TPLO Frequently Asked Questions

Patients typically receive a combination of pre-, intra-, and post-operative injectable pain medications (morphine, hydromorphone, etc). In addition, epidural or local anesthetic blocks are often given to help reduce pain. Finally, patients will also be sent home with oral pain management and anti-inflammatory medications.

Bring all medications your pet is currently taking and all previous medical records.

Remember that your pet has just gone through an anesthetic event and is then placed on multiple medications including a non-steroidal anti-inflammatory drug such as carprofen. If your pet is only a day or two out from surgery, the vomiting or regurgitation may still be associated with the anesthesia and should subside. If vomiting persists, the non-steroidal anti-inflammatory drug should be discontinued, as continuing to give it may cause other gastrointestinal problems. Additional pain medications may need to be prescribed in its place. Please contact your veterinarian if your pet is vomiting after surgery.

Prior to administering any medications, please consult with your veterinarian. Anti-inflammatories such as carprofen or metacam are options in patients with healthy kidney and liver function with no current gastrointestinal upset. Other medication options may include gabapentin, amantadine, or fentanyl. Other options can include gentle limb massage and icing the incision site with a bag of frozen peas, which conforms nicely to the leg, and provides good local pain relief.

Licking or chewing at the incision site can lead to premature removal of the sutures and/or incisional site infection, both of which can require a second procedure to repair. Your pet must not be able to lick or chew at the incision until it is completely healed and the sutures have been removed. If you are by your pet’s side, or feeding him/her, you may remove the e-collar temporarily. However, it takes only a few short moments for a pet to cause significant trauma to the surgery site, so please monitor your pet closely. If you leave your pet’s side, an E-collar (i.e. “cone of shame”) or a similar product should be utilized.

In most cases, persistent lameness following TPLO is associated with post-surgical inflammation, soft tissue associated pain, or pain within the joint secondary to damage caused by the cruciate ligament injury (severe cartilage disease or arthritis). Other potential causes of lameness following TPLO include meniscal injuries and infection.

Rare causes of lameness could include implant failure, fibular fracture, or fracture of the patella (knee cap).

However, whether your pet has a partial or a complete tear of the CCL during TPLO surgery — and whether the remainder of the ligament is left intact or it is completely removed — further need for the CCL and additional procedures would be highly unlikely.

As with any procedure, there are always potential risks with surgery.   

• Anesthesia – Anesthetic complications are very rare. Hospitals typically provide extensive anesthetic monitoring including EKG, blood pressure, pulse oximetry, end-tidal CO2 measurements, heart rate, and respiratory rate. 
• Implant failure – When implant failure happens, the plate or screws could bend or break following surgery. Implant failure is very rare because TPLO plate designs and locking screw technology significantly reduce the risk. 
• Infection – Post-operative TPLO infections may occur in approximately 5-10% of patients. Owners can prevent infection by preventing the licking or biting of the incision site. Antibiotics can help treat surgical site infections. 
• Post-operative meniscal injuries – The risk of post-operative meniscal injury is approximately 10%. The patient may need additional surgery, or their surgeon could recommend rest, anti-inflammatories, and joint supplements.

Other uncommon complications include fibular fracture, patellar fracture, implant-associated discomfort, and osteosarcoma.

Your pet’s activity needs to be severely restricted until there is radiographic evidence of bone healing, which typically takes around 8 weeks. He/she must remain in a small area (6×6 feet) with good footing or in a kennel when he is not directly supervised. Your pet should not have free roam of your home. Running, jumping of any kind, playing, stair climbing, and uncontrolled off-leash activity are strictly prohibited to reduce the risk of delayed healing or implant failure. Please be extra careful when walking on slippery surfaces such as tile, linoleum, or wood floors during this period of recovery. Please follow the instructions for activity outlined below:

Week 1-2: Leash walks for urination and defecation purposes only – no longer than 5 minutes each up to four times a day. All leash walks should be slow enough to encourage your pet to place his/her operated foot with each step. Please use a sling under the belly or a Help-em-Up Harness for support when walking on slick surfaces or if stairs must be used to go outside.

Weeks 3 and beyond: In addition to leash walks to urinate and defecate, 2-3 additional leash walks are allowed. Please start these leash walks with 5 minutes of “active walking” and gradually increase the length of the leash walk by 5 minutes each week up until the 8 week recheck. All other restrictions apply. If at any point your pet begins to demonstrate signs of lameness, soreness, or becomes uncomfortable following walks, please decrease the duration or frequency of the walks. A sling or harness is advised when walking on slippery surfaces.

Excessive activity may result in implant failure, delayed bone healing and other healing complications. If your pet suddenly stops using the leg, or seems painful, please contact your veterinarian for recommendations.

Physical rehabilitation therapy can improve the speed and extent of recovery from surgery. There are exercises that you can perform at home and those that you can have done with a veterinary rehab specialists. We recommend the following exercises post-operatively:

Passive Range of Motion: Gentle flexion and extension of the operated limb can be done 2-3 times daily to ensure very good range of motion of the stifle joint. Support just above the stifle (knee) and at his hock and gently flex the leg up to the body and then extend the limb first straight down in a standing position and then back behind him/her to extend the hip. Hold each position 3-5 seconds and repeat the exercise 10-15 repetitions. This may take a second person to relax your pet in the front end, but this should not be painful.

Massage: Gentle massage of the thigh and lower leg muscles will help your pet to relax and it can encourage him to use his leg better and to allow better range of motion exercises. It can also help reduce some swelling in the limb. It can be performed for 5 minutes before the range of motion exercises.

Weight Shifting: Please encourage your pet to stand on the operated leg at all times, or at least to keep his/her toes on the ground. Gentle weight shifting can be done by carefully pushing the hips side to side, while they are standing. Reward your pet when he/she is standing on the limb. It can be performed for 5 minutes before or after the range of motion exercises.

Both ice and heat are appropriate following TPLO surgery, but at different time points, based on the healing from surgery.

Ice packing: For the first 5 days following surgery, you may ice the incision for 10 minutes 2-3 times per day. A frozen bag of vegetables or an ice pack works well. Do not place an ice pack directly on the skin without a thin cloth or paper towel over it.

Warm packing: After 5 days of icing, a warm washcloth *in a plastic bag* may be used on any residual swelling or bruising to aid in the reduction of swelling, bruising, and to increase circulation. Please make sure the warm pack is of a temperature comfortable on your own skin before applying it to your pet’s skin. If he/she does not tolerate the icing or warm packing well, please discontinue.

If at any time during the recovery your pet stops using the operated leg, or fails to begin using the leg within 2 weeks, please contact Dr. Bergh or your veterinarian.