Orthopedic Surgery / TPLO Surgery
Dr. Eric Andersen has advanced training in cruciate ligament repair by the TPLO technique, as well as fracture repair, luxating patella and hip repair, femoral head ostectomy and many others.
Tibial Plateau Leveling Osteotomy (TPLO)
TPLO is an advanced technique for repair of the torn cranial cruciate ligament (CCL – the same as the ACL in humans). Rupture of the cruciate ligament is the most common orthopedic injury of dogs of all breeds and especially large breeds such as Labrador Retrievers and Rottweilers. Dr. Andersen received training to perform the TPLO in 2007 and started offering TPLO surgery at the Ballston Spa Veterinary Clinic shortly thereafter.
The knee (stifle joint) of the dog is similar to a human’s knee. Located inside the joint of the knee is the cranial cruciate ligament, which is responsible for maintaining stability of the joint, preventing backward sliding of the femur on the tibia. When the ligament ruptures,the joint becomes unstable and the femur slides backwards and forwards on the tibia, creating what is called “drawer motion”. This causes debilitating long-term lameness and accelerated formation of degenerative joint disease. We see this problem in all breeds, large and small, all ages, and even cats. TPLO is the technique of choice for large (over 40 pounds) active dogs because it results in a faster return to normal function, better range of motion and less arthritis in the joint later in life than the standard extracapsular technique.
Using a model of a wagon tied to a post helps to demonstrate what happens when the cranial cruciate ligament is torn. Figure A illustrates the motion prior to surgery and figure B after TPLO surgery. The hill is sloped in figure A, this represents the normally sloped tibial plateau or top of the tibia bone. The wagon represents the femur bone and the cable represents the cranial cruciate ligament. When the cable breaks, the wagon will slide downhill. The same thing happens in the knee joint when the cranial cruciate ligament tears; the femur will slide down the tibial plateau toward the back of the joint. The surgery levels the tibial plateau, creating a stable joint even without the cranial cruciate ligament. This is illustrated in figure B; downward pressure from the femur bone onto the tibial plateau causes no sliding along the plane.
TPLO Surgical Preparation
Your pet will receive all the pre-surgical preparation, diagnostics and careful monitoring that we perform for all of our surgical patients. Radiographs will be taken of the knee for pre-surgical planning and the hips checked for arthritis and Dysplasia by Dr. Andersen prior to the surgery.
Dr. Andersen will make a curved cut along the top of the tibia bone (called an osteotomy), which includes the tibial plateau. The cut piece of bone is then rotated so that the tibial plateau is leveled. When the angle is adjusted to the correct degree, Dr. Andersen will screw in a stainless steel plate to hold the bone in its new place so that it can heal correctly. See the above radiographs to see the pre-surgical tibial plateau angle and the post-surgical correction. The radiograph below shows the cuts made to the bone and the screws which hold the TPLO Plate in place to allow the bone to heal correctly.
The illustration at right shows the side view of the curved cut that is made to level the Tibial Plateau. The plate is held in place with screws for correct healing of the bone.
At discharge, we will give you instructions and go over all the post-surgical care required at home. We will send home pain medications to keep your pet comfortable while he is healing. We can, upon request, send a tranquilizer to make sure your dog doesn’t get out of control when he starts feeling better. It is important to follow the strict guidelines for post-surgical care for optimum healing. Your pet’s activities will need to be restricted while the bone heals, which takes at least 8 weeks. He will also need to have an Elizabethan collar kept on to prevent licking at the incision for 2 weeks. He will probably not be using the leg at the time of discharge, but most animals will begin weight-bearing within 1 to 2 weeks post-surgery. Most are walking well by 4 weeks and back to normal activity by 16 weeks post-op.
