The Tibeal Plateau Levelling Osteotomy, TPLO for short, is a specialised surgery to repair the common problem of the ruptured cruciate ligament in the stifle (the knee joint) of dogs. In Tauranga, Dr Campbell Johnston is the only in-house Surgical Consultant to be offering this specialised surgery and VetCare and the pets of Tauranga are lucky to have him. It has been an extremely successful surgery and in the last 7+ years we have offered it at VetCare, we haven’t had one fail yet!
Whilst smaller dogs may be able to get away with less involved surgeries to stabilise the joint, often in larger dogs they prove to be inadequate. The fabella tie technique of passing a suture through the joint to tighten and stabilise the stifle, may only be successful 75% of cases (depending of what studies referred to) as the suture may break or the knot of nylon may cause ongoing inflammation and lameness. However, the TPLO offers a 100% success rate at VetCare, (the only complication that has occurred, is one patient had a reaction to the plate and it needed removing, once the plate was off the lameness was gone!). So, we offer the TPLO to dogs over 20kg, but as time goes on and the surgery is considered so much more successful and versatile than other techniques in practice, we may start offering this surgery to smaller dogs as well. Internationally, it has even been used in cats!!!
The procedure alters the angles within the stifle joint to neutralise the tibial shifting that causes the joint to be unstable resulting in the dogs reluctance to use it. In surgery, the joint is explored to remove any damaged pieces of ligament and cartilage that may be floating in the joint, then a cut is made with a specialised curved blade through the top of the tibia. The cut top portion is then fixed in the new position guided by a patented piece of equipment called the jig to create that new angle of loading for the stifle joint. To fix it in place, a stainless steel plate is used, moulded to the contour of the individuals bone and fixed in place with drilled screws.
Lincoln is a beautiful Maremma Sheepdog and weighing in at 55kgs and with a ruptured cruciate in his right leg he is a perfect candidate for the TPLO. He was dropped off with no breakfast, anaesthetised and Dr CJ took an X-Ray of the stifle to work out how far the wedge of tibia needs to be shifted to create the new angle of loading desired for the stifle. A nurse is responsible for monitoring Lincoln’s anaesthesia whilst either another nurse or vet is trained to assist Dr CJ with the surgery scrubs in. He is a man of many skills, but holding a 55kg dog’s leg completely still whilst sawing through it, is pretty tricky alone!
The jig is used as a guide to help Dr CJ decide where the plate should be fixed in place. It is a critical part of the surgery as there isn’t any room for redo’s. He only gets one chance to get this right. Once you saw the bone or drill a hole in bone, it remains a hole or cut whether you choose to fill it with a screw or not. This is why this surgery in particular has to be trained by TPLO specialists and once the training finished Dr CJ was set up with the specialised equipment including the jig. On days we have TPLO’s Dr CJ uses the surgical theatre, closes the door and is able to blackout the bustle of the Bethlehem clinic for the three to three and a half hour surgery.
Once the plate is in place, Dr CJ is able to relax a little more and often a little music can be heard coming from surgery. After the surgical site is closed, another X-ray is taken as a record of the angle created. Most TPLO patients stay a night for monitoring and pain control. At discharge, due to the new stability of the joint, dogs which came in not using their leg, leave walking! It brightens Dr CJ’s face as he finds it such a successful and rewarding surgery every time. Most clients find their hardest job is to slow their dogs down once they are home!
Dr CJ finds it amusing to see the same clients with their dogs a few years down the track after the surgery have forgotten which leg had the TPLO in the first place! It has been this successful. This is almost unheard of with other options which may not prevent long term nagging degenerative joint disease. We know the surgery is an investment but we also know it is one that pays off with results like these. Lincoln is a young dog and he definitely thinks it’s worth it! He’s back home now and back on his feet. With his knee stabilised and soon fully healed, he will be pain free and able to run, jump and live a full life as he should. He was a wonderful patient and we wish him the best!
FAQ’s on Cruciate Ruptures:
Why did my dog’s cruciate rupture occur?
– A problem such as Hip Dysplasia in the hip joint causing incorrect loading onto the stifle put too much pressure on the stifle, (this may be diagnosed at the same time as the cruciate rupture)
– Breed predisposition – Labradors and Rottweilers have increased rates of rupture to four years of age, but large and giant breeds have increased rates to two years of age.
– Obesity, causing too much weight bearing on the knee
– Highly active dogs causing repetitive stress on the cruciate ligaments
– Speyed females have higher rates than males etc.
How do I know if my dog has a ruptured cruciate?
Generally, either an intermittent nagging lameness persists in the hind leg causing a partial tear to the cruciate or your dog will all of a sudden stop using one if it’s back legs. It may happen on a trip to the park or even at home one day just come in lame with no apparent accident. A cruciate ligament is similar to a piece of rope fraying. It slowly breaks down causing a nagging inflammation of the joint until one day the last piece finally snaps. If left ~ 15% of smaller dogs will return to function within 4-6 weeks, but unfortunately with larger dogs and the 85% of the smaller dogs that don’t return to full function the joint will remain unstable and painful degenerative joint disease (arthritis) will inevitably set in. If this intermittent lameness occurs in your dog, see your vet to have the cruciate checked before permanent degenerative joint disease occurs.
Your Veterinarian will most likely use palpation techniques to feel excessive movement within the joint to diagnose a ruptured cruciate. Sometimes sedation and X-rays will be required if the dog is particularly tense.
Is the TPLO surgery better than other surgeries?
For larger dogs – our answer is ‘yes’ definitely.
As per the international Veterinary Information Network (run by international veterinary specialists) states:….’In the last few years, the research is starting to confirm what surgeons have known all along: TPLO dogs return to function faster, they develop less arthritis and they tend to return to better functional levels than is seen with other techniques.’