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About TPLO

TPLO

What is a TPLO procedure?

Tibial Plateau Leveling Osteotomy (TPLO) surgery is an advanced surgery to repair cranial cruciate ligament (CCL) tears in dogs and cats. The CCL is the dog equivalent to the human ACL. TPLO surgery is considered the gold standard for surgical correction in dogs with CCL ruptures (CCLR) or partial CCL tears. Compared to other surgical procedures that help repair CCLR in dogs, TPLO has the best outcomes when looking at percent return to function, meaning your pet would go back to being closer to normal with this surgery compared to other options. The normal return to function for most dogs is 90 to 95%.

So, what does all of this mean exactly? We’ve broken down why your dog may need surgery, the procedure, and the recovery, so you can better understand why your furry companion may need TPLO surgery.

TPLO vs TTA

Both TPLO and TTA are ways of helping with a canine’s ruptured CCL. We believe that the TPLO procedure is superior for several reasons:

  1. Better return to function
  2. Less complications
  3. Less severe of complications
  4. Easier and more successful hardware removal if necessary

Click here for a video comparing TPLO and TTA procedures

Cranial Cruciate Ligament Rupture in Dogs

Short answer: the CCL keeps the knee stable, and without it working normally, pets will develop debilitating arthritis.

Long answer: A CCL rupture (CCLR) is similar to a torn ACL in humans. Just like humans, when dogs run, play, and are active, joints and ligaments are put under strain. Unlike humans, when dogs put any weight on their back legs, even when just walking, they put strain on their CCLs. The reason  they have more strain on their CCLs than people is because of the shape of their tibia, their shin bone. The top of their tibia is called the tibial plateau. In people it is flat, so when a person walks, the ACL is not engaged much. In a dog, the tibial plateau is angled/sloped. So when a dog walks, their weight travels down the femur (the thigh bone) and pushes against the tibial plateau and the slope and that causes some of the weight to travel down the tibia, and a portion pushes the tibia forward putting pressure on the CCL.

With these different forces, a dog can rupture or damage their CCL in two different ways. They can damage it like we would damage our ACLs with some type of athletic move where they plant their foot and their leg twists and ruptures the CCL quickly. The other way they can damage it is a slower degenerative change where just walking causes a few fibers of the CCL to break, and then the remaining fibers are forced to support more weight which makes them more likely to rupture. Over time, fiber by fiber, it will break and cause the knee to be less stable.

Without the CCL functioning normally, everytime a dog takes a step, the tibia shifts forward causing pain and more instability. The body will respond by growing new bone and the joint capsule will get thicker causing some stability, almost like a knee brace. The problem is now it hurts and it is difficult to bend the leg. This is arthritis.

The goal of surgery is to stabilize the knee so their own body doesn’t need to try to stabilize it with arthritis. If not repaired, the body will stabilize the knee, and the pet will walk better on it for a short time. There is a 2 to 6 month time period where it doesn’t hurt much and the pets seem to be doing well, but then the arthritis starts to hurt and the pet will start to limp again and will need extensive pain medications long term.

TPLO Surgery and Recovery

TPLO surgery is a surgical procedure to correct a ligament rupture and reduce the likelihood of further arthritis progression and injury. Additionally, this procedure corrects the angle at which the femur is resting and rubbing on the tibia.

This is the most common procedure veterinary orthopedic surgeons choose for their patients with a cranial cruciate ligament tear. It requires a surgeon with specialized training and equipment to perform the surgery. Dr. Jacob Mathias at Tipp City Veterinary Hospital will review the x-rays and plan the procedure, measuring the slope (or angle) and how they can best correct the issue.

Here’s a basic explanation of the procedure:

  1. An incision is made to allow access to the top of the tibia.
  2. A special blade is used to slice into the bone to allow for pins to be inserted.
  3. Stainless steel pins are inserted into the bone to stabilize and adjust the angle at which the femur and tibia meet. The angle correction depends on the severity of the injury.
  4. The new position is locked in place with a bone plate and screws.

