TPLO Frequently Asked Questions

Drs. Allman and Might have established working relationships with approximately half of the veterinary hospitals within Austin and its surrounding communities.  We encourage you to speak with your veterinarian or contact us directly to find out if your hospital is a practice partner with MVS.  If you have a veterinarian and they refer out of hospital for specialty surgeries, let them know you may be interested in having the surgery done in-house.

The great thing about mobile surgery is that we are able to bridge the gap between your regular veterinarian and specialty services.  We have the great opportunity to work directly with you AND your veterinarian.  Once a diagnosis has been made and surgery is scheduled, we contact you prior to surgery being performed.  We are happy to discuss any questions you may have regarding your pets injury, surgery, and post-operative care.  Once the surgery is completed, we call you again to let you know the surgical findings and again to address any questions you may have.  We provide a surgery report for your veterinary records and a copy of discharge instructions. The discharge contains our direct email address as well as our phone number, so if you have any questions during the recovery period, we are happy to answer them.  Your veterinarian will recheck your pet 10-14 days following surgery to evaluate the incision site, remove the sutures, and place the limb through range of motion to determine how your pet is progressing.  You will then recheck with your veterinarian again 8 weeks following surgery – this time for x-rays to be taken of the knee to ensure appropriate healing of the bone.  If at any point during the recovery process you feel your pet is not progressing the way you would like, we are happy to perform an in-house recheck with you and your pet.

No problem! If you are new to the area or just haven’t established a relationship with a veterinarian in your area, feel free to contact us.  We are happy to talk with you regarding potential locations where MVS has practicing partners.

Please surf our web page and then give us a call.  We are happy to answer any questions that you may still have.  We can then work with you and your veterinarian directly to set up a time for surgery.

Due to the nature of our business, our appointment times are dictated by the hours of your veterinarian.  However, we typically perform surgery Monday through Friday, from 9am to 5pm.

Yes and no.  An ACL injury is not an emergency surgical procedure. However, our biggest concern is your pet’s quality of life.   As a general rule, we strongly feel the earlier we can address the injury, the more we can slow the progression of arthritis and the faster we can improve comfort in your pet’s knee.  Assuming we can address your pets discomfort with an appropriate medical protocol, then the only drawback of waiting is that arthritis can continue to progress.  If you are on the fence about deciding between medical or surgical management, there is typically little harm in not rushing the decision until you and your family can decide what is the best course of action.

Yes, however, this can often be a very difficult decision for both a pet owner and the veterinary surgeon.  What may be good for one family, may not be best for the next.  So lets look at the pros and cons.

We know that approximately half of all patients who tear one ACL will go on to tear the other, and it is not uncommon to examine patients that have ruptured both ligaments at the time of diagnosis.  Performing surgery on both knees at once means your pet goes through one anesthetic episode, one surgery, one period of hospitalization, and one rehabilitation period.  It is also more economical to perform both surgeries at once.  However, it is known that increased duration of anesthesia time and surgical time can increase the risk of surgical complications, specifically infection.   In addition, if surgery is performed on both limbs at once, then your pet literally doesn’t have a good leg to stand on in the immediate post-operative recovery.  However, if surgery is performed on only one knee, and the other is affected by a cruciate tear, then once the surgical limb is feeling better than the injured limb (which may be only days following surgery), then more weight is born by the surgical limb, and thus there is more stress on that implant.   With surgery done on both limbs at once, stress on the implants may be minimized assuming weight bearing is symmetrical.

Though older literature advised steering clear of performing bilateral TPLO’s, with recent advances in implant technology the most recent peer-reviewed literature on the subject has shown no difference in the complication rate when performing single session bilateral TPLO’s over staged TPLO’s.

A TPLO surgery typically lasts between 45-60 minutes. Some factors that may affect surgery time include surgeon experience and technique, patient anatomy, and the extent of damage in the joint to be assessed and treated.

Pain control is an integral part of a TPLO anesthetic and rehabilitation plan. As with any invasive surgical procedure, patients may experience some discomfort during the recovery, and it’s our goal to minimize the pain.

Patients typically receive a combination of pre-, intra-, and post-operative injectable pain medications (morphine, hydromorphone, etc). In addition, epidural or local anesthetic blocks are often given to help reduce pain. Finally, patients will also be sent home with oral pain management and anti-inflammatory medications.

