what do I need to know?
Just like humans, dog’s have cruciate ligaments that stabilise their knees – and these ligaments (particularly what we call the cranial cruciate ligament) can also break
In humans, the ACL almost always breaks due to trauma – but in dogs this is a degenerative condition and is a very common cause of hindlimb lameness.
Unfortunately, despite many studies, we aren’t yet sure how or why this occurs.
cranial cruciate ligament position
Most commonly, a sudden onset back leg limp (lameness) is usually the first sign.
Often this limp can be subtle, with only a slight lameness after rest – but often it presents as toe-touching back leg lameness that appears for no obvious reason.
The lameness occurs in all breeds of all sizes and genders.
Occasionally, the lameness improves with anti-inflammatory drugs, but this can lead people into a false sense of security. Almost always, progression of cranial cruciate ligament degeneration occurs and surgery is inevitable.
While surgeons have been performing surgery to repair damaged cruciate ligaments for many years, with many different techniques, Tibial Plateau Levelling Osteotomy (TPLO) is now widely acknowledged to be the gold standard for the treatment of cranial cruciate rupture in dogs.
Dr Haydn Sharratt has extensive experience performing stifle surgeries of all types for nearly 30 years. Whilst practicing in London, he was one of the first Surgeons in the UK to be licensed by Dr Barclay Slocum to perform TPLO surgery in Europe.
Apart from standard TPLO in all sizes of dogs, we perform:
TPLO surgery prices include pre-operative and three post-operative consultations with us, initial x-rays and roughly 2-4 weeks of post-operative pain relief.
Post-operative x-rays under sedation are repeated again at 8 weeks after surgery to assess healing and cost an additional $400.
In the rare event that your pet suffers from post-operative complications, such as wound infection due to licking, surgical breakdown due to excessive exercise etc, these costs are NOT included in the prices below.
TPLO refers to Tibial Plateau Levelling Osteotomy.
Think of the top of your shin bone as being a flat table top. In dogs, this isn’t flat like ours. Rather it is sloped, usually around 24 degrees from front to back, but this slope can be steeper in certain cases, especially small breeds.
When the cranial cruciate ligament inside the knee ruptures, the lower part of the thigh bone wants to slide down this slope towards the back of the shin bone – a bit like if you put a ball at the top of a table sloped at 24 degrees.
By changing the slope to around 5 degrees, we eliminate this problem and essentially create a situation where the cruciate ligament is no longer required, and so doesn’t need to be replaced.
We do this by making a circular cut across the top of the shin bone, rotating it into it’s new position, and fixing it there with plates and screws which most often stay in permanently.
TPLO is the gold standard treatment in all sizes of dogs – and cats.
TPLO (Tibial Plateau Levelling Osteotomy) is an excellent technique for treating cruciate ligament rupture in dogs.
Our expectation is that > 95% of dogs will return to normal function within 6 months and most will be recovered by around the 3 -4 month mark, which is backed up by numerous studies that support TPLO as being the best surgical option.
TPLO is not the only technique available, however. Other techniques also have good success rates and are cheaper to perform, so if you would like to discuss alternatives, we will be happy to do so.
Having said that (and understanding that we aren’t the one’s paying the bill) we would prefer to perform TPLO on all sizes of dogs.
TPLO is not a small operation, and while we expect dogs will eventually resume their normal activity levels, as with all surgeries or procedures, not every case will flow smoothly after surgery and be without complication (read more in the FAQ’s).
If you haven’t been to see us before, we will arrange a consultation a few days prior to the surgery, so that we can perform a thorough pre-operative examination to confirm whether this is in fact the cause of your dog’s lameness, and discuss the treatment options in detail.
In spite of a TPLO being a big operation, most patients will be able to go home on the evening of the surgery.
Generally, patients are admitted at 8am and are then prepared for surgery by having blood tests done and giving them pre-emptive pain relief. They will also be placed on a drip for their time with us.
Their surgery will be started late morning and will usually take around 2 hours. Once they are in recovery, we’ll message you with an update – and we’ll then keep you regularly informed through the rest of the day while we administer appropriate pain relief and keep them comfortable.
Most patients will go home in the early evening. At your discharge appointment, all the post-operative instructions will be discussed and a plan for the following few days will be put in place.
Yes.
Usually both front legs will have a patch shaved where their drip will be placed.
The leg that will be operated on will be clipped from the toes to above their hips.
The fur on the opposite foot will also be clipped so we can place a pain-killing patch directly onto the skin. This patch delivers Fentanyl pain relief for the following 3-4 days when it will be removed.
Week 1:
For the first 3-4 days after surgery, pain relief will be provided via a Fentanyl patch on the skin of the opposite foot, anti-inflammatories and possibly a third medication. The first night at home will be the worst night as the anaesthetic drugs wear off. The Fentanyl patch will provide great pain relief, so there will be no need to be concerned your dog will be in excessive pain.
Dog’s will be uncomfortable and unsettled initially, and will need help to go out to the toilet. For large older dogs, a full body harness may be helpful to help lift them up, but usually a long towel, rolled up and placed under the abdomen will be sufficient to help them in the first 3 days. Sometimes, the Fentanyl patch will cause your dog to be a bit sleepy and inappetant. If they are excessively so, the patch may need to be removed before days 3-4, after which they should make a good recovery.
Dogs will need to be strictly confined indoors, except when going out to the toilet. Indoors, they need to be prevented from moving around the house unattended. If you need to go out, they will need to be confined in a small room or pen. If you are home, place them on a leash inside so that you have control of them at all times. A sudden ring of the doorbell, or a possum coming in the yard can be a very exciting thing for a lot of dogs, who will want to jump up and chase after them. This kind of activity needs to be strictly prevented.