This new angle allows for proper knee stability, movement, and better quality of life for your pet. In most cases, pets make a near full recovery, showing little to no signs of a previous injury.

Post Surgery Expectations and Rehab:

The first few days, your pet may hold up their leg. They may need some mild support moving around. Then they will start to toe touch and use their leg to balance. Over time they will use the leg more and more. We have you ice the outside surface of the leg for 5 to 10 minutes several times a day for 3 to 5 days. After 3 to 5 days, we have you switch to using heat on the outside surface of the leg. We also have you perform passive range of motion exercises on your pet to keep their leg from getting stiff. During the first 2 weeks, we have you leash walk your dog only for bathroom breaks and try to rest them the remainder of the time.

At 2 weeks we expect 10 to 25 % normal weight on the surgical leg and moving around comfortably. At this point the incision should be healed and that is when we no longer need to stop them from licking at the incision. We start to do controlled walks for 5 to 10 minutes at a time, one to 4 times per day. Every week after that you can add an additional 5 minutes to the walks. The goal is to use a short leash to prevent sharp movements and to move at the pace that your pet uses the surgical leg the most.

At 8 weeks we expect 50 to 75% normal weight on the surgical leg. At that point we radiograph the leg again and if the surgical site is healed, we have you do 1 week with some light higher impact exercise (jogging for 3 to 5 minutes per day). This is to help strengthen all of their muscles, ligaments, and tendons that they haven’t used much in the last 8+ weeks. After that week of light higher impact exercise, you can let your pet off leash and unrestricted.

In general we recommend only allowing your pet to go outside when on a leash for 8 weeks post surgery. We also recommend no running or jumping, including beds or couches, for 8 weeks.

For more information on TPLO rehab instructions please click here.

Post Surgical Complications (and what we do to prevent them)

Post surgery complications are rare if instructions are followed and include the following:

  1. Infection (This can be days to years post surgery; treatment is antibiotic and potentially removing the plate and screws after the bone is healed). The most common cause of post surgical infection is licking the incision. We recommend an e-collar for 2 weeks post surgery to prevent this from happening. We also administer antibiotics before, during, and after surgery. We have you shampoo your pet’s leg the night before with a specific medicated shampoo to reduce bacteria on the leg. We shave the leg, use 3 different surgical antiseptics on the leg, sterilely drape the leg, apply an ioban drape (sticky plastic iodine infused skin barrier) and perform the surgery with sterile technique to minimize risks. Post surgical, we place an e-collar on your pet to prevent any licking for 2 weeks.
  2. Minor Instability – If your pet is too active after the procedure, it will cause micro movements that slow down the healing process. This typically only causes the healing time to go from 8 to 12 weeks, but it can be more severe. The most important thing to prevent this is to keep your pet from running and jumping. We routinely send sedatives to aid in this because most dogs who rupture their CCL are fairly active.
  3. Plate or screw failure – This can happen if your pet is very active after surgery, for example running or jumping on a regular basis. That movement can cause metal fatigue, like  bending a small piece of metal back and forth until it breaks. If your pet is too active afterwards, this is a potential complication. We have never seen this with our surgical patients
  4. Arthritis – The goal of the surgery is to stabilize the knee and reduce arthritis. It cannot reverse arthritis that is already present. The best way to prevent this is to have the surgery as soon after the CCL ruptures or when it is partially torn. If the surgery is performed within 4 to 6 weeks of the injury, then arthritis accumulation is minimal.
  5. Cartilage issues – Stabilizing the knee reduces the risk of cartilage damage in the future but doesn’t eliminate it. If your pet has cartilage damage, they would have pain, and we would recommend either repair or treatments to help repair the cartilage. At the time of the surgery we inject the knee with platelet rich plasma to help reduce inflammation, reduce pain, and help repair any damaged cartilage.

If your dog suffers from CCLR, the TPLO procedure may be the best option for a full recovery. Call us today if you have questions about this procedure.