Tibial Plateau Leveling Osteotomy (TPLO)

Tibial Plateau Leveling Osteotomy (TPLO) surgery for dogs for cranial cruciate ligament injury.

Cranial cruciate ligament rupture in the knee is one of the most common causes of hind limb lameness in dogs especially in at risk breeds such as Labradors, Retrievers, Boxers and Rottweilers. The risk of cranial cruciate ligament rupture in dogs increases with age as the ligament can be prone to wear and tear over time, ultimately leading to rupture. A dog’s body weight is also an important predisposing factor.

In the knee joint, the cranial (anterior) and caudal (posterior) cruciate ligaments stabilise the stifle. If one of these ligaments is torn or ruptured, the joint becomes unstable leading to movement of the femur with respect to the tibia, this can cause injuries to the meniscal cartilage of the knee joint and significant pain which leads to lameness.

 

Lame dogs require examination by your veterinarian who will check for instability and pain in the knee joint as well as other areas of the affected leg. If an injury or rupture of the cranial cruciate ligament is suspected, your veterinarian will recommend x-rays to be conducted to help confirm the diagnosis.

For evaluation of cruciate ligament disease, it is important to obtain high quality digital x-rays to support the diagnosis, to accurately plan any potential surgery and to determine if there are any concurrent problems such as osteoarthritis or hip dysplasia. To facilitate correct positioning and to allow further examination of the joint with the muscles of the leg completely relaxed, the x-rays are taken whilst the dog is under a general anaesthetic.

If your dog is diagnosed with a cranial cruciate ligament injury, surgery is usually required. Cruciate repair surgery is routinely performed at Sydney Animal Hospitals. The specific procedure will depend on your dog’s breed, weight, activity level, age and anatomical measurements of the knee joint (done utilising orthopaedic planning software). The most critical measurements are the tibial plateau angle and the size and degree of rotation of the tibial fragment required to correct the deficient cranial cruciate ligament.

 

Given there are different surgical treatment options available depending on the patient, one of our veterinarians will explain the treatment management plan most appropriate to you and your pet’s individual needs. For many pets a Tibial Plateau Levelling Osteotomy (TPLO) is the treatment of choice to correct cranial cruciate ligament rupture.

 

What’s involved in a Tibial Plateau Levelling Osteotomy (TPLO) surgery?

Prior to having any procedure under general anaesthetic or sedation, your pet should be fasted (no food) overnight and then brought into the veterinary hospital between 8am and 9am on the morning of the surgery. Access to drinking water overnight should be allowed and any medications that your pet is currently taking should also be brought into the hospital for your pet’s stay.

Tibial Plateau Leveling Osteotomy (TPLO) surgery usually takes about 60-90 minutes. The operation involves creation of a radial cut in the top of the tibia and rotation of the tibial plateau segment of the bone until the joint angle is 5 degrees. The bone is subsequently fixed in this new position using a bone plate and screws, which have been specially measured and chosen to suit the size of the patient’s bones.

TPLO surgery changes the angle and relationship of the femur and the tibia. The overall aim of the surgery is to alter the biomechanics of the joint such that the cranial cruciate ligament is no longer required to stabilise the stifle joint. Restoring a stable joint allows return to function and reduces the risk of developing osteoarthritis.

 

The majority of dogs who have a TPLO surgery are expected to start weight bearing on the operated limb within three to seven days of the surgery. Over 50% of dogs return to normal activity 3-4 months after a TPLO procedure. Almost all patients are at 90% or better at 6 months post op.

 

At Sydney animal Hospitals we offer a set package to manage your dog’s entire procedure. The package includes all rechecks and management of any minor complications.

TPLO procedure package

  1. Lameness examination by your vet
  2. Pre-operative planning and radiographs.
  3. Choice of recommended procedure: e.g. TPLO, TTA,
  4. Surgery – including intra articular examination (meniscal cartilage) if indicated.
  5. Pain management, wound management, infection control medications and visits
  6. Post operative radiographs
  7. Hospital discharge (we offer a complimentary week of post operative care in hospital to assist your patient management)
  8. Arthritis preventative medication
  9. Recovery and rehabilitation – at home
  10. Optional Class IV laser therapy is also additionally available at a discount to our TPLO patients.
  11. Follow up checks and final radiographic check at 6 weeks

 

At Sydney Animal Hospitals, we have an advanced protocol for your dog’s medication regime. Patients are given intravenous antibiotics and pain medication during the procedure, and an intravenous analgesic infusion is continued for 24 hours post operatively. Your pet will also have a course of oral antibiotics, anti-inflammatory and analgesic medications to complete at home. We apply a pain patch and use long term non-steroidal anti-inflammatory medications post operatively to keep your pet comfortable. All these medications are included in our overall TPLO package.

 

Post-operative care

A week of post-operative hospitalisation is included with the surgery to allow our experienced team to care for your pet in the immediate post-operative period and to reduce the risk of complications associated with overuse of the leg. This period can be extended at a heavily discounted rate for pet owners that are unable to care for their pet at home.

