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What is TPLO surgery?
TPLO stands for tibial plateau levelling osteotomy and is one of the surgeries used to manage either full or partial cranial cruciate ligament (CCL) rupture. The CCL is in the stifle (knee) joint and, along with other ligaments and muscles, stabilises the joint.
The tibia (or shin bone) is cut at the top, and the bone is rotated to change the angle at the stifle joint. A metal plate and screws are used to hold the bone in its new position while it fuses.
How does TPLO surgery work?
In a normal dog, the stifle is subjected to a force called cranial tibial thrust when bearing weight. This force acts to push the tibia forward in relation to the femur (or thigh bone).
The cranial cruciate ligament constraints this and prevents the tibia from moving forward maintaining joint stability. If the cranial cruciate ligament ruptures this force is not protected against and the tibia will slide forward during weight bearing making the joint unstable.
By changing the angle of the top of the tibia (which is called the tibial plateau) this force can be neutralised, resulting in a stable joint on weight bearing.
- A curved saw is used to cut the tibia at premeasured points.
- The cut piece of bone is then rotated to flatten the tibial plateau angle – the amount of rotation is calculated before surgery from the radiographs (x-rays).
- The piece of bone is held in this position by a temporary pin.
- A specialised plate is then applied to the inside aspect of the tibia, and screws are placed in both sections to hold the rotated bone in position until it fuses in its new place.
- The temporary pin is then removed, and the soft tissues and skin are closed over the implants with sutures (stitches).
- Radiographs are taken after the surgery to confirm the new angle of the stifle joint and ensure implant placement is satisfactory.
Does my dog need a TPLO surgery?
If your dog has a full or partial rupture of the cranial cruciate ligament then TPLO is likely to be indicated to stabilise the stifle.
Cranial cruciate ligament rupture is normally manifested as a hind limb lameness, stifle swelling and pain and, in cases of full rupture, palpable instability of the joint.
In certain cases, for instance, if there are other problems with the stifle or unrelated issues, alternative management may be recommended.
In some dogs, the anatomical shape of the tibia or the steepness of the plateau may make another procedure, or even a combined technique, preferable.
Instability can be assessed by a veterinary surgeon using specific tests. These are called the cranial draw test and the tibial compression test. In cases of a partial rupture, instability is not always present.
The surgery and alternatives will always be discussed with you prior to admission so an informed decision can be made regarding the surgery. Surgery will only be carried out if we believe it is in the best interests of you and your pet.
Are there alternatives to TPLO?
There are several alternative managements to TPLO, each with its own indications and risk profile.
Some cases of cruciate rupture can be managed conservatively by resting the dog and providing analgesia (pain relief) and anti-inflammatories. Over time the stifle will develop fibrous tissue around the joint, which will give the stifle stability.
This is rarely successful in heavy dogs (greater than 10 kg) or very active dogs.
There is a surgical procedure called a lateral suture where a nylon line is placed from the femur to the tibia in the same direction as the cranial cruciate ligament runs.
This acts to stabilise the joint while fibrous tissue develops. This is usually only advised in small dogs as a stand-alone procedure. If the suture line loosens or breaks before the fibrous tissue develops, the joint will become unstable again.
This suture is sometimes placed in conjunction with bone-cutting techniques to give additional stability to the joint.
There are several other osteotomy techniques which aim to change the angles of the stifle and provide stability in a similar way to the TPLO. These include the cranial closing wedge osteotomy (CCWO) and tibial tuberosity advancement (TTA).
There are some situations where one of these techniques may be preferable to TPLO, and if we believe this is the case for your dog we will discuss this with you.
Some dogs have extremely steep tibial plateau angles, and we will sometimes recommend carrying out a combined TPLO and CCWO.
What does TPLO surgery involve?
Prior to the surgery, a full history and clinical examination are undertaken to confirm that the cause of the lameness is a ruptured cruciate ligament.
This is also used to check for any other concurrent conditions that may affect decision-making for anaesthesia and surgery.
Palpation of the limb is also carried out under general anaesthesia; in some cases, this is essential to confirm instability in the stifle joint.
Radiographs are taken of the stifles, which in most cases of cruciate ligament rupture show increased joint fluid – effusion – and a degree of osteoarthritic change.
The radiographs are also used to rule out other possible causes of stifle lameness and for pre-operative measurements to enable the TPLO surgery to be carried out successfully.
The first stage is to open and explore the stifle joint – this is called an arthrotomy. This allows inspection of the cruciate ligaments and assessment of the degree of rupture. It also allows inspection of the menisci – these are two horseshoe shaped cartilages which sit either side of the joint under the femur.
They provide stability to the femur and cushioning within the joint. In some cases of cranial cruciate ligament rupture, the instability and increased movement of the bones will result in the menisci getting torn. If this occurs then it causes additional pain and inflammation within the joint. In most cases, these injuries cannot be repaired, and the torn section of meniscal cartilage needs to be removed.
