Canine TPLO Surgery - Injury to Recovery
The cute pup was at her happy place in this photo - the beach! A place where she is her best self - happy, carefree, off leash, and loving life. A place where she gets to play with her fav toy of all time "OG" (aka Orange Guy). He is actually a "Gourdo" by Ruffwear. He is bright orange and is the best beach toy. And she LOVES it.
Unfortunately for Miss MP, she had to miss our February trip to the beach this year because she tore the cruciate ligament in her right knee. As a vet tech for many years I was well versed in this procedure, along with the long recovery. And unfortunately for MP, she'd already torn her left cruciate in 2015 when she was 3 years old. In the middle of summer. Four months after I'd left my job as a licensed veterinary technician. Ha. Thanks Universe!
At that time the surgeon had said that her other knee looked stable and he thought she may not need a future surgery on the right knee. He was wrong. And of course it was only an educated guess, and of course there is no guarantee. And most dogs that tear one, tear the other one later. She was just trotting back to me after going potty in our yard. Just as she was approaching me, she screamed, lifted her right rear leg, and was unable to bear weight. This is the classic sign of a cruciate tear. My heart sank. I carried her back to the house and broke the news to my husband.
My job right then was to make her comfortable, restrict her movement, and schedule an appointment at my former clinic to see a doctor. I was hoping against hope this was something else that would not require surgery, even though I knew in my gut what she'd done.
The next several days until we could get an appointment were rough. MP also has hip dysplasia so it was very difficult for her left rear leg to compensate for the right one. She'd already had a TPLO on that side, along with her pretty bad hips. And due to other medical conditions, she could not take canine NSAIDS (non-steroidal anti-inflammatory drug). That left us with some mild pain medication and strict rest.
Once we got to the appointment, it was confirmed she had torn her cruciate and would need surgery. It was scheduled for about 4 weeks out with the veterinary surgeon, so until then, more pain medication and quiet days spent on the couch were ahead.
Although there are different perspectives, the best course of action for a dog owner in this situation is to help their dog be as comfortable as possible, and try to prevent additional injury. Some say once its torn, it's torn. Others say they can do more damage, although ultimately it won't change the outcome of surgical intervention. My opinion after living through two now is, it is painful, and for that alone I limited my dog's activity, and made her as comfortable as possible in her daily routine. No stairs, no jumping or running, no play time - which she didn't want to do anyway, but it sucks. A couple of weeks prior to the procedure, we worked with our vet on weaning her off another medication so we could put her on NSAIDS post-operatively.
SURGERY: When the day arrived, we were all nervous but relieved that this was finally the road to recovery. The procedure went well, and in the case of our surgeon, he called us both before and after surgery, to explain the procedure, answer questions, and give updates. You can't get any better than that! We love him around here. MP, as with most dogs, stayed in the hospital overnight, and was able to go home the next day. Some dogs do need to stay for 2 days. It is very individual to the patients progress, and may be dependent on hospital policy as well.
I have seen a few articles recently about why you should not do a TPLO surgery. It is my opinion, as not only a veterinary technician with inside information, but as a dog owner that has been through two now, that the authors had a bad experience, and have turned that into "don't do it, it's bad". While I completely understand their frustration, and of course their concern for their pet, the fact is that a TPLO procedure is the gold standard for a cruciate repair in most dogs. The information below is from an article posted on Dispomed, written by Dr. Catherine Barnett, DVM. It includes an excellent description of the procedure, comparing it to other techniques for cruciate repair. The surgical outcome and long term prognosis with a TPLO procedure is excellent, and reason enough to go forward. Another consideration is that only board-certified, veterinary surgeons do this procedure, so you will be getting the absolute best care for your pet. That said, if you have a small breed dog, or a geriatric pet, you should discuss all available options for cranial cruciate repair with your veterinarian to decide the best course of action for your individual pet.
I cannot emphasize enough that regardless of which procedure you elect to do, have a board certified surgeon perform the surgery. Your vet should be able to recommend a specialty hospital or a mobile surgeon that will come to your vet hospital to do the procedure.
Most (veterinary) surgeons feel that TPLO is the best surgical option for young, active, large-breed dogs. In these patients, the small functional improvement that can be seen with TPLO over alternative surgeries may make a significant impact on the patient’s overall quality of life and client satisfaction. Additionally, TPLO is typically associated with less progression of arthritis than other surgical repair techniques.
Dogs with a very steep tibial slopes on radiographs (greater than 30 degrees) may also benefit from TPLO instead of an alternative procedure. Alternative techniques may be less likely to succeed in these dogs, because their conformation is placing abnormal forces on the stifle.
Read the full article from Dr. Barnette HERE.
HOSPITAL DISCHARGE: As I mentioned, MP came home the next day with pain medication and canine NSAIDS. She was doing well, but exhausted from the entire experience. She slept ALL day when we got her home, and most of the next. After a few days, she started to feel better, but of course the pain meds helped keep her quiet and on the down low so her leg could heal.
The list below is a few items you will need to help both you and your pet's post-op recovery go smoothly.
Create a designated area for your dog where they can be confined and recover in a comfortable and quiet place. Have a sleeping area, a place for fresh water, and a place they can be fed, all in the same area if at all possible. We set this up on surgery day while she was out of the house.
A crate or small exercise pen to define the space mentioned above, and confine your pet when you are not able to watch them.
A sling to help your dog walk and go potty after surgery. Click HERE for the one we used.
A raised bowl to make it easier to stand and eat, or a KONG so they can eat laying down.
A baby gate to block off rooms and/or stairs when not in the ex pen.
