Pomeranian Luxating Patella: 4 Stages From "Skip-Hop" to Surgery

By Daon  |  Last updated: August 8, 2026  |  Researched and written from published veterinary literature. About this desk

Every time I work through a case series on toy-breed knees, the same line turns up in the patient history: owner noticed intermittent skipping, assumed it was nothing. Months or years later, the same dog is back with a knee that no longer goes back into place, and sometimes a torn ligament on top of it.

That gap is what this post is about. The OFA lists patellar luxation among the most common inherited orthopedic problems in toy breeds, and Pomeranians sit near the top of the list. Big registry studies out of Sweden and Korea put the same breed in the same place. The anatomy behind it is inherited and you can't undo it. How fast it gets worse is a different question, and that part is largely in your hands: his weight, your floors, and what he's allowed to jump off of.

Below: what's actually going on in your dog's knee, what each of the four grades looks like from your side of the room, what surgery runs in the U.S., and which home-care habits have real evidence behind them.

What Every Pom Owner Should Know First

• The up-on-two-legs greeting is worse than it looks: When your dog pops up on his back legs to say hello, his knee is bent and loaded at the same time. That's exactly the position where a shallow groove lets the kneecap slide inward. It isn't the worst thing he does all day, but cutting down how often it happens costs you nothing.
• One pound is a big deal on a 5-pound dog: A single extra pound can be 15–20% of his body weight. In Purina's 14-year lifetime study, dogs kept lean showed delayed onset of chronic joint disease compared with their free-fed littermates. A Pom's coat hides weight gain completely, so run your hands along his ribs instead of trusting the silhouette.
• Hardwood is the problem, not the dog: Poms grow long fur between their paw pads, which kills what little grip they have on wood and tile. Every slide sends a twisting load through his knee.

🚨 Real Talk

If your dog has been doing the little skip-hop for eight months and you've decided it's just how he walks, I need you to hear this: that's not a quirk, that's a grade. And a knee that keeps popping out doesn't stay a solo problem. In a JAVMA review of 162 dogs, higher-grade luxation came with a higher rate of torn cranial cruciate ligaments, because a kneecap that won't stay put shifts the load onto a ligament that was never built to carry it.

Nobody's asking you to book surgery this week. Get him graded. A grading exam takes about two minutes, costs less than a bag of good food, and gives you a baseline to measure against next year. Guessing costs more.

1. Why Pomeranians Are Prone to Luxating Patella

The kneecap (patella) normally slides up and down a groove at the bottom of the thigh bone. Luxation means it's slipping out of that groove. In toy breeds it almost always slips inward, toward the other leg.

• You didn't cause this: Affected dogs are built with a groove that's too shallow, and often the whole leg is put together slightly crooked, from the hip down through the thigh bone and shin. The OFA notes those deformities are present from birth even before the kneecap ever slips, and the condition is heritable. Nothing you fed him or let him do created it.
• What you do every day decides how fast it moves: Sudden stops, hard landings, and repeated twisting drive shear force through a joint that's already mechanically compromised. That's what wears the cartilage and builds arthritis over time.
• A skipping knee can take the ligament down with it: The 162-dog JAVMA series found concurrent cruciate rupture showed up more often as the luxation grade went up. That's the practical reason not to shrug off a knee that's "only skipping once in a while."

2. The Four Grades, From Your Side of the Exam Table

Your vet grades this by hand. She flexes and extends your dog's back leg while feeling whether the kneecap slips, how far, and whether it goes back on its own. The scale the OFA uses runs from Grade 0 (normal, the kneecap won't budge out of the groove) up to Grade 4. X-rays come into it for checking bone alignment and arthritis, not for assigning the grade.

Most people reading this are somewhere around Grade 2. That's the one with the skip.

Grade 1 (Mild)

What you'll notice: Nothing, usually. Your dog walks normally and shows no limp. Your vet can push the kneecap out of the groove during the exam, but it drops right back the second she lets go. It rarely pops out on its own during normal activity.

What usually happens next: Managed without surgery. Keep him lean, put traction under his feet, build back-leg muscle. Most Grade 1 knees are found by accident at a wellness visit.

Grade 2 (Intermittent) — the skip

What you'll notice: Your dog is trotting along, picks up one back leg for two or three strides, gives it a little shake, and carries on like nothing happened. That's the kneecap sliding out when the knee bends and dropping back in when he straightens the leg. You may also see his lower leg starting to rotate slightly inward when he stands.

What usually happens next: It splits. Plenty of Grade 2 dogs are managed without surgery for years. Others get sent to a surgeon, especially if the skipping is frequent, if he's young, or if the grade is climbing between checkups. Ask your vet directly: recheck in six months, or refer me out now?

Grade 3 (Out All the Time, but It Goes Back)

What you'll notice: The kneecap now sits outside the groove full time. Your vet can push it back in, but it slides out again as soon as she releases it. By this point the shin bone is usually twisted a fair amount (roughly 30–50 degrees), and you can see it in how he stands: bow-legged, crouched, or carrying his rear low.