During the post-operative period, it’s important to follow the advice of our veterinary team, which will include instructions about medications, exercise, rehabilitation techniques and follow up re-checks.

 

Medications and rechecks

Patients will usually be treated with a course of oral antibiotics for approximately 7 days, and a non-steroidal anti-inflammatory drug (NSAID) which is used for 3-4 weeks. NSAID medications should be given with food, and they provide both pain relief and anti-inflammatory coverage.

A course of injectable glycosaminoglycan medication to help prevent arthritis is also recommended. This medication is started immediately post-operatively and subsequent injections are given once a week for a total of four injections.

Weekly rechecks are conducted weekly for the first 4 weeks post-surgery to monitor your pet’s recovery, these are included in the cost of your pet’s procedure.

It is essential that the surgical site is protected against self-injury by your pet. As wounds heal they can become quite itchy which can cause most dogs to lick the wound, this can introduce infection which can lead to serious complications. For these reasons it is essential that your pet is fitted with an Elizabethan collar or cone until the sutures are removed – this usually occurs 2 weeks after the surgery is completed.

 

Exercise

It is very important that your dog has strict enforced rest for the first 6 weeks following the TPLO surgery. This means confining your dog to a small room or crate for the duration of this period. The only exercise allowed is short-duration (5 minute) slow walks on a leash in the backyard or verge for toileting purposes only.

Walking up and down flights of stairs, jumping up or down, or any uncontrolled activity must be avoided, as this can risk re-injuring the leg. It’s also important to take care to avoid your pet slipping when walking on wet or smooth surfaces. We can provide a hind-quarter sling to be placed underneath the abdomen to help support your dog.

 

Post-operative muscle therapy

Muscle therapy in the form of passive range-of-motion exercises can be performed to aid your pet’s rehabilitation. Ideally, all joints of the affected limb should receive physiotherapy two to three times a day but we instruct clients to concentrate mainly on the knee joint if time is short.

During each session, a minimum of 10 flexions and extensions should be performed on each joint. After flexion and extension of the individual joints, the entire limb should be cycled through its full, pain-free range-of-motion 10 times. It is very important never to force the joints or cause pain, but gently manoeuvre the limb through a range-of motion that is well tolerated. Our veterinary team will be able to demonstrate this muscle therapy techniques to you and can perform these exercises for your pet if you wish.

In addition to muscle therapy, laser therapy may assist in your pet’s recovery. Class IV lasers can improve blood flow, improve healing time, reduce pain, and decrease swelling. Please ask our team if you are interested in adding laser therapy to your pet’s rehabilitation program.

 

 

Longer-term follow-up and care

Six weeks after the TPLO surgery, our veterinarians will schedule a revisit to take x-rays of the knee joint to assess the progress of healing. This x-ray is usually taken under a general anaesthetic or sedation and is included in the initial cost of the TPLO procedure.

Once healing is confirmed, then controlled exercise on a leash may begin. Leash walks should be minimal at first (15 to 20 minutes twice daily), and then gradually increased by 20 minutes per week after eight weeks post-operatively.

Undertaking a set of sit and stand exercises should also begin at six weeks post-operatively. This can be achieved during leash walking by commanding your dog to “sit” and just before the dog assumes the sitting position, the command to “walk-on” is given. This routine is repeated ten or more times every walk and helps to restore the quadriceps muscle mass, which is very important in rehabilitation following cruciate repair.

There should be no unsupervised or off-leash exercise, and running and jumping should be avoided during the initial 6 to 12 week post-operative period. Between 8 to 12 weeks after the TPLO surgery, exercise can be increased slowly to 30 to 40 minutes twice daily. If available, deep-water swimming for 10 to 15 minutes several times a week is excellent therapy at this stage.

By 12 to 16 weeks the patient should have returned to near normal activity. However, there is a large variation in how quickly individual dogs return to full function following TPLO surgery. If there is not near normal activity by 12 to 16 weeks post-operatively, then it is advisable to make an appointment with one of our veterinarians for reassessment.

 

Possible complications

With appropriate care post operatively, the complication rates for TPLO surgery are very low (3%). Infections of the surgery site or joint can usually be treated with antibiotics and appropriate follow up revisits. Mechanical complications such as bone and plate issues usually occur in dogs that have resumed exercise prematurely and before the bones have appropriately healed after the surgery. Most mechanical complications can be managed with extended rest and anti-inflammatory medication.

 

If you have any further questions about cruciate ligament injuries or Tibial Plateau Leveling Osteotomy (TPLO) surgery please speak with one of our friendly veterinary team.

 

Contact Sydney Animal Hospitals for veterinary advice for your dogs cruciate ligament injury.

 

For further information visit:

DOG CRUCIATE LIGAMENT SURGERY  (TTO)

TIBIAL TUBEROSITY ADVANCEMENT SURGERY (TTA)

POST OPERATIVE CRUCIATE LIGAMENT CARE FOR DOGS