TIBIAL PLATEAU LEVELING OSTEOTOMY (TPLO)
WHAT IS THE TIBIAL PLATEAU LEVELING OSTEOTOMY (TPLO) PROCEDURE?
The TPLO procedure is one of the most commonly performed knee stabilization procedures for cranial cruciate ligament injuries in the dog. The TPLO is considered a geometry modifying procedure whereby the orientation of the cartilage surface of the tibia (tibial plateau) is altered to provide stability to the knee. With this procedure, the torn cranial cruciate ligament does not need to be reconstructed or repaired with a graft or synthetic suture. Once the TPLO is performed, your dog’s knee will be able to function without the cranial cruciate ligament.
HOW IS THE TPLO PROCEDURE PERFORMED?
The TPLO procedure requires general anesthesia and is performed under strict aseptic conditions to minimize the risk of post-operative infection. An incision is made along the inner portion of the knee. The incision is typically around 8 inches in length. Initially, the knee is evaluated either arthroscopically or via a mini-arthrotomy to evaluate the cranial cruciate ligament (CCL) and confirm the presence of a tear. The knee is evaluated for arthritis and damage to the medial meniscus, which can occur in approximately 50% of dogs who have sustained a CCL tear. If a medial meniscal tear is identified, surgical removal of the torn portion of the meniscus (meniscectomy) is typically performed to eliminate it as a source of pain. A curved osteotomy (bone cut) is performed within the top portion of the tibia. This allows for a rotation of the tibial plateau with the goal of making the tibial plateau level or flat. It is this leveling of the tibial plateau that provides stability to the knee. A bone plate designed specifically for the TPLO procedure is secured to the tibia to keep the osteotomy site stable and maintain the tibial plateau in it’s new position. The incision site is closed with a combination of internal and external sutures.
WHAT IS THE RECOVERY TIME FOLLOWING THE TPLO PROCEDURE?
The initial recovery period following the TPLO is typically 10 weeks. This is the time period when your dog’s activity will need to be restricted. After 10 weeks, most dogs can start to resume regular levels of activity. Total recovery time is typically 4 to 6 months.
WHAT IS THE SUCCESS RATE OF THE TPLO PROCEDURE?
The prognosis for return to full function is good to excellent depending on the degree of chronic osteoarthritis present in the knee at the time of surgery.
WHAT ARE THE POTENTIAL COMPLICATIONS WITH THE TPLO PROCEDURE?
Potential complications include surgical site infection, seroma formation, implant infection or failure, tibial tuberosity fracture, fibular fracture, patella luxation, medial meniscal tear, and chronic osteoarthritis. Most of these complications can be managed without additional surgery but they may delay recovery time.
DO I NEED TO COMPLETELY RESTRICT MY DOG’S ACTIVITY WHILE RECOVERING?
Activity restriction is very important and will affect the overall success of the surgery. Too much activity after surgery will cause pain, soreness, and may contribute to complications. We will encourage you to take your dog for short walks as this will help with rehabilitation and strengthening. If your dog cannot be supervised, it is best to confine to a small room or crate. Following the post-operative activity restriction guidelines and rehabilitation therapy protocol will be the absolute best way to maximize recovery.
IS THE TPLO PLATE PERMANENT OR DOES IT NEED TO BE REMOVED?
The TPLO implants do not need to be removed unless they cause a problem. Infection is the most common reason for implant removal. Infection of the implant can occur shortly after the surgery or years afterwards. Implant infections manifest as a localized skin sore that develops directly over the location of the plate. If the sore persists despite a course of antibiotics, it is likely related to the implant. Removal of the implant is the only way to completely eradicate an implant-associated infection. This is a minor procedure, but will require general anesthesia to perform. Recovery time following implant removal is typically 2 weeks.
WILL MY PET NEED REHABILITATION THERAPY AFTER SURGERY?
There is much evidence that therapy guided by a rehabilitation-trained veterinarian can speed recovery and improve long-term outcomes. Rehabilitation therapy plans are individualized for each patient but typically include LASER treatments to decrease inflammation and assist healing, passive range of motion exercises to restore joint movement, and therapeutic exercise and underwater treadmill sessions to promote weight bearing, muscle strengthening and balance.
WILL SURGERY PREVENT ARTHRITIS FROM DEVELOPING IN THE KNEE?
After a CCL injury, arthritis does occur in the knee joint regardless of treatment, but it is usually slower to develop and less severe when surgery is performed. Cartilage protective supplements such as glucosamine, chondroitin sulfate, and omega-3 fatty acids may be recommended. It is also important for all pets who have undergone TPLO