Tibial Plateau Leveling Osteotomy in Dogs

Tibial plateau levelling osteotomy (TPLO) is a surgical procedure used on dogs who have torn their cranial cruciate ligament. The cranial cruciate ligament (CCL) is located in the knee. Its human counterpart is the anterior cruciate ligament (ACL). The aim of the treatment is to change the mechanics of the dog’s knee so the torn ligament is irrelevant to the knee’s stability. The procedure is one of the most popular orthopedic surgeries performed on dogs. Due to the risks that come as part of a major surgery, other alternatives are usually explored first. The surgery is performed by a veterinarian surgeon or an orthopedic specialist.

Prior to the tibial plateau levelling osteotomy procedure, the dog will need to be diagnosed. This will entail an initial examination, but possibly an additional examination under light sedation. Specific X-rays will be taken, allowing for accurate planning of the operation. An extraction of fluid from the knee may also be taken for analysis. It may take several visits within a couple of weeks to achieve these preliminary steps. The operation could then take place within just a few days. 

A breakdown of the surgery itself is as follows:

• The dog will be anaesthetised. Antibiotics and painkillers will be administered at the same time.
• An incision will be made and the torn ends of the cranial cruciate ligament will be entirely removed.
• The medial and lateral meniscus cartilages will be examined for damage. In 50% of dogs there is damaged cartilage. If there is, it will be removed.
• A curved cut will be made in the top of the tibia bone to fit the tibial plateau.
• The tibial plateau is then rotated to a level of about 5 degrees. 
• Plates and screws are then fitted to hold the tibial plateau in its new place.

This procedure is highly effective in achieving its aim of returning stability to the knee, allowing full weight bearing. Approximately 90% of dogs that undergo the surgery return to normal functioning of the limb. However, whilst the operation can permanently solve the problem in that cranial cruciate ligament, 30 to 40% of dogs will tear the same ligament in another knee.

There is the option for conservative treatment instead. This aims to give the dog complete rest for up to a month, allowing the ligament to heal. However, this treatment is only really successful with dogs that weigh less than 10 kg (about 22 lbs), so it is not a universal solution. 

There is also the external joint stabilization technique. The surgeon would secure a heavy nylon structure outside the joint but under the knee muscles. Whilst this older technique has some success, TPLO has more and is widely considered the gold standard of corrective surgery for ruptured cruciate ligaments.

The dog may need to stay at the vet’s for a couple of days. After check-ups within the first couple of days the dog may be released home. Regular check-ups within the first two weeks should be expected. Further check-ups will be required at least until six to eight weeks after. The frequency of these are decided on a case by case basis. X-rays will be taken immediately after surgery and again within the first six to eight weeks. 

Once home, exercise must be restricted to a minimum for three to four weeks. This can be gradually increased after that. At four, months exercise restrictions can be lifted. The wound also needs to be prevented from being licked. An Elizabethan collar may be appropriate for that. Dependant on progress, hydrotherapy may be recommended. Painkillers and antibiotics will be taken regularly until the pain decreases. 

Signs of improvement can be fast. 50% of treated dogs put some weight on their leg within 24 hours. Within five days, most dogs are walking with some weight on the limb regularly, but it may take up to six months before the dog will be fully recovered. 

The overall cost of tibial plateau levelling osteotomy can be between $2,500 and $4,500 (dependant on the surgeon and the veterinary hospital). Here is a breakdown of the approximate costs to expect with this surgery:

The initial X-ray and the X-ray needed after cost around $200 each.

The surgery itself costs around $700-$1,000.

The cost of metal plates and screws is around $400.

The anaesthetic depends on the size of the dog, but could cost around $400.

Painkillers and additional medication will cost around $40 a week.

There are also additional costs of 24-hour care in the 48 hours post-surgery. The cost of IVs and blood work also need to be factored in, and will vary depending on the veterinary hospital. 

Conservative treatment is significantly less expensive, but the success rate is much lower. The external joint stabilization surgery is still expensive as its surgical, however, it may cost less than TPLO. But the efficacy of both of these alternatives is much lower in comparison with TPLO. 

TPLO is major surgery, so with it comes some risk. There is the short-term risk of infection plus the risk of the screws coming loose or the bone healing slowly. These could have long term implications as further surgery would be needed. As with any surgery on a joint, there is also an increased risk of osteoarthrosis and degenerative disease, but this is a relatively permanent fix. The benefits of this operation far outweigh the risks. The likelihood of the aforementioned risks are extremely low, whilst the likelihood of a fully functioning limb again are over 90%.

The best cure is always prevention. While it is difficult to diminish the risk of rupturing a cranial cruciate ligament entirely, there are actions an owner can take to minimize the risks. The first method of prevention is to minimize the stress on the ligament. This can be done with the following weight management practices:

Keeping your dog slim: extra weight means extra stress on the ligaments.

Ensuring your dog is well exercised: strong muscles aid stability in the knee and protect the ligaments.

Promote forms of exercise that don’t over-stress the knee, i.e., swimming and walking on even surfaces. Activities involving frequent fast starting and stopping will be more strenuous on the knee, i.e., throwing balls.

An owner can also reduce the risk of ligament damage by ensuring a healthy, balanced diet. Generally, dogs should be fed a balance of raw, lean meats, some fat, but a generous amount of fresh fruit and vegetables. Grains and starchy foods should be avoided. Discuss the most appropriate diet options with your veterinarian.

These measures can be very effective in long term prevention. It is most important to keep the dog, fit and strong to aid knee stabilisation and protection. Exercising the dog regularly will also promote a healthy, active lifestyle in the owner. 

It is also worth monitoring the dog to look out for initial signs of strain on the knee, such as the dog limping and avoiding putting weight on it. This will allow for alternative measures to be tried before full rupture occurs and surgery is required.