TPLO surgery – your ultimate guidebook

What is TPLO surgery?

TPLO is an acronym for Tibial Plateau Leveling Osteotomy, and TPLO surgery is a surgical procedure for dogs that suffer from cranial cruciate ligament (CCL) tear or rupture.

TPLO surgery alters the slope of your pet’s tibia plateau to reduce strain on the knee, preventing the femur from “rolling down the hill” onto the tibia. The surgery actually alters the biomechanical process of the knee, cutting and relocating the curved section of the tibia to prevent the femur from moving past a predetermined position.

This is then stabilized with a TPLO plate which also holds the bone together for healing.

Altering the slope of a bone sounds extreme, and it is, but the success rate for TPLO surgeries is through the roof. You’ll be hard-pressed to find many bad reviews or unhappy customers of TPLO surgeries.

Because of its success rate, TPLO has become the standard process for repairing cranial cruciate ligament ruptures in dogs.

Below is the best video I’ve seen that explains TPLO end-to-end succinctly and yet with solid and detailed information. Well worth watching.

TPLO is time-tested and well-vetted.

Recent studies show an overall success rate of greater than 90% and overwhelmingly satisfied customers (dogs and their humans), with almost all returning to full limb function within one year postoperatively.

Additionally, dogs that had TPLO surgeries are far less likely to suffer ongoing pain or mobility issues than dogs that were treated via alternate methods. See more about this here.

TPLO surgery – what is it?

Commonly abbreviated as TPLO, tibial plateau leveling osteotomy is a surgery that corrects a cranial cruciate ligament rupture in dogs.

Given how common it is for dogs to tear this knee ligament, TPLO surgeries are highly sought-after.

In fact, my own dog has undergone this procedure, so I have firsthand experience of what TPLO surgery is like, what you can expect during recovery, and what your dog will endure.

One of our dogs has had TPLO, and we are in the process of getting another one done at this very moment (just got the estimate yesterday…gasp!).

With the following insight, you’ll get a feel for what TPLO surgery is and its many benefits.

Why is TPLO surgery necessary?

Often likened to a human’s ACL, a dog’s CCL can weaken over time.

This deterioration is caused by genetic, conformational, or immune responses within the joint.

Unlike an ACL, a CCL can rupture even if it hasn’t sustained significant trauma.

With that said, it’s easier for dogs to injure their CCL than it is for humans to damage their ACL.

If left untreated, a ruptured CCL can render your dog’s limbs useless and, in turn, make them unstable.

With TPLO surgery, your dog’s quality of life improves, and they’re more likely to return to normal function.

Signs your dog may have a cranial cruciate ligament tear or rupture

If your dog is limping or sitting awkwardly, TPLO surgery may be warranted.

They may drag one of their hind legs, or “toe touch”, which shows there is real tenderness in the area.

Since a CCL tear or rupture impacts your dog’s knees, the way they sit and walk will likely be influenced.

These red flags will let you know that your dog is in pain and needs medical attention. For your peace of mind, consult with your veterinarian to ensure that the proper steps are taken to correct the issue.

With their keen eye, they’ll help you determine how you should proceed.

You can see more about the symptoms and indicators on our TPLO Symptoms page.

Why opt for TPLO surgery?

Backed by extensive research, TPLO surgery is a proven procedure.

In other words, it’s been wildly effective for over two decades, which is why many pet owners prefer this surgery to other knee procedures.

Not only is TPLO surgery more likely to restore normal limb function, but it’s also suitable for a wide range of dogs.

TPLO Statistics

We’ve compiled information we could find regarding TPLO surgeries – surprisingly, the details are difficult to find. What we find, however, points to a well better and largely successful procedure that enables dogs to get back to roughhousing and playing within a year’s timeframe.

• Success rate (return of full limb function): 93%
• Complication rate: 14-34%
• Second surgery on same leg: 6%
• How many develop similar problems on other leg: 40-60%
• How long does TPLO surgery take? About one hour
• How long does TPLO recovery take? Up to a year for full recovery
• Dog sizes that get TPLO surgeries? 5 – 250 lbs
• Comparison of TPLO surgeries and other CCL corrective procedures:
  • TPLO: 78.6
  • TTA: 13.9%
  • LFS: 5.9%
  • TR: 1.6%

Sources of the above information:

• Arthrex Vet Systems – long-term follow-up study
• Whitehair, JG, Vasseur, PB, Willits, NH. 1993. Journal of the American Veterinary Medical Association. 203(7):1016-9.
• American College of Veterinary Surgeons. Cranial Cruciate Ligament Disease.
• Palmer, RH. 2005. Understanding tibial plateau leveling osteotomies in dogs. Veterinary Medicine.
  • Available at: http://veterinarymedicine.dvm360.com/understanding-tibial-plateau-leveling-osteotomies-dogs
• McCarthy, RJ. 2011. Tibial plateau leveling osteotomy–is it really more effective?
• Colorado State University Veterinary Teaching Hospital. Treatment options for cranial cruciate ligament injury/disease of the dog knee.
• Christopher, SA, Beetem, J, Cook, JL. 2013. Veterinary Surgery. 42(3):329-34. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs.
• Survey of Veterinary Orthopedic society members on the preferred method to treat CCL

Bilateral TPLO

It’s not at all unusual for a dog to need TPLO surgery on both hind legs.

Statistics also indicate that a high number of dogs that have one TPLO surgery will need the other leg worked on in the future.

With this in mind, some folks opt for bilateral TPLO, where the TPLO surgery is done on both legs at the same time. Below are some considerations when faced with a bilateral TPLO surgery decision.

