quickly, but she does not appear to have had an injury. It appears to be a birth defect that started to trouble her at this point in her growth (though she has always had a slightly odd walk). These last five days she’s been hobbling around the house and hissing at everybody who gets near her, the poor thing.

So, we are working with our veterinarian, who does seem to be pretty on top of things – but it is apparently pretty unusual to be having both of these problems, and in both legs.

We hear the hip problem is actually pretty easy to fix in cats. Apparently they basically just chop off the ball on the end of the femur, and the raw bone end just nestles into the proper socket and things turn out well. It doesn’t sound like that should work, but I am a human, and we carry huge weight on our hips, and I guess human hips have to be handled just so and everything has to be pretty perfect or it is a disaster for us. Cats, on the other hand, don’t carry that much of their weight on their hips, and so their hips aren’t that fussy I guess.

About the kneecaps, well, this apparently is much less common, and there’s a question as to whether fixing the hips might make the kneecaps start to behave on their own.

Also it looks like the hips will cost $1200 total and the knees (if they still need fixing) will be $2400 total, so this stray kitten that was living under a dumpster is evolving right before our eyes into a $3600 cat. We rescue cats, as something between a hobby and a calling. $3600 would rescue a lot of other cats, but now she’s a beloved member of the household. Damn. So, we will fix her, but I have to feel some pain about the opportunity cost.

Anyway, this is all surprising enough, I’m fishing around for clues as to what to expect. Anybody have any experience with this sort of thing?

Thanks!

2

It sounds like your vet knows what he’s doing, but I wouldn’t rule out a second opinion. That removal of the ball at the end of the femur sounds like something that may become a huge problem down the road. Cats’ bodies do a lot of contorting when playing or grooming, and it sounds like an invitation for disaster when the bone pops out. The poor cat is obviously suffering, and something needs to be done . . . even if it’s putting her down.

3

The name of the procedure usually called a femoral head and neck ostectomy, shortened to FHO. There is connective tissue that is left behind, and during the healing process after the surgery, that connective tissue helps form a sort of false joint. Cats are especially adaptive to this procedure. One of my cats had his right femoral head and neck removed in January 2011, and it was curative for him. The symptoms of discomfort/pain he displayed disappeared within 6 months of the surgery, and he stopped dangling his leg of off the sides of furniture (something they do to alleviate pressure on the joint) from habit within a year. Now I see him do the dangling thing once in a rare while when a storm is coming, but his ostectomy was the result of an old trauma so there’s still some old injured bone there that acts as a barometer.

The recovery time is a very strict six weeks of cage rest. You can use a large wire dog crate, and an e-collar has to stay on until the sutures are removed after the first two weeks. The convalescence is the hardest part!

Do make sure the vet you’re working with has done this procedure plenty of times before. I had mine done at a specialty center with a board certified surgeon who could do this blindfolded and one hand tied behind his back. The competence of the surgeon has a lot to do with how the healing process goes afterward, the less muscle and tissue the surgeon is able to displace while getting to the bone and sawing it out, and the smoothness of the remainder of the bone all have a hand in how well things go long term.

The price you’ve been quoted for the double FHO is very reasonable, obviously it varies greatly by region, but around here that’s a bargain. Only you can determine whether it’s a deal from a good vet to a good client or whether it could be getting what you’re paying for!

And IMO, the hips need to be fixed asap, sooner than asap, if you’re going to do it. The patellas can be addressed later, as indeed the legs lining back up to normal may help the knees a lot. Once she’s had a few months to recover and get back to normal activities, you can determine whether the luxations are still troublesome enough to need to fix surgically. I’ve seen mild cases where the kneecap pops out, the cat hobbles on it until it pops back in, and then back to playing and no pain. So it depends on whether they remain troublesome and painful for her after her FHO recovery.

4

Seconding SeaDragonTattoo. Although it sounds weird to us that they can do that, dogs and cats can lead a very nice life after FHO. And yes, cage rest is important! And if you can get physical therapy, that would also be helpful.

The patella luxations… depending on how severe, it may or may not require surgery. They are definitely not as urgent as the upper limb problems.

Another thing to add: I do not know how big your cat is, but it will be very helpful if the cat stays in shape. An overweight cat will put more stress on its limbs (knees), than a slimmer one.

5

Thank you for encouraging replies. We are definitely going to treat this kitty, the biggest challenge being getting ourselves well informed. Keep the info coming, thanks!

6

Check here for questions you may, they address some of them and give a good basic description of the treatments.

This page discusses surgical options in hip dysplasia (not likely what your cat had, but similar treatments). Look down the page for the femoral head ostectomy part.

7

Just to add a another point of view, I prefer early mobilization in my patients, starting around one week post-operatively. My worry is that prolonged enforced rest could lead to restrictive fibrosis of the forming pseudo-joint. To that end, a good pain management plan is needed, starting peri-operatively.

In addition, physiotherapy IMO is very helpful in getting these patients ‘up and running’ as soon as possible. Cats are not as easy as dogs in that regard (most do not appreciate swimming) but it is usually possible to do some controlled exercises. An enthusiastic and knowledgeable therapist is worth their weight in gold.

Fully concur with the importance of a good surgeon/well-performed surgery, and that the patella problem might well be less pressing than it currently appears.

8

Here’s a pic of my boy Nimbus when he came home from the hospital, his incision site, the day after surgery.

Full disclosure, his surgeon did not make me put him in a crate. He stayed in the bedroom with makeshift stairs for the bed, and was not allowed out to play or interact with the other cats or do any jumping or climbing onto high places. Seems to still depend on the doctor, as a friend of mine had her cat get an FHO the year previously and he was strictly confined to a crate. When her guy was let out, there was no limping or favoring of the altered limb. My guy seemed to favor his very mildly for a few months, but his doctor was not concerned, and he did so well that he didn’t need physical therapy. Yours getting a double FHO, I would think some cage rest might be in order maybe until the sutures are removed.

Here’s another pic of Nimbus, after he was allowed out of the bedroom. He’s doing the habitual leg dangle in this pic, that he kept doing until he finally forgot that it used to hurt. Such a good boy.

9

Thanks. I’m starting to worry more about an extended confinement than anything else (and that isn’t even a sure thing yet, we are still awaiting the extended conversation with the vet).