I have been meaning to write for a long time now about Tibial Plateau Leveling Osteotomy (TPLO) surgery for dogs. A common human knee injury is the Anterior Cruciate Ligament (ACL) tear. In dogs, the corresponding structure is called the Cranial Cruciate Ligament (CrCL). When it fails, the dog's knee (stifle) joint becomes unstable and the dog goes lame.
Left untreated, a dog with a torn CrCL will have limited or no mobility, and the joint will suffer from arthritis and further degradation. In small breed dogs, the ligament can be surgically reattached. In large breeds, however, the inherent instability of the joint and the load on the ligament virtually guarantees that reattachment will last only a short time before it fails again. Instead, the large-breed treatment is to make a round cut to separate the top of the tibia, rotate it around, and then reattach it with a plate and screws so that it heals in the new position. The new orientation levels the tibial plateau so that it is stable, and the femur isn't always trying to slide down the top of the tibia.
About five years ago, our older Golden Retriever, a female named Dory, suffered a complete tear of the CrCL in her right leg. When our vet first explained the surgery to me, my first impression was "that sounds like a goofy hack." Rather than put the joint back together, they change the shape of one of the bones so that the joint is mechanically stable. Imagine that you have a big inflatable Santa Claus decoration sitting on your steeply sloped roof, and a rope tied to your chimney keeps it from sliding off. One day the rope breaks, and off it slides. Well, the TPLO approach says "instead of reattaching the rope, we're just going to cut out a portion of the roof, tilt it upwards, and reattach it to the house in that position, so that our inflatable Santa is sitting on a flat surface." I was skeptical.
Because our dogs are family to us, and the TPLO has the best track record for treating her type of injury, we decided we had to try. We checked Dory into the pet hospital one morning, and picked her up the next day with one leg completely shaved bald, a a spectacular scar. It took a while for her to heal, but eventually she did. Physical therapy involved gentle, short walks, and swimming. We put a cheap above ground pool into our back yard to provide a place to swim her regularly.
One unfortunately reality of the CrCL tear is that if it happens on one hind leg, there is a very high chance that it will happen on the other leg within a year. Sure enough, almost a year to the day after her initial injury, Dory's left leg went. We had the surgery on that side as well, and after more recovery and physical therapy, she was back up and doing great.
The initial quiet period after the surgery was the hardest. Dory had to stay in her box almost continuously, so she wouldn't be putting stress on the hardware holding her tibia together while it was healing. Getting just enough, but not too much, physical activity is hard for dogs that love to run and jump and play. The swimming definitely helped a lot, because it provided an exercise that, because it was non-load-bearing, she could do as much as she wanted, without the risk of injuring the healing bone. And as a water breed, Dory loves to swim anyway. We always put a doggy life vest on her, so that if she did get tired or cramp up or just want to hold still, she would float like a cork. But usually she'd paddle around and around until she was completely exhausted.
We have also been told by our vet that Dory has had the best TPLO outcome that she has ever seen. Dory is more of a hyperactive puppy today, at almost nine and a half years old, than she was when she was three. Except for being a bit bow-legged, it is impossible to tell that she has had major surgery on both legs. She runs circles (literally!) around our five year old male Golden (Rex), and she has amazing quality of life. To help maintain her, we do have her on low dose daily Deramaxx, an anti-inflamatory. We also give her Dasuquin, and Science Diet "prescription diet j/d," designed for joint health maintenance. And she's doing great.
I mention all of this because if you find yourself in our position, I encourage you to think very seriously about the TPLO surgery. It is expensive, and requires careful handling during recovery, but we have found it to be well worth it. With any medical procedure, there are no guarantees. But I can tell you from our experience, an excellent outcome is possible.
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4 comments:
I agree, pets are family. We went another route, but had different circumstances.
My "whatever can go wrong, will go wrong" dog Buzz tore his knee up a couple of years ago. Buzz had never been a healthy dog. I'm not saying sickly, he has always been accident prone. He lost an eye at 9 weeks and developed cherry eye in his "good" eye when he was 12 weeks old. He had 3 surgeries by the time he was 6 months old. He nearly lost his other eye a year later while he was remodeling his dog house (what a dog to add windows without having to be asked). The gash was less than 1/2 inch from his eye and went all the way to his skull. This injury was treated at home with superglue. I had already explained to him that he was out of emergency vet visits and of course this happened on a Sunday.
Buzz, being Buzz, tore his knee to shreds during a nasty winter storm a couple of years back. His luck. We couldn't get him to the vet for a couple of weeks because of the weather conditions (and our driveway conditions). When he finally went to the vet, they explained the surgery. They also took some x-rays and discovered that even if Buzz got the best surgery available he would probably be lame within a couple of years due to hip dysplasia. Add that to the cost and the knowledge that the second knee would have to be done within a year and we had quite the decision to make. We had a 3 year old dog that needed help standing up and walking. Oh yeah, I forgot to mention that Buzz is a 170 pound Neapolitan Mastiff.
Our vet didn't want to pressure us into the surgery knowing the chances weren't on our side. Our vet offered to do an experimental surgery that he had done once before. The surgery is done much like the fix for small dogs. The ligaments are reattached and you just hope for the best. The vet wasn't necessarily confident, but felt it was the best chance and he had done it on a large breed dog once before and it had worked. Never mind that the "large breed" dog it was successful on was an 80 pound lab.
We ended up taking our chances with the experimental surgery. The vet used some different bands and threads than are typical and used a lot more of them. After the first couple of weeks of healing, things started to look much better. Unfortunately, my dogs are afraid of water so rehab wasn't smooth. Today, Buzz has a limp and takes an anti-inflammatory only on the bad days. He has done well to self limit his activity which really wasn't much to begin with. Mainly we make sure he stays skinny to keep his knee from having to work too hard. He's down to about 160 pounds and has some trouble getting in and out of cars, but he isn't in pain and is quite the happy dog.
Hi,
The initial period after the surgery was the hardest for our pets. They feel more pain on their joints. So it is safe for us to have pain relief like deramaxx. Thanks a lot.
Deramaxx
I am so glad I just read your post. My dog, Luna is literally in surgery now having a TPLO done to reapair her CrCL. I was sitting her wondering if I had made the right decision both monetarily and for her well being. But after reading your post I am optimistic that my gut instinct to choose the TPLO was the right one. And the fact that I am almost beside myself worried about her reassures me that the money has to be a non-issue. I hope we have the same outcome with our 2 1/2 year old lab mix! But sounds like I should heed the Dr's advice and start saving for the other leg now!
Coffee Bean, I hope that Luna has as good an outcome as Dory did. Follow the vet's post-operative instructions to the letter, which will probably be almost impossible, because keeping a dog like a Retriever or Lab quiet for weeks is a real challenge. Dory was literally depressed and moping during the period of her recoveries, but as she got better, her spirits returned. It isn't easy, but it is worth it.
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