I would try PROMAXOL to reduce the pain and help healing to begin. PROMAXOL contains the stronger LM potencies. After improvement is seen then you can switch over to ARTHRO-IONX. In addition it is helpful to give Canine Probiotics with each meal and Omega 3,6,9 daily. You may continue with the glucosamine supplement. The oligotherapeutic mineral base found in the IONX products helps the body to better utilize the other nutritional substances given for a synergistic response and faster healing. Also be sure to give sufficient fresh water that is free of chlorine and fluoride. For your dog on Tramadol you may give it along with PROMAXOL. Just give them at separate times. Ask your veterinarian about reducing the dosage as you see some improvement.
Please let us know how you progress or if you have any other questions.