We offer a range of referral surgeries.
TPLO (Tibial Plateau Levelling Osteotomy)
Cranial Cruciate Ligament (CCL) rupture is very common in dogs and may be the result of sudden trauma or gradual weakness. The stifle or knee of a dog is a complex joint forming a mechanical hinge between the thigh bone (femur) and the shin bone (tibia). The stifle joint is composed of articular surface and menisci (shock pads) which distribute and absorb the forces of weight bearing, and ligaments that keep the joint together and prevent inappropriate movement in the stifle. When the CCL is ruptured, the stifle becomes unstable, leading to pain when your dog tries to bear weight. Dogs’ stifles are different in that the top of the tibia slopes steeply backwards. When the dog bears weight, the cruciate ligament is designed to stop the femur sliding off the back of the tibia. When the CCL has ruptured, the resultant instability causes the tibia to slide forward in relation to the femur (tibial thrust). It also causes uneven load distribution through the joint which results in meniscal and articular cartilage damage, rapidly leading to degenerative changes or arthritis. This is a painful condition and usually dogs either cannot walk or walk with an odd gait.
The goal of TPLO surgery is to neutralise this forward tibial thrust and eliminate abnormal movements in the stifle during weight bearing. This is achieved by changing the tibial angle of the stifle by performing corrective surgery to alter the biomechanics of the stifle and eliminate the need for a cranial cruciate ligament.
Advantages of TPLO over other surgeries:
- Joint range of motion is preserved
- Reduced arthritis and thickening of the stifle joint
- Quicker return to pre-injury function
- Dogs are ambulatory during rehabilitation period allowing easier owner management, especially with large dogs
- Reduced muscle wastage
You and your pet will have a consultation with the vet before we begin. This will allow us to perform a full examination, discuss any questions or concerns you have and complete the relevant surgical consent paperwork.
Your dog will require a general anaesthetic for the procedure. He or she will receive intravenous fluids thoughout the anaesthetic and during the immediate post-operative period.
Before we start surgery, radiographs (x-rays) will be taken of the affected stifle allowing us to make measurements and calculations specific to your dog’s surgery. We also check the radiographs for pre-existing signs of arthritis and other bone disease before we start.
The leg will be clipped of hair and prepared for surgery. Intravenous antibiotics and anti-inflammatories will be administered. An incision is made on the medial (inside) surface of the affected leg and the stifle joint is thoroughly examined. We surgically open the joint, remove the torn CCL and check the menisci (knee cartilage shock absorbers), removing any torn or damaged pieces. The joint is then flushed with sterile saline before closure.
The TPLO is then performed. The measurements made on the pre-operative radiographs are used to determine the placement of the cut in the bone. The cut is made and the top of the tibia is rotated allowing for it to be levelled off. A specially designed plate is then applied to the inside of the tibia with surgical screws. The surgical site is then closed. Post-surgical radiographs will be taken. This confirms correct placement of the plate and ensures the corrective angle of the tibia has been achieved.
Your dog will remain in the hospital with us for 2 to 3 days after the surgery. This allows us to administer medication and pain relief as necessary, ensure very strict rest, maintain cleanliness of the wound, ice the leg three times a day to reduce swelling and keep the leg more comfortable. We will only discharge your pet once we are happy that they will be comfortable in a home environment.
You will be updated throughout your dog’s stay with us. You are welcome to visit your dog the day after the surgery, at a pre-arranged time. Please feel free to bring any special bedding, toys or food if you think these will make your dog feel more at home.
What to expect when your dog comes home
After a few days your dog will be ready to go home. You will have an appointment with the veterinarian to discuss the surgery, home management, medications and care you need to perform at home. The home care post-operative period is very important to ensure optimal recovery without complications. Your dog will probably be wearing a buster collar to prevent them licking at the stitches which reduces the risk of infection of the wound.
We will do a follow up examination of your dog about 10 days later and remove the stiches, and discuss ongoing care which may be needed.
As with all surgical procedures, patients take several weeks to heal after TPLO surgery. Strict adherence to the post-operative convalescence program is essential to reduce chances of surgical site breakdown during the healing phase.
Any unstable stifle, will be predisposed to the formation of arthritis with time. TPLO has been scientifically proven to reduce the formation of arthritis compared to other corrective procedures, but the sooner your dog’s stifle is stabilised the less arthritis will form. We always recommend adjuvant therapy to help reduce any subsequent osteoarthritis. There are various nutraceuticals available. We recommend 4cyte as we have had good success with it, and the dogs love to eat it. Cod liver oil also has proven benefits (a dose will be advised in your post-operative instructions).
Cruciate disease can be a bilateral problem – that means it can occur in the other leg. 50% of dogs will rupture the other leg’s cruciate ligament within 5 years. This risk can be reduced by weight control and exercise modification. Weight control is essential for reducing the risks of arthritis as well as reducing forces applied on the stifle joint. We advise avoiding high risk activities such as high speed twisting and turning and jumping. If necessary, TPLO surgery can be performed on the other stifle. If you dog has bilateral CCL rupture already, we recommend staging the procedures at least 3 weeks apart.