Tibial Plateau Leveling Osteotomy (TPLO) Surgery

A small black Pit Bull mix stares into the camera. A nurse stands behind him petting him.

Learning that your pet needs surgery can be an overwhelming experience, especially if you are unsure of what the procedure entails. At Anicira, we work with pet parents to ensure that you are well-informed before your pet’s surgery. Our veterinary team provides compassionate care before, during, and after surgery to ensure that your pet is safe and comfortable.

What is TPLO surgery, and why does my pet need it?

Tibial Plateau Leveling Osteotomy is surgery on your pet’s knee that reorients the knee joint compensating for a torn cranial cruciate ligament (CCL). Typically, an injury to the CCL is painful and causes a pet to walk abnormally.

TPLO surgery will help your pet move better and relieve pain. It is recommended that your pet receive surgery as soon as possible to reduce the risk of damage to the knee joint.

More information from our partners at Agile Veterinary Surgery:

The cranial cruciate ligament (CCL) is similar in its location to our anterior cruciate ligament (ACL). There are two things that are notably different. First, the vast majority of CCL ruptures in dogs are not the result of trauma, overactivity, or stepping the wrong way, as is the case in humans. The ligament can tear or tear more that way, but in almost all canine cases there is a pre-existing degeneration and weakening. We don’t understand what triggers the weakening and unfortunately cannot prevent it, but we know that most types of dogs can get the condition. We also know that depending on the situation, a typical expectation is for around 30-40% dogs that get diagnosed with CCL disease to eventually be diagnosed in the other knee.

Second, the canine knee (stifle) puts a lot of stress on the CCL. This is because the two bones that make up the joint, the femur on top and the tibia on the bottom, do not lock together. In fact, they are arranged like a ball on top of a ramp (in people this surface is flatter). When a dog places weight on the leg, unconscious muscular contractions that keep us standing and propelling ourselves forward cause the bones to squeeze against eachother (compression). In

the absence of a connected CCL, this causes the femur to slide down backwards against the slanted top of the tibia (this part of the bone is called the tibial plateau). This in turn shoves the tibia forward, placing a stretch in the joint that hurts and results in reluctance to put full weight on the leg.

Pre-Surgical Instructions

Admission Time – Bring your pet to Anicira at 7 am.
Food – You may feed your pet a quarter of their normal breakfast no later than 6 am.
Water – Your pet may have water until the surgery.
Pre-surgical exam – Your pet must be in good health and show no signs of sickness such as coughing, sneezing, or diarrhea.
Medical records – Please bring proof of rabies vaccination if you have not already provided this. If your cat or dog has not been previously vaccinated or lacks proof of vaccination, we will administer a rabies vaccine on the day of surgery. If you have not already sent your medical records, please bring all relevant medical records.

TPLO Surgery

Before surgery, our veterinary team will perform a thorough pre-surgical examination to ensure your pet is a good candidate for anesthesia. It is strongly recommended that your pet receives pre-anesthetic blood work to ensure that no health concerns go undetected.

Your pet will be under general anesthesia. The surgical team will prepare the surgical site by shaving and then cleaning the area to remove bacteria and decrease the risk of potential infection.

During surgery, the veterinarian will cut the upper portion of the tibia (shin bone) and change the orientation of the top of the bone.  A metal plate and screws will hold the bone in place while it heals.  In most cases, this plate will stay in your pet for the rest of their life.

Caring for Your Pet After TPLO Surgery

Anesthesia may take 24 to 48 hours to wear off.

  • Your pet may be groggy or whiny during this time.
  • Keep your pet confined in a secure, quiet, and comfortable space. We recommend a crate or a small room.
  • Isolate them from other pets and children while recovering.

Make sure your pet wears their Elizabethan Collar (E Collar / Cone)

  • Your pet’s incision will take 10 to 14 days to heal. During this period, they should wear an e-collar at all times.
  • Allowing your pet to lick their incision can lead to infection or dehiscence (opening of the incision).

Offer food & water after surgery

  • When your pet returns home, offer them food and water
  • Anesthesia may cause nausea, so your pet may not be interested in food
  • If vomiting occurs, wait 12 hours before offering more food.
  • Resume regular feeding the day after surgery. Your pet’s appetite should be back to normal within 24 hours.
  • If your pet refuses to eat, you may try offering a bland diet such as white rice and lean protein (for example, boiled chicken breast) while they regain a normal appetite.
  • Please do not feed your pet junk food, table scraps, or milk.

Give all medications as directed

  • Your pet will be sent home with oral pain medication. Please follow the instructions on the label.
  • If possible, please give the pain medication with food. If your pet has no appetite, please ensure that they still take the pain medication.
  • OTC pain relievers such as Tylenol and Advil are toxic to pets. Please do not give these to your pet.

Other shaved areas

  • Your pet may have shaved areas on one or more legs from where an IV catheter was placed.
  • These areas may be irritated or bruised.  If your pet is excessively licking, please use a taste deterrent spray or e collar to prevent self trauma.
  • If your pet went home with a brightly colored wrap on their leg, this should be removed 30 minutes after returning home.