The procedure’s second stage is carrying out the osteotomy or bone cut. Once cut, the top part of the tibia is rotated to flatten the tibial plateau angle to a premeasured level. The cut bone is stabilised with a specially designed bone plate and screws. The soft tissue is then all closed with sutures.
Overall, TPLO is a technical procedure which involves careful pre-operative planning and rigorous attention to detail in surgery to achieve an optimal outcome, and we strive to achieve this in every case.
If your dog is recovered fully from the anaesthesia and is comfortable then they will be discharged, and in most cases, this is the same day as the surgery.
They will require a strict crate or small room rest at home and no running, jumping or slipping is to be allowed. They will need to be on a lead when they are taken out to the toilet. Most dogs will require a course of anti-inflammatories and paracetamol following the surgery.
Some patients may require additional levels of analgesia, and if you have any concerns over the comfort of your pet you should contact us. A wound check is normally required at five days, and the sutures are removed at ten days. These checks are normally carried out by your normal vets.
We will carry out a telephone consultation in two weeks and following this short lead walks can normally be started. Further radiographs are taken at six weeks to assess the level of bone healing and if this is adequate the exercise can be increased gradually from this point.
What you need to know about recovery
To ensure the surgery has the best chance of success it is imperative that the post-operative care regime is followed.
If you have any concerns over your dog or their progress following the surgery then please get in contact with us straight away. This allows us to check for and deal with any complications that may have arisen promptly.
Frequently Asked Questions
The majority of dogs that undergo TPLO surgery will be taking some weight on the limb within a few days of surgery, and this will gradually improve over the following weeks.
Although your pet is able to weight bear it is important that exercise is restricted to some degree for the twelve weeks after the procedure. Initially, this is very strict, but short lead walks will be started at two weeks and gradually built up from that point.
From twelve weeks, normal activity can usually be resumed.
TPLO is a very successful surgery with good outcomes in over ninety per cent of patients. By this, we mean they will return to normal activity and not require any medication.
However, as with any surgery, there are possible risks and complications that can occur, even though these are at very low rates. The surgery is carried out under general anaesthesia, and this always carries a small risk.
The risk of death associated with general anaesthesia in cats and dog is very small at 0.14%. In surgery, there is a risk of haemorrhage from blood vessels behind the stifle when the bone is cut. Measures are taken to reduce this risk but it can not be removed completely. If a haemorrhage does occur it can normally be brought safely under control before major blood loss.
Post-surgery risks include infection, implant and bone problems, and meniscal injury. Infection can occur following surgery and is reported in approximately 4% of clean surgeries. This can normally be treated with a course of antibiotics.
However if the bacteria adhere to the implants then clearing the infection can be more difficult and in some case may necessitate implant removal. On rare occasions the implants can break or loosen or the bone can fracture. This is very uncommon if you and your pet adhere to our recommended exercise regime. The meniscal cartilages are always inspected at the time of surgery and if no injury is identified they are left in situ.
A small number of dogs will tear these cartilages after the surgery and become lame again. If this occurs then a further small surgery is required to access the joint and remove the torn portion. This can be done in a key hole fashion or with a mini incision meaning recovery is normally quick. Any joint injury will inevitably lead to the development of osteoarthritis but the progression of this appears to be slower following TPLO. In some cases this will require medical management.
Any surgery will result in some pain and discomfort, but we strive to keep this to a minimum. The fact that a lot of dogs will take some weight on the limb on the day of surgery shows this can be achieved.
Opioids and anti-inflammatory medications are given prior to the surgery starting making them most effective.
After the surgery, a course of anti-inflammatories and paracetamol is normally given. The duration of these will depend on the individual dog.
Stronger analgesics may be required in some cases, and if you have any concerns over the comfort of your pet, please contact us.
To give peace of mind that your pet is safe following TPLO surgery it is preferable to keep them crate-rested when they are unattended, such as at night or when you are out of the house.
It’s important that your pet is not allowed to run, jump or slip as this might damage the repair and, in the worst cases, could necessitate further surgery.
Yes, your pet can be left unattended, but we recommend that they are crate-rested so that they can’t get into any mischief while you are out.
As a general rule, TPLO surgery is very successful, with over 90% of cases returning to normal activity.
Complications are rare but can include infection, implant-associated problems, secondary fracture, meniscal injury and osteoarthritis.
The risks and benefits of the surgery will be discussed at your consultation prior to surgery.
We recommend that your pet is prevented from jumping until we have evidence that the bone is fusing.
In most cases, this will be from six weeks but in some cases, it can take longer. We will advise you of acceptable levels of activity following any check ups or radiographs.
Arranging a referral for your pet?
If your dog has been diagnosed with a cruciate ligament rupture and you would like us to carry out TPLO surgery, all you have to do is ask your veterinary surgeon to refer you to us.
They can do this easily via our website, email or phone call. If you can let us know when you have made the request we will know to expect the referral and can follow it up if required.