Cost

The cost of having bilateral TPLO will be less than having two distinct surgeries. A portion of any surgical procedure’s cost is anesthesia, hospital time, medicine, etc. By doing both legs at the same time, these costs are reduced since you are only paying for them one time. Of course, you are paying more for the double surgery at a time when you’d otherwise be paying less for the single surgery, so you have to come out of pocket with more money upfront.

Recovery

Recovering from bilateral TPLO will be a bit more difficult, but surprisingly not as much as you may think,

With a single TPLO, the dog is up and around, walking outside to use the bathroom the day after TPLO.

The recovery advice is to keep it to a minimum and gradually increase.

This doesn’t change with bilateral TPLO. Same advice, same timeframes.

Your dog will obviously walk more gingerly, and you may need to assist more, but after a few days, your dog will be walking on its own just fine (although slowly…very, very slowly).

The recovery time of bilateral TPLO is the same as the recovery time for having TPLO on only one leg.

So about 10 weeks after the bilateral TPLO, recovery is about done. With two separate procedures, you’re looking at 20 weeks of total recovery time.

Risk

There is always a risk when putting any dog (or human!) under anesthesia. That’s why you sign the waivers.

Waking up from anesthesia is never guaranteed.

So a single operation, instead of two, is less risky in that respect.

Cost of TPLO surgery

The cost of TPLO surgery is ultimately determined by your pet insurance and veterinary surgeon, but the average price falls between $3,500 and $5,000.

You may also have to pay additional fees for exams, medications, and physical therapy.

Fortunately, some insurance companies cover the cost of TPLO surgery, so be sure to reach out to your provider if you have pet insurance.

Buying pet insurance after diagnosis won’t help – it won’t cover pre-existing conditions. Also, most pet insurance plans have up to a 6 month waiting period before they will pay for surgeries, etc.

Learn more about the cost of TPLO surgery.

Before surgery – how to prepare your home.

Before the surgery, ask your veterinarian how you can make the process as comfortable as possible for your dog.

For your pet’s sake, here are some tips on how you can prepare your home for a streamlined recovery process before the procedure even takes place.

• Invest in a spacious crate that will allow your dog to sit up and turn around.
• It’s best to have your pup recovering in a comfy location, which often means in sight of you or other family members. For this reason, consider moving the crate or, as we did, have several crates so the dog can be moved to wherever the family is hanging out.
• Block off areas like the kitchen or living room to reduce the risk of injury.
• If the recovery room you’ve chosen has slippery floors, place rugs down so that your dog can walk easier.

What to expect during surgery on your dog’s knee joint

Now that you know how to accommodate your pet following the surgery, here’s what you should know as the procedure unfolds.

Before the surgery takes place, the veterinary surgeon will remove the torn ends of your dog’s CCL.

To adjust the structure of your pet’s knee joint, they’ll make a circular cut near the top of the tibia.

Your surgeon will then rotate this section of the bone to reduce the slope of the tibial plateau.

From there, the two segments of bone are stabilized using a plate and screws.

The plate and screws will remain there until the bone heals.

As the tibial plateau is leveled, the knee joint will become more stabilized.

• Your dog will undergo anesthesia
• Antibiotics and painkillers are given
• Incision made, and torn ends of the CCL are removed
• Meniscus (the shock absorbers for the knee) are examined and removed if they are torn or badly damaged
• A curved cut is made at the top of the tibia to fit the tibial plateau (rewrite)
• The tibial plateau is rotated 5 degrees. Plates and screws are then fitted to hold the tibial plateau in place and to allow the bones to fuse together over time
• Post-surgery x-rays will be reviewed to ensure proper placement
• Usually, your dog will be discharged the same day, although you should plan on a possible overnight stay if closer observation is deemed necessary

Below is a video with more detail and really nice animation. The video goes into good detail on all aspects of your dog’s knee joint, what can go wrong, and how it can be fixed.

How painful is TPLO surgery?

Your veterinarian will likely have several options available to assist in pain management. Below is an overview of some types of anesthesia that may be administered.

Injectable Narcotics

• Injectable narcotics are given before, during, and after surgery to help reduce pain. They can be used intermittently or as constant rate infusions.

Epidurals

• Epidurals help relieve discomfort 10 hours after surgery. They also lower the amount of anesthesia needed during surgery.

Nocita

• Nocita is a long-lasting local anesthetic that’s administered during surgery and lasts up to 72 hours following the procedure. Nocita is why your dog may not show pain for the first day or two following the TPLO but may show increased pain or uneasiness after the Nocita wears off.

TPLO surgery recovery

After the surgery, your top priorities will include protecting surgical wounds, letting the anesthesia clear, maintaining your dog’s comfort, restricting activity, and minimizing disruption to your household routine.

To guarantee that everything is going smoothly, routine checkups will begin two weeks after the surgery. In the weeks following, your veterinarian will take X-rays to make sure that your pet is healing properly.

Click for more details about the recovery process, follow-ups, etc. – TPLO Recovery.

Additional advice for recovering from tibial plateau leveling osteotomy (TPLO) surgery

To expedite your dog’s recovery while following the necessary protocols, here are some suggestions on how you can facilitate the process.

• Look into quality joint supplements.
• Give your dog a change of scenery by moving their crate around the house.
• Go easy on the treats to avoid weight gain.
• Freeze treats like peanut butter, blueberries, and bananas so that your dog has something to look forward to.
• Consider interactive dog toys and a slow feeder.
• Section off an area outside so that your dog can enjoy the sun.

What is the success rate of tibial plateau leveling osteotomy (TPLO) surgery?

Fortunately, TPLO surgery boasts an exceedingly high success rate. It’s for this reason that this procedure is in such high demand.

According to research, 90 to 95 percent of dogs who have received TPLO surgery regain normal function.

Best of all, the vast majority of dogs return to basic activities fairly quickly and can resume their normal activities within about 6 months or so. Of course, work with your surgeon for more precise details.