What usually happens next: Surgery is commonly recommended, especially if he's limping or the leg is visibly changing shape year over year.

Grade 4 (Out All the Time, and It Won't Go Back)

What you'll notice: The kneecap is permanently out and can't be pushed back into place at all. Rotation in the shin can reach 50–90 degrees, the groove may be shallow to nonexistent, and your dog walks in a crouch and struggles to straighten his back leg.

What usually happens next: Surgery is generally the recommendation, and it's a bigger operation, often involving cutting and realigning bone. How well he does depends heavily on how deformed the leg already is.

Heads up: the skip-hop is the single most recognizable early sign, and it's also the one owners most often wait out. If your dog kicks a back leg mid-walk or suddenly hops on three legs, don't give it a few more weeks. Get him in.

3. Dog-Proofing the House

Most of the damage here happens in small doses. A slide in the hallway, a jump off the couch, four trips down the stairs a day. Start with the house, not the dog.

• Fix the hallway he sprints down: Every time a back leg slides sideways on a slick floor, his knee eats a twisting load. Put non-slip runners, rubber-backed rugs, or foam puzzle mats along the routes he actually uses: the hallway, the path to the food bowl, the landing spot next to the couch. You don't need to carpet the house, just the racetrack. Keep the fur between his paw pads trimmed while you're at it.
• Stairs count more than the couch: If you're in an apartment or a walk-up, stairs are his highest-volume load, not furniture. Carry him down when you can, gate the top if he bolts, and run a stair runner or adhesive treads on bare wood. Down is harder on the knee than up.
• Trade the jump for a ramp: Launching off a couch or bed drives the landing force straight through his back legs. A gently sloped ramp cuts both the impact and how far he has to bend the knee. Expect to bribe him onto it with treats for a week or two. Most dogs don't just take to a ramp on their own.

4. Weight, Exercise, and What to Skip on the Supplement Aisle

Fixing the floors only goes so far if he's carrying extra weight.

• Stop eyeballing his weight — this one has the best evidence: Of everything on this page, keeping him lean has the strongest long-term joint data behind it. In the Purina study above, the dogs fed 25% less than their littermates lived a median of nearly two years longer and developed chronic joint disease later. Here's the test: you should feel his ribs easily under a thin layer of fat, and see a waist when you look down at him. Then stop guessing and have your vet score his body condition and write down a target weight in pounds.
• Boring walks beat fetch, every time: The quadriceps help hold the kneecap where it belongs, and you build those with steady work, not bursts. Two 20–30 minute walks on flat ground or grass do more for that knee than ten minutes of fetch, which is nothing but the sudden stops and pivots you're trying to avoid. If he's already limping, ask for a referral to a certified canine rehab vet (CCRP or CCRT) before you start a program.
• Be realistic about supplements: Glucosamine and chondroitin get recommended constantly, but a review in Open Veterinary Journal concluded the clinical evidence in dogs is still thin. Green-lipped mussel (labeled PCSO-524) has somewhat better trial data in canine osteoarthritis, though the studies are small. Supplements also aren't held to pharmaceutical manufacturing standards, so what's in the bottle varies. Run any product past your vet, and don't let it stand in for weight control.

5. What Surgery Costs in the U.S., and How the Referral Works

Here's the path most American owners end up on. Your primary vet does the grading exam and the X-rays. If she thinks the knee needs fixing, she refers you out, either to a board-certified surgeon (DACVS) at a private specialty hospital or to a veterinary teaching hospital. Your regular clinic doesn't usually do the corrective work itself. Urgent care and 24-hour ER aren't part of this unless he's suddenly non-weight-bearing.

Ballpark numbers, before anyone tells you it varies:

• Grading exam plus X-rays: roughly $250–$600 at a general practice.
• Surgery at a general practice that does orthopedics: roughly $1,500–$3,000 per knee.
• Surgery with a board-certified surgeon: roughly $3,000–$5,000 per knee, and higher grades needing bone realignment can run $5,000–$7,000. You're paying for a surgeon who does this weekly, dedicated anesthesia monitoring, and a specialist to call at 9 p.m. on a Sunday.
• Both knees: usually staged a couple of months apart rather than done at once, and rarely discounted. Budget for two.

Metro areas run high, and these figures move, so treat them as a starting point rather than a quote. Ask for a written estimate that itemizes anesthesia, implants, hospitalization, recheck X-rays, and pain meds before you commit. If the number is out of reach right now, most U.S. specialty hospitals take CareCredit or Scratchpay, and it's worth asking whether the practice does in-house payment plans.

On insurance: most major carriers now cover hereditary and congenital conditions, but nearly all impose an orthopedic waiting period of roughly 6–12 months after enrollment, and some will shorten or waive it if you submit an exam showing sound knees. The trap is timing. Once your vet notes a skip in the chart, that knee is a pre-existing condition and it's excluded for good. If you have a young Pom and no policy yet, that's the decision to make this month, not after the first limp.

