TPLO for Torn ACL
What is It?
Frequently recommended for dogs with torn
ligaments, TPLO is an acronym
for Tibial Plateau Leveling Osteotomy.
This surgery uses a specific
power saw to cut off one of the leg bones, creating an arc shaped cut
on the surface. One section of the bone is then rotated through the arc
and is reattached at a different angle using a metal plate and screws.
The end result is that the TPA (Tibial Plateau Angle) is reduced.
It is an extremely invasive and expensive
procedure. And
has recently become the surgery-du-jour for dogs with ligament
injuries.
TTA (Tibial Tuberosity Advancement) is a
similar surgery
that alters the bone structure. Somewhat less invasive, it also reduces
the TPA.
TPLO & TTA do not stabilize the
joint. Instead,
the relationship between the leg bones is altered.
Why do it?
For most ligament injuries, the focus should
be on re-establishing
joint stability. Instead of radically changing the bone structure.
There are a small number of cases where TPLO
may be the
best surgical option. In dogs where the TPA is pathologically steep
(~30-32 degrees), it may be a good option. It may also benefit dogs
with angular limb deformity or luxation of the patella from a ligament
injury.
Bone altering surgery that decreases the TPA
is thought
to make joint stability less important for proper mobility. Short term
results appear favorable as the dog is more likely to put weight on the
leg after recovery from the surgery. But the long term effects are
questionable at best.
What are the Risks?
Potential complications of the surgery are
numerous and severe.
- cracking/splintering of the bones where
the screws
attach the metal plates
- damage to the joint meniscus
- failure of the bone to fuse back together
- increased risk for arthritis
- infection of the bone and increased risk
for cancer
- loosening of the metal plate due to
failure of the
screws (backing out or unable to attach to crumbling bone)
- problems with the patellar ligament from
increased
stress caused by the altered joint
- spinal issues from the altered bone
structure
- tibial tuberosity fractures (surface
fractures on the
bones)
- but that's not all...
All surgery carries some degree of risk. But
the potential risks of
this particular surgery far outweigh the benefits.
While short term
results may appear to be favorable, the long term outlook for this
invasive surgery is overwhelmingly poor.
What Does the Developer Say?
Slocum Enterprises, creator of the TPLO
procedure, responded to a
request seeking information and follow-up studies for complications
related to the surgery.
|
"... To answer your question regarding
post-operative
studies, there is no legal requirement between Slocum Enterprises and
any veterinarian who performs the TPLO procedure to report their
surgeries and/or complications to us..." |
But, it's very expensive, so it must be
good, right?
According to the Experts
Dr. Ron Hines DVM PhD references a statistic
from an article printed in
The Journal of the American Veterinary Medical Association.
|
"An article in... the Journal of the AVMA
does not give
an overly optimistic evaluation of surgery for cruciate ligament
damage. This paper found that only... 10.9% of the dogs treated with
tibial plateau leveling osteotomy (TPLO) regained normal leg function
subsequent to surgery..." |
Gail Smith, Professor of Orthopedics and
Department
Chairman at the University of Pennsylvania Vet School is quoted in an
email.
|
"...[In regard to TPLO there is a] virtual
absence of
research to show that this highly invasive and expensive method has any
benefits whatsoever in post operative clinical function over other less
invasive and expensive methods. I have taken a stand early in my career
to avoid endorsing procedures that are not evidence-based ...and TPLO
is a classic case of surgeons ...jumping on the bandwagon without
adequate investigation to demonstrate the purported benefits of the
procedure..."
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What Training is Involved to Perform TPLO?
One would think that an expensive and risky
surgery would require a
vast amount of proper training. Not the case with TPLO.
After just a few hours in training at the
Slocum
Enterprises' facility, vets are able to utilize the procedure. Or, they
can watch a training DVD, buy the recommended equipment and they're
good to go.
The surgery takes less than an hour. While
the costs of
doing the operation (minus anesthesia) are relatively small, vets
commonly charge well
over $2500.
So, What Do I Do About My Dog's Injury?
Do as much research on the topic as you can.
You owe it to your dog.
And beware the websites written by vets who stand to gain much profit
from this procedure.
Attempt Conservative Management. Restrict
your dog's
activity.
A lot.
No jumping or running. Limit walks. There
have been
many success
stories for owners who have religiously (and patiently)
used this tactic. Some dogs have even been known to recover while
waiting for their surgery date.
Sound difficult? This is what you would have
to do after
surgery anyway. And joint-stabilizing scar tissue will form with or
without surgery.
Don't expect overnight changes. Scar tissue
takes time
to build. One wrong jump can set your dog back to square one.
If you do decide that TPLO surgery is right
for your
dog, just be aware of the risks going in.
The information and
products recommended by german-shepherd-lore.com are not intended to
take the place of expert veterinarian care. Please consult with your
vet and ask about using a natural and alternative approach for the
healthcare and treatment of your pet. Find a holistic vet.
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