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Surgical Comparison Chart

  • Pet Owner
  • Surgeon
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  • Pet Owner
  • Surgeon
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  • Surgery name
  • Lateral Extracapsular
  • TPLO
  • TightRope
  • CBLO
Extracapsular Osteotomy Osteotomy Extracapsular Osteotomy
1975 1994 2002 2010 2013
>10 >200 >100 >10^ 5^
5 16 8 3 0
>1,000 >6,000 >3,000 >200 143
17% 5-36% 11-59% 18-29% 16%
7% 0-12% 4-35% 9-12.5% 11%
4% 0.8-16% 5-15% 4% 4%
8.5-15% 0.7-6% 2-22% 4-8% 9%
100% 20% 80 Unknown 75%
$ $$$ $$$ $$ $$$$

Step 5: Why Undergo TPLO Surgery?

Tibial plateau leveling osteotomy (TPLO) was one of the original osteotomy (bone cutting) methods used to treat CCL injuries in dogs. It has been used in practice for over 20 years, with nearly 200 research articles published on the topic.

This dog knee surgery involves making a semi-circular bone cut at the top of the tibia (shin bone). The surgeon will then rotate this small section of bone to reduce the tibial plateau slope (TPS–an average of approximately 25-30° in dogs) to approximately 5-7°. The two segments of bone are then stabilized with a plate and screws until the bone heals.

In essence, we create a fracture and shift the bone to a new, more stable position. By rotating the tibial plateau and leveling it, the goal is to prevent the femur from sliding down the slope of the tibia, helping to stabilize the knee.

What Research Says About TPLO Surgery in Dogs

Despite the perceived invasiveness of this procedure, dogs are generally comfortable enough to begin weight bearing on the limb within days of surgery. This rapid return to function/comfort is one of the reasons we prefer TPLO surgery in dogs over the lateral suture and other techniques.

A recent study found that even small breed dogs had a more rapid return to weight bearing with a higher level of function with TPLO over a less invasive extracapsular repair technique (lateral imbrication, not a lateral suture).

When Should a Vet Remove the Implants in a Dog’s Knee?

For the first 8 weeks after TPLO surgery in dogs, we rely entirely on the implants (plate and screws) to stabilize the surgery site. Once the bone has healed, the plate and screws are no longer necessary. 

But in most cases, implants are left in place unless there is a problem, such as infection or irritation. Approximately 3% of patients who undergo a TPLO procedure will need to have the plate removed.

Can Smaller Breeds Undergo TPLO Surgery?

Research supports the use of TPLO in small-breed dogs, and some surgeons may prefer this technique over the lateral extracapsular suture.

A recent review of research on TPLO and expected outcomes for smaller dogs recommends this procedure as it can yield:

  • Significant recovery of limb function
  • Minimal lameness
  • Fewer complications

This recent study also cites TPLO as a more stable technique to repair a ruptured cranial cruciate ligament in small canines.

How Can TPLO Surgery Improve a Medium or Large Pet’s Condition?

In medium and large breed dogs (>30 pounds), more and more evidence-based literature shows improved outcomes with TPLO surgery in dogs over other commonly performed procedures.

For instance, a recent study comparing long-term results of TPLO and tibial tuberosity advancement (TTA) surgeries reported better mobility and less pain in canines that underwent the first procedure. This research even noted that this dog knee surgery helped patients achieve a better quality of life over time.

Specifically, the study’s authors found that TPLO improved the following issues:

  • Average pain in the last seven days
  • Interference with walking
  • Morning stiffness
  • Jumping and climbing
  • Limping during mild activities
  • Overall quality of life

What Outcomes Can You Expect Post-Surgery?

The TPLO procedure has a reported 90-95% good to excellent outcome. An excellent outcome is one where your pet can run, jump and play, and you wouldn’t notice your pet ever had a problem. With a good outcome, your pet may feel sore for a while and need a short course of anti-inflammatories after heavy activity.

But for one reason or another, 5-10% of patients will not return to the level of function we hope for. It’s important to note that even if your pet suffers from complications, such as an infection or a meniscal injury, it can still have a good to excellent long-term outcome, but there may be some hiccups along the way.

To view more information and read different articles where we pulled a lot of our information, visit our Literature page.

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