There will be a post-surgical recheck scheduled 2 weeks after the surgery with Dr. Andersen. The staples will also be removed at this time. Once the incision is healed, it will be time to start rehabilitation which will expedite your dog’s return to normal function. We recommend starting rehab 3 to 4 weeks after surgery. We have found that rehabilitation in the underwater treadmill greatly speeds the recovery. We recommend 2 sessions per week for 5 weeks. Please see the Rehabilitation page for more information on Hydrotherapy using the Underwater Treadmill. The final doctor recheck will be scheduled at 8 weeks post-op and we will recheck the x-rays at that time to confirm good bone healing.
In the weeks following the TPLO surgery, you can expect to see more and more use of the repaired leg. As the post-surgical swelling decreases and your pet feels more comfortable, as well as with the aid of Hydrotherapy Rehabilitation, the limb will regain its normal use. Most dogs will get back normal, or near normal weight-bearing function within 4 months.
Hunter – September 13, 2009
Dear Dr. Andersen:
It has been almost a year since Hunter had his Orthopedic Surgery. I cannot believe how well he has done. From a lame Labrador (weeks of his 3 legged walk) to a dog full of energy and able to keep up with our Bloodhound, hopping in and out of the car excited to take a ride or go for a walk. Your TPLO procedure was a total success. I will admit I was anxious at the prospect, he was pushing age 7 and had already had a traditional ACL repair on the same leg less than a year before we had moved upstate. Your full explanation of the procedure, post-op care and what to expect helped alleviate the anxiety as well as your very professional and attentive staff. It is here I have to add a special “thank you” to Tina who was very patient and kind to Hunter during his water treadmill visits. She encountered a Lab who didn’t like the water and she went in the tank with him, reassuring all the while.
My sincere thanks to you and your staff,
Saratoga Springs, NY
Cannon – September 29, 2009
(from an e-mail sent by our client)
When Cannon, our 16 month old Chesapeake Bay Retriever, started to favor his right rear leg with a limp and partial weight bearing, we took him to BSVC where he was evaluated by Dr. Eric Andersen. After a thorough exam, Cannon was diagnosed with a cruciate ligament rupture.
Dr. Andersen informed us of our options and the different procedures available. Because Cannon is a very active athlete and a large breed dog, Dr. Andersen told us he would benefit from a newer surgical procedure called tibial plateau leveling osteotomy (TPLO). Dr. Andersen explained this procedure using a model to help us visualize what would take place during the surgery. After all of our questions were answered to our satisfaction we decided on the TPLO for Cannon.
After a successful operation we took Cannon home and followed his discharge care plan. We watched Cannon progress daily. At his post op visit, Dr. Andersen said he was ready for the underwater treadmill PT which he was able to do right at BSVC. With the added physical therapy Cannon continued to improve at a rapid rate.
A few months later Cannon came with us to pick up his older brother at Cornell University Hospital for Animals. A doctor stopped us in the hall noting Cannon’s shaved leg and asked what kind of procedure he had done. When we told him it was a TPLO he asked if he could show his intern. With our approval he examined Cannon’s leg, teaching his student as he proceeded. When he was finished he thanked Cannon and said, “Perfect.” He then told us Cannon’s leg looked great and went on his way. I asked our student who he was and she said he was an orthopedic specialist, confirming what we knew all along.
Dr. Andersen and BSVC was the right choice for us.
Thank you Dr. Andersen and to all your staff that helped Cannon regain his mobility so he can again run, jump and swim and be the athlete he was born to be.
Hercules – May 2010
Hercules could not walk for more than half an hour without pain in her knees. She was having trouble on the stairs and started to limp more frequently. I took her to Dr. Anderson and she had the TPLO surgery done on both knees. She is now running, swimming, and playing like she used to do without any problems. I am now able to walk her for as long as I’d like and not have to worry about her knees. During the procedure the staff at Ballston Spa Vet took great care of Hercules and kept me informed on her status through out the day. I knew she was in good hands with people who knew what they were doing.
Having the surgery has made my dog’s life so much more enjoyable and pain free.
I would recommend Dr. Anderson and his staff to anyone looking to have the TPLO surgery done.