A second crate for sleeping (if necessary) and/or for a different room.
Chew toys or a KONG to help with boredom and mental stimulation. This really helps when dogs are unable to get traditional exercise. Just be sure they are safe items that your dog will not destroy, ingest, or choke on. Always supervise your dog at all times when they are chewing on anything.
Be prepared to carry your pet up and down any and all stairs for a minimum of 8 weeks. No joke. This is critical to recovery.
An e-collar or another option to prevent your pet from licking/harming the incision. Your vet can provide you with a standard E-collar. Lets just say MP hates them, so I opted to use "jammies" that easily covered her rear legs. They are adorable (see photos below!), and made by a company called Tooth and Honey. Find them and other styles HERE.
Please note! The jammies option will not work for every dog. If your dog is prone to licking, or if sutures bother them, they may still access the incision around or even through the jammies. If you elect to use jammies, monitor them closely at all times! If you have to leave them alone and are unsure, place an E-collar on them.
The recovery area we use for MP is in our small family room. It is the area we spend the most time in, and is easy to block off from the rest of the house. Within that room we set up a small exercise pen, with her crate initially, and later just her bed. She stays in it when we are working, or anytime we cannot watch her., or she will climb or jump up onto the couch. Which is illegal on a "good leg day" but she'll do it anyway LOL. MP in general is a very good girl, and is not one to break out of ex pens. If your dog would just knock the gate over and head out, I would recommend using a metal crate. Try your local pet store, feed store, or even Craig's List, for a heavy duty dog crate or ex pen.
If your dog is not crate trained, create a comfortable setting, and entice them with treats. It is crucial to make the crate a safe space, and not a place they feel like they are being punished. Talk to your vet about good options if you need guidance.
POST-OP X-RAYS: TPLO surgery requires follow up radiographs at both 4 and 8 weeks after surgery.
The purpose of these is to ensure things are properly aligned and healing well. Plan to have your dog sedated again for both follow up appointments, as patient positioning and knee alignment are crucial to reading the films and assessing the surgical site.
Plan to have your dog in recovery for a total of about 16 weeks. Don't let this scare you. After the first 8 weeks, if things are looking good and the surgery site is healed, you can start mini leash walks for rehabilitation to strengthen the knee, and gradually work up to off leash activity. By 16 weeks out, if you are compliant, your dog should be completely healed and rehabbed, and, as in MP's case, ready to go back to the beach!
Discuss the specifics of your dog's rehab program with your veterinarian and create a plan. We use a calendar for MP to track her mini walks, her overall progress, and when to increase the distance of her walks - typically once a week. If your dog experiences pain or discomfort during or after a walk, take a step back and do not increase the distance for an additional week. Ask your vet about NSAIDS and pain management if necessary, it is important they are comfortable during this period.
WEEK 10 POST-OP: Today we are 10 weeks post surgery and MP is doing well! Her 8 week post-op radiographs showed that her osteotomy site is completely healed, and were ready to start to rebuild strength in her knee. We started her rehab walks, about 2 blocks total per walk, and she has been doing very well overall.
WEEK 12 POST OP : We are now just past 12 weeks post op and the pup is doing great. We had a small hiccup with a flare up of her IBD, which unfortunately showed down the rehab for a couple of weeks, but she is back in action and loving her fun but short walks. This past weekend we took her to a local beach for a short but fun-filled walk along the water with the rocks, oyster shells, little crabs, seaweed, and so. many. smells! Pacific Northwest beaches are filled with fun and exciting things for dogs!
Her annual vet visit is coming up in late May, so that gives us another opportunity to check in with the veterinarian about her progress and ongoing rehab program at about 13-14 weeks post surgery.
While you don't necessarily need another appointment at that stage, its never a bad idea to follow up and be sure things are progressing as they should be, and use the opportunity to ask any questions you may have going forward. I am sure it won't come as a surprise that this is not an inexpensive procedure and process, so I tend to look at it like, what's another few bucks for an exam to protect my investment in my pup. It is truly an investment in her health and long term quality of life, and, well, she's our baby, so only the best!! Ha. No. It's absolutely true.
WEEK 13 POST OP : We are in the home stretch, and MP is doing great with her rehab and recovery.
Walk distance has increased, and she is steadily improving her strength. All she wants to do is jump and play, but we aren't there quite yet. We do let her play in our family room, but no catching, tugging or jumping is allowed. She still has fun shaking her toys, and we bat at it like we're going to steal it, which she loves. Lol. We are behind by about 2 weeks in the rehab process due to her IBD episode, so typically by this point your dog should be able to do more than MP can, just FYI.
Her annual vet visit is in two days, so we will add a discussion about her rehab and recovery to this appointment, and will update the blog afterwards!
WEEK 15 POST OP & ANNUAL VET VISIT : MP continues to do very well. Her annual vet visit went great, and her surgery site was solid. We walk her every other day and she does great. Please note daily walks are better and likely what you will be doing with your dog at this stage.
WEEK 18 POST OP: Back to the BEACH! She's earned it! A trip to the Oregon Coast for a few days is what we all need after a tough year and a half for both us and the pup.
We will still limit her a bit, no off leash, but she did get the long line that allows her 30 feet of freedom and the ability to go at her own pace and play with OG. She did very well and is acting like herself again. YAY!
CONCLUSION: After two TPLO procedures in the books, would I make the same choice again? 100% yes. If you are considering TPLO surgery, the best advice is please do your research. Get a second opinion and talk to veterinary specialists, even if you dont have someone in your area, just so you have all of the information. This is not something you want to gamble with or choose the "cheapest" option. Do it for your dog's sake.