What is TPLO surgery?

TPLO is the abbreviation for tibial plateau levelling osteotomy. This a surgical procedure used to repair cranial (or anterior) cruciate ligament rupture leading to stability in the knee joints of dogs. It involves changing the angle of femoral condyles and top of the tibial plateau (the shin bone) by cutting the bone, rotating it, and stabilizing it in a new position with a bone plate and screws.

How does TPLO surgery work?

Rupture of the cranial cruciate ligament leads to the knee (stifle) instability. When the dog walks on the affected limb this instability allows the shin bone to move forward relative to the thigh bone. This causes the dog to become severely lame on the affected limb. The stifle joint becomes painful from the sliding of these bones against each other.
The tibia moves forward with weight-bearing as that the top of the bone (tibial plateau) is not perpendicular (90 degrees) to the length (the axis) of the tibial bone. 
TPLO surgery aims to make the tibial plateau perpendicular to the long axis of the bone which helps prevent the shin bone from moving forward. The stifle joint becomes stable for the dog when weight-bearing.

Does my dog need a TPLO Surgery?

Dogs with a ruptured cranial cruciate ligament that have signs of lameness and stifle joint instability may require TPLO procedure. Dogs with rupture of cruciate ligaments in both stifle joints (bilateral disease) are particularly good candidates for TPLO surgery.
Tibial plateau levelling osteotomy surgery is a major orthopedic procedure. It is performed in dogs where the benefits of surgery outweigh the possible risks and where alternative methods of treatment may be less successful.

What does TPLO surgery involve?

A full clinical and orthopedic examination will be performed on your pet on the day of the surgery. Routine blood tests are essential, especially if your pet is older. This will ensure that your pet is healthy enough for the anesthetic and surgery. A further examination of the stifle will often be performed whilst your pet is sedated or anaesthetized. This allows us to demonstrate any abnormal movement of the stifle. Radiographs of the stifle will be performed. Special radiographic views are required, not only to assess whether underlying osteoarthritis is present but also to allow us to measure the slope of the tibial plateau which is essential to allow precise leveling of the tibial plateau. The position of the cut on the bone, the amount the bone needs to be rotated, and the size of plate necessary to stabilize the bone in its new position may be evaluated from these X-ray films. Sometimes joint fluid is collected from the stifle joint to rule out any evidence of infection or inflammation.

The surgery is usually performed immediately after the investigations. An incision is made on the inside of the shin and thigh bone to provide access to the stifle. A small incision is made into the joint to visualize the structures in the joint. Tears of the meniscus, which is the cartilage within the stifle, are common and may need to be surgically treated. The cut is made in the bone and the fragment rotated. A bone plate and screws are then placed to keep the bone in the new position. The incision site is closed, and stitches / staples will be placed in the skin. Immediately after the surgery radiographs will be taken to ensure the implants are in the correct position and that the tibial plateau has been levelled satisfactorily. Most dogs can go home the day after surgery. 

What care is required after TPLO surgery?

Aftercare following TPLO surgery is very important. Rehabilitation may take 12 - 16 weeks. Antibiotics and painkillers are prescribed at the time of discharge. If the dog tends to excessively lick the wound it may be necessary to use a Elizabethan collar. Weekly rechecks for next 4 weeks are recommended.
Exercise must be very restricted for the first few weeks until the soft tissues and cut bone heal, and at this stage is primarily for elimination purposes. It must be on a very short leash. No off-leash activity is allowed for first 12 weeks. At other times confinement to a dog crate or a small room is recommended. No jumping. stair climbing or off leash activity for 12 weeks. After a few weeks, exercise may be gradually increased in a controlled manner (still on a leash). 
X-rays are obtained to evaluate healing of the bone cut (osteotomy) at 6- 8 weeks. Depending on progress advice is given regarding increasing exercise. Further clinical and radiographic examination may be necessary on an individual case basis.

What are the risks of TPLO surgery?

As with all surgical procedures there are risks, but these risks tend to be very low for TPLO procedures. Some of the complications that can develop include infection, wound breakdown, implant failure (screws becoming loose or break) and late tears of the meniscus leading to recurrence of lameness. However, although there is the potential for complications, in the majority of patients selected to undergo TPLO surgery, knee pain is reduced, and function of the limb is improved.

What is the prognosis following TPLO surgery?

The outlook for dogs having this surgery is good. Most dogs are able to lead a full and active life and resume their normal activity levels within three months. Unfortunately, osteoarthritis is usually associated with cranial cruciate ligament damage and although TPLO surgery can slow down the progress, it will not eliminate the underlying disease, and in some cases long term medication may be required for the osteoarthritis.

If you have any questions or need more information, please do not hesitate to contact us. 

Dr. H Sekhon has been performing orthopedic surgeries since 1996. When TPLO procedure was developed a few years ago, he trained with a board-certified surgeon and received his certification for performing the TPLO procedure in 2003. He had been performing TPLO procedure both at Angel Animal Hospital and also as at some of the other clinics in lower mainland. Dr. Sekhon is available for consultation, second opinions and referrals for the TPLO surgery.

Extracapsular suture – Key Points:

• Reliable technique in small/medium dogs, but risk of suture stretching/failure which can result in recurrent instability.
• Postoperative function enhanced through the use of a minimally invasive arthrotomy, isometric suture placement & use of high stiffness nylon and crimps.

TPLO / TTA– Key Points: 

• Very reliable techniques even in very active or large/giant breeds of dog
• Early return to limb use (often weight-bearing next day)
• For TPLO, Synthes locking plate technology provides mechanical advantages and reduces risk of complications compared to other cheaper implant systems.
• Greater cost than suture stabilization due to the complexity of the surgery and implant costs
• We offer both TPLO and TTA and will advise the most appropriate surgery for your dog after assessment of his or her condition and x-rays.

Further information on TPLO is available here: www.TPLOanswers.com