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Orthopeadic Services

Tibial Platue Leveling Osteotomy (TPLO)

 

  • The Tibial Plateau Levelling Osteotomy (TPLO) surgery stabilises the knee after a ligament injury.

  • Allows the leg can be used without its cranial cruciate ligament. This is done by changing the angle at the top of the tibia (shin bone) with a crew and bone plate. This decreases the level of tibial plateau and also the sliding motion of the joint to encourage healing.

  • Strengthening of supporting structures

  • This procedure allows the other muscles to support the knee without a cranial cruciate ligament.

  • The knee joint is exposed while the animal is under general anaesthetic. Damaged menisci or other injuries are addressed where medically necessary.

Tibial Tuberosity Advancement (TTA)

  • TTA fixes a cranial cruciate ligament rupture within the knee. It is similar to the TPLO, in that the TTA increases the knee’s stability and also allows the limb to be used without the cranial cruciate ligament.

  • Strengthening of supporting structures

  • The TTA allows the menisci to be exposed and a linear cut is made to the front of the tibia (shin bone).

  • The Tibia is moved forward and screws and plates are placed to secure the new placement.


Post Surgical Expectations with the TPLO and the TTA:

- Grogginess
- Decreased appetite for 24-48 hours
- Decreased bowel movements for 1-2 days after the surgery
- Discomfort a day after surgery
- Slight cough 2-3 days after surgery from the anesthetic tube causing a small amount of throat irritation
- Mild clipper rash around areas that have been surgical prepared
- Significant swelling, especially for the first week
- Bruising around the surgical site

- Checking the surgical site 1-2 times per day
- Limited exercise (no running, twisting or jumping) or stairs for the first 2 months. Exercise restrictions for 6-8 weeks
- Leash walking after the first 2 months

- No access to slippery flooring or stairs
- Preventing licking at the surgery site (by using an Elizabethan Collar)
- A sling for the first 2 weeks post-surgery to prevent falling, especially whilst the pet is toileting
- Revisits at 3-5 days for a bandage change and 10-14 days for suture removal

- Follow-up X-rays may be needed 8 weeks following the procedure
- After such an orthopaedic surgery, patients are still more prone to arthritis and other joint problems. But, the TPLO surgery allows animals to continue to have an active lifestyle, with 93% of pets being able to return to full normal function within a year after surgery.
- 50% of dogs with a history of ruptured cranial cruciate ligaments, the other leg will rupture the same ligament within 2 years.

- Crate or cage confinement for 10-14 days until sutures are removed (NOTE: Intradermal sutures are dissolving sutures in the skin that do not require removal. In these cases, your pet will require a post-surgery checkup but no sutures will be removed.)
 

  • Your pet should put some weight on their leg within 10 days of the procedure, with full recovery starting to occur 3-6 months post surgery.

  • There should be a progressive increase in weight-bearing over the next few weeks


Potential Risks Associated with the TPLO and the TTA:
- Infection (off smell and discharge coming from wound)
- Implant failure
- Meniscal injury
- Bleeding
- Long-term lameness
- Risk of repeat surgery

- Arthritis

- Implant failure

- Wound breakdown
- Failure to return to normal function
- Delayed bone healing, non-healing or incorrect bone positioning
- Bone fracture

 

  • Such complications occur in less than 14.8% of patients.

  • Please note that 6.6% of cases need the surgery to be repeated and still have long term lameness. In addition to the TPLO and TTA surgery, other long-term management therapies also need to be utilised including:
    - Physical Rehabilitation through planned exercises may help speed up recovery times.
    - Managing the animal’s weight and feeding a diet rich in Omega-3 fish oil, glucosamine or prescription joint diets to reduce inflammation.
    - Additional therapies such as cold presses, balance exercise, swimming and leash walking in addition to pain relief medication tailored to the animal by the vet, encourages rehabilitation through increased bloodflow and flexibility and prevents further injury.

 

Luxating Patella Repair

  • Patella (kneecap) luxation occurs in nearly 10% of all puppies.

  • Patella Luxation effects more smaller breed dogs, however all breeds can be affected.

  • In small breed dogs, this condition is genetically inherited. However, this condition can also be caused from trauma to the limb.

  • The kneecap sits outside the groove in which it should sit in. This causes an instability joint and leads to the leg being held up. Other signs include:

-Limping

-Bowlegged

-Reluctance to jump

  • A luxating patella increases the risk of pain and arthritis.

  • Over 50% of dogs that suffer a luxating patella are affected in both legs.

  • Most common breeds to be affected:

-Pomeranian

-Cocker Spaniel

-Yorkshire terrier

-Chow chow

-Bedlington Terrier

-Japanese Chin

-Pug

-Dachshund

  • Grading of the luxating patella is determined through the vet palpating the limb:

  1. Grade 1: the kneecap can be moved out of the joint but returns to normal. The animal is happy and only intermittently lifts the leg.

  2. Grade 2: the kneecap spontaneously moves but returns to normal when the knee extends

  3. Grade 3: the kneecap is out most of the time but can be returned

  4. Grade 4: the kneecap is out permanently and cannot be returned

  • Patella Luxation Repair fixes this condition by stabilising the joint and helps prevent early arthritis.

  • Due to there being many different surgical techniques, the veterinarian will discuss the technique appropriate for your pet.

Hip and Elbow Scoring

  • Used for owners to diagnose hip and elbow dysplasia (where the hip or elbow joint is abnormally formed).

  • Used to determine a pets suitability to be used for breeding purposes.

  • Radiographs are taken and sent to a Specialist Veterinary Radiologist.

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