A four-year-old male castrated Boxer mix presented to Cornell University's Orthopedic Surgery Service initially on August 24th, 2016 for further work up of progressive bilateral hind limb lameness. A referring veterinarian had previously diagnosed the patient with a left cranial cruciate ligament rupture. An orthopedic exam performed on August 24th and repeated later on October 12"', revealed gait abnormalities, muscle atrophy of the hind limbs, decreased range of motion in both hips, as well as instability of the left stifle joint. Initial diagnostics included sedated radiographs that showed signs consistent with cruciate disease of his left stifle joint as well as a complete craniodorsally luxated left femoral head, global degenerative changes of both hips, and stifles and bilateral hip dysplasia. The decision was made to take the patient to surgery for a combined femoral head ostectomy (FHO) and tibial plateau leveling osteotomy (TPLO) on October 13th, 2016. The patient was discharged after surgery with a rehabilitation plan that combined medical management and a strict eight-week course of physical therapy. The focus of this report will be on the postoperative challenges of a combined femoral head ostectomy and tibial plateau leveling osteotomy and how the unique rehabilitation goals try to address them.