When a dog’s cranial cruciate ligament (CCL) ruptures, one of the surgical options that veterinarians recommend is tibial plateau levelling osteotomy (TPLO).
The CCL connects a dog’s tibia (shin bone) to the femur (thigh bone) and is responsible for stabilising the joint. When torn or ruptured, the tibia slips forward relative to the femur. As the dog cannot walk correctly, the cartilage and surrounding can get damaged and result in osteoarthritis.
TPLO is a surgical technique used to treat cruciate ligament injury in dogs. Rather than repair the ligament, it aims to correct the poor joint conformation which is the underlying cause of the injury. By reconfiguring the angle of the femur and tibia, reliance on the CCL is minimised and function is improved.
At Paws & More Vet Clinic, we typically recommend osteotomy techniques like TPLO and TTA surgery. This is because they offer superior results to other types of cruciate ligament surgery for dogs in all but the smallest dog breeds.
If your dog is suffering a cruciate ligament injury, you’re probably keen to find out more about what techniques can be used to resolve it.
Read on to learn everything you need to know about TPLO surgery.
What Is TPLO Surgery?
Tibial plateau levelling osteotomy or TPLO is a procedure that helps treat a torn cranial cruciate ligament (CCL) in dogs. This surgery is an osteotomy-based, geometry-modifying procedure that adjusts the angle of the top of the tibia.
TPLO helps reduce mechanical stress in dogs via a reconfiguration of the knee joint that removes the reliance on the cruciate ligament. TPLO is performed by doing a semi-circular cut through the top of the tibia, which is then rotated to a specific point to reduce the tibial plateau angle.
Whilst the usual pre-operative slope is within 22–30 degrees, the target during TPLO is to bring it to 0–6 degrees. Once the rotation is done, the rotated tibial segment is secured with a bone plate to help it stabilise and heal.
Rather than simply repairing the injury or stabilising the joint, osteotomy-based surgery techniques such as TPLO surgery are designed to address the underlying conformation issues in the dog’s knee. The surgery reconfigures the actual conformation of the joint to avoid reliance on the cruciate ligament.
What Is the Success Rate of TPLO Surgery?
TPLO surgery has a remarkably high success rate at 90% to 95%. In the small percentage of cases where TPLO surgery fails, there are often other factors affecting the dog that impact the success of the surgery.
TPLO is a well-researched surgical procedure in dogs. A 2013 study compared the clinical outcomes in patients that underwent surgical treatments for CCL rupture. It was observed that patients receiving TPLO showed a 93% return of limb function a year after the surgery.
This means that TPLO is an effective treatment for CCL rupture. Most dogs that undergo TPLO recover sooner and regain full mobility.
How Is TPLO Surgery Different from other Cruciate Ligament Surgeries?
TPLO differs from other cruciate ligament surgeries like Tibial Tuberosity Advancement (TTA), Modified Maquet Procedure (MMP), and De Angelis (or lateral suture).
As an osteotomy technique, TPLO offers superior results to soft tissue stabilisation procedures such as the De Angelis (lateral suture) method, particularly for medium to large dogs.
De Angelis, or lateral suture surgery, is a form of extracapsular stabilising procedure. A prosthetic device, such as a nylon fishing line prosthesis or Liga Fiba as an artificial ligament, is placed outside the joint capsule.
Compared to TPLO, this procedure requires minimal specialised equipment and is easy to perform. However, soft tissue procedures that aim to stabilise the joint tend not to be particularly successful as the materials use, break, stretch and fail to restore the normal joint dynamics.
The De Angelis technique is more suitable for the smallest dogs (<5kg), who can have good results with this surgical solution, as well as purely traumatic tears. Active medium and large dogs are observed to have poor results after this type of surgery, as they place more weight and pressure on the poorly conformed joint.
TPLO also differs from other osteotomy techniques like TTA in invasiveness, location of the surgical cut, and implant materials.
Osteotomy surgeries like TPLO and TTA are minimally invasive procedures that aim to correct the poor joint confirmation, providing a more reliable solution to CCL injuries.
Comparing the two, the location of the bone cut for TPLO surgery is more invasive and takes longer to heal. Surgery with TTA is less stressful, so the healing process is faster.
Also, TTA uses titanium, whilst TPLO uses steel implant material. Additionally, TPLO uses plates and screws to secure the bone cut, whereas TTA uses various cage-like implants.
MMP surgery has the same principle as TTA, but is said to be more straightforward and provide better stability. It is also less invasive, quicker to perform, and less expensive than TPLO. A titanium foam wedge or a cage is used as an implant material, not plates.
Dogs that have undergone MMP are also shown to have faster recovery time than those who have had TPLO.
Is TPLO Surgery Painful for Dogs?
With effective anaesthesia and pain relief medication, veterinary surgeons aim to minimise pain for dogs during TPLO surgery and recovery, but some discomfort is possible. However, this shouldn’t stop you from pursuing a necessary surgery for your dog, as CCL injuries cause disruptive long-term pain and mobility issues.
With appropriate medication, the pain of TPLO surgery is manageable; even immediately following the surgery, your vet will prescribe pain relief to keep your dog comfortable. TPLO is also more comfortable than the lateral suture method, as the bone plate and screws used to secure the bones help minimise discomfort.