It is unlikely that the operated leg will be used much in the first 2 weeks, but your dog may touch the toe to the ground when walking. Using the leg is to be encouraged. Walking slowly on the leash, going out to the back yard to the toilet 5-6 times daily for 5 minutes is a great idea – as long as they are on the leash and take it slowly. No other walking other than for toiletting purposes.
Stairs….
If you have stairs to get out to the garden and your dog is too big to carry up and down, then use a supportive harness or brace to navigate them in a controlled manner.
Ice pack the knee for 5 to 10 minutes three times per day for the first 3 days after surgery. A frozen bag of peas, wrapped in a tea towel will be all you need. When your dog is lying down with the operated leg uppermost, place the peas on the inside of the knee, directly over the wound. The cold might be uncomfortable at first, but providing some treats as a distraction is a good idea.
Leash walks for elimination purposes ONLY: 5 minutes, 5 times daily (in the backyard only)
Day 3-4:
Return to us, or your referring Vet for a wound check and removal of the Fentanyl patch. If you return to visit us, the costs of this visit are included in the Surgery price. Other Vets may charge for this visit.
Weeks 2, 3 and 4:
Continue strict indoor control when home and confinement when out.
Slow leash walks can be started – for 10 minutes, 2 times daily in addition to the 5 visits to the backyard for toiletting purposes.
Walks should be strictly on the leash, and should be slow sniff-fests only. They should be away from other dogs so that the excitement of meeting another dog is avoided.
It’s likely that at this time, your dog will only be on anti-inflammatory medication. Please book a post-operative appointment at 4 weeks so we can further review progress.
Week 5 :
If progress is good at this point, we will be able to start increasing the length of walks, likely to slow leash walks: 20 to 30 minutes, 2 to 3 times daily in addition to regular toilet breaks.
Sit/stand exercise: 10 repetitions, 3 times daily
Figure-of-eight walks, curls to left or right
Weeks 6, 7 and 8: (post-op radiographs scheduled for 8 weeks post-op)
Leash walks: 30 to 40 minutes
Incline walks = hills
Stairs, slowly: 5 to 10 flights, 2 times daily (if available)
Weeks 9, 10, 11 & 12 (healing almost complete):
Faster walks
Runs on the leash with you, without sharp turns
Gradual return to full activity after a final check at 12 weeks
We recommend someone is home with your dog for the first week after Surgery so that they can be monitored and prevented from making excessive movements.
Thereafter, if your dog is quite relaxed and happy to be confined to a room without any furniture to jump up on, and isn’t likely to be very active indoors, then they can be left unattended for periods through the day.
If you have a very active, energetic dog that will be difficult to rest and confine, please speak to us about some medication to calm them down to reduce the chances of excitement induced jumping, turning and sliding on wooden floorboards.
It’s important to note that some dogs can get very excitable in small spaces, so good control on the leash, even indoors, is important.
We would like to think that recovery will be smooth and uncomplicated in all cases, but in a few cases, complications do occur. In almost every cases, these can be managed successfully and won’t have a bearing on your dog’s long-term recovery.
Infection:
Licking of the wound is a common cause of wound infection. If this infection stays at the skin level, it can be easily managed. However, if the infection spreads down to the plate, screws and bone it will be difficult to manage. Bone can heal in the presence of infection, but it’s likely that we’ll need to start high doses of antibiotics for long periods of time. Furthermore, we may need to remove the plate and screws once the bone has healed.
Late meniscal injury:
The cartilages inside the knee are always assessed for damage during the surgery, but in rare instances, can be damaged during the post-op period. Fortunately, TPLO has btter outcomes in this regard compared with other procedures, but if lameness persists past 12 weeks, this is one of the potential causes.
Rock-back:
In TPLO, we aim to flatten the angle of the top of the shin bone to 5 degrees. Many dogs will recover surprisingly quickly from the surgery and will walk normally quite quickly. This is a very challenging scenario for owners, who find it difficult to confine and restrict their dogs. Repeated cyclic loading on the plate and screws can cause some loosening and movement of the top part of the shin bone, which ‘rocks back’and increases the angle to much greater than 5 degrees again. If this angle increases too much, it increases the chance of a poor outcome and the surgery will need to be repeated.
Pivot shift and patella luxation:
In rare instances, a condition called ‘pivot shift’ can occur, where the knee appears to bow outwards after surgery. Occasionally this can also be associated with dislocation of the knee-cap. If this occurs, we may need to perform an additional procedure to manage this.
Plate associated pain:
In some dogs, regardless of how well the surgery proceeded, they will remain very subtly lame. If this is the cases, we will assess them for all the conditions noted above, but at times the lameness is simply due to the plate and screws causing pain. In these cases, we will then remove the implants once everything has healed.
Tibial tuberosity fracture:
Occasionally, a small section at the front of the shin bone cut, will fracture where the straight patella tendon inserts. This will cause a sudden limp to occur, but fortunately will likely not need to be surgically repaired.
If your dog is progressing according to their post-op plan, x-rays will be repeated at 8 weeks to check to see that the bone has adequately healed.
However, x-rays may need to be performed sooner than this if we suspect there is a problem
The 8 week x-rays are really critical in evaluating healing. If this is confirmed and the following 4 weeks of their rehab program proceed without complication, then at 12 weeks life will get back to normal!
Our clients understandably have many questions about their pets – especially those requiring complex Surgery.
We prefer to discuss all of these in person during a relaxed and approachable consultation, so please feel free to contact us for a free initial telephone chat.