FAQ

Why does my Pomeranian skip when he walks?
The skip-hop is the signature sign of a luxating kneecap, usually Grade 2. The kneecap slides out when the knee bends, so he lifts the leg for a few steps until it drops back into the groove. It's not a habit and it's not him being dramatic. Have it graded.

Can a luxating patella fix itself?
No. The groove is too shallow and the leg is built the way it's built, and neither changes on its own. Grade 1 and many Grade 2 knees can be managed without surgery for years with weight control, traction, and controlled exercise, but that slows progression rather than correcting anything. Grades 3 and 4 warrant a surgical conversation.

Is it painful?
Grade 1 often isn't, and gets found by accident. As the grade climbs, cartilage wear, inflammation, and arthritis start producing real discomfort. Dogs hide it well, which is why a change in how he moves tells you more than whether he's crying.

How much is luxating patella surgery for a small dog?
Roughly $1,500–$3,000 per knee at a general practice, $3,000–$5,000 with a board-certified surgeon, more for higher grades needing bone realignment. Full breakdown in section 5 above.

Is the surgery worth it?
For Grade 3 and 4, most surgeons will tell you the alternative is a leg that keeps deforming and a joint that keeps arthritis-ing. For Grade 2 it's genuinely a judgment call, and it hinges on how often he's limping, how old he is, and whether the grade is climbing. Ask the surgeon what she expects the knee to look like in three years with and without the operation.

How long is recovery?
Plan on 8–12 weeks of strict restriction: leash-only potty breaks, no stairs, no couch, no zoomies, usually a pen or crate setup. Recheck X-rays around the 6–8 week mark. Formal rehab with a CCRP-certified vet speeds up muscle recovery. The hard part isn't the surgery, it's enforcing the crate rest on a Pom who feels fine by week two.

Will pet insurance cover it?
Only if you enrolled before any knee issue appeared in his records, and only after the orthopedic waiting period clears. See section 5.

Bottom Line

You can't rebuild the skeleton your Pom was born with. You can change how fast a mild grade turns into a serious one, and the evidence points at four things: keep him lean, put traction under his feet, stop the jumping and stair-pounding, and build back-leg muscle with steady, boring walks.

One more thing for anyone who brought a Pom home through rescue. You probably have no OFA paperwork and no health history on him at all, which makes a baseline knee grade at that first vet visit more valuable, not less. Ask for it by name.

And if you're seeing an on-and-off limp, a skipping gait, or a back leg getting shaken out mid-walk, schedule the appointment instead of watching it another month. The exam is quick, it isn't invasive, and it gives you a number to measure the next few years against.

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Related Reading

• Maltese Heart Disease: Why Half of Seniors Get MMVD, Plus Vet Cost Breakdown
• Pomeranian Alopecia X: Symptoms, Treatment Options, and What It Costs

Sources

• Orthopedic Foundation for Animals. "Patellar Luxation." OFA
• American College of Veterinary Surgeons. "Patellar Luxations." ACVS
• Cornell University Riney Canine Health Center. "Patellar luxation." Cornell CVM
• Di Dona F, Della Valle G, Fatone G. "Patellar luxation in dogs." Vet Med (Auckl). 2018;9:23-32. PMC
• Alam MR, Lee JI, Kang HS, et al. "Frequency and distribution of patellar luxation in dogs: 134 cases (2000 to 2005)." Vet Comp Orthop Traumatol. 2007;20(1):59-64. PubMed
• Engdahl K, Emanuelson U, Höglund O, et al. "The epidemiology of patellar luxation in an insured Swedish dog population." Prev Vet Med. 2023;213:105857. Preventive Veterinary Medicine
• Campbell CA, Horstman CL, Mason DR, Evans RB. "Severity of patellar luxation and frequency of concomitant cranial cruciate ligament rupture in dogs: 162 cases (2004–2007)." J Am Vet Med Assoc. 2010;236(8):887-891. JAVMA
• Kealy RD, Lawler DF, Ballam JM, et al. "Effects of diet restriction on life span and age-related changes in dogs." J Am Vet Med Assoc. 2002;220(9):1315-1320. PubMed
• Bhathal A, Spryszak M, Louizos C, Frankel G. "Glucosamine and chondroitin use in canines for osteoarthritis: A review." Open Vet J. 2017;7(1):36-49. PMC
• Vijarnsorn M, Kwananocha I, Kashemsant N, et al. "The effectiveness of marine based fatty acid compound (PCSO-524) and firocoxib in the treatment of canine osteoarthritis." BMC Vet Res. 2019;15:349. BMC Veterinary Research

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This article is for educational purposes only and is not a substitute for professional veterinary advice. Cost figures are U.S. estimates and vary by region and clinic. Please read our Medical Disclaimer and Editorial Policy.