What is a TPLO?

TPLO is a surgical technique used for the treatment of cranial cruciate ligament failure in dogs. TPLO stands for Tibial Plateu Levelling Osteotomy.

When the cranial cruciate ligament ruptures, the tibia slides forwards (cranially) when any weight is put on the foot. The slope of the tibial joint surface affects this sliding force and it is known as the “cranial tibial thrust force”.

The images below show the tibial plateau slope (Fig 1) and the tibia in its displaced position (Fig 2). If the tibial plateau is surgically altered so as to level this slope then the cranial tibial thrust force is counteracted and the tibia no longer slides forward.

Figs 3 and 4 illustrate the way that the slope is levelled. A bone plate and screws are used to hold the repositioned tibial plateau in position whilst it heals (this usually takes 8-12 weeks). Plate removal is not usually necessary.

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Why choose a TPLO?

Although other surgical techniques exist to correct damaged cruciate ligaments, the TPLO option has the highest chance of success (over 90%), especially in larger dogs and allows for these patients to go back a normal level of exercise. There is also less progression of arthritis compared to other techniques.

 

What are the risks of TPLO surgery?

General anaesthesia is required for any cruciate surgery and this has potential risks for any animal. With the modern anaesthetic agents and the intensity of monitoring, these risks are very low.

Although complication rates are very low, as with any surgery there is always the potential for an unforeseen issue. These can include minor complications such as wound swelling, bleeding etc to more severe complications such as infection and plate failure. It is important to stress that most complications can be resolved with prompt treatment, and to let us know straight away if there is any deterioration after we have discharged your dog.

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TPLO post-operative aftercare:

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Exercise

Since the TPLO involves cutting the bone and resetting it, it is extremely important to ensure you are able to strictly rest the dog for the first 6 weeks after surgery.

For the first 6 weeks after surgery, patients should be confined to a large crate. Running, jumping, flights of stairs and slippery floors should be avoided.

Short lead walks are permitted (preferably only in the garden) for toilet purposes only.

One or two steps outside (e.g. patio) are OK as long as they are taken slowly and under close control.

Walking slowly using the operated leg is beneficial for post-operative healing/rehabilitation and is an indication of good post-operative progress.

Patients are expected to be putting weight on the leg within two or three days of surgery. A steady improvement in both comfort and use of the leg should be seen for 6 weeks.

You will be provided with a strict exercise plan to follow which will detail how much exercise can be undertaken over this period, and it is important to follow this carefully.

Dogs should under no circumstances be allowed to jump, run or have off lead sessions until after the 6 weeks when x-rays have checked to make sure the bone is healing well.

 

Diet:

In an effort to minimise changes to the daily routine it is best not to change the type of food given or the times of feeding during the recovery period after surgery. Dietary intake should be reduced by around 20% to minimise the risk of weight-gain whilst exercise is limited.

Stitches

If present, these should be removed 10-14 days after surgery.

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Follow-up care

After 6 weeks, follow-up radiographs should be taken to assess healing of the osteotomy. No food should be given on the day of the re-examination as a sedative or general anaesthetic will be needed for the radiographic assessment.

If the radiographs show that the bone is healing satisfactorily then progressively increasing lead walks are permitted with the intention of allowing off lead exercise 12 weeks after surgery.

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What is the prognosis following TPLO?

Most dogs (over 90%) are expected to regain a very active and athletic lifestyle with no post-operative complications and without the need for any pain relieving medication.

All dogs that suffer cranial cruciate ligament rupture are likely to develop some degree of arthritis but this can be expected to progress more slowly in dogs that have had surgery.

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Unfortunately, many dogs suffer cruciate ligament failure in both stifles (sometimes concurrently). In some cases the treatment for the two joints overlaps although the surgeries are staged.

As a general rule we prefer to have a delay of at least 4 weeks between the two operations.

 

Costs:

Costs can vary depending on the condition, and if there are any concurrent conditions such as patella luxation that would also need to be corrected at the same time. All costs are inclusive of post-operative