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Location - Carnation, WA 98014

Orthopedic Procedures

(TPLO) Tibial Plateau Levelling Osteotomy

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What is a TPLO?

TPLO stands for Tibial Plateau Levelling Osteotomy. A TPLO is performed for patients with cranial cruciate ligament ruptures of the stifle. This ligament is referred to as an ACL in human medicine.

Whereas other surgical techniques aim at restoring the function of the ACL, a TPLO approaches the problem by changing the biomechanics of the knee so that a functioning ACL is no longer necessary. In order to understand how this is done, it’s necessary to understand what happens biomechanically in a knee with a non-functioning ACL.

The ACL is a small thick ligament running from the back to front right through the middle of the stifle joint. It holds the femur and tibia in place and prevents the bones from moving forward and backward against one another. It also has some function in preventing internal rotation.

In a dog with an absent ACL the tibia is allowed to move forward and upward every time the dog puts weight on the leg. This, combined with excessive internal rotation is the main reason for lameness in a dog with an ACL tear.

The tibia moves this way because it’s joint surface (the tibial plateau) is sloped. Sometimes excessively. Once again, in a dog with a functioning ACL, these forces are contained and there is no forward and upward movement. But in a dog with a torn ACL, the tibia is free to shift and move every time the force of weight bearing is applied to it.

To fix this biomechanical situation, a crescent shaped bone cut is made towards the top of the tibia. The upper portion of the tibia is then rotated so that the slope of the tibial plateau if much more level. Usually a difference of 20-25 degrees. This rotation is held in place with a special bone plate and screws.

With the tibial plateau more level, the femur and the tibia have a more “stacked” effect. Now when the dog puts it’s leg down, the force of weight bearing is directed through the tibia and up into the femur, allowing the tibia to remain stable.
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Advantages
of a TPLO

A TPLO is a much more stable surgical repair overall, especially for large and giant breed dogs. Surgical implants used in other types of repairs like heavy gauge nylon are known for the ability to stretch and break when dogs are too active. A TPLO is held together with a bone plate and screws.
Another big advantage to a TPLO is less introduction of osteoarthritis to the joint. Dogs who have TPLO’s generally have less degenerative changes to the joint and surrounding tissues than those who have other repair techniques done.
TPLO’s generally have a very good return to function over the long term.

Potential Complications of a TPLO

Complications with TPLO’s are rare. Especially when compared with the complication rate of other types of repairs. However when complications do happen, they do have the potential to be more serious.

Possible complication include:

Surgery Site Infection

An infected surgical incision is usually the result of the patient licking their incision during the first two weeks after surgery. Dogs have a greater tendency to want to lick their incision with a TPLO, because of the bone plate just below the skin.
It is crucial to the success of the surgery that an E-collar is worn by the dog at all times for 14 days following surgery. Failure to follow these instructions can result in a surgery site infection.
Infections of surgery sites when an implant is involved (such as a bone plate) can mean delayed healing, non-union of the fracture site, and even a second surgery down the road to remove the affected plate.

Implant Failure

This is the rarest complication for a TPLO, but also the most serious. Dogs with bone plate failure have usually been far too active, and somehow managed to either break their repair apart, or actually break the bone plate itself apart.
Implant failure always requires additional surgery. The worst-case scenario in a catastrophic implant failure would be amputation.

Medial Meniscal Tear

This is a rare complication, as a procedure called a “meniscal release” is performed during surgery to help prevent this. However, it can still happen postoperatively. Besides restricted activity, there isn’t a specific way you would prevent this from happening.

Tibial Tuberosity Fracture and/or Patellar Tendonitis

Dogs who are too active after surgery run the risk of creating a small fracture line along the front of their tibia and/or developing patellar tendonitis. These problems usually heal and resolve on their own without surgical intervention, however they do set back healing time for the patient significantly.
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After Care

Proper aftercare is essential to the success of a TPLO surgery. There are two main focus areas:

    1. The incision: The patient should never lick it’s incision. In order to prevent this, an E-collar must be worn 24/7 for the first 14 days following surgery. Any signs of redness, puffiness, or discharge should be seen by your veterinarian immediately.

    2. Activity Restriction: The patient is not allowed off leash at all for at least 14 weeks after surgery. Even in the backyard you should have a leash on your dog. There should be no running, jumping, or rough housing with other dogs. It is also important that your dog not use stairs; is lifted in and out of the car; and is not allowed to jump up and down off of furniture.

More Information

For more information on aftercare please see the TPLO rehabilitation instructions.

Riverbend Veterinary

Riverbend Veterinary orthopedic surgeries performed in-house at your local veterinary clinic in King County, WA and surrounding areas.

Contact Details

Carnation, WA 98014

(913) 708.3394

info@riverbendveterinary.com