Reduce pet’s caloric intake

  • Extra weight can make recovery difficult.
  • We recommend that pets with orthopedic disease maintain a body condition score of 4-5 on the Nestle Purina Body Condition System.

Caring for the incision and what to expect

  • Monitor the incision for redness, discharge or swelling
  • If your pet tolerates it, apply an ice pack wrapped in a thin cloth to the incision for 10 minutes 3 times daily for the next 2 days. For the following 2 days, apply a warm compress to the surgical site 3 times daily and leave in place for 10 minutes per application. Use a washcloth soaked in warm water (not too hot for your skin, wrung out, placed in a plastic bag and applied to the wound).
  • Swelling usually develops at the ankle in the first week. The swelling is usually soft and jelly-like, and is caused by fluid under the skin moving down the leg with gravity and will run its course.
  • Bruising is also possible and will go away within the first two weeks.

Please schedule an appointment for an incision check and suture removal in 10-14 days

  • Your pet may need to be sedated for the removal procedure, so please plan accordingly.

Schedule an appointment for radiographs at eight weeks to assess bone healing

  • If the bone at the osteotomy site has healed, your pet may be released from our care.
  • If the bone at the osteotomy site is not healed, we recommend continued confinement and a 12-week post-op recheck with radiographs. Please recheck with Anicira Veterinary Center in 12 weeks for the second X-rays.

How much can my pet do after surgery?

The following activity guidelines are designed to minimize the chance of complications while allowing good rehabilitation, so that when the bone is healed enough to allow heavier activity, the muscles and other soft tissues are more ready. SLOW walks are recommended until your pet is putting the foot down consistently with each step. NO running, jumping or playing with other pets is allowed in the first 8 weeks after surgery. In between the prescribed periods of activity below, keep your pet in a crate or small area with good footing where they will not be able to run and jump. It is best to take a “less is more” approach for a smooth healing process. It’s not fun for anyone involved but will be appreciated by you and your pet when everything looks good at the recheck!

Week 1

Your pet should be confined while in the house, with no running, jumping, playing, or use of stairs. A crate or kennel should be used for activity confinement. When you are home and your pet is being closely supervised, your pet can spend time with you in a confined room with carpeting to avoid slipping, and with no furniture that would encourage jumping. Do 5 minutes of short and slow controlled leashed walks. At first these walks should be for elimination purposes only. The slower your dog walks, the more likely they will place the repaired leg down while walking.

Week 2

As long as your pet appears comfortable, we will start short leash walks. If there is excessive bruising/swelling, or you have other concerns, please contact us before starting activity. Leash walks should be started to encourage weight bearing on the operated limb. On a level surface, 5-10 minute slow leash walks should be performed 3-5 times daily. Keep in mind that these walks are meant as light physical therapy, and they are not meant as exercise. Walks should be in a “heel position” using a 4-6ft leash.

Week 3 and 4

Leash walks should be slow and controlled for up to 15 minutes, 4 times a day. Perform Sit-to-Stand exercises, also known as puppy squats. You want to get your dog to sit down and immediately stand back up. Perform these 3-4 times a day.

Weeks 5 to 8

Continue with walks 4 times daily but increase the duration to 20 minutes per walk. If all is going well, include small inclines and declines. Continue Sit-to-Stand exercises and introduce Curb Work: To perform these exercises your pet should step up small curbs. Curbs should be appropriate to your dog’s height. A small 10-30 pound dog should step on and off a curb that is about 2 inches high.

Radiographs should be taken by Anicira Veterinary Center at eight weeks.

Weeks 8+

Once the X-rays are done eight weeks after surgery and show the proper amount of bone healing, walks can continue to be increased gradually (10 extra minutes per walk can be added per week) to your pet’s normal amount. You can start to allow off-leash activity including running, jumping, and playing with other pets. Start with 5 minutes of running or playing, and 1-2 jumps up per day. Repeat that amount for 2 more days, then increase gradually as long as your pet is not limping more.

If there is any worsening lameness after any activity increase, your pet should be rested for 24 hours, then the activity should be reduced by half until the lameness improves, then work back up through the guidelines above.

By 1-2 months after the x-rays (3-4 months after surgery), no restrictions should be needed and the lameness should be gone. Please contact Anicira Veterinary Center if lameness persists. Thank you for entrusting your pet to our care. We look forward to hearing from you as the post-operative recovery progresses.

Rare, but serious surgical complications

Complications from TPLO are rare. If your pet experiences these issues after surgery, please contact Anicira.

  • Failure or infection of the metal implants
  • Patellar tendonitis
  • Meniscal disease
  • Continued lameness
  • Worsening of arthritis
  • Breaking of the tibia
  • Non-union or delayed union

Please contact Anicira, your primary care veterinarian, or an emergency clinic if any of the following occur:

  • No urine passed for more than 24 hours
  • Pale gums
  • Severe pain, depression or weakness
  • Vomiting or Diarrhea
  • Labored breathing
  • Decreased appetite for more than 24 hours
  • Lethargy lasting more than 24 hours