Tibial Plateau Levelling Osteotomy (TPLO Surgery)
TPLO surgery involves cutting the shin bone (tibia) with a circular cut, changing the geometry of the stifle joint then applying a surgical steel plate. This alters how the knee joint works in such a way that a Cranial Cruciate Ligament is no longer required to provide stability within the joint. Once the bone has healed the implants become redundant, and all of the stresses are carried through normal bone, tendons and muscle. Therefore once healed, the implants are not prone to future fatigue and breakage as can occur with some other repair techniques. The implants are left in place for the rest of the dog’s life unless they cause a clinical problem which is very rare. When you collect your dog they will usually have the wound covered with an adhesive dressing which may be removed within 3-5 days, or earlier if the dressing gets dirty or has exudates leaking through it. Sutures should be removed 10-14 days after surgery. Follow up X-rays will need to be performed 7-8 weeks after the surgery to assess the amount of healing of the bone, as this will determine when the dog can return to normal exercise. You should anticipate that your dog will need 6-8 weeks of STRICT REST in a controlled environment. If your dog needs to walk over a slippery surface or down 1-2 steps for access outside then a towel may be placed around the stomach just in front of the hind limbs to help ensure that the can be supported if their feet slip from under them. If at any point during recover the lameness seems to significantly worsen then you should revisit your surgeon immediately and X-rays may need to be performed to assess the surgical site.
Enforced rest is required for the first 6 weeks following TPLO surgery. This means the dog should be confined to a small room or run for the duration of this period. The only exercise allowed is short-duration (10 minutes maximum), slow walks on a leash for toileting purposes. Walking up and down flights of stairs, jumping up, or any uncontrolled activity must be avoided. Take care to avoid slipping when walking on wet or smooth surfaces. An old towel can be used as a hind-quarter sling if it is placed underneath the abdomen.
Postoperatively, physiotherapy in the form of passive range-of motion exercises can be performed after bandage removal. Ideally, all joints of the affected limb should receive physiotherapy 2 to 3 times a day but it is best to concentrate mainly on the stifle joint if time is short. During each session, a minimum of 10 flexions and extensions should be performed on each joint. After flexion and extension of the individual joints, the entire limb should be cycled through its full, pain-free range-of motion 10 times. It is very important never to force the joints or cause pain, but gently manoeuvre the limb through a range of-motion that is well tolerated.
Longer-term follow-up and care
At around 6 weeks post-operatively a radiograph of the stifle to assess the progress of healing are recommended. All going well, controlled exercise on a leash may begin at this time. Leash walks should be minimal at first (15 to 20 minutes twice daily), and then gradually increased after 8 weeks post-operatively. Sit /stand exercises should also begin around 6 weeks postoperatively. This can be achieved during leash walking by commanding the dog to “sit” and just before the dog assumes the sitting position, the command to “walk-on” is given. This routine is repeated 10 or more times every walk and has the effect of building the quadriceps muscle mass, which is very important in rehabilitation following cruciate repair. There should be no unsupervised exercise, and running and jumping should be avoided during the 6 to 12 week post-operative period. Between 8 and 12 weeks, exercise can be increased slowly to 30 to 40minutes twice daily. Deep-water swimming for 10 to 15 minutes several times a week, if possible, is excellent therapy at this stage. By 12 to 16 weeks the patient should have returned to near normal activity. However, there is a large variation in how quickly individuals return to full function following TPLO surgery. If there is not near normal activity by 12 to 16 weeks post-operatively, then make an appointment for reassessment.