Yes. Radiographs (x-rays) of the knee are required prior to surgery so that the tibial plateau angle can be measure.  This is required to determine how much the small top segment of the tibia must be rotated.  This x-ray is typically best performed on a sedated patient so precise patient positioning can be obtained.

In most cases, yes.  Most patients with ACL tears are happy, healthy, middle aged dogs.  However, we want to ensure the highest care is being provided to you and your pet, and attention to detail is part of this.  A patient’s overall health is important to know prior to anesthesia.  Blood work allows MVS and your veterinarian to evaluate certain vital organ functions prior to administering medications that alter the body’s physiology.

Your pet can eat and drink the evening before surgery. The morning of surgery, small amounts of water are allowed but food should be withheld.

Bring all medications your pet is currently taking and all previous medical records.

Once an ACL tear is diagnosed, institution of a medical management protocol can be immediately instituted, including limiting activity to controlled leash-walks.

NO! We want you to be calm and stress free when dropping your pet off at the hospital. In order to ensure this, please call when you have questions so that we can help you work through the decision making process.

There are three options for post-operative care.  For most cases, patients are hospitalized overnight at your veterinarian’s’ hospital.  Medications can be administered to ensure your pet is comfortable overnight so they can rest in a quiet environment.

Approximately 10% of patients that undergo a TPLO surgery have complications of one sort or another.  Most often these complications are minor (swelling, bruising, inflammation).  We expect to be fully invested in your dog’s recovery.  If complications occur post-operatively, we work directly with you and your veterinarian to make sure your pet returns to peak potential as soon as possible.  Sometimes, this may simply involve emailing photographs of an incision, while other times it may require a full evaluation at your veterinarian’s office.  It is important to remember that even if your pet endures a complication, a good to excellent outcome can still be obtained.

Patients undergoing surgery are typically fasted the night before surgery, and may not eat normally the evening or day following surgery.  In addition, they have undergone anesthesia and receive pain medications, which can slow down motility of the intestinal tract.  For these reasons, it is not uncommon for patients to go up to 5 days following surgery without a bowel movement.

It’s not uncommon for dogs to not want to eat the evening after surgery.  Sometimes, this may even extend into the day or two following surgery.  If this is the case, feel free to offer a diet of bland food – boiled chicken (no skin or spices), white rice, low-fat cottage cheese, or plain yogurt.  Warming the food may also help entice them to eat.  Other options may include baby food or canned dog food.

Remember that your pet has just gone through an anesthetic event and is then placed on multiple medications including antibiotics, pain medications, and typically a non-steroidal anti-inflammatory drug such as carprofen.  If your pet is only a day or two out from surgery, the vomiting or regurgitation may still be associated with the anesthesia and should subside.  If there is concern that the vomiting may be associated with a medication, it’s a good idea to try and spread out the medications by a couple hours.  Typically, if a medication leads to vomiting you may see signs of nausea (drooling or inappetence) within an hour or two of administration. Medications may be stopped or changed to a separate drug if necessary.  Please contact your veterinarian or MVS if your pet is vomiting after surgery.

Prior to administering any medications, please consult with your veterinarian or MVS.  Anti-inflammatories such as carprofen or metacam are options in patients with healthy kidney and liver function with no current gastrointestinal upset.   Other medication options may include narcotic medication such as tramadol, butorphanol, or fentanyl.  Other options can include icing the incision site with a bag of frozen peas, which conforms nicely to the leg.

Licking or chewing at the incision site can lead to premature removal of the sutures and/or incisional site infection, both of which can require a second procedure to repair.  Your pet should not be able to lick or chew at the incision until it is completely healed and the sutures have been removed.  If you are by your pet’s side, you may remove the e-collar temporarily.  However, it takes only a few short moments for a pet to cause significant trauma to the surgery site.  If you leave your pet’s side, the cone of shame or a similar product should be utilized.

Recovery from TPLO is a gradual rehabilitation process, but pet owners can expect a positive trend in limb use within six months after TPLO surgery.

In most cases, persistent lameness following TPLO is associated with post-surgical inflammation, soft tissue associated pain, or pain within the joint secondary to damage caused by the cruciate ligament injury (severe cartilage disease or arthritis). Other potential causes of lameness following TPLO include meniscal injuries and infection.

Rare causes of lameness could include implant failure, fibular fracture, or fracture of the patella (knee cap).

