Knee injuries are surprisingly common in dogs of all sizes but are well studied and understood by vet experts. Anterior cruciate ligament damage is a condition very often encountered in canine orthopedics. The most popular and successful treatment is TPLO surgery.
Tibial Plateau Leveling Osteotomy surgery is, as its name suggests, an osteotomy. This means the surgeon needs to cut into the tibial bone in order to reposition it, and fix it with plates and screws to functionally stabilize the knee joint.
It is an invasive surgery (this just means the surgeon needs to cut through tissue) practiced under general anesthesia. The procedure has been largely performed and developed since the 70s: your friend is in good hands with their surgeon.
Does your dog need to undergo TPLO surgery?
Nowadays, TPLO is the only procedure allowing for very quick recovery with a return to normal activity and mobility, while limiting the risk of arthritis development. While there exist alternative treatments, TPLO has excellent prognostics.
Unfortunately, physical rehabilitation alone, in the absence of surgical intervention, has not proven to be sufficient in the vast majority of cases, leaving persistent limping and even significant pain.
Preparing your dog for TPLO surgery
Injuries in dogs are always worrying for their owners. An ACL rupture or partial tear will cause a recognizable limp and often pain. Needless to say, treatment is imperative – the sooner the better.
The week before surgery: diagnostic and preparation
TPLO has an even better chance of success if performed soon after the injury. Your veterinarian should refer you to an orthopedic surgeon if they suspect a ligament injury (even a partial tear).
The orthopedic consultation will precisely diagnose an ACL injury and determine the degree of instability in the knee. A local radiological assessment will be made: your dog will be placed in specific positions (under sedation) so the radiologist can take x-rays and measures. They will calculate the angle of the tibial slope, look for existing arthritic lesions, and inspect your dog’s menisci.
Once the orthopedic surgeon knows the extent of the damage, the degree of slope correction needed with regards to the tibial plateau, and the size of the surgical plate needed, they can plan the surgery. This is a good time to ask them any questions you may have about the stages of TPLO procedure and what the next few days entail.
Surgery will usually be planned as soon as possible. If you must wait a few days, you’ll need to put your dog at strict rest, so they don’t risk further pain or damage.
The day and night before surgery: preparing your dog
Most often, you will be asked to present your dog at the hospital or clinic in the morning. According to the planned time of surgery, the surgeon or care team will give recommendations for last feeding time the night before, to ensure your dog arrives on an empty stomach the day of surgery.
Your dog should be in and out of the hospital or clinic within a 24 to 36-hour timeframe. Make sure you’ve planned your time out around this: how long is the drive, how will you transport your dog on the way to and from, where will you be staying if the hospital is far from home?
Your dog is about to undergo surgery and you may feel anxious or worried. Do not hesitate to ask a friend or family member to join you and try NOT to make your furry friend feel your stress. Plenty of love and hugs should be in store the day and night before surgery!
The day of surgery
When you arrive at the clinic, do ask the vet and care team any questions you may have. Their priority is your dog’s wellbeing, and they know it is yours too as an owner.
At the clinic, your dog will undergo another orthopedic exam. This may be completed by x-rays or knee punctures, and TPLO-specific scans (sometimes with an arthroscopy) once they are under anesthesia.
As for any surgery under general anesthesia, very attentive care and preparation is given to your dog and their comfort. This is especially important as, even before the surgery itself, they will be given strong analgesics.
What exactly happens during a TPLO surgery?
Vets place dogs on their back for TPLO surgery. During this time, vets inspect intra-articular ligament structures and menisci using arthroscopy or a conventional route. The vet and surgical team treat any lesions during this time.
Surgical correction starts with an osteotomy on the proximal end of the tibia. The proximal segment of the tibia is then turned on a pre-determined distance in order to reach the desired angle for the tibial plateau. It is then stabilized with a specific implant (plate and screws).
Finally, the closing and stitching of the opening happens, and patient is sent to post-operative x-ray control. These scans will serve as a basis for post-op follow-up and bone healing. Your dog is slowly awakened and continually given analgesics during the first 24 hours after surgery.
The surgeon will usually inform you as to how the operation went. If you can visit your dog, bear in mind they will be straight out of the operating room and be under heavy pain medication, so may not seem their usual cheery self. This is completely normal. Most dogs simply need time to recuperate and weaning from the analgesics.
Post-surgery: Recovery and follow-up
TPLO allows for fast clinical recovery. In most cases, dogs can bear some weight on the leg straight out of the hospital or clinic. The first few control visits post surgery are critical to ensure long-term success of TPLO surgery and recovery. Visits are often about 8 days after surgery to change the bandage and about a week later to remove stitches.
Strict rest is a MUST for the first 4 to 6 weeks. This means only hygienic walks, at slow pace and on leash (no free runs!). You will notice residual limping on the operated leg for a few days. It should dissipate a bit after a short month, and completely disappear after 2 or 3 months, once the bone has healed.
Your vet surgeon will order x-rays and a consultation about 1 month after surgery. At this point, your dog can normally begin physical rehabilitation. It’ll likely consist of slightly longer walks with a bit of trotting. Another x-ray at 2-3 months post-op should confirm correct bone healing.
Rehabilitation consists of activities aiming to rebuild the musculature around the knee joint. This is essential to TPLO surgery success in the long run. Hydrotherapy sessions are ideal for this and are often begin the third week after surgery.
With TPLO surgery, complications are extremely rare and are usually treatable (skin healing issues, tibial fractures, osteomyelitis …). The chances of a full recovery for your dog are excellent with proper rest and rehabilitation. In most cases, recover happens in as little as two to four months.