Generally, the discomfort experienced during surgery and recovery is preferable to leaving a cruciate ligament injury untreated. When left untreated, or when necessary surgery is postponed or delayed, your dog can develop Degenerative Joint Disease (DJD). This is a degradation of your dog’s joint(s) caused by the instability brought on as a result of an untreated cruciate injury.
How Do I Prepare My Dog for TPLO Surgery?
Once your vet confirms that your dog needs TPLO surgery, you must place the dog on strict rest until the day of the surgery. This is to avoid the risk of further damage or pain. The surgeon will advise you of the latest feeding time the night before surgery.
When preparing your dog for surgery, your entire household must also be ready. Your dog will have limited mobility after the surgery and need a comfortable space to rest where it won’t be tempted to get up. You can fluff up its blankets or pillows and invest in a large crate or gate to limit the space your dog has to walk around. Since the dog won’t be able to put much weight on its injured leg, a quality dog harness is also helpful.
Finally, your kids and other family members should be educated about the situation. This will help them understand why they won’t be able to play with their furry friend for a while.
You’ll also need to plan how you will transport your dog to and from the clinic on the day of surgery. It’s important that the surgery goes ahead on schedule to avoid delays to your dog’s recovery.
How Long Does TPLO Surgery Take?
TPLO surgery generally takes about 45 minutes to 1 hour, while the total anaesthetic time is 1.5 to 2 hours. However, because every dog’s condition is different, the time it takes for a TPLO surgery varies from one dog to another.
Your dog will also need extra time to recover from the procedure at the vet clinic before they’re ready to go home.
What Is the Recovery Time for TPLO Surgery?
The typical recovery time for TPLO surgery is around 12 to 16 weeks. Although the tibia may only require eight weeks to heal completely, 12 to 16 weeks allows your dog to fully recover from the procedure and resume their normal activities.
Twenty-four hours after TPLO surgery, most dogs will be able to walk. However, it is best to consider and follow the weekly ACL surgery recovery guidelines provided to you by the surgeon.
For the first four to six weeks postoperatively, strict rest is required. Slow-paced walks on a leash are allowed, but not free runs. To ensure the bone is healing correctly, x-rays may be taken at four and eight weeks.
Once the bone has healed, you can slowly increase your dog’s activity to rehab its muscles. At four months postoperatively, most dogs can walk and play normally but with restrictions on stressful activities. Within six months, they can usually resume complete physical activities.
What Are the Risks of TPLO Surgery?
The most possible and common complications with TPLO are implant failure or fracture and infection. Swelling, bruising, and osteomyelitis could also occur. However, your vet will inform you of any realistic complications and will not recommend a TPLO surgery if they know it’s not worth the risk.
To avoid implant failure, a dog’s mobility should be restricted for the first two months. It may also need to wear a plastic cone to protect the incision. Dogs without e-collars who have allergies or tend to lick are highly prone to infection. If they lick the incision and infection begins to form, the antibiotics won’t be able to penetrate, and the implant may need to be removed to address the infection.
How Much Does TPLO Surgery Cost?
In Australia, the cost of TPLO surgery largely varies, but it is within the range of $2,500 to $8,500 (inc GST). Among the factors affecting TPLO surgery costs are the breed and weight of the dog, age of injury, lifestyle, and whether blood tests or x-rays were performed.
You can request an estimate from your vet surgeon before proceeding with surgery.
What Are the Alternatives to TPLO Surgery?
Surgical alternatives to TPLO include TTA, TTA, MMP and De Angelis (lateral suture) surgery. Non-surgical options include pain medications, supplements, physical rehabilitation, and knee or leg braces. Your vet’s recommendations should be followed as they know the best treatment for your pet.
We discussed MMP, TTA, and extracapsular repairs like De Angelis or lateral suture surgery earlier. MMP and TTA are similar to TPLO, whereas extracapsular repairs involve an incision on the skin outside the knee and adding a suture outside the joint to stabilise it.
The tightrope technique is similar to extracapsular repairs as it also places a suture outside the knee joint. However, a small hole is drilled through the crest of the shin bone, where the suture is passed. With the tightrope technique, the implant mimics the cruciate ligaments.
Should I Stay Home With My Dog After Surgery?
Yes, you or someone else should always monitor your dog after surgery. This allows you to watch for any complications, ensure they avoid strenuous physical activity, and prevent licking or scratching of the surgical site.
Dogs can remove their cone or e-collar to lick or scratch their incision if not monitored, which can lead to ruptured stitches or infection, so it’s important for someone to keep an eye on them while the incision is healing.
Will My Dog Always Limp After TPLO Surgery?
After TPLO surgery, some pets may still limp, whilst others won’t. While your pet is expected to be non-weight bearing immediately following surgery, it should be able to start bearing some weight after 48 to 72 hours. However, six months post-op, your dog should walk normally without limping.
This article is published in good faith, for general informational and educational purposes only. Paws and More Vet Centre does not make any warranties about the ongoing completeness and reliability of this information. This article should not be used as a substitute for veterinary advice, including for diagnosis or treatment of a pet’s medical condition. Always consult a veterinary professional before making decisions on your pet’s health.