Some dogs may have a partial tear of the CCL before TPLO and a surgeon may leave the intact portion in place since TPLO can help reduce stress on the ligament. In some cases, the intact ligament could continue to tear after going through TPLO.

However, whether your pet has a partial or a complete tear of the CCL during TPLO surgery — and whether the remainder of the ligament is left intact or it is completely removed — further need for the CCL and additional procedures would be highly unlikely.

As with any procedure, there are always potential risks with surgery.   

• Anesthesia – Anesthetic complications are very rare. Hospitals typically provide extensive anesthetic monitoring including EKG, blood pressure, pulse oximetry, end-tidal CO2 measurements, heart rate, and respiratory rate. 
• Implant failure – When implant failure happens, the plate or screws could bend or break following surgery. Implant failure is very rare because TPLO plate designs and locking screw technology significantly reduce the risk. 
• Infection – Post-operative TPLO infections may occur in approximately 5-10% of patients. Owners can prevent infection by preventing the licking or biting of the incision site. Antibiotics can help treat surgical site infections. 
• Post-operative meniscal injuries – The risk of post-operative meniscal injury is approximately 10%. The patient may need additional surgery, or their surgeon could recommend rest, anti-inflammatories, and joint supplements.

Other uncommon complications include fibular fracture, patellar fracture, implant-associated discomfort, and osteosarcoma.

It takes at least eight weeks for bones to heal and good scar tissue to form post-TPLO surgery. During the first two weeks after surgery, you can take your dog on controlled leash walks (make sure to refrain from any off-leash activity). You can conduct short, five-minute walks three to five times a day. Perform the walks slowly at first to gradually improve strength.

Until the bone has healed we are completely relying on the implants (plate and screws) to stabilize the surgery site. It takes a minimum of 8 weeks for bones to heal and good scar tissue to form. Thus, your pet should be confined to a kennel or small room for 8 weeks until radiographs show good bone healing. Any running, jumping on or off furniture, or playing could lead to severe complications.  All activity should be controlled, leash-walks.

The first 4 weeks of recovery are most critical to your pet’s outcome. Your pet may go outside 3-5 times daily for 5 minutes at a time, on leash, for elimination purposes only.

After 4 weeks, if your pet is doing well, you may gradually start increasing the length of walks by 5 minutes/walk/week – in other words, week 5 your pet may go on ~10 minute walks on leash, week 6 ~15 minute walks, etc. By 8 weeks your pet can be up to two 20-30 minute walks per day, ALWAYS ON LEASH, with a couple shorter leash walks for elimination purposes.

These regular walks are critical for maintaining muscle mass and range of motion in the joint.  In addition, weight bearing is beneficial for bone healing.

There are two primary options for post-operative physical therapy – at home physical therapy or professional rehabilitation.  At home physical therapy involves passive range of motion (PROM).  Passive range of motion exercises may benefit your pet by maintaining range of motion in the joint. We recommend 3-4 times a day, placing the surgical limb through complete range of motion, ensuring flexion and extension of all joints. We do not want to hurt your pet with this exercise, but ideally range of motion should improve day by day. We recommend flexing the limb to a point where your pet just begins to show discomfort, and then extending the limb in a similar fashion. This can be done for 15-20 repetitions each time.

If you would like to pursue professional rehabilitation or if your pet is not returning to the level of activity desired, rehab options include:

http://austinvets.com/specialties/rehabilitation-fitness/

http://www.ctvsh.com/services/rehabilitation-conditioning

http://rehabdeb.com

Icing the limb for the first 3-4 days after surgery can help with pain control and inflammation. Please place a bag of ice or a bag of frozen peas, directly over the incision. Ice for 15 minutes per session. Placing a thick towel between the ice and the incision decreases the effectiveness of icing by not allowing the tissues to actually achieve a lower temperature, so this is not recommended.  If a towel is used, it should be a thin dish towel and could be wetted prior to icing.

After 3-4 days, you may begin heat packing the incision site. You may use a heat pack purchased from a pharmacy for this purpose, or you can fill a tube sock with rice and then heat it in the microwave. Remember, if it is too hot for your skin, its too hot for your pet. Heating can be performed for 15 minutes at a time, 3-4 times a day. This helps to reduce swelling and can also be performed prior to passive range of motion therapy.

If at any time during the recovery your pet stops using the operated leg, or fails to begin using the leg within 2 weeks, please contact Dr. Might or your veterinarian.